Prospective cohort study of postpartum depressive symptoms and associated risk factors among women with and without preeclampsia in Sidama Region, Ethiopia.

Abstract

Introduction: Postnatal depression remains a major public health concern requiring urgent attention; however, despite its substantial impact on maternal well-being, it continues to receive limited priority within maternal health programs. Accordingly, this study aimed to assess postpartum depressive symptoms and associated risk factors among women with and without preeclampsia in the Sidama Region, Ethiopia.

Methods: A prospective cohort study was conducted in selected public health facilities. Participant recruitment and follow-up were carried out from September 1, 2024, to December 1, 2025. Descriptive statistics were used to summarize the study participants. A total of 540 study participants were enrolled. A two-stage random sampling technique was employed to recruit study participants. Multivariable linear regressions were applied to estimate adjusted β-coefficients with 95% confidence intervals. A p-value of < 0.05 was considered statistically significant.

Results: Of the 540 women approached, 530 were enrolled in the study, while 10 (1.9%) were lost to follow-up. Among the 530 women enrolled participants, 268 had preeclampsia, yielding an incidence proportion of 50.6%. The mean Edinburgh Postnatal Depression Scale (EPDS) score among postpartum women was 8.5 ± 4.6, with higher mean scores observed among women with preeclampsia compared with normotensive women. In the multivariable analysis, several factors were significantly associated with higher depressive symptom scores, including no formal education (Adjusted β = 1.46, 95% CI: 1.29, 3.66), being a housewife (β = 1.27, 95% CI: 1.10, 1.48), rural residence (β = 2.28, 95% CI: 1.20, 2.66), blurred vision (β = 1.41, 95% CI: 0.85,1.66), convulsion (β = 1.65, 95% CI: 0.43, 1.98), and any physical impairment (β = 1.36, 95% CI: 0.31,1.63), compared with their respective counterparts. The final model explained 48% of the variability in the outcome (R² = 0.48).

Conclusion: Postpartum depressive symptom scores were higher among women with preeclampsia than among normotensive women. Several sociodemographic, obstetric, and clinical factors were also significantly associated with increased depressive symptom scores. These findings suggest that postpartum depressive symptoms are an important concern among women affected by preeclampsia and should be integrated into routine postpartum follow-up care.