{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T20:54:55Z","timestamp":1774385695174,"version":"3.50.1"},"reference-count":98,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Third People's Hospital of Mianyang","award":["SCYW24-01"],"award-info":[{"award-number":["SCYW24-01"]}]},{"name":"Mianyang Municipal Health Commission","award":["202116"],"award-info":[{"award-number":["202116"]}]},{"DOI":"10.13039\/501100012438","name":"Sichuan Veterinary Medicine and Drug Innovation Group of China Agricultural Research System","doi-asserted-by":"publisher","award":["SCWCN2021YB5"],"award-info":[{"award-number":["SCWCN2021YB5"]}],"id":[{"id":"10.13039\/501100012438","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mental health challenges, including insomnia, anxiety, and depression, are common among antenatal women and can affect both maternal and fetal outcomes. This study explores the determinants of these conditions in antenatal women in China, aiming to inform the design of mental health interventions and preventive strategies for this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey design was employed in this hospital-based study targeting antenatal women at a tertiary hospital in China, conducted from May 2024 to March 2025 during routine antenatal visits. Validated questionnaires assessed insomnia, anxiety, and depression. Multiple linear and logistic regression analyses identified factors associated with symptom severity and occurrence, while Structural Equation Modeling (SEM) was used to explore the relationships and mediating effects between biological and social factors, insomnia, anxiety, and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The participants had a mean age of 31.48\u2009\u00b1\u20096.94 years, with most being married (90.7%), living in urban areas (74.3%), and having undergraduate\/college education (45.8%). Significant predictors of insomnia included geographical location, with those in central (OR = 1.818, 95% CI: 1.500\u20132.204) and southern areas (OR = 1.368, 95% CI: 1.143\u20131.637) showing higher odds compared to the northern region. Living in rural areas (OR = 0.796, 95% CI: 0.718\u20130.845) and higher education levels (OR = 1.544, 95% CI: 1.012\u20132.355) were associated with lower odds. Other significant factors included the number of live births and household composition. For anxiety, older age (OR = 0.955, 95% CI: 0.937\u20130.973) and rural living (OR = 0.675, 95% CI: 0.539\u20130.845) decreased odds, while living with others (OR = 3.726, 95% CI: 2.463\u20135.639) increased the risk. Significant predictors of depression included geographical location (central areas: OR = 1.508, 95% CI: 1.106\u20132.055), income level, and number of live births. The logistic regression Area Under the Curve (AUC) were 0.579 for insomnia, 0.603 for anxiety, and 0.567 for depression. SEM demonstrated an excellent model fit (CFI\u2009=\u20090.994, TLI\u2009=\u20090.999, RMSEA\u2009=\u20090.014). Insomnia was strongly predicted by geographic location, education, and number of live births. In turn, insomnia significantly\u00a0predicted anxiety (\u03b2\u2009=\u20090.741) and depression (\u03b2\u2009=\u20090.138). The model explained 54.9% of the variance in anxiety and 70.6% of the variance in depression, indicating partial mediation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identifies the multidimensional factors influencing antenatal women\u2019s insomnia, anxiety, and depression in China, particularly highlighting the roles of geographical location, current living situation, and household composition. These factors were consistently associated with all three outcomes. Targeted\u00a0interventions targeting these specific risk factors are recommended to improve the mental health of antenatal women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0344846","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T17:26:41Z","timestamp":1774373201000},"page":"e0344846","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with insomnia, anxiety, and depression among antenatal women in China: A cross-sectional hospital-based 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antenatal care","volume":"176","author":"JM Dodd","year":"2002","journal-title":"Med J Aust"},{"issue":"5","key":"pone.0344846.ref002","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/OGX.0000000000001261","article-title":"Antenatal care: A comparative review of guidelines","volume":"79","author":"E Boureka","year":"2024","journal-title":"Obstet Gynecol Surv"},{"issue":"2","key":"pone.0344846.ref003","doi-asserted-by":"crossref","first-page":"89","DOI":"10.5830\/CVJA-2016-021","article-title":"Physiological changes in pregnancy","volume":"27","author":"P Soma-Pillay","year":"2016","journal-title":"Cardiovasc J Afr"},{"key":"pone.0344846.ref004","first-page":"267","article-title":"Depression during pregnancy: review of epidemiological and clinical aspects in developed and developing countries","volume":"10","author":"PK Pereira","year":"2011","journal-title":"Psychiatric disorders-trends and 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polska"},{"issue":"2","key":"pone.0344846.ref008","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1089\/jwh.2020.8862","article-title":"Perinatal depression: challenges and opportunities","volume":"30","author":"RK Dagher","year":"2021","journal-title":"J Womens Health (Larchmt)"},{"issue":"2","key":"pone.0344846.ref009","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/1753495x12473751","article-title":"Effects of prenatal stress on pregnancy and human development: mechanisms and pathways","volume":"6","author":"ME Coussons-Read","year":"2013","journal-title":"Obstet Med"},{"issue":"2","key":"pone.0344846.ref010","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1080\/15402002.2023.2232499","article-title":"Sleep quality and associated factors among pregnant women attending antenatal care unit at the referral hospitals in Oromia National Regional State, Ethiopia, 2021: A Multicenter Cross-Sectional Study","volume":"22","author":"A Abdurahman","year":"2024","journal-title":"Behav Sleep Med"},{"issue":"5","key":"pone.0344846.ref011","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1007\/s00737-016-0629-1","article-title":"A review of longitudinal studies on antenatal and postnatal depression","volume":"19","author":"L Underwood","year":"2016","journal-title":"Arch Womens Ment Health"},{"key":"pone.0344846.ref012","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jpsychores.2018.06.011","article-title":"Depressive symptoms and comorbid problems in pregnancy - results from a population based study","volume":"112","author":"D Pampaka","year":"2018","journal-title":"J Psychosom Res"},{"issue":"5","key":"pone.0344846.ref013","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1192\/bjp.bp.116.187179","article-title":"Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis","volume":"210","author":"CL Dennis","year":"2017","journal-title":"The British Journal of Psychiatry"},{"issue":"10","key":"pone.0344846.ref014","doi-asserted-by":"crossref","DOI":"10.4088\/JCP.14r09035","article-title":"Anxiety disorders during pregnancy: a systematic review","volume":"75","author":"JH Goodman","year":"2014","journal-title":"J Clin Psychiatry"},{"issue":"2","key":"pone.0344846.ref015","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.3390\/ijerph20021098","article-title":"Prevalence of Antenatal Anxiety in European Women: A Literature Review","volume":"20","author":"A Val","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0344846.ref016","volume-title":"The course of maternal pregnancy-specific stress across pregnancy and effects on primary pregnancy outcomes: a prospective study","author":"S Zhang","year":"2017"},{"issue":"1","key":"pone.0344846.ref017","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1186\/s12884-021-04188-4","article-title":"The association between social support and antenatal depressive and 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Pauley","year":"2020","journal-title":"J Clin Sleep Med"},{"issue":"2","key":"pone.0344846.ref021","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/YCO.0b013e3283503680","article-title":"Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice","volume":"25","author":"C Dunkel Schetter","year":"2012","journal-title":"Current Opinion in Psychiatry"},{"issue":"2","key":"pone.0344846.ref022","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jad.2012.09.007","article-title":"Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: a prospective population-based study","volume":"146","author":"J Fisher","year":"2013","journal-title":"J Affect Disord"},{"issue":"5","key":"pone.0344846.ref023","doi-asserted-by":"crossref","first-page":"468","DOI":"10.3390\/ijerph13050468","article-title":"Prevalence and risk factors of maternal anxiety in late pregnancy in China","volume":"13","author":"Y-T Kang","year":"2016","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0344846.ref024","doi-asserted-by":"crossref","first-page":"10771","DOI":"10.1038\/s41598-018-28974-x","article-title":"The associations between maternal lifestyles and antenatal stress and anxiety in Chinese pregnant women: A cross-sectional study","volume":"8","author":"Q Hou","year":"2018","journal-title":"Sci Rep"},{"issue":"11","key":"pone.0344846.ref025","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1055\/s-0042-118180","article-title":"Consequences and possible predictors of health-damaging behaviors and mental health problems in pregnancy\u2013a review","volume":"76","author":"F Ulrich","year":"2016","journal-title":"Geburtshilfe und Frauenheilkunde"},{"issue":"6","key":"pone.0344846.ref026","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.midw.2015.02.009","article-title":"Risk factors of transient and persistent anxiety during pregnancy","volume":"31","author":"H Bayrampour","year":"2015","journal-title":"Midwifery"},{"issue":"8","key":"pone.0344846.ref027","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1177\/0020764014524738","article-title":"Prevalence of depressive disorders and related factors in women in the first trimester of their pregnancies in