{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:41Z","timestamp":1760060741371,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background: Depression is a significant public health concern, with working mothers at greater risk due to combined biological and psychosocial stressors. Recent evidence suggests that inner strength may play a mediating role in the link between biological risks and depression. Objectives: The primary objective was to determine whether inner strength mediates the relationship between biological risk factors (hormonal fluctuations, smoking, alcohol use, family psychiatric history, and physical diseases) and depressive symptoms among Chinese working mothers. A secondary objective was to assess the prevalence of depressive symptoms in this population, measured with the OI-Depression subscale (Outcome Inventory-21). Methods: A cross-sectional online survey was conducted with 330 Chinese working mothers aged 30\u201345 years, using validated instruments to measure depression, inner strength, and parental stress. Mediation analysis evaluated the indirect effect of inner strength, while covariate-adjusted regression analyses explored associated factors. Results: Biological risk factors showed a significant direct effect (\u03b2 = 0.584, p &lt; 0.001) and an indirect effect through inner strength (indirect effect = 0.623, 95% CI [0.294, 0.962]. The Sobel test indicated that the indirect effect of biological risk factors on depressive symptoms through inner strength was statistically significant (z = 3.67, p &lt; 0.001). The prevalence of clinically significant depressive symptoms was 38.2%. Conclusions: Biological factors significantly contribute to depressive symptoms, but inner strength partially mediates this relationship, suggesting that interventions to enhance inner strength may help reduce depression risk in working mothers. Further research should investigate strategies to build inner resilience in this population.<\/jats:p>","DOI":"10.3390\/nursrep15100348","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T12:05:13Z","timestamp":1758801913000},"page":"348","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Mediating Role of Inner Strength in the Relationship Between Biological Factors and Depressive Symptoms"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9206-7312","authenticated-orcid":false,"given":"Jia","family":"Jiao","sequence":"first","affiliation":[{"name":"Mental Health Program, Multidisciplinary and Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4534-8046","authenticated-orcid":false,"given":"Rewadee","family":"Jenraumjit","sequence":"additional","affiliation":[{"name":"Mental Health Program, Multidisciplinary and Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3068-9446","authenticated-orcid":false,"given":"Shirley","family":"Worland","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of New England, Armidale, NSW 2351, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5301-8624","authenticated-orcid":false,"given":"Saifon","family":"Bunyachatakul","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8195-4494","authenticated-orcid":false,"given":"Bijing","family":"He","sequence":"additional","affiliation":[{"name":"Mental Health Program, Multidisciplinary and Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Longquan Secondary Vocational School, Longquan 323700, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9062-3468","authenticated-orcid":false,"given":"Tinakon","family":"Wongpakaran","sequence":"additional","affiliation":[{"name":"Mental Health Program, Multidisciplinary and Interdisciplinary School, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.jpsychires.2019.08.002","article-title":"Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study","volume":"126","author":"Liu","year":"2020","journal-title":"J. Psychiatr. Res."},{"key":"ref_2","unstructured":"World Health Organization (2025, March 10). Mental Health in China. Available online: https:\/\/www.who.int\/china\/health-topics\/mental-health."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.jad.2020.08.081","article-title":"Work stress, family stress, and suicide ideation: A cross-sectional survey among working women in Shenzhen, China","volume":"277","author":"Lin","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1146\/annurev-soc-073014-112428","article-title":"Marriage and Family in East Asia: Continuity and Change","volume":"41","author":"Raymo","year":"2015","journal-title":"Annu. Rev. Sociol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Guo, X., Zhong, S., Li, L., and Luo, M. (2024). How housing burden damages residents\u2019 health: Evidence from Chinese cities. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1345775"},{"key":"ref_6","unstructured":"Textor, C. (2025, January 17). Population in China from 2014 to 2024, by Gender. Statista. Available online: https:\/\/www.statista.com\/statistics\/1225146\/china-employment-situation-of-mothers\/."