Skip to main content Accessibility help

Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach

  • A. Gutiérrez-Zotes (a1), J. Labad (a1), R. Martín-Santos (a2) (a3), L. García-Esteve (a2), E. Gelabert (a3) (a4), M. Jover (a5), R. Guillamat (a6), F. Mayoral (a7), I. Gornemann (a7), F. Canellas (a8), M. Gratacós (a9) (a10), M. Guitart (a6), M. Roca (a11), J. Costas (a12), J. Luis Ivorra (a5), R. Navinés (a2) (a3), Y. de Diego-Otero (a7), E. Vilella (a1) and J. Sanjuan (a5)...



Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks.


A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32 weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression.


Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism.


Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.


Corresponding author

*Corresponding author at: Clínica Psiquiátrica Universitaria - Research Department, Hospital Universitari Institut Pere Mata, Ctra, De l'Institut Pere Mata s/n, 43206 Reus, Spain. Tel.: +00 34 977338565; fax: +00 34 977310021. E-mail address: (A. GutiÕrrez-Zotes).


Hide All
[1]Asselmann, E., Wittchen, H.-U., Lieb, R., Höfler, M., Beesdo-Baum, K.Does low coping efficacy mediate the association between negative life events and incident psychopathology? A prospective-longitudinal community study among adolescents and young adults. Epidemiol Psychiatr Sci 2015;25:110.
[2]Baca-Garcia, E., Parra, C.P., Perez-Rodriguez, M.M., Sastre, C.D., Torres, R.R., Saiz-Ruiz, J., et al.Psychosocial stressors may be strongly associated with suicide attempts. Stress Heal 2007;23(3):191198.
[3]Bagner, D.M., Pettit, J.W., Lewinsohn, P.M., Seeley, J.R.Effect of maternal depression on child behavior: a sensitive period?. J Am Acad Child Adolesc Psychiatry 2010;49(7):699707.
[4]Barnett, P.A., Gotlib, I.H.Psychosocial functioning and depression: distinguishing among antecedents, concomitants, and consequences. Psychol Bull 1988;104(1):97126.
[5]Beck, C.T.A meta-analysis of predictors of postpartum depression. Nurs Res 1996;45(5):297303.
[6]Beck, C.T.The effects of postpartum depression on child development: a meta-analysis. Arch Psychiatr Nurs 1998;12(1):1220.
[7]Beck, C.T.Predictors of postpartum depression: an update. Nurs Res 2001;50(5):275285.
[8]Bellón Saameño, J.A., Delgado Sánchez, A., Luna del Castillo, J.D., Lardelli Claret, P.Validity and reliability of the Duke-UNC-11 questionnaire of functional social support. Aten Primaria 1996;18(4):153156. [158–63].
[9]Besser, A., Priel, B.Trait vulnerability and coping strategies in the transition to motherhood. Curr Psychol 2003;22(1):5772.
[10]Billings, A.G., Moos, R.H.The role of coping responses and social resources in attenuating the stress of life events. J Behav Med 1981;4(2):139157.
[11]Bloch, M., Rotenberg, N., Koren, D., Klein, E.Risk factors associated with the development of postpartum mood disorders. J Affect Disord 2005;88(1):918.
[12]Bolger, N.Coping as a personality process: a prospective study. J Pers Soc Psychol 1990;59(3):525537.
[13]Britton, J.R.Maternal anxiety: course and antecedents during the early postpartum period. Depress Anxiety 2008;25(9):793800.
[14]Brockington, I.Postpartum psychiatric disorders. Lancet 2004;363(9405):303310.
[15]Carver, C.S.You want to measure coping but your protocol's too long: consider the brief COPE. Int J Behav Med 1997;4(1):92100.
[16]Carver, C.S., Scheier, M.F., Weintraub, J.K.Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56(2):267283.
[17]Connor-Smith, J.K., Flachsbart, C.Relations between personality and coping: a meta-analysis. J Pers Soc Psychol 2007;93(6):10801107.
