Postpartum Depression in a Tertiary Maternity Service in Dhaka, Bangladesh: Prevalence, Risk Factors, Comorbid Anxiety, and Care Cascade —A Hospital-Based Observational Study (2024–2025)

Background: Postpartum depression (PPD) affects approximately 17% of women globally but reaches substantially higher rates in Bangladesh, where estimates range from 22% to 60% depending on the setting and screening threshold. Despite recommendations for routine screening, the care cascade from positive screening to sustained treatment in Bangladeshi tertiary hospitals remains poorly characterised.Methods: This hospital-based observational study was conducted at a tertiary maternity service affiliated with Bangladesh Medical University, Dhaka, during 2024–2025. A total of 1,200 postpartum women were screened using the validated Bangla Edinburgh Postnatal Depression Scale (EPDS; primary), the Patient Health Questionnaire-9 (PHQ-9), and the Generalised Anxiety Disorder scale (GAD-7) at 4–12 weeks postpartum. The study comprised (A) a cross-sectional prevalence and risk-factor component at first postpartum contact and (B) a prospective follow-up cohort for symptom trajectories and care cascade evaluation. Binary PPD was defined as EPDS ≥10 (primary) and ≥13 (sensitivity analysis). Multivariable logistic regression identified independent risk factors. The care cascade was quantified as proportions progressing through sequential steps frompositive screen to treatment engagement. Reporting followed STROBE guidelines.Results: Among 1,200 women (meanage 26.1 ± 4.6 years), the prevalence of PPD was 38.9% (95% CI: 36.2–41.7) at EPDS ≥10 and 16.8% (95% CI: 14.8–19.1) at EPDS ≥13. PHQ-9 ≥10 prevalence was 22.8% (95% CI: 20.5–25.3); postpartum anxiety (GAD-7 ≥10) was 9.2% (95% CI: 7.7–10.9). In multivariable analysis, the strongest independent predictors of PPD were prior depression/anxiety (aOR 11.61, 95% CI: 6.92–19.47), comorbid anxiety (aOR 9.50, 95% CI: 4.89–18.47), intimate partner violence (aOR 3.64, 95% CI: 2.69–4.93), emergency caesarean section (aOR 3.33, 95% CI: 2.26–4.90), unplanned pregnancy (aOR 3.19, 95% CI: 2.37–4.29), sleep problems (aOR 2.48, 95% CI: 1.85–3.33), and NICU admission (aOR 2.02, 95% CI: 1.36–3.02). Among screen-positive women, 69.6% received counselling, 50.3% were offered referral, but only 20.1% attended at least one mental health appointment. Cohen's kappa for EPDS ≥10versus PHQ-9≥10agreement was 0.498(moderate).Conclusions: PPD is highly prevalent in this urban tertiary-hospital population with substantial care-cascadeattrition. Integration of routine EPDS screening into postnatal and immunisation clinic contacts, combined with on-site counselling and structured referral pathways, is urgently needed