{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:10:23Z","timestamp":1789567823264,"version":"build-2803163510"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n Postpartum depressive symptoms are common and can adversely affect maternal and infant health. Traditional Chinese medicine health literacy may play an important role in promoting physical and mental recovery during the puerperium. However, evidence regarding the association between traditional Chinese medicine health literacy and postpartum depressive symptoms remains limited, and the underlying mediating mechanisms are unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To explore the relationship between Traditional Chinese Medicine health literacy and depressive symptoms in postpartum women, and to examine the sequential mediating role of social support and self-efficacy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Using convenience sampling, this cross-sectional study was conducted in Chengdu, China from December 2025 to April 2026. A total of 501 postpartum women completed measures of traditional Chinese medicine health literacy, social support, self-efficacy, and depressive symptoms. After adjusting for covariates, sequential mediation was examined by PROCESS 4.1 Model 6. Bias-corrected bootstrap (5,000 resamples) was used to generate 95% confidence intervals; indirect effects were deemed significant if the interval did not include zero. All tests were two-tailed with\n \u03b1<\/jats:italic>\n \u202f=\u202f0.05.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The scores of traditional Chinese medicine health literacy, postpartum social support, self-efficacy, and depressive symptoms were (118.21\u202f\u00b1\u202f14.56), (47.72\u202f\u00b1\u202f11.41), (29.22\u202f\u00b1\u202f6.44), and (7.16\u202f\u00b1\u202f4.99), respectively. Depressive symptoms were significantly negatively correlated with traditional Chinese medicine health literacy, social support, and self-efficacy (all\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Traditional Chinese medicine health literacy exerted a direct negative effect on depressive symptoms (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.206, 95%\n CI<\/jats:italic>\n : \u22120.299 to \u22120.112). In addition, three significant indirect pathways were identified: the independent mediating pathway through social support (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.102, 95%\n CI<\/jats:italic>\n : \u22120.167 to \u22120.050), the independent mediating pathway through self-efficacy (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.102, 95%\n CI<\/jats:italic>\n : \u22120.148 to \u22120.059), and the sequential mediating pathway from social support to self-efficacy (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.033, 95%\n CI<\/jats:italic>\n : \u22120.053 to \u22120.018). The total indirect effect accounted for 53.6% of the total effect.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Intervention strategies designed to improve postpartum women\u2019s traditional Chinese medicine health literacy, strengthen social support and boost self-efficacy may aid the prevention and control of postpartum depressive symptoms. The actual effectiveness of relevant intervention programs needs to be further verified in subsequent longitudinal studies and intervention trials.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1891379","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:47:56Z","timestamp":1789566476000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Traditional Chinese medicine health literacy and depressive symptoms in postpartum women: the sequential mediating effects of social support and self-efficacy"],"prefix":"10.3389","volume":"14","author":[{"given":"Dian","family":"Liu","sequence":"first","affiliation":[{"name":"School of Basic Medical Sciences & School of Nursing, Chengdu University","place":["Chengdu, China"]},{"name":"Clinical Medical College & Affiliated Hospital of Chengdu University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomei","family":"Xu","sequence":"additional","affiliation":[{"name":"Clinical Medical College & Affiliated Hospital of Chengdu University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangui","family":"L\u00fc","sequence":"additional","affiliation":[{"name":"Clinical Medical College & Affiliated Hospital of Chengdu University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"248","DOI":"10.3389\/fpsyt.2017.00248","article-title":"Economic and health predictors of National Postpartum Depression Prevalence: a systematic review, Meta-analysis, and Meta-regression of 291 studies from 56 countries","volume":"8","author":"Hahn-Holbrook","year":"2018","journal-title":"Front Psych"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1193490","DOI":"10.3389\/fpsyt.2023.1193490","article-title":"Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries","volume":"14","author":"Fish-Williamson","year":"2023","journal-title":"Front Psych"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"103410","DOI":"10.1016\/j.artmed.2026.103410","article-title":"Machine learning-based methods for predicting postpartum depression: a review","volume":"176","author":"Zhang","year":"2026","journal-title":"Artif Intell Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"5230","DOI":"10.3390\/ijerph17145230","article-title":"Personal and family resources related to depressive and anxiety symptoms in women during puerperium","volume":"17","author":"Feligreras-Alcal\u00e1","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1304226","DOI":"10.3389\/fpubh.2023.1304226","article-title":"Correlation of lifestyle behaviors during pregnancy with postpartum depression status of puerpera in the rural areas of South China","volume":"11","author":"Ding","year":"2023","journal-title":"Front Public Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s12888-025-06557-1","article-title":"The