Personalized exploration of mindfulness-based intervention on antenatal depression: Moderated mediation analyses of a randomized controlled trial

Mindfulness-based interventions have the potential to improve depressive symptoms but are not effective for everyone. The current study aims to find target populations for a mindfulness-based intervention, to improve antenatal depression based on the personalized causal pathway hypothesis. This is a secondary analysis of a randomized controlled trial. A total of 168 pregnant women were randomly allocated to a mindfulness-based intervention group or a control group. Depression assessed by the Edinburgh Postnatal Depression Scale and mindfulness assessed by the Five Facet Mindfulness Questionnaire, that were collected at baseline and post-intervention, were included in the moderated mediation models. Demographic and pregnancy-related characteristics were included as moderators. Pregnant women receiving mindfulness intervention had significantly higher mindfulness scores than those in the control group (F = 5.840, P = 0.017). The intervention group predicted a decrease in depression through an increase in mindfulness compared to the control group, with an indirect effect of -0.151 and 95%CI: [-0.340, -0.007]. Moderated mediation analyses indicated that age (Index = 0.356, 95%CI: [0.001, 0.832]) and parity (Index = 0.356, 95%CI: [0.020, 0.817]) moderated this mediation path. Younger pregnant women and primiparous women gained mindfulness skills through mindfulness intervention and their depressive symptoms were relieved. The results indicate that mindfulness interventions decrease antenatal depressive symptoms among younger pregnant women and primiparous women. Future studies should further examine additional mechanisms of mindfulness interventions and more moderators can be tested to improve depression treatment efficacy. Interventions for older and multiparous pregnant women should be developed.

Automated summary

Mindfulness-based interventions can decrease antenatal depressive symptoms, particularly for younger pregnant women and primiparous women. Future studies should further investigate the mechanisms of interventions and develop interventions for older and multiparous pregnant women.