Depression during pregnancy and after birth is common, often underdiagnosed, and can affect both parent and baby for years. Yet many women and birthing people do not recognize the early signs and symptoms of depression, or they are not offered timely support, therapy, or safe treatment options.
A large Swedish national study has now shed new light on one powerful predictor of perinatal depression: emotion regulation, the skill set we use to understand and manage our feelings. The findings suggest that simple questions about how you cope with emotions in the second trimester could help identify who is at higher risk long before symptoms peak.
Understanding Perinatal Depression
Perinatal depression refers to depression that occurs during pregnancy (antenatal depression) and after childbirth (postnatal or postpartum depression). It is more than a temporary low mood. It can affect sleep, appetite, energy, concentration, bonding with the baby, and overall ability to function.
Common signs and symptoms of depression in the perinatal period
Perinatal depression can look different from person to person, but common signs and symptoms of depression include:
- Persistent sadness, emptiness, or tearfulness
- Loss of interest or pleasure in activities that used to feel rewarding
- Irritability, anxiety, or feeling emotionally overwhelmed
- Changes in sleep, such as insomnia or sleeping much more than usual
- Changes in appetite or weight
- Difficulty concentrating, making decisions, or remembering things
- Feeling worthless, guilty, or like a “bad parent”
- Withdrawal from family, friends, or the baby
- Thoughts that life is not worth living, or thoughts of self-harm
Many of these symptoms overlap with normal pregnancy and new-parent challenges. The key differences are intensity, duration, and how much they interfere with daily life. If symptoms are persistent or worsening, professional assessment is important.
What Is Emotion Regulation and Why Does It Matter?
Emotion regulation is the ability to notice, understand, and respond to emotions in ways that are helpful rather than harmful. It is much more than “holding it together” or suppressing feelings.
Effective emotion regulation includes skills such as:
- Emotional awareness: noticing and naming what you feel
- Emotional acceptance: allowing emotions without judging yourself
- Impulse control: resisting urges to act in ways you later regret
- Staying on track: continuing important tasks even when upset
- Using strategies: having reliable ways to soothe and support yourself
During pregnancy and the first year after birth, hormonal shifts, sleep loss, major life changes, and new responsibilities can strain these skills. Many people find they are more sensitive or reactive than usual. For some, this emotional vulnerability contributes to anxiety or depression.
The Swedish Study: How Emotion Regulation Predicts Perinatal Depression
Researchers in Sweden followed more than 600 pregnant women from mid-pregnancy through the first postpartum year. They used a smartphone app to collect repeated measures of mood and emotion regulation, which allowed them to map individual symptom patterns over time.
How emotion regulation was measured
In the second trimester, participants completed the Difficulties in Emotion Regulation Scale-16 (DERS-16), a brief, validated questionnaire. Higher DERS-16 scores reflect more problems with emotion regulation, such as feeling out of control when upset or believing that nothing can help when distressed.
Depressive symptoms were assessed at eight time points using the Edinburgh Postnatal Depression Scale (EPDS), a widely used screening tool in perinatal care.
Key findings in plain language
- Emotion regulation difficulties in the second trimester strongly predicted higher depressive symptoms from late pregnancy up to around 6 months after birth, even when researchers adjusted for other known risk factors.
- Emotion regulation scores were remarkably stable from pregnancy to mid-postpartum in a subgroup that completed the measure twice. This suggests that for many women, emotion regulation is more of a trait than a passing state.
- Women who later developed postnatal depression already showed higher emotion regulation difficulties in the second trimester, even if they did not yet meet cut-offs for depression on the EPDS.
- By contrast, those with antenatal-only depression (symptoms that resolved after birth) did not differ in emotion regulation from women who stayed mentally well, suggesting different underlying drivers for this pattern.
Together, these findings position emotion regulation as an early, measurable vulnerability marker for perinatal depression, especially for depression that emerges after birth.
Different Depression Trajectories, Different Risk Profiles
The study also grouped women according to how their depressive symptoms changed over time. Five main perinatal depression trajectories emerged:
- Healthy: no clinically significant symptoms during pregnancy or postpartum
- Antenatal-only: high symptoms during pregnancy that improved after birth
- Early postnatal onset: symptoms rising above cut-off in the first weeks after birth
- Late postnatal onset: symptoms appearing several months after birth
- Persistent: symptoms present at one or more points both before and after birth
Important patterns emerged when emotion regulation scores were compared across these groups:
- Early postnatal-onset and late postnatal-onset groups had significantly higher emotion regulation difficulties in mid-pregnancy than the healthy group, even before their depression scores rose.
