Role of psychological resilience and social support in perinatal depression: a systematic review and meta-analysis

Abstract

Perinatal Depression (PND) is a prevalent mental health disorder with adverse effects on both maternal and infant outcomes. Although psychological resilience and social support are widely considered protective factors against PND, the existing evidence is quite inconsistent. Consequently, this meta-analysis aimed to systematically assess and quantify the associations among PND, psychological resilience, and social support. This systematic review and meta-analysis were conducted in accordance with the PRISMA 2020 guidelines. Six electronic databases, grey literature, and reference lists were searched up to March 18, 2025. Studies were eligible if they investigated the association between perinatal depression and resilience or social support. The study quality was assessed using the AHRQ checklist for cross-sectional studies and the Newcastle–Ottawa Scale for cohort designs. A random-effects meta-analysis was conducted in R to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Twenty-nine studies (N = 18,213) were included. The overall meta-analysis showed no significant association between the combined protective factors of resilience and social support with perinatal depression (OR = 0.83, 95% CI: 0.66–1.05). In subgroup analyses based on exposure levels, studies that compared women with higher resilience to those with lower levels showed a reduced risk of postpartum depression (OR = 0.73, 95% CI: 0.62–0.87), while studies that used low resilience as the exposure group reported increased odds (OR = 3.54, 95% CI: 2.34–5.34). A similar pattern was observed for social support: studies using greater support as the exposure found a protective effect (OR = 0.65, 95% CI: 0.50–0.84), whereas those using minimal support as the exposure reported higher odds (OR = 3.90, 95% CI: 2.46–6.18). These contrasting directions reflect differences in how primary studies defined the reference group, and the pooled estimates were therefore derived from distinct study sets rather than from the same data. Effect sizes also varied by maternal age and study design. Sensitivity analyses confirmed the robustness of the findings, and no evidence of publication bias was detected. High resilience and strong social support are associated with reduced risk of PND, whereas low resilience and minimal support are linked to increased risk. Although the overall pooled association was not statistically significant, subgroup findings underscore the importance of considering study context and reference group definitions. These results highlight the value of integrating resilience-building and social support interventions into perinatal mental health strategies.