Role of Family Decision‐Making and Perceived Social Support in the Mental Health of Mothers of Infants in Rural Western China

Background The mental health of mothers has an important impact on both the growth and development of infants and on the health of mothers themselves. Family decision‐making may play an important role in mother’s mental health, yet little research has explored the relationship. This paper explores the association and influential pathways between family decision‐making and mental health among mothers of infants in rural western China. Methods : Mothers with infants aged 0–6 months in four impoverished counties of a predominantly rural province in southwestern China were enrolled in 2021 from the control group of a cluster‐randomized trial using a multistage sampling method and followed up 6 months later. Information on family decision‐making, perceived social support, and maternal mental health was collected through household interviews. Causal mediation analysis was employed to explore the association between family decision‐making and mental health, and a four‐item decomposition was used to explore the control direct effect of family decision‐making on mental health, the pure mediation effect of perceived social support, and the possible interaction between exposure and mediation. Results Baseline data was collected on 444 mother–infant pairs and 331 were followed up 6 months later. After controlling for the set of confounding factors indicated by our causal framework, the results of longitudinal causal mediation analyses showed that family decision‐making was negatively associated with depression, anxiety, and stress after controlling for confounding factors ( β total effect : −1.323, −0.928, and −1.351, respectively). Perceived social support played a proportional mediating role in each of the above associations (pure indirect effects of 22.33%, 22.60%, and 27.02%, respectively), while interaction effects were not significant. Conclusions Family decision‐making had a direct negative effect on maternal depression, anxiety, and stress, and perceived social support played a mediating role. These findings can be used to guide future interventions to improve maternal mental health and healthy child development in rural China.