Birth satisfaction and resilience in the association between prenatal anxiety and postpartum depressive symptoms: A mediational analysis

OBJECTIVE: Postpartum depression (PPD) is a common mental health disorder among women after childbirth. This study aimed to examine whether birth satisfaction and resilience statistically mediated the association between prenatal anxiety and PPD. METHODS: From February to August 2023, pregnant women in the third trimester were recruited using convenience sampling from three tertiary hospitals in Nantong, China. Prenatal anxiety was assessed using the anxiety subscale of the Depression Anxiety Stress Scale-21 (DASS-21), and resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) during pregnancy. Birth satisfaction and postpartum depressive symptoms were assessed using the Birth Satisfaction Scale-Revised Indicator (BSS-RI) and Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postpartum. Parallel mediation analysis was performed using PROCESS macro with 5000 bootstrap samples, adjusting for maternal age and physical discomfort. RESULTS: A total of 635 participants completed two rounds of questionnaire surveys. Birth satisfaction and resilience showed significant indirect associations between prenatal anxiety and PPD. The indirect association through birth satisfaction was 0.047 (95% confidence interval [CI]: 0.025-0.073), accounting for 17.34% of the total statistical association. Furthermore, the indirect association through resilience was 0.082 (95% CI: 0.054-0.116), accounting for 30.26% of the total statistical association. CONCLUSION: Prenatal anxiety was associated with postpartum depressive symptoms, with significant indirect associations through birth satisfaction and resilience. These findings highlight the potential relevance of psychological resources and childbirth experience in postpartum mental health and support further longitudinal and intervention research.