The Relationship Between Postpartum Social Support, Postpartum Depression, and Quality of Lifeduring the Puerperium A Study of Primiparas

The Relationship Between Postpartum Social Support, Postpartum Depression, and Quality of Lifeduring the Puerperium A Study of Primiparas | 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 The Relationship Between Postpartum Social Support, Postpartum Depression, and Quality of Lifeduring the Puerperium A Study of Primiparas Heyu Li, Yang Lu, Yang Tian, Danna Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5918013/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 This study aims to investigate the interrelationship between postpartum social support, postpartum depression, and quality of life during the puerperium, with a specific focus on primiparas. Methods A cross-sectional survey employing a descriptive correlational design was conducted for this study. A total of 328 primiparas participated in the survey, which utilized a self-developed demographic questionnaire tailored to primiparas, the Postpartum Social Support Scale, the Edinburgh Postnatal Depression Scale (EPDS), and the Brief Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF). Results The total quality of life score for primiparas on the 7th day postpartum was 56.87 ± 7.27, whereas the score at 6 weeks postpartum was 53.19 ± 7.95. Statistically significant differences (P < 0.05) were observed in the scores across various domains and in the total scores between these two time points. The total score for postpartum depression exhibited a negative correlation with postpartum social support and quality of life across all domains (P < 0.05). In contrast, the scores for postpartum social support across various dimensions demonstrated a positive correlation with quality of life scores in all domains during the puerperium (P < 0.05). Conclusion Postpartum social support and postpartum depression are critical determinants of postpartum quality of life. Enhancing social support systems in postpartum care can mitigate the risk of postpartum depression and promote quality of life during the puerperium. Primiparas Postpartum Social Support Postpartum Depression Quality of Life during the Puerperium Figures Figure 1 Figure 2 Introduction Primiparas are defined as women who give birth to a full-term infant for the first time, typically with a gestational age ranging from 37 to 42 weeks, a birth weight of at least 2.5 kilograms, and a newborn free from any congenital anomalies or health conditions 1 . After enduring the often challenging and painful labor process, primiparas experience the profound joy associated with motherhood. However, in comparison to multiparas, primiparas frequently encounter more significant challenges.On the one hand, due to their lack of prior experience, primiparas often face difficulties in parenting, which can adversely affect their postpartum quality of life. On the other hand, factors such as insufficient medical resources, traditional cultural constraints, economic challenges, family dynamics, and suboptimal hygiene practices may contribute to inadequate puerperal care for primiparas, thereby leading to various postpartum complications 2 . For primiparas, investigating the unique characteristics and associated factors during the puerperium period is of critical importance 3 . Although hospitals and maternal and child health institutions have made continuous improvements in prenatal screening coverage and the dissemination of prenatal health education, primiparas often lack essential knowledge and skills related to maternal and infant health care during the puerperium. The lack of effective self-care guidance during this period can lead to inadequate postpartum recovery, puerperal infections, delayed postpartum hemorrhage, urinary retention, postpartum depression, and other physical and mental health issues, potentially culminating in maternal mortality 4 . Notably, significant physical, emotional, and psychological changes occur, particularly on the 7th day and the 6th week postpartum 5 . These negative emotions can persist throughout the puerperium, profoundly affecting maternal physical and mental health, family relationships, and social interactions, ultimately reducing overall quality of life during the puerperium 6 . Postpartum quality of life refers to the comprehensive well-being of women after childbirth, encompassing various aspects such as physical recovery, emotional and psychological states, sleep quality, family relationships, and social support. It reflects the overall life experience and adaptive capacity of women during the postpartum period.According to previous studies, Torkan (2009) and Li et al. (2005) found that, due to the unique characteristics of primiparas, factors influencing their quality of life during the puerperium extend beyond basic sociodemographic and medical factors. Postpartum social support and postpartum depression are two significant factors with considerable potential influence [7,8]. Postpartum depression (also referred to as postpartum depressive disorder) was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994, with diagnostic criteria established [9]. Martínez-Galiano et al. (2019) proposed that postpartum depression is not an independent disorder but rather a type of depression specifically occurring during the postpartum period 10 . It typically emerges within the first few weeks post-delivery but may arise at any point during the first year of the infant’s life. Women suffering from postpartum depression often experience profound fatigue, which impairs their ability to manage daily caregiving activities and significantly diminishes their postpartum quality of life. Therefore, enhancing the postpartum quality of life of primiparas is crucial in preventing such conditions. Globally, the prevalence of postpartum depression (PPD) varies between 7% and 40% in Western developed countries and 3.5% to 63.3% in Asian countries. Up to 85% of women experience postpartum blues, with 10% to 20% of these cases progressing to postpartum depression [11,12]. According to the 2022 National Depression Blue Book , the prevalence of postpartum depression in China is 14.7%, exceeding the global average of 13%, which suggests that approximately 1 in 5 mothers in China may experience postpartum depression.Furthermore, 40% of family members fail to recognize postpartum depression, and 13% even attribute it to the mother's "over-sensitivity" or ridicule her. The consultation rate for postpartum depression remains under 30% 13 . In this context, social support is regarded as one of the most crucial emotional coping mechanisms and a vital resource for effectively managing the challenges and stressors of the puerperium period 14 . Social support refers to the perceived protection, care, and assistance an individual receives from their social or familial network. Through active involvement and commitment, individuals experience a sense of being valued, cared for, and connected to others. Zhu (2022) proposed the social support relationship enhancement model, which posits that social support within the context of close relationships promotes health and well-being 15 . Perceived social support, hope, and resilience may function as positive factors in combating depression and preventing puerperal infections, aiding mothers in coping with emotional distress and illness, and ultimately enhancing their quality of life 16 . Although theoretical foundations proposed by researchers such as Bužgová, Hájková & Jasioková (2009), Galiano et al. (2019), Sun (2022), and Zhu (2022) support this concept, no previous studies have specifically investigated the relationships between postpartum social support, postpartum depression, and postpartum quality of life, particularly among primiparas in developing countries. Consequently, this study aims to examine the following four hypotheses: 1. A positive correlation exists between postpartum social support, postpartum depression, and quality of life during the puerperium among primiparas. 2. The level of postpartum social support correlates with the degree of postpartum depression. 3. The level of postpartum social support is associated with the level of postpartum quality of life. 4. The degree of postpartum depression correlates with the level of postpartum quality of life. This study aims to explore the relationship between postpartum social support, postpartum depression, and postpartum quality of life, with primiparas serving as the primary example (Figure 1). Methods Study Design and Participants This study employed a cross-sectional survey design, characterized by a descriptive correlational approach. A total of 328 primiparas, who delivered at five tertiary hospitals between September 2023 and February 2024, were enrolled as participants. The hospitals involved in the study were Zhejiang Provincial Maternal and Child Health Hospital, Hangzhou Women's and Children's Hospital, the First Affiliated Hospital of Wenzhou Medical University, the Second Affiliated Hospital of Harbin Medical University, and Harbin Maternal and Child Health Hospital. Inclusion criteria were as follows: 1. First-time mothers who gave birth to a full-term infant. 2. A gestational age ranging from 37 to 42 weeks. 3. An infant birth weight of at least 2.5 kg. 4. The newborn was free from deformities or diseases. 5. Mothers possessed basic literacy skills and were able to complete the questionnaire independently. The exclusion criteria were as follows: 1. Preterm births (gestational age between 28 and 37 weeks) or post-term births (≥42 weeks). 2. Infant birth weight less than 2.5 kg. 3. Newborns with congenital abnormalities or mothers experiencing severe obstetric complications. 