A descriptive study with two components (quantitative and qualitative) for analytical purposes was conducted in July 2025. The qualitative component provided insight into the perceptions, emotional experiences, and psychosocial factors that could be associated with postpartum blues. This qualitative approach enriched the overall analysis and made it possible to interpret the statistical associations by incorporating subjective and social dimensions, which strengthened the validity of the conclusions regarding the associated factors.

An analytical descriptive mixed-methods study was conducted in July 2025. Roy’s Adaptation Model [13] served as the conceptual reference framework. Indeed, this model [13] is a nursing theory that views the individual as an integrated whole in constant interaction with the environment, possessing innate or acquired adaptation mechanisms (biological, psychological, or social) to maintain integrity, which can be enhanced through nursing interventions.

According to Roy [13] , the factors influencing adaptation are focal, contextual, and residual stimuli. The focal stimulus represents the degree of change or stimulus that the person is facing immediately and must adapt to; it triggers the behavior. The object or event in question is foremost in the person’s mind. The contextual stimulus refers to all other factors present in the situation that will influence the focal stimulus, but are not the center of attention or energy expenditure. Finally, the residual stimulus entails all factors that may influence behavior but whose effects are impossible to verify [13] . In response to the stimuli, the person will adopt innate or acquired coping mechanisms distributed across four modes [13] :

The elements of adaptation of the Roy model [13] under study are presented in Table 1 .

The reaction of the mother to these stimuli can be observed through the four modes of adaptation of the Roy model [13] as follows:

All of these coping strategies ultimately lead to BBP, which in our case is an inappropriate response. The nursing objective, in this context, is to promote positive coping by identifying stimuli that are detrimental to the mothers’ well-being and by proposing interventions focused on the specific needs of each woman.

Data were collected from postpartum women hospitalized in the maternity recovery and hospital units of CHU-MEL in Cotonou, Benin, selected through non-probability convenience sampling from the day of delivery until the day of their discharge from the maternity ward. The sample size, limited to 71 women who had given birth, was determined by the two-week recruitment period for participants who made themselves available at this hospital. This size allowed for a descriptive estimate with sufficient accuracy for an exploratory study, although it did not guarantee the statistical power required for all analyses. Furthermore, the choice of a convenience sample, limited to a single site over a short period of time, restricts the generalizability of the results to other contexts, which is a recognized limitation of the external validity of the study. Excluded from the study were women who experienced intrauterine fetal death or medical termination of pregnancy, as well as those whose newborn had died at the time of data collection.

The French version [14] of the “Maternity Blues Questionnaire” by Kennerley and Gath [15] , coupled with a specific questionnaire composed of sociodemographic and obstetric variables, was the primary standard evaluation tool for Postpartum Blues used for data collection [16] . This tool includes 28 items designed to detect the presence and intensity of the main symptoms of PPB. The items allow women to describe what they feel (examples: “Irritable,” “Feel like crying,” “Mood swings”) by first responding “Yes” or “No” to the item, and then using a five-point Likert scale to rate the intensity of their feelings compared to usual, ranging from “much less than usual” to “much more than usual.” This dual response (absence/presence and intensity) places the surveyed postpartum women on a continuum, thus avoiding a categorical treatment of PPB. The maximum score was 28, and the minimum score was zero (0). A postpartum woman was declared to have PPB when she responded affirmatively to at least 12 out of the 28 items (threshold score set at 12) [9] . The threshold of “≥ 12 positive responses” used as a diagnostic criterion is based on the original validation of the Maternity Blues Questionnaire (MBQ), which is recognized as indicating the significant presence of baby blues. The French version of the MBQ has been adapted and validated in French-speaking contexts, but its specific validation in Benin remains to be confirmed, which somewhat limits the generalization of the results . Using the JAMOVI statistical software version 2.6.26, factors associated with the occurrence of PPB were identified using Pearson’s Chi² test or Fisher’s exact test when the conditions for Pearson’s Chi² test were not met (expected counts > 5), with a significance level set at 5% (p < 0.05). Next, variables with a p-value of less than 20% in bivariate analysis were entered into a stepwise downward multiple logistic regression model. Variables with a p-value greater than or equal to 5% were progressively eliminated until the final model was obtained, which contained only variables with a p-value of less than 5%. The adequacy of the final model was verified using the Hosmer-Lemeshow test. The final model was considered adequate when the p-value was below the 5% threshold.

Our study is part of an epidemiological research project aimed at investigating the prevalence of BPP and associated factors. It was conducted in accordance with ethical and professional standards. Articles 20 and 21 of Law No. 2010-40 of December 8, 2010, relating to the code of ethics and professional conduct for health research in the Republic of Benin, and in accordance with the principles of the current version of the Declaration of Helsinki, specifically Title III: Conditions for Conducting Health Research, Chapter 1: Epidemiological Research, specify the following: Article 20: Any epidemiological research applied to a group of individuals or a community must be subject to prior agreement by their legal representatives. Thus, authorization to collect data was obtained from the Administration of the National Institute of Health and Medical Research, registered under number 153. Article 21: The informed consent of persons participating in any epidemiological research is mandatory. Thus, for this study, data were collected with the free and informed consent of each participant. Participation in this study was strictly voluntary.

The distribution of women who gave birth according to their sociodemographic and sociocultural characteristics is presented in Table 2 .

Seventy-one postpartum women were included in the study. Their mean age was 28.2 ± 6.12 years, with a range from 17 to 42 years. The most common age group was [9] - [17] (n = 40, accounting for 56.3%). In terms of marital status, the vast majority of postpartum women were in a common-law relationship (88.7%). The majority of respondents had a secondary level of education (43.7%), and more than half of them (74.6%) were artisans and traders. Additionally, Christianity (90.1%) was the most practiced religion among the respondents, and nearly half of them (49.3%) were of the “Fon” ethnicity.

The obstetric characteristics of the women surveyed are recorded in Table 3 .

The majority (70.4%) of the postpartum women were multiparous, with an average parity of 2.34 children. A total of 67.6% had given birth via cesarean section, and the gender distribution of newborns was relatively balanced (52.1% girls and 47.9% boys). The overall health status of newborns at birth was deemed satisfactory in 91.5% of cases. Additionally, 19.7% of the births were preterm.

Table 4 below shows the distribution of women according to the number of “yes” responses to the MBQ items.

Of the 71 women surveyed, 37 answered “yes” to the MBQ items at least 12 times, or 52.1%, and were therefore women with BPP.

Table 5 below shows the distribution of BPP among women according to their postpartum days at the time of the survey.

Analysis of Table V shows that more than half (57.1%) of the women surveyed on D0 (n = 07) presented BPP. This rate increases on D1 (68.4%), decreases on D2 (33.3%), before stabilizing in the following days. These results indicate an early worsening of symptoms in the first 24 hours after delivery and that it can persist for several days.

The elements of the analysis of the influence of sociodemographic and sociocultural characteristics on the BPP are presented in Table 6 .

Analysis of Table 6 reveals that no sociodemographic variable was significantly associated with PPB (all p > 0.05). However, postpartum women in a common-law relationship exhibited PPB more frequently (55.6%) compared to those who were married (25%). Similarly, PPB appeared more common among unschooled women (66.7%) and those without professional activity (66.7%) than in other categories, although these differences were not statistically significant. Age did not appear to influence the occurrence of PPB.

Table 7 below presents the frequencies of BPP according to the obstetric characteristics of the women who gave birth.

Analysis of the data in Table 7 shows that the obstetric characteristics of the respondents did not show any statistically significant links with the occurrence of BPP. However, BPP was slightly more present in multiparous women (57.1%) than in primiparous women (50%) and was more frequent after a vaginal delivery (60.9%) than after a caesarean section (47.9%). Similarly, a higher frequency of BPP (83.3%) was noted in women whose newborns were considered to be in poor condition. Sex, term of birth, and the feeding method of the newborn did not show any significant influence.

Table 8 below presents the frequencies of BPP or not according to the other characteristics studied in the women who gave birth.

It appears from the analysis of the data in Table 8 that postpartum complications (p = 0.013) and difficulties in feeding the newborn (p = 0.028) were significantly associated with the occurrence of BPP. As for the other factors, they were not significantly associated with the occurrence of BPP, despite the fact that BPP is more frequent in women with a “low desire for pregnancy” (60%), in a “situation of marital conflict” (60.9%), with “low support from those around them” (62.5%), or having had “complications during pregnancy” (60.9%).

Multivariate analysis

We used a stepwise logistic regression method. All variables that were significantly associated with the 20% threshold in univariate analysis were retained to form our first multivariate model. At each stage, the variable with the highest p-value was eliminated until all variables significantly associated with the 5% threshold were obtained at the ninth stage ( Table 9 ).

Occupation was the only sociodemographic factor to have a statistically significant influence on the risk of BPP. Adjusted for the other variables in the model, midwives who were not working were at greater risk (OR = 1.60; 95% CI = [1.03 - 2.49]) of having BPP.