Most important transformative period of Woman’s life are Pregnancy and motherhood, resulting in an enormous change from a physical psychological, and socially, with women experiencing many difficulties, such as learning various parenting techniques, new familial bonds, and resulting in significant physical and psychological adjustments in her life1,2. Psychological vulnerability is seen mainly during postpartum. Consequently, there is an increase of bonding and mood disorders within this postpartum period , especially postpartum depression, whose incidence, as per new study, came out to be 24% among healthy women during this phase of life and globally prevalence has been estimated as 100‒150 per 1000 births 3,4. During this phase of life particularly during child bearing age years , women are experiencing major depression episode twice more likely than other phase of life.5 A major depressive episode which occurred during the postpartum period is known as postpartum depression (PPD).6 Postpartum depression (PPD) is a state that occurs 4–6 weeks after giving birth, and prolong upto one year.. In Post- partum depression, variety of symptoms occur, such as insomnia, feelings of insecurity, anger, frustration, and feeling guilty over not being able to care for their newborn.7. Many times, it also affects mother- child relationship and bonding and growth and development of the child8. Various risk factors have been identified which results into postpartum depression like any traumatizing event, low attention, unemployment, previous any depressive illness, any history in the family, Cesarean –sections, lack of family support , any stressful circumstances, premature deliveries, marital conflicts, hormonal fluctuations during pregnancy any many more.9 It is a public health concern due to the serious consequences which are affecting the quality of life of both mother and child and involve the entire family.10 Hence, this study was conducted with the objective of estimating the proportion of PPD among mothers attending the postnatal clinics and its association with various sociodemographic and other risk factors.

A cross- sectional study design was conducted to assess the risk factors as well as concerns of postpartum depression among mothers seeking health care using Edinburg Postpartum depression scale among mothers attending postnatal clinic for follow-up in tertiary hospital of Kathua district, J&K. The study was conducted from September 2023 to February 2024, spanning a period of six months. The research was conducted in Kathua City, located in the northern region of India. Tertiary hospital was chosen due to its catering of diverse population from both rural as well as urban area and peripheral area (slum as well as tribal population) to healthcare facilities, providing a representative sample of postpartum mothers from different areas, backgrounds and socioeconomic statuses. The target population consisted of mothers who had infants ie given birth within one year and were attending the Gynae & Obstretics Department OPD for follow-up. Sample size was calculated by taking 9.5% as prevalence from a study by Gaikwad S et al. carried out in Aurangabad considering 95% confidence level and 5% allowable error11. The sample size came to be 137. We have studied total 150 participants. The data was collected using the Edinburg Postpartum depression Scale, which is a validated instrument used to assess the postpartum depression.12 the EPDS score levels, it is essential to note that the EPD scale ranges from 0 to 30 with the threshold which is commonly used to screen for PPD is a score of 12 or higher, which means a positive screen. The EPD scores between 9 and 11 considered as a moderate level of depressive symptoms, while scores between 12 and 13 may indicate the presence of possible depression. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY).Descriptive data was presented as proportions and percentages in tabular form. The chi-square test, or Fisher exact test, was performed for categorical variables to determine the associations between PPD and other relevant factors. A p-value < 0.05 was considered statistically significant.

