Pakistan has the highest prevalence of postpartum depression (PPD) among Asian countries. The purpose of this quantitative, cross-sectional study was to determine the predictors of PPD among women in Karachi, Pakistan. The Transactional Model of Stress and Coping was used as a framework. A purposive convenience sample of 234 postpartum women was taken from out-patient departments of a tertiary care hospital in Karachi, Pakistan. A survey in English and Urdu containing the Edinburgh Postnatal Depression Scale (EPDS), DUREL Religion Index Subscale three, Cohen’s 10-item Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support (MSPSS), Abuse Assessment Screen, Traditional postpartum cultural beliefs, and other demographic variables associated with PPD in the literature was completed by self-report or structured interview. Postpartum women < 16-years-old or having mental disorders other than PPD were excluded. Data was analyzed using SPSS version 24. The sample consisted of 95.7% Muslims, 98.7% married, 52.2% had education of intermediate or below, with a mean age of 27.78 ± 4.43 years, ranging from 19-42 years, and 163 screened positive for PPD using the EPDS. Independent sample t-test, and Pearson’s chi square were significantly different among women with PPD compared to women without PPD on habits detrimental to health (p = .005), MSPSS friends’ subscale (p = .03), MSPSS total (p = .01), abuse (p = .003), special person (p = .031), PSS (p = .00), and a belief ‘consumption of hot foods’ (p = .004). Multiple linear regression revealed, MSPSS total (p = .05), abuse (p = .03), and PSS (p = .00) as significant predictors of PPD, and explained 31% of the variance. Scale reliability was acceptable to excellent, with one Cronbach’s alpha of .65 and the rest ranging from .73 to .92. This study contributes to nursing science by describing predictors of PPD in Pakistan, aiding identification of women at risk for PPD and early detection. Future research is necessary for the development and integration of a holistic approach that includes screening and treatment of PPD in postpartum care to improve maternal mental health and wellbeing.

LLU Discipline





School of Nursing

First Advisor

Roberts, Lisa R.

Second Advisor

Lee, Jerry W.

Third Advisor

Petersen, Anne Berit

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Depression; Postpartum; Postpartum Period; Pakistan;

Subject - Local

Transactional Model of Stress and Coping; Postpartum Depression; Edinburgh Postnatal Depression Scale; DUREL Religion Index Subscale; Perceived Stress Scale; Multidimensional Scale of perceived Social Support



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives