The sacred strain: Religion as both resource and burden in the psychological well-being of Pakistani women navigating postpartum depression

This mixed-methods study examines religion’s dual role in postpartum depression (PPD) among 350 Pakistani women. Quantitative findings indicate that positive religious coping strategies, such as Tawakkul and Sabr , were associated with reduced PPD severity, whereas negative religious coping predicted higher symptom severity, mediated by internalized stigma. Qualitative interviews with 45 participants revealed recurring themes of spiritual guilt, the paradox of the “Ideal Muslim Mother,” and tensions between faith-based meanings of suffering and biomedical mental health care. While religious beliefs provided comfort, meaning, and resilience for many women, they also contributed to moral pressure and self-blame that pathologized psychological distress. The study proposes the Sacred Strain Model, highlighting religion as both a protective resource and a potential burden. Findings underscore the need for culturally and religiously congruent maternal mental health interventions that integrate Islamic frameworks alongside clinical care to promote equitable and sustainable postpartum mental health support in Pakistan.