4. Mothers who lacked basic literacy skills and were unable to complete the questionnaire independently. Before the study commenced, the research protocol was submitted to and approved by the Ethics Committee of the Zhejiang Zhoushan Tourism and Health College, Zhejiang Province (Approval Number: [2023-16]). All participants voluntarily engaged in the survey after receiving comprehensive information about the purpose and content of the study and signing informed consent forms. Throughout the study, the voluntariness, privacy, data confidentiality, right to withdraw, and anonymity of the participants were rigorously protected. This research adhered to the ethical guidelines outlined in the Declaration of Helsinki (2013 revision), as endorsed by the World Medical Association (WMA). Sample Size Calculation and Sampling The study employed survey instruments encompassing four dimensions of the Postpartum Social Support Scale, three dimensions of the Edinburgh Postnatal Depression Scale (EPDS), and four dimensions, along with two overall quality-of-life items from the WHOQOL-BREF, resulting in a total of 13 variables. Following Mueller's sample size estimation method, the required sample size was determined to be 10 to 15 times the number of variables, with an additional 5%–10% included to compensate for potential participant attrition. The final sample size was established to be no fewer than 296 participants. A pilot study was performed prior to data collection to assess the feasibility, clarity, and applicability of the research instruments. The pilot study included 50 primiparas who were admitted to five tertiary hospitals between September 2023 and February 2024, though they were excluded from the final sample. The pilot study results indicated that the research instruments were accurate, clear, and appropriate for the target population, with no revisions necessary. Data Collection Tool 1: Self-Developed Questionnaire for Collecting Demographic and Obstetric Data from Primiparas This instrument was employed to gather comprehensive demographic and obstetric information pertaining to the participants. The validity of this instrument was evaluated by five experts specializing in nursing education, obstetric nursing, community nursing, and health education. Reliability was assessed using Cronbach’s alpha coefficient, which demonstrated strong internal consistency. A detailed description of the content is presented in Table 1. Tool 2: Postpartum Social Support Questionnaire This questionnaire was developed by Lu et al. (2018) and consists of four dimensions, encompassing a total of 20 items. Each item is rated on a 4-point Likert scale (ranging from 0 to 3). Higher scores in each dimension reflect enhanced postpartum social support within that specific category, while higher total scores correspond to greater overall postpartum social support. The questionnaire has shown robust validity and reliability, with a content validity index (CVI) of 0.90 and a Cronbach’s alpha coefficient of 0.89 [16]. Tool 3: Edinburgh Postnatal Depression Scale (EPDS) Developed by Professor John Cox at the University of Edinburgh in 1987, the EPDS has since become widely used for postpartum depression screening in China, starting from the 1990s. Comprising 10 items scored on a 4-point scale, higher total scores on the EPDS correspond to more severe postpartum depression. According to research by Huang (2020), the EPDS exhibits strong validity and reliability for Chinese mothers, with a Cronbach’s alpha coefficient of 0.87 17. Studies by Lee (1998) and Li et al. (2016) suggest a cutoff score of ≥13 for screening postpartum depression in China [18,19]. Consequently, a cutoff score of ≥13 was applied to identify postpartum depression in this study. Tool 4: WHO Quality of Life-BREF (WHOQOL-BREF) The WHOQOL-BREF is a short-form quality-of-life assessment tool developed by the World Health Organization, derived from the WHOQOL-100. It comprises 26 items scored on a 5-point scale, with higher scores denoting a better quality of life. The WHOQOL-BREF has demonstrated strong reliability and validity [20, 21]. Statistical Analysis Data entry was conducted using EpiData 4.0 software to construct a comprehensive database. Statistical analyses were carried out using SPSS software (version 26.0; IBM SPSS Inc., Chicago, USA). Statistical methods included descriptive statistics, analysis of variance (ANOVA), and Pearson correlation coefficients. Measurement data are presented as mean ± standard deviation (x̄ ± s), while categorical data are expressed as frequency and percentage (%). The Kolmogorov-Smirnov test was employed to evaluate the normality of the data distribution. A P-value of <0.05 was deemed statistically significant. The detailed research process is presented in Figure 2. Results A total of 400 questionnaires were distributed across the hospital wards during the survey period, with 392 valid responses collected, yielding an effective recovery rate of 98%. In the follow-up survey, 64 participants were lost to follow-up, and a total of 328 valid responses were collected at 6 weeks postpartum. Consequently, this study included 328 primiparas who had completed both rounds of questionnaires, thus serving as the final research subjects. Detailed demographic information is presented in Table 1 . Table 1 Demographic Characteristics of Primiparas Characteristics N (%) Age ≤ 25 82 (25.0) 26–30 107 (32.6) 31–35 83 (25.3) ≥ 36 56 (17.1) Place of Residence Rural Areas 141 (42.9) Urban Areas 187 (57.1) Education Level Junior High School or Lower 49 (14.9) Senior High School 42 (12.8) Vocational College 109 (33.2) Bachelor's Degree 88 (26.8) Master's Degree or Higher 40 (12.2) Occupation Administrative Personnel 51 (15.5) Self-Employed 94 (28.7) Manual Worker 25 (7.6) Educator 41 (12.5) Healthcare Professional 36 (11.0) Unemployed 81 (24.7) Monthly Per Capita Household Income (USD) 1500 30 (9.2) Only Child (No Siblings) Yes 133 (40.5) No 195 (59.5) Temperament Neuroticism-Stability 185 (56.4) Introversion 89 (27.1) Extraversion 54 (16.5) Familial Relationships Excellent 254 (77.4) Moderate 54 (16.5) Suboptimal 20 (6.1) Mode of Delivery Vaginal Birth 124 (37.8) Cesarean Birth 204 (62.2) The results of the statistical analysis indicate that the differences in scores across various domains, as well as the overall quality of life score, between postpartum Day 7 and Week 6, are statistically significant (P < 0.05). Detailed scores are presented in Table 2 . Table 2 Comparison of Quality of Life Scores at Different Stages of the Postpartum Period Characteristics Total (M ± SD) Physical Domain Psychological Domain Social Domain Environmental Domain 7 Days Postpartum 56.87 ± 7.27 13.67 ± 2.04 14.55 ± 2.13 14.93 ± 2.44 13.72 ± 2.14 6 Weeks Postpartum 53.19 ± 7.95 13. 15 ± 2.13 13.32 ± 2.34 13.69 ± 2.62 13.03 ± 2.29 t-Value 5.266 2.719 6.013 5.337 3.383 p -Value 0.000 0.007 0.000 0.000 0.001 The results of the statistical analysis indicate that the differences in the scores of each dimension of postpartum social support, as well as the overall postpartum social support score, between Day 7 and Week 6 postpartum, are statistically significant (P < 0.05). The results of Pearson correlation analysis show that the scores of each dimension, as well as the total score of postpartum social support, are positively correlated with the scores of each dimension and the overall quality of life score during the postpartum period (P < 0.05). Detailed scores are presented in Table 3 . Table 3 Comparison of Postpartum Social Support Scores at Different Stages of the Puerperium in Primiparas Characteristics Total (M ± SD) Emotional Support Material Support Informational Support Appraisal Support 7 Days Postpartum 49.35 ± 7.76 13.34 ± 1.97 12.75 ± 2.41 11.16 ± 3.44 12.10 ± 2.27 6 Weeks Postpartum 43.29 ± 9.94 11.26 ± 2.93 11.03 ± 2.99 10.08 ± 3.41 10.91 ± 2.78 t-Value 7.568 8.890 6.785 3.430 5.392 p -Value 0.000 0.000 0.000 0.001 0.000 The results of the study show that a cutoff value of 13 was applied to screen for postpartum depression. The incidence of postpartum depression was calculated to be 16.8% at Day 7 and 31.5% at Week 6 postpartum for primiparas. Additionally, a t-test was conducted to analyze the postpartum depression scores across each dimension, as well as the total postpartum depression score, at Week 6 postpartum. The differences were found to be statistically significant (P < 0.05). Results from Pearson correlation analysis indicated that the total postpartum depression score was negatively correlated with the scores of the four dimensions of puerperium quality of life, as well as the overall quality of life score (P < 0.05). Detailed scores are presented in Table 4 . Table 4 Comparison of Postpartum Depression Scores at Different Stages of the Puerperium in Primiparas Characteristics Total (M ± SD) Emotional Deprivation Anxiety Depression 7 Days Postpartum 8.78 ± 4.08 1.21 ± 1.68 4.74 ± 1.55 2.83 ± 2.59 6 Weeks Postpartum 10.04 ± 4.41 1.52 ± 1.57 5.15 ± 1.67 3.38 ± 2.59 t-Value -3.236 -2.061 -2.728 -2.320 p -Value 0.001 0.040 0.007 0.021 Results from Pearson correlation analysis indicate that the total postpartum depression score is negatively correlated with the scores of each dimension of postpartum social support, as well as each dimension of puerperal quality of life (P < 0.05). The scores of each dimension of postpartum social support are positively correlated with the scores of each corresponding dimension of puerperal quality of life (P < 0.05). The scores of the four dimensions of postpartum social support are positively correlated with one another, and similarly, the scores of the four dimensions of puerperal quality of life are positively correlated with each other. All these correlations are statistically significant (P < 0.05). Detailed scores are presented in Table 5 . Table 5 Comparison of Quality of Life Scores at Different Stages of the Puerperium Variable 1 2 3 4 5 6 7 8 9 Emotional Support 1.000 Material Support 0.688 ** 1.000 Informational Support 0.465 ** 0.545 ** 1.000 Appraisal Support 0.560 ** 0.578 ** 0.560 ** 1.000 Physical Domain 0.310 ** 0.308 ** 0.249 ** 0.309 ** 1.000 Psychological Domain 0.447 ** 0.364 ** 