Volume 25, Issue 3 (May-June 2026)
Payesh 2026, 25(3): 373-385 |
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Ethics code: IR.MUBABOL.REC.1401.130
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Rafat N, Adib-Rad H, Bakouei S, Nikbakht H, Bakouei F. Health-promoting behaviors and social and reproductive determinants influencing adherence to these behaviors in prenatal depression. Payesh 2026; 25 (3) :373-385
URL: http://payeshjournal.ir/article-1-2746-en.html
URL: http://payeshjournal.ir/article-1-2746-en.html
1- Student Research Committee, Babol University of Medical Sciences, Babol, I.R. Iran
2- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
3- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
4- Social Determinants of Health Research Center, Health Research Institute, Department of Epidemiology and Biostatistics, School of Public Health, Babol University of Medical Sciences, Babol, Iran
2- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran
3- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
4- Social Determinants of Health Research Center, Health Research Institute, Department of Epidemiology and Biostatistics, School of Public Health, Babol University of Medical Sciences, Babol, Iran
Abstract: (59 Views)
Objective(s): Prenatal depression has numerous adverse effects on fetus, mother, and child's future well-being. Given the importance of health-promoting behaviors as potential predictors of depression, the present study aimed to determine the prenatal depression, related health-promoting behaviors and the social and reproductive factors influencing adherence to these behaviors in pregnant women.
Methods: This cross-sectional study was conducted on 308 eligible pregnant women attending the prenatal clinics of teaching hospitals in Babol. The depression variable was assessed using the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire; while health-promoting behaviors were assessed using the Health Promoting Lifestyle Profile II (HPLPII) and social and reproductive factors were also evaluated. Data were analyzed using version 23 of SPSS software.
Results: The prevalence of antenatal depression based on the EPDS and the PHQ-9 was 17.9% and 29.2%, respectively. The mean total score of health-promoting behaviors and all dimensions except for interpersonal relationships in non-depressed women (based on two questionnaires) was significantly higher than that of the depressed group. The most significant difference was observed in the spiritual growth between the two groups. In the final analysis in the linear regression model, women's education level (P=0.013) and participation in childbirth preparation classes (P<0.001) were identified as two significant predictors of adherence to health-promoting behaviors.
Conclusion: Attending childbirth preparation classes effectively promotes adherence to health-enhancing behaviors and reduces the incidence of depression. Furthermore, considering the influence of education level on health-promoting behaviors, healthcare providers should pay closer attention to mothers with low or moderate education levels. This approach will help to adequately meet the needs of these mothers, ultimately leading to an improved lifestyle and a reduction in prenatal depression.
Methods: This cross-sectional study was conducted on 308 eligible pregnant women attending the prenatal clinics of teaching hospitals in Babol. The depression variable was assessed using the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire; while health-promoting behaviors were assessed using the Health Promoting Lifestyle Profile II (HPLPII) and social and reproductive factors were also evaluated. Data were analyzed using version 23 of SPSS software.
Results: The prevalence of antenatal depression based on the EPDS and the PHQ-9 was 17.9% and 29.2%, respectively. The mean total score of health-promoting behaviors and all dimensions except for interpersonal relationships in non-depressed women (based on two questionnaires) was significantly higher than that of the depressed group. The most significant difference was observed in the spiritual growth between the two groups. In the final analysis in the linear regression model, women's education level (P=0.013) and participation in childbirth preparation classes (P<0.001) were identified as two significant predictors of adherence to health-promoting behaviors.
