Based on previous research and Bandura’s self-efficacy theory and Erikson’s theory of personality development, in this study, a parallel mediation model was constructed with perceived stress as the two dimensions of self-efficacy and perceived helplessness as the mediator variable, meaning in life as the independent variable, and antenatal depression as the dependent variable to explore how meaning in life affects antenatal depression in women. The innovative aspect of this study is the correlation between self-efficacy, perceived helplessness, and meaning in life, which has not been reported in previous research. The results of this study have theoretical and practical significance for deepening the relationship between meaning in life and psychological disorders during pregnancy, guiding pregnant women to improve their meaning in life to alleviate depression and maintain their psychological health during pregnancy. We found that 16.6% of pregnant women in the queue exhibited symptoms of depression, which is similar to the incidence rate reported in other studies [44,45,46]. In addition, univariate analysis showed that educational level [47]sleep status [48]and stress [49] were all significantly associated with depression symptoms (all P < 0.05), which is consistent with previous research conclusions.
The impact of meaning in life on antenatal depression in pregnant women
Research has found that the meaning in life for pregnant women is not only significantly correlated with depressive emotions but can also directly predict depressive emotions, thus H1 has been validated. The results of this study support the viewpoints of previous research and broaden the observed population in existing studies [17, 50, 51]. This conclusion is consistent with certain psychological theories, such as existential psychotherapy [14]which posits that a sense of meaninglessness in life can lead to a sense of emptiness, potentially resulting in psychoneurosis, including depression. Essentially, the meaning in life is a subjective experience [52]. Therefore, there exists a complex and intimate relationship between individual emotions and the experience of meaning in life. Most studies suggest a negative correlation between negative emotions and the search for meaning, that is, the higher the negative emotions, the less individuals can find a sense of meaning [53]. This may be because negative emotions increase the ambiguity of individuals’ judgment of things, further impairing their sense of meaning in life, subsequently leading to feelings of worry and anxiety, and exacerbating the spread of depressive emotions [54, 55].
Medical personnel should fully assess and pay attention to the level of meaning in life of pregnant women. For example, through group counseling in psychology, pregnant women can be guided to engage in deep emotional experiences, thereby enhancing their experiences of meaning in life and emphasizing the visibility and concretization of meaning in life. In terms of implementation, positive psychology and logotherapy can be used as references to develop group intervention plans.
The mediating effect of self-efficacy on the relationship between meaning in life and antenatal depression
The meaning in life positively predicts self-efficacy, which is consistent with previous research findings [24, 25, 56]. Importantly, self-efficacy serves as a mediator in the relationship between the meaning in life and antenatal depression, H2 has received support. The meaning in life is an important source of self-efficacy, aligning with Reker and Wong’s proposed three-dimensional models of meaning three-dimensional model of meaning [57, 58]. They argue that the meaning in life is a personal cognitive system constructed by individuals based on their cultural background, and this system influences their choices, motivations, and achievements of activities and goals. For pregnant women with a higher sense of meaning in life, they tend to anticipate the arrival of the newborn, leading to purposeful living, such as engaging in necessary moderate exercise [59, 60]improving medication compliance [61]and actively participating in antenatal education [62]. By actively participating in prenatal care, they enhance their confidence in assuming the role of a “mother” while simultaneously increasing their self-efficacy. On the other hand, self-efficacy serves as an important internal protective factor against depression, which can be explained by Bandura’s theory of self-efficacy [63]. This theory suggests that self-efficacy influences individuals’ emotional processes and their response to aversive situations, such as potential dangers, misfortunes, and disasters. In summary, self-efficacy plays a mediating role between the meaning in life and depression.
Healthcare staff should encourage pregnant women and their family members to participate in learning about prenatal mental health knowledge. This can be achieved through credible online health information platforms, optimizing the methods and content of information dissemination, and increasing the awareness, trust, and utilization of prenatal mental health information among pregnant women and their families. For example, using prenatal classes as a platform, training can be provided through simulated childbirth scenarios, pregnant women and their partners can watch parenting programs together, and participate in newborn care skills training, thereby stimulating the maternal instincts of pregnant women and their longing for the joy of family and the bond between parent and child.
