INTRODUCTION: Postpartum depressive symptoms (PDS) are common in women after delivery and often progress to postpartum depression (PPD). This secondary analysis aimed to evaluate the effect of acupoint hot compress in patients with different PPD risks. METHODS: We conducted a secondary analysis of data from a multicenter randomized controlled trial involving 1,085 participants. Of these, 537 received acupoint hot compress treatment, while 548 received routine postpartum care. Participants were categorized into two groups based on Edinburgh Postnatal Depression Scale (EPDS) scores measured 76.5 h after delivery. Baseline demographic and clinical characteristics were compared, and logistic regression models were used to assess the association between acupoint hot compress and PDS. Subgroup analyses were used to determine the effect of acupoint hot compress on participants with different PPD risks. RESULTS: Among the 1,085 participants, 866 were in the low-risk PPD group (EPDS score <
9), and 219 in the high-risk PPD group (EPDS score ≥9). Educational level, labor induction, postpartum uterine contraction pain intensity, sleep and appetite during pregnancy significantly impacted PDS. Acupoint hot compress significantly improved PDS after vaginal delivery, particularly in high-risk PPD patients with lower educational levels, abnormal pregnancy appetite or sleep, and serve postpartum uterine contraction pain. CONCLUSION: Acupoint hot compress is an effective, non-invasive intervention with minimal side effects for improving PDS.