[Latent profile analysis of psychological capital and antenatal depression among pregnant women].
Antenatal depression is an important public health issue affecting the physical and mental health of pregnant women and maternal-infant outcomes, with a global prevalence of 10% to 20%. Psychological capital, as a positive psychological resource of pregnant women, includes 4 core dimensions: Self-efficacy, hope, optimism, and resilience, and plays a critical role in coping with pregnancy-related stress and maintaining mental health. However, current research on antenatal depression and psychological capital remains insufficient, particularly with regard to exploration of their latent heterogeneous patterns. This study aims to identify latent joint profile types of psychological capital and antenatal depression among pregnant women using latent profile analysis (LPA), and to quantify the effects of social support, sleep quality, and exercise behavior on different types, so as to provide empirical evidence for the precision of psychological interventions during pregnancy.
A cross-sectional survey design was adopted. From July to December 2023, an online survey platform was used to conduct investigations in tertiary hospitals in Hubei Province, Liaoning Province, and Guangdong Province (one hospital per province, 3 hospitals in total). A total of 772 valid questionnaires were obtained. Data were collected using the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), the 12-item short version of the Psychological Capital Questionnaire (PCQ-12), the Multidimensional Scale of Perceived Social Support (MSPSS) for perceived social support, the Pittsburgh Sleep Quality Index (PSQI), and a self-designed questionnaire. LPA was used to identify latent profile types of psychological capital and antenatal depression. The optimal fitting model was determined based on the Bayesian Information Criterion (BIC), entropy, and the Lo-Mendell-Rubin (LMR) adjusted likelihood ratio test results. Multinomial logistic regression was applied to evaluate the effects of various factors on different latent types.
The three-class model was the optimal fitting model. The comprehensive deprivation group (3.50%) showed the lowest levels of psychological capital and the most severe depressive symptoms; the functionally restricted group (33.94%) showed moderate psychological capital and relatively high depressive symptoms; and the positive adjustment group (62.56%) showed high psychological capital and low depressive symptoms. Univariate analysis showed statistically significant differences among the 3 latent classes in occupation, educational level, monthly income, frequency of alcohol consumption during pregnancy, frequency of exercise during and before pregnancy, relationship with husband, perceived social support, and sleep quality (all P<0.05). After controlling for covariates, each 1-point increase in perceived social support increased the probability of pregnant women entering the positive adjustment group rather than the comprehensive deprivation group by 13.0% [odds ratio (OR)=1.130, 95% confidence interval (CI) 1.091 to 1.171, P<0.001]. Pregnant women who rarely exercised during pregnancy were more likely to enter the comprehensive deprivation group rather than the positive adjustment group (OR=0.107, 95% CI 0.012 to 0.962, P=0.046). Pregnant women with higher perceived social support scores were more likely to enter the positive adjustment group rather than the functionally limited group (OR=1.075, 95% CI 1.058 to 1.091, P<0.001), while pregnant women with poor sleep quality were more likely to enter the functionally limited group rather than the positive adjustment group (OR=0.902, 95% CI 0.848 to 0.959, P<0.001). Pregnant women with higher perceived social support scores were more likely to enter the functionally limited group rather than the comprehensive deprivation group (OR=1.052, 95% CI 1.017 to 1.087, P=0.003).
Significant heterogeneity exists in psychological capital and antenatal depression among pregnant women, and 3 latent classes with clinical and intervention significance can be identified. Social support is a key protective factor in promoting psychological resilience and preventing antenatal depression, while regular physical activity and good sleep also have independent predictive value. It is recommended that positive psychological resources be incorporated into pregnancy mental health screening systems, promoting a shift in service models from "disease-oriented" to "resource-oriented" and implementing stratified intervention strategies based on class characteristics. For the positive adjustment group, participation in community peer support networks can be encouraged, and they can be cultivated as key opinion leaders for mental health promotion. For the functionally limited group, priority should be given to improving sleep disorders, increasing physical activity, and strengthening social connections to prevent progression to high-risk states. For the comprehensive deprivation group, inclusion in high-risk case management pathways in prenatal care clinics is required, with early identification and multidisciplinary collaborative interventions to effectively reduce the risk of adverse psychological and pregnancy outcomes and improve overall maternal and infant health.
A cross-sectional survey design was adopted. From July to December 2023, an online survey platform was used to conduct investigations in tertiary hospitals in Hubei Province, Liaoning Province, and Guangdong Province (one hospital per province, 3 hospitals in total). A total of 772 valid questionnaires were obtained. Data were collected using the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), the 12-item short version of the Psychological Capital Questionnaire (PCQ-12), the Multidimensional Scale of Perceived Social Support (MSPSS) for perceived social support, the Pittsburgh Sleep Quality Index (PSQI), and a self-designed questionnaire. LPA was used to identify latent profile types of psychological capital and antenatal depression. The optimal fitting model was determined based on the Bayesian Information Criterion (BIC), entropy, and the Lo-Mendell-Rubin (LMR) adjusted likelihood ratio test results. Multinomial logistic regression was applied to evaluate the effects of various factors on different latent types.
The three-class model was the optimal fitting model. The comprehensive deprivation group (3.50%) showed the lowest levels of psychological capital and the most severe depressive symptoms; the functionally restricted group (33.94%) showed moderate psychological capital and relatively high depressive symptoms; and the positive adjustment group (62.56%) showed high psychological capital and low depressive symptoms. Univariate analysis showed statistically significant differences among the 3 latent classes in occupation, educational level, monthly income, frequency of alcohol consumption during pregnancy, frequency of exercise during and before pregnancy, relationship with husband, perceived social support, and sleep quality (all P<0.05). After controlling for covariates, each 1-point increase in perceived social support increased the probability of pregnant women entering the positive adjustment group rather than the comprehensive deprivation group by 13.0% [odds ratio (OR)=1.130, 95% confidence interval (CI) 1.091 to 1.171, P<0.001]. Pregnant women who rarely exercised during pregnancy were more likely to enter the comprehensive deprivation group rather than the positive adjustment group (OR=0.107, 95% CI 0.012 to 0.962, P=0.046). Pregnant women with higher perceived social support scores were more likely to enter the positive adjustment group rather than the functionally limited group (OR=1.075, 95% CI 1.058 to 1.091, P<0.001), while pregnant women with poor sleep quality were more likely to enter the functionally limited group rather than the positive adjustment group (OR=0.902, 95% CI 0.848 to 0.959, P<0.001). Pregnant women with higher perceived social support scores were more likely to enter the functionally limited group rather than the comprehensive deprivation group (OR=1.052, 95% CI 1.017 to 1.087, P=0.003).
Significant heterogeneity exists in psychological capital and antenatal depression among pregnant women, and 3 latent classes with clinical and intervention significance can be identified. Social support is a key protective factor in promoting psychological resilience and preventing antenatal depression, while regular physical activity and good sleep also have independent predictive value. It is recommended that positive psychological resources be incorporated into pregnancy mental health screening systems, promoting a shift in service models from "disease-oriented" to "resource-oriented" and implementing stratified intervention strategies based on class characteristics. For the positive adjustment group, participation in community peer support networks can be encouraged, and they can be cultivated as key opinion leaders for mental health promotion. For the functionally limited group, priority should be given to improving sleep disorders, increasing physical activity, and strengthening social connections to prevent progression to high-risk states. For the comprehensive deprivation group, inclusion in high-risk case management pathways in prenatal care clinics is required, with early identification and multidisciplinary collaborative interventions to effectively reduce the risk of adverse psychological and pregnancy outcomes and improve overall maternal and infant health.
Authors
Liu Liu, Zhou Zhou, Zang Zang, Tian Tian, Fan Fan, Feng Feng, Xianyu Xianyu, Liu Liu
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