0.208 ** 0.419 ** 0.647 ** 1.000 Social Domain 0.388 ** 0.372 ** 0.299 ** 0.393 ** 0.647 ** 0.606 ** 1.000 Environmental Domain 0.427 ** 0.378 ** 0.372 ** 0.416 ** 0.479 ** 0.766 ** 0.600 ** 1.000 Postpartum Depression -0.386 ** -0.349 ** -0.243 ** -0.308 ** -0.366 ** -0.418 ** -0.308 ** -0.368 ** 1.000 **: P < 0.05 Discussion During the postpartum period, substantial physiological changes occur in the maternal body, particularly within the reproductive system. Although many women do not have pre-existing conditions prior to childbirth, postpartum women are generally physically weaker than other women and require at least six weeks of specialized care and health maintenance to facilitate both physical and psychological recovery 22. Furthermore, primiparas are more likely to experience delayed recovery during the puerperium and postpartum depression due to their lack of prior experience with pregnancy and childbirth. Moreover, the postpartum period may affect their social interactions, work, and financial stability, potentially leading to symptoms of depression and anxiety, all of which negatively impact postpartum quality of life 23. Therefore, social support is considered a crucial intervention strategy that aids first-time mothers in navigating the postpartum period and enhancing their overall quality of life. Firstly, the results of this study indicate that the quality of life of first-time mothers gradually declined as the postpartum period progressed (Table 2 ). This decline in quality of life may be associated with the two specific time points chosen for this study. In the first seven days postpartum, the joy and happiness of becoming a mother often outweigh the negative emotions associated with physical, psychological, and social challenges. However, by the sixth week postpartum, as first-time mothers undergo physical and psychological recovery, transition into their maternal roles, care for their newborns, and cope with psychological pressures from family and society, they may experience health challenges. These findings align with those of Hou (2012), Symon (2003), Bai (2014), and Chen (2016), and demonstrate that first-time mothers' self-assessment of their quality of life significantly worsens by six weeks postpartum compared to the early postpartum period and is lower than that of women of childbearing age in general [ 24 – 27 ]. Therefore, as the postpartum period progresses, the quality of life of first-time mothers gradually declines, highlighting the need for enhanced postpartum psychological counseling and professional nursing support, particularly from their partners, which can help mothers cope with life changes and improve their quality of life. Second, the study results show that the total score for social support during the postpartum period was relatively high (Table 3 ), and postpartum social support was positively correlated with overall quality of life as well as the four quality-of-life dimensions. The correlation coefficient with overall quality of life was as high as 0.506, suggesting that the social support received by first-time mothers during the postpartum period is strongly associated with their quality of life. This finding aligns with studies by Lu Hong et al. (2001), Wu Liping et al. (2012), Zang Shaomin et al. (2011), and Mannella, P. (2013), where emotional support ranked the highest and informational support the lowest [ 28 – 31 ]. These studies consistently found that the majority of first-time mothers perceive high levels of social support, and a robust social support network plays a crucial role in enhancing psychological well-being. However, Bregman, M. (1997) observed that the types of social support received by first-time mothers during the postpartum period may not always correspond to their most immediate or anticipated needs, which can potentially contribute to postpartum depression 32. These studies further corroborate that social support serves as a significant protective factor for first-time mothers. These findings can be explained from three perspectives: first, the majority of study participants reported strong family relationships (Table 1 ), with their partners providing essential physical and emotional support throughout the puerperium, which helped alleviate postpartum stress. Second, the majority of first-time mothers exhibited extroverted personalities, were younger, and had higher educational levels (Table 1 ), which facilitated the formation of close family and support networks, enabling family members and friends to offer care and support. These results suggest that healthcare providers should assess the level of social support received by first-time mothers and guide family members in providing the types of social support most needed, particularly emotional and appraisal support, to enhance the mothers' overall quality of life during the puerperium. Third, with respect to postpartum depression, the results of this study indicate that the incidence of postpartum depression among first-time mothers was 16.8% at seven days and 31.5% at six weeks postpartum (Table 4 ), both of which are higher than the average incidence rates observed in domestic (14.7%) and international studies (13%). The total postpartum depression score was negatively correlated with both overall quality of life and all four quality-of-life dimensions, with a correlation coefficient of -0.429. This suggests that the severity of postpartum depression is strongly associated with quality of life during the puerperium, indicating that more severe postpartum depression symptoms are linked to lower quality of life. These findings are consistent with those of " Postpartum Care of the Mother and Newborn: A Practical Guide " (1999), Knoester and Li (2021), and Chen (2017), all of which also demonstrate an increasing trend in postpartum depression symptoms over time [ 33 – 35 ]. In contrast, Çankaya (2020) found that social support for first-time mothers significantly decreased at six weeks postpartum compared to seven days and identified a significant negative correlation between social support and postpartum depression 36. Furthermore, a study by Webster et al. (2011) reported that first-time mothers with postpartum depression frequently experienced psychological distress and a profound loss of self-confidence 37. The relatively high incidence of postpartum depression in this study may be attributed to the fact that a significant proportion of the participants underwent cesarean sections (62.2%) (Table 1 ), as the mode of delivery is a key influencing factor for postpartum depression. Postpartum depression not only negatively impacts the mothers but can also lead to emotional, behavioral, and cognitive impairments in newborns. In severe cases, it can even result in suicidal tendencies. The more severe the postpartum depression symptoms, the greater the decline in the health-related quality of life for the mother. The more severe the postpartum depression symptoms, the greater the decline in the health-related quality of life for the mother. Timely attention to their psychological well-being, along with continuous social support when necessary, should be provided. Health education for mothers and their families should also be enhanced to raise awareness of and concern for postpartum depression, encouraging family and friends to provide more care and companionship to support mothers in navigating the postpartum period. Fourth, regarding the relationship between postpartum social support, postpartum depression, and quality of life during the puerperium, the findings of this study reveal that the total postpartum depression score was negatively correlated with scores across all dimensions of both postpartum social support and puerperium quality of life, while the scores for social support and quality of life were positively correlated (P < 0.05). The scores across the four dimensions of social support were positively correlated with each other, as were the four dimensions of quality of life, with statistically significant differences (P < 0.05) (Table 5 ). These findings are consistent with those of studies by Desta et al. (2021), Zhou (2017), Mckee (2001), and Li (2014), all of which demonstrate both direct and indirect effects of postpartum social support on the quality of life during the puerperium [ 38 – 41 ]. Postpartum depression functions as a mediating variable, modulating the relationship between social support and quality of life. Social support plays a protective role in improving quality of life by mitigating the occurrence of postpartum depression. Therefore, healthcare providers, particularly nursing staff, should prioritize the assessment of social support during hospitalization 42. For mothers who lack social support, it is essential to guide family members, particularly spouses, in providing the appropriate types of support, including emotional and appraisal support, and to offer psychological counseling and educational interventions. Such interventions can effectively alleviate symptoms of postpartum depression and improve overall quality of life during the puerperium. This study offers valuable insights for obstetric and gynecological nursing professionals and researchers into the psychosocial challenges encountered by first-time mothers during the puerperium. By recognizing these challenges, more targeted interventions can be designed to enhance emotional resilience and significantly improve maternal quality of life and overall health. This research not only provides important references for optimizing puerperium care but also emphasizes the necessity of offering psychological support in addition to physical recovery for postpartum women. Limitations This study employs a cross-sectional design, which inherently restricts the ability to infer causal relationships. To mitigate this limitation, future longitudinal studies should be conducted, utilizing standardized instruments to yield more comprehensive insights. Furthermore, this