Pregnancy and childbirth are critical life events in a woman’s reproductive cycle, bringing about not only physical but also psychological and social transitions1. While these experiences are usually associated with joy and fulfillment, they can also render women particularly vulnerable to mental health challenges2. As per the World Health Organization, approximately 10% of pregnant women worldwide suffer from some form of psychological disorder, most commonly depression in the immediate postpartum period. The burden is even higher in low- and lower-middle income countries, where it is estimated that 15.6% of women suffer from mental health problems during pregnancy, and 19.8% experience psychological disorders after delivery3. This data highlights a serious public health challenge in maternal mental health care that is often overlooked. Postpartum depression (PPD) is a common, non-psychotic mood disorder that can occur at any point after conception, extending into the postpartum period. Most commonly, PPD presents within 2–6 weeks of childbirth, although it can emerge as late as 30 weeks after delivery. The etiology of postpartum depression is considered multifactorial, involving biological, psychological, and socio-environmental contributors. Hormonal fluctuations after childbirth, disrupted sleep patterns, and changing family dynamics may trigger or exacerbate symptoms.4 PPD can vary in its severity, ranging from a mild, self-limiting depressive state to severe postnatal major depression or even psychosis. Its impact on the mother–infant relationship, breastfeeding practices, and the long-term cognitive and emotional development of the child makes it a significant public health concern. Various social and psychological factors have been associated with the development of postpartum depression5. Stressful life events, childcare stress, and prenatal anxiety are known contributors. Sociocultural pressures6, such as the preferred gender of the baby, or the gender of previous children, can also significantly affect the mother’s psychological well-being. In patriarchal societies, disappointment over the birth of a female child has been observed to increase the risk of PPD. Additionally, marital conflict, poor spousal support, single parenthood, and a history of PPD or other mental illnesses are established risk factors7. Lack of adequate social support during and after pregnancy remains one of the most potent predictors of postpartum depression. Despite its high prevalence and clear negative consequences, postpartum depression is frequently underdiagnosed and undertreated, particularly in low- and middle-income settings. Many women fail to recognize the symptoms of PPD or may dismiss them as normal “baby blues,” while family members and even health professionals might underestimate their severity8. The stigma surrounding mental health issues further prevents women from seeking timely help. However, postpartum depression is both preventable and treatable. Early identification through systematic screening, combined with prompt intervention, can substantially reduce its burden9. Screening tools such as the Edinburgh Postnatal Depression Scale (EPDS) have been validated and are widely used globally to detect women at risk. In India, culturally adapted versions of the EPDS have demonstrated high sensitivity and specificity for detecting postpartum depression, making them suitable for use in diverse populations. Global studies report postpartum depression prevalence rates ranging from 10% to 15% in developed countries. However, evidence from India and other South Asian countries indicates a higher prevalence, generally around 15% or more10. The reasons for this elevated burden include lower socioeconomic status, limited healthcare resources, social stigma, gender-based pressures, and poor mental health literacy11. Considering these factors, it is critical to assess the burden of PPD in diverse communities and to identify the risk factors that may predispose women to this condition. This knowledge can inform targeted interventions to address PPD more effectively.

Aim

Study of Postpartum depression and risk factors in a tertiary care centre in Northern India.

A one-year cross-sectional study was conducted on 178 postpartum women attending the Obstetrics and Gynecology outpatient clinic 2–6 weeks after delivery. Women with cognitive dysfunction, postpartum thyroiditis, or who declined consent were excluded. Data collection used a pretested semi-structured questionnaire covering social, demographic, obstetric, neonatal, mental health, and interpersonal variables, along with the validated Hindi version of the Edinburgh Postnatal Depression Scale (EPDS). A cutoff EPDS score of 13 was applied to identify postpartum depression

Table 1: Socio-demographic factors in postpartum depression

In this study, postpartum depression was more common among women less than 35 years (5 out of 17) and among illiterate women (11 out of 59). Additionally, higher rates of depression were noted in middle- and high-income groups compared to low-income women.

Table 2: Obstetric factors and gender issues in postpartum depression

Postpartum depression was more frequent among primigravida women (12 cases), those reporting male child pressure (15 cases), and mothers of sick babies (11 cases). Higher rates were also seen with complications during pregnancy, vaginal deliveries, and among those practicing breastfeeding.

