Relation Between Pregnancy Psychological Status and Prenatal Depression: A Path Analysis

Relation Between Pregnancy Psychological Status and Prenatal Depression: A Path Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relation Between Pregnancy Psychological Status and Prenatal Depression: A Path Analysis Erfaneh Talebi, Hamideh Mohaddesi, Javad Rasouli, Shaghayegh Kaviani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3870844/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pregnancy is the most stressful period of a woman’s life, during which conditions such as neuroticism, depression, and anxiety are highly prevalent. Considering the literature emphasizing the adverse effects of prenatal depression on the mother and foetus, even in later periods such as childhood and adulthood, the present study aims to identify factors related to prenatal depression among women. Methods This cross-sectional (descriptive and analytical) study was conducted on 130 pregnant women referring to health centres in Urmia in 2021. The participants were selected using the multi-stage random sampling method. The instruments included a Demographic-Pregnancy Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Pregnancy Experience Scale (PES), Positive Feeling Questionnaire (PFQ), and Prenatal Distress Questionnaire (PDQ). Results The depression rate was obtained at 38% among pregnant women. Prenatal depression was negatively correlated with positive feelings towards the spouse and pregnancy experience. However, it was directly associated with prenatal distress. Moreover, women’s employment status and their husbands’ education could affect prenatal depression. Conclusion The results revealed psychological factors such as feelings towards the spouse and pleasant or unpleasant experiences during pregnancy affected women’s mental health. Thus, these factors should be considered when performing interventions to improve depression during pregnancy. Healthcare clinics should be equipped with depression diagnosis tools in routine care programs to screen pregnant mothers, diagnose prenatal depression early, and perform appropriate interventions. Ethical code: IR.UMSU.REC.1400.214 pregnancy depression pregnancy experience positive feelings towards spouse prenatal distress Figures Figure 1 Figure 2 Introduction Pregnancy is among the most important stages of a woman’s life. Although it is a pleasant period for most women, it is often stressful and significantly impacts on women’s mental and physical health [ 1 , 2 ]. Given that the social activity of pregnant women is lower than other people in society, it could be said that pregnancy changes many aspects of a woman’s life and affects her health, happiness and social roles [ 3 ]. These hormonal and social changes during pregnancy can cause mood swings [ 4 ]. Therefore, pregnancy is the most stressful period of a woman’s life, during which conditions such as neuroticism, depression, anxiety, phobia, and obsessive-compulsive disorder are highly prevalent [ 5 – 7 ]. The prevalence of depression among women is 1.5-3 times higher than among men, especially among women at reproductive age [ 8 ], the reason for which could be attributed to factors such as their exposure to childbirth and pregnancy stresses, low social status, and hormonal changes [ 1 , 9 ]. Studies have reported the prenatal depression rate at 13.5–42%, which is higher in the third trimester than in other periods [ 10 , 11 ]. Prenatal depression affects self-care ability and impairs nutrition, sleep, and compliance with medical advice [ 12 ]. Studies have demonstrated more than 45% of women with prenatal depression suffer from postpartum depression [ 13 ]. Therefore, depression is of great importance due to its adverse effects on the mother, foetus, and infant, including impaired memory and concentration, anhedonia, failure to communicate effectively with the infant, feelings of discomfort and low self-esteem, smoking, alcohol and drug abuse, suicide attempts, hypertension, increased risk of preeclampsia, sleep disturbance, weight loss or gain, prematurity, and baby’s behavioural change [ 12 , 14 – 16 ]. Depression could be associated with anxiety and distress [ 17 ]. Huizink et al. (2004) found that prenatal distress was closely correlated with neurological disorders and hormonal changes during pregnancy [ 18 ]. Various studies on prenatal distress have identified many effective factors, including high-risk pregnancies, psychiatric disorders or chronic diseases, exposure to domestic violence, low educational level, family problems, low pregnancy age, unemployment and unintended pregnancy [ 19 – 21 ]. Hueston and Kasik-Miller (1998) reported that receiving support from husbands could affect women’s life quality and mental health during pregnancy [ 22 ]. Therefore, receiving inadequate emotional and psychological support and having unpleasant feelings toward the spouse are among the most important risk factors for depression among pregnant women [ 23 ]. Emotional intimacy and positive feelings toward the spouse are among the major aspects of the marital relationship affecting the mother-child emotional bond [ 24 ]. Ross (2012) found that mother-child attachment was significantly and negatively correlated with a lack of support from the spouse [ 25 ]. Considering the literature emphasizing the adverse effects of prenatal depression on the mother and foetus, even in later periods such as childhood and adulthood [ 26 ], and the point that the mother is the main focus of the child’s social environment in the first year of life, great attention should be paid to factors influencing depression during this period. Therefore, using an analytical model, the present study aims to identify the factors affecting prenatal depression among women referring to health centres in Urmia in 2021. Methods Participants This cross-sectional (descriptive and analytical) study was conducted on 130 pregnant women referring to health centres of Urmia, in 2021. The participants were selected using the multi-stage random sampling method. Thus, all health centres in Urmia were divided into three levels in terms of socioeconomic status, and two centres were randomly selected from each level. After referring to the selected centres, the lead researcher obtained a list of all eligible women for participation in the study. Accordingly, 30, 60, and 40 women were selected from levels 1, 2, and 3, respectively, using the convenience sampling method. Considering the estimated relevant parameters in Eick’s et al. (2020) study as well as r = 0.6, β = 0.01, and α = 0.01, the sample size was calculated as 58 using the corresponding formula for correlational research [ 27 ]. In total, 130 individuals were included in the study by applying the study design coefficient considering a sampling type of 1.8 and an attrition probability of 20%. \({\left(\frac{Z\alpha +Z\beta }{C}\right)}^{2}=n\) =126 C=. 5×Ln [(1 + r)/ (1-r)] Inclusion criteria were patients with 15–49 years old, gestational age less than 20 weeks, being literate, no addiction to psychotropic drugs, cigarettes, and alcohol and willing to participate in the study. Ethics This study was approved by the Ethics Committee of Urmia University of Medical Sciences with reference no. IR.UMSU.REC.1400.214. Each participant provided a written consent form prior to the participation. All the women were allowed to withdraw from completing the questionnaire whenever they wished and were assured that their data would only be available to the senior researcher. Measures After explaining the research objectives and obtaining informed consent from the mothers, the required demographic-pregnancy data, including age, educational level, occupation, economic status, gestational age, number of pregnancies, number of deliveries, history of abortion, number of children in the family, history of infertility, history of mental disorders and hospitalization and addiction to psychotropic drugs, cigarettes and alcohol were collected using the demographic-pregnancy questionnaire. Edinburgh postnatal depression scale (EPDS) was used due to several characteristics such as ease of use, objectivity, targeting symptoms of depression, shortness, high validity in research conducted in other countries, and high acceptance worldwide. The pregnancy experience scale (PES) was applied due to its simplicity, shortness, and considering the important evaluation criteria. A positive feeling questionnaire (PFQ) was employed due to its simplicity, shortness, and high validity in society. A prenatal distress questionnaire (PDQ) was also used due to its simplicity, shortness, and high validity in Iranian society. The questionnaires were completed by pregnant women referring to health centres in the presence of a trained interviewer in a quiet environment. Edinburgh postnatal depression scale (EPDS) This 10-item scale was developed and revised by Cox et al. (1996) to