Postpartum Depressive Symptoms and Their Long-Term Association with Anxiety and Depression in Women: Findings from the Rhea Study in Crete, Greece

<b>Background/Objectives</b>: Postpartum depression affects 10-20% of women and may have long-term consequences for mental health. This study examines the association between postpartum depressive symptoms and women's depression and anxiety symptoms 11 and 15 years after childbirth. <b>Methods:</b> Data were drawn from the Rhea Mother-Child Cohort in Crete, Greece. A total of 1079 women completed the Edinburgh Postnatal Depression Scale (EPDS) at approximately 8-10 weeks postpartum. Of these, 516 participated in follow-up assessments at 11 and 15 years, which included measures of anxiety (State-Trait Anxiety Inventory, Trait version [STAI-Trait]) and depressive symptoms (Beck Depression Inventory [BDI]). Multivariable linear mixed-effects models were used to assess the relationship between postpartum depressive symptoms (EPDS) and later anxiety (STAI-Trait) and depression (BDI) outcomes, adjusting for sociodemographic and family-related characteristics and psychosocial factors. <b>Results:</b> Higher postpartum EPDS scores were associated with greater anxiety (STAI-Trait) and depressive symptoms (BDI) across follow-up assessments. Associations remained significant after adjusting for maternal baseline characteristics and follow-up factors. An interaction with time suggested that the association between postpartum depressive symptoms and anxiety levels strengthened over time, with a stronger association at the 15-year follow-up, indicating a higher long-term mental health burden. <b>Conclusions:</b> Postpartum depressive symptoms are associated with higher levels of depressive and anxiety symptoms 11 and 15 years after childbirth. The association with depression appeared relatively consistent across follow-up assessments, while the relationship with anxiety was stronger at the 15-year follow-up. These findings suggest that postpartum depression is an early marker of long-term vulnerability to mood and anxiety disorders, highlighting the importance of early screening, intervention, and long-term mental health support for mothers to reduce the risk of enduring psychological difficulties.