Factors associated with postpartum depression symptoms among postpartum women in five countries during the COVID-19 pandemic: an online cross-sectional study

Background: This study aimed to examine factors associated with postpartum depression (PPD) symptoms during the COVID-19 pandemic among postpartum women in five countries, a subject that has not been investigated thus far. Methods: A multi-country, cross-sectional, online survey was conducted with a convenience sample of 3,523 postpartum women in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom, from July to November 2021. Sociodemographic and obstetric data, food insecurity, COVID-19 positive status, COVID-19 vaccination, infant feeding, breastfeeding belief score, and social support were investigated. PPD and social support were measured using the Edinburgh Postnatal Depression Scale and Maternal Social Support Scale, respectively. Descriptive statistics, chi-squared tests, and t-tests were used to identify associations with PPD symptoms. A binary logistic regression model was used to identify explanatory factors associated with PPD and adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated. Results: Women in Taiwan (AOR = 0.5; 95%CI 0.34, 0.73) and Thailand (AOR = 0.68; 95%CI 0.46, 0.99) had a lower risk of PPD symptoms than those in Brazil. In addition, women with planned pregnancies had a lower risk of PPD (AOR = 0.74; 95%CI 0.60, 0.91). Younger women (AOR = 1.62; 95%CI 1.05, 2.51), health problems during pregnancy, delivery, or postpartum (AOR = 1.71; 95%CI 1.42, 2.06), and no change or worse food insecurity during COVID-19 (AOR = 1.66; 95%CI 1.21, 1.27 for no change and AOR = 1.68; 95%CI 1.27, 1.23, respectively) presented a higher likelihood of having PPD. Feeding babies with expressed human milk (AOR = 1.25; 95%CI 1.03, 1.50) and/or complementary food (AOR = 1.51; 95%CI 1.17, 1.94) were associated with PPD symptoms. Women who received low (AOR = 7.74; 95%CI 5.43, 11.03) or medium support (AOR = 3.25; 95%CI 2.71, 3.88) had higher likelihoods of PPD. Conclusion: PPD symptoms during the pandemic were high in young women, particularly Brazilian women, with health problems in the puerperal pregnancy cycle who fed their babies expressed breast milk and/or complementary food. Low social support also impacted PPD symptoms. This study highlights the need for the professional screening for PPD and provision of virtual or personal support.