Table 3: Other factors in post partum depression

Postpartum depression was more frequent among women lacking family support (15 cases), those whose husbands consumed alcohol (11 cases), and those reporting adverse life events (8 cases). Additionally, depression was higher among women with a history of domestic abuse (14 cases) and those with a family history of psychiatric disorders (5 cases).

A total of 178 women participated in the present study, of whom 18 were found to have an EPDS score greater than 13, indicating moderate depressive symptoms. This prevalence is consistent with findings from other studies, Chaaya et al.12 found 21% in Lebanon, while Katherine et al.13 and Mohammad et al. noted 22%14 in the United Arab Emirates and Jordan, respectively. These differences in reported prevalence may be attributed to variations in study populations, assessment tools, cultural beliefs, and differences in mental health awareness and reporting practices.

Among the 178 women studied, 18 were found to have postpartum depression while 160 did not. Depression was more common in women less than 35 years (5 cases) compared to those aged >35 years (13 cases). Illiterate women showed a higher burden of depression (11 cases) than literate women (7 cases). Regarding socioeconomic status, most depressed women belonged to middle- (8 cases) or high-income groups (6 cases), while only 4 cases were from the low-income group. These findings suggest that advanced maternal age and lower educational status may increase the risk of postpartum depression. Additionally, depression was distributed across all socioeconomic classes in this cohort.In a study by Kansagra,15 the prevalence of PPD in the study was 14.2%. The mean ± standard deviation age of women was 27.1 ± 4.7 years. Sociodemographic factors such as maternal age, low level of education, were significantly associated with PPD (P < 0.05).

Among the 178 women studied, postpartum depression was more prevalent among primigravida women (12 cases) compared to multigravida women (6 cases). A notable association was seen with male child preference, where 15 depressed women reported pressure to have a male child versus only 3 who did not. Depression was also higher among women experiencing complications during pregnancy (6 cases) compared to those without complications (12 cases). Regarding pregnancy outcomes, mothers of sick babies had more depression (11 cases) than those with healthy babies (7 cases). Vaginal deliveries were linked with higher depression rates (13 cases) compared to cesarean sections (5 cases). In terms of infant feeding, mothers practicing breastfeeding reported more depression (15 cases) than those using formula feeding (3 cases). These results indicate that primigravida status, male child preference, adverse neonatal outcomes, and pregnancy complications may contribute significantly to postpartum depression. These findings are consistent with other studies conducted globally and in India. Likewise, Patel et al. (2002)16 in Goa found that preference for a male child, and complications during delivery were strongly associated with PPD.

In this study, postpartum depression was more frequent among women who lacked family support during pregnancy (15 cases) compared to those who had support (3 cases). Husbands consuming alcohol were reported by 11 depressed women versus 7 whose husbands did not drink. Women who experienced adverse life events showed higher depression rates (8 cases) than those without such events (10 cases). A significant association was also noted with domestic abuse, where 14 depressed women had a history of abuse compared to 4 without. Family history of psychiatric disorders was present in 5 depressed women, while 13 depressed women had no such history. Overall, the findings suggest that lack of family support, adverse life events, domestic violence, and spousal alcohol use are key contributors to postpartum depression. These social stressors highlight the importance of screening and psychosocial interventions during the perinatal period. Socio demographic factors such as birth of the baby girl, pregnancy related complications and factors related to adverse life events and domestic abuse, non-availability of family support during pregnancy and delivery found to be significant to the development of PPD. Similar to our results, a study by Chandran et al. (2002) 17in rural Tamil Nadu identified the incidence of post-partum depression was 11% (95% CI 7.1-14.9). Relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression.

