The prevalence of antenatal depression varies from 7.4% to 50.0% worldwide, and from 5.5% to 23.1% in China [1–7]. The prevalence of depression among pregnant women is higher than that among postpartum women, and it is higher among pregnant women in middle and late pregnancy [5, 8]. Antenatal depression is a debilitating experience which can lead to many problems and sequelae. For example, depressed pregnant women may experience multiple conflicting roles, insufficient social support, uncertainty about future life, instability of emo- tion, and the discontent of body image. Moreover, there can be a risk of preterm birth and obstetric complications. And the newborns’ and husbands’ mental and physical health can also be threatened by their mothers’ and wives’ depression as well [9–16].
The predictors of antenatal depression include several socio-demographic and health behavior factors such as young or old age, low educational background, and low socio-eco- nomic status. Besides, antenatal depression is always related with threatening life events, such as housing problems, financial difficulties, and marital problems [17]. And negative life events contribute more to antenatal depressive symptoms than other socio-demographic factors do [18, 19]. Moreover, there are psychosocial factors such as stress, low social support, and low optimism level that can lead to an increased antenatal depressive level [7, 20–22].
Study design and participants
The study is a cross-sectional hospital-based survey, and it was conducted in Mianzhu County in Sichuan Province and in Gaobeidian County in Hebei Province, China. Ethical approval and consent processes were obtained from the institutional review board of the School of Social Development and Public Policy at Beijing Normal University.
Ten volunteers, who were graduate students majoring in psychology, received a two-day training to be qualified interviewers, and they investigated the participants. In Mianzhu County, the data were collected twice, once in June 2012 and once in October 2012. The data collection in October interviewed a new population of pregnant women. In Gaobeidian County, the data were collected only in October. Each collection lasted for approximate eight days. A self-rating questionnaire was distributed to pregnant women who were receiving rou- tine prenatal care at the hospitals. The women completed the self-reporting questionnaires in approximate 30 minutes during their waiting for a routine antenatal check-up. A signature on the consent form was regarded as a sensitive issue in local cultural context, and participants could reject the investigation because of it. Moreover, this anonymous study was little risk to participants. Thus, an informed oral consent was obtained from each study participant instead of a written consent. The study had been explained to each participant by volunteers, and the volunteers had answered the participants’ questions prior to asking for their permission to conduct the investigation. Participation was entirely voluntary, and each participant had the right to withdraw or to refuse to provide information at any time during the study.
The participants from Mianzhu County got interviewed at Mianzhu People’s Hospital and
Mianzhu Maternal and Child Health Hospital, where around 70% of the pregnant women in this county received antenatal care and post-delivery services. The participants from Gaobei- dian County got interviewed at Gaobeidian County’s Hospital, where nearly 50% of the preg- nant women in this county received antenatal care and post-delivery services. The two hospitals where this study was conducted are the top ranked hospitals in the two counties.
The negative life events were measured by the life events scale for pregnant women
(LESPW) [54]. This scale is self-rating, and it is designed specifically for pregnant women. It includes life events which lead to different levels of sensation, and the events concern family life, work and study, social relationships, etc. There are 53 events, and they are divided into two groups which involve subjective events (SE) and objective events (OE) separately. The OE are also divided into three levels by the extent they impact the emotion of the pregnant women, and they are grouped into OE1, OE2, OE3. The current study used the OE, because the SE are more related with subjective feelings, while we have used other special tools to mea- sure them, which are negative automatic thoughts, stress, and antenatal depression. Thus, we only need the events of in the OE as the events that can lead to stress and depression. Besides, the current study only employed OE2 and OE3, because the events included in OE2 and OE3 have greater significance on sensation to people, and they can have a greater and long- lasting impact on pregnant women’s depressive level. Thus, in order to decrease the influence brought by the temporality of events, we only chose events in OE2 and OE3. The events are all negative life events, which fit well with the objective of this study. A total of 34 life events in OE2 and OE3 were used. In the current study, the scale showed a good internal consistency (Cronbach’s Alpha = 0.60).
The mean age of the participants was 25.49 (min = 18.0, max = 42.0; standard deviation [SD] = 3.85) and nearly half (47.3%) of the participants were 18–24 years old. Nearly half of the pregnant women (47.8%) completed middle school or less. Most of the pregnant women (82.0%) had a family monthly income lower than 816 USD. Most of the pregnant women (86.9%) were unemployed during their pregnancy. Approximately half (50.5%) of the preg- nancies were planned. More than half (58.7%) of the women were primigravida, and most of them (70.8%) had been pregnant for more than 28 weeks. The BMI of most of them (74.5%) were over 23. More than half (52.7%) of the pregnant women had a fair quality of sleep, and there were smaller percentages of pregnant women with a good quality of sleep (39.2%) or a poor quality of sleep (8.1%). Almost all (98.2%) of the pregnant women had no smoking his- tory, and almost all (94.3%) of the pregnant women had no history of alcohol use. Over half (54.5%) of the pregnant women’s husbands were migrant workers (Table 1).
The mean score of negative automatic thoughts was 39.07 (min = 30, max = 99; SD = 10.71), and the median score was 35.00. The mean score of negative life events was 105.31 (min = 0, max = 515; SD = 100.27), and the median score was 84.00. The mean score of stresses of pregnancy was17.11 (min = 10, max = 40; SD = 4.70).
The mean score of antenatal depression was 8.71 (min = 0, max = 25; SD = 3.91), and the median score was 9.00. The EPDS cutoff point recommended by Rubertsson’s study is a score of ≥13. According to this criterion, the prevalence of major depressive symptoms in the cur- rent study was 13.7% [48].
Table 2 displays the bivariate correlations between antenatal depression and the socio- demographic and health behavior factors in the study. Antenatal depression was only signifi- cantly correlated with the sleep quality (p = 0.001), while other variables didn’t have a signifi- cant relationship with antenatal depression.
This study suggested that there was a potentially significant mediating effect of negative automatic thoughts. Pregnant women who had lower scores of negative automatic thoughts were more likely to suffer less from negative life events which might lead to antenatal depression.
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