Erzurum, Turkey","volume":"60","author":"P Ak\u00e7al\u0131 Aslan","year":"2014","journal-title":"Int J Soc Psychiatry"},{"issue":"1","key":"pone.0344846.ref028","first-page":"270","article-title":"Social support and maternal stress during pregnancy: A PATH model","volume":"2","author":"S Shishehgar","year":"2015","journal-title":"Int J Healthc"},{"key":"pone.0344846.ref029","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jad.2020.07.126","article-title":"Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic","volume":"277","author":"C Lebel","year":"2020","journal-title":"Journal of affective disorders"},{"issue":"3","key":"pone.0344846.ref030","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1002\/wps.20769","article-title":"Perinatal mental health: a review of progress and challenges","volume":"19","author":"LM Howard","year":"2020","journal-title":"World Psychiatry"},{"issue":"2","key":"pone.0344846.ref031","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/YCO.0b013e3283503680","article-title":"Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice","volume":"25","author":"C Dunkel Schetter","year":"2012","journal-title":"Curr Opin Psychiatry"},{"issue":"1","key":"pone.0344846.ref032","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12889-020-8293-9","article-title":"Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review","volume":"20","author":"AF Dadi","year":"2020","journal-title":"BMC Public Health"},{"issue":"6","key":"pone.0344846.ref033","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.1016\/j.fmre.2023.09.013","article-title":"The updated understanding of advanced maternal age","volume":"4","author":"X Ye","year":"2023","journal-title":"Fundam Res"},{"issue":"3","key":"pone.0344846.ref034","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3390\/bs14030147","article-title":"Advanced Maternal Age: A Scoping Review about the Psychological Impact on Mothers, Infants, and Their Relationship","volume":"14","author":"M Ahmad","year":"2024","journal-title":"Behav Sci (Basel)"},{"key":"pone.0344846.ref035","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/hec.4565","article-title":"Mental health effects of education","author":"F Kondirolli","year":"2022","journal-title":"Health 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Delivered Parturients","volume":"40","author":"NK Ayala","year":"2023","journal-title":"Am J Perinatol"},{"key":"pone.0344846.ref042","doi-asserted-by":"crossref","first-page":"1151027","DOI":"10.3389\/fpsyg.2023.1151027","article-title":"Hope, optimism, and pessimism as predictors of positive and negative psychological changes related to the COVID-19 pandemic in Slovak adults","volume":"14","author":"E Juri\u0161ov\u00e1","year":"2023","journal-title":"Front Psychol"},{"issue":"7","key":"pone.0344846.ref043","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220003","article-title":"Intimate partner violence and maternal depression during pregnancy: A community-based cross-sectional study in Ethiopia","volume":"14","author":"S Belay","year":"2019","journal-title":"PLoS One"},{"key":"pone.0344846.ref044","first-page":"217","article-title":"HIV-Related Stigma Among Pregnant Adolescents: A Qualitative Study of Patient Perspectives in Southwestern Uganda","volume":"16","author":"A Kabunga","year":"2024","journal-title":"HIV AIDS (Auckl)"},{"key":"pone.0344846.ref045","doi-asserted-by":"crossref","first-page":"620371","DOI":"10.3389\/fpsyt.2021.620371","article-title":"Postpartum depression: Current status and possible identification using biomarkers","volume":"12","author":"Y Yu","year":"2021","journal-title":"Front Psychiatry"},{"issue":"6","key":"pone.0344846.ref046","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/S2215-0366(20)30467-3","article-title":"Barriers and facilitators to implementing perinatal mental health care in health and social care settings: a systematic review","volume":"8","author":"R Webb","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"pone.0344846.ref047","doi-asserted-by":"crossref","first-page":"1330720","DOI":"10.3389\/fpsyg.2024.1330720","article-title":"Social support and mental health: the mediating role of perceived stress","volume":"15","author":"EF Acoba","year":"2024","journal-title":"Front 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Psychology"},{"key":"pone.0344846.ref051","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-11899-0","volume-title":"The biopsychosocial model of health and disease: New philosophical and scientific developments","author":"D Bolton","year":"2019"},{"issue":"10","key":"pone.0344846.ref052","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1111\/j.1365-2648.2010.05394.x","article-title":"Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people","volume":"66","author":"DSF Yu","year":"2010","journal-title":"J Adv Nurs"},{"issue":"4","key":"pone.0344846.ref053","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.dr.2013.08.003","article-title":"Sampling in developmental science: Situations, shortcomings, solutions, and standards","volume":"33","author":"MH