effects of maternal health literacy, family functioning and self-efficacy on antepartum depression in pregnant women in China: a moderated mediation model","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"17455057251343953","DOI":"10.1177\/17455057251343953","article-title":"Predictors of postpartum depression among new mothers in Kumasi, Ghana: a multicenter study using Bayesian analysis","volume":"21","author":"Bening","year":"2025","journal-title":"Womens Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"649972","DOI":"10.3389\/fpsyt.2021.649972","article-title":"Adherence to traditional Chinese postpartum practices and postpartum depression: a cross-sectional study in Hunan, China","volume":"12","author":"Guo","year":"2021","journal-title":"Front Psych"},{"key":"ref9","author":"Yao","year":"2023"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1471-2458-12-80","article-title":"Health literacy and public health: a systematic review and integration of definitions and models","volume":"12","author":"\u00f8rensen","year":"2012","journal-title":"BMC Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"26870","DOI":"10.1038\/s41598-025-12309-8","article-title":"The influence of postpartum depression literacy on health promoting behaviors among postpartum women","volume":"15","author":"Chen","year":"2025","journal-title":"Sci Rep"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.yfpn.2021.12.010","article-title":"Measuring the impact of health literacy on perinatal depression","volume":"4","author":"Audritsh","year":"2022","journal-title":"Adv Fam Pract Nurs"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.joim.2023.03.001","article-title":"Understanding health literacy from a traditional Chinese medicine perspective","volume":"21","author":"Qian","year":"2023","journal-title":"J Integr Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.16448\/j.cjtcm.2021.1005","article-title":"Analysis of postpartum depression based on the liver governing free coursing theory","volume":"33","author":"Shi","year":"2021","journal-title":"Chin J Clin Med Tradit Chin Med"},{"key":"ref15","first-page":"731","article-title":"Study on the correlation between social support and postpartum depression among primiparas","volume":"36","author":"Lu","year":"2001","journal-title":"Chin J Nurs"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"6906","DOI":"10.1038\/s41598-024-57477-1","article-title":"Social support during pregnancy and the risk of postpartum depression in polish women: a prospective study","volume":"14","author":"\u017byrek","year":"2024","journal-title":"Sci Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1714668","DOI":"10.3389\/fpubh.2025.1714668","article-title":"Risk factors for postpartum depression: an umbrella review","volume":"13","author":"Xu","year":"2025","journal-title":"Front Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/7527890","article-title":"Application of traditional Chinese medical science characteristic nursing mode based on evidence-based medicine to puerperal breast tenderness and pain","volume":"2022","author":"Liu","year":"2022","journal-title":"Evid Based Complement Alternat Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"Psychol Bull"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1037\/\/0033-295x.84.2.191","article-title":"Self-efficacy: toward a unifying theory of behavioral change","volume":"84","author":"Bandura","year":"1977","journal-title":"Psychol Rev"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1186\/s12884-026-09177-z","article-title":"The relationship between maternal attachment, maternal self-efficacy, and postpartum depressive symptoms in mothers during the early postpartum period: a cross-sectional study","volume":"26","author":"Ozyazici","year":"2026","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2573","DOI":"10.31557\/APJCP.2024.25.7.2573","article-title":"CheckAP: a checklist for reporting a knowledge, attitude, and practice (KAP) study","volume":"25","author":"Zarei","year":"2024","journal-title":"Asian Pac J Cancer Prev"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2748707","DOI":"10.1155\/da\/2748707","article-title":"Feeding patterns and postpartum depressive symptoms: the mediating role of parenting self-efficacy","volume":"2025","author":"Zhu","year":"2025","journal-title":"Depress Anxiety"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1177\/10547738261428815","article-title":"Effects of maternal self-efficacy and social support in the development of postpartum depression among primiparous mothers in Jordan: a cross-sectional study","volume":"35","author":"Mohammad","year":"2026","journal-title":"Clin Nurs Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"106631","DOI":"10.1016\/j.appet.2023.106631","article-title":"Utility of the capability, opportunity, and motivation behaviour (COM-B) model in explaining the negative association between pre-pregnancy body mass index and exclusive breastfeeding at six weeks postpartum","volume":"188","author":"Ren","year":"2023","journal-title":"Appetite"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1117332","DOI":"10.3389\/fpsyt.2023.1117332","article-title":"Postpartum depression literacy in Chinese perinatal women: a cross-sectional study","volume":"14","author":"Huang","year":"2023","journal-title":"Front Psych"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*power 3.1: tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav Res Methods"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1857565","DOI":"10.3389\/fpubh.2026.1857565","article-title":"eHealth literacy and health responsibility among older adults: the serial indirect roles of self-efficacy and social support based on the health promotion model","volume":"14","author":"Wang","year":"2026","journal-title":"Front Public Health"},{"key":"ref30","first-page":"37","article-title":"Evidences