Does Long-standing Depression/Anxiety Influence the Association Between Caesarean and Postnatal Psychological Distress?

Pavankumar Kamat


August 02, 2021


  • Women with long-standing depression/anxiety who underwent elective caesarean had a lower risk of postnatal psychological distress (PPD).

  • Furthermore, women with long-standing depression/anxiety who underwent emergency caesarean had a greater risk of actively treated depression/anxiety at 3 years.

Why this matters

  • Further studies to determine why the mode of delivery may affect women with long-standing depression/anxiety differently, to help inform interventions for improving care.

Study design

  • A study of 15,936 women from the UK-based Millennium Cohort Study who gave birth between 2000 and 2001.

  • Primary outcome: PPD at 9 months according to the Rutter Malaise Inventory.

  • Secondary outcome: ‘later treatment’ (self-reported active treatment for depression/anxiety at 3 years postnatally).

  • Funding: None disclosed.

Key results

  • Of 15,936 women, 2346 (13.4%) were diagnosed with PPD.

  • Women with long-standing depression/anxiety had a lower risk of PPD following elective caesarean birth (relative risk [RR], 3.25; 95% CI, 2.23-4.75) vs vaginal birth (RR, 4.36; 95% CI, 3.76-5.05) with relative excess risk due to interaction (RERI), −1.28 (95% CI, −2.73 to 0.16).

  • Women with long-standing depression/anxiety had a greater risk of later treatment following emergency caesarean birth (RR, 6.74; 95% CI, 4.87-9.32) vs vaginal birth (RR, 4.95; 95% CI, 3.86-6.34) with RERI, 1.79 (95% CI, −0.13 to 3.71).

  • There was no association between emergency caesarean and PPD and between elective caesarean and later treatment.


  • Lack of a consistent measure of PPD enabling comparison at 9 months and 3 years.


Henderson I, Quenby S. The association between caesarean and postnatal psychological distress: Effect modification by mental health history. Paediatr Perinat Epidemiol. 2021 Jul 13 [Epub ahead of print]. doi: 10.1111/ppe.12791. PMID: 34255373.  View abstract 

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: