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Article

The Role of Social Support and Religiosity in Postpartum Blues: A Cross-Sectional Study

by
Jakov Milić
1,2,†,
Vera Plužarić
2,3,
Mirta Kadivnik
2,4,
Maja Miškulin
2,*,
Katarina Dodig Ćurković
2,5 and
Iva Milić Vranješ
2,4,†
1
Catholic Faculty of Theology, University of Zagreb, 10 000 Zagreb, Croatia
2
Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia
3
Department for Dermatology and Venereology, University Hospital Centre Osijek, 31 000 Osijek, Croatia
4
Clinic for Gynaecology and Obstetrics, University Hospital Centre Osijek, 31 000 Osijek, Croatia
5
Clinic for Child and Adolescent Psychiatry, University Hospital Centre Osijek, 31 000 Osijek, Croatia
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Psychiatry Int. 2026, 7(3), 103; https://doi.org/10.3390/psychiatryint7030103
Submission received: 4 February 2026 / Revised: 8 April 2026 / Accepted: 1 May 2026 / Published: 7 May 2026
Versions Notes

Abstract

Background: The immediate postpartum period is a critical window for maternal mental health, with many women experiencing transient depressive disturbances that can predispose them to perinatal depression. Protective factors such as social support and religiosity may mitigate these depressive symptoms, yet their combined role in the early days after childbirth remains insufficiently explored. This study aimed to assess the relationship between perceived social support, religiosity, and postpartum blues during the first three days postpartum. Methods: A cross-sectional study was conducted with 294 postpartum women (mean age 30.2 ± 5.02 years) at the University Hospital Centre Osijek, Croatia. Participants completed the Edinburgh Postnatal Depression Scale (EPDS), Religiosity Scale (RS), and Social Support Scale (SSS). Nonparametric tests, correlation analyses, and linear regression were used to identify predictors of postpartum blues. Results: Depressive disturbances (EPDS > 10) were observed in 28.2% of participants, while 8.2% had scores suggestive of clinically significant depression. Higher perceived social support correlated with lower EPDS scores (ρ = −0.130, p < 0.05). Religiosity showed modest inverse associations with depressive symptoms. Caesarean section was associated with higher EPDS scores compared to vaginal delivery (p = 0.029). Conclusions: Social support and religiosity appear to be protective factors against depressive disturbances in the early postpartum period. Early screening and culturally sensitive interventions that integrate psychosocial and spiritual dimensions may promote maternal mental well-being.

1. Introduction

Although pregnancy is often considered a joyful time in a woman’s life, the postpartum period can present significant emotional challenges for many women. A considerable proportion of new mothers’ experience the postpartum blues, a brief, self-limiting mood disorder characterised by crying, irritability, depressive symptoms, anxiety, loss of appetite, and emotional lability. These symptoms typically appear in the first few days after delivery and resolve within about two weeks [1,2,3,4].
Despite its transient nature, postpartum blues represent a “silent” public health problem, not only because of its high prevalence—affecting up to 50–80% of women after childbirth—but also because of its potential role as a risk factor for more serious postpartum mood disorders [5,6,7]. A recent systematic review and meta-analysis, which included 26 studies, estimated an overall prevalence of postpartum blues of 39%, ranging from 13.7% to 76% [7]. Common risk factors for developing postpartum blues include primiparity, multiple pregnancy, non-spontaneous labour, caesarean section, cessation of lactation, stress related to childcare, hypochondriasis, a family history of depression, previous depressive or anxiety disorders, and antepartum depressive symptoms [8,9,10]. Studies suggest that postpartum blues have functional correlates in brain areas related to the development of depression [11,12]. Therefore, although postpartum blues is generally mild, early recognition is important, as women who experience postpartum blues represent a distinct subgroup of postpartum women at increased risk of perinatal depression [2], which is a common and clinically heterogeneous disorder with significant implications for maternal and infant well-being [13]. Despite its undeniable importance in terms of prevalence and its association with the development of perinatal depression as a very serious mental health challenge, correct identification of postpartum blues is difficult because a shared definition and well-established diagnostic tools are still not available [4].
To detect transient postpartum blues, some recent studies have used the Edinburgh Postnatal Depression Scale (EPDS) [2,3,12]. These studies confirmed that EPDS is sufficiently reliable to be used as a screening tool for the detection of postpartum blues [2,3,12] as a validated screening tool for the assessment of depressive symptoms in the early postpartum period [14,15,16]. And while perinatal depression has been extensively studied for its detrimental impact on the mother-infant bond and child development, much less attention has been paid to postpartum blues. This omission has left a critical gap in recognition and understanding of this condition as well as addressing its prevention and treatment. There are also a limited number of studies that investigated this issue, but their results have not been systematically synthesised, especially from the perspective of different cultural contexts [17]. Psychologically, the transition to motherhood represents a profound life change that can evoke a range of complex emotions, from joy and fulfilment to doubt and anxiety. Many women experience heightened feelings of responsibility and self-doubt as they cope with the demands of motherhood, while also grappling with their own changing identities and evolving roles within the family [18]. However, some recent studies indicate that certain protective factors, including perceived social support and religiosity, may help reduce postpartum blues. Higher levels of social support and religiosity have been linked to lower scores of postpartum blues, highlighting their potential role as potential protective factor against the condition [4,19,20,21]. Previous studies suggest that religiosity may serve as a protective factor by acting through cognitive frameworks that give meaning to the experience of childbirth pain and changes in life, and through the social capital of the religious community that reduces the feeling of isolation [22,23,24].
Considering the association between postpartum blues and perinatal depression, it has been shown that postpartum blues have functional correlates in brain areas related to the development of depression [11,12]. A recent case–control study among newly delivered Cameroonian women demonstrated that postpartum blues is not only a risk factor but also an independent predictive factor for the manifestation of perinatal depression [25]. Recent literature recommends the use of the EPDS to identify early subgroups of women at higher risk of perinatal depression, which is crucial for early intervention to prevent this serious mental health challenge [2,3,12]. In line with this, a large retrospective cohort study of 1603 postpartum women from the USA, published in March 2026, concluded that implementing EPDS screening at discharge is feasible and useful for identifying patients at risk of perinatal depression [26]. This finding was also confirmed by Ono et al., who showed that EPDS scores at postpartum day 3 are significantly correlated with those at one month and may help identify women at risk for perinatal depression earlier than the conventional one-month screening [27]. Based on these findings, we hypothesised that postpartum blues can be considered a potential marker of elevated risk for the development of perinatal depression, and that higher levels of social support and religiosity may be associated with lower levels of postpartum blues symptoms in new mothers during the immediate postpartum period (the first three days after delivery).
Given the complex interplay of biological, obstetric, psychosocial, and cultural factors in shaping maternal mental health, exploring the role of social support and religiosity in the early postpartum period is essential for developing comprehensive preventive and therapeutic strategies tailored to women during this vulnerable time. Therefore, this study aimed to assess the role of social support and religiosity in postpartum blues among women during the first three days after childbirth.

2. Materials and Methods

The cross-sectional study included a convenience sample of 294 women within the first three days postpartum, with a mean age of 30.2 ± 5.02 years, at the Clinic for Gynaecology and Obstetrics, University Hospital Centre Osijek, Osijek, Croatia. Potential participants (postpartum women) were approached during their early postnatal hospital stay by the nurses and physicians responsible for their care, who explained the study aim in detail. Written informed consent was obtained from each participant before enrolment. Participation was voluntary and without compensation. Data were collected from participants in a non-consecutive manner between 2015 and 2019. Recruitment occurred on all dates and shifts and was not paused for extended periods, as an eligible and trained staff member was always available to collect data. There were no seasonal or staffing effects, and the sampled women did not differ systematically from the broader postpartum population. Considering the total number of births at the Clinic for Gynaecology and Obstetrics during the study period, the final sample of 294 postpartum women represents approximately 3.1% of all women who gave birth at the institution during that time. This study was approved by the Ethics Committee of the University Hospital Centre Osijek (Certificate No. 25-1:7539-5/2015, dated 1 June 2015). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depressive symptoms in the immediate postpartum period [14]. The Religiosity Scale (RS), with its subscales of religious belief, ritualistic religiosity, and the impact of religiosity on social behaviour, was employed to evaluate different dimensions of religiosity [28], while the Social Support Scale (SSS) measured perceived social support [29]. Pain intensity during delivery and during postpartum examinations was assessed using a Numeric Pain Rating Scale ranging from 0 to 10 [30]. In addition, sociodemographic data such as age, education level, relationship status, religious affiliation, and self-assessed financial status, as well as reproductive history including parity, previous abortions, and desire for more children, were collected. Clinical obstetric data, including mode of delivery and Apgar scores, were also collected. All participants were asked to complete the questionnaire at postpartum day 3, since the typical hospital stay after childbirth in Croatia is around 3 days for a vaginal birth and 5–7 days for a caesarean section, depending on the hospital. The inclusion criteria for this study were: females 18 years or older; adequate knowledge of Croatian language and absence of cognitive impairment or intellectual disability. The exclusion criteria were: females younger than 18 years; women without adequate knowledge of Croatian language and women with cognitive impairment or intellectual disability.
Descriptive statistics were calculated, group comparisons of EPDS scores were carried out using non-parametric tests, including Kruskal–Wallis and Brunner–Munzel, and correlations were analysed using Spearman’s rho. Predictors of EPDS scores were analysed using a multiple linear regression model, with EPDS score treated as a continuous dependent variable. Variables that showed significant associations with EPDS scores in the bivariate analyses or were considered clinically relevant based on previous literature were entered into the regression model, while the internal consistency of the scales was evaluated using Cronbach’s alpha. Statistical significance was set at p < 0.05. Data were processed using the jamovi project (2025), jamovi (Version 2.6.26) for Windows.

3. Results

The study included a total of 294 postpartum women (mean age 30.2 ± 5.02) during their first three days post-partum. The median Edinburgh Postnatal Depression Scale score was 7.5 (5–10). The majority of the participants (71.8%) had a score below or at 10, suggesting low depressive symptoms; 83 (28.2%) of the participants had a score above 10, suggesting elevated depressive symptoms. While 24 (8.2%) had a score above 12, suggesting high levels of depression [15]. The Cronbach alpha was 0.785.
The median Religiosity Scale (RS) score was 49 (38–56), with the median religious belief subscale (R1) score of 22 (14.3–22), ritualistic religiosity subscale (R2) score of 19 (15–22), and the impact of religiosity on social behaviour subscale (R3) score of 11 (8–14). The Cronbach alpha was 0.908. The median score on the Social Support Scale (SSS) was 22 (19–24). The Cronbach alpha was 0.875.
The majority of the participants stated that they were in a relationship (288, 98.0%). The majority of the participants stated that they were Catholic (264, 89.8%), 14 (4.8%) were Orthodox, 1 participant was Muslim (0.3%), while 5 (5.1%) stated that they were none of the above. A total of 5 (1.7%) participants had less than an elementary education, 7 (2.4%) had an elementary education, 145 (49.3%) had a high school education, 21 (7.1%) had an undergraduate degree, and 116 (39.5%) had a university degree or higher. A total of 4 (1.4%) participants stated their financial status is significantly below average, 3 (1.0%) stated it was below average, 112 (38.1%) stated it was average, 139 (47.3%) stated it was above average, and 36 (12.2%) stated it was significantly above average.
For 136 (46.3%) of the participants, this was their first childbirth. The majority of the participants had a vaginal delivery with no epidural anaesthesia (187, 63.6%), 48 (16.3%) had epidural anaesthesia during their vaginal delivery, and 55 (18.7%) had a caesarean section (C-section). There were 4 (1.4%) non-responders to this question. The median 0–10 Numeric Pain Rating Scale score during the delivery was 9 (8–10), while during the examination it was 4 (2–6). The majority of new-borns had an Apgar score of 10 both in the first minute (280, 95.2%) and after 5 min (281, 95.6%). The majority of the participants had no prior abortions (283, 96.3%). A total of 133 (45.2%) of participants stated that they do not plan on having more children, 154 (52.4%) stated they plan on having one more child, 5 (1.7%) stated they plan on having two more children, and 2 (0.7%) stated they plan on having 3 more children.
The correlations of the scalar variables are presented in Table 1.
Based on the results of the bivariate analyses and theoretical considerations from previous research, the following variables were included in the multiple linear regression model predicting EPDS scores: SSS, Religiosity Scale RS, pain intensity during examination, assessed with the 0–10 Numeric Pain Rating Scale, education level, and mode of delivery. The model explained 9.33% of the variance, determined as an adjusted R-squared (R2). The ANOVA test results suggest satisfactory explanatory power, F = 4.01, df = 10, p < 0.001.
Diagnostic tests confirmed that all fundamental regression assumptions were satisfied. The normality of residuals was supported by the Kolmogorov–Smirnov test (D = 0.07, p = 0.113). Multicollinearity was negligible, as Variance Inflation Factors (VIF) were well below the critical threshold (1.02–1.05), with corresponding tolerance values between 0.954 and 0.977. Independence of errors was confirmed by a Durbin-Watson statistic of 1.87 (p = 0.27).
Significant differences in EPDS scores were observed between the groups divided by Apgar Scores, with mothers of new-borns with Apgar Scores in the first minute of 10 having higher scores, 8.5 (7–11) vs. 7 (5–10), p = 0.017, Brunner-Munzel Test. Similarly, in the fifth minute, mothers with new-borns scoring 10 had a median EPDS score of 8 (7–10) vs. 7 (5–10), p = 0.040, Brunner-Munzel Test. The scores also differed based on the type of delivery (p = 0.029, Kruskal–Wallis test), with mothers undergoing C-section having the highest scores, 9 (7–11). Mothers delivering naturally had a median EPDS score of 7 (5–9.5), and those with epidural anaesthesia 7.5 (6–10).
There were no differences in the EPDS scores between the groups divided based on relationship status (p = 0.341, Brunner-Munzel Test), previous abortions (p = 0.080, Brunner-Munzel Test), previous childbirth (p = 0.904, Brunner-Munzel Test), religious affiliation (p = 0.606, Kruskal–Wallis test), education (p = 0.203, Kruskal–Wallis test), financial status (p = 0.122, Kruskal–Wallis test), nor whether the women wanted more children (p = 0.282, Kruskal–Wallis test).

