The association between psychological resilience and postpartum depression among Chinese women undergoing cesarean delivery: a cross-sectional study based on restricted cubic spline model

Postpartum depressive symptoms are common after childbirth and may be particularly relevant among women recovering from cesarean delivery. Psychological resilience has been associated with depressive symptoms, but the shape of this association among women after cesarean delivery remains incompletely characterized. This cross-sectional study examined the association between psychological resilience and Edinburgh Postnatal Depression Scale (EPDS)-defined postpartum depressive symptoms among 415 women within the first postpartum year who attended postpartum follow-up between April and November 2025. Demographic and clinical characteristics, EPDS, Caring Behaviors Inventory, 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and Perceived Stress Scale data were collected. Logistic regression and restricted cubic spline (RCS) models were used to characterize associations. Eighty-eight participants (21.2%) screened positive for postpartum depressive symptoms (EPDS ≥ 13). Higher psychological resilience was associated with lower odds of a positive EPDS screen in the overall sample and in age- and parity-stratified analyses. The RCS analysis suggested evidence of nonlinearity in the overall sample ( P -overall < 0.001; P -nonlinearity = 0.009), women aged < 35 years ( P -overall < 0.001; P -nonlinearity = 0.019), and multiparous women ( P -overall = 0.018; P -nonlinearity = 0.017), whereas no evidence of nonlinearity was observed among women aged ≥ 35 years ( P -overall = 0.003; P -nonlinearity = 0.072) or primiparous women ( P -overall < 0.001; P -nonlinearity = 0.144). These findings indicate a strong cross-sectional association between resilience scores and postpartum depressive symptoms, but they do not establish temporal or causal relationships or a clinically actionable resilience threshold. Prospective studies are needed to clarify directionality and clinical implications.