The transition to motherhood is often a joyful experience for women, yet it also presents numerous stressors, include concerns about their infant's health, feeding, and development, as well as the potential for increased feelings of isolation and stress when support from partners, family, or the community is lacking(Leahy-Warren et al., 2012; Mughal et al., 2022). While many mothers successfully navigate these challenges and embrace motherhood, some struggle to adapt to their new roles and experience symptoms of depression during the postnatal period(Roomruangwong & Epperson, 2011). Postpartum depression is a major depressive disorder that occurs within the first six weeks after childbirth but may persist through the 12th month of the postnatal period. According to the DSM-5, individuals are considered to be depressive if they experience at least four symptoms, including depressed mood, loss of appetite or weight, feelings of worthlessness or guilt, sleep disturbance, impaired attention or decision making, fatigue, and suicidal ideation or attempts(Roehr, 2013).

Postpartum depression (PPD) is a significant public health concern with adverse effects on both mothers and their infants(Dinwiddie et al., 2018). A review of 96 studies estimated that the prevalence of PPD during the first three months postpartum is approximately 12 %(Woody et al., 2017). A recent World Health Organization (WHO), 2025 report showed that about 20 % of mothers in developing countries experience clinical depression after childbirth (World Health Organization;, 2025). Additionally, a systematic review and meta-analysis reported that 23 % of Ethiopian mothers experience symptoms of depression following childbirth(Tolossa et al., 2020). Common adverse maternal consequences of PPD include suicidal thoughts, persistent mental illness, and poor parenting practices(Siegel & Brandon, 2014). The negative impact extends to infants, who are more likely to face behavioural disorders, cognitive developmental delays, decreased social engagement, and feeding difficulties, leading to malnutrition and gastrointestinal disorders(Layton et al., 2021; Rai et al., 2023).

In the post-2015 development agenda, the WHO is considering additional indicators to encourage the integration of mental health conditions into maternal and child health services (World Health Organization;, 2025). The integration of mental health services into maternal care has resulted in high-quality, holistic maternal care (Almutairi et al., 2023). Healthcare professionals working with labouring women may utilize nursing intervention programs to minimize PPD(Mohamed et al., 2025). Salutogenesis based intervention advocating health promotion initiatives focusing on the origins of health (salutogenesis) rather than the origins of disease (pathogenesis)(Davis et al., 2019).

Sense of coherence (SOC) refers to an individual's ability to identify and mobilize internal and external resources to cope with stressful situations(Eriksson & Lindström, 2006). It is a coping strategy that helps maintain a balance between personal resources and demands, promoting psychosocial well-being(Geyer, 1997). According to the salutogenesis theory, these resources, termed generalized resistance resources (GRRs), contribute to a strong SOC(Antonovsky, 1979). Generalized resistance resources (GRRs) include self-efficacy (internal coping ability) and social support (external supportive resources)(Idan et al., 2017). Self-efficacy is a social cognitive theory developed by Albert Bandura that pertains to an individual's belief in her or his ability to perform specific tasks (Bandura, 1977). Self-efficacy on parenting role refers to a mother's belief in her ability to fulfil her parenting role, enhances her confidence in managing newborn care, playing a crucial role in reducing the likelihood of developing PPD(Shadhiya et al., 2021). Social support can be provided to postpartum mothers through various sources, including family members, peers, health professionals, and neighbours(Ozbay et al., 2007). Supportive social support during the postpartum period may enhance mothers' psychosocial well-being(Tenaw, Ngai, & Lam, 2024). Existing evidence indicates that social support following childbirth plays a protective role and can reduce the risk of PPD (Tambağ et al., 2018).

Existing literature suggests that SOC, self-efficacy, and social support are positively correlated with mental well-being(Wang et al., 2015). A strong SOC enables mothers to adapt to parenting by fostering self-belief and seeking social support when needed, thereby reducing the risk of depression following childbirth(Ngai & Ngu, 2015). Most studies have predominantly focused on Western and Asian populations, leaving a gap in understanding how these factors interact in African settings, where cultural, social, and economic differences may influence these dynamics. We hypothesize that SOC, self-efficacy, and social support are reinforcing factors that contribute to maintaining psychosocial well-being and reducing the risk of depression following childbirth. The conceptual model is based on existing literature describing the relationships between SOC, self-efficacy, social support, stress, and PPD (Fig. 1). To support culturally adapted programs that promote maternal well-being, we identified the following research questions: 1. What are the direct and indirect effects of sense of coherence, self-efficacy, social support, and perceived stress on postpartum depression among Ethiopian mothers during the transition to motherhood? 2. How do sense of coherence and self-efficacy interact with social support and perceived stress to influence the risk of postpartum depression?