Background: Postpartum depression (PPD) is a critical mental health condition that affects mother-infant bonding, child development, and maternal well-being. It often leads to marital and social challenges that hinder positive parenting. Research on PPD in the Philippines, especially in urban areas, is limited. Additionally, despite WHO guidelines on postpartum care, there is insufficient evidence on PPD service utilization, including barriers to care. Addressing these gaps is crucial for developing targeted interventions and policies to improve maternal mental health support.

Methods: We conducted a mixed methods study in Manila, Philippines, with 410 mothers aged 15-49. Mothers were screened using the Edinburgh Postnatal Depression Scale (EPDS) and completed structured questionnaires. Quantitative data were analyzed using multivariable-adjusted logistic regression to identify PPD determinants. In-depth interviews with 30 mothers suggestive of PPD explored their experiences and challenges with PPD and service utilization. Thematic analysis was performed using the socio-ecological model as the theoretical framework. Both quantitative and qualitative data were integrated using joint displays.

Results: Approximately 25.6% of mothers had EPDS scores suggestive of PPD. Mothers in extended families had lower odds of PPD (AOR [adjusted odds ratio]: 0.63, 95% CI [confidence interval]: 0.51, 0.79) compared to those in nuclear families. Satisfaction with a partner was associated with lower odds of PPD (AOR: 0.21, 95% CI: 0.12, 0.37), and being in a relationship for over a year reduced the odds (AOR: 0.44, 95% CI: 0.22, 0.87). While 50.4% of mothers considered using PPD services, only 4.0% used them regularly, and 63.2% reported not receiving information about these services. Barriers such as long wait times, lack of information, and poorly tailored services contributed to unmet needs and low service utilization. Both quantitative and qualitative findings highlighted significant gaps in service accessibility.

Conclusions: This study highlights the significant prevalence of PPD among mothers in Manila. Family structure and relationship satisfaction are protective factors, but service utilization remains low due to barriers like long wait times and lack of information. These findings emphasize the need for improved accessibility, awareness, and tailored PPD services in the Philippines to support maternal mental health.