study relied on questionnaire surveys for data collection, which, while effective in gathering relevant information, presents challenges in exploring the intricate relationships between social support, postpartum depression, and quality of life in depth. Therefore, further research is necessary to deepen the understanding of the interactions and underlying connections among these variables. Conclusion Postpartum social support and postpartum depression are critical determinants influencing the quality of life during the puerperium. Accordingly, postpartum care should prioritize the enhancement of the social support system to mitigate the risk of postpartum depression and improve maternal quality of life during the puerperium. This initiative will assist obstetric and gynecological care providers in more effectively understanding the needs of postpartum women, thereby enabling them to deliver more efficient, compassionate, and patient-centered care. Declarations Ethics Approval and Informed Consent Prior to initiating the study, the research protocol was submitted for review and subsequently approved by the Ethics Committee of Zhejiang Zhoushan Tourism and Health College(Approval No: [2023-16]). All participants voluntarily consented to participate in the survey after being thoroughly informed about the study's objectives and scope, and they subsequently signed an informed consent form. Throughout the study, participants' voluntariness, privacy protection, data confidentiality, the right to withdraw from the study, and anonymity were rigorously maintained. This study strictly adhered to the ethical standards outlined in the revised Declaration of Helsinki (2013), as promulgated by the World Medical Association (WMA). Consent for Publication Not applicable. Availability of Data and Supporting Materials All data generated or analyzed throughout this study are included in the published article and its supplementary materials. Competing Interests The authors declare no potential conflicts of interest related to the research or the publication of this article. Funding This study was funded by the Zhejiang Provincial Higher Vocational Education "14th Five-Year Plan" Second Batch Teaching Reform Project (Project No: JG20240478). Author Contributions Heyu Li, Yang Lu, Yang Tian, and Danna Wang contributed equally to this work. Heyu Li and Yang Tian designed the study and conducted the experiments, while Yang Lu collected the data and Danna Wang analyzed the data. Heyu Li, Yang Lu, and Yang Tian prepared the manuscript, and all authors reviewed and approved the final version. Acknowledgements The authors wish to express their gratitude to the research institution for their assistance and support throughout the study. References Zhao CY, Cui YJ, Huang JX, Xie Q, Li Y, Zuo PJ. Research progress on risk factors related to perinatal depression. Chin J Maternal Child Health. 2024;3:75-80. doi: 10.19757/j.cnki.issn1674-7763.2024.03.013. Bužgová R, Hájková M, Jasioková A. 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Study on the correlation between maternal role adaptation, coping styles, and social support in primiparas. Chin Nurs J. 2012;5:410-413. Zang SM, Sheng Y. Study on the social support status at different time points in primiparas during the postpartum period. Chin J Maternal Child Health Res. 2011;2:150-152. Mannella P. Female urinary incontinence during pregnancy and after delivery: Clinical impact and contributing factors. World J Obstet Gynecol. 2013;2(4):74. doi: 10.5317/wjog.v2.i4.74. Bregman M. Comparative effectiveness of social support interventions on postpartum depression. PsycEXTRA Dataset. 1997. doi: 10.1037/e537072011-002. Postpartum care of the mother and newborn: A practical guide. Birth. 1999;26(4):255-258. doi: 10.1046/j.1523-536x.1999.00255.x. Knoester C, Li Q. Preferences for paid paternity leave availability, lengths of leave offerings, and government funding of paternity leaves in the United States. Sociol Perspect. 2021;65(2):374-397. doi: 10.1177/07311214211001892. Chen C, Chen JB. Study on the relationship between maternal role adaptation, postpartum depression, and social support in primiparas. Gen Pract Nurs. 2017;22:2789-2790. Çankaya S. The effect of psychosocial risk factors on postpartum depression in the antenatal period: A prospective study. Arch Psychiatr Nurs. 2020;34(3):176-183. doi: 10.1016/j.apnu.2020.04.007. Webster J, et al. Quality of life and depression following childbirth: Impact of social support. Midwifery. 2011;27(5):745-749. doi: 10.1016/j.midw.2010.05.014. Desta M, et al. Postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia: A systematic review and meta-analysis. J Affect Disord. 2021;279:737-748. doi: 10.1016/j.jad.2020.11.053. Zhou HX. Influence of social support on the quality of life, breastfeeding, and postpartum depression in older multiparous women (Master's thesis). Shandong University; 2017. Available from:https://kns.cnki.net/kcms2/article/abstract?v=2G5Y6l-6Cy-jxxCPM_5bY08dOfkkAmH_JFrvS3u-CftVVZG0J0J41XfOc-TQP07TGTqBwe-kGCGClMaj69th5RW4RteQvR471VNUgEUibdx8t7mCWoBS-t0pKGSPt6wqPv2TnyB5NAJ-WAa6qUR_9hCfceAwTi4FLhUQM9mnj5au7uqKyr5B7LONwuIcuneBCX786ibY_Bw=&uniplatform=NZKPT&language=CHS. McKee M. Health-related functional status in pregnancy: Relationship to depression and social support in a multi-ethnic population. Obstet Gynecol. 2001;97(6):988-993. doi: 10.1016/s0029-7844(01)01377-1. Li N. Influence of perinatal health education on the quality of life and depressive symptoms in pregnant and postpartum women. Chin Mod Doctor. 2014;28:107-109. Wu Q. Effect of personalized nursing intervention during the perinatal period on delivery quality and postpartum quality of life in primiparas. Chin Health Stand Manag. 2015;27:260-261. Additional Declarations The authors declare no competing interests. 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Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACNmb+x49/VNjU87M3EKmFj72HzZjhTFqCZM8BIrXI8ZxhkGZsO5xgcCOBWIdJ5B4wLmxjzpOc+XjjDYYam2gitOQlPJ5xjq2YXzqt2ILhWFpuA2EtCQYGPGU8jDNn55hJMDYcJk6LBA+bBOOGm2eI1cJzxkCap80gccMNHmK1sLelGc44k2As2QP0SwIxfpFvZj784EPFfzl+9sMbb3yosSGsBRkYSCSQohyihVQdo2AUjIJRMDIAAIUePmGORAaHAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yang","middleName":"","lastName":"Lu","suffix":""},{"id":408178555,"identity":"c1826a6b-be19-4b98-9121-c7515e5c76c5","order_by":2,"name":"Yang Tian","email":"","orcid":"","institution":"Collage of Humanities and Education, Nanchang Institute of 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10:40:56","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5918013/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5918013/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74988028,"identity":"917e449e-d178-4d23-8954-a475cc7c9902","added_by":"auto","created_at":"2025-01-29 06:27:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48179,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe Theoretical Framework Depicting the Relationship Between Postpartum Social Support, Postpartum Depression, and Postpartum Quality of Life.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5918013/v1/1a1c97bc508d2394a5dfe83f.png"},{"id":74988032,"identity":"45d64512-a931-4819-8a1e-dfc874e69fa4","added_by":"auto","created_at":"2025-01-29 06:27:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":208773,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eOverview of the Research Process in This Study\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5918013/v1/0407c57f99055013df503d5b.png"},{"id":74988968,"identity":"9d7ddf03-21c6-4531-97da-befcd2d27c75","added_by":"auto","created_at":"2025-01-29 06:51:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1015675,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5918013/v1/824c9206-5afb-4adc-b98e-bf2f94d3739d.pdf"},{"id":74988209,"identity":"dc0aec77-81d0-4719-9587-ca5a76206d6d","added_by":"auto","created_at":"2025-01-29 06:35:12","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":135346,"visible":true,"origin":"","legend":"\u003cp\u003eQuestionnaire summary\u003c/p\u003e","description":"","filename":"Questionnairesummary.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5918013/v1/5cbf5694cc1128f7e51cc54c.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eThe Relationship Between Postpartum Social Support, Postpartum Depression, and Quality of Lifeduring the Puerperium A Study of Primiparas\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePrimiparas are defined as women who give birth to a full-term infant for the first time, typically with a gestational age ranging from 37 to 42 weeks, a birth weight of at least 2.5 kilograms, and a newborn free from any congenital anomalies or health conditions \u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAfter enduring the often challenging and painful labor process, primiparas experience the profound joy associated with motherhood. However, in comparison to multiparas, primiparas frequently encounter more significant challenges.On the one hand, due to their lack of prior experience, primiparas often face difficulties in parenting, which can adversely affect their postpartum quality of life. On the other hand, factors such as insufficient medical resources, traditional cultural constraints, economic challenges, family dynamics, and suboptimal hygiene practices may contribute to inadequate puerperal care for primiparas, thereby leading to various postpartum complications\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor primiparas, investigating the unique characteristics and associated factors during the puerperium period is of critical importance\u0026nbsp;\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAlthough hospitals and maternal and child health institutions have made continuous improvements in prenatal screening coverage and the dissemination of prenatal health education, primiparas often lack essential knowledge and skills related to maternal and infant