Background. We previously reported results of a prospective cohort study showing that women whose infants have emergency department visits or frequent problem-oriented primary care visits (PPCV) in the first 3 weeks of life are significantly more likely to exhibit depressive symptoms at 8 weeks postpartum. Objective. To validate our previous findings using a nationally representative sample, specifically testing whether women whose neonates have frequent PPCV have increased risk of postpartum depressive symptoms. Methods. Design. Secondary analysis of the 1988 National Maternal and Infant Health Survey (NMIHS), an interview survey of a nationally representative sample of women who had live births in 1988, conducted by the National Center for Health Statistics. Subjects. NMIHS women who had full term, live singleton births. Measures. Independent measure was >1 PPCV. Depressive symptoms were assessed by the Center for Epidemiologic Studies depression scale (CES-D). The dependent variable was CES-D≥16 (women with incomplete responses to the CES-D were excluded). Covariates were maternal age, race, Hispanic ethnicity, parity, educational level, income, and payor status. Analysis. Weighted percentages were calculated for univariate analyses. Multivariate analyses were adjusted for design effects using SUDAAN. Results. There were 6779 women in the sample. 7.1% of babies had >1 PPCV and 13.2% had >1 well child visit (WCV) in the first month postpartum. 23.1% of mothers had depressive symptoms. Before and after adjustment for covariates, women whose infants had>1 PPCV within the first month of life were more likely to be depressed(Adj OR 2.04, 95%CI 1.45-2.94, p<0.001). Women whose infants had >1 WCV within the first month were no more likely have depressive symptoms (Adj OR 1.11, 95%CI 0.83-1.49, p=0.47). Conclusion. Women whose infants have frequent PPCV, but not WCV, are more likely to exhibit depressive sympoms. Whether depression is the basis or the result of these infant outpatient visit patterns, the risk groups identified need close monitoring. Referral of mothers by pediatric health providers recognizing these patterns may facilitate early diagnosis and treatment of postpartum depression, thereby improving oucomes for women and their families.