ORIGINAL RESEARCH article

Front. Psychiatry

Sec. Perinatal Psychiatry

Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1600448

This article is part of the Research TopicPerinatal mental health: Depression, Anxiety, Stress, and FearView all 12 articles

The relationship between pregnancy stress and antepartum depression in Chinese pregnant women: The mediating effect of social support and

Provisionally accepted
Ling  ZhangLing Zhang1Fanghui  WuFanghui Wu1Fengju  LiFengju Li1Xinyi  FengXinyi Feng1Hong  YangHong Yang2Tao  ZhouTao Zhou1Honghui  RongHonghui Rong1Chuanfen  ZhengChuanfen Zheng1Ting  LuoTing Luo1Lu  LuLu Lu1Enyu  LeiEnyu Lei1Guangxu  DengGuangxu Deng1Li  RenLi Ren2*Ji-An  ChenJi-An Chen1*
  • 1Army Medical University, Chongqing, China
  • 2Chongqing Health Center for Women and Children, Chongqing, Chongqing, China

The final, formatted version of the article will be published soon.

Objective: This study aims to explore the relationship between pregnancy stress (PS) and antenatal depression (AD) among Chinese pregnant women and to investigate whether maternal health literacy (MHL) and social support (SS) mediate the relationship between PS and AD.Method: This cross-sectional study utilized a two-stage sampling approach, combining stratified random cluster sampling in the first stage with convenience sampling in the second stage, to enroll 1,391 pregnant women attending prenatal care at six hospitals in Chongqing between September 2023 and February 2024. Data were collected using structured scales, including general information questionnaire, Edinburgh Postnatal Depression Scale(EPDS), Pregnancy Stress Scale(PSS), Multidimensional Scale of Perceived Social Support(MSPSS) and Maternal health literacy questionnaire. We utilized Amos 22.0 to establish a structural equation model(SEM).Results: 443 participants (31.85%) reported symptoms of depression, and 382 participants (27.46%) had moderate or above stress; in contrast, only 82 participants (5.90%) reached the level of MHL. Spearman correlation analysis revealed that all the variables were significantly correlated with AD (p < 0.01). SEM revealed several effects on AD, including PS (β = 0.470, p < 0.01), SS (β = -0.257, p < 0.01) and MHL (β = -0.095, p < 0.01), all of which were associated with higher depression scores. SS and MHL mediated the link between PS and AD. MHL and SS exerted a negative influence on PS (β =-0.236, -0.289; p < 0.01). There was no evidence of a mediating effect of MHL on the relationship between SS and AD. Conclusion: PS, SS and MHL have a direct effect on AD. Moreover, MHL and SS play a mediating role between PS and AD. Health care providers should be aware of the potential threat of PS progressing to AD. Under the guidance of the principles of enhancing MHL and strengthening SS, in the short term, the focus should be on improving the MHL among Chinese population.

Keywords: depression1, Stress 2, Social support 3, health literacy4, Structural equation modeling 5

Received: 26 Mar 2025; Accepted: 03 Jun 2025.

Copyright: © 2025 Zhang, Wu, Li, Feng, Yang, Zhou, Rong, Zheng, Luo, Lu, Lei, Deng, Ren and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Li Ren, Chongqing Health Center for Women and Children, Chongqing, 400065, Chongqing, China
Ji-An Chen, Army Medical University, Chongqing, China

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