4. Discussion

The present study examined the symptoms of postpartum blues during the first three days after delivery using the Edinburgh Postnatal Depression Scale (EPDS). Our findings indicate that 28.2% of participants had EPDS scores above 10, suggesting elevated depressive symptoms, while 8.2% scored above 12, indicative of clinically significant symptoms. These results highlight the substantial proportion of women experiencing early postpartum mood disturbances, i.e., symptoms of postpartum blues but with a notable subset exhibiting more severe symptoms requiring clinical attention. When compared to previous studies, our prevalence rates are within the higher range of reported early postpartum depressive symptoms. For example, Pawar et al. (2011) reported only 2.5% of women scoring positive on the PHQ-9 within 1–2 days postpartum [31], likely reflecting differences in assessment instruments and cut-off criteria. In studies using EPDS, prevalence rates were generally higher: a Lebanese cohort assessed on day 2 postpartum reported 33.3% of women with EPDS ≥ 9 [32], while studies from Japan (3 days postpartum), Taiwan (48–72 h postpartum) and Southern Iran (3 days postpartum) reported prevalence rates of 23.4% [27], 10.2% [33], and 24.2% [34], respectively. These variations may reflect differences in cultural context, social support, healthcare systems, and methodological approaches, including EPDS cut-offs and sample characteristics.
Comparison with data from Croatia [35] shows somewhat lower prevalence rates during the early postpartum period, although methodological differences limit direct comparability. Croatian participants completed EPDS 2 days postpartum, and the prevalence of clinically significant depressive symptoms was reported at 8.1% using a structured diagnostic interview [35]. This highlights that early postpartum depressive symptoms are present in different populations, but prevalence estimates are sensitive to the instrument used, time of assessment, and population-specific factors.
Similar findings were reported by Mikšić et al. (2018) [36], who investigated depressive symptoms and suicidal ideation among 110 pregnant women in the third trimester using the EPDS, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Their study found that 23.4% of participants demonstrated a risk of perinatal depression, while 2.7% reported occasional suicidal thoughts [36]. These results highlight the continuum between prenatal and postpartum depressive states, underscoring the importance of early screening and psychosocial support during the perinatal period. Our findings are consistent with their conclusions, emphasising that depressive symptoms often appear already during pregnancy and may persist or worsen after delivery, especially in the absence of adequate social or emotional support. Overall, these findings emphasise the crucial importance of early screening for depressive symptoms in the first days after delivery. The early postpartum period presents an opportunity for timely identification and intervention, potentially preventing progression to clinically significant postpartum depression. In their study of Japanese women on the third day postpartum, Ono et al. found that 23.4% of women were positive for the EPDS on the third day after delivery, of whom 16.8% remained positive at one month postpartum. The authors concluded that EPDS scores on day 3 postpartum were significantly correlated with those at one month and may help identify women at risk of postpartum depression earlier than the conventional one-month screening recommended as a consensus guideline by the Japanese Society for Perinatal Mental Health [27]. Routine implementation of EPDS screening in maternal care settings, along with appropriate referral pathways, could improve maternal mental health outcomes and support overall family well-being. The median EPDS score in our cohort was 7.5 (IQR 5–10), consistent with early postpartum mood fluctuations often categorised as postpartum blues. Recent evidence highlights that transient mood changes in the first days postpartum can predict later perinatal depression, reinforcing the importance of early screening using tools such as the EPDS [27,32,37,38]. Moreover, a Japanese study found that women scoring 5–8 points on EPDS at day 3, though below the traditional cutoff, showed an increased risk of later conversion and warrant careful follow-up and supportive interventions due to their increased risk of developing perinatal depression [27]. Therefore, it is reasonable to assume that our study that administered EPDS as a screening tool with a threshold of 10, to indicate possible subpopulation of post-partum women with an increased risk for the development of perinatal depression, can be considered valid in the circumstances in which it was carried out.
Our findings indicate that stronger social support was associated with less early postpartum depressive symptoms. Participants reported relatively high SSS scores (median = 22), and higher social support correlated with lower EPDS scores (Spearman’s rho = −0.130, p < 0.05). This aligns with recent studies demonstrating that perceived support from partners, family, and peers can be considered as a potential buffer against postpartum depressive symptoms [19,39,40]. Specifically, women with stronger social networks are less likely to develop significant mood disturbances, consistent with our observations.
Religiosity also showed a similar association. The median RS score was 49, with strong internal consistency (Cronbach’s α = 0.908). Subscale analyses revealed modest inverse associations with depressive symptoms. These results support previous research indicating that religious belief, ritualistic practices, and socially mediated spiritual support can serve as coping mechanisms, providing psychological comfort and fostering resilience in the postpartum period [19,21,41].
Although our study did not examine molecular mechanisms, existing evidence indicates that social support and religiosity may influence stress regulation and emotional resilience through neurobiological pathways, including modulation of the hypothalamic–pituitary–adrenal (HPA) axis, limbic system activity, cortisol secretion, and oxytocin release [42,43]. This provides a compelling rationale for investigating these psychosocial and spiritual factors, as enhancing support and adaptive religiosity could potentially reduce the risk or severity of postpartum blues and perinatal depression. While we did not measure these biological mechanisms directly, they provide a theoretical basis for why interventions targeting social support and religiosity may be effective. Namely, social support theory, as conceptualised by House (1981), outlines how perceived and received support influences health outcomes through four categories: emotional, evaluative, informational, and instrumental [44,45,46]. These different types of social support are key determinants of maternal satisfaction, psychological resilience, and recovery outcomes during and after childbirth [47,48]. Social support reduces the risk of mental disorders and is associated with improved quality of life [49]. On the other hand, inadequate support is associated with an increased risk of postpartum depression, anxiety, feelings of isolation, and even an increased risk of maternal and neonatal morbidity and mortality [49,50]. In societies