Beyond the blues: marital dissatisfaction as a stronger predictor of postpartum depression than maternity blues among postpartum women: a prospective study in a Turkish cohort

Purpose This study aimed to determine whether maternity blues (MBs) act as an independent predictor of postpartum depression (PPD), after controlling for key psychosocial factors in a Turkish cohort. Methods In this prospective cohort study, 324 women were followed for 6 weeks postpartum. MB status was assessed in the first week, and PPD risk was evaluated at 4–6 weeks via the Edinburgh Postnatal Depression Scale (EPDS; cutoff ≥12). A propensity score matching (PSM) analysis was conducted to control for confounding variables, followed by multivariate logistic regression on the matched cohort. The study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Results Of the 324 participants, 84 (25.9%) were at high risk for PPD. In the matched cohort ( n = 168), multivariate analysis confirmed MB as a significant independent predictor (adjusted odds ratio [aOR] = 3.52, 95% CI: 1.98–6.24, p < 0.001). Critically, marital dissatisfaction emerged as a stronger independent predictor (aOR = 5.98, 95% CI: 2.95–12.14, p < 0.001) than maternity blues. Conclusion While MB is a significant predictor, its standalone accuracy is modest (AUC = 0.62). Marital dissatisfaction is a more powerful determinant in this cohort. Screening should integrate psychosocial risk factors alongside MB symptoms.