Xuemei Ma1, Ying Wang2, Hua Hu3, Xuguang Grant Tao4, Yunhui Zhang5, Huijing Shi6. 1. Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China. 2. Shanghai Songjiang Maternal Child Health Hospital, Shanghai, China. 3. Shanghai Pudong Hospital/ Fudan University Pudong Medical Center, Shanghai, China. 4. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States. 5. Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China. 6. Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China. Electronic address: hjshi@fudan.edu.cn.
Abstract
BACKGROUND: Prenatal anxiety/depression has been a major public health problem globally with higher prevalence in developing countries, which leads to negative health outcomes for both mothers and children. Maternal stress varies over the course of pregnancy and the stress occurring in early pregnancy is the most critical. However, few studies have focused on the impact of resilience to stress on mental health of pregnant women. AIMS: To explore the effect of resilience to stress on prenatal anxiety/depression in pregnant women. METHODS: 2813 participants were recruited from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) in this study. The Life Event Scale for Pregnancy Women (LESPW) was used to assess stress at 12-16 weeks of pregnancy and at 32-36 weeks of pregnancy, respectively. Resilience was assessed by the revised Resilience Scale for Adults (RSA) at 12-16 weeks of pregnancy. The prenatal anxiety and depression were assessed at 32-26 weeks of pregnancy by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively. Hierarchical linear regression analyses were conducted to explore the direct effect of stress and resilience on prenatal anxiety and depression. The indirect effects of mediation were analyzed by structural equation models, and the indirect effect of modification was examined by stratification analysis. RESULTS: There were 11.1% and 10.3% of pregnant women in Shanghai MCPC indicating anxiety and depressive mood, respectively. The stress caused by both subjective and objective events at 32-36 weeks of pregnancy is less than that at 12-16weeks of pregnancy. We found that resilience was a protective factor for maternal mental health and meanwhile it was both an effect modifier and a mediator to the association between stress and prenatal anxiety/depression, with the mediating effect ratio of 15.1% and 23.8%, respectively. LIMITATIONS: The existence of recall bias, missing data, and restricted residential areas of the participants may limit the generalizability of the study. The measurements of resilience, prenatal anxiety, and depression were not designed specifically for pregnant women, so that they might have missed some important indications of mental issues related to pregnant women only. CONCLUSIONS: Resilience could be a direct and indirect protective factor for prenatal anxiety and depression caused by pregnancy stress.
BACKGROUND: Prenatal anxiety/depression has been a major public health problem globally with higher prevalence in developing countries, which leads to negative health outcomes for both mothers and children. Maternal stress varies over the course of pregnancy and the stress occurring in early pregnancy is the most critical. However, few studies have focused on the impact of resilience to stress on mental health of pregnant women. AIMS: To explore the effect of resilience to stress on prenatal anxiety/depression in pregnant women. METHODS: 2813 participants were recruited from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) in this study. The Life Event Scale for Pregnancy Women (LESPW) was used to assess stress at 12-16 weeks of pregnancy and at 32-36 weeks of pregnancy, respectively. Resilience was assessed by the revised Resilience Scale for Adults (RSA) at 12-16 weeks of pregnancy. The prenatal anxiety and depression were assessed at 32-26 weeks of pregnancy by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively. Hierarchical linear regression analyses were conducted to explore the direct effect of stress and resilience on prenatal anxiety and depression. The indirect effects of mediation were analyzed by structural equation models, and the indirect effect of modification was examined by stratification analysis. RESULTS: There were 11.1% and 10.3% of pregnant women in Shanghai MCPC indicating anxiety and depressive mood, respectively. The stress caused by both subjective and objective events at 32-36 weeks of pregnancy is less than that at 12-16weeks of pregnancy. We found that resilience was a protective factor for maternal mental health and meanwhile it was both an effect modifier and a mediator to the association between stress and prenatal anxiety/depression, with the mediating effect ratio of 15.1% and 23.8%, respectively. LIMITATIONS: The existence of recall bias, missing data, and restricted residential areas of the participants may limit the generalizability of the study. The measurements of resilience, prenatal anxiety, and depression were not designed specifically for pregnant women, so that they might have missed some important indications of mental issues related to pregnant women only. CONCLUSIONS: Resilience could be a direct and indirect protective factor for prenatal anxiety and depression caused by pregnancy stress.
Authors: X Liu; M Chen; Y Wang; L Sun; J Zhang; Y Shi; J Wang; H Zhang; G Sun; P N Baker; X Luo; H Qi Journal: BJOG Date: 2020-08-02 Impact factor: 7.331