{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:03:59Z","timestamp":1785434639725,"version":"3.56.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postpartum depression (PPD) is a common mental health condition affecting mothers, infants, and families, with higher prevalence in middle-income countries. Despite its burden, PPD remains under-screened in Lebanese public hospitals, particularly in disadvantaged areas like Tripoli.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess nurses\u2019 knowledge, attitudes, and practices regarding PPD and explore facilitators, and barriers influencing the potential implementation of systematic PPD screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-methods study was conducted in a Lebanese public university hospital, combining a quantitative survey with qualitative focus group discussions involving nurses and managers. Descriptive analyses were applied to survey data, and thematic analysis was used for qualitative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most nurses were aware of PPD (92.9%) and \u201cbaby blues\u201d (92.9%), but only 21.4% were aware of standardized screening tools. Correct identification of key symptoms was reported by 71.4%, while only 35.7% correctly identified all risk factors and 28.6% recognized appropriate combined management (psychotherapy and antidepressants). Regarding attitudes, all participants (100%) agreed that PPD screening should be part of routine postnatal care, and 92.9% recognized its seriousness and the role of nurses in early detection. However, only 78.6% felt confident identifying PPD signs. In terms of practice, only 28.6% consistently assessed mothers\u2019 emotional well-being before discharge. Qualitative findings suggested a generally positive attitude toward the potential implementation of screening, while also highlighting perceived barriers, including insufficient training, unclear role delineation, inadequate referral pathways, time constraints, and weak internal communication regarding mental health services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that challenges to the potential implementation of PPD screening may be related to capacity and organizational support than to resistance among participants. Strengthening training, integrating standardized screening into routine postnatal care, clarifying roles and referral pathways may facilitate the implementation of PPD screening. Given the exploratory nature of this single-center study, further research is needed to assess the transferability of these findings to other maternity care settings in Lebanon.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354470","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:39:10Z","timestamp":1785433150000},"page":"e0354470","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring perceptions, readiness, barriers, and facilitators related to the potential implementation of postpartum depression screening: A mixed-methods study in a Lebanese maternity setting"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7823-0416","authenticated-orcid":true,"given":"Lama","family":"El Haj Sleiman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Abou-Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"issue":"1","key":"pone.0354470.ref001","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1038\/s41398-019-0629-9","article-title":"Genetic risk scores for major psychiatric disorders and the risk of postpartum psychiatric disorders","volume":"9","author":"AE Bauer","year":"2019","journal-title":"Transl Psychiatry"},{"key":"pone.0354470.ref002","author":"American Public Health Association"},{"key":"pone.0354470.ref003","author":"World Health Organization (WHO)"},{"issue":"1","key":"pone.0354470.ref004","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1186\/s12884-021-04016-9","article-title":"Prevalence and risk factors of postpartum depression in the Middle East: a systematic review and meta-analysis","volume":"21","author":"H Alshikh Ahmad","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"pone.0354470.ref005","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1055\/s-0042-1743095","article-title":"Screening of perinatal depression using the Edinburgh postpartum depression scale","volume":"44","author":"TA Oliveira","year":"2022","journal-title":"Rev Fed Bras Soc Ginecol E Obstet"},{"issue":"4","key":"pone.0354470.ref006","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1007\/s10995-020-03104-0","article-title":"A systematic review and meta-analysis of risk factors for postpartum depression among Latinas","volume":"25","author":"LM Edwards","year":"2021","journal-title":"Matern Child Health J"},{"key":"pone.0354470.ref007","author":"DS Allen","year":"2024"},{"key":"pone.0354470.ref008","author":"MD MacIntyre"},{"key":"pone.0354470.ref009","article-title":"Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes","volume":"15","author":"J Slomian","year":"2019","journal-title":"Womens Health"},{"key":"pone.0354470.ref010","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1146\/annurev-clinpsy-050212-185612","article-title":"Postpartum depression: current status and future directions","volume":"9","author":"MW O\u2019Hara","year":"2013","journal-title":"Annu Rev Clin Psychol"},{"issue":"12","key":"pone.0354470.ref011","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1001\/jamapsychiatry.2013.2163","article-title":"Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years","volume":"70","author":"RM Pearson","year":"2013","journal-title":"JAMA Psychiatry"},{"issue":"9956","key":"pone.0354470.ref012","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/S0140-6736(14)61277-0","article-title":"Effects