measure prenatal and postpartum depression [ 54 ]. The items are scored on a 4-point scale, ranging from low to high intensity and vice versa. Each item is scored from 0 to 3, and the overall score ranges from 0 to 30. To classify depressed and non-depressed individuals using this scale, a score of 12 or higher represents depression. The reliability of this scale was confirmed by Cronbach’s alpha coefficient greater than 0.70 in various studies conducted in Iran [ 30 ], France [ 29 ], and Turkey [ 28 ]. Pregnancy experience scale (PES) This scale was designed by Janat et al. (2008) at Johns Hopkins University to assess women’s pregnancy experience. PES consists of 20 items in two dimensions (happiness and anxiety during pregnancy), scored on a 5-point Likert scale. Higher scores indicate more happiness [ 31 ]. Janat et al. calculated the overall reliability of the English version as 0.80. The reliability of happiness and anxiety domains was obtained as 0.82 and 0.83, respectively [ 31 ]. Ebadi et al. (2017) calculated Cronbach’s alpha coefficient of the whole scale as 0.71 in Iranian society, cronbach’s alpha coefficients of happiness and anxiety domains were obtained as 0.77 and 0.67, respectively [ 32 ]. Exploratory factor analysis (EFA) confirmed the construct validity of this two-factor scale. Positive feeling questionnaire (PFQ) : This questionnaire was developed by O’Leary et al. (1975) at the State University of New York couple therapy clinic to assess positive feelings or love towards the spouse [ 33 ]. This tool consists of 17 items rated on the Likert scale (ranging from 1 = strongly negative emotions to 7 = strongly positive emotions) and measures the effect of touching, intimacy, kissing, and sitting close to the spouse. This questionnaire is divided into two sections: 1) Participants’ feelings towards their spouse and 2) Participants’ general opinion about each item. O’Leary et al. (1975) calculated the test-retest reliability of this questionnaire as 0.93 at the interval of 1–3 weeks and correlation coefficient with marital adjustment was obtained as 0.7 [ 33 ]. Sanaei et al. (2017) reported its alpha internal consistency coefficient as 0.94 in Iranian society [ 34 ]. Prenatal distress questionnaire (PDQ) : This 12-item questionnaire was developed by Alderdice et al. (2013) to assess prenatal anxiety and distress. PDQ consists of three subscales: Concerns about giving birth and baby, concerns about body weight and image, and concerns about emotions and relationships. The items are scored on a 5-point Likert scale, ranging from 0 to 4. The highest and lowest scores that a person can get are 48 and 0, respectively. The higher the score, the more anxious the woman is during pregnancy [ 35 ]. Alderdice et al. (2013), calculated Cronbach’s alpha coefficient of this questionnaire as 0.80–0.81 [ 35 ]. Yousefi (2015) examined the reliability of this questionnaire in Iran by obtaining its Cronbach’s alpha coefficient. The overall reliability was calculated as 0.78. Moreover, the reliability of subscales of concerns about giving birth and baby, concerns about body weight and image, and concerns about emotions and relationships was obtained as 0.72, 0.65, and 0.66, respectively. Confirmatory factor analysis (CFA) confirmed these three subscales [ 36 ]. Statistical analysis The data collected through questionnaires were analysed in two sections in order to achieve the research objectives. In the first section, the data were analysed using descriptive statistics such as frequency, mean, and standard deviation in SPSS 21.0. Univariate analysis, including a two-independent t-test, one-way ANOVA, Chi-square, and Pearson’s correlation, was performed to examine correlations. In the second section, the data were analysed by Mplus 7.1. Path analysis was applied to investigate all the effects and control confounding factors. This statistical method could calculate direct, indirect, and total effects. A preliminary conceptual model was developed (Fig. 1 ) and then tested to perform this analysis. The relevant indicators, including the comparative fit index (CFI), Tucker-Lewis index (TLI), root mean squared error of approximation (RMSEA), and standardized root-mean-square residual (SRMR), were calculated to fit the model. According to the number of variables, to ensure enough power of the study, using the R software for power analysis (online calculator) [ 37 ], the results showed that the power of the study was 0.87, indicating its adequacy are the recommended amounts [ 38 ]. Results Questionnaires were distributed to 130 women, and after filling out the questionnaire and removing the incomplete questionnaires, this number was reduced to 121 women. The mean age of the participants was 28.93 ± 5.43 years old. Most had an academic degree (53.7%) or a diploma (26.4%). The majority of women were housewives (69.4%), and 35 women (28.9%) had a history of abortion (Table 1 ). Table 1 Distribution of Demographic & Medical Characteristics Mean ± SD N (%) age 28.93 ± 5.43 121 Husband age 33.89 ± 5.45 121 Marriage duration 6.34 ± 4.92 121 Parity 1.89 ± 1.01 121 BMI 26.93 ± 4.24 121 woman education Elementary 9(7.5%) middle school 15(12.4%) Diploma 32(26.4%) Collegiate 65(53.7%) Husband education Elementary 12(9.9%) middle school 13(10.7%) Diploma 34(28.1%) Collegiate 62(51.3%) woman job Employed 37(30.6%) Unemployed 84(69.4%) Relative Yes 20(16.5%) No 101(83.5%) Abortion Yes 35(28.9%) No 86(71.1%) Economic status >expenditure 18(14.9%) Equal to expenditure 74(61.1) < expenditure 29(24%) As presented in Table 2 , the mean score of participants’ depression was 10.24 ± 5.55. In the 10-item EPDS, a score of 12 or higher represented depression. The results showed that 75 women (62%) were healthy (score < 12), and 46 women (38%) had depression (score ≥ 12). Table 2 Mean of Psychosocial Measures Mean ± SD Depression 10.24 ± 5.55 Pregnancy specific distress 18.56 ± 9.64 Positive Psychological States 105.51 ± 12.37 Pregnancy Experience Scale 56.27 ± 7.25 Moreover, prenatal depression was negatively correlated with positive feelings towards the spouse and pregnancy experience. However, it was directly correlated with prenatal distress (Table 3 ). Table 3 Correlation Coefficients Between Continuous Psychosocial Measures postnatal Depression Pregnancy specific distress Positive Psychological States Pregnancy Experience Scale Depression - .431 (< .001) * − .388 (< .001) * − .428 (< .001) * Pregnancy specific distress .431 (< .001) * - − .344 (.001) * − .543 (< .001) * Positive Psychological States − .388 (< .001) * − .344 (.001) * - .327 (.001) * Pregnancy Experience Scale − .428 (< .001) * − .543 (< .001) * .327 (.001) * - *statistically significance (p < 0.001) Table 4 and Fig. 2 presents the variables that have significant total effects on the psychological variables. The husband’s educational level, pregnancy experience scale and positive psychological states had significant, and total negative effects on depression, while the woman’s occupation and pregnancy-specific distress had significant and direct total effects on depression. Table 4 Direct, Indirect, And Total Effects Between Psychosocial Measures and Demographic & Medical Characteristics Dependent variable Independent variable Direct effect Indirect effect Total effect Pregnancy Experience Scale Woman Job − .109( .216) − .103 (.140) − .212 (.05) * Husband age .244 (.05) * − .073( .467) .170( .282) Pregnancy specific distress − .555(< .001) ** - − .555(< .001) ** Positive Psychological States .162(< .079) .251(< .001) ** .414(< .001) ** Pregnancy specific distress Relative − .188(.028) * .033(.451) − .151(.092) Parity − .303( .045) * .038( .613) − .264( .104) Positive Psychological States Gestational age − .2 ( .035) * - − .2 ( .035) * Depression Woman Job .108( .246) .098 (.070) .206 (.043) * Husband education − .240( .090) − .062( .433) − .303( .05) * Pregnancy Experience Scale − .201(.044) * - − .201(.044) * Positive Psychological States − .206(.044) * − .166 (.002) * − .371 (< .001) ** Pregnancy specific distress .182(.074) .112(.052) .294( 0.05, ** significance at p < 0.001, Model has good fit (RMSEA = < 0.001, SRMR < 0.001, CFI = 0.99, TLI = 0.99) Discussion This study examined the correlation between psychological status during pregnancy and prenatal depression using a conceptual model. The designed model was tested using the path analysis method, which revealed the correlation between psychological factors and depression. Positive psychological states and pregnancy-specific distress were identified as important predictors of depression. Moreover, women who experienced more positive pregnancies had lower levels of depression. The husband’s educational level was recognized as an influential factor in depression among women, and employed women had higher levels of depression. Gestational age, consanguine marriage, number of pregnancies, and husband’s age had significant direct impacts on