Perinatal depression and anxiety symptoms as mediators between grief and PTSD: the moderated effect of social support

Posttraumatic stress symptoms are prevalent mental phenomenon in women with previous perinatal loss due to high grief, high perinatal depression and anxiety or low social support. Although posttraumatic stress symptoms are known to have serious negative implications for women with previous perinatal loss, families and society, the mechanism through which it functions is less clear.

The aim of this study was to examine the moderated mediating effect of social support on perinatal anxiety and depression and its associations with grief and posttraumatic stress symptoms in women with previous perinatal loss. We hypothesized that perinatal depression and anxiety would mediate relationships between grief and posttraumatic stress symptoms and that its mediating effects would differ depending on social support.

This study was a multicentre cross-sectional survey conducted from December 2021 to October 2022, involving 346 women during hospitalization for perinatal loss as participants from two public hospitals in China. Self-reported scales were used to measure the level of perinatal depression and anxiety, grief, posttraumatic stress symptoms and social support. The Pearson's correlation analysis, the PROCESS Macro Model 4 and Model 14 on SPSS were used to analyse the available data.

The positive effect of perinatal grief on posttraumatic stress symptoms was found to be mediated by perinatal depression and anxiety, and this mediating effect was moderated according to social support: the more social support, the weaker the mediating effect of perinatal depression and anxiety was between perinatal grief and posttraumatic stress symptoms. The positive effect of perinatal depression and anxiety on posttraumatic stress symptoms was lowest in the high social support group.

Healthcare providers should closely monitor the psychological well-being of pregnant individuals and implement targeted interventions-such as antenatal education course, group-based prenatal care models, and mindfulness-based therapies (e.g., cognitive behaviour therapy) -to mitigate perinatal anxiety and depression. These measures may also significantly reduce post-traumatic stress symptoms in women with previous perinatal loss and high perinatal grief, particularly among those with insufficient social support.