{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T03:46:05Z","timestamp":1782618365235,"version":"3.54.5"},"reference-count":30,"publisher":"Belitung Raya Foundation","issue":"3","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Faculty of Nursing,\nBurapha University, provided partial reimbursement for the Article\nProcessing Charge","award":[""],"award-info":[{"award-number":[""]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background: Postpartum depression (PPD) significantly impacts maternal well-being, infant development, and family functioning. Studies examining interrelationships among multiple predictors using theoretical frameworks in Chinese populations remain limited.\nObjective: To determine the prevalence of postpartum depression and examine the associations of biological, psychological, and social factors among postpartum women in Wenzhou, China.\nMethods: A predictive correlational cross-sectional study was conducted at a tertiary hospital in Wenzhou from November to December 2024. Using systematic random sampling, 166 postpartum women aged 20-44 years, within 4 weeks to 6 months postpartum, were recruited. Data were collected using validated instruments, including the Edinburgh Postnatal Depression Scale (EPDS), Rosenberg Self-Esteem Scale, Maternal Breastfeeding Evaluation Scale, Revised Dyadic Adjustment Scale, and Stryker Adjustment Checklist. Multiple regression and mediation analyses using the PROCESS macro with bootstrap resampling were performed to identify significant predictors and examine mediating pathways.\nResults: The prevalence of PPD (EPDS score \u22659) was 21.1%. Multiple regression analysis revealed that breastfeeding satisfaction (\u03b2 = -0.419, p &lt; 0.001) and fulfillment of infant gender expectations (\u03b2 = -0.202, p = 0.006) were significant predictors, together accounting for 28.4% of the variance in PPD symptoms.Mediation analysis indicated that breastfeeding satisfaction partially mediated the relationship between infant gender expectations and PPD. Pregnancy complications, self-esteem, marital satisfaction, and mother-in-law relationships were not statistically significant predictors in the final model.\nConclusion: Approximately one in five postpartum women in Wenzhou experienced clinically significant depressive symptoms. Fulfilled gender expectations were associated with lower PPD risk, partially mediated by higher breastfeeding satisfaction, supporting the Biopsychosocial Model. These findings highlight the need for routine PPD screening, satisfaction-focused breastfeeding support, culturally sensitive counseling regarding family gender expectations, and family-centered interventions in postpartum care.<\/jats:p>","DOI":"10.33546\/bnj.4465","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T03:03:29Z","timestamp":1782615809000},"page":"327-335","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of postpartum depression among mothers in Wenzhou, China: A cross-sectional study"],"prefix":"10.33546","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6334-1563","authenticated-orcid":false,"given":"Yufan","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3706-0491","authenticated-orcid":false,"given":"Punyarat","family":"Lapvongwatana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2143-9130","authenticated-orcid":false,"given":"Tatirat","family":"Tachasuksri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19163","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"key":"154797","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists. (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4. Obstetrics & Gynecology, 141(6), 1232\u20131261. https:\/\/doi.org\/10.1097\/aog.0000000000005200","DOI":"10.1097\/AOG.0000000000005200"},{"key":"154798","doi-asserted-by":"crossref","unstructured":"Busby, D. M., Christensen, C., Crane, D. R., & Larson, J. H. (1995). A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy, 21(3), 289\u2013308. https:\/\/doi.org\/10.1111\/j.1752-0606.1995.tb00163.x","DOI":"10.1111\/j.1752-0606.1995.tb00163.x"},{"key":"154799","unstructured":"Carlson, K., Mughal, S., Azhar, Y., & Siddiqui, W. (2025). Perinatal depression. Treasure Island, FL: StatPearls Publishing. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK519070\/"},{"key":"154800","unstructured":"Chu, M. L. (1992). The mother-in-law and daughter-in-law relationships during the transition to parenthood [Master\u2019s Thesis, The University of Hong Kong]. HKU Scholars Hub. http:\/\/hub.hku.hk\/bitstream\/10722\/28656\/1\/FullText.pdf"},{"key":"154801","doi-asserted-by":"crossref","unstructured":"Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782\u2013786. https:\/\/doi.org\/10.1192\/bjp.150.6.782","DOI":"10.1192\/bjp.150.6.782"},{"key":"154802","doi-asserted-by":"crossref","unstructured":"de Avilla, J. C., Giugliani, C., Bizon, A. M. B. L., Martins, A. C. M., Senna, A. F. K. d., & Giugliani, E. R. J. (2020). Association between maternal satisfaction with breastfeeding and postpartum depression symptoms. PloS One, 15(11), e0242333. https:\/\/doi.org\/10.1371\/journal.pone.0242333","DOI":"10.1371\/journal.pone.0242333"},{"key":"154803","doi-asserted-by":"crossref","unstructured":"Dressler, C. M., Shreffler, K. M., Wilhelm, I. R., Price, J. R., & Gold, K. P. (2025). Maternal satisfaction with perinatal care and breastfeeding at 6 months postpartum. International Journal of Environmental Research and Public Health, 22(8), 1246. https:\/\/doi.org\/10.3390\/ijerph22081246","DOI":"10.3390\/ijerph22081246"},{"key":"154804","doi-asserted-by":"crossref","unstructured":"Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535\u2013544. https:\/\/doi.org\/10.1176\/ajp.137.5.535","DOI":"10.1176\/ajp.137.5.535"},{"key":"154805","doi-asserted-by":"crossref","unstructured":"Hahn, L., Dreyer, E.-M., Thomann, M., Beyer, S., Ehmann, L., Ganster, F., Jegen, M., Mahner, S., Kolben, T., & Meister, S. (2025). Satisfaction with breastfeeding and not frequency of feeding is associated with a reduction of postpartum depressive symptoms. Breastfeeding Medicine, 20(6), 424\u2013431. https:\/\/doi.org\/10.1089\/bfm.2024.0315","DOI":"10.1089\/bfm.2024.0315"},{"key":"154806","unstructured":"Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). Guilford Press."},{"key":"154807","doi-asserted-by":"crossref","unstructured":"Ji, Q.-Q., & Wang, M.-Y. (2025). Epidemiology, pathophysiology, and interventions for postpartum depression: Systematic review. World Journal of Clinical Cases, 13(29), 110948. https:\/\/doi.org\/10.12998\/wjcc.v13.i29.110948","DOI":"10.12998\/wjcc.v13.i29.110948"},{"key":"154808","doi-asserted-by":"crossref","unstructured":"Lee, D. T. S., Yip, S. K., Chiu, H. F. K., Leung, T. Y. S., Chan, K. P. M., Chau, I. O. L., Leung, H. C. M., & Chung, T. K. H. (1998). Detecting postnatal depression in Chinese women: Validation of the Chinese version of the Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 172(5), 433\u2013437. https:\/\/doi.org\/10.1192\/bjp.172.5.433","DOI":"10.1192\/bjp.172.5.433"},{"key":"154809","doi-asserted-by":"crossref","unstructured":"Leff, E. W., Jefferis, S. C., & Gagne, M. P. (1994). The development of the maternal breastfeeding evaluation scale. Journal of Human Lactation, 10(2), 105\u2013111. https:\/\/doi.org\/10.1177\/089033449401000217","DOI":"10.1177\/089033449401000217"},{"key":"154810","doi-asserted-by":"crossref","unstructured":"Li, M., Chan, C. W. H., Choi, K. C., Zhang, H., Ng, S. N., Huang, L., Zhang, M., & Zhao, W. (2022). The Chinese version of the Revised Dyadic Adjustment Scale for gynaecological cancer patients and their partners: Translation and psychometric evaluation. Asia-Pacific Journal of Oncology Nursing, 9(1), 48\u201354. https:\/\/doi.org\/10.1016\/j.apjon.2021.12.004","DOI":"10.1016\/j.apjon.2021.12.004"},{"key":"154811","doi-asserted-by":"crossref","unstructured":"Liang, P., Wang, Y., Shi, S., Liu, Y., & Xiong, R. (2020). Prevalence and factors associated with postpartum depression during the COVID-19 pandemic among women in Guangzhou, China: A cross-sectional study. BMC Psychiatry, 20(1), 557. https:\/\/doi.org\/10.1186\/s12888-020-02969-3","DOI":"10.1186\/s12888-020-02969-3"},{"key":"154812","doi-asserted-by":"crossref","unstructured":"Liu, L., Feng, S., Zhang, Y., Xiao, G., Zhou, M., Li, X., Li, Y., & Qin, C. (2025). The role of breastfeeding self-efficacy in the relationship between perinatal depressive symptoms and exclusive breastfeeding: A longitudinal mediation analysis. BMC Pregnancy and Childbirth, 25(1), 356. https:\/\/doi.org\/10.1186\/s12884-025-07481-8","DOI":"10.1186\/s12884-025-07481-8"},{"key":"154813","unstructured":"National Bureau of Statistics of China. (2022). Seventh national population census. China: Statistics Press."