The mediating effect of perceived helplessness on the relationship between meaning in life and prenatal depression
The meaning in life and the perceived helplessness are negatively correlated, aligning with previous research findings [64]. Additionally, the mediating effect of perceived helplessness between the meaning in life and antenatal depression is significant, confirming the H3. These results support the view of previous studies that perceived helplessness is an essential component of executive function, influencing individuals’ attention control over their thoughts and actions. Impaired attention control is a proximal factor for poor psychological and social adaptation caused by other factors. An experiment demonstrated that, when faced with challenging situations, the accumulation of negative emotions leads to a helpless response in pregnant women [65]. Furthermore, negative emotions are somewhat associated with adaptive coping strategies, and how pregnant women handle negative emotions depends on their personal choices. The meaning in life is not an automatic process; it depends on how individuals reflect upon their lives in terms of values, expectations, and daily context, and how they set these standards based on their environment. If pregnant women lack a sense of meaning in life, they may react helplessly to obstacles. Conversely, pregnant women with a sense of meaning in life are more likely to choose to cope with difficulties using positive emotions and behaviors, thus reducing feelings of helplessness.
On the other hand, helplessness is an important predictive factor for increased levels of depression [66, 67]. Existing research indicates that mother’s helplessness plays a bridging role when there is an interaction between environmental and individual factors contributing to depression [68]. Particularly for mothers with a high depressive attribution style, they may experience a greater sense of loss of control and helplessness when facing negative life events, which further exacerbates depression [69]. To summarize, perceived helplessness plays a mediating role between the meaning in life and antenatal depression.
Healthcare professionals should strengthen efforts to ameliorate the sense of helplessness in pregnant women and improve their cognitive coping strategies for dealing with pregnancy difficulties. Cognitive-behavioral therapy can be employed, including psychological education, relaxation training, attention diversion, goal setting, rhythm adjustment, problem-solving, cognitive restructuring, and management of emergencies or high-risk situations. Several studies [70, 71] have shown that participants who received cognitive-behavioral therapy experienced a decrease in levels of helplessness after several treatment sessions, along with improvements in cognitive fatigue severity, depression, self-efficacy, and sleep outcomes. Additionally, mindfulness-based interventions targeting pregnant women, such as mindfulness-based childbirth and parenting education, can alleviate perceived stress, enhance childbirth efficacy, and reduce levels of helplessness, effectively improving the mental health of pregnant women.
Limitations and recommendations
This study has the following limitations. Firstly, relying solely on self – reports from pregnant women poses a significant risk of potential bias. Social desirability bias is particularly likely to occur in self – reporting. Pregnant women may be inclined to respond in a way that aligns with social expectations. For example, they might underreport negative emotions or overstate positive aspects of their mental state due to concerns about being judged as inadequate mothers. This would lead to an inaccurate representation of their true psychological conditions, thereby seriously undermining the reliability and validity of the data. Therefore, future research should employ various assessment methods (such as behavioral measures and interviews) to improve the quality of the data and enhance the validity of the research findings. Secondly, the cross – sectional design utilized in the present study is characterized by inherent limitations. When data collection occurs at a single time – point, the analysis is confined to identifying correlations among variables, such as those existing between the sense of meaning in life, self – efficacy, perceived helplessness, and antenatal depression. Nevertheless, ascertaining the precise temporal sequence of these relationships remains elusive. Hence, future research should employ longitudinal or experimental designs to provide more reliable conclusions regarding the causal temporal sequence of these variables. Thirdly, the sampling scope of this study is confined to pregnant women in the Wuhan area. This geographical limitation raises concerns about the generalizability of the research findings. Different regions vary in terms of cultural norms, economic development levels, and access to healthcare resources, all of which can influence the psychological states of pregnant women. For example, in areas with different cultural attitudes towards pregnancy and motherhood, pregnant women may have distinct experiences of meaning in life, and their self – efficacy and perceived helplessness levels may also differ. As a result, the relationships between meaning in life, self – efficacy, perceived helplessness, and antenatal depression observed in this study may not hold true for pregnant women in other regions.
Despite these limitations, the research findings of this study still hold some innovative value. Firstly, within the same model, this study simultaneously examined the mediating roles of self-efficacy and perceived helplessness on the relationship between the meaning in life and antenatal depression. The results of this study expand our understanding of the mechanism between the meaning in life, self-efficacy, perceived helplessness, and antenatal depression in pregnant women, and complement previous research conclusions. Secondly, this study found that the meaning in life has a positive predictive effect on self-efficacy in pregnant women and a negative predictive effect on perceived helplessness, which further supports the interrelationship between the meaning in life, self-efficacy, and perceived helplessness. Lastly, the results of this study indicate that improving the mental health of pregnant women should focus more on their meaning in life, self-efficacy, and perceived helplessness. Through a comprehensive literature review, this study is one of the few articles that explicitly specify the mediating roles of self-efficacy and perceived helplessness in the relationship between the meaning in life and antenatal depression. For expectant mothers, strengthening training and enhancement of both self-efficacy and the meaning in life are equally important in prenatal examinations, antenatal education, and daily care.
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