depression. In this study, the depression rate among pregnant women was 38%, which was in line with studies conducted in Africa and London [ 39 , 40 ]. However, this rate was higher than the value estimated through systematic studies in countries such as Ethiopia [ 41 ], and some developed countries [ 10 ]. This inconsistency may be due to the dependence of depression-related factors on the culture and economy of the country. Many studies conducted in Iran have reported the prevalence of depression as 21.1–45.7% [ 42 – 45 ]. The results indicated a significant negative correlation between the husband’s educational level and depression, which could be attributed to the point that educated husbands better understood their pregnant women’s conditions. Moreover, positive feelings towards the spouse were identified as a strong effective factor in the incidence of depression during pregnancy, which was consistent with the study by Hartley et al. (2011) [ 39 ]. However, they found no significant correlation between the husband’s educational level and the incidence of prenatal depression [ 39 ]. Furthermore, receiving support from the spouse, having positive feelings towards the spouse, and lack of conflicts were positively correlated with prenatal and postpartum depression, which was in line with studies conducted in many countries [ 46 – 49 ]. Gestational age was identified as a factor influencing positive feelings towards the spouse, so positive feelings towards the spouse decreased with increasing gestational age. It has been proven that pregnancy could cause physical, hormonal, and psychological changes in women, and these changes in the first trimester could be a reason for this result. Moreover, increasing gestational age is associated with higher fatigue levels, which could affect women’s feelings [ 10 , 11 ]. The correlation between prenatal distress and depression among women was similar to those of previous relevant studies [ 50 ]. By conducting a study in California, Eick et al. (2020) found that mothers with higher levels of depression experienced more stressful events during pregnancy and had higher perceived stress levels [ 27 ]. A prospective cohort study in Puerto Rico indicated stressful life events were associated with increased perceived stress and symptoms of depression [ 51 ]. The results revealed the increasing number of pregnancies (whether successful or unsuccessful) affected the perceived distress of women during pregnancy. Duko et al. (2019) reported that an unpleasant experience in previous pregnancies, such as abortion, was directly correlated with prenatal distress [ 52 ]. The results indicated pregnancy experience was significantly and negatively correlated with prenatal depression, so the more sadness, anxiety, and dissatisfaction the women experienced, the higher their expression level. This finding was consistent with those of studies by Bisetegn et al. (2016) [ 41 ] and Rallis et al. (2014) [ 53 ]. Strengths, limitations, and future directions This study included variables that could be measured by a standard scale. However, since this was a cross-sectional study, it was impossible to examine the temporal correlation between depression and other variables as well as identify the cause. Thus, it is recommended to conduct prospective longitudinal studies to better explain changes in the relevant variables during pregnancy. Moreover, this research included only pregnant women who received prenatal care in health centres. Therefore, the variables may have been over- or underestimated. However, attempts were made to overcome this problem by selecting women from different urban areas and centres. It is suggested to perform further studies in public and private healthcare centres in urban and rural areas in order to better explain the correlation between variables. Conclusion The results revealed psychological factors such as feelings towards the spouse and pleasant or unpleasant experiences during pregnancy could affect women’s mental health. Thus, it is essential for women and their husbands to plan for pregnancy. Moreover, factors such as positive feelings towards the spouse, prenatal distress and pregnancy experience were among the major factors influencing depression. Therefore, these factors should be considered when performing interventions to improve depression during pregnancy. Healthcare clinics should be equipped with depression diagnosis tools in routine care programs to screen pregnant mothers, diagnose prenatal depression early and perform appropriate interventions. Abbreviations UMSU: Urmia Medical Sciences University EPDS: Edinburgh Postnatal Depression Scale PES: Pregnancy Experience Scale PFQ: Positive Feeling Questionnaire PDQ: Prenatal Distress Questionnaire CFI: Comparative fit index TLI: Tucker-Lewis index RMSEA: Root mean squared error of approximation SRMR: Standardized root-mean-square residual Declarations Acknowledgements, we would like to appreciate Vice Chancellor for Research and Technology of Urmia University of Medical Sciences who provided conditions for conducting this study, the midwives working in healthcare centres in Urmia and all the pregnant women who generously spent their time and energy to complete the questionnaires. Authors' contributions, ET, HM contributed to the design of the manuscript. JR contributed to the implementation and analysis plan. ET and SK contributed to data collection. ET, HM and JR have written the first draft of this manuscript. All authors read and approved the final manuscript. Funding, this study was supported by UMSU financially. Availability of data and materials, the data used in this study is available from the corresponding author on reasonable request. Ethics approval and consent to participate, the ethics committee of Urmia University of Medical Sciences approved the study (Ethical code: IR.UMSU.REC.1400.214). The participants were fully informed about the study goals. Each participant provided a written consent form prior to the participation. All the women were allowed to withdraw from completing the questionnaire whenever they wished and were assured that their data would only be available to the senior researcher. Consent for publication, not applicable. Competing Interest, the authors declare no conflict of interest. References Leigh, B., Milgrom, J. Risk factors for antenatal depression, postnatal depression and parenting stress. 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Nurs midwifery res j. 2015; 13(3), 215-225. http://unmf.umsu.ac.ir/article-1-1885-en.html Schoemann, A.M., Preacher, K. J., Coffman, D. L. Plotting power curves for RMSEA [Computer software]. 2010. Available from: http://quantpsy.org/ Rezaianzadeh, A., Maghsoudi, B., Tabatabaee, H., Keshavarzi, S., Bagheri, Z., Sajedianfard, J., Gerami, H., Rasouli, J. Factors associated with extubation time in coronary artery bypass grafting patients. Peer J. 2015; 3, e1414. https://doi.org/10.7717/peerj.1414 Hartley, M., Tomlinson, M., Greco, E., Comulada, W.S., Stewart, J., Le Roux, I., Mbewu, N., Rotheram-Borus, M.J. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011; 8(1), 1-7. https://doi.org/10.1186/1742-4755-8-9 Plant, D.T., Pariante, C.M., Sharp, D., Pawlby, S. Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment. Br J Psychiatry. 2015; 207(3), 213-220. https://doi.org/10.1192/bjp.bp.114.156620 Bisetegn, T.A., Mihretie, G., Muche, T. Prevalence and predictors of depression among pregnant women in debretabor town, northwest Ethiopia. PloS one. 2016; 11(9), e0161108. https://doi.org/10.1371/journal.pone.0161108 Ahmadzade, G.H., Sadeghizadeh, A., Amanat, S., Omranifard, V., Afshar, H. Prevalence of depression in pregnant women and its relationship with some socioeconomic factors. Med J Hormozgan Univ. 2007; 10(4), 329-334. https://hmj.hums.ac.ir/PDF/90155.pdf Khamseh, F., Parandeh, A., Hajiamini, Z., Tadrissi, S.D., Najjar, M. Effectiveness of applying problem-solving training on depression in Iranian pregnant women: Randomized clinical trial. J Educ Health Promot. 2019; 8. https://doi.org/10.4103/jehp.jehp_270_18 Omidvar, S., Kheyrkhah, F., Azimi, H. Depression during pregnancy and its related factors. Hormozgan Med J. 2007; 11(3), 213-219. https://hmj.hums.ac.ir/PDF/89562.pdf Hosaynisazi, F., Poorreza, A., Hosayni, M., Shojaee, D. Depression during pregnancy. J Gorgan Univ Med Scien. 2005; 7(1), 60-5. [Persian]. Biratu, A., Haile, D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015; 12(1), 1-8. https://doi.org/10.1186/s12978-015-0092-x Nasreen, H.E., Kabir, Z.N., Forsell, Y., Edhborg, M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC women's health. 2011; 11(1), 1-9. https://doi.org/10.1186/1472-6874-11-22 Ramchandani, P.G., Richter, L.M., Stein, A., Norris, S.A. Predictors of postnatal depression in an urban South African cohort. J Affect Disord. 2009; 113(3), 279-284. https://doi.org/10.1016/j.jad.2008.05.007 Tomlinson, M., Swartz, L., Cooper, P.J., Molteno, C. Social factors and postpartum depression in Khayelitsha, Cape Town. S Afr J Psychol. 2004; 34(3), 409-420. https://doi.org/10.1177/008124630403400305 Kinser, P.A., Thacker, L.R., Lapato, D., Wagner, S., Roberson-Nay, R., Jobe-Shields, L., Amstadter, A., York, T.P. Depressive symptom prevalence and predictors in the first half of pregnancy. J Womens Health. 2018; 27(3), 369-376. https://doi.org/10.1089/jwh.2017.6426 Antonenko, Y.N., Khailova, L.S., Knorre, D.A., Markova, O.V., Rokitskaya, T.I., Ilyasova, T.M., Severina, I.I., Kotova, E.A., Karavaeva, Y.E., Prikhodko, A.S., Severin, F.F. Penetrating cations enhance uncoupling activity of anionic protonophores in mitochondria. Plos one. 2013; 8(4), e61902. https://doi.org/10.1371/journal.pone.0061902 Duko, B., Ayano, G., Bedaso, A. Depression among pregnant women and associated factors in Hawassa city, Ethiopia: an institution-based cross-sectional study. Reprod Health. 2019; 16(1), 1-6. https://doi.org/10.1186/s12978-019-0685-x Rallis, S., Skouteris, H., McCabe, M., Milgrom, J. A prospective examination of depression, anxiety and stress throughout pregnancy. Women Birth. 2014; 27(4), e36-e42. https://doi.org/10.1016/j.wombi.2014.08.002 Cox, J. L., Chapman, G., Murray, D., Jones, P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord. 1996; 39(3), 185-189. https://doi.org/10.1016/0165-0327(96)00008-0 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3870844","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":269081780,"identity":"09267931-a7d6-4a1b-93b5-a75ed33566d1","order_by":0,"name":"Erfaneh Talebi","email":"","orcid":"","institution":"University of Central Lancashire","correspondingAuthor":false,"prefix":"","firstName":"Erfaneh","middleName":"","lastName":"Talebi","suffix":""},{"id":269081781,"identity":"f6214412-5fdd-49f0-b9df-6470a358c2a5","order_by":1,"name":"Hamideh Mohaddesi","email":"","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hamideh","middleName":"","lastName":"Mohaddesi","suffix":""},{"id":269081782,"identity":"054d8028-5e90-45da-828a-e767a192412a","order_by":2,"name":"Javad Rasouli","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYNCCAgkGxvYGGI+xAbdKODAAauk5QJoWIJZIINJJ5u3HHz7mMbBgYJ75xnTjzzYGef4G5rYP+LTInMkxNuYBOWx2jtlt3jYGwxkHGJtn4NMiwZDDJg3XwtjGwLiBgbEZr8Mk+J8/g2iZecbsJtBh9oS1SCSYQbTM4DG7AXRYIhFa3hgbzjGQ4GHsSSu7zXNOInnGYYIOS3/44E1FnZxh++FtN3+U2dj2t7c/xqsFBngMGyBGMDAwE6UBCOSJVTgKRsEoGAUjDwAADQs8R/9QDvQAAAAASUVORK5CYII=","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Javad","middleName":"","lastName":"Rasouli","suffix":""},{"id":269081783,"identity":"d94aa314-4328-4252-b613-4c421dfb898d","order_by":3,"name":"Shaghayegh Kaviani","email":"","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Shaghayegh","middleName":"","lastName":"Kaviani","suffix":""}],"badges":[],"createdAt":"2024-01-16 19:59:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3870844/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3870844/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50169475,"identity":"8f169aaa-229d-49f9-8a81-5a1877eb6d35","added_by":"auto","created_at":"2024-01-25 15:31:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":455225,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHypothesized Pathways Between Psychosocial\u003c/strong\u003e \u003cstrong\u003eMeasures and Demographic \u0026amp; Medical Characteristics\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3870844/v1/126feca7388f01328e1e01f3.jpeg"},{"id":50169476,"identity":"bdd53f7b-71da-44ac-bb3b-2cc8d55b0179","added_by":"auto","created_at":"2024-01-25 15:31:42","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":280764,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFull Empirical Model Indicating the Associations Between Psychosocial Measures and Demographic \u0026amp; Medical Characteristics \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003e(Model has good fit (RMSEA = \u0026lt;0.001, SRMR \u0026lt; 0.001, CFI = 0.99, TLI = 0.99)\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3870844/v1/7544b1243eb0fdc5d438c44b.jpeg"},{"id":59035459,"identity":"fcb9e0ab-e7ff-4931-8a8f-7d824ced0a2e","added_by":"auto","created_at":"2024-06-25 15:01:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1398244,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3870844/v1/562616f9-5077-4c6c-ae11-9452627445fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relation Between Pregnancy Psychological Status and Prenatal Depression: A Path Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePregnancy is among the most important stages of a woman\u0026rsquo;s life. Although it is a pleasant period for most women, it is often stressful and significantly impacts on women\u0026rsquo;s mental and physical health [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Given that the social activity of pregnant women is lower than other people in society, it could be said that pregnancy changes many aspects of a woman\u0026rsquo;s life and affects her health, happiness and social roles [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These hormonal and social changes during pregnancy can cause mood swings [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, pregnancy is the most stressful period of a woman\u0026rsquo;s life, during which conditions such as neuroticism, depression, anxiety, phobia, and obsessive-compulsive disorder are highly prevalent [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prevalence of depression among women is 1.5-3 times higher than among men, especially among women at reproductive age [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the reason for which could be attributed to factors such as their exposure to childbirth and pregnancy stresses, low social status, and hormonal changes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Studies have reported the prenatal depression rate at 13.5\u0026ndash;42%, which is higher in the third trimester than in other periods [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Prenatal depression affects self-care ability and impairs nutrition, sleep, and compliance with medical advice [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Studies have demonstrated more than 45% of women with prenatal depression suffer from postpartum depression [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Therefore, depression is of great importance due to its adverse effects on the mother, foetus, and infant, including impaired memory and concentration, anhedonia, failure to communicate effectively with the infant, feelings of discomfort and low self-esteem, smoking, alcohol and drug abuse, suicide attempts, hypertension, increased risk of preeclampsia, sleep disturbance, weight loss or gain, prematurity, and baby\u0026rsquo;s behavioural change [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDepression could be associated with anxiety and distress [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Huizink et al. (2004) found that prenatal distress was closely correlated with neurological disorders and hormonal changes during pregnancy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Various studies on prenatal distress have identified many effective factors, including high-risk pregnancies, psychiatric disorders or chronic diseases, exposure to domestic violence, low educational level, family problems, low pregnancy age, unemployment and unintended pregnancy [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHueston and Kasik-Miller (1998) reported that receiving support from husbands could affect women\u0026rsquo;s life quality and mental health during pregnancy [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, receiving inadequate emotional and psychological support and having unpleasant feelings toward the spouse are among the most important risk factors for depression among pregnant women [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Emotional intimacy and positive feelings toward the spouse are among the major aspects of the marital relationship affecting the mother-child emotional bond [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Ross (2012) found that mother-child attachment was significantly and negatively correlated with a lack of support from the spouse [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Considering the literature emphasizing the adverse effects of prenatal depression on the mother and foetus, even in later periods such as childhood and adulthood [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and the point that the mother is the main focus of the child\u0026rsquo;s social environment in the first year of life, great attention should be paid to factors influencing depression during this period. Therefore, using an analytical model, the present study aims to identify the factors affecting prenatal depression among women referring to health centres in Urmia in 2021.