Background: Postpartum depression (PPD) is a major maternal mental-health problem with significant consequences for both mother and infant. Prevalence in India varies widely, with higher rates reported in southern states. Limited data are available from northern Karnataka, particularly Kalaburagi, despite regional socioeconomic vulnerabilities. Therefore, the present was undertaken to estimate the prevalence of postpartum depression and identify associated sociodemographic, obstetric, neonatal, and psychosocial determinants among mothers attending the immunisation clinic of a tertiary care centre in Kalaburagi.
Methods: An analytical cross-sectional study was conducted among 380 postpartum mothers using systematic random sampling. Data were collected through a pre-tested questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). A cutoff score of ≥13 identified probable PPD. Associations were examined using Chi-square tests, and significant variables (p < 0.20) were included in multivariable logistic regression. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were computed.
Results: The prevalence of probable PPD was 29.2%, while 28.4% had possible depression (EPDS 8–12). Lower education (45.3% vs. 18.7%), low socioeconomic status (40.6% vs. 20.9%), unwanted pregnancy (52.0% vs. 20.9%), infant illness (47.0% vs. 24.2%), husband’s alcohol use (46.8% vs. 16.9%), low family support (50.4% vs. 17.7%), poor marital relationship (53.9% vs. 12.8%), and family conflict (45.1% vs. 17.4%) were significantly associated with PPD (p < .05). In multivariable analysis, key predictors included low socioeconomic status (AOR 2.36, 95% CI: 1.31–4.24), unwanted pregnancy (AOR 3.12, 1.77–5.48), infant illness (AOR 2.09, 1.15–3.78), and low family support (AOR 3.58, 2.06–6.23).
Conclusion: Socioeconomic vulnerability, unintended pregnancy, neonatal illness, and inadequate family support are major determinants. Incorporating routine PPD screening into immunisation clinics and strengthening family-centered psychosocial support services are essential for early detection and improved maternal and child health outcomes.
Postpartum depression (PPD) is a major maternal mental-health disorder occurring within the first year following childbirth, marked by persistent sadness, anhedonia, irritability, fatigue, and functional impairment [1]. It is more severe and prolonged than transient postpartum blues and has substantial consequences for maternal wellbeing, child development, and family functioning [2,3]. Global estimates suggest PPD affects 10–20% of postpartum women, but the burden is significantly higher in low- and middle-income countries due to social adversity, limited mental-health services, and heightened obstetric and psychosocial stressors [4].
In India, pooled prevalence ranges between 18% and 25% [5], with studies from South India reporting substantial burden. Research from Udupi documented a prevalence of 21.5% [6], while studies from Mangaluru reported rates between 23–34% [7,8]. Goa-based research also reported prevalence close to 30% [9]. A recent Karnataka study by Nisarga et al. reported a prevalence of 44%, suggesting substantial geographical and socioeconomic variation within the state [10]. A comprehensive Indian review concluded that southern states such as Karnataka, Kerala, and Tamil Nadu show some of the highest PPD burdens nationally [11].
Risk factors for PPD are multidimensional. Socioeconomic disadvantage, low education, and financial strain consistently elevate risk [6–8]. Obstetric determinants—including unintended pregnancy, delivery complications, and lack of antenatal preparedness—significantly increase vulnerability, with meta-analyses showing women with unintended pregnancies have up to 2.5-fold higher odds of developing PPD [5]. Neonatal factors such as infant illness, NICU stay, and birth complications further intensify maternal stress, as shown in studies from Udupi and Ethiopia [6,12]. Psychosocial determinants—particularly low family support, marital strain, family conflict, and husband’s alcohol use—are especially influential in the Indian cultural context, where extended families play a central role in postpartum care [7,8,13].
Consequences of untreated PPD are profound. It is associated with impaired mother–infant bonding, early cessation of breastfeeding, developmental delays, increased risk of diarrheal and febrile illnesses in infants, and long-term maternal morbidity [14–16]. Early detection is therefore essential. The Edinburgh Postnatal Depression Scale (EPDS), developed by Cox et al. [17] is widely used and recommended for screening. Immunisation clinics provide an ideal setting for routine PPD screening, as they ensure near-universal contact with postpartum mothers during the early months after delivery. However, data on PPD from northern Karnataka, particularly Kalaburagi, remain limited despite the region’s socioeconomic diversity and known maternal-health disparities.
Therefore, the present study aimed to estimate the prevalence of postpartum depression and identify associated sociodemographic, obstetric, neonatal, and psychosocial determinants among mothers attending the immunisation clinic of a tertiary care centre in Kalaburagi, Karnataka.
