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1. “Community-BasedInsightsintoPostpartumDepressioninUrbanandSuburbanTehsilsofLahore:Dual-ScreeningApproachwithEPDSandPHQ-8”Introduction:Postpartumdepression(PPD)isamongthemostprevalentyetunderminedmaternalmentalhealthconditionsaffectingwomenfromdifferentsocioeconomicandculturalgroupworldwide.Thisconditiondevelopsthroughpersistentlowmoodandsleepdisturbancesandfeelingsofguiltandseverecasesincludesuicidalthoughtsduringthefirstyearafterchildbirth¹.TheworldwideprevalenceofPPDcreatesmajorpublichealthchallengesthatleadtoimpairedmaternalcapabilities,inadequatechildcareanddamagedearlyparent-childrelationships².Recentmeta-analysisindicatesthatPPDaffects17-20%ofwomenworldwidebutLMICsexperiencethehighestratesbecausetheirpopulationsfaceincreasedpsychosocialstressandlimitedhealthcareaccessandsocialdiscriminationagainstmentalhealthissues³
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⁴.SouthAsiafacesasevereburdenofperinatalmentaldisordersbecausePakistanshowsamongthehighestestimatedprevalenceratesintheregionat28–63%⁵.LocalstudiesshowthatPPDdevelopsinwomenwhoexperienceloweconomicstatusandmaritalconflictsandreceiveinsufficientfamilyorspousalbackingandunplannedpregnancies⁶
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⁷.Thecombinationofculturalexpectationsformaternalbehaviorandinsufficientmentalhealthknowledgeresultsinmisseddiagnosesandunreportedcasesofpostpartumdepression⁶.TheThinkingHealthyProgrammefromWHOexistsasanevidence-basedinterventionbutitsimplementationinprimaryhealthcaresettingsremainsrestrictedandpostpartumdepressionscreeningdoesnotoccurasastandardpractice⁸.TheEdinburghPostnatalDepressionScale(EPDS)andPatientHealthQuestionnaire-8(PHQ-8)serveasvalidatedscreeningtoolstoidentifydepressivesymptomsinpostpartumwomen.TheEPDSshowshighsensitivityfordetectingperinataldepressionbecauseitassessesbothdepressiveandanxioussymptomsandself-harmthoughtsinnewmothers⁹.ThePHQ-8showsbetterspecificitythantheEPDSbutitmightmisscasesofmilddepressionandanxietysymptomsinpatients.ResearchstudiesthatvalidatethesetoolsinSouthAsiansettingsshowmoderateagreementbetweenthemwhichrequiresspecificcutoffvalueadjustmentsforeachcontext¹⁰.ResearchconductedinPakistanihospitalsacrossHyderabadandRawalpindiandKarachireportedPPDprevalencebetween19%and38%basedondifferentassessmenttoolsandpostpartumtimepoints⁶
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¹¹.Thecurrentresearchliteraturelackssufficientdataaboutpostpartumdepressionincommunitysettingsbecausetheseareasfacedifferenthealthcareconditionsandeconomicchallengesandfamilystructuresthataffectbothsymptompresentationandhelp-seekingbehavior.Althoughstudieshaveshownfamilysupportactsasaprotectivefactorforpostpartumdepressionthereisneedforfurtherbacking.Thisresearch

