Risk factors associated with postpartum anxiety in Australia, Europe, and North America: A systematic review and narrative synthesis

Background: Reducing the prevalence and consequences of anxiety following childbirth (postpartum anxiety) is a strategic priority in the UK and many similar nations; a comprehensive review of risk factors can support the development of interventions and guide further research. Methods: This registered systematic review was guided by 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) and analysed using 'Synthesis Without Meta-analysis' (SWiM) to answer the question; 'What factors have been reported to increase the risk of maternal postpartum anxiety (PPA) in Australia, Europe, and North America?'. MEDLINE and PsycINFO were searched for relevant research from Australia, Europe, and North America, published up to July 2021. Results: Screening yielded 39 reports (total N = 40,238). Seven risk categories were identified (Psychopathology and personality, Social, Socio-demographic, Health, Cognitive, Pregnancy and birth, and Infant characteristics and postpartum experiences). Historic and concurrent depression, historic anxiety, and low social support were the most frequently evidenced risk factors. Limitations: The review was limited to three geographical regions with comparable health, political, and cultural contexts, and research pertaining only to special populations was excluded. Conclusions: Findings synthesise new evidence of the risk factors associated with PPA, whilst the discussion highlights potentially modifiable factors as targets for intervention. Monitoring for risk factors during routine pregnancy and postpartum care would allow for additional surveillance and earlier intervention with those most at risk. Peer support should be offered to people with heightened vulnerability to PPA. Developing support strategies that address cognitive vulnerabilities (e.g., parenting-related confidence) could prove particularly beneficial.