In the present study, the prevalence of probable postpartum depression (PPD) was 29.2% among mothers attending the immunisation clinic. This figure indicates that nearly one in three postpartum women in Kalaburagi experience significant depressive symptoms. Our prevalence is similar to that reported in rural Udupi (21.5%) [6], Mangaluru (23–34%) [7,8], and Goa (~30%) [9], showing that PPD is consistently high across various regions of South India. However, it is considerably lower than the 44% documented by Nisarga et al. in 2023 [10]. The higher prevalence in their study may reflect differences in population composition, particularly the higher proportion of mothers from disadvantaged backgrounds, as well as variation in psychosocial stressors, healthcare-seeking patterns, and postpartum timing.
Sociodemographic factors: In our study, socioeconomic status emerged as a significant determinant. Mothers belonging to lower socioeconomic classes had a PPD prevalence of 40.6%, compared to 20.9% among those in middle/upper socioeconomic groups. This aligns with findings from Udupi, where low-income mothers showed PPD prevalence exceeding 30% [6], and from Mangaluru, where low socioeconomic status was associated with prevalence between 28–32% [7,8]. These consistent observations suggest that economic stress, limited access to supportive resources, and financial instability substantially elevate psychological vulnerability during the postpartum period.
Lower educational attainment (< high school) in our study was associated with 45.3% prevalence of PPD compared with 18.7% among mothers with higher education. Similar trends were reported in a Goa study, where women with low literacy exhibited PPD prevalence above 30% [9]. Although education did not remain significant in our multivariate model, its strong bivariate association suggests it may act through socioeconomic status, health literacy, or coping capacity.
Obstetric factors: Unwanted pregnancy was a major predictor of PPP in our sample. More than half (52.0%) of mothers with unwanted pregnancies screened positive for PPD, compared with 20.9% among those with wanted pregnancies. This mirrors findings from Nisarga et al. [10], who also reported significantly higher depressive symptoms among mothers with unintended pregnancies. Furthermore, a national meta-analysis demonstrated that unintended pregnancy increases PPD risk by approximately 2.5 times [5], supporting the association observed in our study (AOR 3.12, 95% CI: 1.77–5.48).
Neonatal factors: Infant illness was significantly associated with higher PPD prevalence in our study (47.0% vs 24.2% among mothers of healthy infants). This finding is consistent with evidence from Udupi, where mothers of sick infants had depressive symptoms ranging between 35–45% [6], and similar studies from Ethiopia showing PPD prevalence above 48% among mothers whose infants required medical care [12]. The stress associated with caring for a medically ill infant—combined with fatigue, hospital visits, and financial burden—likely explains this heightened vulnerability.
Psychosocial factors: Psychosocial determinants showed the strongest associations with PPD. Mothers reporting low family support in our study had a PPD prevalence of 50.4%, compared with 17.7% among those with moderate to high support. A Mangaluru-based study similarly identified poor support as a key predictor, with depressive symptoms affecting 40–45% of inadequately supported mothers [7]. The JSAFOG study from rural Karnataka also reported high PPD (approximately 35–40%) among mothers exposed to poor familial support and domestic conflict [13].
Marital relationship quality demonstrated a clear gradient in our sample: PPD prevalence was 12.8% among those reporting good relationships, 28.8% among those with average relationships, and 53.9% among those with poor marital relationships. These findings correspond with studies across India showing that poor spousal communication and conflict predict depression rates above 40% [11,13].
In the adjusted model, low socioeconomic status (AOR 2.36), unwanted pregnancy (AOR 3.12), infant illness (AOR 2.09), and low family support (AOR 3.58) remained robust predictors. These findings reinforce the bio-psycho-social framework of PPD, where economic hardship, reproductive autonomy, neonatal health, and interpersonal support pathways interact to shape maternal mental health outcomes.
A global review reported PPD prevalence ranging from 15% to 30% in LMICs [4], matching our identified prevalence (29.2%). Studies from Ethiopia also demonstrated similar determinants, particularly infant illness and low support, associated with PPD rates exceeding 45% [12]. The biological and psychosocial consequences of PPD noted globally—impaired mother–infant bonding [14], early breastfeeding cessation [15], and increased infant morbidity [16]—underscore the need for early intervention in our setting as well.
In conclusion, the study highlights the need for routine screening, timely referral, and family-centered support interventions within postpartum and immunisation services. Early identification and targeted support for high-risk mothers are critical to improving maternal wellbeing and child health outcomes.
Declaration:
Conflicts of interests: The authors declare no conflicts of interest.
Author contribution: All authors have contributed in the manuscript.
Author funding: Nill
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