Associations between Psychological Distress, Relationship Satisfaction, Family Functioning, and Communication among Low-Income Overweight or Obese Women

Associations between Psychological Distress, Relationship Satisfaction, Family Functioning, and Communication among Low-Income Overweight or Obese Women | 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 Associations between Psychological Distress, Relationship Satisfaction, Family Functioning, and Communication among Low-Income Overweight or Obese Women Mei-Wei Chang, Nathan P. Helsabeck, Holly Jones This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6701146/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 Objective The study explored whether relationship satisfaction, general family functioning, or communication was associated with stress or anxiety. Methods Participants were low-income overweight or obese pregnant (n = 342) or postpartum (n = 365) women. They completed validated surveys measuring relationship satisfaction, general family functioning, and communication (independent variables) as well as stress and anxiety (dependent variables). We performed regression analysis to test the objective while controlling for covariates: race, education, gestation or postpartum weeks. Separate analyses were conducted for pregnant and postpartum women. Results Better relationship satisfaction (pregnant, β = -0.40, p < .001; postpartum, β = -0.53, p < .001) and general family functioning (pregnant, β = -0.36, p < .001; postpartum, β = -0.51, p < .001) were negatively associated with stress. Similarity, better relationship satisfaction (pregnant, β = -0.24, p < .001; postpartum, β = -0.26, p < .001) and general family functioning (pregnant, β = -0.28, p < .001; postpartum, β = -0.23, p < 0.001) were negatively associated with anxiety. However, communication was not associated with stress or anxiety for either pregnant or postpartum women. Conclusions Poor relationship satisfaction and poor general family functioning increased levels of stress and anxiety in low-income overweight or obese pregnant and postpartum women. Interventions designed to reduce stress or anxiety in this at-risk population need to address relationship satisfaction and general family functioning. relationship family functioning communication stress anxiety INTRODUCTION Low-income pregnant women are at risk for psychological distress (stress and anxiety) [ 1 , 2 ], increasing their risk for adverse maternal and birth outcomes such as hypertensive disorders in pregnancy [ 3 ] and premature birth [ 4 ]. Prenatal psychological distress is a strong predictor of postpartum depression [ 5 ], a leading cause of maternal death occurring 6 weeks to one-year postpartum [ 6 ]. Low income postpartum women may experience additional life stressors, for example, care of the newborn and/or family dynamics, thus further contributing to psychological distress [ 7 ] Postpartum psychological distress has a negative influence on breastfeeding adherence and offspring’s growth, language and cognitive development, gross and fine motor movement, and sleep [ 8 ], [ 9 ]. Family dynamics is a commonly overlooked factor associated with psychological distress in pregnancy and postpartum. Family dynamics often serve to assist its members to cope with stressors and manage life events, resulting in lower perceived stress and anxiety symptoms [ 10 ]. Factors affecting family dynamics include relationship satisfaction, general family functioning (defined as adaptability, cohesion, conflict resolution, and affective expression), and communication [ 11 ]. Characteristics of a high family functioning include high adaptivity, good communication, high cohesion, use of healthy conflict resolution strategies, and positive affect. Contrary, a family environment with low adaptivity, poor quality of communication, low levels of cohesion and conflict resolution, and lack of affective expression creates poor general family functioning [ 12 ]. Poor family functioning is a strong predictor of children’s poor emotional adjustment, which might manifest as poor coping strategies, poor self-regulation and mental health, and increased risk for negative thoughts [ 11 , 13 ]. However, we know little about the association between poor general family functioning and psychological distress, especially among low-income pregnant and postpartum women with overweight or obesity. Pregnancy and postpartum periods are important life stage transitions for women that are undoubtedly stressful. Although the impact of these life stages is generally positive, these life transitions can have a negative impact on relationship satisfaction, particularly for low income women who might already deal with multiple additional, competing life stressors [ 14 – 16 ]. Better relationship satisfaction promotes psychological well-being for the mother throughout the perinatal period, which extends to the child [ 17 ]. Indeed, research suggests that positive relationship satisfaction is a protector during stressful events and high family functioning supports the social and emotional skills to cope with stress [ 13 , 18 ]. Prior studies of relationship satisfaction among women have focused on domestic violence. As a result, the association between relationship satisfaction and psychological distress in low-income pregnant and postpartum women is largely understudied. Communication is an essential component of family functioning [ 19 ]. Communication can be defined as oral speech only, oral speech and nonverbal cues, affective communication (communication involving expression of positive feelings), hope vocation and rumination communication, or parent-child communication. High levels of negative communication prior to giving birth put women at risk for problematic communication during postpartum [ 15 ]. Families living in poverty may be more likely to exhibit poor family communication among its members, partly due to financial constraints [ 20 ]. Associations between communication and psychological distress in low-income overweight or obese pregnant women has been under investigated. In summary, relationship satisfaction, general family functioning, and communication are associated with to stress and anxiety yet prior psychological distress studies have not paid attention to these concepts. Thus, this study explored whether relationship satisfaction, general family functioning, or communication were associated with stress or anxiety in this high-risk group. METHODS Participants, Settings , and Procedure Setting, participants, and procedures of the cross-sectional study has been published [ 21 ]. Briefly, participants were recruited through in person invitation while waiting for appointments. They were recruited from a university hospital affiliated Ob/Gyn clinic that serves majority of low-income patients. We also recruited women from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in xxx. WIC is one of the largest federally funded nutrition programs in U.S. for low-income individuals. Qualified participants must be pregnant or within one-year postpartum, be at least 18 years old, have body mass index (BMI) at least 25.0 kg/m 2 computed using self-reported height and weight (pre-pregnancy weight for pregnant women and current weight for postpartum women), and received government assistant programs, for example, WIC, Medicaid. Qualified women provided a written consent for participation followed by completing a pencil and paper survey. The study procedure was approved by The Ohio State University Institutional Review Board. Measures Stress . The short Stress Overload Scale (10 items) was used to measure perception of stress, hereafter stress. The survey has established good validity and reliability [ 22 ]. Responses range from 1 (not at all) to 5 (a lot). Participants were asked in the past seven days have your felt (for example) “swamped by your responsibilities?” We summed the 10-item scores to create a composite stress score ranged from 10 to 50. The higher scores mean higher levels of stress [ 22 ]. Anxiety. Generalized Anxiety Disorder Scale (7 items) was used to measure anxiety. This survey has established good validity and reliability [ 23 ]. Responses range from 0 (not at all) to 3 (nearly every day). Participants were asked in the past two weeks, “how often you have been bothered by (for example) worrying too much about different things.” We summed the 7- item scores to create a composite anxiety score ranged from 0 to 21. Relationship Satisfaction . Relationship Assessment Scale (7 items) was used to measure relationship satisfaction with partners [ 24 ]. This survey has established good validity and reliability [ 25 ]. Responses range from 1 (low satisfaction) to 5 (high satisfaction). Participants were asked (for example) “how good is your relationship compared to most?” We summed the 7-item scores to create a composite relationship satisfaction score ranged from 7 to 35. The higher scores mean higher