In the scholarly literature, socio-demographic factors that could serve as predictors for PPD are discussed. Key predictors include low educational level, unemployment, and low socioeconomic status, which have been consistently associated with higher PPD rates (Howard et al., 2022; Vrcić Amar & Sejfović, 2023). Marital status is another critical factor, with unmarried women showing a higher risk of developing PPD (Smorti et al., 2019). Additionally, dissatisfaction with marriage and lack of social support from partners, family, and friends are significant predictors (Gök et al., 2023; Molgora et al., 2022). A history of depression or anxiety, both personal and familial, also strongly correlates with PPD, highlighting the importance of mental health history in assessing risk (English et al., 2018; Tsai et al., 2023). Other factors include the number of previous pregnancies and abortions, with increased parity and history of abortion linked to higher PPD rates (Martínez-Borba et al., 2020). Unplanned pregnancies and negative feelings about the pregnancy are also significant predictors (Fiala et al., 2017; Unnisa & Lavanya, 2018). Research in the state of New York, USA, delved into the emotional well-being of womens across various socioeconomic backgrounds. Particularly, amidst the challenges of the pandemic era, it was identified that individuals with lower socioeconomic status experienced elevated EPDS scores (Silverman et al., 2020). In Italy, advanced maternal age and poor physical health were associated with adverse mental health outcomes, while in the Netherlands, this was not observed among mothers with higher educational attainment (Guo et al., 2022). These socio-demographic factors, when identified early, can help in the timely intervention and support for at-risk mothers, potentially mitigating the onset and severity of postpartum depression. In our own investigation, no statistically significant disparities in participants' characteristics were found in relation to EPDS scores (p > 0.05) (Table 1).
During the Covid-19 pandemic, reported a 42.2% prevalence of postpartum depressive symptoms (Ostacoli et al., 2020). A study in Spain examining PPD during the pandemic categorized participants into two groups: pre-pandemic and pandemic. The incidence of PPD was notably higher among women who delivered during the epidemic (Mariño-Narvaez et al., 2021). A study in northeastern Italy compared the risk of PPD in mothers who gave birth during the Covid-19 pandemic (study group) with those from 2019 (control group), revealing significantly higher EPDS scores in the Covid-19 study group (Zanardo et al., 2020).
In a study in Türkiye, it was noted that mothers who contracted Covid-19 and gave birth faced elevated risks of PPD, depression, and anxiety during the Pandemic (Işıkalan et al., 2021). The prevalence of PPD in Türkiye during the pandemic was determined to be 14.7% (Oskovi-Kaplan et al., 2021) and 34% (Guvenc et al., 2021). In our study found that 30.90% of participant scored 13 points or higher on the EPDS scale (Table 1), indicating a higher rate compared to pre-pandemic levels in Türkiye. The heightened prevalence of PPD in our study is believed to be linked to the pandemic circumstances, wherein maternity patients lacked social support due to restrictions, experienced quarantine measures, separation from their infants, and fears of contracting or transmitting Covid-19. If postpartum depression is indeed a complex condition influenced by biological, psychological, and social factors, it is likely that the current Covid-19 Pandemic has exacerbated all of these risk elements (Zanardo et al., 2020).
Anxiety can be delineated as a broadened anticipation of an impending threat (APA, 2013). In contrast to fear, which exhibits a specific target and is promptly resolved upon the threat's disappearance, anxiety is indistinct and lingers much longer than fear (Leach et al., 2014). The prevalence of anxiety was documented to range between 20–31% and depression 17–33% based on extensive sample studies and meta-analyses conducted with the general populace during the pandemic era (Cooke et al., 2020; Jahrami et al., 2021; Rossi et al., 2020; Salari et al., 2020). Researchers identified in their research that the fear of Covid-19 significantly foretells postpartum anxiety in a favorable manner (Özşahin et al., 2022). Kurt et al. (2022) observed in their study that the fear of Covid-19 escalates perinatal anxiety (Kurt & Çelikay Söyler, 2022). The investigation by Aktaş et al. (2022) revealed that the anxiety levels of postpartum women amid the Covid-19 pandemic were of moderate intensity (Aktaş & İskender, 2022). According to our study outcomes, individuals scoring 10 points or above on the GAD-7 scale signify that roughly one out of five women undergo generalized anxiety. Additionally, a rise of one point in the GAD-7 scale score leads to a 1.26-fold increase in PPD (Table 3). Our research results establish that the fear of Covid-19 and the circumstances of the pandemic, akin to findings in the literature, impact anxiety. Our discoveries hold significant value in comprehending the repercussions of anxiety on PPD.
Limitations
The study acknowledges several constraints. Primarily, the dynamic nature of the pandemic necessitated the use of online surveys over in-person interviews. This circumstance arose from restricted contact protocols due to the Pandemic. It is imperative to highlight that the respondents who completed the questionnaire constituted a cohort actively engaged with technology, potentially leading to sampling bias. Furthermore, the study should acknowledge the potential impact of factors such as the swift rollout of Covid-19 vaccines in the country, fostering trust, and alleviating anxiety and fears. Nevertheless, the study was not intended to directly assess the efficacy of vaccines or establish causal relationships. Despite these constraints, it is believed that the study could yield valuable insights into postpartum depression. It is anticipated that future research endeavors utilizing diverse methodologies will advance our understanding of this subject matter.