Total 150 study participants were studied in this study, out of these 30(20%) mothers were found to have a score of 10–12 indicating moderate depressive symptoms, and 15(10%) mothers had a score of 13 and above . The mean age of study participants was 23.4 years. Most of i.e., 84 study participants were from age group 20-25 years old. All the study participants were married. 15(10%) participants were illiterate, only 4(2.6%) had completed primary education, 36(24%) had completed middle school , majority i.e 75(50%) had completed Higher Secondary , 20(13.3%) were graduates or post graduates. About 45(30%)participants resided in urban area and 105 in rural area (70%). 92 participants were primigravida ( 61.3 %), and 58 were multigravida ( 38.7 %). 68 pregnancies were planned (45.3 %) and 82(66.7%) pregnancies were not planned . The mode of delivery was vaginal in 46 participants (30.6 %), and LSCS in 104 cases ( 69.4%). 91 participants delivered a male child ( 60.6 %), and 59 delivered a female child ( 39.4%). Majority of the mothers (137) had no preference regarding the gender of the baby (91.3%), 13 say gender of the baby was as expected, and no mother was unhappy with the gender of their child. 45 mother were exclusively breastfeeding their baby ( 30%), majority 96 (64%)on formula feed, and the rest on a combination of the above. 147( 98%) babies were healthy, and 3 (2 %) were sick. Majority of the participants had an uncomplicated pregnancy and delivery. 22(14.6) have suffered from abortions previously . 2 gave the history of domestic abuse during pregnancy.. Majority participants received healthcare advice during their ANC period, 4 had suffered a stressful life event during the past year. Table 1 : Socio demographic profile of study subjects Not Depressed(n=135) Depressed(n=15) Total (n=150) p Age group 20-25 84 8 92 0.602 25-30 42 5 47 >30 9 2 11 Education Illiterate 14 1 15 Primary 3 1 4 Middle school 34 2 36 0.019 Higher secondary 70 5 75 Graduation and above 14 6 20 Occupation Housewife 131 15 146 0.499 Employed 4 0 4 Resident Urban 40 5 45 0.766 Rural 95 10 105 Religion Hindu 116 14 130 Muslim 15 1 16 0.677 Sikh 4 0 4 Others 0 0 0 Type of family Nuclear 12 2 14 0.575 Joint 123 13 136 Husband’s Education Illiterate 6 1 Primary 3 1 Middle school 15 2 0.845 Higher secondary 75 7 Graduation and above 36 4 Table 2 shows association between various risk factors and the prevalence of postnatal depression among the study participants. .Education of the woman ,whether pregnancy is planned or not ,History of abortion and pregnancy outcome were significantly associated with postpartum depression (p <0.05) Table 2: Association between various risk factors and the prevalence of postnatal depression among the study participants. Parameters Not Depressed(n=135) Depressed(n=15) Total (n=150) p Gravida Primigravida 83 9 92 0.911 Multigravida 52 6 58 Planned pregnancy Yes 55 13 68 0.001 No 80 2 82 Mode of delivery Caesarean 92 12 104 0.345 Vaginal 43 3 46 Gender of baby Male 82 9 91 0.956 Female 53 6 59 Preference regarding gender of baby As expected 10 3 13 0.100 No preference 125 12 137 Not as expected 0 0 0 Pregnancy outcome Baby Sick 1 2 3 0.004 Baby Healthy 134 13 147 Baby Feeding practices Breast feeding 44 1 45 Formula feed 83 13 96 0.112 Mixed 8 1 9 Complications during pregnancy Yes 7 1 8 0.809 No 128 14 142 Complications during Delivery Yes 5 2 7 0.903 No 130 13 143 H/O Abortion Yes 11 11 22 0.023 No 124 4 128 H/O Domestic Abuse Yes 0 2 2 0.635 No 133 15 148 Received Health Advise during Pregnancy Yes 130 1 131 0.579 No 5 14 19 Stressful life events in past one year Yes 4 0 4 0.499 No 131 15 146

Globally, Postpartum depression (PPD) is always been a prevalent mental health issue mostly among the new mothers , mostly characterized by feelings of anxiety, sadness, and hopelessness, which can significantly impact both the maternal and infant well-being.13Our study revealed a prevalence of PPD, with 10% of mothers screening positive for depression based on the EPDS scores . Similar findings were also observed in some studies14 and some studies revealed a concerning prevalence from 19 % to 75%.15-16 Various studies highlighted the risk factors which are associated with PPD, including gestational diabetes, poor social support, depression during pregnancy, lower economic status ,history of depression, , and adverse obstetric outcomes.17-18 In our study, we observed significant associations between higher EPDS scores and risk factors such as education of the mother, planned pregnancy, pregnancy outcome, history of abortion. These findings are consistent with the existing literature, which emphasize the impact of demographic, psychosocial, and obstetric factors on PPD risk.19One of the most significant findings of our study was the strong association between Pregnancy outcome, education of the mother and PPD risk. In contrary to other studies, the significant findings mainly were mental illness history.19 As per age ,our study found no significant difference .But some studies found an inverse association between PPD and women age, with an increased risk significantly at a younger age .20,21Our study found a significant association between pregnancy outcome i.e whether baby is sick or healthy and PPD which is also seen in other similar studies.22 Thus ,PPD has been recognized as a public health problem which may cause many negative consequences for both mothers and the infants.

Women during the postpartum need to be supported both for their physical and mental health. Healthcare practitioners should integrate routine depression screenings into their standard treatment protocols to identify co-occurring mental health disorders.Effective measures like psychological counselling and health education, need to be taken to control post-partum depression in India

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