Social determinants of postpartum depression among refugees and internally displaced women in Lebanon: a cross-sectional study

Refugees and internally displaced women (IDW) experience various health risks during displacement including inaccessible healthcare, infectious diseases, and mental health disorders, particularly depression. This cross-sectional study aimed to assess the prevalence of postpartum depression in refugees and IDW in Lebanon and its association with sociodemographic characteristics, interpersonal violence, resilience, and social determinants of health. A convenience sample of 368 females were recruited from a governmental hospital in Beirut and from refugee shelters across Lebanon. The questionnaire included sociodemographic and health-related questions, an item on sense of belonging, and a screening tool to assess health-related social needs. Additionally, the Edinburgh Postnatal Depression Scale (EPDS) and the Brief Resilience Scale were used to measure postpartum depression and resilience, respectively. Descriptive and bivariate analyses were performed to identify the associations between the variables and the EPDS scores. Independent factors associated with postpartum depression were identified using a domain-based multivariable logistic regression approach. The prevalence of PPD was 41.6%, with statistically significant associations to lack of support, loneliness, financial stressors, substandard living conditions, limited access to prenatal care, stigma around mental health, and interpersonal violence. Additionally, 66.7% of women with a positive EPDS score reported low resilience. However, multivariable logistic regression revealed that only interpersonal violence, neutral marital satisfaction, and poor housing conditions including bugs, ants and mice, and lack of heating were associated with higher odds of depressive EPDS scores whereas planned pregnancies were protective. Due to the high prevalence of postpartum depression in refugees and IDW in Lebanon, midwives and health workers should be mobilized to preemptively screen for postpartum depression, guide pregnant women and new mothers toward suitable care pathways, and aim to strengthen the social support provided by the community.