relationship satisfaction. General Family Functioning . A subscale of the McMaster Family Assessment Device (FAD) was used to assess general family functioning (12 items). The FAD has established good validity and reliability [ 26 ]. Responses range from 1 (strongly disagree) to 4 (strongly agree). Participants were asked questions related to general family functioning: quality of communication, adaptability (adjusting to changing stressors), cohesion (emotional connection between family members), conflict resolution (healthy strategies to resolve conflict), and affective expression (openness to share emotion). For example, “we can express our feelings to each other.” We summed 12-item scores to create a composite general family functioning score ranged from 12 to 48. The higher scores indicate better general family functioning. Communication . Another subscale of the FAD was used to assess communication (6 items) [ 26 ]. Responses range from 1 (strongly disagree) to 4 (strongly agree). The communication scale focuses on assessing clarity and directness of information exchange (message directly to the intended person) among family members. For example, “when someone is upset, the others know why.” We summed 6-item of communication score to create a composite communication score ranged from 6 to 24. The higher scores indicate better communication. Statistical Analysis We used descriptive statistics and frequencies to describe the sample demographics (N = 707, pregnant = 342, postpartum 365). The independent variables of interest were relationship satisfaction, general family functioning, and communication. The dependent variables were stress and anxiety. Covariates to control for demographic differences included race, education, and gestational age in weeks or postpartum in weeks of the youngest child. Participants who were not in relationship were asked to skip relationship satisfaction questions, which resulting 11% (pregnant women) and 19% (postpartum women) missing those responses. Additionally, 2 and 3% of pregnant and postpartum women respectively, missed data collection, because their ride arrived prior to completing the survey. Therefore, we conducted a series of sensitivity tests that included all independent and dependent variables as well as covariates to determine if analytic sample (participants without missing data) differed from the full sample (participants who responded to the survey with or without missing data). Results of our sensitivity analysis showed no group difference between the full and the analytic samples on any variable described above for either pregnant or postpartum women. Consequently, we proceeded statistical analysis without imputing any missing data. To determine the association between independent and dependent variables, we conducted a series of regression models. In each model, we included a single independent variable (relationship satisfaction, general family functioning or communication) and a dependent variable (stress or anxiety) while controlling for covariates (described above). We elected to perform the analysis without including multiple independent variables of interests for the following reasons. Our independent variables were all moderately correlated to each other for both pregnant and postpartum subsample, for example, r = .502 (general family function and relationship satisfaction in pregnant women). Second, the single regression approach allows us to examine if there are differences in which covariates are significantly related to each independent variable. We used R 4.2.2 to conduct all statistical analysis [ 27 ] RESULTS Demographics Table 1 summarizes demographics of pregnant and postpartum women. The pregnant and postpartum samples had a similar mean age and BMI. Both subgroups included participants with diverse racial/ethnic backgrounds and had comparable distribution of education, smoking, and employment status. The Stress and Anxiety Associations Table 2 presents means and median of variable of interest. Table 3 shows associations between relationship satisfaction, general family functioning, communication and stress for pregnant and postpartum women. Among pregnant women, we observed negative associations between relationship satisfaction and stress ( β = -0.398, SE = 0.074, p < .001) and between general family functioning and stress ( β = -0.355, SE = 0.089, p < .001) but no association between communication and stress after controlling for covariates. The relationship satisfaction and general family functioning models explained 12.0% and 8.0% of variability in stress, respectively. Similar results were observed in the postpartum women when controlling for covariates. There were negative associations between relationship satisfaction and stress ( β = -0.527, SE = 0.084, p < .001) and between general family functioning and stress ( β = -0.51, SE = 0.1, p < .001). Again, communication was not associated with stress. While the relationship satisfaction model explained 19% of variability in stress, the general family functioning model explained 13% of variability in stress. Table 4 shows associations between relationship satisfaction, general family functioning, communication and anxiety for pregnant and postpartum women. For pregnant women, we found negative associations between relationship satisfaction and anxiety ( β = -0.236, SE = 0.044, p < .001) and between general family functioning and anxiety ( β = -0.277, SE = 0.054, p < .001) after controlling for covariates. However, communication was not associated with anxiety. The relationship satisfaction model explained 10.0% of variability in anxiety, and the general family functioning model explained 8.0% variability in anxiety. We observed the same pattern of anxiety associations for postpartum women. After controlling for covariates, our results showed negative associations between relationship satisfaction and anxiety ( β = -0.260, SE = 0.049, p < .001) and between general family functioning and anxiety ( β = -0.232, SE = 0.058, p < .001). Again, communication was not associated with anxiety. The relationship satisfaction model explained 11% and the general family functioning model explained 6.1% variability in anxiety. DISCUSSION Pregnancy, a major life event, is stressful for women because of physiological, emotion, body, and family changes. Also, transition to parenthood (postpartum) is a major challenge for women because of (for example) change of family domain [ 28 ]. These two major life events can be even more challenging for low-income women when they already live in stressful daily life [ 1 , 2 ]. We explored the associations between relationship satisfaction, general family functioning or communication and psychological health (stress and anxiety) among low-income overweight or obese pregnant and postpartum women. We consistently found negative associations between relationship satisfaction and stress/anxiety and between family functioning and stress/anxiety for both pregnant and postpartum. Our findings suggest stress management or psychological distress intervention studies need to go beyond traditional approach, for example, time management, relaxation technique, by addressing relationship satisfaction and general family functioning to help pregnant and postpartum women reduce stress and anxiety. We found that poor relationship satisfaction was associated with increased levels of stress and anxiety for pregnant and postpartum women. Our findings are consistent with results of prior studies of women [ 29 – 32 ]. A prior longitudinal study showed that change in relationship satisfaction predicted changes in stress over time [ 32 ]. Also, the association between relationship satisfaction and anxiety could be bidirectional [ 33 ]. Therefore, it is importance and urgent to screen relationship satisfaction in low-income overweight or obese pregnant and postpartum women followed by providing tailor intervention to reduce levels of stress and anxiety. Our results show that poor general family functioning was associated with higher levels of stress and anxiety in pregnant and postpartum women. Our findings are inconsistent with a prior study of Chinese pregnant women showing no association between general family functioning and stress [ 34 ]. The cultural differences between American and Chinese pregnant women might have contributed to the contrary findings. Nevertheless, our findings are in line of prior studies that showed poor family functioning was associated with stress in African American adults [ 35 ], young adults [ 36 ] and college students [ 37 ]. Our findings also support prior studies of adolescents. Poor general family functioning was associated with higher level of stress [ 38 , 39 ] and anxiety [ 38 – 41 ]. Our and prior studies evidence the urgent needs to address general family functioning in pregnant and postpartum women to promote psychological health of mothers and their offspring. We did not find the association between