Factors Associated with Postpartum Depression in Mothers of the Kangaroo Mother Care Program in Southern Colombia: A Cross-Sectional Study

Factors Associated with Postpartum Depression in Mothers of the Kangaroo Mother Care Program in Southern Colombia: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Factors Associated with Postpartum Depression in Mothers of the Kangaroo Mother Care Program in Southern Colombia: A Cross-Sectional Study Rosa Lisset Salazar Herrán, Gisella Bonilla Santos, Madeleine Melissa Rocha Perdomo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7171044/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Postpartum depression is a worldwide public health problem associated with postpartum risk factors, which requires being studied in mothers with newborns enrolled in kangaroo care programs. Objective To establish the frequency and the factors related to postpartum depression in mothers attending kangaroo care in Colombia. Methods Cross-sectional analytic study that used Edinburgh's postpartum depression survey, and a questionnaire that asked for the sociodemographic, obstetric-gynecological, and psycho-emotional factors in 140 mothers with newborns. Results The postpartum depression frequency was 23.5% higher in young women with an average age of 27 years, from urban areas, and low socio-economic stratum; a significant proportion reported the obstetric-gynecological factor associated with the number of pregnancies, vaginal delivery, and live births. The multivariate analysis by logistic regression showed that the care of the newborn and the irritability caused by the newborn's crying to the mother are associated with postpartum depression. Conclusion Establishing the postpartum depression frequency and risk factors provides the nursery with a theoretical ground to offer programs oriented towards the care of women during postpartum at the community level, strengthening the childcare of the newborn, articulated to an interdisciplinary team where the mother's physical and mental health are integrated. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Postpartum depression mental health Edinburgh's Scale Kangaroo care Introduction During the perinatal period, women undergo emotional and psychological changes that increase their vulnerability to psychiatric disorders, such as postpartum depression ( 1 ). The Diagnostic and Statistical Manual of Mental Disorders defines postpartum depression as the "occurrence of a major depressive episode (MDE) within four weeks after childbirth, which may include irritability, excessive crying, or panic."( 2 ). However, these episodes may begin or persist during the first year after childbirth. ( 3 ). Postpartum depression can impair parenting skills and judgment ( 4 ), diminish enjoyment of the maternal role, and create poor mother-baby interactions ( 4 ). Mothers with postpartum depression (PPD) show early cessation of breastfeeding and less care for their babies, leading to decreased immunity and putting babies at risk of stunted growth and development ( 5 ). In addition, maternal mental health directly influences the emotional and cognitive well-being of children, impacting their holistic development ( 6 ). Undetected PPD imposes a high cost on society, as the mother is less able to fulfill her caring responsibilities( 7 ). Globally, it is estimated that 14–17% of women in the postnatal period experience symptoms of PPD, which equates to approximately one in six to seven mothers ( 8 )( 9 ). In low- and middle-income countries, PPD affects up to 48.5% of women, but only 6.5–12.9% of women in high-income countries ( 10 ). Postpartum depression has been linked to several risk factors, including stressful life events, a history of depression, not breastfeeding, first birth, and negative body image. Other risk factors include having a poor relationship with a partner and low socio-economic status ( 11 ). However, in some contexts, higher education, permanent employment, a friendly and trustworthy partner, and belonging to the majority ethnic group were protective factors against PPD ( 12 ). In Europe, data show an increase in DPP. In England, prevalence increased from 10.3% in 2014 to 16.0% in 2018 and rose dramatically to 23.9% during the COVID-19 pandemic in 2020 ( 13 ). In Portugal, a study revealed rates of 18.5% during the third trimester of pregnancy and 17.6% at 2–3 months postpartum, with a higher incidence in adolescent mothers (25.9% versus 9.3% in adults)( 14 ). In Africa, the variability is even greater, with rates ranging from 6.9 percent in Morocco to 43 percent in Uganda ( 15 ). A recent study in Uganda (2019–2020) reported a prevalence of 27.1% (95% CI 22.2–32.5), which is significantly higher than the historical data for the country ( 16 ). In Burkina Faso, prevalence can be as high as 44% ( 15 ). In Latin America, recent studies show a prevalence ranging from 13–21.7%, with Brazil being one of the countries with the highest incidence in the region ( 17 )( 18 ). A 2021 systematic review revealed that approximately 13% of Latin American women suffer from PPD, although this figure can rise to 34.46% in specific populations such as young and urban women ( 19 ). In Colombia, the frequency is 5.1% and 22.36% of mothers, with an estimated national prevalence of 12.9% according to the 2010 National Demographic and Health Survey, being higher in urban areas (15.1%) than in rural areas (6.8%) ( 20 ). The most prevalent risk factors include relationship breakdown (OR = 6.26), severe economic hardship (OR = 6.61), and death in the family (OR = 3.79) ( 20 ). Therefore, the present study aimed to identify the frequency and factors related to postpartum depression in mothers attending the kangaroo care program in a high-complexity institution in Colombia. Method Type of study and participants Cross-sectional analytical study, conducted in Southern Colombia between August 2021 and May 2022, with 140 women participants who had preterm and/or low birth weight and were in the Kangaroo Care program at the Hospital Universitario Hernando Moncaleano Perdomo. This hospital is the only center that offers the Kangaroo Care program in the city of Neiva, and it is expected that postpartum women will be cared for there with their babies. Mothers who agreed to participate gave their consent and received a self-administered questionnaire that included the validated Colombian version of the Edinburgh Postnatal Depression Scale- EPDS. This instrument is commonly used as a self-administered questionnaire for screening for postpartum depression. In addition, studies have shown comparable efficacy between self-administered questionnaires and face-to-face interviews in diagnosing this condition. To ensure the data quality, one of the researchers was present at the site of data collection to ensure that the questionnaire was comprehensive. Inclusion criteria Inclusion criteria were NB under two months old, registered and active in kangaroo care in a fourth-level health institution, and being of legal age. Exclusion criteria Women previously diagnosed with depressive disorder, anxiety disorder, bipolar disorder, addiction to psychoactive substances and/or alcohol, or intellectual disability, were excluded. Besides, it was kept in mind that NBs showed no congenital diseases such as Down’s syndrome, cleft lip, spina bifida, or Edwards’ syndrome. Sample size and sampling method. The sample size was calculated in the OpenEpi Version 3.0 program. The minimum sample size was 140 with a confidence level of 95%, a margin of error of 5%, and a response distribution of 50%. The sample was then non-probability convenience sampling. Instrument PPD may be associated with some sociodemographic, gynecological-obstetrical, and psycho-emotional factors, which were measured with the following 2-part self-administered questionnaire: 1) Sociodemographic: age, place of residence, socioeconomic status, educational level, marital status, occupation, family and social support. Obstetric and gynecological: number of pregnancies, births, abortions, cesarean sections, live births, stillbirths, smoking, illnesses during pregnancy, difficulty breastfeeding, and perinatal complications (cleft lip, asphyxia, low birth weight). Psychoemotional: planned pregnancy, physical and/or psychological abuse before, during, or after pregnancy, irritability when hearing the baby cry, adequate fulfillment of the maternal role, and care of the baby (alone, in a couple, in a family, employed in the home). 