health care during the puerperium. The lack of effective self-care guidance during this period can lead to inadequate postpartum recovery, puerperal infections, delayed postpartum hemorrhage, urinary retention, postpartum depression, and other physical and mental health issues, potentially culminating in maternal mortality\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e Notably, significant physical, emotional, and psychological changes occur, particularly on the 7th day and the 6th week postpartum\u0026nbsp;\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThese negative emotions can persist throughout the puerperium, profoundly affecting maternal physical and mental health, family relationships, and social interactions, ultimately reducing overall quality of life during the puerperium\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostpartum quality of life refers to the comprehensive well-being of women after childbirth, encompassing various aspects such as physical recovery, emotional and psychological states, sleep quality, family relationships, and social support. It reflects the overall life experience and adaptive capacity of women during the postpartum period.According to previous studies, Torkan (2009) and Li et al. (2005) found that, due to the unique characteristics of primiparas, factors influencing their quality of life during the puerperium extend beyond basic sociodemographic and medical factors. Postpartum social support and postpartum depression are two significant factors with considerable potential influence\u003cstrong\u003e[7,8].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePostpartum depression (also referred to as postpartum depressive disorder) was included in the\u003cem\u003e\u0026nbsp;Diagnostic and Statistical Manual of Mental Disorders\u003c/em\u003e (DSM) in 1994, with diagnostic criteria established\u003cstrong\u003e[9].\u0026nbsp;\u003c/strong\u003eMartínez-Galiano \u003cstrong\u003eet al. (2019)\u0026nbsp;\u003c/strong\u003eproposed that postpartum depression is not an independent disorder but rather a type of depression specifically occurring during the postpartum period\u0026nbsp;\u003cstrong\u003e10\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eIt typically emerges within the first few weeks post-delivery but may arise at any point during the first year of the infant’s life. Women suffering from postpartum depression often experience profound fatigue, which impairs their ability to manage daily caregiving activities and significantly diminishes their postpartum quality of life. Therefore, enhancing the postpartum quality of life of primiparas is crucial in preventing such conditions.\u003c/p\u003e\n\u003cp\u003eGlobally, the prevalence of postpartum depression (PPD) varies between 7% and 40% in Western developed countries and 3.5% to 63.3% in Asian countries. Up to 85% of women experience postpartum blues, with 10% to 20% of these cases progressing to postpartum depression\u003cstrong\u003e\u0026nbsp;[11,12].\u0026nbsp;\u003c/strong\u003eAccording to the \u003cem\u003e2022 National Depression Blue Book\u003c/em\u003e, the prevalence of postpartum depression in China is 14.7%, exceeding the global average of 13%, which suggests that approximately 1 in 5 mothers in China may experience postpartum depression.Furthermore, 40% of family members fail to recognize postpartum depression, and 13% even attribute it to the mother's \"over-sensitivity\" or ridicule her. The consultation rate for postpartum depression remains under 30%\u0026nbsp;\u003cstrong\u003e13\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this context, social support is regarded as one of the most crucial emotional coping mechanisms and a vital resource for effectively managing the challenges and stressors of the puerperium period\u0026nbsp;\u003cstrong\u003e14\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eSocial support refers to the perceived protection, care, and assistance an individual receives from their social or familial network. Through active involvement and commitment, individuals experience a sense of being valued, cared for, and connected to others. Zhu (2022) proposed the social support relationship enhancement model, which posits that social support within the context of close relationships promotes health and well-being\u0026nbsp;\u003cstrong\u003e15\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003ePerceived social support, hope, and resilience may function as positive factors in combating depression and preventing puerperal infections, aiding mothers in coping with emotional distress and illness, and ultimately enhancing their quality of life\u0026nbsp;\u003cstrong\u003e16\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough theoretical foundations proposed by researchers such as Bužgová, Hájková \u0026amp; Jasioková (2009), Galiano et al. (2019), Sun (2022), and Zhu (2022) support this concept, no previous studies have specifically investigated the relationships between postpartum social support, postpartum depression, and postpartum quality of life, particularly among primiparas in developing countries. Consequently, this study aims to examine the following four hypotheses:\u003c/p\u003e\n\u003cp\u003e1. A positive correlation exists between postpartum social support, postpartum depression, and quality of life during the puerperium among primiparas.\u003c/p\u003e\n\u003cp\u003e2. The level of postpartum social support correlates with the degree of postpartum depression.\u003c/p\u003e\n\u003cp\u003e3. The level of postpartum social support is associated with the level of postpartum quality of life.\u003c/p\u003e\n\u003cp\u003e4. The degree of postpartum depression correlates with the level of postpartum quality of life.\u003c/p\u003e\n\u003cp\u003eThis study aims to explore the relationship between postpartum social support, postpartum depression, and\u003cu\u003e\u0026nbsp;postpartum quality of life,\u003c/u\u003e with primiparas serving as the primary example (Figure 1).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a cross-sectional survey design, characterized by a descriptive correlational approach. A total of 328 primiparas, who delivered at five tertiary hospitals between September 2023 and February 2024, were enrolled as participants. The hospitals involved in the study were Zhejiang Provincial Maternal and Child Health Hospital, Hangzhou Women's and Children's Hospital, the First Affiliated Hospital of Wenzhou Medical University, the Second Affiliated Hospital of Harbin Medical University, and Harbin Maternal and Child Health Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInclusion criteria were as follows:\u003c/p\u003e\n\u003cp\u003e1. First-time mothers who gave birth to a full-term infant.\u003c/p\u003e\n\u003cp\u003e2. A gestational age ranging from 37 to 42 weeks.\u003c/p\u003e\n\u003cp\u003e3. An infant birth weight of at least 2.5 kg.\u003c/p\u003e\n\u003cp\u003e4. The newborn was free from deformities or diseases.\u003c/p\u003e\n\u003cp\u003e5. Mothers possessed basic literacy skills and were able to complete the questionnaire independently.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria were as follows:\u003c/p\u003e\n\u003cp\u003e1. Preterm births (gestational age between 28 and 37 weeks) or post-term births (≥42 weeks).\u003c/p\u003e\n\u003cp\u003e2. Infant birth weight less than 2.5 kg.\u003c/p\u003e\n\u003cp\u003e3. Newborns with congenital abnormalities or mothers experiencing severe obstetric complications.\u003c/p\u003e\n\u003cp\u003e4. Mothers who lacked basic literacy skills and were unable to complete the questionnaire independently.\u003c/p\u003e\n\u003cp\u003eBefore the study commenced, the research protocol was submitted to and approved by the Ethics Committee of the Zhejiang Zhoushan Tourism and Health College, Zhejiang Province (Approval Number: [2023-16]). All participants voluntarily engaged in the survey after receiving comprehensive information about the purpose and content of the study and signing informed consent forms. Throughout the study, the voluntariness, privacy, data confidentiality, right to withdraw, and anonymity of the participants were rigorously protected. This research adhered to the ethical guidelines outlined in the Declaration of Helsinki (2013 revision), as endorsed by the World Medical Association (WMA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculation and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study employed survey instruments encompassing four dimensions of the Postpartum Social Support Scale, three dimensions of the Edinburgh Postnatal Depression Scale (EPDS), and four dimensions, along with two overall quality-of-life items from the WHOQOL-BREF, resulting in a total of 13 variables. Following Mueller's sample size estimation method, the required sample size was determined to be 10 to 15 times the number of variables, with an additional 5%–10% included to compensate for potential participant attrition. The final sample size was established to be no fewer than 296 participants.\u003c/p\u003e\n\u003cp\u003eA pilot study was performed prior to data collection to assess the feasibility, clarity, and applicability of the research instruments. The pilot study included 50 primiparas who were admitted to five tertiary hospitals between September 2023 and February 2024, though they were excluded from the final sample. The pilot study results indicated that the research instruments were accurate, clear, and appropriate for the target population, with no revisions necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTool 1: Self-Developed Questionnaire for Collecting Demographic and Obstetric Data from Primiparas\u003c/p\u003e\n\u003cp\u003eThis instrument was employed to gather comprehensive demographic and obstetric information pertaining to the participants. The validity of this instrument was evaluated by five experts specializing in nursing education, obstetric nursing, community nursing, and health education. Reliability was assessed using Cronbach’s alpha coefficient, which demonstrated strong internal consistency. A detailed description of the content is presented in Table 1.