Bornstein","year":"2013","journal-title":"Developmental Review"},{"key":"pone.0344846.ref054","doi-asserted-by":"crossref","DOI":"10.1136\/sbmj.0106187","article-title":"How to design a questionnaire","volume":"322","author":"WC Leung","year":"2001","journal-title":"BMJ"},{"issue":"6","key":"pone.0344846.ref055","first-page":"447","article-title":"Assessment of insomnia: validation of three questionnaires","volume":"23","author":"F Blais","year":"1997","journal-title":"Encephale-Revue De Psychiatrie Clinique Biologique Et Therapeutique"},{"key":"pone.0344846.ref056","volume-title":"Overcoming insomnia: A cognitive-behavioral therapy approach","author":"JD Edinger","year":"2014"},{"key":"pone.0344846.ref057","doi-asserted-by":"crossref","DOI":"10.1016\/S0924-9338(13)77338-3","article-title":"2738 \u2013 Reliability and Validity of the Chinese Translation of Insomnia Severity Index (C-ISI) in Chinese patients with insomnia","volume":"28","author":"S Badiee Aval Baghyahi","year":"2013","journal-title":"Eur psychiatr"},{"issue":"3","key":"pone.0344846.ref058","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S1087-0792(03)00060-1","article-title":"Self-report measures of insomnia in adults: rationales, choices, and needs","volume":"8","author":"DE Moul","year":"2004","journal-title":"Sleep Med Rev"},{"issue":"5","key":"pone.0344846.ref059","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/sleep\/34.5.601","article-title":"The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response","volume":"34","author":"CM Morin","year":"2011","journal-title":"Sleep"},{"key":"pone.0344846.ref060","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/978-1-4419-9893-4","article-title":"Insomnia Severity Index (ISI).","volume-title":"STOP, THAT and One Hundred Other Sleep Scales","author":"A Shahid","year":"2012"},{"issue":"10","key":"pone.0344846.ref061","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Archives of Internal Medicine"},{"issue":"3","key":"pone.0344846.ref062","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jad.2010.07.010","article-title":"Validity of the GAD-7 scale as an outcome measure of disability in patients with generalized anxiety disorders in primary care","volume":"128","author":"MA Ruiz","year":"2011","journal-title":"J Affect Disord"},{"key":"pone.0344846.ref063","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s10862-016-9571-9","article-title":"Psychometric properties of the generalized anxiety disorder scale-7 (GAD-7) in outpatients with anxiety and mood disorders","volume":"39","author":"LA Rutter","year":"2017","journal-title":"Journal of Psychopathology and Behavioral Assessment"},{"key":"pone.0344846.ref064","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.eplepsyres.2015.11.019","article-title":"Validation of the Generalized Anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy","volume":"120","author":"X Tong","year":"2016","journal-title":"Epilepsy Res"},{"key":"pone.0344846.ref065","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jad.2020.12.129","article-title":"Validation of the 7-item Generalized Anxiety Disorder scale (GAD-7) as a screening tool for anxiety among pregnant Chinese women","volume":"282","author":"Y Gong","year":"2021","journal-title":"J Affect Disord"},{"issue":"3","key":"pone.0344846.ref066","doi-asserted-by":"crossref","first-page":"873","DOI":"10.3390\/jcm9030873","article-title":"Factorial Structure and Validity of Depression (PHQ-9) and Anxiety (GAD-7) Scales after Traumatic Brain Injury","volume":"9","author":"A Teymoori","year":"2020","journal-title":"J Clin Med"},{"issue":"18","key":"pone.0344846.ref067","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1001\/jama.282.18.1737","article-title":"Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study","volume":"282","author":"RL Spitzer","year":"1999","journal-title":"JAMA"},{"issue":"9","key":"pone.0344846.ref068","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"pone.0344846.ref069","doi-asserted-by":"crossref","DOI":"10.1016\/j.genhosppsych.2014.05.021","article-title":"Patient Health Questionnaire-9; Chinese Version","author":"W Wang","year":"2014","journal-title":"General Hospital 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Kachingwe","year":"2025","journal-title":"The South African Journal of Psychiatry: SAJP: the Journal of the Society of Psychiatrists of South Africa"},{"issue":"1","key":"pone.0344846.ref080","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1186\/s12888-025-07314-0","article-title":"Magnitude and level of association between poor sleep quality and common mental disorders among reproductive age women in Ethiopia: systematic review and meta-analysis","volume":"25","author":"AA Hasen","year":"2025","journal-title":"BMC Psychiatry"},{"issue":"1","key":"pone.0344846.ref081","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12884-021-03755-z","article-title":"A systematic review and meta-analysis of prevalence of insomnia in the third trimester of pregnancy","volume":"21","author":"N Salari","year":"2021","journal-title":"BMC Pregnancy 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