2) The Edinburgh postpartum depression scale is a questionnaire consisting of 10 items to explore the mother's mood during the seven days before its application, scoring each question from zero to three, according to symptomatic severity and a maximum of 30 points( 21 ). For Colombia, the EPDS was validated in a study conducted in the city of Cartagena, showing a high internal consistency of 0.78 Cronbach's Alpha for postpartum depression( 22 ). Data analysis The nominal variables were described with frequency tables and were compared with the Chi-2 test. The ratio variables were summarized with measures of central tendency and dispersion and were presented with the mean and standard deviation based on the normality assumption. Furthermore, they were compared to the t-student test for independent samples. A correlation analysis was carried out between the factors measured as ratio variables (age, pregnancy weeks, number of pregnancies, labors, cesarean births, abortions, live births, number of prenatal care of the reference pregnancy, and, number of current children) and the ordinal variables (socio-economic stratum and educational level) with each of the dimensions of the postpartum depression scale (depressed mood, anhedonia, hopelessness, and guilt), the depression level and the total score of the scale, applying Pearson and Spearman correlation statistics respectively. The variables that showed statistical significance in the comparisons were included in the binary logistic regression model by entering postpartum depression (Yes/No) as a dependent variable. All tests used alfa = 0.05, and the statistical analyses were carried out using the R Studio computer program. Ethical consideration This study was conducted according to the Declaration of Helsinki of the World Medical Association. Before data collection, written informed consent was obtained from the participants, and the role of the researchers, the objectives of the study, the confidentiality and anonymity of the information, and voluntary participation and withdrawal from the study at any time were explained to them. The approval of the ethics and ethics committee was conferred by the Hospital Universitario Hernando Moncaleano Perdomo de Neiva through number 012 − 005 of 2020. Results Regarding sociodemographic factors, participants reported their age, ranging from 18 to 43 years, with a mean of 27.01 (standard deviation ± 6.44). The table in the supplementary material shows that most of the participants resided in urban areas, in localities of low socioeconomic stratum, with occupations that do not generate direct income or are unemployed. When comparing the socioeconomic factors, there were no differences between the group of mothers with indicators of depression and the control group. The frequency of PDD was 23.5% in the population studied. Regarding gynecological-obstetric factors, Table 1 shows the differences identified between the two groups in the antecedents related to reproductive history, women with depression indicators referred a higher number of pregnancies ( p = 0.02), vaginal deliveries ( p = 0.02), live births ( p = 0.02), and children ( p = 0.00), the latter with marginal statistical significance. The other factors show similar behavior between the groups presented in the table in the supplementary material. Table 1 Gynaeco-obstetric and Psycho-emotional factors of mothers attending the kangaroo program. Factors Depression Statistic p Value No % Si % Pregnancies 2.2 a 1.1 2.7 b 1.3 2.14 0.02 Vaginal deliveries No 52 85.2 9 14.8 3.84 0.05 Yes 55 69.6 24 30.4 Live births No 79 83.2 16 16.8 6.31 0.01 Yes 28 62.2 17 37.8 Nº children Equal or less than two 77 83.7 15 16.3 6.73 0.00 More than two 30 62.5 18 37.5 Abuse in pregnancy No 106 77.9 30 22.1 3.46 0.06 Yes 1 25 3 75 NB care Alone 4 44.4 5 55.6 6.68 0.04 Couple 50 74.6 17 25.4 Relatives 53 82.8 11 17.2 Irritability NB cry No 91 82.7 19 17.3 9.73 0.00 Yes 16 53.3 14 46.7 Note. NB = Newborn. The statistic for comparing the nominal factors was \(\:{\chi\:}^{2}\) Note. SES = Socio-economic stratum. a= Mean. b= Standard deviation. The statistic for comparing the nominal factors was \(\:{\chi\:}^{2}\) and t-Student test for the quantitative factors for independent samples. Regarding the Psycho-emotional factors, conditions related to newborn care, such as care ( p = 0.04) and the mother's emotional response to hearing crying ( p = 0.04), were significant. The variable maltreatment in pregnancy showed marginal significance, with a higher frequency in the postpartum depression group. However, the total number of cases in both groups was low. The other factors showed similar behavior between the two groups. Correlation analysis is shown in Table 2 , identifying a negative correlation between the hopelessness and guilt items of the Edinburgh questionnaire and level of education (r = -0.37, p = 0.03). In contrast, the relationship with the number of births was positive (r = 0.42, p = 0.01). Likewise, the level of depression was related to education and obstetric-gynecological factors such as the number of pregnancies (r = 0.36, p = 0.04), births (r = 0.34, p = 0.05), live births (r = 0.34, p = 0.05), and children (r = 0.37, p = 0.04). Table 2 Correlations among factors with the dimensions of the post-partum scale (Edinburgh) of mothers attending the kangaroo program. Factor Depressed mode Anhedonia Hopelessness and guilt Depression level Depression Age 0.20 (0.26) 0.03 (0.88) 0.11 (0.54) 0.19 (0.28) 0.22 (0.22) SES -0.28 (0.12) -0.15 (0.41) -0.18 (0.33) -0.34 (0.06) -0.26 (0.14) Schooling -0.13 (0.47) 0.14 (0.44) -0.37 (0.03) -0.37 (0.03) -0.21 (0.25) Pregnancies 0.00 (0.99) 0.21 (0.24) 0.30 (0.09) 0.36 (0.04) 0.24 (0.18) Deliveries 0.11 (0.53) -0.01 (0.95) 0.42 (0.01) 0.34 (0.05) 0.33 (0.06) Caesarean deliveries 0.02 (0.89) 0.27 (0.12) -0.29 (0.09) 0.04 (0.82) -0.04 (0.85) Abortions -0.08 (0.65) 0.04 (0.83) 0.12 (0.50) 0.06 (0.74) 0.00 (0.99) Live 0.12 (0.49) 0.20 (0.25) 0.18 (0.33) 0.34 (0.05) 0.27 (0.13) Nº of children 0.12 (0.52) 0.20 (0.25) 0.19 (0.29) 0.37 (0.04) 0.28 (0.12) Nº controls prenatal -0.17 (0.34) -0.38 (0.03) 0.04 (0.81) -0.00 (0.97) -0.13 (0.48) Weeks Pregnancy -0.11 (0.54) -0.20 (0.26) 0.10 (0.57) -0.08 (0.66) -0.13 (0.46) Note. SES = Socio-economic stratum. The statistics used for correlations were Pearson and Spearman. The table shows the value of r for correlation, and the values in parentheses correspond to statistical significance. A multivariate analysis was performed using binary logistic regression; the dependent variable was PPD, measured by the EPDS, and included as independent variables those mentioned in the comparison with Chi-2 and T-Student statistics. This analysis produced a Nagelkerke's R2 of 0.362. The model presented could explain 36% of the relationship between the sociodemographic and Psycho-emotional factors included. During the analysis, factors that lost statistical significance, those that did not fit the model, or contributed minimally to the R2 were excluded when introducing each variable. Table 3 Multivariate analysis between factors with post-partum depression in mothers attending the kangaroo program. Factors Beta Standard Error value (p) Intercept -1.893 1.049 0.07 Age 0.058 0.032 0.07 NB care -0.467 0.225 0.04 Irritability on cry NB 1.145 0.463 0.01 AIC 143.28 Note. NB = Newborn Table 3 shows the model for postpartum depression, explained mainly by the variables: maternal irritability due to the crying of the NB (β = 1.14, p = 0.01) and newborn care (β= -0.47, p = 0.04). Discussion The study showed that the prevalence of PPD was 23.5%, which is consistent with recent global reports for vulnerable populations. In this regard, Wang et al. (2021) documented a global prevalence of 17.22% (95% CI: 16.00-18.51), being significantly higher in low- and middle-income countries ( 23 ). In Latin America, research shows prevalences ranging from 13–21.7%, with Brazil being the country with the highest rates in the region. ( 24 ). In Colombia, the estimated national prevalence is 12.9% according to the 2010 National Demographic and Health Survey, with a higher frequency in urban areas (15.1%) compared to rural areas (6.8%)( 25 ). The findings of our study exceed these national figures, which may be explained by the specific characteristics of the population studied: mothers with preterm or low birth weight infants in kangaroo care programs, who face additional risk factors ( 26 ). The average age of the participants (27 years) and the higher proportion of young women with postpartum depression are consistent with recent evidence. A US study of more than 1.1 million mothers worldwide identified that mothers under the age of 25 are at the highest risk of postpartum depression ( 27 ). Specifically, women aged 40–44 years showed a 3.72 times higher risk (OR: 3.72; 95% CI: 2.15–6.41) compared to women aged 30–35 years( 28 ). The predominance of women from urban areas in our study reflects global patterns, with the urban prevalence of postpartum depression reaching 10% versus 6% in rural areas. This phenomenon is attributed to factors such as weaker social support networks, especially in urban migrant populations( 29 ). Recent studies indicate that economic hardship is the strongest predictor of postpartum depression (OR: 4.0; 95% CI: 1.4–6.3)( 30 ). In our study, the predominant population was of middle and low socioeconomic income. In turn, Mexican research confirms that women in below-median income groups have the highest prevalence of postpartum depression (22%) compared to middle- and high-income groups ( 30 ). Income emerges as the strongest predictor among all social status indices, surpassing even education and occupational prestige( 31 ). The findings relating to a higher number of pregnancies, vaginal deliveries, and live births to PPD are differential findings concerning the literature and what is presented in high-income countries. A Japanese study of 1,509 patients showed that primiparas have a higher risk of depressive symptoms (22.2%) compared to multiparas (11.6%) (OR: 1.65; 95% CI: 1.31–2.06) ( 32 ). On the other hand, Spanish research with 2,990 postpartum women confirmed that primiparas are 1.6 times more likely (OR: 1.60; 95% CI: 1.35–1.89) to have feelings of sadness and 1.65 times more likely to have depressive symptoms( 32 ). This difference in results can be explained by the specific characteristics of our population: mothers who participate in the kangaroo care program may experience greater anxiety when faced with neonatal complications due to their previous experience of childbirth. Furthermore, in Colombia, mothers give birth at a younger age than in the countries mentioned above, and families have a higher average number of children ( 33 ). Although our study found only marginal statistical differences according to mode of delivery, recent evidence suggests significant associations. A 2019 meta-analysis reported that cesarean delivery is associated with a higher risk of postpartum depression (OR: 2.0; 95% CI: 1.35–2.96) compared to vaginal birth ( 34 ). In turn, an Iranian study of 300 postpartum women documented that 13.3% of women who had cesarean sections developed depression, compared to 7.1% of those who had vaginal births. However, the heterogeneity between studies suggests that other moderating factors, such as the experience of kangaroo care, may influence this association( 35 ). The most significant finding of our study was the association between maternal irritability due to newborn crying and postpartum depression (β = 1.14, p = 0.01). This relationship is well documented in recent literature. A longitudinal study of 587 mothers showed that maternal reports of inconsolable infant crying for more than 20 minutes per day were associated with an OR of 4.0 (95% CI: 2.0-8.1) for postpartum depression( 36 ). Oberlander et al. (2017) reported that exposure to infant crying predicts dynamic fluctuations in maternal mental health, with effects accumulating over hours( 37 ). Specifically, when crying was above average for 8 hours, mothers reported subsequent increases in depressive symptoms. Recent neurological research demonstrates that depressed mothers show reduced neural activation in regions related to emotional response and regulation when they hear their babies cry ( 37 ). The negative association between caregiving and postpartum depression (β= -0.47, p = 0.04) suggests that caregiving support acts as a protective factor. A Korean study during the COVID-19 pandemic identified that paternal involvement in infant care significantly reduces the risk of postpartum depression ( 38 ). Research on mothers with infants in NICU showed that early parental engagement and early interactions reduce the risk of late postpartum depression ( 39 ). This is particularly relevant in the context of kangaroo care, where family support is critical to the success of the program. Limitations This study has the following limitations. First, its cross-sectional design prevents conclusions from being drawn about causality or temporal relationships between the identified risk factors and postpartum depression. Second, the use of non-probability sampling may limit the generalization of the results. Third, postpartum depression was assessed solely using the Edinburgh Postnatal Depression Scale, which, although validated, is a self-report instrument and not a diagnostic psychiatric interview, which could introduce classification bias. The sample size may limit statistical power, especially in multivariate analysis. Finally, given that all participants were mothers of premature or low birth weight babies, the results are not applicable to all postpartum women. Conclusion The study revealed the prevalence of postpartum depression of 23.5%. Psychoemotional factors, specifically maternal irritability in response to the baby's crying, were associated with an increased risk of postpartum depression, while support in caring for the newborn showed a protective effect. Similarly, multiparity, a higher number of vaginal births and a higher number of live births were associated with an increased risk. These results highlight the importance of considering context-specific factors and psycho-emotional dynamics in the identification and prevention of postpartum depression in kangaroo care settings. Recommendations It is recommended that systematic screening protocols for postpartum depression be implemented in all kangaroo care programs, using the EPDS with culturally validated cut-off points. It is essential to develop specific interventions aimed at improving maternal skills for managing infant crying and strengthening family support networks. Finally, maternal mental health assessments need to be integrated into clinical practice guidelines for kangaroo care programs, with clear protocols for referral to specialized mental health services. Abbreviations PPD postpartum depression DSM-5 Mental Disorder Diagnose and Statistical Manual NB Newborn EPDS Edinburgh's Postpartum Depression Scale Declarations Ethics approval and consent to participate. This study was conducted according to the Declaration of Helsinki of the World Medical Association. Before data collection, written informed consent was obtained from the participants, and the role of the researchers, the objectives of the study, the confidentiality and anonymity of the information, and voluntary participation and withdrawal from the study at any time were explained to them. The approval of the ethics and ethics committee was conferred by the Hospital Universitario Hernando Moncaleano Perdomo de Neiva through number 012-005 of 2020. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to promises of participant anonymity and confidentiality, but are available from the corresponding author upon reasonable request. Competing interests The authors declare no conflicts of interest. Funding This research was financially supported by Universidad Surcolombiana, Internal Call PSEM01-2020, the bank of Research and Technological Development and Innovation student seedbed groups, in the financing mode code 3567. Author contributions RLSH, GBS: study conception and design. RLSH, GBS: data collection data collection. GBS: data analysis and interpretation. RLSH, GBS, and JDDCH Manuscript writing. GBS, RLSH, JDDCH: Critical revision. All authors read and approved of the final manuscript. Acknowledgments The authors thank the kangaroo method health team in the University Hospital Hernando Moncaleano Perdomo in Neiva, Colombia, and the participating women who made it possible to carry out this study. Author Details 1. Nursing Program, Faculty of Health Sciences, Universidad Surcolombiana. 2. Faculty of Nursing, Universidad Antonio Nariño. 3. Psychology Program, Faculty of Social and Human Sciences, Universidad Surcolombiana, Universidad Cooperativa de Colombia. References McKelvey, M. M. & Espelin, J. Postpartum depression. Nursing Made Incredibly Easy [Internet]. 2018 May [cited 2025 Jul 14];16(3):28–35. Available from: https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2018/05000/postpartum_depression__beyond_the__baby_blues_.7.aspx American Psychiatric Association Staff. 