Postpartum depression in women during war: from acute crisis to prolonged conflict

This study examines the prevalence of probable postpartum depression (PPD) and associated factors among Israeli Jewish women who gave birth during acute and prolonged phases of an ongoing war, addressing the gap in understanding the progression of depressive symptoms across conflict stages.

A cross-sectional study included 279 women who delivered after October 7, 2023. Data were collected in the acute phase (February-April 2024) and prolonged phase (March 2025). Demographic, obstetric, and war-related variables were collected. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariable logistic regression analysis assessed the odds of probable PPD (score ≥ 10).

The prevalence of probable PPD was 25.7% in the initial phase and 26.0% in the prolonged phase. Women with prior depression history (OR = 2.7, 95% CI: 1.3-5.7), pregnancy complications (OR = 1.9, 95% CI: 1.02-3.7), or infants older than 4 months (OR = 2.0, 95% CI: 1.1-3.8) had significantly higher odds of scoring above the cutoff. Secular women were nearly twice as likely to experience elevated symptoms as religious women (OR = 2.0, 95% CI: 1.1-3.8). Maternal age, obstetric characteristics, and war-related exposures were not significantly associated with depression scores.

Rates of probable PPD during the war were more than triple pre-war Israeli estimates and remained elevated across conflict phases. These findings underscore the need to extend postpartum screening beyond the early postpartum period (at 4-6 months postpartum), consistent with international recommendations for repeated or ongoing assessment. Higher rates among secular women may reflect differences in community support and warrant further investigation.