Affective disorders are a widespread clinical problem among women in their postpartum period. The most commonly observed ones are postpartum blues and postpartum depression. According to researchers, the incidence of postpartum depression symptoms ranges between 30 and 75%, and varies depending on the research instruments used, study sample size, and study timing [14]. Niyonsenga et al. found a high level of postpartum depressive symptoms in 48% of the teenage mothers studied [15]. In a study by Tambaga et al., the prevalence of postpartum blues among women in the 2nd and 3rd month after giving birth was 34.5% [13]. The analysis by Edhborg showed that as many as 64% of women exhibited symptoms of postpartum blues in the first days after giving birth, but only 24% did after a week. Women with a history of postpartum depression were twice as likely to have subsequent depressive episodes in the 5-year follow-up period [16].
The results of the present study indicate a significant association between postpartum mood disorders and global orientation to life. We confirmed that more severe postpartum mood disorders are associated with a lower level of global sense of coherence. This is consistent with Antonovsky’s concept of salutogenesis, where one’s sense of coherence (SOC) or “global orientation to life” describes one’s way of seeing the world as predictable, manageable, and orderly. Research by Antonovsky indicates that SOC changes during one’s lifetime, affected by one’s life experiences. It also depends on an individual’s strength and ability to adapt effectively to stressors encountered in life [12]. These findings are also in line with those obtained by Sekizuki et al., who confirmed that a high level of SOC increases the effectiveness of coping with stress [17]. Results from a study by Ogawa suggest that women with low SOC scores were less resistant to stress, and their reactions to stress were more intense, increasing the risk of developing depression [18].
Significant predictors of postpartum mood disorders in the present study included global SOC and two of its components: meaningfulness and comprehensibility. This finding corroborates Antonovsky’s concept, as the author attributed a particular role in shaping the sense of coherence to meaningfulness [19]. The sense of meaningfulness determines an individual’s motivation to act. A study by Rados et al. indicates that people with a strong sense of meaningfulness treat problems as challenges that are worth their effort and commitment [20]. Kurowska et al. observed that this group of people uses all their defense mechanisms to try and change their situation for the better [21].
Many studies sought to identify the relationship between socio-demographic factors and postpartum depression. In the present analysis, there was a notable association between postpartum mood disorders and the women’s marital status. A study by Fei-Wan Ngai demonstrated that women in steady relationships have a high level of family-related sense of coherence, which helps them adapt to new life situations [22]. In turn, Charline El-Hachem did not observe any significant impact of relationship status on the prevalence of postpartum depression among single women [23]. Małus et al. reported that women who were more satisfied with their relationships were characterized by better psychological condition after giving birth [24]. Umuziga et al. found more severe symptoms of mood disorders after giving birth among respondents having four or more children, who had a poor relationship with their partner, compared to those who only had one child [25]. An association between postpartum depression symptoms and marital conflict was also observed by Brackington. One may suppose that the sense of security provided by a stable relationship is a precondition for a high quality of life [26].
The present study suggests that better self-esteem due to one’s higher educational level may have a protective effect against mood disorders. Postpartum blues symptoms were higher in intensity in less educated respondents. A similar finding was reported by David et al. [27]. These observations may be explained by the relationship between education and household income, which in turn affects women’s concerns about raising a child. Contrasting data were reported by Vaezi et al. and Maliszewska et al., who found no association between postpartum depression and education [28, 29].
There are reports indicating the impact of age on psychological changes after giving birth. Available studies suggest that younger women are more susceptible to negative emotions and more likely to exhibit symptoms of postpartum blues [30, 31]. An interesting finding was reported by Rihua Xie et al., who demonstrated a twofold increase in postpartum depression risk among women giving birth by cesarean section. A higher rate of postpartum mood disorders was found among women with medical indications to cesarean delivery than in those with psychiatric indications [32]. Researchers have demonstrated that women with a strong desire to have a spontaneous vaginal delivery were at a higher risk of postpartum depression in the case of an unplanned cesarean section than those who delivered vaginally [33]. In turn, a study by Olieman shows that women having elective cesarean section demonstrated higher levels of prenatal depression, but similar levels of postnatal depression, compared to those having a vaginal delivery [34].
In the years 2000–2015, a considerable increase in cesarean deliveries was observed globally [35]. In the year 2000, the percentage of deliveries by cesarean section in Western Europe was 19.6%, increasing to 26.9% just 4 years later. In the USA, cesarean sections accounted for 24.3% of all births in 2000, and for 32% in 2015. In 2014, the percentage of cesarean sections among all births in Poland was 42.2%. In Europe, higher rates were only recorded in Cyprus, with 56.9% of all pregnancies ending in cesarean section, and in Romania (45.9%). In Northern Europe, cesarean section rates are the lowest: 16.1% in Iceland, 16.4% in Finland, and 16.5% in Norway [36].
Considering the cited reports from Polish and international authors, measures should be developed to control the ever-increasing rate of cesarean deliveries [37]. While women increasingly opt for elective cesarean section, they are not fully aware of the negative psychological outcomes that are more likely to occur after surgical delivery, and which affect the subsequent development of parental attitudes.
One major limitation of the present study is the inclusion of hospitalized patients only in the first postpartum days, which prevented generalization to the entire population of mothers. In subsequent studies, a longitudinal design should be applied to provide more complete information on postpartum depression.
Though the correlations between socio-demographic factors and postpartum depression observed here are weak and differ from other authors’ findings, they may become the starting point for further research, ultimately leading to a clearer understanding of factors predicting postnatal emotional disorders.