[18]Crespo, M., Cruzado, J.A.La evaluación del afrontamiento: adaptación española del cuestionario COPE con una muestra de estudiantes universitarios. Anal Modif Conduct 1997;23:797830.
[19]Da Costa, D., Larouche, J., Dritsa, M., Brender, W.Psychosocial correlates of prepartum and postpartum depressed mood. J Affect Disord 2000;59(1):3140.
[20]De Tychey, C., Spitz, E., Briançon, S., Lighezzolo, J., Girvan, F., Rosati, A., et al.Pre- and postnatal depression and coping: a comparative approach. J Affect Disord 2005;85(3):323326.
[21]Dennis, C.-L., Ross, L.Women's perceptions of partner support and conflict in the development of postpartum depressive symptoms. J Adv Nurs 2006;56(6):588599.
[22]Eysenck, H.J., Eysenck, S.B.G.Cuestionario revisado de personalidad de Eysenck: versiones completa (EPQ-R) y abreviada (EPQ-RS) [Eysenck Personality Questionnaire-Revised: Full Version (EPQ-R) and Short (EPQ-RS)]. Madrid: TEA; 2001.
[23]Faisal-Cury, A., Tedesco, J.J.A., Kahhale, S., Menezes, P.R., Zugaib, M.Postpartum depression: in relation to life events and patterns of coping. Arch Womens Ment Health 2004;7(2):123131.
[24]Gao, L.-L., Chan, S.W., Mao, Q.Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period. Res Nurs Health 2009;32(1):5058.
[25]Garcia-Esteve, L., Ascaso, C., Ojuel, J., Navarro, P.Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers. J Affect Disord 2003;75(1):7176.
[26]Gavin, N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G., Swinson, T.Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106(5 Pt 1):10711083.
[27]Georgiopoulos, A.M., Bryan, T.L., Wollan, P., Yawn, B.P.Routine screening for postpartum depression. J Fam Pract 2001;50(2):117122.
[28]Guardino, C.M., Schetter, C.D.Coping during pregnancy: a systematic review and recommendations. Health Psychol Rev 2014;8(1):7094.
[29]Hall, L.A., Kotch, J.B., Browne, D., Rayens, M.K.Self-esteem as a mediator of the effects of stressors and social resources on depressive symptoms in postpartum mothers. Nurs Res 1996;45(4):231238.
[30]Holahan, C.J., Moos, R.H., Holahan, C.K., Brennan, P.L., Schutte, K.K.Stress generation, avoidance coping, and depressive symptoms: a 10-year model. J Consult Clin Psychol 2005;73(4):658666.
[31]Honey, K.L., Bennett, P., Morgan, M.Predicting postnatal depression. J Affect Disord 2003;76(1–3):201210.
[32]Hooper, D., Coughlan, J., Mullen, M.Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods 2008;6(1):5360.
[33]Howell, E.A., Mora, P., Leventhal, H.Correlates of early postpartum depressive symptoms. Matern Child Health J 2006;10(2):149157.
[34]Hu, L., Bentler, P.M.Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J 1999;6(1):155. [Taylor & Francis Group].
[35]Huizink, A.C., de Medina, P.G.R., Mulder, E.J.H., Visser, G.H.A., Buitelaar, J.K.Coping in normal pregnancy. Ann Behav Med 2002;24(2):132140.
[36]Hung, C.-H.Predictors of postpartum women's health status. J Nurs Scholarsh 2004;36(4):345351.
[37]Hung, C.H., Chung, H.H.The effects of postpartum stress and social support on postpartum women's health status. J Adv Nurs 2001;36(5):676684.
[38]Jacobsen, T.Effects of postpartum disorders on parenting and on offspringMiller, L.J.Postpartum mood disorders Washington, DC: American Psychiatric Association; 1999.p. 119139.
[39]Johnstone, S.J., Boyce, P.M., Hickey, A.R., Morris-Yatees, A.D., Harris, M.G.Obstetric risk factors for postnatal depression in urban and rural community samples. Aust N Z J Psychiatry 2001;35(1):6974.
[40]Josefsson, A., Angelsiöö, L., Berg, G., Ekström, C.-M., Gunnervik, C., Nordin, C., et al.Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstet Gynecol 2002;99(2):223228.
