Burden and determinants of perinatal depression: population-based estimates from linked healthcare utilization data and EPDS screening

Perinatal depression is a frequent disorder affecting about 10–15% of women. Despite its significance, only a proportion of the female population is screened or intercepted by professional services. The aim of this study was to estimate its occurrence and to examine potential risk and protective factors. Events attributable to perinatal depression were identified through an algorithm applied to Health Care Utilization (HCU) data in a cohort of 164,767 resident mothers giving birth between 2017 and 2023 in Agenzia di Tutela della Salute (ATS) della Città Metropolitana di Milano. Two multivariate logistic models were fitted, including prior psychological distress (12 months before pregnancy), sociodemographic variables (age, citizenship, education, employment, marital status) and parity. According to the HCU algorithm, 16.0% of mothers experienced perinatal depression–related events. Among screened mothers, 23.6% met criteria for high psychological vulnerability (EPDS ≥ 8). Risk factors included prior psychological distress (OR 8.1; 95% CI 7.7–8.6), age > 40 years (OR 1.3; 95% CI 1.2–1.4), migrant background (OR 1.1; 95% CI 1.1–1.2) and primiparity (OR 1.4; 95% CI 1.4–1.5). Lower education and employment appeared as modest protective factors. Perinatal depression affects approximately one in six women within the territory of ATS Milan. Prior psychological distress, advanced maternal age, migrant background, unmarried status and primiparity emerged as key risk factors. The identification of key risk and protective factors underscores the need for targeted, equity-oriented policies and early intervention strategies, strengthening the integration between primary care, mental health services, social services, and community-based resources to effectively reach and support vulnerable women. Perinatal depression and related factors were studied in a cohort of Italian mothers. Previous psychological distress was the strongest predictor of perinatal depression. Primiparity, age over 40, being single, and migrant background were also relevant risk factors. Routine screening with attention to risk factors should occur from pregnancy to infant check-ups. Equity-driven outreach using mediators and multilingual tools should be implemented to improve access.