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Cesarean Section and Postpartum Depression: A Review of the Evidence Examining the Link

From the Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.

Address correspondence and reprint requests to Frances A. Carter, Department of Psychological Medicine, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand. E-mail: frances.carter{at}chmeds.ac.nz

Objective: The objective of this study was to examine the evidence for an association between cesarean section and postpartum depression.

Methods: Medline and PsychInfo databases were searched. All studies on cesarean section that evaluated maternal mood between 10 days and 1 year after delivery were reviewed. Nine methodologically superior studies, including the only randomized, controlled trial (RCT), were analyzed separately. The nine studies that provided adequate summary statistics were combined in a meta-analysis.

Results: Of the 24 studies that have examined the association between cesarean section and postpartum depression, five found a significant adverse association, 15 found no significant association, and four found mixed results. With only one exception, methodologically superior studies found either no significant association or mixed evidence for an association between cesarean section and postpartum depression. Meta-analyses of suitable studies failed to find evidence for a significant association between cesarean section and postpartum depression. Possible reasons why different studies have obtained different results are critically evaluated.

Conclusion: A link between cesarean section and postpartum depression has not been established.

Key Words: cesarean section • postpartum depression • review

Abbreviations: CS = cesarean section; EPDS = Edinburgh Postnatal Depression Scale; PPD = postpartum depression; RCT = randomized, controlled trial.

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