Conclusion: Attending childbirth preparation classes effectively promotes adherence to health-enhancing behaviors and reduces the incidence of depression. Furthermore, considering the influence of education level on health-promoting behaviors, healthcare providers should pay closer attention to mothers with low or moderate education levels. This approach will help to adequately meet the needs of these mothers, ultimately leading to an improved lifestyle and a reduction in prenatal depression.
type of study: Descriptive |
Subject:
Social Determinants of Health
Received: 2024/12/14 | Accepted: 2025/05/14 | ePublished ahead of print: 2026/04/28 | Published: 2026/05/6
Received: 2024/12/14 | Accepted: 2025/05/14 | ePublished ahead of print: 2026/04/28 | Published: 2026/05/6
References
1. Insan N, Weke A, Forrest S, Rankin J. Social determinants of antenatal depression and anxiety among women in South Asia: A Systematic Review & Meta-Analysis. PLOS ONE 2022; 17:e0263760 [DOI:10.1371/journal.pone.0263760]
2. Gong M, Zhang S, Xi C, Luo M, Wang T, Wang Y, et al. Comprehensive intervention during pregnancy based on short message service to prevent or alleviate depression in pregnant women: A quasi-experimental study. Early Intervention in Psychiatry 2021; 15:352-359 [DOI:10.1111/eip.12953]
3. Wegbom AI, Edet CK, Ogba AA, Osaro BO, Harry AM, Pepple BG, et al. Determinants of Depression, Anxiety, and Stress among Pregnant Women Attending Tertiary Hospitals in Urban Centers, Nigeria. Women 2023; 3:41-52 [DOI:10.3390/women3010003]
4. Atak M, Sezerol MA, Koçak EN, Değer MS, Kurubal H. Prevalence of depression, anxiety, and associated factors in immigrant pregnant women in Türkiye: A cross-sectional study. Medicine (Baltimore) 2023; 102: e36616 [DOI:10.1097/MD.0000000000036616]
5. Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. The Lancet Psychiatry 2016; 3:973-982 [DOI:10.1016/S2215-0366(16)30284-X]
6. Williams A, Sarker M, Ferdous ST. Cultural Attitudes Toward Postpartum Depression in Dhaka, Bangladesh. Medical Anthropology 2018; 37:194-205 [DOI:10.1080/01459740.2017.1318875]
7. Huang X, Wang Y, Wang Y, Guo X, Zhang L, Wang W, et al. Prevalence and factors associated with trajectories of antenatal depression: a prospective multi-center cohort study in Chengdu, China. BMC Pregnancy Childbirth 2023; 23:358 [DOI:10.1186/s12884-023-05672-9]
8. Yin X, Sun N, Jiang N, Xu X, Gan Y, Zhang J, et al. Prevalence and associated factors of antenatal depression: Systematic reviews and meta-analyses. Clinical Psychology Review 2021; 83:101932 [DOI:10.1016/j.cpr.2020.101932]
9. Firouzbakht M, Rahmani N, Sharif Nia H, Omidvar S. Coping strategies and depression during the COVID-19 pandemic in pregnant women: a cross sectional study. BMC Psychiatry 2022; 22:153 [DOI:10.1186/s12888-022-03792-8]
10. Mirsalimi F, Montazeri A, Noroozi A. The Prevalence of Depression and Associated Factors among Primigravid Women. Health Education and Health Promotion 2020; 8:189-195
11. Frankham LJ, Thorsteinsson EB, Bartik W. The Impact of COVID-19 Related Distress on Antenatal Depression in Australia. International Journal of Environmental Research And Public Health 2023; 20:4783 [DOI:10.3390/ijerph20064783]
12. Oljira L, Abdissa E, Lema M, Merdassa E, Wakoya Feyisa J, Desalegn M. Antenatal depression and associated factors among pregnant women attending antenatal care at public health facilities in the Gida Ayana district, Oromia Region, West Ethiopia, in 2022. Frontiers in Public Health 2023; 11:1176703 [DOI:10.3389/fpubh.2023.1176703]
13. Al-Abri K, Edge D, Armitage CJ. Prospective analysis of factors associated with perinatal depression. Midwifery 2024; 128:103871 [DOI:10.1016/j.midw.2023.103871]