communication and stress or anxiety for low-income overweight or obese pregnant and postpartum women. Our results are inconsistent with results of prior studies. A prior study of Chinese pregnant women with hypertensive disorders in pregnancy showed lack of clarity and direct communication was positively associated with higher levels of stress [ 34 ]. Another study showed that poor parent-child communication worsened psychological distress such as anxiety and depression among adolescents [ 42 ]. Other studies have also shown affective communication decreased levels of stress among parents at outpatient pediatric unit [ 43 ] and decreased recovery of stress response among college students participating in an experiment [ 44 ]. Another experiment study of college students found that hope evocation, communication focusing on take advantages toward rewards in the near future, reduced anxiety. Yet, ruminating messages, repeating talking about negative feelings and consequence with each other, increased anxiety [ 45 ]. There is a possible explanation of our nonsignificant communication findings. In daily life, individuals use a variety of ways to communicate, for example, oral speech plus nonverbal cues. However, we only focused on measuring direct oral speech. Future studies of pregnant and postpartum women should consider using a variety of measurements to identify types of communications associated with stress and/or anxiety. Limitations. There are limitations to the study. The cross-sectional design precludes us from drawing causal-effect relationship. Our communication scale only measured oral communication, which may prevent us to collect valuable information associated with communication, for example, nonverbal cues, email or text messaging, affective communication. Also, we enrolled pregnant and postpartum women regardless of their gestational age or postpartum weeks, retrospectively. Consequently, results of this study are not generalizable. CONCLUSIONS We found that poor relationship satisfaction and poor general family functioning were associated with higher levels of stress and anxiety across low-income overweight or obese pregnant and postpartum women. Our findings suggest the need to screen relationship satisfaction and general family functioning in these at risk-groups to provide tailored intervention. Also, stress management and psychological interventions should consider addressing relationship satisfaction and family function. In terms of communication, we did not find its association with stress and anxiety, thus, future studies of the population should measure different types of communication. Declarations Funding. No funding supported the study. Competing Interest. All authors declare no conflict of interest . Ethics Approval and consent to participate. Participants were volunteers and signed a written inform consent form prior to participating in the study. The study procedure was approved by The Ohio State University Institutional Review Board and adhered to the Declaration of Helsinki. Consent to publish. The participants signed consent forms included a statement that the results of the study would be published in scientific journal. AUTHOR CONTRIBUTIONS The study conception, design, material preparation, and data collection were performed by MC. Data analysis was performed by NH. The first draft of the manuscript was written by MC (method and discussion), NH (statistical analysis and results), HJ (introduction). All authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript. Also, all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. References Hammen C: Stress and Depression . Annual Review of Clinical Psychology 2005, 1 (1):293-319. Yang L, Zhao Y, Wang Y, Liu L, Zhang X, Li B, Cui R: The Effects of Psychological Stress on Depression . Curr Neuropharmacol 2015, 13 (4):494-504. [https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm] Preis H, Mahaffey B, Pati S, Heiselman C, Lobel M: Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset . Ann Behav Med 2021, 55 (3):179-191. Obrochta CA, Chambers C, Bandoli G: Psychological distress in pregnancy and postpartum . Women and Birth 2020, 33 (6):583-591. Trost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA, Byatt N, Madni SA, Goodman D: Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17 . Health Aff (Millwood) 2021, 40 (10):1551-1559. Mollard E, Kupzyk K, Moore T: Postpartum stress and protective factors in women who gave birth in the United States during the COVID-19 pandemic . Women's Health 2021, 17 :17455065211042190. Gila-Díaz A, Carrillo GH, López de Pablo ÁL, Arribas SM, Ramiro-Cortijo D: Association between Maternal Postpartum Depression, Stress, Optimism, and Breastfeeding Pattern in the First Six Months . International Journal of Environmental Research and Public Health 2020, 17 (19):7153. Oyetunji A, Chandra P: Postpartum stress and infant outcome: A review of current literature . Psychiatry Research 2020, 284 :112769. Pollock ED, Kazman JB, Deuster P: Family Functioning and Stress in African American Families: A Strength-Based Approach . Journal of Black Psychology 2014, 41 (2):144-169. Lewandowski AS, Palermo TM, Stinson J, Handley S, Chambers CT: Systematic review of family functioning in families of children and adolescents with chronic pain . J Pain 2010, 11 (11):1027-1038. Alderfer MA, Fiese BH, Gold JI, Cutuli JJ, Holmbeck GN, Goldbeck L, Chambers CT, Abad M, Spetter D, Patterson J: Evidence-based assessment in pediatric psychology: family measures . J Pediatr Psychol 2008, 33 (9):1046-1061; discussion 1062-1044. Hooper A, Hustedt JT, Slicker G, Hallam RA, Gaviria-Loaiza J: Linking early head start children's social-emotional functioning with profiles of family functioning and stress . J Fam Psychol 2023, 37 (1):153-160. Doss BD, Rhoades GK: The transition to parenthood: impact on couples' romantic relationships . Curr Opin Psychol 2017, 13 :25-28. Doss BD, Rhoades GK, Stanley SM, Markman HJ: The effect of the transition to parenthood on relationship quality: an 8-year prospective study . J Pers Soc Psychol 2009, 96 (3):601-619. Randall AK, Bodenmann G: Stress and its associations with relationship satisfaction . Current Opinion in Psychology 2017, 13 :96-106. Hoffmann L, Hilger N, Riolino E, Lenz A, Banse R: Partner support and relationship quality as potential resources for childbirth and the transition to parenthood . BMC Pregnancy and Childbirth 2023, 23 (1):435. Gouveia F, Gouveia-Pereira M, Portugal A: COVID-19, Family and Love Relationships: Perception of Stress, Relational Quality, Family Functioning and Online Infidelity Behaviors . Journal of Couple & Relationship Therapy 2024, 23 (3):213-228. Epstein NB, Bishop DS, Levin S: The McMaster Model of Family Functioning . Journal of Marital and Family Therapy 1978, 4 (4):19-31. Banovcinova A, Levicka K: The Impact of the Financial Income on the Family Communication. . Revista Romaneasca pentru Educatie Multidimensionala 2015, 7 (2):35-46. Chang M, Pek J, Wegener D, Lee RE: Associations Between Stress, Body Mass Index, Demographics and Eating Behaviors in Low-Income Overweight or Obese Women . Austin Journal of Public Health and Epidemiology 2022, 9 (1). Amirkhan J: A brief stress diagnostic tool: The short stress overload scale . Assessment 2016:1-13. Spitzer RL, Kroenke K, Williams JB, Lowe B: A brief measure for assessing generalized anxiety disorder: the GAD-7 . Arch Intern Med 2006, 166 (10):1092-1097. Hendrick SS: A generic measure of relationship satisfaction Journal of Marriage and the Family 1988, 50 :93-98. Vaughn MJ, & Matyastik Baier, M. E.: Reliability and validity of the Relationship Assessment Scale . American Journal of Family Therapy 1999, 27 (2):137-147. Epstein NB, Baldwin LM, Bishop DS: The McMaster Family Assessment Device . Journal of Marital and Family Therapy 1983, 9 (2):171-180. R: A Language and Environment for Statistical Computing [https://www.R-project.org/] Jones NA: Delayed reactive cries demonstrate emotional and physiological dysregulation in newborns of depressed mothers . Biological Psychology 2012, 89 (2):374-381. Pieh C, Rourke TO, Budimir S, Probst T: Relationship quality and mental health during COVID-19 lockdown . PLoS ONE 2020, 15 (9). Leach LS, Butterworth P, Olesen SC, Mackinnon A: Relationship quality and levels of depression and anxiety in a large population-based survey . Soc Psychiatry Psychiatr Epidemiol 2013, 48 (3):417-425. Salehi F, Shahhosseini Z: Association Between Women’s Marital Satisfaction and Anxiety During Pregnancy . Iran J Psychiatry Behav Sci 2017, 11 (3):e7937. Pauly T, Lüscher J, Berli C, Scholz U: Dynamic associations between stress and relationship functioning in the wake of COVID-19: Longitudinal data from the German family panel (pairfam) . J Soc Pers Relat 2022, 39 (11):3183-3203. Kasalova P, Prasko J, Holubová M, Vrbova K, Zmeskalova D, Slepecky M, Grambal A: Anxiety disorders and marital satisfaction . Neuroendocrinol Lett 2018, 38 (8):555-564. Xing S, Wan L, Fu A, Liu W, Lin L, Wang C, Wang J, Huang G, Lu M: Correlation analysis of stress and family function and coping modes in pregnant women with pregnancy-induced hypertension syndrome . Ann Palliat Med 2021, 10 (11):11688-11694. Pollock ED, Kazman JB, Deuster P: Family functioning and stress in African American families: A strength-based approach . Journal of Black Psychology 2015, 41 (2):144-169. Chapman LK, Woodruff-Borden J: The impact of family functioning on anxiety symptoms in African American and European American young adults . Personality and Individual Differences 2009, 47 (6):583-589. Uruk AÇ, Sayger TV, Cogdal PA: Examining the Influence of Family Cohesion and Adaptability on Trauma Symptoms and Psychological Well-Being . Journal of College Student Psychotherapy 2007, 22 (2):51-63. Hua Y, Jiang W, He Y, Zheng X, Huang C, Guo L, Guo Y, Guo L: Associations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning . Eur J Psychotraumatol 2024, 15 (1):2337577. Farmakopoulou I, Lekka M, Gkintoni E: Clinical Symptomatology of Anxiety and Family Function in Adolescents-The Self-Esteem Mediator . Children (Basel) 2024, 11 (3). Gauntlett-Gilbert J, Eccleston C: Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning . Pain 2007, 131 (1):132-141. Guo Z, Zhao J, Peng J: Family function and anxiety among junior school students during the COVID-19 pandemic: a moderated mediation model . Front Psychiatry 2023, 14 :1217709. Romero-Abrio A, Martínez-Ferrer B, Musitu-Ferrer D, León-Moreno C, Villarreal-González ME, Callejas-Jerónimo JE: Family communication problems, psychosocial adjustment and cyberbullying . International journal of environmental research and public health 2019, 16 (13):2417. Gemmiti M, Hamed S, Lauber-Biason A, Wildhaber J, Pharisa C, Klumb PL: Pediatricians’ affective communication behavior attenuates parents’ stress response during the medical interview . Patient Education and Counseling 2017, 100 (3):480-486. Floyd K, Mikkelson AC, Tafoya MA, Farinelli L, La Valley AG, Judd J, Haynes MT, Davis KL, Wilson J: Human affection exchange: XIII. Affectionate communication accelerates neuroendocrine stress recovery . Health Commun 2007, 22 (2):123-132. Chadwick AE, Zoccola PM, Figueroa WS, Rabideau EM: Communication and Stress: Effects of Hope Evocation and Rumination Messages on Heart Rate, Anxiety, and Emotions After a Stressor . Health Commun 2016, 31 (12):1447-1459. Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6701146","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":473536930,"identity":"7046b826-504f-47e1-b2c3-d04d964090ed","order_by":0,"name":"Mei-Wei Chang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDACCQhZb3+8+QBE5ABxWiwSGM4cSyBJS0UCw40cA+K08M9ufvbwC4NEHmNDzseHP9sY5PhuJBCw5M4xc2MZBoliZoazm4152xiMJQlpMZBIMJOWYJBgbGPs3SbN2MaQuIGwlvRvYC09zDzPJIEOqydCS46Z5AcGicQZbDxsEkCHJRgQ9MuNnDJpoEZjAx42Y2OecxKGM888wK+Ff0b6NskfFXVyBvKPHz78UWYjz3ecgC0gwMxjgLCVsHIQYPxBnLpRMApGwSgYqQAA2Bo/aaD0brcAAAAASUVORK5CYII=","orcid":"","institution":"The Ohio State University College of Nursing","correspondingAuthor":true,"prefix":"","firstName":"Mei-Wei","middleName":"","lastName":"Chang","suffix":""},{"id":473536931,"identity":"9fee9e7a-e588-4d50-94bc-f7982de6a569","order_by":1,"name":"Nathan P. Helsabeck","email":"","orcid":"","institution":"The Ohio State University College of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Nathan","middleName":"P.","lastName":"Helsabeck","suffix":""},{"id":473536932,"identity":"4a9ee5b5-998b-4de8-88f8-abe5e7707e3a","order_by":2,"name":"Holly Jones","email":"","orcid":"","institution":"The Ohio State University College of Nursing","correspondingAuthor":false,"prefix":"","firstName":"Holly","middleName":"","lastName":"Jones","suffix":""}],"badges":[],"createdAt":"2025-05-19 17:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6701146/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6701146/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88398278,"identity":"8619edfb-b558-4c71-b43c-8402498e849a","added_by":"auto","created_at":"2025-08-06 06:38:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2144524,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6701146/v1/d3f0965a-4dd7-4675-81ac-6583de7ba7e8.pdf"},{"id":85080031,"identity":"188647f1-4334-42fe-afea-fc428b2988c2","added_by":"auto","created_at":"2025-06-20 17:30:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39238,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6701146/v1/b408865334381771b07ecb6d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Associations between Psychological Distress, Relationship Satisfaction, Family Functioning, and Communication among Low-Income Overweight or Obese Women","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLow-income pregnant women are at risk for psychological distress (stress and anxiety) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], increasing their risk for adverse maternal and birth outcomes such as hypertensive disorders in pregnancy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and premature birth [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Prenatal psychological distress is a strong predictor of postpartum depression [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], a leading cause of maternal death occurring 6 weeks to one-year postpartum [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Low income postpartum women may experience additional life stressors, for example, care of the newborn and/or family dynamics, thus further contributing to psychological distress [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Postpartum psychological distress has a negative influence on breastfeeding adherence and offspring\u0026rsquo;s growth, language and cognitive development, gross and fine motor movement, and sleep [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFamily dynamics is a commonly overlooked factor associated with psychological distress in pregnancy and postpartum. Family dynamics often serve to assist its members to cope with stressors and manage life events, resulting in lower perceived stress and anxiety symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Factors affecting family dynamics include relationship satisfaction, general family functioning (defined as adaptability, cohesion, conflict resolution, and affective expression), and communication [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Characteristics of a high family functioning include high adaptivity, good communication, high cohesion, use of healthy conflict resolution strategies, and positive affect. Contrary, a family environment with low adaptivity, poor quality of communication, low levels of cohesion and conflict resolution, and lack of affective expression creates poor general family functioning [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Poor family functioning is a strong predictor of children\u0026rsquo;s poor emotional adjustment, which might manifest as poor coping strategies, poor self-regulation and mental health, and increased risk for negative thoughts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, we know little about the association between poor general family functioning and psychological distress, especially among low-income pregnant and postpartum women with overweight or obesity.\u003c/p\u003e \u003cp\u003ePregnancy and postpartum periods are important life stage transitions for women that are undoubtedly stressful. Although the impact of these life stages is generally positive, these life transitions can have a negative impact on relationship satisfaction, particularly for low income women who might already deal with multiple additional, competing life stressors [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Better relationship satisfaction promotes psychological well-being for the mother throughout the perinatal period, which extends to the child [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Indeed, research suggests that positive relationship satisfaction is a protector during stressful events and high family functioning supports the social and emotional skills to cope with stress [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Prior studies of relationship satisfaction among women have focused on domestic violence. As a result, the association between relationship satisfaction and psychological distress in low-income pregnant and postpartum women is largely understudied.\u003c/p\u003e \u003cp\u003eCommunication is an essential component of family functioning [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Communication can be defined as oral speech only, oral speech and nonverbal cues, affective communication (communication involving expression of positive feelings), hope vocation and rumination communication, or parent-child communication. High levels of negative communication prior to giving birth put women at risk for problematic communication during postpartum [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Families living in poverty may be more likely to exhibit poor family communication among its members, partly due to financial constraints [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Associations between communication and psychological distress in low-income overweight or obese pregnant women has been under investigated.\u003c/p\u003e \u003cp\u003eIn summary, relationship satisfaction, general family functioning, and communication are associated with to stress and anxiety yet prior psychological distress studies have not paid attention to these concepts. Thus, this study explored whether relationship satisfaction, general family functioning, or communication were associated with stress or anxiety in this high-risk group.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e \u003cb\u003eParticipants, Settings\u003c/b\u003e, \u003cb\u003eand Procedure\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSetting, participants, and procedures of the cross-sectional study has been published [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Briefly, participants were recruited through in person invitation while waiting for appointments. They were recruited from a university hospital affiliated Ob/Gyn clinic that serves majority of low-income patients. We also recruited women from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in xxx. WIC is one of the largest federally funded nutrition programs in U.S. for low-income individuals. Qualified participants must be pregnant or within one-year postpartum, be at least 18 years old, have body mass index (BMI) at least 25.0 kg/m\u003csup\u003e2\u003c/sup\u003e computed using self-reported height and weight (pre-pregnancy weight for pregnant women and current weight for postpartum women), and received government assistant programs, for example, WIC, Medicaid. Qualified women provided a written consent for participation followed by completing a pencil and paper survey. The study procedure was approved by The Ohio State University Institutional Review Board.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003e \u003cb\u003eStress\u003c/b\u003e. The short Stress Overload Scale (10 items) was used to measure perception of stress, hereafter stress. The survey has established good validity and reliability [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Responses range from 1 (not at all) to 5 (a lot). Participants were asked in the past seven days have your felt (for example) \u0026ldquo;swamped by your responsibilities?\u0026rdquo; We summed the 10-item scores to create a composite stress score ranged from 10 to 50. The higher scores mean higher levels of stress [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eAnxiety.\u003c/b\u003e Generalized Anxiety Disorder Scale (7 items) was used to measure anxiety. This survey has established good validity and reliability [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Responses range from 0 (not at all) to 3 (nearly every day). Participants were asked in the past two weeks, \u0026ldquo;how often you have been bothered by (for example) worrying too much about different things.\u0026rdquo; We summed the 7- item scores to create a composite anxiety score ranged from 0 to 21.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRelationship Satisfaction\u003c/b\u003e. Relationship Assessment Scale (7 items) was used to measure relationship satisfaction with partners [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This survey has established good validity and reliability [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Responses range from 1 (low satisfaction) to 5 (high satisfaction). Participants were asked (for example) \u0026ldquo;how good is your relationship compared to most?\u0026rdquo; We summed the 7-item scores to create a composite relationship satisfaction score ranged from 7 to 35. The higher scores mean higher relationship satisfaction.\u003c/p\u003e \u003cp\u003e\u003cb\u003eGeneral Family Functioning\u003c/b\u003e. A subscale of the McMaster Family Assessment Device (FAD) was used to assess general family functioning (12 items). The FAD has established good validity and reliability [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Responses range from 1 (strongly disagree) to 4 (strongly agree). Participants were asked questions related to general family functioning: quality of communication, adaptability (adjusting to changing stressors), cohesion (emotional connection between family members), conflict resolution (healthy strategies to resolve conflict), and affective expression (openness to share emotion). For example, \u0026ldquo;we can express our feelings to each other.\u0026rdquo; We summed 12-item scores to create a composite general family functioning score ranged from 12 to 48. The higher scores indicate better general family functioning.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCommunication\u003c/b\u003e. Another subscale of the FAD was used to assess communication (6 items) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Responses range from 1 (strongly disagree) to 4 (strongly agree). The communication scale focuses on assessing clarity and directness of information exchange (message directly to the intended person) among family members. For example, \u0026ldquo;when someone is upset, the others know why.\u0026rdquo; We summed 6-item of communication score to create a composite communication score ranged from 6 to 24. The higher scores indicate better communication.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eWe used descriptive statistics and frequencies to describe the sample demographics (N\u0026thinsp;=\u0026thinsp;707, pregnant\u0026thinsp;=\u0026thinsp;342, postpartum 365). The independent variables of interest were relationship satisfaction, general family functioning, and communication. The dependent variables were stress and anxiety. Covariates to control for demographic differences included race, education, and gestational age in weeks or postpartum in weeks of the youngest child. Participants who were not in relationship were asked to skip relationship satisfaction questions, which resulting 11% (pregnant women) and 19% (postpartum women) missing those responses. Additionally, 2 and 3% of pregnant and postpartum women respectively, missed data collection, because their ride arrived prior to completing the survey. Therefore, we conducted a series of sensitivity tests that included all independent and dependent variables as well as covariates to determine if analytic sample (participants without missing data) differed from the full sample (participants who responded to the survey with or without missing data). Results of our sensitivity analysis showed no group difference between the full and the analytic samples on any variable described above for either pregnant or postpartum women. Consequently, we proceeded statistical analysis without imputing any missing data.\u003c/p\u003e \u003cp\u003eTo determine the association between independent and dependent variables, we conducted a series of regression models. In each model, we included a single independent variable (relationship satisfaction, general family functioning or communication) and a dependent variable (stress or anxiety) while controlling for covariates (described above). We elected to perform the analysis without including multiple independent variables of interests for the following reasons. Our independent variables were all moderately correlated to each other for both pregnant and postpartum subsample, for example, \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.502 (general family function and relationship satisfaction in pregnant women). Second, the single regression approach allows us to examine if there are differences in which covariates are significantly related to each independent variable. We used R 4.2.2 to conduct all statistical analysis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eDemographics\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes demographics of pregnant and postpartum women. The pregnant and postpartum samples had a similar mean age and BMI. Both subgroups included participants with diverse racial/ethnic backgrounds and had comparable distribution of education, smoking, and employment status.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eThe Stress and Anxiety Associations\u003c/h3\u003e\n\u003cp\u003eTable 2 presents means and median of variable of interest. Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows associations between relationship satisfaction, general family functioning, communication and stress for pregnant and postpartum women. Among pregnant women, we observed negative associations between relationship satisfaction and stress (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.398, SE\u0026thinsp;=\u0026thinsp;0.074, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between general family functioning and stress (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.355, SE\u0026thinsp;=\u0026thinsp;0.089, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) but no association between communication and stress after controlling for covariates. The relationship satisfaction and general family functioning models explained 12.0% and 8.0% of variability in stress, respectively. Similar results were observed in the postpartum women when controlling for covariates. There were negative associations between relationship satisfaction and stress (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.527, SE\u0026thinsp;=\u0026thinsp;0.084, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between general family functioning and stress (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.51, SE\u0026thinsp;=\u0026thinsp;0.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Again, communication was not associated with stress. While the relationship satisfaction model explained 19% of variability in stress, the general family functioning model explained 13% of variability in stress.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows associations between relationship satisfaction, general family functioning, communication and anxiety for pregnant and postpartum women. For pregnant women, we found negative associations between relationship satisfaction and anxiety (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.236, SE\u0026thinsp;=\u0026thinsp;0.044, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between general family functioning and anxiety (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.277, SE\u0026thinsp;=\u0026thinsp;0.054, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) after controlling for covariates. However, communication was not associated with anxiety. The relationship satisfaction model explained 10.0% of variability in anxiety, and the general family functioning model explained 8.0% variability in anxiety. We observed the same pattern of anxiety associations for postpartum women. After controlling for covariates, our results showed negative associations between relationship satisfaction and anxiety (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.260, SE\u0026thinsp;=\u0026thinsp;0.049, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) and between general family functioning and anxiety (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.232, SE\u0026thinsp;=\u0026thinsp;0.058, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Again, communication was not associated with anxiety. The relationship satisfaction model explained 11% and the general family functioning model explained 6.1% variability in anxiety.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePregnancy, a major life event, is stressful for women because of physiological, emotion, body, and family changes. Also, transition to parenthood (postpartum) is a major challenge for women because of (for example) change of family domain [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. These two major life events can be even more challenging for low-income women when they already live in stressful daily life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. We explored the associations between relationship satisfaction, general family functioning or communication and psychological health (stress and anxiety) among low-income overweight or obese pregnant and postpartum women. We consistently found negative associations between relationship satisfaction and stress/anxiety and between family functioning and stress/anxiety for both pregnant and postpartum. Our findings suggest stress management or psychological distress intervention studies need to go beyond traditional approach, for example, time management, relaxation technique, by addressing relationship satisfaction and general family functioning to help pregnant and postpartum women reduce stress and anxiety.\u003c/p\u003e \u003cp\u003eWe found that poor relationship satisfaction was associated with increased levels of stress and anxiety for pregnant and postpartum women. Our findings are consistent with results of prior studies of women [\u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. A prior longitudinal study showed that change in relationship satisfaction predicted changes in stress over time [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Also, the association between relationship satisfaction and anxiety could be bidirectional [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, it is importance and urgent to screen relationship satisfaction in low-income overweight or obese pregnant and postpartum women followed by providing tailor intervention to reduce levels of stress and anxiety.\u003c/p\u003e \u003cp\u003eOur results show that poor general family functioning was associated with higher levels of stress and anxiety in pregnant and postpartum women. Our findings are inconsistent with a prior study of Chinese pregnant women showing no association between general family functioning and stress [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The cultural differences between American and Chinese pregnant women might have contributed to the contrary findings. Nevertheless, our findings are in line of prior studies that showed poor family functioning was associated with stress in African American adults [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], young adults [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and college students [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Our findings also support prior studies of adolescents. Poor general family functioning was associated with higher level of stress [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] and anxiety [\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Our and prior studies evidence the urgent needs to address general family functioning in pregnant and postpartum women to promote psychological health of mothers and their offspring.\u003c/p\u003e \u003cp\u003eWe did not find the association between communication and stress or anxiety for low-income overweight or obese pregnant and postpartum women. Our results are inconsistent with results of prior studies. A prior study of Chinese pregnant women with hypertensive disorders in pregnancy showed lack of clarity and direct communication was positively associated with higher levels of stress [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Another study showed that poor parent-child communication worsened psychological distress such as anxiety and depression among adolescents [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Other studies have also shown affective communication decreased levels of stress among parents at outpatient pediatric unit [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] and decreased recovery of stress response among college students participating in an experiment [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Another experiment study of college students found that hope evocation, communication focusing on take advantages toward rewards in the near future, reduced anxiety. Yet, ruminating messages, repeating talking about negative feelings and consequence with each other, increased anxiety [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. There is a possible explanation of our nonsignificant communication findings. In daily life, individuals use a variety of ways to communicate, for example, oral speech plus nonverbal cues. However, we only focused on measuring direct oral speech. Future studies of pregnant and postpartum women should consider using a variety of measurements to identify types of communications associated with stress and/or anxiety.\u003c/p\u003e \u003cp\u003e\u003cb\u003eLimitations.\u003c/b\u003e There are limitations to the study. The cross-sectional design precludes us from drawing causal-effect relationship. Our communication scale only measured oral communication, which may prevent us to collect valuable information associated with communication, for example, nonverbal cues, email or text messaging, affective communication. Also, we enrolled pregnant and postpartum women regardless of their gestational age or postpartum weeks, retrospectively. Consequently, results of this study are not generalizable.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eWe found that poor relationship satisfaction and poor general family functioning were associated with higher levels of stress and anxiety across low-income overweight or obese pregnant and postpartum women. Our findings suggest the need to screen relationship satisfaction and general family functioning in these at risk-groups to provide tailored intervention. Also, stress management and psychological interventions should consider addressing relationship satisfaction and family function. In terms of communication, we did not find its association with stress and anxiety, thus, future studies of the population should measure different types of communication.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding.\u0026nbsp;\u003c/strong\u003eNo funding supported the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest.\u0026nbsp;\u003c/strong\u003eAll authors declare no conflict of interest\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and consent to participate.\u0026nbsp;\u003c/strong\u003eParticipants were volunteers and signed a written inform consent form prior to participating in the study. The study procedure was approved by The Ohio State University Institutional Review Board and adhered to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish.\u0026nbsp;\u003c/strong\u003eThe participants signed consent forms included a statement that the results of the study would be published in scientific journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study conception, design, material preparation, and data collection were performed by MC. Data analysis was performed by NH. The first draft of the manuscript was written by MC (method and discussion), NH (statistical analysis and results), HJ (introduction). All authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript. Also, all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u0026nbsp;\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHammen C: \u003cstrong\u003eStress and Depression\u003c/strong\u003e. \u003cem\u003eAnnual Review of Clinical Psychology \u003c/em\u003e2005, \u003cstrong\u003e1\u003c/strong\u003e(1):293-319.\u003c/li\u003e\n\u003cli\u003eYang L, Zhao Y, Wang Y, Liu L, Zhang X, Li B, Cui R: \u003cstrong\u003eThe Effects of Psychological Stress on Depression\u003c/strong\u003e. \u003cem\u003eCurr Neuropharmacol \u003c/em\u003e2015, \u003cstrong\u003e13\u003c/strong\u003e(4):494-504.\u003c/li\u003e\n\u003cli\u003e[https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm]\u003c/li\u003e\n\u003cli\u003ePreis H, Mahaffey B, Pati S, Heiselman C, Lobel M: \u003cstrong\u003eAdverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset\u003c/strong\u003e. \u003cem\u003eAnn Behav Med \u003c/em\u003e2021, \u003cstrong\u003e55\u003c/strong\u003e(3):179-191.\u003c/li\u003e\n\u003cli\u003eObrochta CA, Chambers C, Bandoli G: \u003cstrong\u003ePsychological distress in pregnancy and postpartum\u003c/strong\u003e. \u003cem\u003eWomen and Birth \u003c/em\u003e2020, \u003cstrong\u003e33\u003c/strong\u003e(6):583-591.\u003c/li\u003e\n\u003cli\u003eTrost SL, Beauregard JL, Smoots AN, Ko JY, Haight SC, Moore Simas TA, Byatt N, Madni SA, Goodman D: \u003cstrong\u003ePreventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008-17\u003c/strong\u003e. \u003cem\u003eHealth Aff (Millwood) \u003c/em\u003e2021, \u003cstrong\u003e40\u003c/strong\u003e(10):1551-1559.\u003c/li\u003e\n\u003cli\u003eMollard E, Kupzyk K, Moore T: \u003cstrong\u003ePostpartum stress and protective factors in women who gave birth in the United States during the COVID-19 pandemic\u003c/strong\u003e. \u003cem\u003eWomen\u0026apos;s Health \u003c/em\u003e2021, \u003cstrong\u003e17\u003c/strong\u003e:17455065211042190.\u003c/li\u003e\n\u003cli\u003eGila-D\u0026iacute;az A, Carrillo GH, L\u0026oacute;pez de Pablo \u0026Aacute;L, Arribas SM, Ramiro-Cortijo D: \u003cstrong\u003eAssociation between Maternal Postpartum Depression, Stress, Optimism, and Breastfeeding Pattern in the First Six Months\u003c/strong\u003e. \u003cem\u003eInternational Journal of Environmental Research and Public Health \u003c/em\u003e2020, \u003cstrong\u003e17\u003c/strong\u003e(19):7153.\u003c/li\u003e\n\u003cli\u003eOyetunji A, Chandra P: \u003cstrong\u003ePostpartum stress and infant outcome: A review of current literature\u003c/strong\u003e. \u003cem\u003ePsychiatry Research \u003c/em\u003e2020, \u003cstrong\u003e284\u003c/strong\u003e:112769.\u003c/li\u003e\n\u003cli\u003ePollock ED, Kazman JB, Deuster P: \u003cstrong\u003eFamily Functioning and Stress in African American Families: A Strength-Based Approach\u003c/strong\u003e. \u003cem\u003eJournal of Black Psychology \u003c/em\u003e2014, \u003cstrong\u003e41\u003c/strong\u003e(2):144-169.\u003c/li\u003e\n\u003cli\u003eLewandowski AS, Palermo TM, Stinson J, Handley S, Chambers CT: \u003cstrong\u003eSystematic review of family functioning in families of children and adolescents with chronic pain\u003c/strong\u003e. \u003cem\u003eJ Pain \u003c/em\u003e2010, \u003cstrong\u003e11\u003c/strong\u003e(11):1027-1038.\u003c/li\u003e\n\u003cli\u003eAlderfer MA, Fiese BH, Gold JI, Cutuli JJ, Holmbeck GN, Goldbeck L, Chambers CT, Abad M, Spetter D, Patterson J: \u003cstrong\u003eEvidence-based assessment in pediatric psychology: family measures\u003c/strong\u003e. \u003cem\u003eJ Pediatr Psychol \u003c/em\u003e2008, \u003cstrong\u003e33\u003c/strong\u003e(9):1046-1061; discussion 1062-1044.\u003c/li\u003e\n\u003cli\u003eHooper A, Hustedt JT, Slicker G, Hallam RA, Gaviria-Loaiza J: \u003cstrong\u003eLinking early head start children\u0026apos;s social-emotional functioning with profiles of family functioning and stress\u003c/strong\u003e. \u003cem\u003eJ Fam Psychol \u003c/em\u003e2023, \u003cstrong\u003e37\u003c/strong\u003e(1):153-160.\u003c/li\u003e\n\u003cli\u003eDoss BD, Rhoades GK: \u003cstrong\u003eThe transition to parenthood: impact on couples\u0026apos; romantic relationships\u003c/strong\u003e. \u003cem\u003eCurr Opin Psychol \u003c/em\u003e2017, \u003cstrong\u003e13\u003c/strong\u003e:25-28.\u003c/li\u003e\n\u003cli\u003eDoss BD, Rhoades GK, Stanley SM, Markman HJ: \u003cstrong\u003eThe effect of the transition to parenthood on relationship quality: an 8-year prospective study\u003c/strong\u003e. \u003cem\u003eJ Pers Soc Psychol \u003c/em\u003e2009, \u003cstrong\u003e96\u003c/strong\u003e(3):601-619.\u003c/li\u003e\n\u003cli\u003eRandall AK, Bodenmann G: \u003cstrong\u003eStress and its associations with relationship satisfaction\u003c/strong\u003e. \u003cem\u003eCurrent Opinion in Psychology \u003c/em\u003e2017, \u003cstrong\u003e13\u003c/strong\u003e:96-106.\u003c/li\u003e\n\u003cli\u003eHoffmann L, Hilger N, Riolino E, Lenz A, Banse R: \u003cstrong\u003ePartner support and relationship quality as potential resources for childbirth and the transition to parenthood\u003c/strong\u003e. \u003cem\u003eBMC Pregnancy and Childbirth \u003c/em\u003e2023, \u003cstrong\u003e23\u003c/strong\u003e(1):435.\u003c/li\u003e\n\u003cli\u003eGouveia F, Gouveia-Pereira M, Portugal A: \u003cstrong\u003eCOVID-19, Family and Love Relationships: Perception of Stress, Relational Quality, Family Functioning and Online Infidelity Behaviors\u003c/strong\u003e. \u003cem\u003eJournal of Couple \u0026amp; Relationship Therapy \u003c/em\u003e2024, \u003cstrong\u003e23\u003c/strong\u003e(3):213-228.\u003c/li\u003e\n\u003cli\u003eEpstein NB, Bishop DS, Levin S: \u003cstrong\u003eThe McMaster Model of Family Functioning\u003c/strong\u003e. \u003cem\u003eJournal of Marital and Family Therapy \u003c/em\u003e1978, \u003cstrong\u003e4\u003c/strong\u003e(4):19-31.\u003c/li\u003e\n\u003cli\u003eBanovcinova A, Levicka K:\u003cstrong\u003e The Impact of the Financial Income on the Family Communication. \u003c/strong\u003e. \u003cem\u003eRevista Romaneasca pentru Educatie Multidimensionala \u003c/em\u003e2015, \u003cstrong\u003e7\u003c/strong\u003e(2):35-46.\u003c/li\u003e\n\u003cli\u003eChang M, Pek J, Wegener D, Lee RE: \u003cstrong\u003eAssociations Between Stress, Body Mass Index, Demographics and Eating Behaviors in Low-Income Overweight or Obese Women\u003c/strong\u003e.\u003cem\u003e Austin Journal of Public Health and Epidemiology \u003c/em\u003e2022, \u003cstrong\u003e9\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eAmirkhan J: \u003cstrong\u003eA brief stress diagnostic tool: The short stress overload scale\u003c/strong\u003e. \u003cem\u003eAssessment \u003c/em\u003e2016:1-13.\u003c/li\u003e\n\u003cli\u003eSpitzer RL, Kroenke K, Williams JB, Lowe B: \u003cstrong\u003eA brief measure for assessing generalized anxiety disorder: the GAD-7\u003c/strong\u003e. \u003cem\u003eArch Intern Med \u003c/em\u003e2006, \u003cstrong\u003e166\u003c/strong\u003e(10):1092-1097.\u003c/li\u003e\n\u003cli\u003eHendrick SS: \u003cstrong\u003eA generic measure of relationship satisfaction \u003c/strong\u003e\u003cem\u003eJournal of Marriage and the Family \u003c/em\u003e1988, \u003cstrong\u003e50\u003c/strong\u003e:93-98.\u003c/li\u003e\n\u003cli\u003eVaughn MJ, \u0026amp; Matyastik Baier, M. E.:\u003cstrong\u003e Reliability and validity of the Relationship Assessment Scale\u003c/strong\u003e. \u003cem\u003eAmerican Journal of Family Therapy \u003c/em\u003e1999, \u003cstrong\u003e27\u003c/strong\u003e(2):137-147.\u003c/li\u003e\n\u003cli\u003eEpstein NB, Baldwin LM, Bishop DS: \u003cstrong\u003eThe McMaster Family Assessment Device\u003c/strong\u003e. \u003cem\u003eJournal of Marital and Family Therapy \u003c/em\u003e1983, \u003cstrong\u003e9\u003c/strong\u003e(2):171-180.