Postpartum Depression: More Than a Hormonal Condition

Abstract Introduction Postpartum depression has a pathophysiology partly driven by hormonal changes such as decreased estrogen and progesterone, alongside neurochemical dysregulation. However, the interaction with lifestyle factors may facilitate the onset of this condition. Objectives To determine the association between lifestyle habits, psychosocial factors, and postpartum depression. Methods A cross-sectional and prospective study was conducted among mothers aged 18 to 40 years in Veracruz, Mexico, between 4 weeks and 12 months postpartum. Postpartum depression (dependent variable) was assessed using the Edinburgh Postnatal Depression Scale (α = 0.88). Independent variables included age, marital status, education level, diet quality, stress levels, anxiety, somatic symptoms, sleep quality, social dysfunction, and self-esteem. Non-probability sampling was used with data collected via digital questionnaires. Statistical analysis included Student's t-test, Chi-square test, odds ratio (OR), and 95% confidence intervals (CI), using SPSS v.27 and Epidat 3.1. A p-value <0.05 was considered significant. Results Among 473 women surveyed, 64% showed postpartum depression symptoms. Significant associations were found for younger age (<19 years, OR = 1.8, CI:1.07-3.2), secondary education (OR = 1.5, CI:1.02-2.2), and high school education (OR = 0.6, CI:0.4-0.8). Anxiety and insomnia symptoms (OR = 9.3, CI:9.2-20.7), social dysfunction (OR = 8.5, CI:3.6-20.06), and medium (OR = 5.8, CI:3.08-11.01) or high (OR = 0.16, CI:0.08-0.3) self-esteem were also significantly associated. Stress levels (high OR = 3.7, CI:2.3-5.9; moderate OR = 0.3, CI:0.2-0.6; low OR = 0.01, CI:0.05-0.3) and poor diet quality (OR = 1.8, CI:1.2-2.6) were linked to postpartum depression (p < 0.05). No significant associations were found with other variables (p > 0.05). Conclusions Lifestyle factors such as education, mental health status, insomnia, diet quality, and stress level are associated with postpartum depression. Key messages • Stress and low self-esteem linked to fulfilling socially constructed maternal roles are modifiable psychosocial factors contributing to the risk of developing postpartum depression. • Screening should target predictive factors for postpartum depression - such as anxiety, insomnia, and social dysfunction - among high-risk maternal populations.