14. Dosani A, Arora H, Mazmudar S. mHealth and Perinatal Depression in Low-and Middle-Income Countries: A Scoping Review of the Literature. International Journal of Environmental Research and Public Health 2020; 17:7679 [DOI:10.3390/ijerph17207679]
15. Eastwood J, Ogbo FA, Hendry A, Noble J, Page A. The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women. PLOS ONE 2017; 12: e0169907 [DOI:10.1371/journal.pone.0169907]
16. United Nations. Transforming our world: the 2030 agenda for sustainable development [Internet]. New York, NY: UN; 2015 [cited 2024 May 8]. Available from: https:// wedocs.unep.org/20.500.11822/9814
17. Silva MMJ, Serrano TBM, Porcel GDS, Monteiro BB, Clapis MJ. Risk of depression during pregnancy in usual risk antenatal care. Revista Latino-Americana De Enfermagem 2023; 31: e3962 [DOI:10.1590/1518-8345.6463.3963]
18. Xiao J, Xiong R, Wen Y, Liu L, Peng Y, Xiao C, et al. Antenatal depression is associated with perceived stress, family relations, educational and professional status among women in South of China: a multicenter cross-sectional survey. Frontiers in Psychiatry 2023; 14:1191152 [DOI:10.3389/fpsyt.2023.1191152]
19. Rehman A U, Kazmi S. Psychopathology, health promoting and health impairing behavior among pregnant women. Pakistan Journal of Social Research 2023; 5:69-75 [DOI:10.52567/pjsr.v5i01.1004]
20. Abdolkarimi M, Mobini Lotfabad M, Khodadadi H, ُShahabinejad E, Shakoeizadeh A. The survey of health-promoting behaviors among students of Rafsanjan University of Medical Sciences in 2022: A Descriptive Study. Journal of Rafsanjan University of Medical Sciences 2024; 22:1191-1204 [Persian] [DOI:10.61186/jrums.22.11.1191]
21. Kara P, Evsen N, Yıkar S, Var E, Akçayüzlü Ö, Özdemir F. Health-Promoting Lifestyles in Pregnant Adolescents and the Affecting Factors. Journal of Midwifery and Health Research 2024; 7:125-134
22. Montazeri M, Shabani F, Rezaie R, Mirghafourvand M. Relationship between health practices with attitudes towards pregnancy and motherhood and pregnancy symptoms in Iranian pregnant women: a cross-sectional study. BMJ Open 2023; 13: e074048 [DOI:10.1136/bmjopen-2023-074048]
23. Fathnezhad-Kazemi A, Aslani A, Hajian S. Association between perceived social support and health-promoting lifestyle in pregnant women: A cross-sectional study. Journal of Caring Sciences 2021; 10:96-102 [DOI:10.34172/jcs.2021.018]
24. Van Lee L, Chia A, Phua D, Colega M, Padmapriya N, Bernard JY, et al. Multiple modifiable lifestyle factors and the risk of perinatal depression during pregnancy: Findings from the GUSTO cohort. Comprehensive Psychiatry 2020; 103:152210 [DOI:10.1016/j.comppsych.2020.152210]
25. Bae HS, Kim SY, Ahn HS, Cho YK. Comparison of nutrient intake, life style variables, and pregnancy outcomes by the depression degree of pregnant women. Nutrition Research and Practice 2010; 4:323-331 [DOI:10.4162/nrp.2010.4.4.323]
26. Seixas A, Connors C, Chung A, Donley T, Jean-Louis G. A pantheoretical framework to optimize adherence to healthy lifestyle behaviors and medication adherence: The use of personalized approaches to overcome barriers and optimize facilitators to achieve adherence. Journal of Medical Internet Research Mhealth Uhealth 2020 8: e16429 [DOI:10.2196/16429]
27. World Health Organization. Available online: https://www.who.int/health-topics/social-determinants-of-health (accessed on 8 May 2024)
28. Centers for Disease Control and Prevention (CDC) [Internet]. [cited 2024 May 8]. Available from: https://www.cdc.gov/about/sdoh/index.html