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eR: A Language and Environment for Statistical Computing \u003c/strong\u003e[https://www.R-project.org/]\u003c/li\u003e\n\u003cli\u003eJones NA: \u003cstrong\u003eDelayed reactive cries demonstrate emotional and physiological dysregulation in newborns of depressed mothers\u003c/strong\u003e. \u003cem\u003eBiological Psychology \u003c/em\u003e2012, \u003cstrong\u003e89\u003c/strong\u003e(2):374-381.\u003c/li\u003e\n\u003cli\u003ePieh C, Rourke TO, Budimir S, Probst T: \u003cstrong\u003eRelationship quality and mental health during COVID-19 lockdown\u003c/strong\u003e. \u003cem\u003ePLoS ONE \u003c/em\u003e2020, \u003cstrong\u003e15\u003c/strong\u003e(9).\u003c/li\u003e\n\u003cli\u003eLeach LS, Butterworth P, Olesen SC, Mackinnon A: \u003cstrong\u003eRelationship quality and levels of depression and anxiety in a large population-based survey\u003c/strong\u003e. \u003cem\u003eSoc Psychiatry Psychiatr Epidemiol \u003c/em\u003e2013, \u003cstrong\u003e48\u003c/strong\u003e(3):417-425.\u003c/li\u003e\n\u003cli\u003eSalehi F, Shahhosseini Z: \u003cstrong\u003eAssociation Between Women\u0026rsquo;s Marital Satisfaction and Anxiety During Pregnancy\u003c/strong\u003e. \u003cem\u003eIran J Psychiatry Behav Sci \u003c/em\u003e2017, \u003cstrong\u003e11\u003c/strong\u003e(3):e7937.\u003c/li\u003e\n\u003cli\u003ePauly T, L\u0026uuml;scher J, Berli C, Scholz U: \u003cstrong\u003eDynamic associations between stress and relationship functioning in the wake of COVID-19: Longitudinal data from the German family panel (pairfam)\u003c/strong\u003e. \u003cem\u003eJ Soc Pers Relat \u003c/em\u003e2022, \u003cstrong\u003e39\u003c/strong\u003e(11):3183-3203.\u003c/li\u003e\n\u003cli\u003eKasalova P, Prasko J, Holubov\u0026aacute; M, Vrbova K, Zmeskalova D, Slepecky M, Grambal A: \u003cstrong\u003eAnxiety disorders and marital satisfaction\u003c/strong\u003e. \u003cem\u003eNeuroendocrinol Lett \u003c/em\u003e2018, \u003cstrong\u003e38\u003c/strong\u003e(8):555-564.\u003c/li\u003e\n\u003cli\u003eXing S, Wan L, Fu A, Liu W, Lin L, Wang C, Wang J, Huang G, Lu M: \u003cstrong\u003eCorrelation analysis of stress and family function and coping modes in pregnant women with pregnancy-induced hypertension syndrome\u003c/strong\u003e. \u003cem\u003eAnn Palliat Med \u003c/em\u003e2021, \u003cstrong\u003e10\u003c/strong\u003e(11):11688-11694.\u003c/li\u003e\n\u003cli\u003ePollock ED, Kazman JB, Deuster P: \u003cstrong\u003eFamily functioning and stress in African American families: A strength-based approach\u003c/strong\u003e. \u003cem\u003eJournal of Black Psychology \u003c/em\u003e2015, \u003cstrong\u003e41\u003c/strong\u003e(2):144-169.\u003c/li\u003e\n\u003cli\u003eChapman LK, Woodruff-Borden J: \u003cstrong\u003eThe impact of family functioning on anxiety symptoms in African American and European American young adults\u003c/strong\u003e. \u003cem\u003ePersonality and Individual Differences \u003c/em\u003e2009, \u003cstrong\u003e47\u003c/strong\u003e(6):583-589.\u003c/li\u003e\n\u003cli\u003eUruk A\u0026Ccedil;, Sayger TV, Cogdal PA: \u003cstrong\u003eExamining the Influence of Family Cohesion and Adaptability on Trauma Symptoms and Psychological Well-Being\u003c/strong\u003e. \u003cem\u003eJournal of College Student Psychotherapy \u003c/em\u003e2007, \u003cstrong\u003e22\u003c/strong\u003e(2):51-63.\u003c/li\u003e\n\u003cli\u003eHua Y, Jiang W, He Y, Zheng X, Huang C, Guo L, Guo Y, Guo L: \u003cstrong\u003eAssociations of recent stressful life events with anxiety symptoms among Chinese adolescents with a consideration of family functioning\u003c/strong\u003e. \u003cem\u003eEur J Psychotraumatol \u003c/em\u003e2024, \u003cstrong\u003e15\u003c/strong\u003e(1):2337577.\u003c/li\u003e\n\u003cli\u003eFarmakopoulou I, Lekka M, Gkintoni E: \u003cstrong\u003eClinical Symptomatology of Anxiety and Family Function in Adolescents-The Self-Esteem Mediator\u003c/strong\u003e. \u003cem\u003eChildren (Basel) \u003c/em\u003e2024, \u003cstrong\u003e11\u003c/strong\u003e(3).\u003c/li\u003e\n\u003cli\u003eGauntlett-Gilbert J, Eccleston C: \u003cstrong\u003eDisability in adolescents with chronic pain: Patterns and predictors across different domains of functioning\u003c/strong\u003e. \u003cem\u003ePain \u003c/em\u003e2007, \u003cstrong\u003e131\u003c/strong\u003e(1):132-141.\u003c/li\u003e\n\u003cli\u003eGuo Z, Zhao J, Peng J: \u003cstrong\u003eFamily function and anxiety among junior school students during the COVID-19 pandemic: a moderated mediation model\u003c/strong\u003e. \u003cem\u003eFront Psychiatry \u003c/em\u003e2023, \u003cstrong\u003e14\u003c/strong\u003e:1217709.\u003c/li\u003e\n\u003cli\u003eRomero-Abrio A, Mart\u0026iacute;nez-Ferrer B, Musitu-Ferrer D, Le\u0026oacute;n-Moreno C, Villarreal-Gonz\u0026aacute;lez ME, Callejas-Jer\u0026oacute;nimo JE: \u003cstrong\u003eFamily communication problems, psychosocial adjustment and cyberbullying\u003c/strong\u003e. \u003cem\u003eInternational journal of environmental research and public health \u003c/em\u003e2019, \u003cstrong\u003e16\u003c/strong\u003e(13):2417.\u003c/li\u003e\n\u003cli\u003eGemmiti M, Hamed S, Lauber-Biason A, Wildhaber J, Pharisa C, Klumb PL: \u003cstrong\u003ePediatricians\u0026rsquo; affective communication behavior attenuates parents\u0026rsquo; stress response during the medical interview\u003c/strong\u003e. \u003cem\u003ePatient Education and Counseling \u003c/em\u003e2017, \u003cstrong\u003e100\u003c/strong\u003e(3):480-486.\u003c/li\u003e\n\u003cli\u003eFloyd K, Mikkelson AC, Tafoya MA, Farinelli L, La Valley AG, Judd J, Haynes MT, Davis KL, Wilson J: \u003cstrong\u003eHuman affection exchange: XIII. Affectionate communication accelerates neuroendocrine stress recovery\u003c/strong\u003e. \u003cem\u003eHealth Commun \u003c/em\u003e2007, \u003cstrong\u003e22\u003c/strong\u003e(2):123-132.\u003c/li\u003e\n\u003cli\u003eChadwick AE, Zoccola PM, Figueroa WS, Rabideau EM: \u003cstrong\u003eCommunication and Stress: Effects of Hope Evocation and Rumination Messages on Heart Rate, Anxiety, and Emotions After a Stressor\u003c/strong\u003e. \u003cem\u003eHealth Commun \u003c/em\u003e2016, \u003cstrong\u003e31\u003c/strong\u003e(12):1447-1459.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e\n"}],"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":"relationship, family functioning, communication, stress, anxiety","lastPublishedDoi":"10.21203/rs.3.rs-6701146/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6701146/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study explored whether relationship satisfaction, general family functioning, or communication was associated with stress or anxiety.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were low-income overweight or obese pregnant (n = 342) or postpartum (n = 365) women. They completed validated surveys measuring relationship satisfaction, general family functioning, and communication (independent variables) as well as stress and anxiety (dependent variables). We performed regression analysis to test the objective while controlling for covariates: race, education, gestation or postpartum weeks. Separate analyses were conducted for pregnant and postpartum women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetter relationship satisfaction (pregnant, β = -0.40, p \u0026lt; .001; postpartum, β = -0.53, p \u0026lt; .001) and general family functioning (pregnant, β = -0.36, p \u0026lt; .001; postpartum, β = -0.51, p \u0026lt; .001) were negatively associated with stress. Similarity, better relationship satisfaction (pregnant, β = -0.24, p \u0026lt; .001; postpartum, β = -0.26, p \u0026lt; .001) and general family functioning (pregnant, β = -0.28, p \u0026lt; .001; postpartum, β = -0.23, p \u0026lt; 0.001) were negatively associated with anxiety. However, communication was not associated with stress or anxiety for either pregnant or postpartum women.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePoor relationship satisfaction and poor general family functioning increased levels of stress and anxiety in low-income overweight or obese pregnant and postpartum women. Interventions designed to reduce stress or anxiety in this at-risk population need to address relationship satisfaction and general family functioning.\u003c/p\u003e","manuscriptTitle":"Associations between Psychological Distress, Relationship Satisfaction, Family Functioning, and Communication among Low-Income Overweight or Obese Women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-20 17:30:53","doi":"10.21203/rs.3.rs-6701146/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":"b818351b-7f1a-4b78-b6bd-3b273c87552e","owner":[],"postedDate":"June 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-06T06:38:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-20 17:30:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6701146","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6701146","identity":"rs-6701146","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}