\u003c/p\u003e\n\u003cp\u003eTool 2: Postpartum Social Support Questionnaire\u003c/p\u003e\n\u003cp\u003eThis questionnaire was developed by Lu et al. (2018) and consists of four dimensions, encompassing a total of 20 items. Each item is rated on a 4-point Likert scale (ranging from 0 to 3). Higher scores in each dimension reflect enhanced postpartum social support within that specific category, while higher total scores correspond to greater overall postpartum social support. The questionnaire has shown robust validity and reliability, with a content validity index (CVI) of 0.90 and a Cronbach’s alpha coefficient of 0.89 [16].\u003c/p\u003e\n\u003cp\u003eTool 3: Edinburgh Postnatal Depression Scale (EPDS)\u003c/p\u003e\n\u003cp\u003eDeveloped by Professor John Cox at the University of Edinburgh in 1987, the EPDS has since become widely used for postpartum depression screening in China, starting from the 1990s. Comprising 10 items scored on a 4-point scale, higher total scores on the EPDS correspond to more severe postpartum depression. According to research by Huang (2020), the EPDS exhibits strong validity and reliability for Chinese mothers, with a Cronbach’s alpha coefficient of 0.87 17. Studies by Lee (1998) and Li et al. (2016) suggest a cutoff score of ≥13 for screening postpartum depression in China [18,19]. Consequently, a cutoff score of ≥13 was applied to identify postpartum depression in this study.\u003c/p\u003e\n\u003cp\u003eTool 4: WHO Quality of Life-BREF (WHOQOL-BREF)\u003c/p\u003e\n\u003cp\u003eThe WHOQOL-BREF is a short-form quality-of-life assessment tool developed by the World Health Organization, derived from the WHOQOL-100. It comprises 26 items scored on a 5-point scale, with higher scores denoting a better quality of life. The WHOQOL-BREF has demonstrated strong reliability and validity [20, 21].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData entry was conducted using EpiData 4.0 software to construct a comprehensive database. Statistical analyses were carried out using SPSS software (version 26.0; IBM SPSS Inc., Chicago, USA). Statistical methods included descriptive statistics, analysis of variance (ANOVA), and Pearson correlation coefficients. Measurement data are presented as mean ± standard deviation (x̄ ± s), while categorical data are expressed as frequency and percentage (%). The Kolmogorov-Smirnov test was employed to evaluate the normality of the data distribution. A P-value of \u0026lt;0.05 was deemed statistically significant. The detailed research process is presented in Figure 2.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 400 questionnaires were distributed across the hospital wards during the survey period, with 392 valid responses collected, yielding an effective recovery rate of 98%. In the follow-up survey, 64 participants were lost to follow-up, and a total of 328 valid responses were collected at 6 weeks postpartum. Consequently, this study included 328 primiparas who had completed both rounds of questionnaires, thus serving as the final research subjects. Detailed demographic information is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of Primiparas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (32.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (25.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56 (17.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of Residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural Areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141 (42.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban Areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e187 (57.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior High School or Lower\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (14.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (12.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVocational College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109 (33.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (26.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster's Degree or Higher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (12.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdministrative Personnel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94 (28.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManual Worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (7.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare Professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (11.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81 (24.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMonthly Per Capita Household Income (USD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71 (21.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e400\u0026ndash;700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105 (32.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e701\u0026ndash;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (26.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1001\u0026ndash;1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (9.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOnly Child (No Siblings)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133 (40.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195 (59.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTemperament\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuroticism-Stability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185 (56.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntroversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89 (27.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtraversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eFamilial Relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e254 (77.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (16.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSuboptimal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMode of Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaginal Birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124 (37.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCesarean Birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204 (62.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the statistical analysis indicate that the differences in scores across various domains, as well as the overall quality of life score, between postpartum Day 7 and Week 6, are statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Quality of Life Scores at Different Stages of the Postpartum Period\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhysical Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychological Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSocial Domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEnvironmental Domain\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 Days Postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 Weeks Postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13. 15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the statistical analysis indicate that the differences in the scores of each dimension of postpartum social support, as well as the overall postpartum social support score, between Day 7 and Week 6 postpartum, are statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The results of Pearson correlation analysis show that the scores of each dimension, as well as the total score of postpartum social support, are positively correlated with the scores of each dimension and the overall quality of life score during the postpartum period (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Postpartum Social Support Scores at Different Stages of the Puerperium in Primiparas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotional Support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaterial Support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInformational Support\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAppraisal Support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 Days Postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.35\u0026thinsp;\u0026plusmn;\u0026thinsp;7.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 Weeks Postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.29\u0026thinsp;\u0026plusmn;\u0026thinsp;9.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.08\u0026thinsp;\u0026plusmn;\u0026thinsp;3.