[41]Lakey, B., Cronin, A.Low social support and major depression. Research, theory and methodological issues. Risk factors in depression. San Diego, CA: Elsevier Inc.; 2008.
[42]Leahy Warren, P.First-time mothers: social support and confidence in infant care. J Adv Nurs 2005;50(5):479488.
[43]Leung, S.S.K., Martinson, I.M., Arthur, D.Postpartum depression and related psychosocial variables in Hong Kong Chinese women: findings from a prospective study. Res Nurs Health 2005;28(1):2738.
[44]Logsdon, M.C., Usui, W.Psychosocial predictors of postpartum depression in diverse groups of women. West J Nurs Res 2001;23(6):563574.
[45]Martín-Santos, R., Gelabert, E., Subirà, S., Gutierrez-Zotes, A., Langorh, K., Jover, M., et al.Research letter: is neuroticism a risk factor for postpartum depression?. Psychol Med 2012;42(7):15591565.
[46]McCrae, R.R.The five-factor model and its assessment in clinical settings. J Pers Assess 1991;57(3):399414.
[47]McCrae, R.R., John, O.P.An introduction to the five-factor model and its applications. J Pers 1992;60(2):175215.
[48]McWilliams, L.A., Cox, B.J., Enns, M.W.Use of the Coping Inventory for Stressful Situations in a clinically depressed sample: factor structure, personality correlates, and prediction of distress. J Clin Psychol 2003;59(4):423437.
[49]Miles, J., Hempel, S.The Eysenck personality scales: the Eysenck Personality Questionnaire-Revised (EPQ-R) and the Eysenck Personality Profiler (EPP). Hersen, M.Hilsenroth, M.Segal, D.Comprehensive handbook of psychological assessment: personality assessment, Vol 2. New York: Wiley; 2003. p. 99107.
[50]Morling, B., Kitayama, S., Miyamoto, Y.American and Japanese women use different coping strategies during normal pregnancy. Pers Soc Psychol Bul 2003;29(12):15331546.
[51]National Collaborating Centre for Mental Health Antenatal and postnatal mental health. The NICE guideine on clinical management. Leicester (UK): British Psychological Society 2007.
[52]Nurnberger, J.I., Blehar, M.C., Kaufmann, C.A., York-Cooler, C., Simpson, S.G., Harkavy-Friedman, J., et al.Diagnostic interview for genetic studies. Rationale, unique features, and training. NIMH Genetics Initiative. Arch Gen Psychiatry. 1994;51(11):849859. [discussion 863–4].
[53]O’Hara, M.W., Rehm, L.P., Campbell, S.B.Postpartum depression. A role for social network and life stress variables. J Nerv Ment Dis 1983;171(6):336341.
[54]O’Hara, M.W., Swain, A.M.Rates and risk of postpartum depression – a meta-analysis. Int Rev Psychiatr 1996;8:3754.
[55]Pakenham, K.I., Smith, A., Rattan, S.L.Application of a stress and coping model to antenatal depressive symptomatology. Psychol Health Med 2007;12(3):266277.
[56]Peñacoba-Puente, C., Carmona-Monge, F.J., Marín-Morales, D., Naber, K.Coping strategies of Spanish pregnant women and their impact on anxiety and depression. Res Nurs Health 2013;36(1):5464.
[57]Pierce, G.R., Lakey, B., Sarason, I.G., Sarason, B.R., Joseph, H.Personality and social support processes: a conceptual overview. Pierce, G.R.Lakey, B.Sarason, I.G.Sarason, B.R.Sourcebook of social support and personality New York: Plenum Press; 1997. p. 318.
[58]Podolska, M.Z., Bidzan, M., Majkowicz, M., Podolski, J., Sipak-Szmigiel, O., Ronin-Walknowska, E.Personality traits assessed by the NEO Five-Factor Inventory (NEO-FFI) as part of the perinatal depression screening program. Med Sci Monit 2010;16(9):PH77PH81.
[59]Razurel, C., Kaiser, B., Sellenet, C., Epiney, M.Relation between perceived stress, social support, and coping strategies and maternal well-being: a review of the literature. Women Health 2013;53(1):7499.
