Probable postpartum depressive symptoms and associated factors among conflict-affected women attending primary healthcare centres in North-West Syria: a cross-sectional study

Abstract Background Postpartum depression (PPD) constitutes a major public mental health burden globally, with disproportionately elevated prevalence in conflict-affected settings. North-West Syria (NWS), subjected to over a decade of armed conflict, represents a critically underserved humanitarian context in which evidence on postpartum depressive symptoms remains scarce. Methods A cross-sectional study was conducted between January and February 2023 in Idlib City and Atmeh displacement camps, NWS. A random sample of 397 postpartum women aged 18–45 years within 3–8 weeks of delivery was recruited from five primary healthcare centres. Probable PPD was assessed using the Arabic-validated Edinburgh Postnatal Depression Scale (EPDS, cut-off ≥ 12), which is a validated screening instrument, not a diagnostic tool; all positive cases represent probable postpartum depressive symptoms based on self-reported screening. Univariable and multivariable logistic regression were performed using SPSS v26, with overall Wald tests for multi-category variables. Results Overall, 59.7% ( n = 237) of women screened positive for probable PPD. The majority were internally displaced persons (IDPs) (91.7%). In univariable analysis, lack of social support (OR = 8.924, 95% CI: 5.079–15.680, p < 0.001), unintended pregnancy (OR = 2.123, 95% CI: 1.373–3.283, p = 0.001), and maternal age 26–35 years (OR = 2.005, 95% CI: 1.303–3.084, p = 0.002) showed the strongest associations. After multivariable adjustment, lack of social support (AOR = 9.411, 95% CI: 4.891–18.106, p < 0.001), employment outside the home (AOR = 2.082, 95% CI: 1.079–4.018, p = 0.029), and economic level (overall adjusted Wald p = 0.010; income < expenses vs. income = expenses: AOR = 2.305, 95% CI: 1.312–4.049) remained associated with probable PPD. Associations with unintended pregnancy and maternal age were attenuated to non-significance after adjustment. Conclusions A high proportion of postpartum women attending selected PHC services in NWS screened positive for probable PPD, indicating a substantial burden of psychological symptoms. Because the EPDS is a screening instrument and conflict-related distress may also elevate scores, this proportion should not be equated with the prevalence of clinically diagnosed PPD. Lack of social support during pregnancy was the factor most strongly associated with screening positive. Routine screening linked to clinical assessment, community psychosocial support, and integration of family planning services within emergency maternal health programmes are warranted.