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the study show that a cutoff value of 13 was applied to screen for postpartum depression. The incidence of postpartum depression was calculated to be 16.8% at Day 7 and 31.5% at Week 6 postpartum for primiparas. Additionally, a t-test was conducted to analyze the postpartum depression scores across each dimension, as well as the total postpartum depression score, at Week 6 postpartum. The differences were found to be statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Results from Pearson correlation analysis indicated that the total postpartum depression score was negatively correlated with the scores of the four dimensions of puerperium quality of life, as well as the overall quality of life score (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Postpartum Depression Scores at Different Stages of the Puerperium in Primiparas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotional Deprivation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7 Days Postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.74\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 Weeks Postpartum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.320\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults from Pearson correlation analysis indicate that the total postpartum depression score is negatively correlated with the scores of each dimension of postpartum social support, as well as each dimension of puerperal quality of life (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The scores of each dimension of postpartum social support are positively correlated with the scores of each corresponding dimension of puerperal quality of life (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The scores of the four dimensions of postpartum social support are positively correlated with one another, and similarly, the scores of the four dimensions of puerperal quality of life are positively correlated with each other. All these correlations are statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Detailed scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Quality of Life Scores at Different Stages of the Puerperium\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmotional Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.688\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformational Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.465\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.545\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppraisal Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.560\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.578\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.560\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.310\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.308\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.249\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.309\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.447\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.364\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.208\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.419\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.647\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.388\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.372\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.299\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.393\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.647\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.606\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironmental Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.427\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.378\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.372\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.416\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.479\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.766\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.600\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostpartum Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.386\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.349\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.243\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.308\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.366\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-0.418\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.308\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.368\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e**:\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDuring the postpartum period, substantial physiological changes occur in the maternal body, particularly within the reproductive system. Although many women do not have pre-existing conditions prior to childbirth, postpartum women are generally physically weaker than other women and require at least six weeks of specialized care and health maintenance to facilitate both physical and psychological recovery 22. Furthermore, primiparas are more likely to experience delayed recovery during the puerperium and postpartum depression due to their lack of prior experience with pregnancy and childbirth. Moreover, the postpartum period may affect their social interactions, work, and financial stability, potentially leading to symptoms of depression and anxiety, all of which negatively impact postpartum quality of life 23. Therefore, social support is considered a crucial intervention strategy that aids first-time mothers in navigating the postpartum period and enhancing their overall quality of life.\u003c/p\u003e \u003cp\u003eFirstly, the results of this study indicate that the quality of life of first-time mothers gradually declined as the postpartum period progressed (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This decline in quality of life may be associated with the two specific time points chosen for this study. In the first seven days postpartum, the joy and happiness of becoming a mother often outweigh the negative emotions associated with physical, psychological, and social challenges. However, by the sixth week postpartum, as first-time mothers undergo physical and psychological recovery, transition into their maternal roles, care for their newborns, and cope with psychological pressures from family and society, they may experience health challenges. These findings align with those of Hou (2012), Symon (2003), Bai (2014), and Chen (2016), and demonstrate that first-time mothers' self-assessment of their quality of life significantly worsens by six weeks postpartum compared to the early postpartum period and is lower than that of women of childbearing age in general [\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Therefore, as the postpartum period progresses, the quality of life of first-time mothers gradually declines, highlighting the need for enhanced postpartum psychological counseling and professional nursing support, particularly from their partners, which can help mothers cope with life changes and improve their quality of life.\u003c/p\u003e \u003cp\u003eSecond, the study results show that the total score for social support during the postpartum period was relatively high (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), and postpartum social support was positively correlated with overall quality of life as well as the four quality-of-life dimensions. The correlation coefficient with overall quality of life was as high as 0.506, suggesting that the social support received by first-time mothers during the postpartum period is strongly associated with their quality of life. This finding aligns with studies by Lu Hong et al. (2001), Wu Liping et al. (2012), Zang Shaomin et al. (2011), and Mannella, P. (2013), where emotional support ranked the highest and informational support the lowest [\u003cspan additionalcitationids=\"CR29 CR30\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. These studies consistently found that the majority of first-time mothers perceive high levels of social support, and a robust social support network plays a crucial role in enhancing psychological well-being. However, Bregman, M. (1997) observed that the types of social support received by first-time mothers during the postpartum period may not always correspond to their most immediate or anticipated needs, which can potentially contribute to postpartum depression 32. These studies further corroborate that social support serves as a significant protective factor for first-time mothers. These findings can be explained from three perspectives: first, the majority of study participants reported strong family relationships (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with their partners providing essential physical and emotional support throughout the puerperium, which helped alleviate postpartum stress. Second, the majority of first-time mothers exhibited extroverted personalities, were younger, and had higher educational levels (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which facilitated the formation of close family and support networks, enabling family members and friends to offer care and support. These results suggest that healthcare providers should assess the level of social support received by first-time mothers and guide family members in providing the types of social support most needed, particularly emotional and appraisal support, to enhance the mothers' overall quality of life during the puerperium.\u003c/p\u003e \u003cp\u003eThird, with respect to postpartum depression, the results of this study indicate that the incidence of postpartum depression among first-time mothers was 16.8% at seven days and 31.5% at six weeks postpartum (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), both of which are higher than the average incidence rates observed in domestic (14.7%) and international studies (13%). The total postpartum depression score was negatively correlated with both overall quality of life and all four quality-of-life dimensions, with a correlation coefficient of -0.429. This suggests that the severity of postpartum depression is strongly associated with quality of life during the puerperium, indicating that more severe postpartum depression symptoms are linked to lower quality of life. These findings are consistent with those of \"\u003cem\u003ePostpartum Care of the Mother and Newborn: A Practical Guide\u003c/em\u003e\" (1999), Knoester and Li (2021), and Chen (2017), all of which also demonstrate an increasing trend in postpartum depression symptoms over time [\u003cspan additionalcitationids=\"CR34\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In contrast, \u0026Ccedil;ankaya (2020) found that social support for first-time mothers significantly decreased at six weeks postpartum compared to seven days and identified a significant negative correlation between social support and postpartum depression 36. Furthermore, a study by Webster et al. (2011) reported that first-time mothers with postpartum depression frequently experienced psychological distress and a profound loss of self-confidence 37. The relatively high incidence of postpartum depression in this study may be attributed to the fact that a significant proportion of the participants underwent cesarean sections (62.2%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), as the mode of delivery is a key influencing factor for postpartum depression. Postpartum depression not only negatively impacts the mothers but can also lead to emotional, behavioral, and cognitive impairments in newborns. In severe cases, it can even result in suicidal tendencies. The more severe the postpartum depression symptoms, the greater the decline in the health-related quality of life for the mother. The more severe the postpartum depression symptoms, the greater the decline in the health-related quality of life for the mother. Timely attention to their psychological well-being, along with continuous social support when necessary, should be provided. Health education for mothers and their families should also be enhanced to raise awareness of and concern for postpartum depression, encouraging family and friends to provide more care and companionship to support mothers in navigating the postpartum period.