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Open Access 01-12-2021 | Anxiety | Research

Resilience mediates the effect of self-efficacy on symptoms of prenatal anxiety among pregnant women: a nationwide smartphone cross-sectional study in China

Authors: Ruqing Ma, Fengzhi Yang, Lijuan Zhang, Kristin K. Sznajder, Changqing Zou, Yajing Jia, Can Cui, Weiyu Zhang, Wenzhu Zhang, Ning Zou, Xiaoshi Yang

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Prenatal anxiety is one of the most prevalent mental disorders during pregnancy. This study assessed the prevalence of prenatal anxiety and examined whether resilience could play the mediating role in the association between self-efficacy and symptoms of prenatal anxiety among pregnant women in China.

Methods

A nationwide smartphone cross-sectional study was carried out in three cities (Shenyang of Liaoning Province, Zhengzhou of Henan Province and Chongqing Municipality) in China from July 2018 to July 2019. The questionnaire consisted of questions on demographic characteristics, the Generalized Anxiety Disorder Scale (GAD-7), the Chinese version of General Self-efficacy Scale (GSES), and the 14-item Wagnild and Young Resilience Scale (RS-14). A total of 665 pregnant women were recruited in this study. A hierarchical multiple regression model was employed to explore the associate factors and mediators of symptoms of prenatal anxiety. A structural equation model was employed to test the hypothesis that resilience mediates the association between self-efficacy and symptoms of prenatal anxiety.

Results

The prevalence of symptoms of prenatal anxiety was 36.4% in this study. Self-efficacy was negatively correlated with symptoms of prenatal anxiety (r = -0.366, P < 0.01). Resilience had a significant positive correlation with self-efficacy (r = 0.612, P < 0.01) and had a negative correlation with symptoms of prenatal anxiety (r = -0.427, P < 0.01). The hierarchical multiple regression model indicated that self-efficacy and resilience were the main factors associated with symptoms of prenatal anxiety and contributed to 11.9% and 6.3% to the variance of symptoms of prenatal anxiety, respectively. Resilience served as a mediator between self-efficacy and symptoms of prenatal anxiety (a*b = -0.198, Bias-corrected and accelerated bootstrap 95% Confidence interval: -0.270, -0.126).

Conclusions

Self-efficacy was a negative predictor of symptoms of prenatal anxiety among pregnant women. Moreover, resilience mediated the relation between self-efficacy and symptoms of prenatal anxiety among pregnant women in China. It was observed in this study that psychological interventions might be beneficial for pregnant women to relieve symptoms of prenatal anxiety through improved self-efficacy and resilience.

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Sajjan P, Pattanshetti JI, Padmini C, Nagathan VM, Sajjanar M, Siddiqui T. Oral Health Related Awareness and Practices among Pregnant Women in Bagalkot District, Karnataka. India Journal of international oral health. 2015;7:1–5. https://doi.org/10.4103/jiaomr.JIAOMR_246_15.CrossRefPubMed

Teixeira C, Figueiredo B, Conde A, Pacheco A, Costa R. Anxiety and depression during pregnancy in women and men. J Affect Disord. 2009;119:142–8. https://doi.org/10.1016/j.jad.2009.03.005.CrossRefPubMed

Alqahtani AH, Al Khedair K, Al-Jeheiman R, Al-Turki HA, Al Qahtani NH. Anxiety and depression during pregnancy in women attending clinics in a University Hospital in Eastern province of Saudi Arabia: prevalence and associated factors. Int J Women’s Health. 2018;10:101–8. https://doi.org/10.2147/IJWH.S153273.

Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. The Lancet. 2014;384:1775–88. https://doi.org/10.1016/S0140-6736(14)61276-9.CrossRef

Li CX, Sun XH, Li Q, Sun Q, Wu BB, Duan DY. Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis. Medicine. 2020;99:e20947–e20947. https://doi.org/10.1097/MD.0000000000020947.CrossRefPubMed

Can GG, Okanli A. The Effects of Cognitive-Behavioral Model-Based Intervention on Depression, Anxiety, and Self-Efficacy in Alcohol Use Disorder. Clin Nurs Res. 2019;28:52–78. https://doi.org/10.1177/1054773817722688.CrossRef

Tang X, Lu Z, Hu DH, Zhong XN. Influencing factors for prenatal Stress, anxiety and depression in early pregnancy among women in Chongqing. China Journal of affective disorders. 2019;253:292–302. https://doi.org/10.1016/j.jad.2019.05.003.CrossRefPubMed

Hou QZ, Li SS, Jiang C, Huang YL, Huang LL, Ye J, et al. The associations between maternal lifestyles and antenatal stress and anxiety in Chinese pregnant women: A cross-sectional study. Sci Rep. 2018;8:765–75. https://doi.org/10.1038/s41598-018-28974-x.CrossRef

Wang W, Yin XH, Wang XX, Ge J. Analysis of pregnant women’s psychological stress and influencing factors. Chinese Journal of Woman and Child Health Research. 2017;28:252–5. https://doi.org/10.3969/j.issn.1673-5293.2017.03.011.