[60]Robertson, E., Grace, S., Wallington, T., Stewart, D.E.Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 2004;26(4):289295.
[61]Roca, M., Martin-Santos, R., Saiz, J., Obiols, J., Serrano, M.J., Torrens, M., et al.Diagnostic Interview for Genetic Studies (DIGS): inter-rater and test-retest reliability and validity in a Spanish population. Eur Psychiatry 2007;22(1):4448.
[62]Rothbart, M.K., Hwang, J.Temperament and the development of competence and motivationElliot, A.J.Dweck, C.S.Handbook of competence and motivation New York: Guilford; 2005. p. 167184.
[63]Sanjuan, J., Martin-Santos, R., Garcia-Esteve, L., Carot, J.M., Guillamat, R., Gutierrez-Zotes, A., et al.Mood changes after delivery: role of the serotonin transporter gene. Br J Psychiatry 2008;193(5):383388.
[64]Sarason, B.R., Shearin, E.N., Pierce, G.R., Sarason, I.G.Interrelations of social support measures: theoretical and practical implications. J Pers Soc Psychol 1987;52(4):813832.
[65]Soliday, E., McCluskey-Fawcett, K., O’Brien, M.Postpartum affect and depressive symptoms in mothers and fathers. Am J Orthopsychiatry 1999;69(1):3038.
[66]Spielgberger, C.D., Gorsuch, R., Lushene, R., Vagg, P.R., Jacobs, G.A.Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.
[67]Suls, J., Fletcher, B.The relative efficacy of avoidant and nonavoidant coping strategies: a meta-analysis. Health Psychol 1985;4(3):249288.
[68]Swickert, R.J., Hittner, J.B., Foster, A.Big five traits interact to predict perceived social support. Pers Individ Di 2010;48(6):736741.
[69]Taylor, S.E., Stanton, A.L.Coping resources, coping processes, and mental health. Annu Rev Clin Psychol 2007;3:377401.
[70]Vliegen, N., Casalin, S., Luyten, P.The course of postpartum depression: a review of longitudinal studies. Harv Rev Psychiatry 2014;22(1):122.
[71]Wang, S.-Y., Chen, C.-H.Psychosocial health of Taiwanese postnatal husbands and wives. J Psychosom Res 2006;60(3):303307.
[72]Wang, Z., Gan, Y.Coping mediates between social support, neuroticism, and depression after earthquake and examination stress among adolescents. Anxiety Stress Coping 2011;24(3):343358.
[73]Watson, D., Pennebaker, J.W.Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev 1989;96(2):234254.
[74]Wells, J.D., Hobfoll, S.E., Lavin, J.Resource loss, resource gain, and communal coping during pregnancy among women with multiple roles. Psychol Women Q 1997 645662.
[75]Wills, T.A.Social support and interpersonal relationships. Clark, M.S.Prosocial behavior Newbury park, CA: Sage; 1991. p. 265289.
[76]Wisner, K.L., Parry, B.L., Piontek, C.M.Clinical practice. Postpartum depression. N Engl J Med 2002;347(3):194199.


Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach

  • A. Gutiérrez-Zotes (a1), J. Labad (a1), R. Martín-Santos (a2) (a3), L. García-Esteve (a2), E. Gelabert (a3) (a4), M. Jover (a5), R. Guillamat (a6), F. Mayoral (a7), I. Gornemann (a7), F. Canellas (a8), M. Gratacós (a9) (a10), M. Guitart (a6), M. Roca (a11), J. Costas (a12), J. Luis Ivorra (a5), R. Navinés (a2) (a3), Y. de Diego-Otero (a7), E. Vilella (a1) and J. Sanjuan (a5)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach

  • A. Gutiérrez-Zotes (a1), J. Labad (a1), R. Martín-Santos (a2) (a3), L. García-Esteve (a2), E. Gelabert (a3) (a4), M. Jover (a5), R. Guillamat (a6), F. Mayoral (a7), I. Gornemann (a7), F. Canellas (a8), M. Gratacós (a9) (a10), M. Guitart (a6), M. Roca (a11), J. Costas (a12), J. Luis Ivorra (a5), R. Navinés (a2) (a3), Y. de Diego-Otero (a7), E. Vilella (a1) and J. Sanjuan (a5)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *