Abstract
Objectives: Pregnant women in the third trimester can be more vulnerable to adverse mental health outcomes, but there is limited research on the association between family function and self-efficacy and potential mediation by symptoms of anxiety and depression.Methods: The cross-sectional study enrolled 813 pregnant women in the third trimester from 14 communities of Hengyang city, Hunan province of China. All of the participants completed a battery of self-report measures of family function (Family Adaptation Partnership Growth and Resolve Index, APGAR-family), self-efficacy (General Self-Efficacy Scale, GSES), anxiety (measured by Generalized Anxiety Disorder scale with seven items, GAD-7), and depression symptoms (Patient Health Questionnaire with nine items, PHQ-9). The correlation analysis was performed using Spearman's correlation coefficient. Baron and Kenny's method and multiple mediation models with bootstrapping were used to determine whether the symptoms of anxiety and depression mediated the association between family functions and self-efficacy.Results: There were 22.6% pregnant women in the low level of self-efficacy, with 60.9% in the moderate level and 16.5% of respondents in the high level. Self-efficacy had significant correlations with both anxiety symptoms (r = −0.19, p < 0.05), depression symptoms (r = −0.22, p < 0.05), and family function (r = 0.31, p < 0.05). Anxiety symptoms were significantly associated with self-efficacy (β = −0.016, p < 0.05). Depression symptoms were significantly associated with self-efficacy (β = −0.024, p < 0.05). Anxiety and depression symptoms partly mediated the association between family function and self-efficacy, accounting for 11.4 and 16.4% of total effect, respectively. It was indicated that pregnant women with a high degree of family function are less likely to have emotional symptoms and predicted to have higher levels of self-efficacy.Conclusions: Anxiety and depression show mediating effects in the association between family function and self-efficacy. Improved family function can have a positive impact on pregnant women in the third trimester.
Highlights
Self-efficacy is defined as an individual’s ability to change his/her behavior [1]
Based on a community-based survey from a representative mid-income country, this study was planned to resolve the following three research questions: [1] What is the status of emotional problems, family functioning, and selfefficacy among pregnant women in the third trimester? [2] What is the relationship between emotional problems, family functioning, and self-efficacy? [3] How do anxiety or depression symptoms mediate the relationship between family function and self-efficacy? We provided public health implications to identify vulnerable populations among pregnant women and identify effective measures for mothers and infants to improve maternal quality during pregnancy and postpartum recovery
The inclusion criteria for the study were [1] pregnant women in their third trimester with the pregnancy registered in the community health centers, [2] those participants were not diagnosed with anxiety/depression disorders by grade II and III hospital before, [3] those who volunteered to participate in this project, and [4] those who lived in the community for more than 6 months
Summary
Self-efficacy is defined as an individual’s ability to change his/her behavior [1]. To be specific, it is one aspect of confidence that a person believes in his/her abilities and competencies for achieving success [2]. Functions, which are closely related to social support, global stress, and mental health perception in women, emphasize the family as a multidimensional concept that includes the effectiveness of family member’s emotional connection, family regulation, family communication, and coping with external events in life [8, 9]. Functions are more important for pregnant women, especially in families with a Confucian cultural context that is widely located in Asia and other countries [10, 11]. These families emphasize family partnership and family affection to provide full support to pregnant women and adversities that they may face. The importance of a positive role for well-Functioning families to prevent negative psychological outcomes has been discussed in a previous study [12]
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