10.

van Heyningen T, Honikman S, Myer L, Onah MN, Field S, Tomlinson M. Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Arch Womens Ment Health. 2017;20:765–75. https://doi.org/10.1007/s00737-017-0768-z.CrossRefPubMedPubMedCentral

11.

Kirupamani V, Guy DE, Vladan S. Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis. J Affect Disord. 2019;255:27–40. https://doi.org/10.1016/j.jad.2019.05.016.CrossRef

12.

Faruk U, Eda Y, Semra A, Melike GB, Kazim G. Prevalence of mood and anxiety disorders during pregnancy: A case-control study with a large sample size. Psychiatry Res. 2019;272:316–8. https://doi.org/10.1016/j.psychres.2018.12.129.CrossRef

13.

Dennis CL, Falah-Hasani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210:315–23. https://doi.org/10.1192/bjp.bp.116.187179.CrossRefPubMed

14.

Waqas A, Raza N, Lodhi HW, Muhammad Z, Jamal M, Rehman A. Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator? PLoS ONE. 2015;10: e0116510. https://doi.org/10.1371/journal.pone.0116510.CrossRefPubMed

15.

Khorsandi M, Ghofranipour F, Faghihzadeh S, Hidarnia A, Bagheban AA, Aguilar-Vafaie ME. Iranian version of childbirth self-efficacy inventory. J Clin Nurs. 2008;17:2846–55. https://doi.org/10.1111/j.1365-2702.2008.02385.x.CrossRefPubMed

16.

Fan F, Zou Y, Tian H, Zhang Y, Zhang J, Ma X, et al. Effects of maternal anxiety and depression during pregnancy in Chinese women on children’s heart rate and blood pressure response to stress. J Hum Hypertens. 2016;30(3):171–6. https://doi.org/10.1038/jhh.2015.64.

17.

Peltola MJ, Mäkelä T, Paavonen EJ, Vierikko E, Saarenpää-Heikkilä O, Paunio T, et al. Respiratory sinus arrhythmia moderates the impact of maternal prenatal anxiety on infant negative affectivity. Dev Psychobiol. 2017;59(2):209–16. https://doi.org/10.1002/dev.21483.CrossRefPubMed

18.

Ma XM, Wang Y, Hu H, Tao XGG, Zhang YH, Shi HJ. The impact of resilience on prenatal anxiety and depression among pregnant women in Shanghai. J Affect Disord. 2019;250:57–64. https://doi.org/10.1016/j.jad.2019.02.058.CrossRefPubMed

19.

Pınar S, Hatice B. Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment. Midwifery. 2016;34:166–72. https://doi.org/10.1016/j.midw.2015.11.016.CrossRef

20.

Shorey S, Chan SW, Chong YS, He HG. Predictors of Maternal Parental Self- Efficacy Among Primiparas in the Early Postnatal Period. West J Nurs Res. 2015;37:1604–22. https://doi.org/10.1177/0193945914537724.CrossRefPubMed

21.

Colleen JH. Social Foundations of Thought and Action: A Social Cognitive Theory. Behav Chang. 1988. https://doi.org/10.1017/S0813483900008238.CrossRef

22.

Khresheh RM, Ahmad NM. Breastfeeding self-efficacy among pregnant women in Saudi Arabia. Saudi Med J. 2018;39(11):1116–22. https://doi.org/10.15537/smj.2018.11.23437.CrossRefPubMedPubMedCentral

23.

Albert B. Self-efficacy conception of anxiety. Anxiety Stress Coping. 1988;1(2):77–98. https://doi.org/10.1080/10615808808248222.CrossRef

24.

Sónia B, Denisa M, Cláudia CD, Tiago MP, Cindy-Lee D, Bárbara F. The Breastfeeding Self-Efficacy Scale-Short Form: psychometric characteristics in Portuguese pregnant women. Midwifery. 2018;66:49–55. https://doi.org/10.1016/j.midw.2018.07.014.CrossRef

25.

Anca G, Anita C, Harry P. Enhancing self-efficacy and exercise readiness in pregnant women. Psychol Sport Exerc. 2012;13(5):550–7. https://doi.org/10.1016/j.psychsport.2012.03.001.CrossRef

26.

Cramp AG, Bray SR. A prospective examination of exercise and barrier self-efficacy to engage in leisure-time physical activity during pregnancy. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2009;37(3):325–34. https://doi.org/10.1007/s12160-009-9102-y.

27.

Gagnon AJ, Stewart DE. Resilience in international migrant women following violence associated with pregnancy. Arch Womens Ment Health. 2014;17(4):303–10. https://doi.org/10.1007/s00737-013-0392-5.CrossRefPubMed

28.

Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59(1):20–8. https://doi.org/10.1037/0003-066X.59.1.20.CrossRefPubMed

29.

Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18(2):76–82. https://doi.org/10.1002/da.10113.CrossRefPubMed

30.

Zeng W, Chen YL, Qian XF, Liu GH. The Mediating Role of Psychological Resilience for Mindfulness and Anxiety and Depression among Women in the Pregnancy Termination for Fetal Abnormality. Nurs. Chinese People's Liberation. Army. 2017;34(20):25–28. (in Chinese). doi: https://doi.org/10.3969/j.issn.1008-9993.2017.20.006.

31.

Shi M, Liu L, Wang ZY, Wang L. The mediating role of resilience in the relationship between big five personality and anxiety among Chinese medical students: a cross-sectional study. PloS one. 2015;10(3). doi: https://doi.org/10.1016/j.sleep.2017.08.023.

32.

Judith EZ, Wieke de V, Mimmi T, Hasse K, J Marieke B, Hans MK, et al. Longitudinal associations between sleep and anxiety during pregnancy, and the moderating effect of resilience, using parallel process latent growth curve models. Sleep Med. 2017;40:63–68. doi: https://doi.org/10.1016/j.sleep.2017.08.023.

33.

Bussieres EL, Tarabulsy GM, Pearson J, Tessier R, Forest JC, Giguère Y. Maternal prenatal stress and infant birth weight and gestational age: A meta-analysis of prospective studies. Dev Rev. 2015;36:179–99. https://doi.org/10.1016/j.dr.2015.04.001.CrossRef

34.

Palagini L, Gemignani A, Banti S, Manconi M, Mauri M, Riemann D. Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Sleep Med. 2014;15:853–9. https://doi.org/10.1016/j.sleep.2014.02.013.CrossRefPubMed

35.

이미란, Lee H,탁정화. The mediating effect of resilience on the relationship between the self-efficacy and grit of pre-service early childhood teachers. The Journal of Learner-Centered Curriculum and Instruction. 2017;17(2):491–512. (in Korean). doi: https://doi.org/10.22251/jlcci.2017.17.2.491.

36.

Yang CY, Zhou Y, Cao QL, Xia M, An J. The Relationship Between Self-Control and Self-Efficacy Among Patients With Substance Use Disorders: Resilience and Self-Esteem as Mediators. Front Psych. 2019;10:388. https://doi.org/10.3389/fpsyt.2019.00388.CrossRef

37.

Lin Z, Pan YQ. A Study on the Intermediate Effect of Resilience of Patients in the Intensive Care Unit on General Self-efficacy and Anxiety. Chinese Rural Health Service Administration. 2016;36:473–5 (in Chinese).

38.

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092.CrossRefPubMed

39.

Plummer F, Manea L, Trepel D, McMillan D. Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry. 2016;39:24–31. https://doi.org/10.1016/j.genhosppsych.2015.11.005.CrossRefPubMed

40.

Hu Q, Wan Y, Su L, Li H, Jin Y, Li T, et al. Prevalence of anxiety disorder among mainland residents in China: a meta-analysis (in Chinese). Chin J Psychiatry. 2013;46(4):204–11.

41.

Schwarzer R. Measurement of Perceived Self-efficacy. Psychometric Scales for Cross-cultural Research. Berlin: Freie Universitat; 1993.

42.

Cheung SK, Sun SY. Assessment of optimistic self-beliefs: further validation of the Chinese version of the General Self-Efficacy Scale. Psychol Rep. 1999;85(3 Pt 2):1221–4. https://doi.org/10.2466/pr0.1999.85.3f.1221.CrossRefPubMed

43.

Tian J, Hong JS. Validation of the Chinese version of the resilience scale and its cutoff score for detecting low resilience in Chinese cancer patients. Support Care Cancer. 2013;21(5):1497–502. https://doi.org/10.1007/s00520-012-1699-x.CrossRefPubMed

44.

Hayes AF, Rockwood NJ. Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behav Res Ther. 2017;98:39–57. https://doi.org/10.1016/j.brat.2016.11.001 Epub 2016 Nov 5 PMID: 27865431.CrossRefPubMed

45.

Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology. 1982;13,:290e312.

46.

Roomruangwong C, Epperson CN. Perinatal depression in Asian women: prevalence, associated factors, and cultural aspects. Asian Biomed. 2011;5(2):179–93. https://doi.org/10.5372/1905-7415.0502.024.CrossRef

47.

Kleinman AM. Depression, somatization and the “new cross-cultural psychiatry.” Soc Sci Med. 1977;11(1):3–10. https://doi.org/10.1016/0037-7856(77)90138-x.

48.

Chang SR, Kenney NJ, Chao YMY. Transformation in self-identity amongst Taiwanese women in late pregnancy: a qualitative study. Int J Nurs Stud. 2010;47(1):60–6. https://doi.org/10.1016/j.ijnurstu.2009.06.007.CrossRefPubMed

49.

Halbreich U, Karkun S. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. J Affect Disord. 2006;91(2–3):97–111. https://doi.org/10.1016/j.jad.2005.12.051.CrossRefPubMed

50.

Ankumah NE, Sibai BM. Chronic Hypertension in Pregnancy: Diagnosis, Management, and Outcomes. Clin Obstet Gynecol. 2017;60(1):206–14. https://doi.org/10.1097/GRF.0000000000000255.CrossRefPubMed

51.

Merlinda AT, Hülya O, Cindy-Lee D. Translation and psychometric assessment of the Breast-feeding Self-Efficacy Scale—Short Form among pregnant and postnatal women in Turkey. Midwifery. 2010;26(1):101–8. https://doi.org/10.1016/j.midw.2008.04.002.CrossRef

52.

Liu N, Liu SH, Yu N, Peng YH, Wen YM, Tang J, et al. Correlations among Psychological Resilience, Self-Efficacy, and Negative Emotion in Acute Myocardial Infarction Patients after Percutaneous Coronary Intervention. Front Psych. 2018;23(9):1. https://doi.org/10.3389/fpsyt.2018.00001.CrossRef

53.

Zhang LJ, Yang XS, Zhao JF, Zhang WY, Cui C, Yang FZ, et al. Prevalence of Prenatal Depression Among Pregnant Women and the Importance of Resilience: A MultiSite Questionnaire-Based Survey in Mainland China. Front Psychiatry. 2020;11:374. https://doi.org/10.3389/fpsyt.2020.00374.CrossRefPubMed

54.

María ÁG, Rafael AC, Borja R, Raquel GP, Isabel PR. Resilience as a protective factor in pregnancy and puerperium: Its relationship with the psychological state, and with Hair Cortisol Concentrations. Midwifery. 2019;75:138–45. https://doi.org/10.1016/j.midw.2019.05.006.CrossRef

55.

Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Moore STA, et al. Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety. Journal of obstetric, gynecologic, and neonatal nursing: JOGNN. 2017;46:272–81. https://doi.org/10.1016/j.jogn.2017.01.001.CrossRefPubMed

56.

Rallis S, Skouteris H, McCabe M, Milgrom J. A prospective examination of depression, anxiety and stress throughout pregnancy. Women and birth: journal of the Australian College of Midwives. 2014;27(4):e36-42. https://doi.org/10.1016/j.wombi.2014.08.002.CrossRef

57.

Surkan PJ, Hamdani SU, Huma Zill-E, Nazir H, Atif N, Rowther AA, et al. Cognitive-behavioral therapy-based intervention to treat symptoms of anxiety in pregnancy in a prenatal clinic using non-specialist providers in Pakistan: design of a randomised trial. BMJ Open. 2020;10(4):e037590. doi: https://doi.org/10.1136/bmjopen-2020-037590.

58.

Jung-Ah M, Chang-Uk L, Jeong-Ho C. Resilience moderates the risk of depression and anxiety symptoms on suicidal ideation in patients with depression and/or anxiety disorders. Compr Psychiatry. 2015;56:103–11. https://doi.org/10.1016/j.comppsych.2014.07.022.CrossRef

59.

Paula S, Tobias T, Nathalie F, Forkmann T, Glaesmer H, Zhang XC, et al. Resilience to suicide ideation: A cross-cultural test of the buffering hypothesis. Clin Psychol Psychother. 2018;25(1):e1–9. https://doi.org/10.1002/cpp.2118.CrossRef

Title: Resilience mediates the effect of self-efficacy on symptoms of prenatal anxiety among pregnant women: a nationwide smartphone cross-sectional study in China
Authors: Ruqing Ma
Fengzhi Yang
Lijuan Zhang
Kristin K. Sznajder
Changqing Zou
Yajing Jia
Can Cui
Weiyu Zhang
Wenzhu Zhang
Ning Zou
Xiaoshi Yang
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Anxiety
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03911-5

2024 ASCO Annual Meeting

Springer Medicine

Resilience mediates the effect of self-efficacy on symptoms of prenatal anxiety among pregnant women: a nationwide smartphone cross-sectional study in China

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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