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C., Lima-Gómez, V. & Asbun-Bojalil, J. Diagnostic accuracy of the edinburgh postnatal depression scale: Consequences of screening in mexican women. Gac Med Mex [Internet]. May [cited 2025 Jul 14];156:201–7. (2020). Available from: https://www.gacetamedicademexico.com/frame_esp.php?id=424 Campo-Arias, A., Ayola-Castillo, C., Peinado-Valencia, H. M., Amor-Parra, M. & Cogollo, Z. Escala de Edinburgh para depresión posparto: consistencia interna y estructura factorial en mujeres embarazadas de Cartagena, Colombia. Rev. Colomb Obstet. Ginecol. 58 , 277–283 (2007). Wang, Z. et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry [Internet]. 2021 Dec [cited 2025 Jul 14];11. Available from: https://www.nature.com/articles/s41398-021-01663-6 Rondon, M. B. Perinatal mental health around the world: priorities for research and service development in South America. BJPsych Int [Internet]. 2020 Nov [cited 2025 Jul 14];17:85–7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7609984/ Rincón-Pabón, D., Ramírez-Vélez, R., Rincón-Pabón, D. & Ramírez-Vélez, R. Depresión posparto en mujeres colombianas: análisis secundario de la Encuesta Nacional de Demografía y Salud-2010. Revista de Salud Pública [Internet]. 2013 [cited 2025 Jul 14];16:534–46. Available from: https://www.scielosp.org/pdf/rsap/2014.v16n4/534-546 Erduran, B. & Yaman Sözbir, Ş. Effects of intermittent kangaroo care on maternal attachment, postpartum depression of mothers with preterm infants. J Reprod Infant Psychol [Internet]. 2023 Sep [cited 2025 Jul 14];41:556–65. (2022). Available from: https://www.tandfonline.com/doi/10.1080/02646838 .2035703?url_ver=Z39.88-2003픯_id=ori:rid:crossref.org픯_dat=cr_pub%20%200pubmed. Bradshaw, H., Riddle, J. N., Salimgaraev, R., Zhaunova, L. & Payne, J. L. Risk factors associated with postpartum depressive symptoms: A multinational study. J Affect Disord [Internet]. 2022 Mar [cited 2025 Jul 14];301:345–51. Available from: https://pubmed.ncbi.nlm.nih.gov/34979186/ Muraca, G. M. & Joseph, K. S. The Association Between Maternal Age and Depression. Journal of Obstetrics and Gynaecology Canada [Internet]. 2014 Sep [cited 2025 Jul 14];36:803–10. Available from: https://pubmed.ncbi.nlm.nih.gov/25222359/ Putri, A. S., Wurisastuti, T., Suryaputri, I. Y. & Mubasyiroh, R. Postpartum Depression in Young Mothers in Urban and Rural Indonesia. Journal of Preventive Medicine and Public Health [Internet]. 2023 May [cited 2025 Jul 14];56:272–81. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10248106/ Robledo-Clemente, M., Silva Godínez, J. C., García Montes, L. D., Valencia-Ortega, J. & Saucedo, R. Barriers to postnatal care utilization during the COVID-19 pandemic: a cross-sectional study of sociodemographic and spatial factors in Mexico City. Front. Glob Womens Health ; 6 . (2025). O’Connor, S. & Su, L. J. Postpartum Depressive Symptoms: An Analysis of Social Determinants Using the Pregnancy Risk Assessment Monitoring System. Women’s Health Reports [Internet]. 2023 Dec [cited 2025 Jul 14];4:584–93. Available from: https://pubmed.ncbi.nlm.nih.gov/38099076/ Martínez-Galiano, J. M., Hernández-Martínez, A., Rodríguez-Almagro, J., Delgado-Rodríguez, M. & Gómez-Salgado, J. Relationship between parity and the problems that appear in the postpartum period. Sci Rep [Internet]. 2019 Dec [cited 2025 Jul 14];9. Available from: https://www.nature.com/articles/s41598-019-47881-3 Kawai, K. et al. Effects of Parity and Postpartum Depression on Mother-Infant Bonding in the First Month Postpartum: A Retrospective Study. Cureus [Internet]. Sep [cited 2025 Jul 14]; (2023). Available from: https://pubmed.ncbi.nlm.nih.gov/37868565/ Moameri, H., Ostadghaderi, M., Khatooni, E. & Doosti-Irani, A. Association of postpartum depression and cesarean section: A systematic review and meta-analysis. Clin Epidemiol Glob Health [Internet]. 2019 Sep [cited 2025 Jul 14];7:471–80. Available from: https://www.sciencedirect.com/science/article/pii/S2213398418301416 Gravensteen, I. K. et al. Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: A prospective study. BMC Pregnancy Childbirth [Internet]. Jan [cited 2025 Jul 14];18. (2018). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5781321/ Radesky, J. S. et al. Inconsolable infant crying and maternal postpartum depressive symptoms. Pediatrics [Internet]. Jun [cited 2025 Jul 14];131. (2013). Available from: https://pubmed.ncbi.nlm.nih.gov/23650295/ de Barbaro, K. et al. Infant Crying Predicts Real-Time Fluctuations in Maternal Mental Health in Ecologically Valid Home Settings. Dev Psychol [Internet]. 2023 Feb [cited 2025 Jul 14];59:733–44. Available from: https://pubmed.ncbi.nlm.nih.gov/36848043/ Cho, M. & Lee, M. H. Predictors of Postpartum Depression in Korean Women: A National Cross-Sectional Study During the COVID-19 Pandemic. Healthcare (Switzerland) [Internet]. 2025 May [cited 2025 Jul 14];13. Available from: https://www.mdpi.com/2227-9032/13/10/1128 Xie, J. et al. Parental engagement and early interactions with preterm infants reduce risk of late postpartum depression. Journal of Nervous and Mental Disease [Internet]. 2019 May [cited 2025 Jul 14];207:360–4. Available from: https://journals.lww.com/jonmd/abstract/2019/05000/parental_engagement_and_early_interactions_with.8.aspx Additional Declarations No competing interests reported. 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10:29:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":785217,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7171044/v1/683669e6-10e6-487b-afbe-aea97da284a9.pdf"},{"id":95625586,"identity":"da2c1934-5563-43f4-85e8-b8e9ea910c13","added_by":"auto","created_at":"2025-11-11 10:32:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16239,"visible":true,"origin":"","legend":"","description":"","filename":"SuplementaryTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-7171044/v1/f8753095fa640fe52a9185a4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Associated with Postpartum Depression in Mothers of the Kangaroo Mother Care Program in Southern Colombia: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDuring the perinatal period, women undergo emotional and psychological changes that increase their vulnerability to psychiatric disorders, such as postpartum depression (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Diagnostic and Statistical Manual of Mental Disorders defines postpartum depression as the \"occurrence of a major depressive episode (MDE) within four weeks after childbirth, which may include irritability, excessive crying, or panic.\"(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, these episodes may begin or persist during the first year after childbirth. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Postpartum depression can impair parenting skills and judgment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), diminish enjoyment of the maternal role, and create poor mother-baby interactions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Mothers with postpartum depression (PPD) show early cessation of breastfeeding and less care for their babies, leading to decreased immunity and putting babies at risk of stunted growth and development (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In addition, maternal mental health directly influences the emotional and cognitive well-being of children, impacting their holistic development (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUndetected PPD imposes a high cost on society, as the mother is less able to fulfill her caring responsibilities(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Globally, it is estimated that 14\u0026ndash;17% of women in the postnatal period experience symptoms of PPD, which equates to approximately one in six to seven mothers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn low- and middle-income countries, PPD affects up to 48.5% of women, but only 6.5\u0026ndash;12.9% of women in high-income countries (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Postpartum depression has been linked to several risk factors, including stressful life events, a history of depression, not breastfeeding, first birth, and negative body image. Other risk factors include having a poor relationship with a partner and low socio-economic status (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, in some contexts, higher education, permanent employment, a friendly and trustworthy partner, and belonging to the majority ethnic group were protective factors against PPD (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Europe, data show an increase in DPP. In England, prevalence increased from 10.3% in 2014 to 16.0% in 2018 and rose dramatically to 23.9% during the COVID-19 pandemic in 2020 (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In Portugal, a