Postpartum Depression in conflict-affected areas: Prevalence and Sociodemographic Determinants among Women in Al Anbar Governorate, Iraq

Background Postpartum depression (PPD) is a common and disabling condition, affecting an estimated 17.2% of women globally and 19.8% in low- and middle-income countries. However, data from conflict-affected settings are scarce. This study aimed to determine the prevalence of PPD and its sociodemographic and psychosocial determinants among women in Al Anbar governorate, Iraq, a region profoundly impacted by prolonged instability. Methods In this cross-sectional survey conducted from February 2024 to February 2025, 618 women up to eight weeks postpartum attending 23 randomly selected primary health care centers were interviewed. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS; cutoff ≥ 13). Associations between PPD and maternal age, parity, education, household income, social support, and time since delivery were evaluated with chi-square tests and odds ratios; p < 0.05 denoted statistical significance. Results The overall prevalence of probable PPD was 42.4% (262/618). Women aged ≥ 40 years had the highest prevalence (70.0%), whereas those aged 30–39 years exhibited the lowest (37.9%) (p = 0.013). Illiterate mothers demonstrated a 59.3% PPD rate compared with 34.5% among postgraduates (p = 0.035). Insufficient income (50.8% vs. 39.0%; p = 0.007) and lack of family support (50.3% vs. 39.7%; p = 0.021) were both associated with elevated PPD risk. Depressive symptoms were more common within four weeks postpartum (46.4% vs. 35.4%; p = 0.008). Parity was not significantly related to PPD (p = 0.49). Notably, even sociodemographic groups typically at lower risk in stable contexts showed rates well above global averages, underscoring the extreme impact of conflict-related stressors. Conclusions PPD prevalence in Al Anbar is markedly higher than global and regional estimates. Advanced maternal age, low education, economic hardship, limited social support, and early postpartum timing identify high-risk subgroups. Universal screening and integration of mental health services into primary maternal care, tailored to the needs of conflict affected areas are urgently needed. Clinical trial number : not applicable