Mediating effect of mindfulness level on the relationship between marital quality and postpartum depression among primiparas

BACKGROUND: Postpartum depression refers to a depressive episode or depressive symptoms up to 12 mo after delivery. Trait mindfulness has presented a protective factor for postpartum depressive symptoms and proved efficient in improving relationship satisfaction among couples. AIM: To investigate the correlations among mindfulness, marital quality, anxiety, and depression in a large city in western China during the post-corona virus infectious disease-2019 era and determine whether trait mindfulness mediates the relationship between marital quality and postpartum anxiety and depression among primiparas. METHODS: A cross-sectional study was conducted. The self-administered questionnaire was submitted online through smartphones. The levels of mindfulness, anxiety, depression, and marital quality were respectively investigated by the mindful attention awareness scale (MAAS), the self-rating anxiety scale (SAS), the self-rating depression scale (SDS), and the marriage perception scale (MPS) in these enrolled Han and Tujia primiparas. RESULTS: No statistical significance was observed in the prevalence of postpartum anxiety and depression, nor scores of MAAS and MPS-Total in different regions or ethnicities (P > 0.05). However, MPS-Marital interaction (P < 0.05), MPS-Family relationship (MPS-FR) (P < 0.01), and MPS-Marital conflict (MPS-MC) (P < 0.01) scores of urban primiparas were higher than those of rural primiparas. The MPS-MC score of Han primiparas was higher than that of Tujia primiparas (P < 0.05). Negative correlations were observed between MAAS and SAS (r = -0.457, P < 0.01), and MAAS and SDS (r = -0.439, P < 0.01). SAS has revealed a highly positive correlation with SDS (r = 0.720, P < 0.01) and a weak negative correlation with MPS (r = -0.200, P < 0.05). Besides, a weak negative correlation was observed between MAAS and MPS-MC (r = -0.184, P < 0.05), and a weak positive correlation was noticed between SAS and MPS-MC (r = -0.225, P < 0.01). Mediation analysis demonstrated a full mediation effect of mindfulness level on the relationship between MPS-FR and postpartum anxiety (P < 0.05, 95%CI: -0.384 to 0.033), MPS-MC and postpartum anxiety (P < 0.01, 95%CI: 0.027-0.193), MPS-FR and postpartum depression (P < 0.05, 95%CI: -0.365 to 0.031), and MPS-MC and postpartum depression (P < 0.01, 95%CI: 0.022-0.206). CONCLUSION: Mindfulness demonstrates negative correlations with marital conflict, postpartum anxiety and depression, and it may have cross-ethnic and trans-regional characteristics. Although the mindfulness levels have revealed no significant mediating effect between the total score of marital quality and postpartum depression in this study, it demonstrates a full mediation effect on the relationships between family relationships, marital conflict, and postpartum anxiety and depression.