The mediating and moderating role of rumination and cognitive reappraisal between perceived stress and prenatal depression: a multicenter cross-sectional study in southeast China

Abstract Background Prenatal depression is one of the most prevalent psychiatric disorders among maternal. Perceived stress plays an important role in the onset of prenatal depression, however, the underlying mechanisms between them are not well understood. We aimed to explore the mechanisms from rumination(risk factors) and cognitive reappraisal(protective factors) perspectives, which may be used to design interventions to improve prenatal depression. Methods A multicenter cross-sectional survey of 1055 maternal were enrolled using a convenience sampling method from June 2020 to January 2021 and was conducted in five hospitals in Guangzhou, southeastern China. A moderated mediation model was performed to examine the role of rumination(Ruminative Responses Scale, RRS), and cognitive reappraisal(Emotional Regulation Questionnaire, ERQ) in the relationship between perceived stress(Perceived Stress Scale 10, PSS-10) and prenatal depression(Edinburgh Postpartum Depression Scale, EPDS). Results The prevalence of prenatal depression was 37.53%. There was a significant correlation among perceived stress, rumination, cognitive reappraisal, and prenatal depression(all P < 0.001). Rumination played a partial mediating role in the relationship between perceived stress and prenatal depression, accounting for 58.92% of the total effect. Moreover, the indirect effect of rumination in this link was moderated by cognitive reappraisal. This mediation effect was stronger for pregnant women with lower levels of cognitive reappraisal( P < 0.001). Conclusions The study provides powerful evidences through a large maternal sample for the mediating role of rumination and the moderating role of cognitive reappraisal between perceived stress and prenatal depression. Ongoing clinical care and targeted interventions may need to carry out from the perspective of rumination according to the different cognitive levels of maternal.