Postpartum depression in Israel: prevalence, risk factors, and ethnic disparities

Background

Postpartum depression (PPD) is a common and serious mental health disorder causing maternal and neonatal morbidity. This study assessed 1) the PPD prevalence in the Tel Aviv and Central Districts of Israel during 2017-2022 and 2) risk and protective factors for positive PPD screening.

Methods

Data from 211,476 births between 2017 - 2022 in the Tel Aviv and Central districts were analyzed. This retrospective cohort study included all mothers attending Mother and Child Health clinics for whom Edinburgh Postnatal Depression Scale (EPDS) scores were available. The primary outcome was EPDS positivity. Statistical analyses compared EPDS scores across pre-COVID-19 and COVID-19 periods. Factors associated with EPDS positivity were assessed using multivariable analysis.

Results

PPD prevalence was low throughout the study period, between 2.1% and 2.8% each year. The strongest influence on EPDS positivity was religion/ethnicity, ranging from 0.6% in ultra-orthodox Jewish mothers to 14.1% in Muslim Bedouin women. While multiple factors reached statistical significance due to the large study size, only a subset were clinically meaningful, including instrumental delivery, single or divorced mothers, unemployed mothers and multiple birth (all p < 0.01).

Conclusions

Overall, PPD prevalence in this cohort of Israeli women was lower than previously reported in Western societies or the Middle East. Higher prevalence was observed in subgroups, particularly among Muslim Arab and Bedouin women. Comparison of pre-COVID-19 and COVID-19 periods showed a statistically significant increase in PPD, however, the magnitude was small and likely not clinically meaningful. These findings support enhancing culturally tailored screening and prevention strategies, improved access to maternal mental health services for women with positive screening results, and strengthened surveillance to monitor disparities in PPD among minority women in Israel.

Key messages

• Rates of postpartum depression (PPD) in this large cohort of Israeli women was substantially lower (2.1% - 2.8%) than commonly reported in Western societies or the Middle East.

• Marked disparities were observed, with substantially higher PPD rates among Muslim Arab and Bedouin women. These findings highlight the need for culturally tailored screening and intervention.