Registration of this systematic review research has been carried out at PROSPERO (International Prospective Register of Systematic Reviews) with ID Number CRD420250655837.

The inclusion and exclusion criteria are discussed in the (Table 1).

Data collection was conducted 10 years from April 2016 to March 2025 on four databases: Scopus, PubMed, ScienceDirect, and Google Scholar. The keywords were combined based on Medical Subject Headings (MeSH): Postpartum Depression, Husband Support or Husband Involvement, and Indonesia. Language was explicitly selected in English, and the journal search year was not restricted in the initial search. A full-text review was conducted and tailored to the research objectives. The query used in searching articles in the journal database was “Postpartum depression” AND “husband support” OR “husband involvement” AND “Indonesia.” The number of articles in each database search included the following (Table 2).

Research articles were selected using the Rayyan.ai software and Reference Manager (Mendeley).

A thorough screening procedure must be followed to evaluate the gathered literature's relevance, reliability, and methodological rigor. Three reviewers (NR, SWL, and SHHK) independently reviewed studies, titles, abstracts, and full texts, selecting articles according to predetermined inclusion and exclusion criteria. Screening and selection of duplicate articles was performed using the Rayyan.ai software. Reviewers extracted data based on author, publisher, publication year, region, respondents' mean age, and depression level.

A quality assessment was conducted using eight criteria based on the JBI’s Critical Appraisal Tools to assess the quality of articles to be discussed in the literature review. The following table presents the JBI scores for each research article. The JBI tool includes 10 items scored 0 or 1. If an item was not applicable (NA) for the study, it was not scored. The total score was calculated as the sum of obtained points divided by the maximum possible score after excluding NA items. Scores ranged from 0 to 1 and were classified as very weak (0-0.20), weak (0.21-0.40), moderate (0.41-0.60), strong (0.61-0.80), and very strong (0.81-1)—assessment conducted by NR and SHHK.

The quality assessment results presented in Table 3 indicate that all four articles had a strong quality assessment. This indicates that the articles used in the literature review have a relatively low risk of bias.

This study shows how husband support, especially when the husband lives with his wife, is vital for protecting the mental health of mothers in the postpartum period. The presence of a husband not only provides emotional stability but also contributes to reducing psychological distress, anxiety, and depressive symptoms experienced by new mothers. Husband involvement, especially the quality of the marital relationship during pregnancy and after childbirth, significantly reduces the risk of postpartum depression. A history of depression during pregnancy was the strongest predictor of postpartum depression. However, factors related to the husband, such as effective communication, marital satisfaction, and consistent emotional support, also played a critical role. Couples with strong communication skills reported lower depression rates, highlighting the importance of a supportive relationship [20].

High levels of husband support, including constant presence, attentiveness, and responsiveness, reduced the likelihood of postpartum depression [21]. Conversely, insufficient support increased the risk, with mothers lacking husband support being 6.013 times more likely to develop postpartum depression. Creating a positive and secure environment was shown to help prevent depressive symptoms [8]. Low husband support led to significant drops in estrogen, progesterone, and cortisol levels within 48 hours after childbirth, increasing susceptibility to depression [22].

A comparison of the impact of husbands' support in urban and rural areas found that urban mothers who lived with their husbands had a higher risk of postpartum depression [23]. Multivariate analysis confirmed that women who did not live with their husbands were significantly more likely to experience postpartum depression. These results are consistent with cohabitation and husband’s support as key protective factors against depression in Brazilian mothers with children under two years of age. Urban husbands tend to work full-time, resulting in less time spent with their wives.

In contrast, rural mothers showed lower rates of postpartum depression due to strong community ties and social support systems, which compensated for the lack of husbands' involvement [24, 25]. This suggests that while husbands' support is crucial, its absence can be offset by strong social networks within a close-knit community to reduce postpartum depression. This difference highlights a shift in expectations and support structures: in urban environments focused on the nuclear family, husbands become the main and almost sole source of emotional and practical support. In contrast, in rural environments, support is communal in nature, where the responsibility of caring for mothers and babies is distributed among extended families and neighbors, making the husband's role part of a broader social ecosystem, rather than the sole pillar.

Women who received primary support from their own mothers exhibited significantly fewer depressive symptoms than those whose primary source of support was their husbands. During the breastfeeding period, 90% of mothers reported needing support from their husbands. In Indonesia, it is also common for postpartum mothers to live with extended family to receive help with housekeeping, self-care, and childcare. This family support can create comfort, thereby reducing the risk of postpartum depression. Thus, the role of husbands and family is proven to be very important in maintaining mothers' mental health [26, 27].

