Marital adjustment and depressive symptoms among Chinese perinatal women: a prospective, longitudinal cross-lagged study

BMJ Open. 2023 Oct 29;13(10):e070234. doi: 10.1136/bmjopen-2022-070234.

Abstract

Objectives: The objective was to assess the prevalence of perinatal depressive symptoms and determine the trajectories of marital adjustment and depressive symptoms and their reciprocal relationships among Chinese perinatal women.

Design: This was a prospective, longitudinal cross-lagged study.

Setting: The study was conducted at the outpatient department of the largest women's and children's hospital in China, which is located in Chengdu, Sichuan Province.

Participants: Four hundred and sixty-three mothers were conveniently sampled.

Main outcome measures: The Dyadic Adjustment Scale and the Chinese version of the Edinburgh Postnatal Depression Scale were used to evaluate marital adjustment and depressive symptoms, respectively, at three time points: the first trimester of pregnancy (T1), the third trimester of pregnancy (T2) and 6 weeks after childbirth (T3). Descriptive statistics were used to assess the prevalence of perinatal depressive symptoms, and repeated-measures analysis of variance (ANOVA) was used to determine the trajectories of marital adjustment and depressive symptoms among the participants. A cross-lagged model was used to explore the reciprocal relationship between marital adjustment and depressive symptoms.

Results: The prevalence of perinatal depressive symptoms among our participants ranged from 21.2% to 24.0%. Repeated-measures ANOVA showed that during the perinatal period there was a significant tendency towards worse marital adjustment (F=33.031, p=0.000) and a slight but not significant reduction in depressive symptoms (F=1.883, p=0.153) among the participants. The cross-lagged model showed that maternal marital adjustment at T1 significantly and negatively predicted depressive symptoms at T2 (β=-0.165, p<0.001), and that depressive symptoms at T2 significantly and negatively predicted marital adjustment at T3 (β=-0.135, p<0.001). However, the predictive effects of depressive symptoms at T1 on marital adjustment at T2 and that of marital adjustment at T2 on depressive symptoms at T3 were not significant.

Conclusion: The prevalence of perinatal depressive symptoms ranged from 21.2% to 24.0% among the participants. During the perinatal period, the marital adjustment of women tended to be worse; however, there was no significant change in depressive symptoms. This study showed that better marital adjustment at T1 was a protective factor against maternal depressive symptoms at T2, and a higher level of depressive symptoms at T2 was a risk factor for worse marital adjustment at T3.

Keywords: mental health; obstetrics; perinatology.

MeSH terms

  • Child
  • Depression* / diagnosis
  • Depression* / epidemiology
  • Depression, Postpartum* / diagnosis
  • Depression, Postpartum* / epidemiology
  • Female
  • Humans
  • Mothers
  • Parturition
  • Pregnancy
  • Prospective Studies