\u003c/p\u003e \u003cp\u003eFourth, regarding the relationship between postpartum social support, postpartum depression, and quality of life during the puerperium, the findings of this study reveal that the total postpartum depression score was negatively correlated with scores across all dimensions of both postpartum social support and puerperium quality of life, while the scores for social support and quality of life were positively correlated (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The scores across the four dimensions of social support were positively correlated with each other, as were the four dimensions of quality of life, with statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). These findings are consistent with those of studies by Desta et al. (2021), Zhou (2017), Mckee (2001), and Li (2014), all of which demonstrate both direct and indirect effects of postpartum social support on the quality of life during the puerperium [\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Postpartum depression functions as a mediating variable, modulating the relationship between social support and quality of life. Social support plays a protective role in improving quality of life by mitigating the occurrence of postpartum depression. Therefore, healthcare providers, particularly nursing staff, should prioritize the assessment of social support during hospitalization 42. For mothers who lack social support, it is essential to guide family members, particularly spouses, in providing the appropriate types of support, including emotional and appraisal support, and to offer psychological counseling and educational interventions. Such interventions can effectively alleviate symptoms of postpartum depression and improve overall quality of life during the puerperium.\u003c/p\u003e \u003cp\u003eThis study offers valuable insights for obstetric and gynecological nursing professionals and researchers into the psychosocial challenges encountered by first-time mothers during the puerperium. By recognizing these challenges, more targeted interventions can be designed to enhance emotional resilience and significantly improve maternal quality of life and overall health. This research not only provides important references for optimizing puerperium care but also emphasizes the necessity of offering psychological support in addition to physical recovery for postpartum women.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study employs a cross-sectional design, which inherently restricts the ability to infer causal relationships. To mitigate this limitation, future longitudinal studies should be conducted, utilizing standardized instruments to yield more comprehensive insights. Furthermore, this study relied on questionnaire surveys for data collection, which, while effective in gathering relevant information, presents challenges in exploring the intricate relationships between social support, postpartum depression, and quality of life in depth. Therefore, further research is necessary to deepen the understanding of the interactions and underlying connections among these variables.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePostpartum social support and postpartum depression are critical determinants influencing the quality of life during the puerperium. Accordingly, postpartum care should prioritize the enhancement of the social support system to mitigate the risk of postpartum depression and improve maternal quality of life during the puerperium. This initiative will assist obstetric and gynecological care providers in more effectively understanding the needs of postpartum women, thereby enabling them to deliver more efficient, compassionate, and patient-centered care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Informed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to initiating the study, the research protocol was submitted for review and subsequently approved by the Ethics Committee of Zhejiang Zhoushan Tourism and Health College(Approval No: [2023-16]). All participants voluntarily consented to participate in the survey after being thoroughly informed about the study\u0026apos;s objectives and scope, and they subsequently signed an informed consent form. Throughout the study, participants\u0026apos; voluntariness, privacy protection, data confidentiality, the right to withdraw from the study, and anonymity were rigorously maintained. This study strictly adhered to the ethical standards outlined in the revised Declaration of Helsinki (2013), as promulgated by the World Medical Association (WMA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Supporting Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed throughout this study are included in the published article and its supplementary materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflicts of interest related to the research or the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Zhejiang Provincial Higher Vocational Education \u0026quot;14th Five-Year Plan\u0026quot; Second Batch Teaching Reform Project (Project No: JG20240478).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHeyu Li, Yang Lu, Yang Tian, and Danna Wang contributed equally to this work. Heyu Li and Yang Tian designed the study and conducted the experiments, while Yang Lu collected the data and Danna Wang analyzed the data. Heyu Li, Yang Lu, and Yang Tian prepared the manuscript, and all authors reviewed and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to express their gratitude to the research institution for their assistance and support throughout the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eZhao CY, Cui YJ, Huang JX, Xie Q, Li Y, Zuo PJ. Research progress on risk factors related to perinatal depression. Chin J Maternal Child Health. 2024;3:75-80. doi: 10.19757/j.cnki.issn1674-7763.2024.03.013.\u003c/li\u003e\n \u003cli\u003eBužgov\u0026aacute; R, H\u0026aacute;jkov\u0026aacute; M, Jasiokov\u0026aacute; A. 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Chin Health Stand Manag. 2015;27:260-261.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Zhejiang Zhoushan Tourism and Health College, Zhoushan, China","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":"Primiparas, Postpartum Social Support, Postpartum Depression, Quality of Life during the Puerperium","lastPublishedDoi":"10.21203/rs.3.rs-5918013/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5918013/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study aims to investigate the interrelationship between postpartum social support, postpartum depression, and quality of life during the puerperium, with a specific focus on primiparas.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional survey employing a descriptive correlational design was conducted for this study. A total of 328 primiparas participated in the survey, which utilized a self-developed demographic questionnaire tailored to primiparas, the Postpartum Social Support Scale, the Edinburgh Postnatal Depression Scale (EPDS), and the Brief Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF).\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe total quality of life score for primiparas on the 7th day postpartum was 56.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27, whereas the score at 6 weeks postpartum was 53.19\u0026thinsp;\u0026plusmn;\u0026thinsp;7.95. Statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were observed in the scores across various domains and in the total scores between these two time points. The total score for postpartum depression exhibited a negative correlation with postpartum social support and quality of life across all domains (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, the scores for postpartum social support across various dimensions demonstrated a positive correlation with quality of life scores in all domains during the puerperium (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePostpartum social support and postpartum depression are critical determinants of postpartum quality of life. Enhancing social support systems in postpartum care can mitigate the risk of postpartum depression and promote quality of life during the puerperium.\u003c/p\u003e","manuscriptTitle":"The Relationship Between Postpartum Social Support, Postpartum Depression, and Quality of Lifeduring the Puerperium A Study of Primiparas","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 06:27:07","doi":"10.21203/rs.3.rs-5918013/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":"cd7561b8-b754-4683-bc5f-a0104739f97b","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-29T06:27:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-29 06:27:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5918013","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5918013","identity":"rs-5918013","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}