- The persistent depression group had the highest emotion regulation difficulties of all. This suggests that chronic problems with managing emotions may interact with perinatal stressors to sustain symptoms over time.
- The antenatal-only group did not differ in emotion regulation from the healthy group, which implies that their symptoms may be driven more by psychosocial adversity, age, socioeconomic factors, or pregnancy-specific stress than by longstanding emotion dysregulation.
For clinicians, this supports a more nuanced approach to screening and treatment, recognizing that “perinatal depression” is not one uniform condition but a set of distinct symptom patterns with different risk factors and needs.
What This Means for Screening and Early Support
Using emotion regulation as an early risk marker
The DERS-16 is brief, low cost, and easy to administer digitally. Because mid-pregnancy scores predicted depressive symptoms months later, the study suggests that integrating an emotion regulation screener into routine antenatal care could help identify those who might benefit from preventive support.
For example, someone who does not currently show many signs and symptoms of depression but reports intense emotional swings, difficulty calming down, or feeling helpless when upset may be at higher risk of developing postnatal depression. Proactive support for emotion regulation could then be offered before symptoms escalate.
Complementing existing depression screening
The EPDS remains a cornerstone of perinatal mental health screening and is valuable for detecting current depressive symptoms. Emotion regulation assessment does not replace EPDS but can complement it by:
- Highlighting people at risk of late-onset depression who might otherwise be missed
- Identifying those with persistent vulnerability who may need more intensive, longer-term support
- Providing a concrete skill target for therapy and self-help interventions
How to Help Someone with Depression in the Perinatal Period
Whether you are a partner, family member, friend, or health professional, you can play an important role in supporting someone with perinatal depression or high emotion regulation difficulties.
Recognize early warning signs
Be alert to mood and behavior changes that persist for more than two weeks, such as:
- Marked withdrawal or loss of interest in the baby or everyday life
- Intense guilt, shame, or hopelessness
- Frequent crying, irritability, or emotional outbursts that feel “out of character”
- Changes in sleep or appetite not explained by baby care alone
- Comments about “not coping,” “being a failure,” or wishing to disappear
If there are any thoughts of self-harm or harming the baby, urgent professional help is needed. Encourage immediate contact with a health provider or emergency service.
Offer practical and emotional support
- Listen without judgment. Avoid dismissive reassurances like “everyone feels that way” or “you should be grateful.”
- Normalize seeking help. Depression is common and treatable. It is not a personal failing.
- Help with logistics. Offer to research options such as the best therapy for depression near me, perinatal mental health clinics, or local support groups.
- Reduce daily stress. Assist with meals, child care, or household tasks to free time for rest and appointments.
- Support healthy routines. Gentle encouragement toward sleep, movement, and regular meals can support mood regulation.
Supporting someone with depression can feel daunting, but simply showing up consistently and taking their feelings seriously can make a meaningful difference.
Treatment Options: Therapy, Medication, and Natural Supports
There is no single “best” treatment for perinatal depression. The most effective approach depends on symptom severity, personal preferences, medical history, and access to care. Many people benefit from a combination of professional therapy, lifestyle changes, social support, and when appropriate, medication.
Therapy options that build emotion regulation skills
Several psychological therapies have strong evidence for depression and specifically target emotion regulation, including:
- Cognitive behavioral therapy (CBT) focuses on the links between thoughts, feelings, and behaviors, and teaches practical skills to challenge unhelpful thinking patterns and increase positive activities.
- Dialectical behavior therapy (DBT) and DBT-informed skills groups place special emphasis on emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. Early studies in perinatal populations are promising.
- Interpersonal psychotherapy (IPT) focuses on role transitions, grief, relationship conflicts, and social support, all of which are highly relevant during pregnancy and postpartum.
When searching for the best therapy for depression near me, look for clinicians or services that mention perinatal mental health, postpartum depression, or specialized support for pregnant and new parents. Many healthcare systems and midwifery services can provide referrals.
Natural remedies for depression and lifestyle approaches
Natural remedies for depression can be helpful adjuncts, especially for mild symptoms or as part of a broader plan, but they should not replace professional care for moderate to severe depression. Always discuss new supplements or drastic lifestyle changes with a health professional, particularly during pregnancy or breastfeeding.