of perinatal mental disorders on the fetus and child","volume":"384","author":"A Stein","year":"2014","journal-title":"Lancet"},{"issue":"8","key":"pone.0354470.ref013","doi-asserted-by":"crossref","first-page":"608","DOI":"10.2471\/BLT.11.088187","article-title":"Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis","volume":"89","author":"PJ Surkan","year":"2011","journal-title":"Bull World Health Organ"},{"issue":"19","key":"pone.0354470.ref014","article-title":"Prenatal and postpartum depression in fathers and its association with maternal depression: a meta-analysis","volume":"303","author":"P Jf","year":"2010","journal-title":"JAMA"},{"issue":"2","key":"pone.0354470.ref015","first-page":"35","article-title":"Sad dads: paternal postpartum depression","volume":"4","author":"P Kim","year":"2007","journal-title":"Psychiatry Edgmont"},{"key":"pone.0354470.ref016","doi-asserted-by":"crossref","first-page":"230107","DOI":"10.5888\/pcd20.230107","article-title":"Timing of postpartum depressive symptoms","volume":"20","author":"CL Robbins","year":"2023","journal-title":"Prev Chronic Dis"},{"key":"pone.0354470.ref017","author":"Maternal Mental Health Leadership Alliance: MMHLA [Internet]"},{"key":"pone.0354470.ref018","author":"P H","year":"2025"},{"issue":"2","key":"pone.0354470.ref019","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s00737-002-0140-8","article-title":"Postpartum depression: prevalence and determinants in Lebanon","volume":"5","author":"M Chaaya","year":"2002","journal-title":"Arch Womens Ment Health"},{"issue":"1","key":"pone.0354470.ref020","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s40359-025-02410-y","article-title":"Prevalence, correlates of postpartum depression during the COVID-19 pandemic; and validation of the arabic edinburgh postnatal depression scale among Lebanese women","volume":"13","author":"C El Kahwaji","year":"2025","journal-title":"BMC Psychol"},{"key":"pone.0354470.ref021","author":"Lebanese Republic Ministry of Public Health and UNFPA","year":"2021"},{"key":"pone.0354470.ref022","unstructured":"Lebanese Republic Ministry of Public Health. National Mental Health Strategy for Lebanon (2024-2030) [Internet]. Lebanese Republic Ministry of Public Health. 2024. Available from: TheNationalMentalHealthProgramme(moph.gov.lb)"},{"key":"pone.0354470.ref023","author":"Agence Fran\u00e7aise de D\u00e9veloppement (AFD)","year":"2022"},{"issue":"3","key":"pone.0354470.ref024","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.ijgo.2004.09.002","article-title":"Gender and sexual health in clinical practice in Lebanon","volume":"87","author":"F El-Kak","year":"2004","journal-title":"Int J Gynecol Obstet"},{"key":"pone.0354470.ref025","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1186\/s12888-014-0242-7","article-title":"Early identification of women at risk of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) in a sample of Lebanese women","volume":"14","author":"C El-Hachem","year":"2014","journal-title":"BMC Psychiatry"},{"issue":"1","key":"pone.0354470.ref026","first-page":"18","article-title":"Nurses\u2019 knowledge, beliefs and practices regarding the screening and treatment of postpartum depression in maternal and child health clinics: A cross-sectional survey","volume":"14","author":"PS Kang","year":"2019","journal-title":"Malays Fam Physician"},{"key":"pone.0354470.ref027","article-title":"Knowledge, attitude, and practice of obstetrics trainees in Sudan Medical Specialisation Board (SMSB), Sudan, towards postpartum depression","author":"YH Hashim","year":"2022","journal-title":"Ann Case Rep"},{"key":"pone.0354470.ref028","author":"G Stevens","year":"2024"},{"key":"pone.0354470.ref029"},{"key":"pone.0354470.ref030","doi-asserted-by":"crossref","first-page":"103365","DOI":"10.1016\/j.midw.2022.103365","article-title":"Frontline health professionals\u2019 perinatal depression literacy: a systematic review","volume":"111","author":"M Branquinho","year":"2022","journal-title":"Midwifery"},{"issue":"6","key":"pone.0354470.ref031","doi-asserted-by":"crossref","first-page":"1882","DOI":"10.1007\/s10903-015-0165-5","article-title":"Postpartum depression among immigrant and Arabic women: literature review","volume":"17","author":"D Alhasanat","year":"2015","journal-title":"J Immigr Minor Health"},{"issue":"2","key":"pone.0354470.ref032","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.170691","article-title":"Addressing overestimation of the prevalence of depression based on self-report screening questionnaires","volume":"190","author":"BD Thombs","year":"2018","journal-title":"Can Med Assoc J"},{"issue":"15","key":"pone.0354470.ref033","doi-asserted-by":"crossref","first-page":"5487","DOI":"10.3390\/ijerph17155487","article-title":"Perinatal mental illness in the Middle East and North Africa region-a systematic overview","volume":"17","author":"S Doraiswamy","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0354470.ref034","doi-asserted-by":"crossref","first-page":"1335437","DOI":"10.3389\/fgwh.2024.1335437","article-title":"Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers","volume":"5","author":"JMS Place","year":"2024","journal-title":"Front Glob Womens Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:39:16Z","timestamp":1785433156000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354470"}},"subtitle":[],"editor":[{"given":"Shivanand","family":"Kattimani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":34,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354470","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}