},{"key":"154814","doi-asserted-by":"crossref","unstructured":"Nisar, A., Yin, J., Waqas, A., Bai, X., Wang, D., Rahman, A., & Li, X. (2020). Prevalence of perinatal depression and its determinants in Mainland China: A systematic review and meta-analysis. Journal of Affective Disorders, 277, 1022\u20131037. https:\/\/doi.org\/10.1016\/j.jad.2020.07.046","DOI":"10.1016\/j.jad.2020.07.046"},{"key":"154815","doi-asserted-by":"crossref","unstructured":"Rong, X.-F., Li, M.-Q., P\u00e9rez-L\u00f3pez, F. R., Wu, J.-N., & Zhang, B. (2023). Maternal expectations of fetal gender and risk of postpartum depression. BMC Pregnancy and Childbirth, 23(1), 112. https:\/\/doi.org\/10.1186\/s12884-023-05419-6","DOI":"10.1186\/s12884-023-05419-6"},{"key":"154816","doi-asserted-by":"crossref","unstructured":"Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.","DOI":"10.1515\/9781400876136"},{"key":"154817","unstructured":"Stryker, S. (1955). Attitude ascription in adult married offspring-parent relationships: A study of implications of the social psychological theory of G. H. Mead [Doctoral Dissertation, University of Minnesota, Minneapolis]."},{"key":"154818","doi-asserted-by":"crossref","unstructured":"Sun, M., Cao, F., Peng, J., Tang, J., He, Y., Zeng, Y., Tan, X., & Zhao, Q. (2024). Prevalence and risk factors of postpartum depression among women in low-income developing rural areas: A cross-sectional study in China. Depression and Anxiety, 2024(1), 8841423. https:\/\/doi.org\/10.1155\/2024\/8841423","DOI":"10.1155\/2024\/8841423"},{"key":"154819","doi-asserted-by":"crossref","unstructured":"Von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., G\u00f8tzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. The Lancet, 370(9596), 1453\u20131457. https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"154820","unstructured":"Wang, X. D., Wang, X. L., & Ma, H. (1999). Rating scales for mental health [in Chinese]. Beijing: Chinese Mental Health Journal Press."},{"key":"154821","doi-asserted-by":"crossref","unstructured":"Wang, Y., Gu, J., Zhang, F., & Xu, X. (2024). The multiple mediation model of social support and postpartum anxiety symptomatology: The role of resilience, postpartum stress, and sleep problems. BMC Psychiatry, 24(1), 630. https:\/\/doi.org\/10.1186\/s12888-024-06087-2","DOI":"10.1186\/s12888-024-06087-2"},{"key":"154822","doi-asserted-by":"crossref","unstructured":"Wang, Z., Liu, J., Shuai, H., Cai, Z., Fu, X., Liu, Y., Xiao, X., Zhang, W., Krabbendam, E., Liu, S., Liu, Z., Li, Z., & Yang, B. X. (2021). Mapping global prevalence of depression among postpartum women. Translational Psychiatry, 11(1), 543. https:\/\/doi.org\/10.1038\/s41398-021-01663-6","DOI":"10.1038\/s41398-021-01692-1"},{"key":"154823","unstructured":"WHO. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines (Vol. 1). World Health Organization. https:\/\/www.who.int\/publications\/i\/item\/9241544228"},{"key":"154824","unstructured":"WHO. (2022). Guide for integration of perinatal mental health in maternal and child health services. World Health Organization. https:\/\/www.who.int\/publications\/i\/item\/9789240057142"},{"key":"154825","unstructured":"Yu, H. J. (2012). Preliminary revision and application of the Maternal Breastfeeding Evaluation Scale [in Chinese] [Master's Thesis, Central South University]."},{"key":"154826","doi-asserted-by":"crossref","unstructured":"Zheng, J., Han, R., & Gao, L. (2024). Social support, parenting self-efficacy, and postpartum depression among Chinese parents: The actor-partner interdependence mediation model. Journal of Midwifery & Women's Health, 69(4), 559\u2013566. https:\/\/doi.org\/10.1111\/jmwh.13588","DOI":"10.1111\/jmwh.13588"}],"container-title":["Belitung Nursing Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4465\/1367","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4465\/1388","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/4465\/1367","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T03:31:01Z","timestamp":1782617461000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/view\/4465"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,28]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6,28]]}},"URL":"https:\/\/doi.org\/10.33546\/bnj.4465","relation":{},"ISSN":["2477-4073"],"issn-type":[{"value":"2477-4073","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,28]]},"assertion":[{"value":"2025-11-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-30","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}