This study aimed to evaluate the independent association between the mode of anesthesia and the risk of postpartum depression (PPD) among mothers undergoing cesarean delivery.

This retrospective cohort study utilized the South Korean National Health Insurance Service database for first-time cesarean deliveries (2015–2023). Anesthesia was classified as neuraxial (NA) or general (GA). The primary endpoint was newly diagnosed PPD within one year, analyzed via 1:1 propensity score matching and Cox regression. Number needed to harm (NNH), the reciprocal of absolute risk difference, indicated the number of GA exposures required for one additional PPD case.

Of the 890,801 mothers included, 555,373 (62.3%) received NA and 335,428 (37.7%) received GA. In the crude analysis, the incidence of PPD was 2.4% in the GA group and 1.9% in the NA group (hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.76–0.80; P   <  0.001). After 1:1 PS matching (302,511 women in each group; n = 605,022 total), the NA group maintained a significantly lower risk of PPD compared to the GA group (2.1% vs . 2.3%; HR 0.88; 95% CI 0.85–0.91; P   <  0.001), yielding an absolute risk difference of 0.28% (95% CI, 0.21%–0.36%) and a NNH of 353.

NA for cesarean delivery is associated with a significantly lower risk of PPD compared to GA. Given the rising global rates of both cesarean delivery and maternal mental health disorders, prioritizing neuraxial techniques may optimize long-term maternal mental health outcomes.