for reliability and validity of the Chinese version of general self-efficacy scale","volume":"7","author":"Wang","year":"2001","journal-title":"Chin J Appl Psychol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12889-024-21213-1","article-title":"Factor structure and longitudinal measurement invariance of Edinburgh postnatal depression scale during the whole perinatal period: a multicenter cohort study in China","volume":"25","author":"Yang","year":"2025","journal-title":"BMC Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1692231","DOI":"10.3389\/fpubh.2025.1692231","article-title":"Prevalence and influencing factors of perinatal depression across different stages of pregnancy and postpartum: a cross-sectional study in China","volume":"13","author":"Fu","year":"2026","journal-title":"Front Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1186\/s13063-024-08202-w","article-title":"Accounting for center-level effects in multicenter randomized controlled trials","volume":"25","author":"Islam","year":"2024","journal-title":"Trials"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"52","DOI":"10.5395\/rde.2013.38.1.52","article-title":"Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis","volume":"38","author":"Kim","year":"2013","journal-title":"Restor Dent Endod"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol"},{"key":"ref36","first-page":"2865","article-title":"Analysis of Chinese citizens\u2019 traditional Chinese medicine health culture literacy level and its influence factors in 2017","author":"Tan","year":"2019"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"17455057251347086","DOI":"10.1177\/17455057251347086","article-title":"Association between maternal-infant health literacy, social support, and psychological stress during the perinatal period among women in Macao, China","volume":"21","author":"Lai","year":"2025","journal-title":"Womens Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e20250187","DOI":"10.1590\/1980-220X-REEUSP-2025-0187en","article-title":"Perceptions of discharge readiness among primiparas based on the king\u2019s theory of goal attainment: a qualitative study","volume":"59","author":"Liu","year":"2025","journal-title":"Rev Esc Enferm USP"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"62","DOI":"10.29063\/ajrh2025\/v29i10.6","article-title":"Association between postpartum post-traumatic stress disorder, maternal functioning, and self-efficacy in women after cesarean section","volume":"29","author":"Ma","year":"2025","journal-title":"Afr J Reprod Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1942","DOI":"10.1186\/s12889-025-23132-1","article-title":"Mental health service utilization among pregnant and postpartum women: status, determinants, and insights from a mixed-methods study","volume":"25","author":"Zhu","year":"2025","journal-title":"BMC Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1627853","DOI":"10.3389\/fpsyt.2025.1627853","article-title":"Health education and postpartum depression: exploring associations in clinical data","volume":"16","author":"Song","year":"2025","journal-title":"Front Psych"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"2444","DOI":"10.3390\/healthcare14162444","article-title":"Health literacy, psychological distress and fertility attitudes among postpartum women: a mediation analysis","volume":"14","author":"Buljuba\u0161i\u0107","year":"2026","journal-title":"Healthcare"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e28939","DOI":"10.1097\/MD.0000000000028939","article-title":"Effects of the non-pharmacological interventions of traditional Chinese medicine on postpartum depression: a protocol for systematic review and network meta-analysis","volume":"101","author":"Huang","year":"2022","journal-title":"Medicine"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1186\/s12906-025-04952-5","article-title":"Predictors of pregnant and breastfeeding women\u2019s intention to use traditional Chinese medicine: a cross-sectional study from China","volume":"25","author":"Li","year":"2025","journal-title":"BMC Complement Med Ther"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"633","DOI":"10.3390\/ijerph18020633","article-title":"Social support, health literacy and depressive symptoms among medical students: an analysis of mediating effects","volume":"18","author":"Zhong","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.whi.2025.10.009","article-title":"Matrescence: a critical and sensitive period in the maternal and child health (MCH) life course perspective","volume":"36","author":"Parimi","year":"2026","journal-title":"Womens Health Issues"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e0249538","DOI":"10.1371\/journal.pone.0249538","article-title":"Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women","volume":"16","author":"Mercan","year":"2021","journal-title":"PLoS One"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.3390\/healthcare13131626","article-title":"Pathways linking ICT use to chronic disease self-management among older adults with comorbidities in Shanghai, China","volume":"13","author":"Chen","year":"2025","journal-title":"Healthcare"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1904185","DOI":"10.3389\/fpubh.2026.1904185","article-title":"Understanding the relationship between eHealth literacy, self-efficacy, social support, and patient activation in breast cancer patients: a chain mediation analysis","volume":"14","author":"Hou","year":"2026","journal-title":"Front Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1891379\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:47:58Z","timestamp":1789566478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1891379\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2026.1891379"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1891379","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1891379"}}