Various forms of life stressors have been implicated as causes of antenatal depression. However, there is a lack of understanding of which forms of stress lead to antenatal depression and through what mechanisms. Modeling stress processes within a theoretical model framework can enhance an understanding of the mechanisms underlying relationships between stressors and stress outcomes. This study used the stress process model framework to explore the causal mechanisms underlying antenatal depression in Gondar, Ethiopia. Questionnaires, using an Online Data collection Kit (ODK) tool were administered face-to-face in 916 pregnant women in their second and third trimesters. Pregnant women were included from six randomly selected urban districts in Gondar, Ethiopia during June and August 2018. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depression. A Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effect of stressors and mediators of antenatal depression. Sixty-three participants (6.9%) reported symptoms of depression. Of these, 16 (4.7%) and 47 (8.1%) were in their second and third trimesters, respectively. The SEM demonstrated several direct effects on antenatal depression scores including unplanned pregnancy (standardized β = 0.15), having a history of common mental health disorder (standardized β = 0.18) and fear of giving birth to the current pregnancy (standardized β = 0.29), all of which were associated with a higher depression score. Adequate food access for the last 3 months (standardized β = − 0.11) was associated with decreased depression score. Social support (β = − 0.21), marital agreement (β = − 0.28), and partner support (β = −.18) appeared to partially mediate the link between the identified stressors and the risk of antenatal depression. Both direct and indirect effects contributed to higher antenatal depression score in Ethiopian women. The three psychosocial resources namely marital agreement, social and partner support, mediated reduced antenatal depression scores. Early screening of antenatal depression and enhancing the three psychosocial resources would help to improve maternal resilience.

中文翻译：

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贡德尔镇孕产妇产前抑郁及其潜在因果机制：结构方程模型的应用


各种形式的生活压力源已被认为是产前抑郁症的原因。然而，人们对哪些形式的压力导致产前抑郁症以及通过哪些机制缺乏了解。在理论模型框架内对压力过程进行建模可以增强对压力源和压力结果之间关系的潜在机制的理解。本研究使用压力过程模型框架探讨埃塞俄比亚贡德尔产前抑郁症的因果机制。使用在线数据收集套件 (ODK) 工具对 916 名处于妊娠中期和晚期的孕妇进行了面对面的问卷调查。 2018 年 6 月至 8 月，来自埃塞俄比亚贡德尔的六个随机选择的城区的孕妇被纳入其中。爱丁堡产后抑郁量表（EPDS）用于筛查产前抑郁症。采用结构方程模型（SEM）来探讨产前抑郁症的压力源和中介因素的直接、间接和总体影响。六十三名参与者（6.9%）报告了抑郁症状。其中，分别有 16 名 (4.7%) 和 47 名 (8.1%) 处于妊娠中期和晚期。 SEM 证明了对产前抑郁评分的几个直接影响，包括计划外怀孕（标准化 β = 0.15）、有常见心理健康障碍史（标准化 β = 0.18）以及对当前怀孕分娩的恐惧（标准化 β = 0.29），所有这些都与较高的抑郁评分相关。过去 3 个月获得充足的食物（标准化 β = − 0.11）与抑郁评分下降相关。社会支持（β = − 0.21）、婚姻协议（β = − 0.28）和伴侣支持（β = −。18）似乎部分介导了已确定的压力源与产前抑郁症风险之间的联系。直接和间接影响都导致埃塞俄比亚妇女产前抑郁评分较高。三种心理社会资源，即婚姻协议、社会和伴侣支持，介导了产前抑郁评分的降低。产前抑郁症的早期筛查和增强三种心理社会资源将有助于提高孕产妇的复原力。