study revealed rates of 18.5% during the third trimester of pregnancy and 17.6% at 2\u0026ndash;3 months postpartum, with a higher incidence in adolescent mothers (25.9% versus 9.3% in adults)(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Africa, the variability is even greater, with rates ranging from 6.9 percent in Morocco to 43 percent in Uganda (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A recent study in Uganda (2019\u0026ndash;2020) reported a prevalence of 27.1% (95% CI 22.2\u0026ndash;32.5), which is significantly higher than the historical data for the country (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In Burkina Faso, prevalence can be as high as 44% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Latin America, recent studies show a prevalence ranging from 13\u0026ndash;21.7%, with Brazil being one of the countries with the highest incidence in the region (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A 2021 systematic review revealed that approximately 13% of Latin American women suffer from PPD, although this figure can rise to 34.46% in specific populations such as young and urban women (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Colombia, the frequency is 5.1% and 22.36% of mothers, with an estimated national prevalence of 12.9% according to the 2010 National Demographic and Health Survey, being higher in urban areas (15.1%) than in rural areas (6.8%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The most prevalent risk factors include relationship breakdown (OR\u0026thinsp;=\u0026thinsp;6.26), severe economic hardship (OR\u0026thinsp;=\u0026thinsp;6.61), and death in the family (OR\u0026thinsp;=\u0026thinsp;3.79) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, the present study aimed to identify the frequency and factors related to postpartum depression in mothers attending the kangaroo care program in a high-complexity institution in Colombia.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eType of study and participants\u003c/h2\u003e\u003cp\u003e Cross-sectional analytical study, conducted in Southern Colombia between August 2021 and May 2022, with 140 women participants who had preterm and/or low birth weight and were in the Kangaroo Care program at the Hospital Universitario Hernando Moncaleano Perdomo. This hospital is the only center that offers the Kangaroo Care program in the city of Neiva, and it is expected that postpartum women will be cared for there with their babies.\u003c/p\u003e\u003cp\u003eMothers who agreed to participate gave their consent and received a self-administered questionnaire that included the validated Colombian version of the Edinburgh Postnatal Depression Scale- \u003cb\u003eEPDS.\u003c/b\u003e This instrument is commonly used as a self-administered questionnaire for screening for postpartum depression. In addition, studies have shown comparable efficacy between self-administered questionnaires and face-to-face interviews in diagnosing this condition.\u003c/p\u003e\u003cp\u003eTo ensure the data quality, one of the researchers was present at the site of data collection to ensure that the questionnaire was comprehensive.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria were NB under two months old, registered and active in kangaroo care in a fourth-level health institution, and being of legal age.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eWomen previously diagnosed with depressive disorder, anxiety disorder, bipolar disorder, addiction to psychoactive substances and/or alcohol, or intellectual disability, were excluded. Besides, it was kept in mind that NBs showed no congenital diseases such as Down\u0026rsquo;s syndrome, cleft lip, spina bifida, or Edwards\u0026rsquo; syndrome.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size and sampling method.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was calculated in the OpenEpi Version 3.0 program. The minimum sample size was 140 with a confidence level of 95%, a margin of error of 5%, and a response distribution of 50%. The sample was then non-probability convenience sampling.\u003c/p\u003e\n\u003ch3\u003eInstrument\u003c/h3\u003e\n\u003cp\u003ePPD may be associated with some sociodemographic, gynecological-obstetrical, and psycho-emotional factors, which were measured with the following 2-part self-administered questionnaire: \u003cb\u003e1)\u003c/b\u003e Sociodemographic: age, place of residence, socioeconomic status, educational level, marital status, occupation, family and social support. Obstetric and gynecological: number of pregnancies, births, abortions, cesarean sections, live births, stillbirths, smoking, illnesses during pregnancy, difficulty breastfeeding, and perinatal complications (cleft lip, asphyxia, low birth weight). Psychoemotional: planned pregnancy, physical and/or psychological abuse before, during, or after pregnancy, irritability when hearing the baby cry, adequate fulfillment of the maternal role, and care of the baby (alone, in a couple, in a family, employed in the home). \u003cb\u003e2)\u003c/b\u003eThe Edinburgh postpartum depression scale is a questionnaire consisting of 10 items to explore the mother's mood during the seven days before its application, scoring each question from zero to three, according to symptomatic severity and a maximum of 30 points(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). For Colombia, the EPDS was validated in a study conducted in the city of Cartagena, showing a high internal consistency of 0.78 Cronbach's Alpha for postpartum depression(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eThe nominal variables were described with frequency tables and were compared with the Chi-2 test. The ratio variables were summarized with measures of central tendency and dispersion and were presented with the mean and standard deviation based on the normality assumption. Furthermore, they were compared to the t-student test for independent samples. A correlation analysis was carried out between the factors measured as ratio variables (age, pregnancy weeks, number of pregnancies, labors, cesarean births, abortions, live births, number of prenatal care of the reference pregnancy, and, number of current children) and the ordinal variables (socio-economic stratum and educational level) with each of the dimensions of the postpartum depression scale (depressed mood, anhedonia, hopelessness, and guilt), the depression level and the total score of the scale, applying Pearson and Spearman correlation statistics respectively.\u003c/p\u003e\u003cp\u003eThe variables that showed statistical significance in the comparisons were included in the binary logistic regression model by entering postpartum depression (Yes/No) as a dependent variable. All tests used alfa\u0026thinsp;=\u0026thinsp;0.05, and the statistical analyses were carried out using the R Studio computer program.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical consideration\u003c/h2\u003e\u003cp\u003e This study was conducted according to the Declaration of Helsinki of the World Medical Association. Before data collection, written informed consent was obtained from the participants, and the role of the researchers, the objectives of the study, the confidentiality and anonymity of the information, and voluntary participation and withdrawal from the study at any time were explained to them. The approval of the ethics and ethics committee was conferred by the Hospital Universitario Hernando Moncaleano Perdomo de Neiva through number 012\u0026thinsp;\u0026minus;\u0026thinsp;005 of 2020.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eRegarding sociodemographic factors, participants reported their age, ranging from 18 to 43 years, with a mean of 27.01 (standard deviation \u0026plusmn; 6.44). The table in the supplementary material shows that most of the participants resided in urban areas, in localities of low socioeconomic stratum, with occupations that do not generate direct income or are unemployed. When comparing the socioeconomic factors, there were no differences between the group of mothers with indicators of depression and the control group. The frequency of PDD was 23.5% in the population studied.\u003c/p\u003e\u003cp\u003eRegarding gynecological-obstetric factors, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the differences identified between the two groups in the antecedents related to reproductive history, women with depression indicators referred a higher number of pregnancies (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), vaginal deliveries (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), live births (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), and children (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.00), the latter with marginal statistical significance. The other factors show similar behavior between the groups presented in the table in the supplementary material.