where religious practice is culturally central, religiosity may thus act as a potential additional buffer against postpartum blues. The connection between religiosity and postpartum blues can be explained by the action of religiosity through cognitive frameworks that give meaning to the experience of childbirth pain and changes in life, and through the social capital of the religious community that reduces the feeling of isolation [22,23,24]. However, evidence regarding the protective role of religiosity in perinatal depression remains mixed. While many studies suggest that religious belief and practice provide emotional comfort, meaning, and community support that can mitigate depressive symptoms, others report no significant association or even higher depression rates among certain subgroups. For instance, the benefits of religiosity may depend on contextual and personal factors such as the type of religious coping used, cultural environment, or the presence of guilt-oriented or punitive beliefs [51,52]. Recent findings by Fotez et al. (2025) further support this complexity, showing that religiosity moderated the relationship between sociodemographic factors and mental health during the COVID-19 pandemic in Croatia, and that higher religiosity was sometimes associated with higher levels of depression and anxiety when negative religious coping existed [53]. Negative religious coping, characterised by feelings of abandonment by God or spiritual discontent, has been associated with an increase in depressive symptoms in both the postpartum population and the general population [54]. Therefore, religiosity may exert a differential effect depending on whether it promotes adaptive coping and social connectedness or reinforces stress and self-blame. Further studies in diverse sociocultural settings are needed to clarify these complex relationships and identify which aspects of religiosity are most beneficial for maternal mental health.
Regarding obstetric characteristics, women who underwent caesarean sections had higher EPDS scores (median = 9), consistent with previous research linking surgical delivery to increased postpartum distress [4,55,56,57,58,59]. A study among Czech women concluded that the mode of delivery correlated with postpartum blues [58], which was also confirmed in a study of Italian women that found postpartum blues was significantly more frequent following caesarean section [57]. Additionally, a study of Dutch women reported that instrumental delivery was an independent risk factor for postpartum blues [59]. Besides the latter, triggers of traumatic birth experiences include labour pain, anxiety before childbirth, concern for the newborn, pre-existing depression, and lack of support during childbirth [56]. Considering the pain, results from several studies revealed a significant positive correlation between the pain scores during delivery and during postpartum and the “maternity blues” questionnaire scores, and between pain scores during delivery and during postpartum and EPDS score at three days postpartum [60,61]. This was one of the reasons pain intensity was included in the analysis. Interestingly, a statistically significant difference in EPDS scores was observed according to Apgar scores. However, this finding should be interpreted with caution because the vast majority of newborns in the sample had Apgar scores of 10, resulting in highly unequal group sizes. Such imbalance may reduce the stability of statistical comparisons and increase the likelihood of chance findings. Therefore, the observed association may reflect a statistical artefact rather than a clinically meaningful relationship. Future studies with more balanced distributions of neonatal outcomes are needed to clarify whether Apgar scores are meaningfully related to early postpartum mood. Sociodemographic factors such as education, financial status, parity, and prior abortions were not significantly associated with EPDS scores in our cohort, suggesting that psychosocial and spiritual resources may play a more immediate role in early postpartum mood than socioeconomic variables, at least within this relatively high-resource population.
A recent study conducted in Croatia by Mikuš et al. (2021) investigated early postpartum mood disturbances, reporting that a significant proportion of women experienced baby blues within the first few days after delivery [62]. Their findings indicated a prevalence rate of 19.9% for maternity blues among Croatian mothers. This study employed Stein’s Maternity Blues Scale, Connor-Davidson Resilience Scale (CD-RISC), Multidimensional Scale of Perceived Support (MSPSS), and Brennan’s Experiences in Close Relationship Scale, along with demographic and obstetric data, to assess the occurrence and associated factors of maternity blues [62].
In comparison, our study provides a more standardised and quantitative assessment using the Edinburgh Postnatal Depression Scale (EPDS), focusing specifically on social support and religiosity as protective factors. While both studies observed a high prevalence of early postpartum mood fluctuations, differences in assessment tools, timing of evaluation, and sample characteristics, our cohort being relatively more educated and financially secure, may explain variations in the rates of clinically significant depressive symptoms.
It should be noted that the regression model explained a relatively modest proportion of variance in EPDS scores (adjusted R2 = 9.33%). This finding suggests that depressive symptoms in the immediate postpartum period are influenced by a wide range of biological, psychological, and contextual factors that were not fully captured in the present model. Therefore, the present model should be interpreted primarily as identifying potential associations rather than providing a comprehensive explanatory framework.
This study is not without limitations. They include its cross-sectional design, which prevents conclusions about causal relationships between the research variables. Also, the collection of the data was non-consecutive, and the study included a convenience sample of new mothers who voluntarily participated in this study. Voluntary participation raises the possibility of bias, as some women who participated might have given socially desirable answers due to discomfort about revealing their religiosity or that they might have excluded themselves from the study due to discomfort about the lack of social support during such an important life event as the birth of a child. On the other hand, since in our exclusion criteria we did not exclude women who had history of some mental issues it is possible that the observed prevalence of the symptoms of postpartum blues can partially be attributed to such participants who were represented in final sample. The lack of longitudinal follow-up prevents the exact determination of whether early elevated EPDS scores predict persistent postpartum depression. Additionally, the sample was culturally and religiously homogeneous, limiting generalizability. However, it is important to note that our sample mirrors the Croatian population regarding religiosity as one of the main research variables, with the 2011 Census data showing that 86.28% of the population is Catholic [63]. Finally, data collection was not based on systematic sampling, and response rates could not be calculated, which may introduce selection bias.

