Background/Objectives: Postpartum depression and anxiety affect up to 20% of women worldwide, yet remain understudied in Eastern Europe. Romania, one of Europe’s most religious countries, provides a unique context for examining how coping strategies and religiosity influence perinatal mental health. This cross-sectional study characterized coping styles, depressive and anxiety symptoms, and religiosity among postpartum women from two western Romanian counties (Bihor and Timiș) and examined associations between coping dimensions and psychological outcomes. Methods: A cross-sectional study was conducted among 201 postpartum women recruited from two public maternity hospitals between 2024 and 2025. Sociodemographic, obstetric, neonatal, coping (COPE Inventory), depressive (EPDS; PHQ-9), anxiety (GAD-7), and religiosity (RCI-10) data were collected through questionnaires and medical record extraction. Associations between coping dimensions and psychological symptoms were examined using Pearson correlations. Analyses were performed in RStudio. Results: Prevalence of possible depression (EPDS ≥ 10) was 32.8% overall, with no regional difference (Bihor 32.0% vs. Timiș 33.7%, p = 0.920). EPDS demonstrated strong convergent validity with PHQ-9 (r = 0.58, p < 0.001) and GAD-7 (r = 0.61, p < 0.001). In bivariate analyses, avoidant coping showed the strongest association with depressive symptoms (r = 0.28, p < 0.001), particularly in Bihor (r = 0.35, p < 0.001). Multiple regression analysis (R² = 0.196, p < 0.001) identified avoidant coping as the strongest independent predictor (β = 2.82, 95% CI [1.16, 4.48], p < 0.001), followed by social support coping (β = 2.46, 95% CI [1.09, 3.83], p < 0.001). Emotion-focused coping showed an unexpected protective effect (β = −2.97, p = 0.004). Problem-focused coping and religiosity were not significant predictors. Critically, county was non-significant after controlling for coping strategies (p = 0.732), indicating regional differences are mediated by coping patterns rather than geographic location. Conclusions: Postpartum depression prevalence in Romania aligns with international estimates. Avoidant coping emerged as the primary modifiable risk factor. Findings support integrating coping assessment into postpartum screening and developing interventions targeting avoidant strategies in Romanian perinatal care.

Background: Postpartum depression and anxiety are common in the perinatal period and can adversely affect maternal functioning and infant outcomes. Self-esteem is a relevant psychosocial factor, yet evidence from Eastern Europe remains limited. Objectives: To describe self-esteem levels among postpartum Romanian women, examine correlational associations between self-esteem and postpartum depression/anxiety symptoms, and assess whether these associations persist after adjustment for sociodemographic and clinical covariates, across two maternity centers in a cross-sectional design. Methods: This cross-sectional study included 201 postpartum women recruited consecutively during their initial postpartum hospitalization from two public maternity hospitals in Western Romania (Bihor, n = 100; Timiș, n = 101) during 2024–2025. Participants completed the Rosenberg Self-Esteem Scale (RSES), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Associations were assessed with χ² tests (categorical comparisons), Pearson correlations, and multivariable linear regression models including center and selected sociodemographic/obstetric covariates. Results: Self-esteem showed a strong inverse correlation with postpartum depressive symptoms (RSES–EPDS: r = −0.542 overall; r = −0.537 in Bihor; r = −0.552 in Timiș; all p < 0.001). Negative correlations were also observed with anxiety (RSES–GAD-7: r = −0.400; p < 0.001) and PHQ-9 depressive severity (r = −0.370; p < 0.001). Stratified analyses indicated graded symptom burden across self-esteem categories, with higher EPDS risk proportions among women with moderate/low self-esteem within each center (χ²p ≤ 0.039). In adjusted models, EPDS (B = −0.37; p < 0.001) and GAD-7 (B = −0.15; p = 0.021) remained independently associated with lower RSES, alongside study center (Timiș vs. Bihor: B = −1.08; p = 0.043) and educational attainment. Conclusions: Lower self-esteem co-occurs with postpartum depressive symptoms and, secondarily, anxiety in Romanian women. While the cross-sectional design precludes causal inference, these robust correlational associations support the potential value of self-esteem assessment for early psychosocial risk identification. Longitudinal research is needed to establish temporal relationships and evaluate whether self-esteem can prospectively predict postpartum mental health outcomes.