The relationship between positive psychological qualities and prenatal negative emotion in pregnant women: A path analysis

Trait Mindfulness, Resilience, Self-Efficacy, and Postpartum Depression: A Dominance Analysis and Serial-Multiple Mediation Model

Background

Postpartum depression affects many women after childbirth, impacting both maternal and child well-being. Psychological traits such as trait mindfulness, resilience, and self-efficacy have been linked to postpartum depression, but their interactions and collective influence are not well understood.

Objective

The study aims to examine the associations between trait mindfulness, resilience, self-efficacy, and postpartum depression.

Methods

A cross-sectional survey was conducted from August 2022 to May 2023 using the Mindful Attention Awareness Scale, the 10-item Connor-Davidson Resilience Scale, the General Self-efficacy Scale, and the Edinburgh Postnatal Depression Scale. Dominance analysis, latent profile analysis, and serial-multiple mediation models were employed for data analysis.

Results

Dominance analysis showed that trait mindfulness, resilience, and self-efficacy explained 36.3%, 35.4%, and 28.3% of the variance in postpartum depression, respectively. Three trait mindfulness profiles were identified as mild (23.2%), moderate (55.5%), and high (21.3%). Postpartum women in the mild group exhibited higher postpartum depressive symptoms than those in the moderate and high groups. The effects of trait mindfulness on postpartum depression were significantly mediated by resilience (B=-0.064, 95% CI -0.088 to -0.044), self-efficacy (B=-0.014, 95% CI -0.023 to -0.006), and serial mediation between resilience and self-efficacy (B=-0.027, 95% CI -0.040 to -0.015). Similar significant mediation effects were observed for moderate (resilience: B=-0.126, 95% CI -0.169 to -0.065, self-efficacy: B=-0.041, 95% CI -0.078 to -0.010, resilience and self-efficacy: B=-0.053, 95% CI -0.090 to -0.023) and high trait mindfulness profiles (resilience: B=-0.381, 95% CI -0.514 to -0.267, self-efficacy: B=-0.082, 95% CI -0.139 to -0.033, resilience and self-efficacy: B=-0.160, 95% CI -0.237 to -0.089) when compared to the mild reference group.

Conclusion

Trait mindfulness significantly impacts postpartum depression and exhibits heterogeneity among postpartum women. The relationship between trait mindfulness and postpartum depression was mediated by resilience and self-efficacy.

A Study on Emotional Intelligence, Breastfeeding Self-Efficacy, and Prenatal Maternal Expectations in Women Attending a Pregnancy School

This study was conducted to determine the relationship between emotional intelligence (EI), breastfeeding self-efficacy, and maternal expectations of women who did and did not receive education and counseling during pregnancy. An observational cross-sectional study was conducted in a state hospital with 146 pregnant women (intervention group, n = 72; control group, n = 74). The intervention group had five stages, while the control group received standard pregnancy care. Data is collected by the "Personal Information Form", "Rotterdam EI Scale", "Prenatal Breastfeeding Self-Efficacy Scale", and "Prenatal Maternal Expectations Scale". When the emotional intelligence scores increased in the intervention group, breastfeeding self-efficacy and antenatal motherhood expectations also increased in the intervention group. In addition, the intervention group's EI, EI self-evaluation sub-dimension, prenatal motherhood expectations, unrealistic negative motherhood expectations mean, and breastfeeding self-efficacy scale were higher than those of the control group. The regression analysis revealed that the "self-evaluation" sub-dimension of the EI in the intervention group is correlated with regulate others and their own emotions, EI, breastfeeding self-efficacy, and prenatal motherhood expectations. This study shows that pregnant women who attended antenatal classes during the prenatal period had higher EI, breastfeeding self-efficacy, and prenatal maternal expectations than those who were pregnant and did not receive education.

Analysis of risk factors for co-morbid anxiety and depression in pregnant women

Co-morbid anxiety and depression (CAD) is defined as the co-existence of anxiety and depression. During pregnancy, women are more prone to negative emotions, such as anxiety and depression, than the general female population. The incidence of CAD during pregnancy is 1-26 %. The aims of this study were to investigate the incidence and influencing factors of CAD during pregnancy. The study cohort included 3053 pregnant women who underwent maternity check-ups at a tertiary hospital in China. Demographic characteristics, level of social support, and psychological characteristics were collected from participants via a self-reported questionnaire, which included the General Demographic Information Questionnaire, Pregnancy Stress Scale, the Generalized Anxiety Scale, Patient Health Questionnaire-9, and Perceived Social Support Scale. A binary logistic regression model and a categorical decision tree based on the Chi-square Automatic Interaction Detector algorithm were used to identify factors influencing CAD during pregnancy, and the differences between the two models were analysed and compared. The results of the logistic regression and decision tree models identified pregnancy stress, social support, pregnancy knowledge, couple relationship satisfaction, advanced maternal age, and occupation as factors influencing CAD during pregnancy. Pregnancy stress was the most influential factor. The areas under the curve of the classification decision tree and logistic regression models were 0.801 (95 % CI: 0.778-0.823) and 0.827 (95 % CI: 0.807-0.847), respectively, with specificities of 63 and 77 %, and sensitivities of 83.9 and 76.3 %. Logistic regression excels when dealing with linear relationships, while decision trees are particularly useful when dealing with nonlinear relationships. Therefore, combining logistic regression and decision trees can achieve some degree of model diversity, thus improving predictive power and confidence in the results.