5. Conclusions

In conclusion, the results of this study suggest that perceived social support and religiosity may serve as protective factors against postpartum blues in the immediate postpartum period. These findings underscore the importance of early screening and the development of multidimensional, culturally sensitive interventions that incorporate psychosocial and spiritual support to improve maternal mental health. However, given the design of the present study and inconsistencies in similar research, the direction of causality and the clinical significance of these findings remain uncertain. Future research should include longitudinal follow-up to distinguish transient postpartum blues from the onset of persistent perinatal depression, assess the relationships between these constructs, and examine more thoroughly the interactions among various sociodemographic, obstetric, and psychosocial variables.

Author Contributions

Conceptualization, J.M., K.D.Ć. and I.M.V.; methodology, J.M., K.D.Ć., M.M. and I.M.V.; validation, J.M., M.M., M.K., V.P. and I.M.V.; formal analysis, J.M.; investigation, M.K. and I.M.V.; resources, J.M., M.K. and I.M.V.; data curation, J.M., M.K. and I.M.V.; writing—original draft preparation, J.M., V.P. and M.K.; writing—review and editing, J.M., K.D.Ć., M.M. and I.M.V.; visualisation, J.M., M.K. and M.M.; supervision, M.M., K.D.Ć. and I.M.V.; project administration, J.M., I.M.V., K.D.Ć. and M.M.; funding acquisition, M.M. All authors have read and agreed to the published version of the manuscript.

