Coping Styles, Postpartum Depression, and Anxiety in Romanian Women: A Cross-Sectional Study Using the Brief COPE Inventory

<b>Background/Objectives:</b> Postpartum depression and anxiety affect up to 20% of women worldwide, yet remain understudied in Eastern Europe. Romania, one of Europe's most religious countries, provides a unique context for examining how coping strategies and religiosity influence perinatal mental health. This cross-sectional study characterized coping styles, depressive and anxiety symptoms, and religiosity among postpartum women from two western Romanian counties (Bihor and Timiș) and examined associations between coping dimensions and psychological outcomes. <b>Methods:</b> A cross-sectional study was conducted among 201 postpartum women recruited from two public maternity hospitals between 2024 and 2025. Sociodemographic, obstetric, neonatal, coping (COPE Inventory), depressive (EPDS; PHQ-9), anxiety (GAD-7), and religiosity (RCI-10) data were collected through questionnaires and medical record extraction. Associations between coping dimensions and psychological symptoms were examined using Pearson correlations. Analyses were performed in RStudio. <b>Results:</b> Prevalence of possible depression (EPDS ≥ 10) was 32.8% overall, with no regional difference (Bihor 32.0% vs. Timiș 33.7%, <i>p</i> = 0.920). EPDS demonstrated strong convergent validity with PHQ-9 (r = 0.58, <i>p</i> < 0.001) and GAD-7 (r = 0.61, <i>p</i> < 0.001). In bivariate analyses, avoidant coping showed the strongest association with depressive symptoms (r = 0.28, <i>p</i> < 0.001), particularly in Bihor (r = 0.35, <i>p</i> < 0.001). Multiple regression analysis (R² = 0.196, <i>p</i> < 0.001) identified avoidant coping as the strongest independent predictor (β = 2.82, 95% CI [1.16, 4.48], <i>p</i> < 0.001), followed by social support coping (β = 2.46, 95% CI [1.09, 3.83], <i>p</i> < 0.001). Emotion-focused coping showed an unexpected protective effect (β = -2.97, <i>p</i> = 0.004). Problem-focused coping and religiosity were not significant predictors. Critically, county was non-significant after controlling for coping strategies (<i>p</i> = 0.732), indicating regional differences are mediated by coping patterns rather than geographic location. <b>Conclusions:</b> Postpartum depression prevalence in Romania aligns with international estimates. Avoidant coping emerged as the primary modifiable risk factor. Findings support integrating coping assessment into postpartum screening and developing interventions targeting avoidant strategies in Romanian perinatal care.