Postpartum depression (PPD) and postpartum anxiety (PPA) are among the most common mental health disorders affecting women during the postnatal period. Globally, it is estimated that 10–30% of women experience PPD, while postpartum anxiety may affect 25–40%, posing significant risks to both maternal well-being and infant development^1,2. These disorders can impair maternal-infant bonding, reduce breastfeeding initiation, and negatively influence child growth and cognitive outcomes³.

In low- and middle-income countries like India, the burden of perinatal mental health disorders is substantial, yet often underrecognized. According to a meta-analysis, the prevalence of postpartum depression in India ranges between 22% and 30%, with even higher rates in disadvantaged and rural populations⁴. The National Mental Health Survey of India (2015–16) highlighted that women in the reproductive age group are particularly vulnerable to common mental disorders, including depression and anxiety⁵.

Multiple psychosocial factors have been identified as contributing to the risk of PPD and PPA. These include unplanned pregnancy, low educational attainment, unemployment, lack of social or partner support, and recent bereavement^3,6. These stressors are often exacerbated in india settings due to limited access to mental health care and social safety nets.

Given this background, the current study was conducted to estimate the prevalence of postpartum depression and anxiety among women attending a tertiary care hospital in India and to identify key psychosocial determinants contributing to these conditions.

Objective: To determine the prevalence of postpartum depression and anxiety and identify the psychosocial factors associated with these conditions among women attending a tertiary care hospital in India,

Study Design and Setting

This hospital-based cross-sectional study was conducted in the Department of Obstetrics & Gynaecology at BRD Medical College, Gorakhpur a tertiary care center in, India, from January 2023 to June 2024.

Study Population

Women aged 18–40 years, between 4 weeks to 6 months postpartum, attending the postnatal or immunization outpatient clinics were eligible. Inclusion required a live, healthy infant and willingness to participate. Women with stillbirths, major psychiatric illness (other than PPD/A), or ongoing psychiatric treatment were excluded. Based on a presumed prevalence of 15% and a 20% margin of error, a minimum sample size of 567 was estimated. Accounting for a 5% non-response rate, 600 participants were enrolled. the The ethical clearance was obtained from the Institutional Ethics Committee B.R.D.M.C, Gorakhpur (S.No.07/CRC/2023 Date 070/2/2023)

In Methods:

The questionnaire was divided into two sections. The first section collected information on the socio-demographic profile of participants, along with factors previously identified in research as being linked to perinatal depression and anxiety. The Edinburgh Postnatal Depression Scale (EPDS), consisting of 10 items rated on a Likert scale from 0 to 3, was used to assess depressive symptoms. Scores could range up to 30, and in this study, a threshold score of 10 or above was considered indicative of possible depression [5]. Anxiety was measured using the Zung Self-Rating Anxiety Scale (SAS), which includes 20 items rated on a 1–4 Likert scale. The SAS raw score ranges from 20 to 80; prior research in LMICs classifies scores below 45 as normal, 45–59 as moderate, 60–74 as severe, and 75 or above as extreme anxiety [6]. Both instruments demonstrated strong reliability, with Cronbach’s alpha values of 0.89 for EPDS and 0.87 for SAS.

Data collection involved two visits to each health centre: one on the designated antenatal clinic day and another during the same week on the immunization clinic day. Systematic sampling was employed by enrolling every 5th eligible woman who attended on those days. Additionally, around 15 participants were recruited from the district hospital’s paediatric ward by asking mothers about their child’s age and including every 5th eligible respondent in the study.

Statistical analysis: The data was entered in the MS Excel. Analysis was carried out using Jamovi v2.3.26.0. Descriptive data was represented as mean with standard deviation. Descriptive statistics such as frequency, percentage for categorical variables was determined. Bivariate and multivariate ordinal logistic regression was performed and P-value<0.05 was be considered significant

Table 1. Socio-demographic Characteristics among Study Participants (N = 600)

The majority of the participants (35.2%) were aged 25–29 years, followed by 27.3% aged 18–24 years, 22.5% aged 30–34 years, and 15.0% aged 35–40 years. Regarding marital status, 68.0% were married, 23.0% were living with a partner, and 9.0% were single, divorced, or separated. The education, 12.0% had no formal education, 49.0% had completed primary education, and 39.0% had attained secondary education or above. Employment status revealed that 56.0% of the women were unemployed, 31.0% were self-employed, and only 13.0% were in formal employment. Additionally, 59.0% of the participants reported that their pregnancy was planned, while 41.0% had unplanned pregnancies. (table 1)

Table 2. Prevalence of Postpartum Depression and Anxiety among Study Participants (N = 600)

28.0% (n = 168) were found to have postpartum depression, defined by an Edinburgh Postnatal Depression Scale (EPDS) score of ≥10, while 72.0% (n = 432) had no depression (EPDS <10). Regarding postpartum anxiety, measured using the Self-Rating Anxiety Scale (SAS), 34.0% (n = 204) of participants had anxiety (SAS ≥45), whereas 66.0% (n = 396) did not report anxiety symptoms (SAS <45). When categorized by severity of anxiety, 66.0% (n = 396) of the women had normal anxiety levels (SAS <45), 23.0% (n = 138) had moderate anxiety (SAS scores 45–59), 8.0% (n = 48) exhibited severe anxiety (SAS scores 60–74), and 3.0% (n = 18) experienced extreme anxiety (SAS ≥75).(table 2)

Table 3. Association Between Psychosocial Factors and Postpartum Depression (N = 600)