According to Stress-Buffering Models, other support (friends and family) may mitigate depression caused by a lack of husband support. However, husbands' support plays a unique and fundamental role that other forms of social support cannot fully replace. It provides aspects not found in friends, family, or the community, including emotional intimacy, co-parenting (shared responsibility for caring for the baby), and marital relationship quality [28].

Four key aspects of husband involvement: instrumental, emotional, and informational support, as well as participation in maternal care [29]. Instrumental support included practical help such as household chores and childcare, while emotional support involved empathy and encouragement. Informational support covered health education, and maternal care participation included attending antenatal visits and assisting with breastfeeding. This comprehensive approach helped reduce postpartum depression by lowering stress and improving emotional stability [11, 30]. According to Cohen & Wills’ theory, such involvement acts as a buffer against stress by enhancing the mother’s ability to cope with psychological and physical changes after childbirth [31-33].

However, patriarchal cultural norms in Indonesia often limit husband support, placing the burden of childcare entirely on mothers and increasing their emotional strain [34]. Patriarchy creates conditions that increase mothers' vulnerability through pressure to be the 'perfect mother', which leads to feelings of failure when they encounter difficulties. The pressure to fulfill the demands of being a ‘perfect mother’ is related to the theory of Cultural Expectations of Motherhood. This theory explains that when difficult postpartum experiences conflict with highly idealized cultural narratives, mothers experience intense cognitive dissonance, which triggers deep feelings of guilt and inadequacy.

The lack of practical and emotional support from husbands, whose roles are often limited to being breadwinners, leaves mothers feeling alone and overwhelmed. In addition, the intense stigma surrounding mental health considers complaints to be shameful or ungrateful, so mothers are reluctant to seek help and bottle up their feelings. The loss of self-identity that comes with being seen only as 'the mother of her children' also contributes to this. Therefore, patriarchy acts as a catalyst that exacerbates risk factors by creating an environment full of pressure, minimal support, and stigma, which hinders early treatment [26, 35, 36]. Thus, patriarchal culture not only removes the mother's primary support system, her partner, but also actively erects barriers that make it difficult for her to seek help from other sources. This combination of emotional overload and isolation is what leads to the development of postpartum depression.

Husbands play the role of primary caregivers and companions for postpartum mothers. Couples whose husbands serve as primary caregivers during the postpartum period are less likely to experience depressive symptoms. Conversely, those without such support are more likely to experience it. This highlights the protective role of partner involvement in mitigating postpartum depression. Husbands are expected not only to be present but also to actively participate in supporting the mothers.

Physical, emotional, and psychological support from husbands plays a crucial role in reducing the risk of postpartum depression in mothers. Physical support provided by a husband, such as helping with household chores and caring for the baby, can ease the mother's burden, reducing fatigue and stress that can trigger depression. Furthermore, emotional support, manifested through the husband's active presence, attention, and understanding, also provides a sense of security and comfort to the mother, thereby strengthening emotional stability and reducing feelings of loneliness [28, 30]. Psychological support, including motivational encouragement, open communication, and increased maternal self-confidence, helps address the mental stress that occurs during the postpartum period. The combination of these three forms of support forms an effective support system in reducing stress and improving the psychological well-being of postpartum mothers, thereby significantly reducing the risk of postpartum depression [31, 33].

In Indonesia, there are several programmes with significant potential, such as 'Suami SIAGA' or ‘Husband Alert’ and 'Ayah ASI' or ‘Breastfeeding Father’, but their implementation has not been optimal or integrated. 'Suami SIAGA' ('Suami Siap Antar Jaga') is a government programme that educates husbands about the danger signs of pregnancy and childbirth and their role in postnatal care through counselling and motherhood classes. Meanwhile, 'Ayah ASI' is a community initiative that prioritises practical training for husbands in supporting breastfeeding and the psychological well-being of mothers. Comprehensive synergy between these two programmes is essential. By combining the medical parts of Suami SIAGA and the emotional support of Ayah ASI, husbands will become more informed and active supporters. This practical and emotional support has been proven to reduce stress, strengthen the parent-child bond, and ultimately lower the risk of postpartum depression in mothers [34, 35].