Social Support, Posttraumatic Stress, and Postpartum Depressive Symptomatology among Japanese Women

Background: In Japan, 13% of new mothers suffer from elevated postpartum depressive symptomatology (PPDS), and one-third of women have posttraumatic stress (PTS) symptoms following birth. Researchers reported that women with elevated PPDS often had more PTS symptoms and perceived low social support in the postpartum period. However, the role of social support in the relationship between PTS and PPDS has not been examined. Understanding how social support affects the relationship between PTS and PPDS is necessary to develop effective interventions to prevent elevated PPDS. Purpose: To examine the role of social support in the relationship between PTS and PPDS among Japanese women. Design and Methods: This study is a cross-sectional secondary data analysis. Based on the Stress Process Model, two conceptual models (moderation and mediation), consisting of four study concepts (PPDS, PTS, social support, and maternal background factors) were examined. PPDS was measured with the Postpartum Depression Screening Scale-Short Form. PTS was measured with two items of posttraumatic stress disorder symptoms. Social support (by a partner/others except a partner) was measured with an adaptation of the Medical Outcomes Study Social Support Survey. The study sample consisted of 207 Japanese women between one and three months after birth. Both multiple linear regressions and path analyses were used to examine the proposed models. Results: In this study, it was inferred that posttraumatic stress (PTS) following birth had a significant direct effect on postpartum depressive symptomatology (PPDS); that both partner and others’ support had similar direct effects on PPDS; and that primiparous women, those who engaged in less health promotion behaviors, and those with more physical health problems had more PPDS. On the other hand, neither the moderating effects of social support on the relationship between PTS and PPDS nor the mediating effect of PTS on the relationship between social support and PPDS was supported in this study. Conclusions: Mental health care focusing on PTS following birth will contribute to preventing depressive symptoms. From the current study results, alternative moderation and mediation models that include coping or self-concepts are suggested for future study.