Screening for sexually transmitted infections in high school students in the Kurdistan Region of Iraq: a school-based screening study.

Depression and anxiety represent critical challenges for global public health, standing as primary drivers of non‐fatal disease burden and disability among women in their reproductive years []. The vast majority of this psychiatric burden occurs in low‐ and middle‐income countries (LMICs), where resource constraints and limited infrastructure leave families to shoulder roughly 82% of all cases [, ]. These common mental disorders (CMDs) have extensive societal impacts, accounting for nearly 11% of the total disease burden in developing nations and 14% on a global scale, while also sharing a deep, two‐way relationship with physical health issues [, ]. Worldwide patterns show that women are impacted far more severely than men, with women facing a 50% higher likelihood of experiencing depressive episodes and twice the risk of developing chronic anxiety conditions [, , , ]. Overall, statistics suggest that approximately one in five women will struggle with a common mental disorder at some point during their lifetime []. Pregnancy is one of the periods in a woman's reproductive life where this baseline vulnerability may be most sharply reshaped, for reasons that are both biological and social, and it is this reshaping that motivates the present study. The first of these pathways is biological. Pregnancy involves rapid shifts in gonadal hormones such as estrogen and progesterone, which act directly on brain circuits and neurotransmitter systems responsible for mood regulation [, ]. Layered onto this neuroendocrine shift is a psychological adjustment: the transition into motherhood requires renegotiating self‐image, family role, and identity, alongside anticipatory worry about childbirth and infant health, all of which draw on a woman's emotional coping capacity [, , ]. Evidence on the net effect of this biological pathway is mixed. Some studies report elevated perinatal depression and anxiety, while others find stable or even lower symptom levels when women have strong supportive environments around them. These findings suggest that biological influences interact with social context rather than acting in isolation. Although these biological mechanisms cannot be directly measured within the BDHS, they provide the rationale for examining pregnancy status as the primary exposure in the present study. That social context constitutes a second, psychosocial pathway, and in Bangladesh it pulls in two directions at once. On one hand, women of childbearing age frequently face a triple burden of early marriage, immediate expectation to bear children, and relocation into the husband's family home [, ], transitions associated with loss of personal autonomy, restricted access to financial resources, and heightened exposure to intimate partner violence, all established risk factors for depression and anxiety [, , , ]. On the other hand, pregnancy occupies a celebrated place in Bengali culture, where an expected child confers elevated social status, increased family attention, and practical help from the extended household []. Pregnancy may therefore act as both a source of psychological stress and a period of increased social support, depending on household circumstances. Accordingly, the association between pregnancy and mental health cannot be assumed and requires direct empirical comparison between pregnant and non‐pregnant women.