Burden and Determinants of Postpartum Depression among Low-income Mothers: A Community-based Cross-sectional Study in Peri-urban Accra, Ghana

Abstract

Background: Postpartum depression (PPD) is a leading contributor to maternal morbidity in sub-Saharan Africa and is associated with adverse infant developmental, nutritional and growth outcomes. Robust community-based estimates from urban poor populations in Ghana remain limited. The present study determined the prevalence of PPD and identified its sociodemographic, obstetric and psychosocial determinants among low-income mothers in peri-urban Accra. Methods: A community-based cross-sectional study was conducted in four low-income enumeration areas of peri-urban Accra over eight months. Multistage cluster sampling enrolled 410 mothers between two and twelve weeks postpartum. PPD was screened using the validated Twi/Ga adaptation of the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥13 defining probable PPD. Intimate partner violence, food insecurity, perceived social support and obstetric variables were captured. Multivariable logistic regression identified independent determinants. A two-sided p < 0.05 was considered significant. Results: The mean age was 26.4 ± 5.9 years; 36.6% were primiparous. The point prevalence of probable PPD (EPDS ≥13) was 22.2% (95% CI 18.4–26.5), with active suicidal ideation in 29.7% of probable cases. On multivariable analysis, intimate partner violence (adjusted OR 3.84; 95% CI 2.31–6.39), poor perceived social support (aOR 3.21; 1.93–5.34), previous depression or family history of mental illness (aOR 2.96; 1.62–5.41), unplanned pregnancy (aOR 2.59; 1.56–4.30), household food insecurity (aOR 2.42; 1.46– 4.01), recent infant illness (aOR 2.31; 1.32–4.06), and absence of partner support (aOR 2.18; 1.20–3.96) were independent determinants of PPD. Conclusion: Approximately one in five low-income mothers in peri-urban Accra experienced clinically significant postpartum depressive symptoms, with intimate partner violence, poor social support and food insecurity emerging as the strongest modifiable determinants. Integrating EPDS screening, IPV identification and psychosocial support into existing maternal and child health platforms is urgently warranted.