Mapping Postpartum Depression in Latvia: Prevalence and Associated Factors Among Women Receiving Outpatient Care

Abstract

Objectives: Postpartum depression is a major global mental health concern, yet epidemiological evidence from the Baltic region remains limited. This study aimed to estimate the prevalence of depressive symptoms among postpartum women attending postpartum outpatient care in Latvia and identify associated sociodemographic and clinical factors. Methods: A cross-sectional study was conducted at the outpatient department of the largest maternity hospital in Latvia from May 2024 to June 2025. All women aged 18 years or older, who attended a routine postpartum gynaecological visit 4 to 6 weeks after delivery and screened positive on the Patient Health Questionnaire-9 (PHQ-9) (≥5 points), completed a sociodemographic and clinical questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics were used in the study, and logistic regression was used to examine factors associated with postpartum depressive symptoms. Results: A total of 272 women aged 18 to 49 years (mean age 30.66 ± 5.59) participated. PHQ-9 results indicated that 43.02% of respondents met the threshold for a positive screen (≥5 points) and were included in the further analysis. Using a cut-off EPDS ≥11, the point prevalence of clinically significant depressive symptoms among women who screened positive on the PHQ-9 was 11.4%. In univariate analyses, postpartum depressive symptoms were most strongly associated with comorbid mental disorders (OR = 4.55; 95% CI 1.85–11.18; p = 0.001), caesarean section (OR = 3.05; 95% CI 1.18–7.92; p = 0.022), stress (OR = 2.49; 95% CI 1.04–5.94; p = 0.04) and obstetric complications (OR = 2.78; 95% CI 1.01–7.64; p = 0.048) during pregnancy. In the multivariate model, only three independent predictors remained: comorbid mental disorder (aOR = 9.54; 95% CI 2.72–33.49; p < 0.001) and caesarean section (aOR = 5.80; 95% CI 1.66–20.21; p = 0.006) were associated with higher odds of postpartum depression, while first-time motherhood was associated with a substantially lower likelihood of depressive symptoms (aOR = 0.14; 95% CI 0.04–0.49; p = 0.002). Sociodemographic characteristics, including age, education, employment, and income, were not significant predictors. Conclusions: The point prevalence of clinically significant depressive symptoms among Latvian postpartum women screening positive for depression appears similar to other European settings. Comorbid mental disorders and caesarean section were the strongest predictors of depressive symptoms, while primiparity showed a protective effect. Sociodemographic factors did not independently contribute to risk. As the first study of its kind in Latvia and conducted within a clinical setting that captures a large and diverse proportion of postpartum women, these findings highlight the context-specific nature of postpartum depression and underscore the need for further longitudinal research to inform effective screening and intervention strategies.