Negative Life Events and Antenatal Depression among Pregnant Women in Rural China: The Role of Negative Automatic Thoughts

RESEARCH ARTICLE Negative Life Events and Antenatal Depression among Pregnant Women in Rural China: The Role of Negative Automatic Thoughts Yang Wang1, Xiaohua Wang2, Fangnan Liu3, Xiaoning Jiang3, Yun Xiao4, Xuehan Dong3, Xianglei Kong3, Xuemei Yang5, Donghua Tian2, Zhiyong Qu2* a11111 1 School of Social Work, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America, 2 School of Social Development and Public Policy, China Institute of Health, Beijing Normal University, Beijing, China, 3 School of Social Development and Public Policy, Beijing Normal University, Beijing, China, 4 Maternal and Child Health Hospital in Mianzhu County, Deyang, Sichuan, China, 5 Teacher Education College, Sichuan Normal University, Chengdu, Sichuan, China * Abstract OPEN ACCESS Citation: Wang Y, Wang X, Liu F, Jiang X, Xiao Y, Dong X, et al. (2016) Negative Life Events and Antenatal Depression among Pregnant Women in Rural China: The Role of Negative Automatic Thoughts. PLoS ONE 11(12): e0167597. doi:10.1371/journal.pone.0167597 Editor: Dongmei Li, University of Rochester, UNITED STATES Background Few studies have looked at the relationship between psychological and the mental health status of pregnant women in rural China. The current study aims to explore the potential mediating effect of negative automatic thoughts between negative life events and antenatal depression. Received: August 23, 2016 Accepted: November 16, 2016 Published: December 15, 2016 Copyright: © 2016 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. The data about the manuscript has been uploaded by using SPSS 17.0 format in a supplemental file. Funding: The study was sponsored by the project of psychological services to children and adults affected by the earthquake in Sichuan Province of the Beijing Normal University Education Foundation. Methods Data were collected in June 2012 and October 2012. 495 rural pregnant women were interviewed. Depressive symptoms were measured by the Edinburgh postnatal depression scale, stresses of pregnancy were measured by the pregnancy pressure scale, negative automatic thoughts were measured by the automatic thoughts questionnaire, and negative life events were measured by the life events scale for pregnant women. We used logistic regression and path analysis to test the mediating effect. Results The prevalence of antenatal depression was 13.7%. In the logistic regression, the only socio-demographic and health behavior factor significantly related to antenatal depression was sleep quality. Negative life events were not associated with depression in the fully adjusted model. Path analysis showed that the eventual direct and general effects of negative automatic thoughts were 0.39 and 0.51, which were larger than the effects of negative life events. PLOS ONE | DOI:10.1371/journal.pone.0167597 December 15, 2016 1 / 14 Negative Life Events and Antenatal Depression: Negative Automatic Thoughts Competing Interests: The authors have declared that no competing interests exist. Conclusions This study suggested that there was a potentially significant mediating effect of negative automatic thoughts. Pregnant women who had lower scores of negative automatic thoughts were more likely to suffer less from negative life events which might lead to antenatal depression. Background The prevalence of antenatal depression varies from 7.4% to 50.0% worldwide, and from 5.5% to 23.1% in China [1–7]. The prevalence of depression among pregnant women is higher than that among postpartum women, and it is higher among pregnant women in middle and late pregnancy [5, 8]. Antenatal depression is a debilitating experience which can lead to many problems and sequelae. For example, depressed pregnant women may experience multiple conflicting roles, insufficient social support, uncertainty about future life, instability of emotion, and the discontent of body image. Moreover, there can be a risk of preterm birth and obstetric complications. And the newborns’ and husbands’ mental and physical health can also be threatened by their mothers’ and wives’ depression as well [9–16]. The predictors of antenatal depression include several socio-demographic and health behavior factors such as young or old age, low educational background, and low socio-economic status. Besides, antenatal depression is always related with threatening life events, such as housing problems, financial difficulties, and marital problems [17]. And negative life events contribute more to antenatal depressive symptoms than other socio-demographic factors do [18, 19]. Moreover, there are psychosocial factors such as stress, low social support, and low optimism level that can lead to an increased antenatal depressive level [7, 20–22]. Apart from those listed above, automatic thoughts are also believed to have a reciprocal relationship with depression, indicating that automatic thoughts can be the outcome of depression, and it can also have an impact on depressive level [23]. Automatic thoughts reflect one’s underlying core beliefs. If some events, which challenge one’s core beliefs, take place, the stream of negative automatic thoughts may run through one’s mind, and it will cast a negative interpretation of the events. The negative interpretation may increase the stress level and cause depressive symptoms [24–29]. That is consistent with the vulnerability model, which postulates that negative automatic thoughts play a mediating role between negative life events and depression [23]. This mediating effect has been examined in the study among adolescents [30]. It has also been applied in practice. Some interventions, which employed cognitive-behavioral therapy principles, used this mediating effect with their design of targeting and altering negative automatic thoughts, and building more adaptive automatic thoughts among pregnant women [24, 31]. Rural pregnant women used to be believed to have a lower depressive level in some studies, because they are supposed to have stronger family support and community connections, which can protect them from the risk of perinatal depression[32, 33]. Conversely, some studies showed conflicting findings. According to a quantitative study conducted in four provinces of China from 2001 to 2005, which included 63004 adult participants from both rural and urban sampling sites, there was a higher prevalence of depressive disorders among rural residents than that among urban residents [34, 35]. Further, some studies illustrated the difficulties encountered by rural pregnant woman. Pregnant women in rural areas could suffer from the PLOS ONE | DOI:10.1371/journal.pone.0167597 Decem (...truncated)