Network analysis of postpartum depression symptoms and perinatal risk factors in Chinese women: a prospective observational study.

Background: Postpartum depression (PPD) is a prevalent mental health issue with significant implications for maternal and infant wellbeing. Despite extensive research, the complex interplay of perinatal factors contributing to PPD remains inadequately characterized. This study utilizes a network analysis approach to identify central depressive symptoms, critical perinatal risk factors, and pathways contributing to PPD among Chinese postpartum women. Methods: A prospective observational study enrolled 377 women from 10 tertiary hospitals in China. Sociodemographic and perinatal factors were assessed shortly after childbirth. At 4-6 weeks postpartum, PPD symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). Maternal and infant health outcomes, breastfeeding experiences, and family support were captured through self-administered questionnaires. Random forest and Bayesian network analyses were employed to identify influential factors and their interrelationships. Results: Among the participants, 98 women (26.0, 95% CI: 21.6-30.7%) screened positive for PPD (EPDS score ≥10). Anxiety/Worry emerged as the most central symptom in the network, with the highest strength and centrality (Degree = 0.893, Betweenness = 0.888). Key risk factors included breastfeeding challenges (RF = 0.752), maternal physical complaints (RF = 0.431), and adverse infant health conditions (RF = 0.350). Protective effects were observed for prolonged skin-to-skin contact, family support for breastfeeding, and positive childbirth self-perception. Hospital type served as a central bridging node within the network, strongly connected with factors related to peripartum care services, childbirth experience and PPD. Conclusion: This study reveals a significant prevalence of PPD among mothers in China. It underscores the positive impact of skin-to-skin contact, continuous postpartum care and tailored breastfeeding support in addressing PPD. These findings will advance PPD prevention strategies and inform evidence-based clinical practice in postpartum care.