Symptom network analysis of pregnancy stress, depressive symptoms and quality of life: a cross-sectional study of pregnant women in Xinjiang, China, 2023-2024

Abstract

Background: Pregnancy is a period of high risk for women's mental health problems, and the high prevalence and severity of pregnancy-related stress and depressive symptoms have become an important public health and social issue globally. In addition, pregnant women generally report low levels of quality of life (QoL), and there is a strong bidirectional association between QoL and mental health (pregnancy stress, depression): low QoL exacerbates the risk of mental health problems, while high QoL is protective. Despite the significant associations, existing studies have focused on specific gestational stages, single factors, or outcome effects, and there is a lack of studies examining the substantive associations and core symptoms of pregnancy stress, depressive symptoms, and quality of life across the entire gestational stage. Therefore, the aim of this study was to reveal the specific symptom network relationships and core symptoms of pregnant women's pregnancy stress, depressive symptoms and quality of life by themselves and among the three, using a network analysis methodology that integrates the early, middle and late stages of pregnancy, in order to deepen the understanding and to guide precise health interventions.

Methods: From February 2023 to January 2024, a convenience sampling method was used to conduct a cross-sectional study of 1,349 pregnant women in a tertiary hospital in the Xinjiang Uygur Autonomous Region of China using the Patient Health Questionnaire Depressive Symptom Cluster and the Stress in Pregnancy and Health-Related Quality of Life Scale, to construct a network to perform network estimation, and to determine core nodes of the network structure based on the centrality indexes.

Results: Maternal pregnancy stress score (1.71 ± 0.55), depressive symptoms (15.36 ± 4.70), and quality of life had the highest social functioning score (74.45 ± 12.63) and the lowest physical functioning score (65.18 ± 26.75). There was a statistically significant difference in depressive symptoms among pregnant women with different literacy levels, living environments, types of occupation, gestational cycles, number of fetuses and sleep (P < 0.05), pregnancy stress among pregnant women with different ages, living environments, total monthly family income, gestational cycles, number of fetuses and sleep (P < 0.05), and the quality of life among pregnant women with different gestational cycles (P < 0.05). In the network of maternal pregnancy stress and depressive symptoms, "difficulty sleeping, restlessness, or sleeping too much" had the strongest correlation with "feelings of stress stemming from ensuring the health and safety of the mother and child" (egde = 0.07), and in the network of depression and quality of life "Irritability, fidgeting, moving around to the point where others perceive individual behavior or talking slowly" had the strongest correlation with "affective functioning" (egde = -0.07); In the stress and quality of life network was the strongest correlation with "affective function" (egde = -0.05); "other factors" was the core symptom of the whole network.

Conclusion: This study suggests that psychological intervention programs for pregnant women should focus on increasing their confidence in taking care of their children and becoming competent mothers, fostering the spirit of "teamwork" between husband and wife, and improving the quality of life and mental health of pregnant women.

Keywords: Depressive symptoms; Mental health; Pregnancy stress; Pregnant women; Quality of life.

Fig. 1

Symptom network of pregnancy stress and depressive symptoms and quality of life in pregnant women. Note: Each node in the figure represents an entry or dimension, with the 9 dimensions of the PHQ-9 scale in orange, the 3 dimensions of the PSRS scale and “other factors” in blue, and the 8 dimensions of the SF-12 scale in green

Fig. 2

Centrality of pregnancy stress and depressive symptoms and quality of life in pregnant women. Note: The centrality indicators are presented as standardized Z-scores, and the expected impacts are ranked in order of degree centrality from top to bottom

Fig. 3

Regularized partial correlations of maternal pregnancy stress with depressive symptoms and quality of life scale scores. Note: The different colored curves represent the average relationship between the original sample centrality measures and the subsample measures

Fig. 4

Side weights of the regularized partial correlation network of maternal pregnancy stress with depressive symptoms and quality of life scale scores 95% confidence intervals