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis cross-sectional (descriptive and analytical) study was conducted on 130 pregnant women referring to health centres of Urmia, in 2021. The participants were selected using the multi-stage random sampling method. Thus, all health centres in Urmia were divided into three levels in terms of socioeconomic status, and two centres were randomly selected from each level. After referring to the selected centres, the lead researcher obtained a list of all eligible women for participation in the study. Accordingly, 30, 60, and 40 women were selected from levels 1, 2, and 3, respectively, using the convenience sampling method.\u003c/p\u003e \u003cp\u003eConsidering the estimated relevant parameters in Eick\u0026rsquo;s et al. (2020) study as well as r\u0026thinsp;=\u0026thinsp;0.6, β\u0026thinsp;=\u0026thinsp;0.01, and α\u0026thinsp;=\u0026thinsp;0.01, the sample size was calculated as 58 using the corresponding formula for correlational research [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In total, 130 individuals were included in the study by applying the study design coefficient considering a sampling type of 1.8 and an attrition probability of 20%.\u003c/p\u003e \u003cp\u003e \u003cspan class=\"InlineEquation\"\u003e \u003cspan class=\"mathinline\"\u003e\\({\\left(\\frac{Z\\alpha +Z\\beta }{C}\\right)}^{2}=n\\)\u003c/span\u003e \u003c/span\u003e=126\u003c/p\u003e \u003cp\u003eC=. 5\u0026times;Ln [(1\u0026thinsp;+\u0026thinsp;r)/ (1-r)]\u003c/p\u003e \u003cp\u003eInclusion criteria were patients with 15\u0026ndash;49 years old, gestational age less than 20 weeks, being literate, no addiction to psychotropic drugs, cigarettes, and alcohol and willing to participate in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003e This study was approved by the Ethics Committee of Urmia University of Medical Sciences with reference no. IR.UMSU.REC.1400.214. Each participant provided a written consent form prior to the participation. All the women were allowed to withdraw from completing the questionnaire whenever they wished and were assured that their data would only be available to the senior researcher.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eAfter explaining the research objectives and obtaining informed consent from the mothers, the required demographic-pregnancy data, including age, educational level, occupation, economic status, gestational age, number of pregnancies, number of deliveries, history of abortion, number of children in the family, history of infertility, history of mental disorders and hospitalization and addiction to psychotropic drugs, cigarettes and alcohol were collected using the demographic-pregnancy questionnaire. Edinburgh postnatal depression scale (EPDS) was used due to several characteristics such as ease of use, objectivity, targeting symptoms of depression, shortness, high validity in research conducted in other countries, and high acceptance worldwide. The pregnancy experience scale (PES) was applied due to its simplicity, shortness, and considering the important evaluation criteria. A positive feeling questionnaire (PFQ) was employed due to its simplicity, shortness, and high validity in society. A prenatal distress questionnaire (PDQ) was also used due to its simplicity, shortness, and high validity in Iranian society. The questionnaires were completed by pregnant women referring to health centres in the presence of a trained interviewer in a quiet environment.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEdinburgh postnatal depression scale (EPDS)\u003c/strong\u003e \u003cp\u003eThis 10-item scale was developed and revised by Cox et al. (1996) to measure prenatal and postpartum depression [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. The items are scored on a 4-point scale, ranging from low to high intensity and vice versa. Each item is scored from 0 to 3, and the overall score ranges from 0 to 30. To classify depressed and non-depressed individuals using this scale, a score of 12 or higher represents depression. The reliability of this scale was confirmed by Cronbach\u0026rsquo;s alpha coefficient greater than 0.70 in various studies conducted in Iran [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], France [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], and Turkey [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePregnancy experience scale (PES)\u003c/strong\u003e \u003cp\u003eThis scale was designed by Janat et al. (2008) at Johns Hopkins University to assess women\u0026rsquo;s pregnancy experience. PES consists of 20 items in two dimensions (happiness and anxiety during pregnancy), scored on a 5-point Likert scale. Higher scores indicate more happiness [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Janat et al. calculated the overall reliability of the English version as 0.80. The reliability of happiness and anxiety domains was obtained as 0.82 and 0.83, respectively [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Ebadi et al. (2017) calculated Cronbach\u0026rsquo;s alpha coefficient of the whole scale as 0.71 in Iranian society, cronbach\u0026rsquo;s alpha coefficients of happiness and anxiety domains were obtained as 0.77 and 0.67, respectively [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Exploratory factor analysis (EFA) confirmed the construct validity of this two-factor scale.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cem\u003ePositive feeling questionnaire (PFQ)\u003c/em\u003e: This questionnaire was developed by O\u0026rsquo;Leary et al. (1975) at the State University of New York couple therapy clinic to assess positive feelings or love towards the spouse [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This tool consists of 17 items rated on the Likert scale (ranging from 1\u0026thinsp;=\u0026thinsp;strongly negative emotions to 7\u0026thinsp;=\u0026thinsp;strongly positive emotions) and measures the effect of touching, intimacy, kissing, and sitting close to the spouse. This questionnaire is divided into two sections: 1) Participants\u0026rsquo; feelings towards their spouse and 2) Participants\u0026rsquo; general opinion about each item. O\u0026rsquo;Leary et al. (1975) calculated the test-retest reliability of this questionnaire as 0.93 at the interval of 1\u0026ndash;3 weeks and correlation coefficient with marital adjustment was obtained as 0.7 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Sanaei et al. (2017) reported its alpha internal consistency coefficient as 0.94 in Iranian society [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003ePrenatal distress questionnaire (PDQ)\u003c/em\u003e: This 12-item questionnaire was developed by Alderdice et al. (2013) to assess prenatal anxiety and distress. PDQ consists of three subscales: Concerns about giving birth and baby, concerns about body weight and image, and concerns about emotions and relationships. The items are scored on a 5-point Likert scale, ranging from 0 to 4. The highest and lowest scores that a person can get are 48 and 0, respectively. The higher the score, the more anxious the woman is during pregnancy [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Alderdice et al. (2013), calculated Cronbach\u0026rsquo;s alpha coefficient of this questionnaire as 0.80\u0026ndash;0.81 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Yousefi (2015) examined the reliability of this questionnaire in Iran by obtaining its Cronbach\u0026rsquo;s alpha coefficient. The overall reliability was calculated as 0.78. Moreover, the reliability of subscales of concerns about giving birth and baby, concerns about body weight and image, and concerns about emotions and relationships was obtained as 0.72, 0.65, and 0.66, respectively. Confirmatory factor analysis (CFA) confirmed these three subscales [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data collected through questionnaires were analysed in two sections in order to achieve the research objectives. In the first section, the data were analysed using descriptive statistics such as frequency, mean, and standard deviation in SPSS 21.0. Univariate analysis, including a two-independent t-test, one-way ANOVA, Chi-square, and Pearson\u0026rsquo;s correlation, was performed to examine correlations. In the second section, the data were analysed by Mplus 7.1. Path analysis was applied to investigate all the effects and control confounding factors. This statistical method could calculate direct, indirect, and total effects. A preliminary conceptual model was developed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and then tested to perform this analysis. The relevant indicators, including the comparative fit index (CFI), Tucker-Lewis index (TLI), root mean squared error of approximation (RMSEA), and standardized root-mean-square residual (SRMR), were calculated to fit the model. According to the number of variables, to ensure enough power of the study, using the R software for power analysis (online calculator) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], the results showed that the power of the study was 0.87, indicating its adequacy are the recommended amounts [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eQuestionnaires were distributed to 130 women, and after filling out the questionnaire and removing the incomplete questionnaires, this number was reduced to 121 women. The mean age of the participants was 28.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43 years old. Most had an academic degree (53.7%) or a diploma (26.4%). The majority of women were housewives (69.4%), and 35 women (28.9%) had a history of abortion (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of Demographic \u0026amp; Medical Characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eN (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e28.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHusband age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e33.89\u0026thinsp;\u0026plusmn;\u0026thinsp;5.45\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarriage duration\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e6.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.92\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eParity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBMI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e26.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e121\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003ewoman education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eElementary\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9(7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emiddle school\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15(12.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eDiploma\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32(26.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCollegiate\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65(53.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eHusband education\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eElementary\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12(9.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003emiddle school\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13(10.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eDiploma\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34(28.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCollegiate\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62(51.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ewoman job\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eEmployed\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37(30.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eUnemployed\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e84(69.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eRelative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20(16.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101(83.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eAbortion\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35(28.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e86(71.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eEconomic status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026gt;expenditure\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18(14.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eEqual to expenditure\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74(61.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026lt; expenditure\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29(24%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the mean score of participants\u0026rsquo; depression was 10.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55. In the 10-item EPDS, a score of 12 or higher represented depression. The results showed that 75 women (62%) were healthy (score\u0026thinsp;\u0026lt;\u0026thinsp;12), and 46 women (38%) had depression (score\u0026thinsp;\u0026ge;\u0026thinsp;12).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMean of Psychosocial Measures\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e10.24\u0026thinsp;\u003cem\u003e\u0026plusmn;\u0026thinsp;5.55\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePregnancy specific distress\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e18.56\u0026thinsp;\u003cem\u003e\u0026plusmn;\u0026thinsp;9.64\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive Psychological States\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e105.51\u0026thinsp;\u003cem\u003e\u0026plusmn;\u0026thinsp;12.37\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePregnancy Experience Scale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cp\u003e56.27\u0026thinsp;\u003cem\u003e\u0026plusmn;\u0026thinsp;7.25\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMoreover, prenatal depression was negatively correlated with positive feelings towards the spouse and pregnancy experience. However, it was directly correlated with prenatal distress (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCorrelation Coefficients Between Continuous Psychosocial Measures\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003epostnatal Depression\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePregnancy specific distress\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePositive Psychological States\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePregnancy Experience Scale\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.431 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.388 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.428 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePregnancy specific distress\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.431 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.344 (.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.543 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive Psychological States\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.388 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.344 (.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.327 (.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePregnancy Experience Scale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.428 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.543 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.327 (.001) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n\u003cp class=\"Heading\"\u003e\u003cem\u003e*statistically significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the variables that have significant total effects on the psychological variables. The husband\u0026rsquo;s educational level, pregnancy experience scale and positive psychological states had significant, and total negative effects on depression, while the woman\u0026rsquo;s occupation and pregnancy-specific distress had significant and direct total effects on depression.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDirect, Indirect, And Total Effects Between Psychosocial Measures and Demographic \u0026amp; Medical Characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDependent variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIndependent variable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDirect effect\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIndirect effect\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal effect\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003ePregnancy Experience Scale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eWoman Job\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.109( .216)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.103 (.140)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.212 (.05) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eHusband age\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.244 (.05) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.073( .467)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.170( .282)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePregnancy specific distress\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.555(\u0026lt;\u0026thinsp;.001) \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.555(\u0026lt;\u0026thinsp;.001) \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePositive Psychological States\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.162(\u0026lt;\u0026thinsp;.079)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.251(\u0026lt;\u0026thinsp;.001) \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.414(\u0026lt;\u0026thinsp;.001) \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003ePregnancy specific