Path analysis of influencing factors for maternal antenatal depression in the third trimester

Maternal antenatal depression (AD) is a nonpsychotic depressive episode during pregnancy that can harm both the pregnant woman and the fetus. This study aimed to investigate the intrinsic interrelationships between AD and its influencing factors by constructing a path model. This survey-based cross-sectional study included 1071 pregnant women who underwent pregnancy examinations in three hospitals in Nantong City, China, between February and June 2023. General information and information regarding maternal AD, pregnancy stress, prenatal anxiety, social support, marital satisfaction, sleep quality, and resilience were collected. Multiple linear regression analysis using SPSS 25.0 was employed to determine the factors influencing pregnancy depression, and Amos25.0 was used to construct a structural equation model. AD incidence was 19.4% (208/1071). The independent risk factors affecting AD in pregnant women have been integrated into the established path analysis model. The model demonstrated a good fit (χ2/DF = 1.238, comparative fit index = 0.999, goodness-of-fit index = 0.998, normed fit index = 0.996, adjusted goodness-of-fit index = 0.990, incremental fit index = 0.999, and root mean square error of approximation = 0.015). While prenatal anxiety (0.230) and hyperthyroidism (0.048) only had direct effects on AD, mental resilience was the biggest factor affecting AD, followed by pregnancy stress, marital satisfaction, prenatal anxiety, sleep quality, social support, and hyperthyroidism. Improved mental resilience, social support, sleep quality, and marital satisfaction; reduced pregnancy stress and prenatal anxiety; and effective hyperthyroidism treatment might reduce AD. This study underscored the significance of delivering actionable strategies and tangible assistance to pregnant women to reduce AD.

The relationship between pregnancy stress and mental health of the pregnant women: the bidirectional chain mediation roles of mindfulness and peace of mind

Objective

This study aimed to investigate the relationship between pregnancy stress and mental health of the pregnant women, employing a positive psychology perspective. Specifically, the study sought to explore how the two positive psychological qualities of mindfulness and peace of mind may serve as potential mediators in the association between pregnancy stress and mental health of the pregnant women.

Methods

Seven hundreds and thirteen pregnant women seeking care at the First Affiliated Hospital of Sun Yat-Sen University were included in this study. The participants completed a self-report demographic questionnaire, as well as several validated scales including the Pregnancy Pressure Scale (PPS), Mindful Attention Awareness Scale (MAAS), Peace of Mind Scale (PoMS), and Chinese Health Questionnaire (CHQ). The Amos 23.0 system was utilized to construct structural equation models.

Results

A total of 713 participants had an average age of 29.46 ± 4.81 years and an average gestational age of 24.26 ± 22.66 weeks. Out of the pregnant women, 163 (22.9%) experienced moderate or higher levels of pregnancy stress (PPS > 1), while 212 (29.7%) exhibited mental distress (CHQ > 3). Pregnancy stress exhibited a positive association with mental distress, while displaying negative associations with mindfulness and peace of mind. Mindfulness and peace of mind were negatively associated with mental distress. By employing structural equation modeling, the analysis revealed that mindfulness and peace of mind acted as partial mediators in the relationship between pregnancy stress and mental health. Furthermore, the identified models exhibited bidirectional sequential mediating pathways, suggesting that the pathways of mindfulness ↔ peace of mind mitigated the harmful influence of pregnancy stress on the mental health of pregnant women.

Conclusion

This study adds to the current body of knowledge by investigating the relationships among mindfulness, peace of mind, pregnancy stress, and mental health in pregnant women. From a positive psychology framework, it provides valuable understanding of the intricate dynamics between pregnancy stress and protective factors of mental health. Consequently, interventions aimed at bolstering positive psychological qualities in pregnant women should prioritize the cultivation of mindfulness to foster peace of mind, or alternatively, the cultivation of peace of mind to enhance mindfulness, ultimately leading to improved mental health outcomes.

The mediating role of social support and resilience between self-efficacy and prenatal stress: a mediational analysis

BACKGROUND

Prenatal stress is a highly prevalent mental disorder experienced by pregnant women. This study assessed the prevalence and influencing factors of prenatal stress and investigated the mediating role of social support and resilience between self-efficacy and prenatal stress among pregnant women in China.

METHODS

A convenience sample comprising 1071 pregnant women from three hospitals in Nantong, Jiangsu Province, China, was recruited between February and June 2023. These participants completed a set of general survey questionnaires and were assessed using the Pregnancy Pressure Scale, Perceived Social Support Scale, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the General Self-Efficacy Scale. Furthermore, a hierarchical multiple regression model was employed to investigate the relevant factors and mediators of prenatal stress symptoms. A structural equation model was used to examine the mediating role of social support and resilience in the relationship between self-efficacy and prenatal stress.

RESULTS

The results of the multivariate regression analysis indicated significant associations between prenatal stress and parity, self-efficacy, social support, and resilience (P < 0.001). Self-efficacy accounted for 35.33% of the total effect, with a direct effect of -2.5306 (95% confidence interval [CI]: -4.0309 to -1,0303). Further examination through mediation analysis revealed the mediating roles of social support and resilience in the relationship between self-efficacy and prenatal stress. The mediating effect of social support was - 1.5933 (95% CI: -2.2907 to -0.9496), accounting for 22.24% of the total effect. Similarly, resilience exhibited a mediating effect of -3.0388 (95% CI: -4.3844 to -1.7135), accounting for 42.43% of the total effect.

CONCLUSION

The mediation analysis revealed that among pregnant women in China, the influence of self-efficacy on prenatal stress is channelled through social support and resilience. Therefore, enhancing social support, resilience, and self-efficacy might alleviate prenatal stress.