Approaches that may support mood and emotion regulation include:
- Sleep protection: prioritizing rest, sharing night care with a partner when possible, naps, and realistic expectations about productivity
- Gentle physical activity: regular walking, stretching, or pregnancy-safe exercise when medically approved
- Nourishing diet: regular meals with adequate protein, healthy fats, and complex carbohydrates to support stable blood sugar and brain function
- Mindfulness and breathing practices: short, guided practices that help you notice feelings and calm the nervous system
- Social connection: parent groups, trusted friends, or family members who offer emotional support and practical help
Some people explore herbal or nutritional supplements as natural remedies for depression. Because safety data in pregnancy and breastfeeding can be limited, these should only be used under professional guidance.
Depression medication and side effects in the perinatal period
For moderate to severe perinatal depression, antidepressant medication may be recommended. Many women are understandably concerned about depression medication side effects for themselves and their baby. It is essential to balance these concerns against the risks of untreated depression, which can also affect pregnancy outcomes, infant development, and long-term maternal health.
Possible depression medication side effects can include:
- Nausea, headache, or gastrointestinal discomfort
- Sleep changes
- Sexual side effects
- Changes in appetite or weight
Most side effects are manageable and often lessen over time, but any new or worsening symptoms should be discussed with the prescribing clinician. In the perinatal context, treatment decisions are highly individualized and should involve a careful review of risks and benefits, ideally with a provider experienced in reproductive psychiatry or perinatal mental health.
Strengthening Emotion Regulation as a Preventive Strategy
One of the most hopeful findings from the Swedish research is that emotion regulation, while relatively stable over time, is also trainable. Several interventions have already shown that focused skills training during pregnancy can improve emotion regulation and reduce anxiety and depressive symptoms.
Practical ways to build emotion regulation skills
Whether you are currently experiencing symptoms or want to lower your risk, you can begin strengthening emotion regulation in everyday life:
- Label your emotions: when you notice a strong feeling, pause and name it as precisely as you can (for example, “frustrated,” “overwhelmed,” “lonely”). This simple step can reduce intensity and clarify what you need.
- Practice non-judgment: notice when you are criticizing yourself for feeling a certain way. Gently redirect to a more compassionate stance (“It makes sense that I feel this way right now”).
- Create a calming toolkit: identify a few short, realistic strategies you can use when upset, such as stepping outside for fresh air, a brief breathing exercise, or texting a trusted friend.
- Plan ahead for known stressors: if evenings, feeding times, or appointments are especially hard, think in advance about how to build in support or breaks.
- Seek structured skills training: group programs, online courses, or therapy that explicitly targets emotion regulation can provide more comprehensive support.
Over time, these practices can make it easier to ride emotional waves without feeling swept away, which may reduce vulnerability to depression and support healthier parenting relationships.
Limitations and Why Context Still Matters
The Swedish study offers strong evidence from a large, well-characterized sample, but the findings come with caveats:
- The sample included a higher proportion of Swedish-born, highly educated women than the general population, which may limit generalizability to more diverse or disadvantaged groups.
- The main depression measure (EPDS) screens for symptoms but does not provide a formal diagnosis.
- The study did not track how different treatments, such as therapy or medication, may have influenced symptom trajectories.
- Perinatal depression is multifactorial. Emotion regulation is just one piece of a complex picture that includes biology, hormones, psychosocial stressors, trauma history, relationship quality, and more.
Despite these limitations, the research reinforces a key message: focusing only on current symptoms can miss those who are quietly struggling to manage intense emotions and may be on a path toward depression. Early, skill-based support has the potential to change that trajectory.
Takeaway: Emotion Skills as a Foundation for Perinatal Mental Health
This national Swedish cohort study highlights mid-pregnancy emotion regulation difficulties as a robust marker of risk for perinatal depressive symptoms, especially for depression that starts after birth or persists over time. A brief tool like the DERS-16 could help maternity services flag those who might benefit from preventive support, long before crisis points are reached.
At the same time, emotion regulation is a hopeful target. Unlike many risk factors, it is a set of skills that can be learned and strengthened. Whether through therapy, structured group programs, or practical self-help strategies, investing in emotion skills during pregnancy may not only reduce the risk of depression but also support more responsive parenting and healthier child development.
If you recognize yourself in the signs and symptoms of depression or in the description of emotion regulation difficulties, reaching out for help is an act of strength, not weakness. Talk with your midwife, doctor, or mental health professional about your options, from natural supports to talking therapies and, when needed, carefully chosen medication. You deserve support during this profound life transition, and effective treatments are available.