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGynaeco-obstetric and Psycho-emotional factors of mothers attending the kangaroo program.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSi\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePregnancies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.2\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal deliveries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive births\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u0026ordm; children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEqual or less than two\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than two\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbuse in pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e3.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNB care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e6.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCouple\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelatives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrritability NB cry\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e9.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote. NB\u0026thinsp;=\u0026thinsp;Newborn. The statistic for comparing the nominal factors was \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\chi\\:}^{2}\\)\u003c/span\u003e\u003c/span\u003e Note. SES\u0026thinsp;=\u0026thinsp;Socio-economic stratum. \u003csup\u003ea=\u003c/sup\u003e Mean. \u003csup\u003eb=\u003c/sup\u003e Standard deviation. The statistic for comparing the nominal factors was \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\chi\\:}^{2}\\)\u003c/span\u003e\u003c/span\u003e and t-Student test for the quantitative factors for independent samples.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the Psycho-emotional factors, conditions related to newborn care, such as care (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04) and the mother's emotional response to hearing crying (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04), were significant. The variable maltreatment in pregnancy showed marginal significance, with a higher frequency in the postpartum depression group. However, the total number of cases in both groups was low. The other factors showed similar behavior between the two groups.\u003c/p\u003e\u003cp\u003eCorrelation analysis is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, identifying a negative correlation between the hopelessness and guilt items of the Edinburgh questionnaire and level of education (r = -0.37, p\u0026thinsp;=\u0026thinsp;0.03). In contrast, the relationship with the number of births was positive (r\u0026thinsp;=\u0026thinsp;0.42, p\u0026thinsp;=\u0026thinsp;0.01). Likewise, the level of depression was related to education and obstetric-gynecological factors such as the number of pregnancies (r\u0026thinsp;=\u0026thinsp;0.36, p\u0026thinsp;=\u0026thinsp;0.04), births (r\u0026thinsp;=\u0026thinsp;0.34, p\u0026thinsp;=\u0026thinsp;0.05), live births (r\u0026thinsp;=\u0026thinsp;0.34, p\u0026thinsp;=\u0026thinsp;0.05), and children (r\u0026thinsp;=\u0026thinsp;0.37, p\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelations among factors with the dimensions of the post-partum scale (Edinburgh) of mothers attending the kangaroo program.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepressed mode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAnhedonia\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHopelessness and guilt\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDepression level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.20 (0.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.03 (0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.11 (0.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.19 (0.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.22 (0.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSES\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.28 (0.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.15 (0.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.18 (0.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.34 (0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.26 (0.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSchooling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.13 (0.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.14 (0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.37 (0.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.37 (0.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.21 (0.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePregnancies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00 (0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.21 (0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.30 (0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.36 (0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.24 (0.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeliveries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.11 (0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.01 (0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.42 (0.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.34 (0.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.33 (0.06)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaesarean deliveries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.02 (0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.27 (0.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.29 (0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.04 (0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.04 (0.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbortions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.08 (0.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.04 (0.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.12 (0.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.06 (0.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.00 (0.99)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.12 (0.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.20 (0.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.18 (0.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.34 (0.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.27 (0.13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u0026ordm; of children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.12 (0.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.20 (0.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.19 (0.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.37 (0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.28 (0.12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN\u0026ordm; controls prenatal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.17 (0.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.38 (0.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.04 (0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.00 (0.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.13 (0.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeeks Pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.11 (0.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.20 (0.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.10 (0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.08 (0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.13 (0.46)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote. SES\u0026thinsp;=\u0026thinsp;Socio-economic stratum. The statistics used for correlations were Pearson and Spearman. The table shows the value of r for correlation, and the values in parentheses correspond to statistical significance.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA multivariate analysis was performed using binary logistic regression; the dependent variable was PPD, measured by the EPDS, and included as independent variables those mentioned in the comparison with Chi-2 and T-Student statistics. This analysis produced a Nagelkerke's R2 of 0.362. The model presented could explain 36% of the relationship between the sociodemographic and Psycho-emotional factors included. During the analysis, factors that lost statistical significance, those that did not fit the model, or contributed minimally to the R2 were excluded when introducing each variable.