Funding

The APC was partially financed by a grant from the Croatian Ministry of Science, Education and Youth, and dedicated to multi-year institutional financing of scientific activity at the Josip Juraj Strossmayer University of Osijek, Faculty of Medicine Osijek, Osijek, Croatia—grant number: IP29/2026.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki (“World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects”, 2013) and approved by the Ethics Committee of the University Hospital Centre Osijek (Certificate No. 25-1:7539-5/2015, dated 1 June 2015).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author due to privacy or ethical restrictions.

Acknowledgments

We are grateful to the women who participated in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
EPDSEdinburgh Postnatal Depression Scale
RSReligiosity Scale
R1Religious Belief Subscale
R2Ritualistic Religiosity Subscale
R3Impact of Religiosity on Social Behaviour Subscale
SSSSocial Support Scale
PPDPostpartum Depression
HPAHypothalamic–Pituitary–Adrenal Axis
IQRInterquartile Range
ANOVAAnalysis of Variance
R2Coefficient of Determination (Adjusted R-squared)
CD-RISCConnor–Davidson Resilience Scale
MSPSSMultidimensional Scale of Perceived Social Support

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Table 1. The correlations (Spearman’s rho) between age and the scores of the Edinburgh Postnatal Depression Scale (EPDS), the Religiosity Scale (RS) and its subscales: religious belief (R1), ritualistic religiosity subscale (R2) and the impact of religiosity on social behaviour subscale (R3), as well as the Social Support Scale (SSS) (n = 294).
Table 1. The correlations (Spearman’s rho) between age and the scores of the Edinburgh Postnatal Depression Scale (EPDS), the Religiosity Scale (RS) and its subscales: religious belief (R1), ritualistic religiosity subscale (R2) and the impact of religiosity on social behaviour subscale (R3), as well as the Social Support Scale (SSS) (n = 294).
EPDSR1R2R3RSSSS
R10.047
R2−0.0290.671 ***
R30.126 *0.586 ***0.429 ***
RS0.0580.898 ***0.811 ***0.787 ***
SSS−0.130 *0.215 ***0.151 *0.0520.180 **
age−0.0590.155 ***0.139 *0.1060.160 **−0.44
* p < 0.05, ** p < 0.01, *** p < 0.001.
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Milić, J.; Plužarić, V.; Kadivnik, M.; Miškulin, M.; Ćurković, K.D.; Vranješ, I.M. The Role of Social Support and Religiosity in Postpartum Blues: A Cross-Sectional Study. Psychiatry Int. 2026, 7, 103. https://doi.org/10.3390/psychiatryint7030103

AMA Style

Milić J, Plužarić V, Kadivnik M, Miškulin M, Ćurković KD, Vranješ IM. The Role of Social Support and Religiosity in Postpartum Blues: A Cross-Sectional Study. Psychiatry International. 2026; 7(3):103. https://doi.org/10.3390/psychiatryint7030103

Chicago/Turabian Style

Milić, Jakov, Vera Plužarić, Mirta Kadivnik, Maja Miškulin, Katarina Dodig Ćurković, and Iva Milić Vranješ. 2026. "The Role of Social Support and Religiosity in Postpartum Blues: A Cross-Sectional Study" Psychiatry International 7, no. 3: 103. https://doi.org/10.3390/psychiatryint7030103

APA Style

Milić, J., Plužarić, V., Kadivnik, M., Miškulin, M., Ćurković, K. D., & Vranješ, I. M. (2026). The Role of Social Support and Religiosity in Postpartum Blues: A Cross-Sectional Study. Psychiatry International, 7(3), 103. https://doi.org/10.3390/psychiatryint7030103

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