A total of 1,654 postpartum women were included in the analysis, of which 266 (16.1%) had PPD and 1,388 (83.9%) did not. The demographic and health characteristics of the study participants were summarised in Table 1. Statistically significant differences were observed between social support and having PPD. There were more women with PPDs in groups with low social support. Additionally, there were differences in education level, household income, current employment status, current breastfeeding status, degree of parenting burden within the last month, subjective health status, perceived body image, stress, past diagnosis of depression, and smoking experience between women with and without PPD.
Table 2 shows social support status among participants: 6.0% of women had low, 53.9% had moderate and 40.1% had high social support. Women with lower levels of social support were significantly more likely to have lower education and income levels, job, abortion experience, higher parenting burden, lower subjective health status, higher stress levels, and depression compared with women with moderate or higher supports.
Univariate and multiple logistic regression were conducted to determine the association between PPD and social support while controlling for potential covariates (Table 3). In univariable logistic regression analyses, the women with moderate (OR = 2.66, 95% CI = 1.93–3.67) and low (OR = 6.89, 95% CI = 4.22–11.24) level of social supports had increased likelihood for PPD compared to women with high level of social support. Further, in multivariable logistic regression analyses, women with moderate and low social support levels were 1.78 (95% CI = 1.25–2.52) and 2.73 (95% CI = 1.54–4.83) times more likely to develop PPD, respectively, compared to the women with high social support levels. Furthermore, there was a significant association of PPD in women with jobs (OR = 2.80, 95% CI = 2.02–3.88), breastfeeding women (OR = 1.48, 95% CI = 1.10–2.01), and those diagnosed with depression (OR = 2.78, 95% CI = 1.34–5.78). Regarding degree of parenting burden, women with moderate and high parenting burden reported 5.10 (95% CI = 2.66–9.98) and 10.09 (95% CI = 5.08–20.04) times higher chances of having PPD, respectively, compared to the women with low level of parenting burden. Also, women with moderate and low subjective health status were 1.48 (95% CI = 1.07–2.05) and 5.41 (95% CI = 2.83–10.36) times more likely to develop PPD, respectively. Women with moderate (OR = 2.28, 95% CI = 1.32–3.95) and higher (OR = 4.76, 95% CI = 2.58–8.79) levels of stress were also more likely to develop PPD. Interestingly, those with higher household income level reported less likelihood of PPD (OR = 0.50, 95% CI = 0.27–0.90).
The results of subgroup analyses on social support awareness and PPD with covariates were summarised in Table 4. Among women with multiparity, those with moderate and low levels of social support were 2.85 (95% CI = 1.68–4.82) and 4.90 (95% CI = 2.14–11.23) times more likely to develop PPD, respectively; but there were no statistical differences in women with primiparity. Further, in case of women who have pregnancy loss experience compared to those with no experience, the lower the social support, the greater the odds ratios of PPD. In women with pregnancy loss experience, the odds ratios of PPD were 10.26 times higher in such women with low social supports (low: OR = 10.26, 95% CI = 2.16–48.73). Women with moderate and low levels of social support who reported their body image as normal or obese were more likely to develop PPD (P value for trend < 0.001). In addition, women with jobs and low levels of social support showed the highest likelihood of PPD (OR = 10.34, 95% CI = 2.34–45.64).
Figure 1 presents the relationship between the level of social support in each scale of the development of PPD, and shows that the lower the social support level in all subscales, the higher the odds ratios of PPD. The results showed a high degree of association in order of family, significant others, and friends.