OBJECTIVES: Postpartum depression (PPD) is widely acknowledged as a significant mental health problem for postpartum women, and several factors have been associated with PPD. This study aimed to assess the prevalence of PPD and explore the factors and relationships associated with PPD symptoms in postpartum women using path analysis. Furthermore, a new framework for PPD modeling for postpartum women was introduced. METHODS: A cross-sectional survey of 406 women at 42 days postpartum was conducted to collect the basic postpartum conditions and the factors associated with PPD. Linear regression was used to identify factors associated with PPD, and path analysis was used to explore the relationship between PPD and related factors. RESULTS: The incidence of PPD symptoms was 18.5% (75/406). Multiple linear regression analysis showed that the independent risk factors associated with PPD symptoms in postpartum women included maternal postpartum stress, postpartum anxiety, social support, marital satisfaction, sleep quality, and maternal postnatal attachment (P <
0.05). The constructed path analysis model had good a fit (χ2/DF = 1.779, CFI = 0.998, GFI = 0.997, AGFI = 0.965, NFI = 0.995, IFI = 0.998, and RMSEA = 0.044). The path analysis revealed that postpartum anxiety exhibited only a direct effect on PPD (effect value: 0.243). Sleep quality was the factor that most affected PPD symptoms, followed by maternal postnatal attachment, postpartum stress, social support, postpartum anxiety, and marital satisfaction. DISCUSSION: Our findings show that interventions targeting enhanced maternal postnatal attachment, improved sleep quality, strengthened social support, better marital relationships, as well as reduced postpartum stress and anxiety, can effectively alleviate PPD symptoms. The direct and indirect effects of these factors on PPD highlight its complexity and the significance of a multifaceted prevention and treatment approach. Our study deepens the understanding of the intricate relationships between psychosocial factors and PPD, providing insights for potential intervention targets.