Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2023; 11(12): 2729-2739
Published online Apr 26, 2023. doi: 10.12998/wjcc.v11.i12.2729
Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas
Jian Yang, Xin-Zhu Lin, Qian-Wen Guo, Cheng-Ling Wang, Ren-Yan Yang, Jun-Wen Zhang, Yan Zeng
Jian Yang, Jun-Wen Zhang, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Xin-Zhu Lin, Yan Zeng, Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Qian-Wen Guo, Cheng-Ling Wang, Department of Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Ren-Yan Yang, Department of Obstetrics, Chongqing Shizhu Tujia Autonomous County People’s Hospital, Chongqing 409100, China
Author contributions: Zeng Y designed and supervised the research; Lin XZ, Guo QW, Wang CL, and Yang RY enrolled participants and performed the data collection and initial analysis; Yang J and Zhang JW analyzed and interpreted the data; Yang J performed the literature search and drafted the initial manuscript; Zeng Y and Zhang JW revised the final manuscript; All authors have read and approved the final manuscript.
Supported by Chongqing Science and Health Joint Medical Research Project, No. 2021MSXM034.
Institutional review board statement: Ethics approval for the study was granted by the Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University, No. 2021-288.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data related to this current research is available from the corresponding author on reasonable request, at yan_zeng@hospital.cqmu.edu.cn.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Zeng, MD, PsyD, Attending Doctor, Lecturer, Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. yan_zeng@hospital.cqmu.edu.cn
Received: December 24, 2022
Peer-review started: December 24, 2022
First decision: February 28, 2023
Revised: March 8, 2023
Accepted: March 27, 2023
Article in press: March 27, 2023
Published online: April 26, 2023
Processing time: 122 Days and 7.1 Hours
Abstract
BACKGROUND

Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery. Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples.

AIM

To investigate the correlations among mindfulness, marital quality, anxiety, and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas.

METHODS

A cross-sectional study was conducted. The self-administered questionnaire was submitted online through smartphones. The levels of mindfulness, anxiety, depression, and marital quality were respectively investigated by the mindful attention awareness scale (MAAS), the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), and the marriage perception scale (MPS) in these enrolled Han and Tujia primiparas.

RESULTS

No statistical significance was observed in the prevalence of postpartum anxiety and depression, nor scores of MAAS and MPS-Total in different regions or ethnicities (P > 0.05). However, MPS-Marital interaction (P < 0.05), MPS-Family relationship (MPS-FR) (P < 0.01), and MPS-Marital conflict (MPS-MC) (P < 0.01) scores of urban primiparas were higher than those of rural primiparas. The MPS-MC score of Han primiparas was higher than that of Tujia primiparas (P < 0.05). Negative correlations were observed between MAAS and SAS (r = -0.457, P < 0.01), and MAAS and SDS (r = -0.439, P < 0.01). SAS has revealed a highly positive correlation with SDS (r = 0.720, P < 0.01) and a weak negative correlation with MPS (r = -0.200, P < 0.05). Besides, a weak negative correlation was observed between MAAS and MPS-MC (r = -0.184, P < 0.05), and a weak positive correlation was noticed between SAS and MPS-MC (r = -0.225, P < 0.01). Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety (P < 0.05, 95%CI: -0.384 to 0.033), MPS-MC and postpartum anxiety (P < 0.01, 95%CI: 0.027-0.193), MPS-FR and postpartum depression (P < 0.05, 95%CI: -0.365 to 0.031), and MPS-MC and postpartum depression (P < 0.01, 95%CI: 0.022-0.206).

CONCLUSION

Mindfulness demonstrates negative correlations with marital conflict, postpartum anxiety and depression, and it may have cross-ethnic and trans-regional characteristics. Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study, it demonstrates a full mediation effect on the relationships between family relationships, marital conflict, and postpartum anxiety and depression.

Keywords: Mediating effect; Mindfulness; Marital quality; Postpartum depression; Postpartum anxiety; Primiparas

Core Tip: Postpartum depression is a common mental complication during the postpartum period. This cross-sectional observational study aimed to investigate the correlations among mindfulness, marital quality, anxiety, and depression in different regions and ethnicities in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas. Mindfulness is closely related to the mental health conditions of primiparas, and it may have cross-ethnic and trans-regional characteristics. Although the mindfulness levels revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study, it demonstrated a full mediation effect on the relationship between family relationships, marital conflict, and postpartum anxiety and depression. Our findings can provide a reference for further application of mindfulness in Chinese postpartum mental disorders.