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analysis between factors with post-partum depression in mothers attending the kangaroo program.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBeta\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003evalue (p)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNB care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIrritability on cry NB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAIC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e143.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote. NB\u0026thinsp;=\u0026thinsp;Newborn\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the model for postpartum depression, explained mainly by the variables: maternal irritability due to the crying of the NB (β\u0026thinsp;=\u0026thinsp;1.14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01) and newborn care (β= -0.47, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study showed that the prevalence of PPD was 23.5%, which is consistent with recent global reports for vulnerable populations. In this regard, Wang et al. (2021) documented a global prevalence of 17.22% (95% CI: 16.00-18.51), being significantly higher in low- and middle-income countries (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In Latin America, research shows prevalences ranging from 13\u0026ndash;21.7%, with Brazil being the country with the highest rates in the region. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In Colombia, the estimated national prevalence is 12.9% according to the 2010 National Demographic and Health Survey, with a higher frequency in urban areas (15.1%) compared to rural areas (6.8%)(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The findings of our study exceed these national figures, which may be explained by the specific characteristics of the population studied: mothers with preterm or low birth weight infants in kangaroo care programs, who face additional risk factors (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe average age of the participants (27 years) and the higher proportion of young women with postpartum depression are consistent with recent evidence. A US study of more than 1.1\u0026nbsp;million mothers worldwide identified that mothers under the age of 25 are at the highest risk of postpartum depression (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Specifically, women aged 40\u0026ndash;44 years showed a 3.72 times higher risk (OR: 3.72; 95% CI: 2.15\u0026ndash;6.41) compared to women aged 30\u0026ndash;35 years(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The predominance of women from urban areas in our study reflects global patterns, with the urban prevalence of postpartum depression reaching 10% versus 6% in rural areas. This phenomenon is attributed to factors such as weaker social support networks, especially in urban migrant populations(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent studies indicate that economic hardship is the strongest predictor of postpartum depression (OR: 4.0; 95% CI: 1.4\u0026ndash;6.3)(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In our study, the predominant population was of middle and low socioeconomic income. In turn, Mexican research confirms that women in below-median income groups have the highest prevalence of postpartum depression (22%) compared to middle- and high-income groups (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Income emerges as the strongest predictor among all social status indices, surpassing even education and occupational prestige(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings relating to a higher number of pregnancies, vaginal deliveries, and live births to PPD are differential findings concerning the literature and what is presented in high-income countries. A Japanese study of 1,509 patients showed that primiparas have a higher risk of depressive symptoms (22.2%) compared to multiparas (11.6%) (OR: 1.65; 95% CI: 1.31\u0026ndash;2.06) (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). On the other hand, Spanish research with 2,990 postpartum women confirmed that primiparas are 1.6 times more likely (OR: 1.60; 95% CI: 1.35\u0026ndash;1.89) to have feelings of sadness and 1.65 times more likely to have depressive symptoms(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This difference in results can be explained by the specific characteristics of our population: mothers who participate in the kangaroo care program may experience greater anxiety when faced with neonatal complications due to their previous experience of childbirth. Furthermore, in Colombia, mothers give birth at a younger age than in the countries mentioned above, and families have a higher average number of children (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough our study found only marginal statistical differences according to mode of delivery, recent evidence suggests significant associations. A 2019 meta-analysis reported that cesarean delivery is associated with a higher risk of postpartum depression (OR: 2.0; 95% CI: 1.35\u0026ndash;2.96) compared to vaginal birth (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In turn, an Iranian study of 300 postpartum women documented that 13.3% of women who had cesarean sections developed depression, compared to 7.1% of those who had vaginal births. However, the heterogeneity between studies suggests that other moderating factors, such as the experience of kangaroo care, may influence this association(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe most significant finding of our study was the association between maternal irritability due to newborn crying and postpartum depression (β\u0026thinsp;=\u0026thinsp;1.14, p\u0026thinsp;=\u0026thinsp;0.01). This relationship is well documented in recent literature. A longitudinal study of 587 mothers showed that maternal reports of inconsolable infant crying for more than 20 minutes per day were associated with an OR of 4.0 (95% CI: 2.0-8.1) for postpartum depression(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Oberlander et al. (2017) reported that exposure to infant crying predicts dynamic fluctuations in maternal mental health, with effects accumulating over hours(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Specifically, when crying was above average for 8 hours, mothers reported subsequent increases in depressive symptoms. Recent neurological research demonstrates that depressed mothers show reduced neural activation in regions related to emotional response and regulation when they hear their babies cry (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe negative association between caregiving and postpartum depression (β= -0.47, p\u0026thinsp;=\u0026thinsp;0.04) suggests that caregiving support acts as a protective factor. A Korean study during the COVID-19 pandemic identified that paternal involvement in infant care significantly reduces the risk of postpartum depression (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Research on mothers with infants in NICU showed that early parental engagement and early interactions reduce the risk of late postpartum depression (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). This is particularly relevant in the context of kangaroo care, where family support is critical to the success of the program.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study has the following limitations. First, its cross-sectional design prevents conclusions from being drawn about causality or temporal relationships between the identified risk factors and postpartum depression. Second, the use of non-probability sampling may limit the generalization of the results. Third, postpartum depression was assessed solely using the Edinburgh Postnatal Depression Scale, which, although validated, is a self-report instrument and not a diagnostic psychiatric interview, which could introduce classification bias. The sample size may limit statistical power, especially in multivariate analysis. Finally, given that all participants were mothers of premature or low birth weight babies, the results are not applicable to all postpartum women.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study revealed the prevalence of postpartum depression of 23.5%. Psychoemotional factors, specifically maternal irritability in response to the baby's crying, were associated with an increased risk of postpartum depression, while support in caring for the newborn showed a protective effect. Similarly, multiparity, a higher number of vaginal births and a higher number of live births were associated with an increased risk. These results highlight the importance of considering context-specific factors and psycho-emotional dynamics in the identification and prevention of postpartum depression in kangaroo care settings.