In this study, multiple psychosocial determinants were significantly linked to postpartum depression. A notably higher proportion of women with unplanned pregnancies experienced depression (65.5%) compared to their non-depressed counterparts (28.9%) (p < 0.001). Depression was also more prevalent among women with lower educational levels (up to primary school), with 84.5% of depressed participants falling into this category versus 47.9% among those without depression (p < 0.001). Similarly, 55.4% of depressed women reported inadequate partner support, compared to only 18.8% of those without depression (p < 0.001). Unemployment emerged as another contributing factor, with 80.4% of women with depression being unemployed, in contrast to 45.8% in the non-depressed group (p < 0.001). Additionally, a history of losing a parent or sibling was reported by 52.4% of depressed women, compared with 27.5% of women who did not report depression (p < 0.001). (table 3)

Table 4. Association Between Psychosocial Factors and Postpartum Anxiety (N = 600)

Postpartum anxiety was likewise found to be significantly linked with several psychosocial factors. Women with unplanned pregnancies exhibited a much higher prevalence of anxiety (62.3%) compared to those without anxiety (27.3%), with a p-value of <0.001. Low educational attainment (up to the primary level) was also strongly associated, observed in 78.4% of women experiencing anxiety versus 47.7% of those without anxiety (p < 0.001). Similarly, lack of partner support was reported by 48.0% of anxious women compared to only 19.2% of non-anxious participants (p < 0.001). Unemployment emerged as another significant factor, with 78.4% of anxious women being unemployed, compared to 43.7% of those without anxiety (p < 0.001). Finally, the history of losing a parent or sibling was more common among women with anxiety (46.6%) than among those without (28.3%), also showing a statistically significant association (p < 0.001).(table 4)

The majority of the postpartum women (35.2%) were aged between 25 and 29 years, followed by 27.3% aged 18–24 years, 22.5% aged 30–34 years, and 15.0% aged 35–40 years. Most of the women were married (68.0%), while 23.0% were living with a partner, and 9.0% were single, divorced, or separated similar result found that^1,4. Educational attainment revealed that 12.0% had no formal education, 49.0% completed primary education, and 39.0% had secondary or higher education^7,8. Regarding employment status, 56.0% were unemployed, 31.0% self-employed, and only 13.0% formally employed. In terms of pregnancy planning, 41.0% reported their pregnancy as unplanned⁹.

Present study, 28.0% of the participants were found to have postpartum depression (EPDS ≥10), while 34.0% had postpartum anxiety (SAS ≥45). When anxiety was categorized by severity, 23.0% of the participants had moderate anxiety, 8.0% had severe anxiety, and 3.0% had extreme anxiety symptoms. Two-thirds (66.0%) of the women had normal anxiety levels. The observed prevalence of postpartum depression aligns with studies from both India and neighboring countries, which report a prevalence between 20% and 35%^10,11. The National Mental Health Survey of India (2015–16) also highlighted the high burden of common mental disorders among reproductive-age women¹². Likewise, the prevalence of postpartum anxiety (34.0%) in our study is in line with global estimates that place it between 25% and 40%^13-15. The presence of moderate to extreme anxiety in over one-third of participants is particularly concerning. High levels of maternal anxiety are associated with adverse outcomes, including delayed infant cognitive development, impaired maternal bonding, and increased risk of postpartum depression^16,17.

Women with unplanned pregnancies reported a notably higher prevalence of depression (65.5%) compared to those without depression (28.9%), with a p-value < 0.001. Similarly, low education status (up to primary level) was significantly associated with depression, with 84.5% of depressed women having low education, in contrast to 47.9% among non-depressed women (p < 0.001)^18-20.  The lack of partner support was reported by 55.4% of women with depression, compared to 18.8% without depression (p < 0.001)^21,22.  Unemployment was also significantly associated, as 80.4% of women with depression were unemployed versus 45.8% without depression (p < 0.001). [19 Additionally, a history of loss of a parent or sibling was reported by 52.4% of depressed women, compared to 27.5% of those without depression (p < 0.001)^1,7.

Women with unplanned pregnancies had a significantly higher prevalence of anxiety (62.3%) compared to those without anxiety (27.3%), with a p-value < 0.001. Low educational attainment was observed in 78.4% of anxious women, as opposed to 47.7% among those without anxiety (p < 0.001). Similar to earlier studies, unplanned pregnancies and low education significantly contributed to anxiety during the postpartum period^23,24. The lack of partner support was reported by 48.0% of women with anxiety, versus 19.2% of those without (p < 0.001). Lack of partner support and unemployment, as psychosocial stressors, likely exacerbate the transition to motherhood, increasing susceptibility to anxiety disorders^25,26. Unemployment was again significantly related, with 78.4% of anxious women being unemployed compared to 43.7% of non-anxious women (p < 0.001). Lastly, loss of a parent or sibling was more frequently reported among those with anxiety (46.6%) compared to those without (28.3%), also showing a statistically significant association (p < 0.001). The loss of a parent or sibling during a period of increased emotional sensitivity may compound anxiety symptoms, a relationship documented in bereavement-related literature^27,28.

Prevalence of postpartum depression (28.0%) and anxiety (34.0%) among women attending a tertiary care hospital in India, with significant associations observed with psychosocial factors such as unplanned pregnancy, low education, unemployment, lack of partner support, and bereavement. These findings underscore the urgent need for routine mental health screening and psychosocial interventions in postnatal care settings.

Limitations of study:

The study is limited by its hospital-based design, which may not fully capture the mental health status of women in community settings, and by its reliance on self-reported screening tools rather than clinical diagnostic interviews, which may lead to under- or overestimation of the true prevalence.

Conflict of Interest: None

Funding: Nil

Acknowledgement: None

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