29. Romero-Barranca J, Garcia-Cabrera E, Román E, Quintero-Flórez A, Luque-Romero LG, Vilches-Arenas Á. Influential social determinants of adherence to preventive and health promotion activities during pregnancy and the first year of life: Systematic Review. Children (Basel, Switzerland) 2024; 11:331 [DOI:10.3390/children11030331]
30. Chorwe-Sungani G, Chipps J. Validity and utility of instruments for screening of depression in women attending antenatal clinics in Blantyre district in Malawi. South African Family Practice 2018; 60:114-120 [DOI:10.1080/20786190.2018.1432136]
31. Stefana A, Langfus JA, Palumbo G, Cena L, Trainini A, Gigantesco A, et al. Comparing the factor structures and reliabilities of the EPDS and the PHQ-9 for screening antepartum and postpartum depression: a multigroup confirmatory factor analysis. Archives of Women's Mental Health 2023; 26:659-668 [DOI:10.1007/s00737-023-01337-w]
32. Rashan N, Sharifi N, Fathnezhad-Kazemi A, Golnazari K, Taheri S. The association between social support and psychological factors with health-promoting behaviours in pregnant women: A cross-sectional study. Journal of Education and Health Promotion 2021; 10:9 [DOI:10.4103/jehp.jehp_390_20]
33. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry: The Journal of Mental Science 1987; 150:782-786 [DOI:10.1192/bjp.150.6.782]
34. Zubaran C, Schumacher M, Roxo MR, Foresti K. Screening tools for postpartum depression: validity and cultural dimensions. African Journal of Psychiatry 2010; 13:357-365 [DOI:10.4314/ajpsy.v13i5.63101]
35. Montazeri A, Torkan B, Omidvari S. The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the iranian version. BMC Psychiatry 2007; 7:11 [DOI:10.1186/1471-244X-7-11]
36. Sun Y, Fu Z, Bo Q, Mao Z, Ma X, Wang C. The reliability and validity of PHQ-9 in patients with major depressive disorder in psychiatric hospital. BMC psychiatry 2020; 20:474 [DOI:10.1186/s12888-020-02885-6]
37. Dadfar M, Kalibatseva Z, Lester D. Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. Trends in Psychiatry and Psychotherapy 2018; 40:144-151 [DOI:10.1590/2237-6089-2017-0116]
38. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 2001; 16:606-613 [DOI:10.1046/j.1525-1497.2001.016009606.x]
39. Baygi F, Jensen OC, Mohammadi-Nasrabadi F, Qorbani M, Mansourian M, Mirkazemi R, et al. Factors affecting health-promoting lifestyle profile in Iranian male seafarers working on tankers. International Maritime Health 2017; 68:1-6 [DOI:10.5603/IMH.2017.0001]
40. Stefana A, Cena L, Trainini A, Palumbo G, Gigantesco A, Mirabella F. A Screening for antenatal maternal depression: comparative performance of the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9. Annali Dell'istituto Superiore Di Sanità 2024; 60:55-63
41. Wang L, Kroenke K, Stump TE, Monahan PO. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis. General Hospital Psychiatry 2021; 68:74-82 [DOI:10.1016/j.genhosppsych.2020.12.007]
42. Liu W, Li W, Wang Y, Yin C, Xiao C, Hu J, et al. Comparison of the EPDS and PHQ-9 in the assessment of depression among pregnant women: Similarities and differences. Journal of Affective Disorders 2024; 351:774-781 [DOI:10.1016/j.jad.2024.01.219]
43. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th Edition, American Psychiatric: USA, 2022 [DOI:10.1176/appi.books.9780890425787]
44. Barat S, Shahrokhi S, Mirtabar SM, Kheirkhah F, Basirat Z, Shirafkan H, et al. Prevalence and risk factors of prenatal and postnatal depressive symptoms in Babol pregnancy mental health registry: A cross-sectional study. International Journal of Fertility & Sterility 2024; 18:271-277
