Maternal Resilience And Postpartum Depression Symptoms In A Cohort Study

ObjectiveTo investigate the trajectories of maternal resilience,perceived social support and selfefficacy in the perinatal period,and to analyze whether they can effectively predict postpartum depression symptoms,with the aim of providing a reference for health professionals and health institutions conducting maternal health services and jointly promoting maternal mental health.MethodsThe 10-item Connor-Davidson Resilience Scale,Perceived Social Support Scale,General Self-Efficacy Scale and Edinburgh Postpartum Depression Scale were used to measure maternal resilience,perceived social support,self-efficacy and postpartum depressive symptoms among 372 routinely examined pregnant women in the maternity clinic of a tertiary Chinese hospital in Guangzhou from October 2021 to October 2022,at11-13 weeks of pregnancy,24-28 weeks of pregnancy,34-40 weeks of pregnancy and 6weeks postpartum.Latent growth mixed model(LGMM)was used to map the trajectories maternal resilience,perceived social support,self-efficacy and identify their potential subgroups;Generalized additive models and mediated effects analysis were conducted to investigate the relationships among maternal resilience,perceived social support,selfefficacy and postpartum depression symptoms.ResultsThe development of maternal resilience tended to be stable during the perinatal period,and resilience level in the first-trimester could be classified as "low resilience"(21.4%),"moderate resilience"(45.9%),"high resilience"(32.7%).The development of maternal perceived social support showed a relatively stable and slightly decreasing trend,with small differences between categories,and perceived social support in the first-trimester could be divided into two subgroups: "low social support"(44.6%)and "high social support"(55.4%).The development trajectory of maternal self-efficacy could be divided into three subgroups: "rising"(8.9%),"stable"(39.6%)and "declining"(51.5%).Pregnant women with low self-efficacy in the first-trimester may show a small decrease in selfefficacy during pregnancy.Compared to the high resilience group,the low and moderate resilience groups were 13.656(95% CI: 4.572-40.786,P<0.01)and 4.491(95% CI: 1.554-12.978,P<0.01)times more likely to experience postpartum depression symptoms,respectively,and the low perceived social support group was 2.668 times more likely to experience postpartum depression symptoms compared to the high perceived social support group.The relationship between perceived social support and postpartum depression symptoms was mediated by maternal resilience and self-efficacy,and the effect of perceived social support on postpartum depression symptoms could be realized through three pathways:(1)T0 perceived social support → T0 resilience → T3 postpartum depression symptoms(28.3%),(2)T0 perceived social support → T3 self-efficacy → T3 postpartum depression symptoms(28.1%),and(3)T0 perceived social support → T0 resilience → T3 self-efficacy → T3 postpartum depression symptoms(43.6%).In this study,primipara or multipara(OR:1.822,95% CI:1.113-2.982,P<0.05),adverse childhood experiences(OR:2.776,95% CI:1.540-5.004,P<0.01),resilience(r:-0.415--0.593,P<0.01),perceived social support(r:-0.289--0.411,P<0.01),and self-efficacy(r:-.0362--0.571,P<0.01)significantly affected postpartum depression symptoms,and resilience,perceived social support,and self-efficacy had better predictive effects on postpartum depression symptoms(AUC=0.788,95% CI 0.739-0.838,P<0.01).ConclusionMaternal resilience,perceived social support and self-efficacy were relatively stable and all heterogeneous.Postpartum depression symptoms was influenced by primipara or multipara,adverse childhood experiences,resilience,perceived social support and selfefficacy,therefore,more attention should be paid to primipara and mothers with adverse childhood experiences,and high perceived social support is conducive to the development of higher resilience and self-efficacy for maternal,thus reducing the probability of postpartum depression symptoms.Therefore,we should focus on improving their perceived social support,resilience and self-efficacy to improve their mental health.