Exploring Community Perspectives on Postpartum Depression: An Anthropological Approach Using Cognitive Interviews

Introduction

Postpartum depression (PPD) affects 22–28% of Indian postnatal women but is often underdiagnosed due to cultural stigma. Addressing PPD is vital for maternal mental health and infant well-being. The Edinburgh Postnatal Depression Scale (EPDS) is widely used, but needs cultural and context-specific adaptations for India’s diverse population. This study explored how postnatal women interpreted EPDS items within their cultural and linguistic contexts through cognitive interviews.

Methods

A semi-structured cognitive interview guide was used to capture culturally relevant terminology and perspectives on PPD. Cognitive interviews were conducted with 30 postnatal women in the puerperium period, selected through purposive sampling from 35 rural and tribal villages. Local dialects facilitated data collection by trained students. Interviews were transcribed, translated, and thematically analyzed, identifying both recurring patterns ("dominant trends") and unique insights ("discoveries"). Ethical approval was obtained, and participants provided written informed consent.

Results

Participants, aged 18–38 years, had education levels ranging from primary school to graduation. While 30% were housewives, others worked in housekeeping, farming, tailoring, beauty services, teaching, and entrepreneurship. Husbands’ education varied from illiterate to graduate, with occupations spanning labor, farming, clerical work, transport, and skilled professions. Household income ranged from Rs. 5,000 to Rs. 100,000.

Women related the scale items to their lived experiences, expressing joy in caring for their newborn, welcoming guests, and engaging in spiritual activities. However, concerns included having a girl child, balancing responsibilities, and lack of family support. Sleep deprivation, isolation, and parental guilt affected well-being, while unmet expectations, relationship struggles, and fears of a husband's second marriage caused emotional distress, sometimes leading to self-harm thoughts.

Conclusion

While the validated Marathi EPDS remained unchanged, cognitive interviews improved participant understanding, ensuring accurate responses. Findings support culturally sensitive adaptations for broader implementation in Maharashtra.