\u003c/p\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eIt is recommended that systematic screening protocols for postpartum depression be implemented in all kangaroo care programs, using the EPDS with culturally validated cut-off points. It is essential to develop specific interventions aimed at improving maternal skills for managing infant crying and strengthening family support networks. Finally, maternal mental health assessments need to be integrated into clinical practice guidelines for kangaroo care programs, with clear protocols for referral to specialized mental health services.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003epostpartum depression\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSM-5\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMental Disorder Diagnose and Statistical Manual\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNewborn\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEPDS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEdinburgh's Postpartum Depression Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted according to the Declaration of Helsinki of the World Medical Association. Before data collection, written informed consent was obtained from the participants, and the role of the researchers, the objectives of the study, the confidentiality and anonymity of the information, and voluntary participation and withdrawal from the study at any time were explained to them. The approval of the ethics and ethics committee was conferred by the Hospital Universitario Hernando Moncaleano Perdomo de Neiva through number 012-005 of 2020.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to promises of participant anonymity and confidentiality, but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was financially supported by Universidad Surcolombiana, Internal Call PSEM01-2020, the bank of Research and Technological Development and Innovation student seedbed groups, in the financing mode code 3567.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRLSH, GBS: study conception and design. RLSH, GBS: data collection data collection. GBS: data analysis and interpretation. RLSH, GBS, and JDDCH Manuscript writing. GBS, RLSH, JDDCH: Critical revision. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the kangaroo method health team in the University Hospital Hernando Moncaleano Perdomo in Neiva, Colombia, and the participating women who made it possible to carry out this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Nursing Program, Faculty of Health Sciences, Universidad Surcolombiana.\u003c/p\u003e\n\u003cp\u003e2. Faculty of Nursing, Universidad Antonio Nari\u0026ntilde;o.\u003c/p\u003e\n\u003cp\u003e3. Psychology Program, Faculty of Social and Human Sciences, Universidad Surcolombiana, Universidad Cooperativa de Colombia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMcKelvey, M. M. \u0026amp; Espelin, J. Postpartum depression. Nursing Made Incredibly Easy [Internet]. 2018 May [cited 2025 Jul 14];16(3):28\u0026ndash;35. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2018/05000/postpartum_depression__beyond_the__baby_blues_.7.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2018/05000/postpartum_depression__beyond_the__baby_blues_.7.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association Staff. \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision\u003c/em\u003e20\u0026ndash;40 (American Psychiatric Association Publishing, 2010). editor. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://books.google.com.co/books/about/Diagnostic_and_Statistical_Manual_of_Men.html?id=w_HajjMnjxwC\u0026amp;redir_esc=y\u003c/span\u003e\u003cspan address=\"https://books.google.com.co/books/about/Diagnostic_and_Statistical_Manual_of_Men.html?id=w_HajjMnjxwC\u0026amp;redir_esc=y\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGavin, N. I. et al. Perinatal depression: A systematic review of prevalence and incidence [Internet]. Vol. 106, Obstetrics and Gynecology. 2005 [cited 2025 Jul 14]. pp. 1071\u0026ndash;83. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/greenjournal/abstract/2005/11000/perinatal_depression__a_systematic_review_of.27.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/greenjournal/abstract/2005/11000/perinatal_depression__a_systematic_review_of.27.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEarls, M. F., Yogman, M. W., Mattson, G. \u0026amp; Rafferty, J. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice. Pediatrics [Internet]. 2019 Jan [cited 2025 Jul 14];143:142. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lww.com/jonmd/abstract/2019/05000/parental_engagement_and_early_interactions_with.8.aspx\u003c/span\u003e\u003cspan address=\"https://journals.lww.com/jonmd/abstract/2019/05000/parental_engagement_and_early_interactions_with.8.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Postpartum depression, mental health, Edinburgh's Scale, Kangaroo care","lastPublishedDoi":"10.21203/rs.3.rs-7171044/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7171044/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePostpartum depression is a worldwide public health problem associated with postpartum risk factors, which requires being studied in mothers with newborns enrolled in kangaroo care programs.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo establish the frequency and the factors related to postpartum depression in mothers attending kangaroo care in Colombia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eCross-sectional analytic study that used Edinburgh's postpartum depression survey, and a questionnaire that asked for the sociodemographic, obstetric-gynecological, and psycho-emotional factors in 140 mothers with newborns.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe postpartum depression frequency was 23.5% higher in young women with an average age of 27 years, from urban areas, and low socio-economic stratum; a significant proportion reported the obstetric-gynecological factor associated with the number of pregnancies, vaginal delivery, and live births. The multivariate analysis by logistic regression showed that the care of the newborn and the irritability caused by the newborn's crying to the mother are associated with postpartum depression.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eEstablishing the postpartum depression frequency and risk factors provides the nursery with a theoretical ground to offer programs oriented towards the care of women during postpartum at the community level, strengthening the childcare of the newborn, articulated to an interdisciplinary team where the mother's physical and mental health are integrated.\u003c/p\u003e","manuscriptTitle":"Factors Associated with Postpartum Depression in Mothers of the Kangaroo Mother Care Program in Southern Colombia: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 10:31:56","doi":"10.21203/rs.3.rs-7171044/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-28T09:30:53+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-16T16:29:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-10T17:36:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180835820882920865132653010899219693649","date":"2025-11-03T11:55:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168684257518870582463596427848763015022","date":"2025-11-03T07:12:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-30T22:37:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-28T09:48:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-11T08:43:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-07T16:36:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-08-07T16:32:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c105eda1-ee90-45d8-b7cf-d80d37ed12af","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":57750278,"name":"Health sciences/Diseases"},{"id":57750279,"name":"Health sciences/Health care"},{"id":57750280,"name":"Health sciences/Medical research"},{"id":57750281,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-03-18T14:40:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 10:31:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7171044","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7171044","identity":"rs-7171044","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}