Perceived family support and postpartum posttraumatic stress and depressive symptoms: a network analysis with temporal within-site replication
Year: 2026
Type: article
Abstract: Background Postpartum posttraumatic stress and depressive symptoms often co-occur, but whether perceived support from family, friends, and significant others is associated with particular symptoms, or with symptoms of particular domains, remains unclear. Methods In this cross-sectional study at an obstetric outpatient clinic in Shanghai, China, 1,135 women were recruited at routine follow-up visits approximately 42 days after childbirth in 2023, and a further 510 women from the same clinic in 2024 formed a temporal within-site replication sample. Posttraumatic stress symptoms, depressive symptoms, and perceived social support were assessed with the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Multidimensional Scale of Perceived Social Support (MSPSS). Regularized network models were used to estimate the association between each support source and each individual symptom after accounting for the other variables measured, and a bridge centrality index summarized each support source’s overall pattern of direct associations with symptoms. Results Perceived family support showed the strongest overall inverse association with posttraumatic stress and depressive symptoms among the three support sources, particularly when both symptom domains were examined together; individual symptom associations varied between samples, but the overall pattern did not differ statistically between them. Questionnaire scores were treated as approximately continuous, the standard specification for this class of model; in sensitivity analyses, the association between support and symptoms was no longer present when analyses were re-run, treating responses as categorical instead of continuous. Limitations The cross-sectional, self-report design precludes causal inference. The sample came from a single, relatively homogeneous hospital; perinatal anxiety and the quality of support were not measured; and symptoms related to childbirth could not be distinguished from those related to infant hospitalization. Conclusions Perceived family support was more strongly associated with fewer posttraumatic stress and depressive symptoms than perceived support from friends or significant others, but no support-symptom associations were retained when symptom responses were analysed as ordered categories. Perceived family support may therefore be a useful contextual factor for future longitudinal research in China, although the present cross-sectional findings do not establish a causal effect or support a specific intervention.
Source: Frontiers in Psychiatry
Authors: Lan Zhang, Xiu Ni, Nafei Guo, Junying Li, Xuemei Li, Ying Liu
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7225828762