distress\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eRelative\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.188(.028) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.033(.451)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.151(.092)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eParity\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.303( .045)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.038( .613)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.264( .104)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePositive Psychological States\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eGestational age\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.2 ( .035)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.2 ( .035)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eDepression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eWoman Job\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.108( .246)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.098 (.070)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.206 (.043) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eHusband education\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.240( .090)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.062( .433)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.303( .05)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePregnancy Experience Scale\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.201(.044) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.201(.044) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePositive Psychological States\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.206(.044) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.166 (.002) \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;\u0026thinsp;.371 (\u0026lt;\u0026thinsp;.001) \u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePregnancy specific distress\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.182(.074)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.112(.052)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e.294(\u0026lt;\u0026thinsp;.001)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e\u003cstrong\u003e*significance at p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, ** significance at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Model has good fit (RMSEA\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001, SRMR\u0026thinsp;\u0026lt;\u0026thinsp;0.001, CFI\u0026thinsp;=\u0026thinsp;0.99, TLI\u0026thinsp;=\u0026thinsp;0.99)\u003c/strong\u003e\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the correlation between psychological status during pregnancy and prenatal depression using a conceptual model. The designed model was tested using the path analysis method, which revealed the correlation between psychological factors and depression.\u003c/p\u003e \u003cp\u003ePositive psychological states and pregnancy-specific distress were identified as important predictors of depression. Moreover, women who experienced more positive pregnancies had lower levels of depression. The husband\u0026rsquo;s educational level was recognized as an influential factor in depression among women, and employed women had higher levels of depression. Gestational age, consanguine marriage, number of pregnancies, and husband\u0026rsquo;s age had significant direct impacts on depression.\u003c/p\u003e \u003cp\u003eIn this study, the depression rate among pregnant women was 38%, which was in line with studies conducted in Africa and London [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, this rate was higher than the value estimated through systematic studies in countries such as Ethiopia [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and some developed countries [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This inconsistency may be due to the dependence of depression-related factors on the culture and economy of the country. Many studies conducted in Iran have reported the prevalence of depression as 21.1\u0026ndash;45.7% [\u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results indicated a significant negative correlation between the husband\u0026rsquo;s educational level and depression, which could be attributed to the point that educated husbands better understood their pregnant women\u0026rsquo;s conditions. Moreover, positive feelings towards the spouse were identified as a strong effective factor in the incidence of depression during pregnancy, which was consistent with the study by Hartley et al. (2011) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, they found no significant correlation between the husband\u0026rsquo;s educational level and the incidence of prenatal depression [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, receiving support from the spouse, having positive feelings towards the spouse, and lack of conflicts were positively correlated with prenatal and postpartum depression, which was in line with studies conducted in many countries [\u003cspan additionalcitationids=\"CR47 CR48\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Gestational age was identified as a factor influencing positive feelings towards the spouse, so positive feelings towards the spouse decreased with increasing gestational age. It has been proven that pregnancy could cause physical, hormonal, and psychological changes in women, and these changes in the first trimester could be a reason for this result. Moreover, increasing gestational age is associated with higher fatigue levels, which could affect women\u0026rsquo;s feelings [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe correlation between prenatal distress and depression among women was similar to those of previous relevant studies [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. By conducting a study in California, Eick et al. (2020) found that mothers with higher levels of depression experienced more stressful events during pregnancy and had higher perceived stress levels [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A prospective cohort study in Puerto Rico indicated stressful life events were associated with increased perceived stress and symptoms of depression [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results revealed the increasing number of pregnancies (whether successful or unsuccessful) affected the perceived distress of women during pregnancy. Duko et al. (2019) reported that an unpleasant experience in previous pregnancies, such as abortion, was directly correlated with prenatal distress [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results indicated pregnancy experience was significantly and negatively correlated with prenatal depression, so the more sadness, anxiety, and dissatisfaction the women experienced, the higher their expression level. This finding was consistent with those of studies by Bisetegn et al. (2016) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and Rallis et al. (2014) [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStrengths, limitations, and future directions\u003c/h2\u003e \u003cp\u003eThis study included variables that could be measured by a standard scale. However, since this was a cross-sectional study, it was impossible to examine the temporal correlation between depression and other variables as well as identify the cause. Thus, it is recommended to conduct prospective longitudinal studies to better explain changes in the relevant variables during pregnancy. Moreover, this research included only pregnant women who received prenatal care in health centres. Therefore, the variables may have been over- or underestimated. However, attempts were made to overcome this problem by selecting women from different urban areas and centres. It is suggested to perform further studies in public and private healthcare centres in urban and rural areas in order to better explain the correlation between variables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results revealed psychological factors such as feelings towards the spouse and pleasant or unpleasant experiences during pregnancy could affect women\u0026rsquo;s mental health. Thus, it is essential for women and their husbands to plan for pregnancy. Moreover, factors such as positive feelings towards the spouse, prenatal distress and pregnancy experience were among the major factors influencing depression. Therefore, these factors should be considered when performing interventions to improve depression during pregnancy. Healthcare clinics should be equipped with depression diagnosis tools in routine care programs to screen pregnant mothers, diagnose prenatal depression early and perform appropriate interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUMSU: Urmia Medical Sciences University\u003c/p\u003e\n\u003cp\u003eEPDS: Edinburgh Postnatal Depression Scale\u003c/p\u003e\n\u003cp\u003ePES: Pregnancy Experience Scale\u003c/p\u003e\n\u003cp\u003ePFQ: Positive Feeling Questionnaire\u003c/p\u003e\n\u003cp\u003ePDQ: Prenatal Distress Questionnaire\u003c/p\u003e\n\u003cp\u003eCFI: Comparative fit index\u003c/p\u003e\n\u003cp\u003eTLI: Tucker-Lewis index\u003c/p\u003e\n\u003cp\u003eRMSEA: Root mean squared error of approximation\u003c/p\u003e\n\u003cp\u003eSRMR: Standardized root-mean-square residual\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements,\u003c/strong\u003e we would like to appreciate Vice Chancellor for Research and Technology of Urmia University of Medical Sciences who provided conditions for conducting this study, the midwives working in healthcare centres in Urmia and all the pregnant women who generously spent their time and energy to complete the questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eET, HM contributed to the design of the manuscript. JR contributed to the implementation and analysis plan. ET and SK contributed to data collection. ET, HM and JR have written the first draft of this manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding,\u0026nbsp;\u003c/strong\u003ethis study was supported by UMSU financially.