Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel.

Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2 to 4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.