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Obstetric complications, more prevalent among women with a psychiatric history, are also independent risk factors. However, the mechanisms linking these factors to PPD remain unclear. We examined whether obstetric complications mediate the association between psychiatric history and PPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This cohort study utilized Danish nationwide Edinburgh Postnatal Depression Scale (EPDS) screenings (2015\u20132021) linked with register data. Psychiatric history was defined as psychiatric diagnoses (ICD\u201010: F00\u201099) or filled psychotropic prescriptions (ATC: N05A, N05BE01, N06A, N06BA) from 1995 until conception. Complications were defined as a composite measure of complications occurring between conception and delivery.\n                      <jats:italic>PPD symptoms<\/jats:italic>\n                      were defined as a positive EPDS score (\u2265\u200911), and\n                      <jats:italic>PPD diagnosis<\/jats:italic>\n                      was defined as a depression diagnosis (ICD\u201010: F32\u201033) or antidepressant prescription fill (ATC: N06A indicated for depression).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 170,218 mothers (163,326 in analyses), 23.9% had a psychiatric history. These mothers had higher levels of PPD symptoms (13.4% vs. 6.1%), PPD diagnosis (7.0% vs. 0.4%), and complications (34.1% vs. 28.5%) compared to those without. (A) Psychiatric history (PPD symptoms: OR\u2009=\u20092.32 [95% CI, 2.22; 2.41]; PPD diagnosis: OR\u2009=\u20095.09 [95% CI, 4.48; 5.79]) and complications (PPD symptoms: OR\u2009=\u20091.16 [95% CI, 1.11; 1.21]; PPD diagnosis: OR\u2009=\u20091.18 [95% CI, 1.04; 1.34]) were independently associated with PPD. (B) Psychiatric history did not modify the association between complications and PPD (PPD symptoms: OR\u2009=\u20091.20 [95% CI, 1.14; 1.26] vs. 1.09 [95% CI, 1.02; 1.17]; PPD diagnosis: OR\u2009=\u20091.22 [95% CI, 1.00; 1.49] vs. 1.15 [95% CI, 0.97; 1.36]). (C) Complications mediated only a small fraction of the association between psychiatric history and PPD (proportion mediated: PPD symptoms\u2009=\u20090.68% [95% CI, 0.50%; 1.00%], PPD diagnosis\u2009=\u20090.42% [95% CI, 0.14%; 0.79%]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychiatric history and complications are independently associated with PPD, but complications explain only a negligible portion. These findings suggest that the link between psychiatric vulnerability and PPD is primarily driven by direct mechanisms rather than mediation through complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.70105","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T04:10:52Z","timestamp":1778040652000},"page":"223-233","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychiatric History and Postpartum Depression: The Mediating Role of Obstetric Complications"],"prefix":"10.1111","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7487-3427","authenticated-orcid":false,"given":"Mette\u2010Marie","family":"Zacher Kjeldsen","sequence":"first","affiliation":[{"name":"National Centre for Register\u2010Based Research, Department of Public Health Aarhus University  Aarhus Denmark"},{"name":"CIRRAU\u2014Centre for Integrated Register\u2010Based Research, 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