45. Zhong Q, Gelaye B, Rondon M, Sánchez SE, García PJ, Sánchez E, et al. Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. Journal of Affective Disorders 2014; 162:1-7 [DOI:10.1016/j.jad.2014.03.028]
46. Insan N, Forrest S, Jaigirdar A, Islam R, Rankin J. Social determinants and prevalence of antenatal depression among women in rural Bangladesh: A cross-sectional study. International Journal of Environmental Research and Public Health 2023; 20:2364 [DOI:10.3390/ijerph20032364]
47. Niazi AU, Alekozay M, Osmani K, Najm AF. Prevalence and associated factors of depression, anxiety, and stress among pregnant women in Herat, Afghanistan: A cross-sectional study. Health Science Reports 2023; 6: e1490 [DOI:10.1002/hsr2.1490]
48. Ciochoń A, Apanasewicz A, Danel DP, Galbarczyk A, Klimek M, Ziomkiewicz A, et al. Antenatal classes in the context of prenatal anxiety and depression during the COVID-19 pandemic. International Journal of Environmental Research and Public Health 2022; 19:5073 [DOI:10.3390/ijerph19095073]
49. Kuo TC, Au H-K, Chen SR, Chipojola R, Lee GT, Lee PH, et al. Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: A single-blind randomized controlled trial. Midwifery 2022; 113:103438 [DOI:10.1016/j.midw.2022.103438]
50. Zhao Y, Yang L, Sahakian BJ, Langley C, Zhang W, Kuo K, et al. The brain structure, immunometabolic and genetic mechanisms underlying the association between lifestyle and depression. Nature Mental Health 2023; 1:736-750 [DOI:10.1038/s44220-023-00120-1]
51. Roldán-Espínola L, Riera-Serra P, Roca M, García-Toro M, Coronado-Simsic V, Castro A, et al. Depression and lifestyle among university students: A one-year follow-up study. The European Journal of Psychiatry 2024; 38:100250 [DOI:10.1016/j.ejpsy.2024.100250]
52. Xiong T. Association between psychosocial, obstetric, and lifestyle factors and antenatal depression. Walden Dissertations and Doctoral Studies 2023; 11891 https://scholarworks.waldenu.edu/dissertations/11891
53. Ören EDT, Ertem G, Yaşar Ö. The effects of depressive symptoms on healthy lifestyle behaviors during pregnancy depression and healthy lifestyle behaviors during pregnancy. Journal of Basic & Clinical Medical Sciences 2023; 7:376-386 [DOI:10.30621/jbachs.1120795]
54. Rafat N, Bakouei F, Adib-Rad H, Nikbakht HA, Bakouei S. Predicting the health-promoting lifestyle profile of pregnant women based on their health literacy levels: A cross-sectional study. Nursing Open 2025; 12: e70136 [DOI:10.1002/nop2.70136]
55. Kaiser LL, Campbell CG. Practice paper of the Academy of Nutrition and Dietetics abstract: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the Academy of Nutrition and Dietetics 2014; 114:1447 [DOI:10.1016/j.jand.2014.07.001]
56. American College of Obstetrics and Gynecology [ACOG]. Physical activity and exercise during pregnancy and the postpartum period. Obstetrics and Gynecology 2020; 135:178-188 [DOI:10.1097/AOG.0000000000003772]
57. Rashed MS, Nour SA, Mohamed HSE-D, Ragab AR, Nasr EH. Effectiveness of childbirth preparation classes on primigravida womens health behavior. Port Said Scientific Journal of Nursing 2023; 10:76-94 [DOI:10.21608/pssjn.2023.153917.1213]
58. Imancioglu N, Uyar Hazar H. Effect of participation in the pregnant information class on healthy lifestyle behaviors of pregnant women: Case-control study. Archives of Health Science and Research (Online) 2021; 8:131-138 [DOI:10.5152/ArcHealthSciRes.2021.20095]
59. Pazandeh F, Banihashem F, Mohseni S, Mohseni M, Firouzi H. Social determinants of health and health-promoting lifestyle of pregnant women in Hormozgan Province, southern Iran. Journal of Preventive Medicine 2024; 10:398-411 [Persian]
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