2. investigatespostpartumdepressionprevalenceinurbanandsuburbanLahorethroughEPDSandPHQ-8assessmentswhilestudyinghowsociodemographicvariables,deliverytimeandfamilysupportlevelsaffecttheseresults.Thestudyalsodetermineshowoftenself-harmthoughtsappearedinthispopulationtodevelopbetterscreeningmethodsforearlydetectionandriskevaluationinprimarymaternalhealthcareservices.PrimaryObjective:TodeterminetheprevalenceofpostpartumdepressionamongwomeninurbanandsuburbanTehsilsofLahoreusingEPDSandPHQ-8scalesSecondaryObjectives:ToassesstheseverityofdepressivesymptomsamongpostpartumwomenbasedonEPDSandPHQ-8.Toexploreassociationsbetweenpostpartumdepressionand:1.Agegroup2.Timesincelastconception3.Perceivedsocialsupport4.Self-harmTocomparethescreeningperformanceofEPDSandPHQ-8inidentifyingpostpartumdepression.Methodology:StudyDesignandSetting:Amulti-centrecross-sectionalstudywasconductedinthreetertiarycarehospitalsofLahore,includingCentralParkTeachingHospital,SheikhZayedMedicalComplex,ShalamarHospitalandlocalgynae-obsclinicsamongpostpartumwomenresidingindifferentTehsilsofLahore,Pakistan.StudyPopulationandSampling:AprovisionalsamplesizewascalculatedviaRaosoftsoftwarewhichcameas271,andthetargetwasreached.Atotalof314postpartumwomen,aged18to45years,whohaddeliveredwithinthelast18months,wererecruitedusingconvenientsamplingfromCPMC,SKMC,ShalamarHospitalandlocalmaternal-childhealthclinicsacrossvariousurbanandsuburbanTehsilsofLahore.Inclusioncriteriaincluded:age≥18years,havingalivebirthwithinthepast18months,andtheabilitytocomprehendUrduorEnglish.Womenwithaknownhistoryofpsychiatricillnessorcognitiveimpairment,Womenwithstillbirthsorneonataldeathswereexcluded.AquestionnaireformcontainingtwovalidatedtoolswasusedandfilledviainterviewsandbycirculatingthroughWhatsAppaccordingtotheinclusioncriteria.Theaimwastodeterminetheprevalenceand

3. severityofpostpartumdepression(PPD),exploreassociatedsociodemographicfactors,andcomparethescreeningperformanceoftheEdinburghPostnatalDepressionScale(EPDS)andthePatientHealthQuestionnaire-8(PHQ-8).DataCollectionTools:EdinburghPostnatalDepressionScale(EPDS)TheEPDSisa10-itemself-reportquestionnairedevelopedtoscreenforpostpartumdepression.Eachitemisscoredfrom0to3,withthetotalscorerangingfrom0to30.Possibledepressionwasindicatedbyacutoffscoreof≥10PatientHealthQuestionnaire-8(PHQ-8)ThePHQ-8isavalidatedtoolderivedfromthePHQ-9.Itassessesdepressivesymptomsoverthepasttwoweeksusing8items,eachscoredona4-pointscale(0–3).Totalscoresrangefrom0to24.Moderatetoseveredepressivesymptomswerecategorizedbyacutoffof≥10.Depressionseveritywascategorizedas:0–4:Minimal5–9:Mild10–14:Moderate15–19:Moderatelysevere20–24:SevereOtherVariables:Sociodemographicandinformation,includingage,timesincelastconception,andperceivedfamilysupport,werecollectedusingastructuredquestionnaire.Agewascategorizedintothreegroups:18–24(youngmothers),25–34(primereproductiveage),and35–45(advancedmaternalage).Timesincelastconceptionwasgroupedas0–6months,6–12months,and12–18months.Familysupportwasrecordedasfrequent,sometimes,ornone.Self-harmideationwassetat≥1.DataAnalysis:DatawasanalysedusingIBMSPSSversion26.Descriptivestatistics(frequencies,percentages,means,andstandarddeviation)wereusedtosummarizedemographicvariablesandprevalenceofdepression.Chi-squaretestswereconductedtoassessassociationsbetweendepressionstatusandcategoricalvariables(agegroup,timesinceconception,familysupport,andself-harmideation).TheCohen’sKappastatisticwasusedtoevaluateagreementbetweenEPDSandPHQ-8depressionclassifications.Specificity,sensitivity,positivepredictivevalues,andnegativepredictivevaluescalculatedwereusingEPDSasthereferencestandard