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chai, H., Fu, R., and Coyte, P.C. (2021). How Do Middle-Aged Chinese Men and Women Balance Caregiving and Employment Income?. Healthcare, 9.","DOI":"10.20944\/preprints202102.0430.v1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s11199-019-01035-x","article-title":"Emotional Support Makes the Difference: Work-Family Conflict and Employment Related Guilt Among Employed Mothers","volume":"82","year":"2020","journal-title":"Sex Roles"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1093\/geroni\/igab046.3123","article-title":"Parenting stress and mental health in midlife adults: Evaluating the role of gender","volume":"5","author":"Choi","year":"2021","journal-title":"Innov. Aging"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"He, L., Mai, Z., Guan, X., Cai, P., Li, X., Feng, J., and Hung, S. (2025). The Moderating Role of Social Capital Between Parenting Stress and Mental Health and Well-Being Among Working Mothers in China. Healthcare, 2.","DOI":"10.3390\/healthcare13020117"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11920-024-01490-8","article-title":"Sex differences in stress susceptibility as a key mechanism underlying depression risk","volume":"26","author":"Mengelkoch","year":"2024","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.jad.2019.11.032","article-title":"Associations of body dissatisfaction with anxiety and depression in the pregnancy and postpartum periods: A longitudinal study","volume":"263","author":"Chan","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_13","first-page":"4","article-title":"Postpartum hormonal changes and maternal mental health: A narrative review","volume":"30","author":"Miller","year":"2021","journal-title":"J. Womens Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1177\/10398562231165439","article-title":"Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review","volume":"31","author":"Alblooshi","year":"2023","journal-title":"Australas Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1001\/jamapsychiatry.2021.0350","article-title":"Association of multigenerational family history of depression with lifetime depressive and other psychiatric disorders in children: Results from the Adolescent Brain Cognitive Development (ABCD) Study","volume":"78","author":"Murphy","year":"2021","journal-title":"JAMA Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101208","DOI":"10.1016\/j.jacadv.2024.101208","article-title":"Anxiety and depression associated with increased cardiovascular disease risk through accelerated development of risk factors","volume":"3","author":"Osborne","year":"2024","journal-title":"JACC Adv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jpsychires.2021.05.017","article-title":"Dynamic associations between anxiety, depression, and tobacco use in older adults: Results from The Irish Longitudinal Study on Ageing","volume":"139","author":"Monroe","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/00048674211009617","article-title":"Tobacco smoking and mental disorders in Australian adolescents","volume":"56","author":"Lawrence","year":"2022","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1192\/bjp.bp.111.097550","article-title":"Alcohol use disorders and the course of depressive and anxiety disorders","volume":"200","author":"Boschloo","year":"2012","journal-title":"Br. J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/0844562118790714","article-title":"Inner Strength-State of the Science","volume":"51","author":"Smith","year":"2019","journal-title":"Can. J. Nurs. Res."},{"key":"ref_21","unstructured":"Xie, Y. (2016). The Relationship Among Internal Strength, Self-Efficacy and Quality of Life in Patients with Chronic Liver Disease. [Master\u2019s Thesis, Yanbian University]."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mao, B., Kanjanarat, P., Wongpakaran, T., Permsuwan, U., and O\u2019Donnell, R. (2023). Factors Associated with Depression, Anxiety and Somatic Symptoms Among International Salespeople in the Medical Device Industry: A Cross-sectional Study in China. Healthcare, 11.","DOI":"10.20944\/preprints202306.0518.v1"},{"key":"ref_23","unstructured":"Wu, X., Luo, Q., Ma, W., and Xie, C. (2024). Status and development of community nursing in China: Challenges and opportunities. Front. Public Health, 12."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2409423122","DOI":"10.1073\/pnas.2409423122","article-title":"Intracranial substrates of meditation-induced neuromodulation in the amygdala and hippocampus","volume":"122","author":"Maher","year":"2025","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_25","first-page":"121","article-title":"The intervention effect of mindfulness-based stress reduction therapy on patients with depression","volume":"19","author":"Wang","year":"2024","journal-title":"Psychol. Mon."