The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: a systematic review.

BACKGROUND Although much is known about risk factors for postpartum depression (PPD), many potentially important clinical variables have still not been investigated. In this systematic literature review, we examine the published evidence for the prevalence of PPD among three populations of women commonly seen by providers of perinatal care: women who use substances, women with current or past experiences of abuse, and women with chronic illness. METHODS We searched Medline, CINAHL, EMBASE, PsycINFO, and the Cochrane Library from their start dates through to August 1, 2008, using keywords relevant to depression and each of the three target clinical populations. All published, peer-reviewed papers in English or French were included in the review if a standardized assessment of depression between 3 and 52 weeks postpartum was used and if either the prevalence of PPD in the target population or a comparison of depression scores between the target population and a control group were reported. RESULTS Seventeen papers were included in the review. There were high rates of PPD among substance-using women and those with current or past experiences of abuse. However, little evidence was found to suggest an increased risk for depression among women with chronic illness. CONCLUSIONS Few eligible studies were identified for each clinical population of interest. Despite limitations of the studies reviewed, the results indicate that both substance use and current or past experiences of abuse are associated with increased risk for PPD. Targeted clinical interventions for these women may be beneficial.