The study was performed using a diagnostic survey with questionnaires. We used standardized research instruments: the Edinburgh Postnatal Depression Scale (EPDS) and the Orientation to Life Questionnaire (SOC-29), as well as a original survey questionnaire.
The EPDS comprises 10 statements describing various aspects of a woman’s mood, including: anhedonia, guilt, anxiety, panic attacks, fatigue/overload, sleep disorders, sadness/depression, tearfulness, and suicidal ideation. The patient chooses one of the proposed responses to each statement. Scores for each statement range between 0 and 3 points. The total score is the sum of all item scores, with a maximum of 30 points. Higher scores indicate a higher probability of postpartum depression. Increased risk of depression is indicated by scores of 12–13 points or higher. In the overall evaluation, any positive score for suicidal ideation should be considered alarming, even with a low total EPDS score. The questionnaire’s reliability in the original study was measured by internal consistency (Cronbach’s α) is 0.88. Cronbach’s α for the EPDS in Polish settings is 0.91 [13].
The Orientation to Life Questionnaire (SOC-29) designed by Aaron Antonovsky measures the “sense of coherence” (SOC), also called “global orientation to life”. It reflects an individual’s perception of the world as predictable, manageable, and worthy of commitment. SOC has three components: the sense of comprehensibility — belief in the predictability and coherence of stimuli coming in from one’s external environment; manageability — belief in one’s ability to meet the requirements posed by these stimuli; and meaningfulness — an attitude of readiness to commit and make an effort. The questionnaire comprises 29 items in three subscales, reflecting the three components of coherence: manageability, meaningfulness, and comprehensibility. The respondent rates each statement in reference to themself and their life on a 7-item scale. The Cronbach’s α is 0.85 for the entire questionnaire, and between 0.72 and 0.75 for each subscale [10, 14]. The Polish version of the SOC-29 questionnaire has been found highly reliable. Internal consistency values were as follows: 0.92 for global sense of coherence, 0.78 for comprehensibility, 0.72 for manageability, and 0.68 for meaningfulness, while Cronbach’s α ranged between 0.82 and 0.95 in different studies [15].
Original survey questionnaire included sociodemographic variables like age, education, residence, relationship status, number of children, professional activity (Additional file 1).
Statistical analysis
Statistical analyses of data from the questionnaires were performed using the SPSS Statistics 25.0 software. Correlations between socio-demographic factors, the incidence of early postpartum emotional disorders, and the global SOC and its components were calculated using the non-parametric Spearman’s rho correlation coefficient. Predictors of postpartum emotional disorders were identified using stepwise hierarchical regression analysis. This method involves stepwise inclusion in the model of variables with the most significant impact on the dependent variable, thus limiting the problem of variable correlation. Based on standardized regression residual values, 6% of outliers were removed. To find which variables, out of SOC components and socio-demographic factors, are significant predictors of emotional disorders in the postpartum patients, hierarchical regression analysis was used. In the first step, SOC was considered, and in the second, marital status and education were also included. The dependent variable was the severity of postpartum emotional disorders. Two models were built: one for SOC components, and another for global SOC. Findings at p < 0.05 were considered statistically significant.