Magnitude of antenatal depression among women attending antenatal care at public health centers in post-war Shire, Tigray region, Ethiopia: a facility based cross-sectional study

Introduction: Antenatal depression is a major public health concern linked to adverse maternal and neonatal outcomes, including preterm birth, impaired fetal growth, low birth weight, infant malnutrition, and increased episodes of childhood illness. This study assessed the magnitude and factors associated with antenatal depression among pregnant women attending public health centers in Shire town, Tigray, Ethiopia. Methods: This facility-based cross-sectional study allocated the sample proportionally across health centers based on November-December 2025 antenatal care caseloads. After selecting the first participant by lottery, every third eligible attendee was enrolled through systematic sampling. Variables with p[≤]0.25 in bivariable analysis were entered into a multivariable logistic regression model to identify factors associated with antenatal depression among pregnant women in post-war Shire Town, Tigray, Ethiopia. Results: All 463 participants were included (response rate: 100%). The magnitude of antenatal depression was 34.3% (95% CI: 30-38.7%). Increased odds of depression were observed among age group 25-34 years (AOR = 3.43; 95% CI: 1.7-7.2), those with unplanned pregnancies (AOR=2.2; 95% CI: 1.25-3.87), exposure to conflict-related traumatic events (AOR=2.6; 95% CI: 1.41-4.81), Internally displaced people (AOR=2.02; 95% CI: 1.05-3.92), experience of intimate partner violence (AOR=2.22; 95% CI: 1.31-3.8), poor partner relationship (AOR=2.17; 95% CI: 1.2-3.96), and low perceived neighborhood safety (AOR=2.7; 95% CI: 1.5-5.08). Protective factors included middle income (AOR=0.54;(95% CI:0.31-0.93), higher income (AOR=0.15; 95% CI: 0.065-0.33), and very good pre-war economic status (AOR=0.4; 95% CI: 0.16-0.94). Conclusion: Antenatal depression was common among pregnant women in this post-war population, with internally displaced women experiencing higher odds. Integrating mental health and psychosocial support into antenatal care, alongside interventions addressing conflict-related trauma, intimate partner violence, socioeconomic vulnerability, and community safety, is warranted.