‘The Yellow Wallpaper,’ by American author Charlotte Perkins Gilman, was published in The New England Magazine in 1892. It is a gothic horror story, a feminist classic and a harrowing depiction of a life where postpartum depression and psychosis tangle with the mores and conventions of the day.

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The narrator, who has just given birth, is suffering from a prolonged bout of ‘nervousness.’ The remedy, prescribed by her physician husband, is strict rest for the summer in their large, rented home. Her appeals for social interaction and activity are ignored as she attempts to remain a dutiful, compliant wife. While her husband’s sister assumes care of the baby, the narrator is relegated to solitude in a nursery room with peeling, ‘hideously’ patterned yellow wallpaper and where she becomes increasingly unmoored.

She furtively writes, “But these nervous troubles are dreadfully depressing… It does weigh on me so not to do my duty in any way! I meant to be such a help to John, such a real rest and comfort, and here I am a comparative burden already! Nobody would believe what an effort it is to do what little I am able — to dress and entertain, and order things.”

Contrary to the assertions of her character, Perkins Gilman created a very believable account of a woman in the consuming throes of deep mental illness. More than 130 years later, it is still provocative and resonant, underscoring the tension with which many women contend between struggling with a perinatal mental health condition and the myriad norms and expectations associated with pregnancy and childbirth.

The notion that the perinatal period should be a time of unmitigated excitement, joy and fulfillment is a persistent cultural myth — one that obscures the reality that this period carries heightened vulnerability to serious medical and mental health conditions. Nearly a third of women report depressive symptoms during pregnancy, and global prevalence estimates of postpartum depression hover around 20%, with even higher rates reported in lower- and middle-income countries. Though postpartum psychosis is relatively rare (1–2 per 1,000 births), it carries an elevated risk of suicide and infanticide. Mental health conditions overall account for more than one in five maternal deaths. Despite these sobering figures, roughly 75% of women affected by a perinatal mental health condition receive no treatment, whether because of stigma or lack of access to healthcare, underscoring the urgent need for greater awareness, screening and intervention across the perinatal continuum.

The perinatal period typically spans from the middle of the second trimester of pregnancy through to the first week after birth, though definitions vary across institutions and research frameworks. The American College of Obstetricians and Gynecologists defines it as beginning at week 20 of gestation, whereas the World Health Organization’s window starts at week 22 and extends through to seven days postpartum. Broader research definitions may encompass 28 days or one to two years after birth. Unlike some perinatal medical conditions that occur during a circumscribed phase, such as preeclampsia, perinatal mental health conditions may bear potentially longer-term consequences on infant and child development. Untreated perinatal depression, for instance, has been linked to low birth weight, preterm birth and adverse social, cognitive and behavioral outcomes in children, highlighting how maternal mental health is intertwined with early developmental trajectories.

Given the high burden of perinatal mental health conditions and the implications for children’s development, improving detection, prevention and treatment is crucial. Although psychotherapy and medication are established first-line treatments, existing guidelines may offer limited clarity and specificity on what constitutes best practice. Newer approaches synthesizing recommendations reflect movement toward prevention and personalization strategies, including a greater emphasis on early screening, psychoeducation and timelier diagnosis, in addition to the integration of innovative therapies and medications.

In the November 2025 issue of Nature Mental Health, we include a Perspective from Pawluski and Oberlander, which explores the literature on the potential risks and benefits of selective serotonin reuptake inhibitors (SSRIs) to help inform clinical guidelines and treatment strategies. Integrating data from animal models and human studies, the authors consider the methodological challenges that can impede isolating SSRI-specific effects on developmental outcomes from those of maternal mood disorders. They advocate for an integrated approach that considers how prenatal SSRI use and perinatal mental health conditions affect maternal and child health and wellbeing within a broader context of factors: from biological (for example, genetics and gut microbiome) to psychological (for example, relationship distress and mental load) and societal factors (for example, access to health care and parental leave). Importantly, many of these factors are modifiable.

Complementing this Perspective, an Article by Weinmar and colleagues focuses on emotion regulation as a transdiagnostic factor implicated in depression and other forms of psychopathology. Emotion regulation allows individuals to modulate their emotional responses through adaptive reframing or reappraisal processes, which are crucial to social functioning. In the context of perinatal mental health, impairments in emotion regulation capacity may be associated with potentially differing patterns of depressive symptoms. Data on depressive symptoms was collected from a prospective Swedish national study across the perinatal period, from the second trimester to one year after birth. Self-reported emotion regulation difficulties in the second trimester were strongly associated with perinatal depression symptoms up to 14–23 weeks after giving birth. The authors interpret these findings as evidence that decreased emotion regulation capacity may serve as a marker of risk for the development of perinatal depression and could present a possible target for skills training to improve maternal mental health.

Perinatal depression is the most common psychiatric complication of childbirth, yet post-traumatic stress, which can be highly comorbid with depression, is understudied. In this issue we include a secondary analysis of the SUMMIT trial by Singla and colleagues that looks at the prevalence of post-traumatic stress symptoms and sociodemographic data in a large, diverse sample of perinatal patients. Nearly 70% of participants met clinical thresholds for post-traumatic stress, with higher rates among ethnic minorities and economically disadvantaged women. Those who received at least one session of behavioral activation therapy, a psychotherapy technique that encourages engagement in meaningful and rewarding activities, showed significant reductions in both post-traumatic stress and depressive symptoms between baseline and three months, reinforcing its potential as an accessible treatment option.

Improving perinatal mental health requires navigating a sometimes thorny path between cultural expectation and clinical reality. More than a century after Perkins Gilman gave voice to a hushed maternal suffering, too many continue to experience distress that is minimized, dismissed or left untreated. Refining understanding of the mechanisms that underlie perinatal mental health conditions — biological, psychological and social — will continue to be a necessity. But many promising solutions could be within reach, including universal perinatal mental health screening, integrated mental health and obstetric care, and availability of effective and scalable psychosocial interventions, if we dare to expect better.