A scoping review of risk factors of postpartum depression among military personnel and spouses

Abstract: INTRODUCTION: In recent years, there has been increased recognition and awareness surrounding mental health among US military personnel. However, the prevalence of postpartum depression (PPD) among female service members is significantly higher than that of the general US population. There is currently a gap in the literature characterizing the unique factors of the military experience accounting for the higher predisposition to PPD relative to civilian Americans. This qualitative review aims to address this gap by isolating risk factors which have been consistently identified in the available literature as contributing to the prevalence discrepancy. MATERIALS AND METHODS: A MeSH database-built search utilizing key terms "postpartum depression" and "military" was used to gather sources that fit the inclusion criteria. These sources were analyzed for explicitly identified PPD risk factors pertaining to US military personnel and spouses. RESULTS: Of the 14 sources meeting inclusion criteria, a history of a mental health disorder and a lack of social support were identified in seven distinct articles as significant risk factors for PPD among military personnel. Low rank and pay, as well as deployments of self and/or spouse, were specified in six papers. A history of depression, history of anxiety, and exposure to combat were identified in five papers. Four papers isolated branch of service and young age as risk factors. Factors that were recognized in three papers or less included, but are not limited to: tobacco use, history of PTSD, history of sexual assault, low education attainment, high number of child dependents, race, and job stress. CONCLUSIONS: Women in the military and spouses of military personnel are subject to an environment with distinct stressors, increasing their predisposition for PPD. Identifying specific risk factors is critical for quality screening, diagnosis, and care of PPD among this population. Significant risk factors consistently isolated from the available literature include history of mental health disorders, lack of adequate social support, low rank and pay, deployment of self or spouse, history of combat exposure, branch of service, and young maternal age. Findings of this review also suggest that early detection via thorough screening and disease mitigation by means of a 12-week maternity leave led to lower rates of PPD and better disease outcomes. Military-specific family health resources are widely available across branches of service and individual bases, though the use and quality of these resources are inconsistent. Providers of women experiencing at least one of these stressors should increase PPD precautions and refer patients to the appropriate preventative and acute care.