Around one in five mothers experience perinatal depression . This condition involves depressive episodes during pregnancy or just after birth - often with lasting effects on both mother and child .
Author
- Franziska Weinmar
PhD Candidate, Women's Mental Health & Brain Function, University of Tübingen
Yet despite its prevalence, identifying who is at risk of experiencing perinatal depression remains one of the greatest challenges in maternal health. More than half of cases go undetected. This means many women with signs of the condition receive no treatment at all.
But new research published by my colleagues and me in the journal Nature Mental Health shows that it may be possible to identify a mother's vulnerability to perinatal depressive symptoms as early as the second trimester.
To conduct our study, we used data from over 600 women living in Sweden who were taking part in the Mom2B study . This large national project tracks perinatal mental health using a smartphone app.
We looked at whether the ability to regulate emotions in pregnancy is related to depressive symptoms through the perinatal period.
Previous studies have suggested that emotion regulation is crucial for maternal mental health. Difficulties managing emotions has been linked to higher stress and poor sleep , and greater risk of depression and anxiety after birth.
In the second trimester, participants completed a short questionnaire . This assessed how well they understood and accepted their emotions, controlled impulses and stay focused on goals when upset. It also looked at whether or not they used effective strategies to manage and recover from emotional distress.
We then followed up with these women at seven different points from mid-pregnancy up to one year after birth.
At each stage we assessed their depressive symptoms using the Edinburgh postnatal depression scale , a standard clinical screening measure. We wanted to know whether self-reported difficulties with emotion regulation during pregnancy could help identify those most likely to experience perinatal depression.
Our results showed that this was indeed the case. Women who reported greater difficulty regulating their emotions in the second trimester experienced higher depressive symptoms throughout pregnancy and up to six months after giving birth.
These associations held true even after accounting for other known risk factors of perinatal depression - such as previous depressive episodes, psychological resilience, previous pregnancy loss, fear of childbirth and negative birth experience.
Most striking was that women who later developed depressive symptoms in the postnatal period (the time after childbirth) had already reported greater difficulties regulating their emotions during pregnancy, that is, long before any symptoms appeared.
This suggests that self-reported problems with emotion regulation could serve as an early marker of a mother's vulnerability for perinatal depression. These findings could be used to identify at-risk women before symptoms occur.
Emotion regulation
Emotion regulation is a core psychological skill. It involves being able to recognise, understand and manage emotions effectively. But it isn't only about suppressing feelings. It's about being able to respond flexibly and constructively to life's challenges.
This skill is essential for stress management, healthy relationships and overall wellbeing . Research also shows that emotion regulation plays a role in many mental health conditions , including anxiety and depression.
Pregnancy is a profound transition with hormonal shifts, physical changes and, for some, worries about birth and new responsibilities. For women who already find it hard to regulate emotions, these challenges can heighten vulnerability to depression.
Fortunately, emotion regulation is not a fixed trait but a skill that can be strengthened. Approaches such as cognitive behavioural therapy and mindfulness training have been shown to improve emotion regulation. These therapies help people become more aware of their emotions, recognise unhelpful thought patterns and respond to stress with greater calm and flexibility.
These approaches have also been adapted for pregnant women. They focus on incorporating information about parent-infant bonding and teaching emotional coping skills during pregnancy and early parenthood. Supporting these skills in expectant mothers could offer a valuable way to prevent depressive symptoms before they develop.
Perinatal depression screening
Despite the high prevalence of perinatal depression, routine screening is not standard practice in many countries. Even where screening exists, it typically focuses on depressive symptoms that have already emerged - often after childbirth, when the window for early prevention has passed.
Our study provides strong evidence that emotion regulation is linked to perinatal depressive symptoms. Our research has also shown that this link appears early - long before signs of distress may be noticed.
The findings also highlight how simple questionnaires, which only take a few minutes to complete, could be used to effectively identify those most at risk. This also means that doctors and nurses would be able to offer targeted support to those women most at risk before their symptoms develop.
Future research will need to test how best to implement emotion regulation screenings into antenatal care. It should also aim to identify which interventions work best to strengthen emotional resilience.
Perinatal depression can affect bonding and child development . Being able to identify those most at risk of the condition and intervene early would have long-term wellbeing benefits for both mother and child. By recognising the importance of emotion regulation, we can take a meaningful step toward earlier detection, effective prevention and healthier beginnings for families.
Franziska Weinmar is associated to the University of Tübingen, Germany and Uppsala University, Sweden. She receives funding from the German Research Foundation (DFG) as part of the International Research Training Group "Women's Mental Health Across the Reproductive Years" (DFG, IRTG2804).