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E17","DOI":"10.5888\/pcd22.240200","article-title":"Nurse-Led Mental Health Interventions for College Students: A Systematic Review","volume":"22","author":"Russell","year":"2025","journal-title":"Prev. Chronic Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e09682","DOI":"10.1016\/j.heliyon.2022.e09682","article-title":"Development and validation of 21-item outcome inventory (OI-21)","volume":"8","author":"Wongpakaran","year":"2022","journal-title":"Heliyon"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wongpakaran, T., Yang, T., Varnado, P., Siriai, Y., Mirnics, Z., K\u00f6vi, Z., and Wongpakaran, N. (2023). The development and validation of a new resilience inventory based on inner strength. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-29848-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1177\/0265407595123009","article-title":"The parental stress scale: Initial psychometric evidence","volume":"12","author":"Berry","year":"1995","journal-title":"J. Soc. Pers. Relat."},{"key":"ref_30","first-page":"253","article-title":"Psychometric properties of the Chinese version of the parental stress scale","volume":"43","author":"Cheung","year":"2000","journal-title":"Psychologia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s10433-021-00642-6","article-title":"Relationships among inner strength, health and function, well-being, and negative life events in old people: A longitudinal study","volume":"19","author":"Viglund","year":"2021","journal-title":"Eur. J. Ageing"},{"key":"ref_32","first-page":"101987","article-title":"Emotional regulation mediates the effect of inner strengths on depression","volume":"85","author":"Johnson","year":"2021","journal-title":"Clin. Psychol. Rev."},{"key":"ref_33","first-page":"456","article-title":"Mindfulness-based cognitive therapy for nurses: Impact on mindfulness and burnout","volume":"71","author":"Smith","year":"2023","journal-title":"Nurs. Outlook"},{"key":"ref_34","first-page":"1654","article-title":"A randomized controlled trial of acceptance and commitment therapy for patience and equanimity improvement","volume":"77","author":"Johnson","year":"2021","journal-title":"J. Clin. Psychol."},{"key":"ref_35","unstructured":"Gawlik, K., and Melnyk, B. (2024). Pandemic Parenting: Examining the Epidemic of Working Parental Burnout and Strategies to Help, Ohio State University."},{"key":"ref_36","first-page":"448","article-title":"Association of working hours with depressive symptoms: A longitudinal study of UK employees","volume":"73","author":"Weston","year":"2019","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_37","first-page":"1373","article-title":"Perinatal mental health in India and Thailand: A call for collaboration","volume":"18","author":"Jatchavala","year":"2023","journal-title":"J. Taibah Univ. Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ajp.2018.08.014","article-title":"Interventions for perinatal depression in low and middle-income countries: A systematic review","volume":"37","author":"Gajaria","year":"2018","journal-title":"Asian J. Psychiatr."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Wang, X., Zhao, G., Di, J., Wang, L., and Zhang, X. (2022). Prevalence and risk factors for depressive and anxiety symptoms in middle-aged Chinese women: A community-based cross-sectional study. BMC Womens Health, 22.","DOI":"10.1186\/s12905-022-01908-6"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Zhao, J., and Zhang, M. (2024). Postpartum depression and risk factors among working women one year after delivery in Beijing, China: A cross-sectional study. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1346583"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2114182","DOI":"10.1080\/19932820.2022.2114182","article-title":"Prevalence and associated factors of perinatal depression among working pregnant women: A hospital-based cross-sectional study","volume":"17","author":"Jihed","year":"2022","journal-title":"Libyan J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.3126\/nje.v12i1.43633","article-title":"The Growing Importance of Mixed-Methods Research in Health","volume":"12","author":"Wasti","year":"2022","journal-title":"Nepal. J. Epidemiol."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/10\/348\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:49:32Z","timestamp":1760035772000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/10\/348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nursrep15100348"],"URL":"https:\/\/doi.org\/10.3390\/nursrep15100348","relation":{},"ISSN":["2039-4403"],"issn-type":[{"type":"electronic","value":"2039-4403"}],"subject":[],"published":{"date-parts":[[2025,9,25]]}}}