In this study, 18% of postpartum women were found to have moderate depressive symptoms, consistent with regional and international data. Significant risk factors included primigravida status, preference for a male child, complications during pregnancy, and adverse neonatal outcomes. Lack of family support, spousal alcohol use, domestic violence, and stressful life events also emerged as important contributors to postpartum depression. These findings highlight the complex interplay of social, cultural, and obstetric factors influencing maternal mental health. Early screening using validated tools such as the EPDS is essential for timely diagnosis. Integrating psychosocial interventions with routine obstetric care can improve outcomes. Further research in diverse populations will help refine prevention and management strategies

1. Milgrom J, Gemmill AW, Bilszta JL, et al.: Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008;108(1-2):147-57. DOI: https://doi.org/10.1016/j.jad.2007.10.014 PMid:18067974
2. Tajwar Y, Aman K, Shivani S, Shishir K, Sanjay K. Assessment of Magnitude and Risk Factors of Postpartum Depression among mothers attending immunization clinics of IGIMS, Patna. Int J Acad Med Pharm. 2024;6(2):1040-4.
3. Page M. J., McKenzie J. E., Bossuyt P. M., Boutron I., Hoffmann T. C., Mulrow C. D. et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews 2021. Bmj, 2021;372:n71. DOI: https://doi.org/10.31222/osf.io/v7gm2
4. Cohen J: Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968;70(4):213-220. DOI: https://doi.org/10.1037/h0026256 PMid:19673146
5. Munn Z, Moola S, Lisy K, Riitano D, & Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. International Journal of Evidence-Based Healthcare 2015;13(3):147-153. DOI: https://doi.org/10.1097/XEB.0000000000000054 PMid:26317388
6. Rajati, F., Ahmadi, N., Naghibzadeh, Z.-A.-S., & Kazeminia, M. The global prevalence of oropharyngeal dysphagia in different populations: A systematic review and meta-analysis. Journal of Translational Medicine 2022;20:175. DOI: https://doi.org/10.1186/s12967-022-03380-0 PMid:35410274 PMCid:PMC9003990
7. Bala J, Kumari R, Gupta RK, Langer B, Mahajan R, Zaffer I. Prevalence and Predictors of Postpartum Depression among Mothers Attending Tertiary Care Hospital, Jammu, India. Natl J Community Med 2024;15(8):642-648. DOI: https://doi.org/10.55489/njcm.150820244035
8. Begum S, S Anitha, Sushantha. A Cross-Sectional Study on Magnitude of Post-Partum Depression and Factors Associated with it among Postnatal Mothers Visiting a Tertiary Care Setting in Mangalore, Karnataka. Indian Journal of Public Health Research & Development. 2024 Jul 1;15(3):371-377. DOI: https://doi.org/10.37506/58n00148
9. Fatima N, Datta MR, Minhaz A. Evaluation of Mental Health in Postpartum Indian women-A Prospective hospital-based observational study. O&G Forum 2024;34(3s):2919-2921.
10. Kapoor B, Malik N, Gupta G, Khan IA. A cross-sectional study exploring postpartum depression at a tertiary care center in eastern Uttar Pradesh, India. Cureus. 2024;16(4):e58653. DOI: https://doi.org/10.7759/cureus.58653
11. Kar S, Samantaray PC, Patnaik L, Mishra A, Lakshmi P. Family and facility care variables attributing to postnatal depression among women in two tribal dominated districts of Odisha: Log model analysis to suggest intervention. J Family Med Prim Care 2024;13(3):958-63. DOI: https://doi.org/10.4103/jfmpc.jfmpc_1367_23 PMid:38736796 PMCid:PMC11086792
12. Chaaya M, Campbell OM, El Kak F, Shaar D, Harb H, Kaddour A. Postpartum depression: prevalence and determinants in Lebanon. Arch Women Ment Health. 2002;5(2):65–72.
13. Katherine G, Broome H, Mirabella J. Postnatal depression among mothers in the United Arab Emirates: socio-cultural and physical factors. Psychol Health Med. 2006;11(4):425–31.
14. Mohammad KI, Gamble J, Creedy DK. Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women. Midwifery. 2011;27(6):238–45
15. Kansagra, Dharti J.; Amin, Chikitsa D.; Chauhan, Rajendra B.. The Prevalence and Risk Factors of Postpartum Depression in Western India: A Cross-Sectional Study. Indian Journal of Community Medicine 50(1):p 70-75, Jan–Feb 2025. | DOI: 10.4103/ijcm.ijcm_232_23
16. Patel V, Rodrigues M, DeSouza N. Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry. 2002;159(1):43–47. doi:10.1176/appi.ajp.159.1.43
17. Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Br J Psychiatry. 2002;181:499–504. doi:10.1192/bjp.181.6.499.