# Predictors of postpartum depression in Syrian refugee women: indirect pathways between postmigration stress and depression through resilience and social support

## TL;DR

Syrian refugee women in Türkiye are at risk for postpartum depression, with anxiety and resilience being key factors, and social support and resilience acting as indirect pathways from postmigration stress to depression.

## Contribution

Identifies anxiety and resilience as direct predictors of postpartum depression and reveals social support and resilience as indirect pathways in Syrian refugee women.

## Key findings

- Resilience and anxiety significantly predict postpartum depression.
- Postmigration stress is indirectly linked to depression through social support and resilience.
- Interventions targeting anxiety, social support, and resilience are recommended to reduce depression symptoms.

## Abstract

Refugee women are at high risk for developing postpartum depression (PPD). This study aimed to examine the relationships of postmigration stress, intimate partner violence, anxiety, posttraumatic stress disorder (PTSD) symptoms, social support, and resilience with PPD, and to explore if social support and resilience serve as indirect pathways linking postmigration stress and PPD in Syrian refugee women in Türkiye.

Data for this cross-sectional study were collected using structured telephone interviews from a convenience sample of 200 Syrian refugee women living in Türkiye between August 2022 and February 2023. Participants completed validated measures, including the Edinburgh Postnatal Depression Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, Posttraumatic Stress Disorder Checklist for DSM-5, Generalized Anxiety Disorder-7, Abuse Assessment Screen, and Postmigration Living Difficulties scale. Logistic regression analysis was used to examine the predictors of PPD. The bootstrapping technique with bias-corrected confidence intervals was employed to estimate indirect effects in Mplus.

The findings of this study revealed that resilience (adjusted odds ratio [AOR]: 0.921, 95% Confidence Interval [CI]: 0.867–0.979) and anxiety (AOR: 1.338, 95% CI: 1.17–1.53) significantly predicted PPD. Path analysis demonstrated that postmigration stress was indirectly associated with PPD through Social support (β = 0.033, 95% CI: 0.004–0.079) and resilience (β = 0.157, 95% CI: 0.077–0.244).

Among the examined factors, only anxiety and resilience predicted PPD. Syrian refugee mothers in Türkiye might experience unique social life conditions that influence reporting postmigration stress and PTSD. Whereas social support and resilience served as significant indirect pathways between postmigration stress and PPD, the cross-sectional nature of the data precludes causal or temporal inferences. Yet, Interventions targeting anxiety and aimed at enhancing social support and resilience are suggested to reduce PPD symptoms among refugee women.