Validation of Chinese Multidimensional Depression Assessment Scale (MDAS) in Inner Mongolia pregnant women and risk factors of antenatal depression in Inner Mongolia in the era of one-child policy

BACKGROUND: Pregnancy involves physiological changes in reproductive and endocrine systems, and social role changes that can increase the risk of mental health problems. In China, greater emphasis has been given to postpartum depression and its negative impact on infant development. This study examined depression in pregnant women in Inner Mongolia, who are under the influence of cultural values of collectivism and social factors specific to China. Chinese society adheres firmly to traditional values, while market reform, birth-control policy, together with high parental investment in childcare and rearing construct a unique and sometimes unfavorable environment for Chinese women that may influence their depression expression. THE AIMS OF THIS STUDY ARE TWOFOLD: First, it validated the Chinese Multidimensional Depression Assessment Scale (MDAS), a holistic self-report questionnaire measuring depression severity in four domains of depression-emotional, somatic, cognitive and interpersonal in pregnant women in Inner Mongolia; second, it examined the influences of demographic characteristics (including age, education and employment), pregnancy characteristics (week of gestation, first pregnancy), self-esteem, social support, social activity, work stress, and work-family balance on depression. METHODS: A total of 234 pregnant women, mostly in their third trimester, were recruited in an antenatal hospital in Inner Mongolia and self-reported questionnaires were completed. RESULTS: Using Confirmatory factor analysis (CFA), MDAS gave rise to a best-fit four-factor model corresponding to each subscale when it was first developed. MDAS also reported high Cronbach’s alpha (0.96) and good convergent validity. Using hierarchical multiple linear regressions with significant demographic variables controlled for, self-esteem, work-family conflict, and social support were found to be significant predictors for depression. CONCLUSIONS: MDAS is a valid scale to be used with Chinese pregnant women, especially in more collectivistic geographical areas. Risk factors specific to the Chinese context add insights to the experience of antenatal depression in China and contribute to understanding depression in from a global mental health perspective.