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials,\u0026nbsp;\u003c/strong\u003ethe data used in this study is available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate,\u0026nbsp;\u003c/strong\u003ethe ethics committee of Urmia University of Medical Sciences approved the study (Ethical code: IR.UMSU.REC.1400.214). The participants were fully informed about the study goals. Each participant provided a written consent form prior to the participation. All the women were allowed to withdraw from completing the questionnaire whenever they wished and were assured that their data would only be available to the senior researcher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication,\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest,\u0026nbsp;\u003c/strong\u003ethe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLeigh, B., Milgrom, J. Risk factors for antenatal depression, postnatal depression and parenting stress. BMC psychiatry. 2008; 8(1), 1-11. https://doi.org/10.1186/1471-244X-8-24 \u003c/li\u003e\n\u003cli\u003eSatyanarayanaV, A., Lukose, A., Srinivasan, K. Maternal mental health in pregnancy and child behavior. 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Reprod Health. 2011; 8(1), 1-7. https://doi.org/10.1186/1742-4755-8-9 \u003c/li\u003e\n\u003cli\u003ePlant, D.T., Pariante, C.M., Sharp, D., Pawlby, S. Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment. Br J Psychiatry. 2015; 207(3), 213-220. https://doi.org/10.1192/bjp.bp.114.156620\u003c/li\u003e\n\u003cli\u003eBisetegn, T.A., Mihretie, G., Muche, T. Prevalence and predictors of depression among pregnant women in debretabor town, northwest Ethiopia. PloS one. 2016; 11(9), e0161108. https://doi.org/10.1371/journal.pone.0161108 \u003c/li\u003e\n\u003cli\u003eAhmadzade, G.H., Sadeghizadeh, A., Amanat, S., Omranifard, V., Afshar, H. Prevalence of depression in pregnant women and its relationship with some socioeconomic factors. Med J Hormozgan Univ. 2007; 10(4), 329-334. https://hmj.hums.ac.ir/PDF/90155.pdf\u003c/li\u003e\n\u003cli\u003eKhamseh, F., Parandeh, A., Hajiamini, Z., Tadrissi, S.D., Najjar, M. Effectiveness of applying problem-solving training on depression in Iranian pregnant women: Randomized clinical trial. J Educ Health Promot. 2019; 8. https://doi.org/10.4103/jehp.jehp_270_18\u003c/li\u003e\n\u003cli\u003eOmidvar, S., Kheyrkhah, F., Azimi, H. Depression during pregnancy and its related factors. Hormozgan Med J. 2007; 11(3), 213-219. https://hmj.hums.ac.ir/PDF/89562.pdf\u003c/li\u003e\n\u003cli\u003eHosaynisazi, F., Poorreza, A., Hosayni, M., Shojaee, D. Depression during pregnancy. J Gorgan Univ Med Scien. 2005; 7(1), 60-5. [Persian].\u003c/li\u003e\n\u003cli\u003eBiratu, A., Haile, D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015; 12(1), 1-8. https://doi.org/10.1186/s12978-015-0092-x \u003c/li\u003e\n\u003cli\u003eNasreen, H.E., Kabir, Z.N., Forsell, Y., Edhborg, M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC women\u0026apos;s health. 2011; 11(1), 1-9. https://doi.org/10.1186/1472-6874-11-22 \u003c/li\u003e\n\u003cli\u003eRamchandani, P.G., Richter, L.M., Stein, A., Norris, S.A. Predictors of postnatal depression in an urban South African cohort. J Affect Disord. 2009; 113(3), 279-284. https://doi.org/10.1016/j.jad.2008.05.007 \u003c/li\u003e\n\u003cli\u003eTomlinson, M., Swartz, L., Cooper, P.J., Molteno, C. Social factors and postpartum depression in Khayelitsha, Cape Town. S Afr J Psychol. 2004; 34(3), 409-420. https://doi.org/10.1177/008124630403400305 \u003c/li\u003e\n\u003cli\u003eKinser, P.A., Thacker, L.R., Lapato, D., Wagner, S., Roberson-Nay, R., Jobe-Shields, L., Amstadter, A., York, T.P. Depressive symptom prevalence and predictors in the first half of pregnancy. J Womens Health. 2018; 27(3), 369-376. https://doi.org/10.1089/jwh.2017.6426\u003c/li\u003e\n\u003cli\u003eAntonenko, Y.N., Khailova, L.S., Knorre, D.A., Markova, O.V., Rokitskaya, T.I., Ilyasova, T.M., Severina, I.I., Kotova, E.A., Karavaeva, Y.E., Prikhodko, A.S., Severin, F.F. Penetrating cations enhance uncoupling activity of anionic protonophores in mitochondria. Plos one. 2013; 8(4), e61902. https://doi.org/10.1371/journal.pone.0061902 \u003c/li\u003e\n\u003cli\u003eDuko, B., Ayano, G., Bedaso, A. Depression among pregnant women and associated factors in Hawassa city, Ethiopia: an institution-based cross-sectional study. Reprod Health. 2019; 16(1), 1-6. https://doi.org/10.1186/s12978-019-0685-x \u003c/li\u003e\n\u003cli\u003eRallis, S., Skouteris, H., McCabe, M., Milgrom, J. A prospective examination of depression, anxiety and stress throughout pregnancy. Women Birth. 2014; 27(4), e36-e42. https://doi.org/10.1016/j.wombi.2014.08.002 \u003c/li\u003e\n\u003cli\u003eCox, J. L., Chapman, G., Murray, D., Jones, P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord. 1996; 39(3), 185-189. https://doi.org/10.1016/0165-0327(96)00008-0 \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pregnancy, depression, pregnancy experience, positive feelings towards spouse, prenatal distress","lastPublishedDoi":"10.21203/rs.3.rs-3870844/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3870844/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePregnancy is the most stressful period of a woman\u0026rsquo;s life, during which conditions such as neuroticism, depression, and anxiety are highly prevalent. Considering the literature emphasizing the adverse effects of prenatal depression on the mother and foetus, even in later periods such as childhood and adulthood, the present study aims to identify factors related to prenatal depression among women.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional (descriptive and analytical) study was conducted on 130 pregnant women referring to health centres in Urmia in 2021. The participants were selected using the multi-stage random sampling method. The instruments included a Demographic-Pregnancy Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Pregnancy Experience Scale (PES), Positive Feeling Questionnaire (PFQ), and Prenatal Distress Questionnaire (PDQ).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe depression rate was obtained at 38% among pregnant women. Prenatal depression was negatively correlated with positive feelings towards the spouse and pregnancy experience. However, it was directly associated with prenatal distress. Moreover, women\u0026rsquo;s employment status and their husbands\u0026rsquo; education could affect prenatal depression.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe results revealed psychological factors such as feelings towards the spouse and pleasant or unpleasant experiences during pregnancy affected women\u0026rsquo;s mental health. Thus, these factors should be considered when performing interventions to improve depression during pregnancy. Healthcare clinics should be equipped with depression diagnosis tools in routine care programs to screen pregnant mothers, diagnose prenatal depression early, and perform appropriate interventions.\u003c/p\u003e\u003ch2\u003eEthical code:\u003c/h2\u003e \u003cp\u003eIR.UMSU.REC.1400.214\u003c/p\u003e","manuscriptTitle":"Relation Between Pregnancy Psychological Status and Prenatal Depression: A Path Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-25 15:31:37","doi":"10.21203/rs.3.rs-3870844/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b6dedd8e-9793-488e-b922-2d163e7ff370","owner":[],"postedDate":"January 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-25T14:53:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-25 15:31:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3870844","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3870844","identity":"rs-3870844","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}