Exploring Postpartum Depression and Its Demographic Correlates among Women: The Mediating Role of Social Support

Abstract

Background. While postpartum depression (PPD) is one of the most prevalent postpartum complications, determining factors for the condition are not well understood in low- and middle-income countries where social and economic hardship tend to cluster. Objective. This study aimed to explore the relationship between sociodemographic and obstetric factors, perceived social support and postpartum depressive symptoms amongst women in Punjab, Pakistan and to determine whether the perceived social support was a mediating effect between background factors and postpartum depressive symptoms. Method. The cross-sectional design included 147 women who were recruited from urban and rural households after they had just given birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987), and social support was assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS; Sherbourne & Stewart, 1991) which had four subscores (Material, Affective, Emotional/Informational, Social Interaction) and a total score. Hierarchical multiple regression and bootstrapped mediation analyses (5,000 resamples) were used to test direct and indirect effects. Results. There were high levels of depressive symptoms in the sample (M = 14.20, SD = 7.91), with subscales of social support having strong, negative correlations with EPDS scores (r = -.60 to -.68, p < .01). Results showed that family type, parity, mode of delivery, unplanned pregnancy and previous mental-health history were significantly correlated with social support and depressive symptoms, and that social support (total score) significantly mediated the effect of family type, parity, unplanned pregnancy, mode of delivery, monthly household income and previous mental-health history on EPDS scores, which accounted for 60.2% of the variance in depressive symptoms. Conclusion. In terms of maternal mental-health care, the importance of family-based and social network–based interventions is highlighted, and perceived social support is found to be a powerful psychosocial pathway between demographic and obstetric vulnerability and postpartum depressive symptoms.