Postpartum Mental Health and its Relationship with Social-Structural Determinants of Health in Iran with the Approach of the World Health Organization Model: A Systematic Review

Postpartum psychiatric disorders are a key concept in maternal-infant mental health, and determining the related factors is necessary. We aimed to determine the relationship between postpartum mental health and social-structural determinants of health in Iran.

In this systematic review, all Persian and English observational studies in Iran carried out through advanced search in online databases such as Medline, Scopus, Web of Science, EMBASE, SID and Magiran, as well as the Google Scholar between 2005 and 2020, using keywords of social determinants, structural factors, socio-economic status, risk factors, mental health, postpartum, Iran, and their English equivalents were obtained from MESH. Article quality was assessed using the standard Newcastle-Ottawa Scale (NOS).

Out of 56 eligible articles (sample size: 36,515), 49 articles reported the prevalence of postpartum depression and one article reported the prevalence of postpartum psychosis. The lowest and highest prevalence of postpartum depression was between 4.8-68.5% using the Edinburgh tool in 2014-2017 and using the Beck tool between 3-78.27% in 2013-2014. Structurally significant effective factors on postpartum depression were identified including mother's age, mother's education, father's education, mother's job, father's job, family economic status (income adequacy), ethnicity and race, social class, culture, and religion, and in the field of postpartum psychosis, age, level of education, and mother's job. The most common structural determinant related to postpartum mental health was education and the least factor was related to social class.

Due to the effects of numerous related factors on common postpartum mental disorders, it is suggested that longitudinal studies be conducted to investigate the role of all the known factors, especially Intermediate factors, on postpartum mental health.