# Associations Between Self-Esteem and Postpartum Depression and Anxiety: A Cross-Sectional Study Using the Rosenberg Scale in Romanian Women

## TL;DR

This study found that lower self-esteem is strongly linked to higher postpartum depression and anxiety symptoms in Romanian women, suggesting self-esteem assessment could help identify at-risk mothers.

## Contribution

The study provides novel evidence on the relationship between self-esteem and postpartum mental health in Eastern Europe, specifically Romania.

## Key findings

- Self-esteem showed a strong inverse correlation with postpartum depressive symptoms (r = −0.542 overall).
- Lower self-esteem was independently associated with higher Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD-7) scores.
- Higher proportions of EPDS risk were observed among women with moderate/low self-esteem in both study centers.

## Abstract

Background: Postpartum depression and anxiety are common in the perinatal period and can adversely affect maternal functioning and infant outcomes. Self-esteem is a relevant psychosocial factor, yet evidence from Eastern Europe remains limited. Objectives: To describe self-esteem levels among postpartum Romanian women, examine correlational associations between self-esteem and postpartum depression/anxiety symptoms, and assess whether these associations persist after adjustment for sociodemographic and clinical covariates, across two maternity centers in a cross-sectional design. Methods: This cross-sectional study included 201 postpartum women recruited consecutively during their initial postpartum hospitalization from two public maternity hospitals in Western Romania (Bihor, n = 100; Timiș, n = 101) during 2024–2025. Participants completed the Rosenberg Self-Esteem Scale (RSES), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Associations were assessed with χ2 tests (categorical comparisons), Pearson correlations, and multivariable linear regression models including center and selected sociodemographic/obstetric covariates. Results: Self-esteem showed a strong inverse correlation with postpartum depressive symptoms (RSES–EPDS: r = −0.542 overall; r = −0.537 in Bihor; r = −0.552 in Timiș; all p < 0.001). Negative correlations were also observed with anxiety (RSES–GAD-7: r = −0.400; p < 0.001) and PHQ-9 depressive severity (r = −0.370; p < 0.001). Stratified analyses indicated graded symptom burden across self-esteem categories, with higher EPDS risk proportions among women with moderate/low self-esteem within each center (χ2
p ≤ 0.039). In adjusted models, EPDS (B = −0.37; p < 0.001) and GAD-7 (B = −0.15; p = 0.021) remained independently associated with lower RSES, alongside study center (Timiș vs. Bihor: B = −1.08; p = 0.043) and educational attainment. Conclusions: Lower self-esteem co-occurs with postpartum depressive symptoms and, secondarily, anxiety in Romanian women. While the cross-sectional design precludes causal inference, these robust correlational associations support the potential value of self-esteem assessment for early psychosocial risk identification. Longitudinal research is needed to establish temporal relationships and evaluate whether self-esteem can prospectively predict postpartum mental health outcomes.