Postpartum Depressive Symptoms Among Women with Elevated Prenatal Anxiety in Kazakhstan: Prospective Observational Cohort Study

Background: Postpartum depression (PPD) is a common mental health condition, and women with elevated prenatal anxiety are at increased risk. Evidence from Kazakhstan remains limited. This study aimed to describe postpartum depressive symptoms and associated factors among women with elevated prenatal anxiety who received routine perinatal care and participated in the PRISM prenatal psychoeducational program. Methods: This prospective single-arm cohort study with postpartum follow-up was conducted in Astana, Kazakhstan. Of 1232 pregnant women screened, 234 women with elevated prenatal anxiety participated in the PRISM program, and 226 completed the postpartum assessment. Because no control group was included, the study was not designed to evaluate the effectiveness of PRISM or establish causal effects. Postpartum depressive symptoms were assessed using the Postpartum Depression Screening Scale–Short Form (PDSS-SF). Descriptive statistics were calculated, and associations with age, parity, and postpartum assessment period were examined using Spearman’s rank correlation and non-parametric tests. Results: The mean PDSS-SF score was 20.65 ± 6.00. Using a cut-off score of ≥17, 158 of 226 participants screened positive for clinically significant depressive symptoms, corresponding to 69.9% (95% confidence interval (CI): 63.6–75.5%). Scores were highest among women assessed between 6 weeks and 6 months postpartum (p < 0.001). Age showed a weak negative correlation with depressive symptoms, whereas parity was not significantly associated. The most frequently reported symptoms were sleep disturbance, loneliness, and depressed mood. Conclusions: A substantial burden of postpartum depressive symptoms was observed in this high-risk cohort. The findings support early identification of prenatal anxiety, continued postpartum screening, and access to appropriate psychological and psychiatric care. Controlled studies are needed to evaluate PRISM and similar preventive programs.