Background
Existing research evaluating mindfulness and pregnancy has explored the utility of mindfulness courses during pregnancy but the mechanism of change is unclear. Exploration of how mindfulness relates to mood during pregnancy should be conducted to expand the literature and support studies examining the change which takes place during and after mindfulness-based courses but very few studies have examined the relationship between dispositional mindfulness and mood in non-intervention samples. One study found that higher dispositional mindfulness was associated with lower anxiety during pregnancy and less self-regulation problems and negative affect in the 10 month old infant [
1]. A further small study [
2] found that higher ‘act aware’ dispositional mindfulness (a subscale on the FFMQ [
3]) during pregnancy was related to lower postnatal depression and anxiety scores and that as prenatal mindfulness decreased over time, postnatal depression and anxiety scores increased. A recent study found a similar relationship with dispositional mindfulness during pregnancy such that higher levels of mindfulness were related to lower levels of depression and distress [
4].
Pregnancy-specific and general anxiety and stress likely reflect different emotional constructs [
5‐
8]. However, research to date has not examined the association between dispositional mindfulness and pregnancy specific measures.
This study aimed to extend previous work by examining the association of dispositional mindfulness with general and pregnancy specific measures in a large sample of pregnant women. The results were examined to evaluate whether increasing dispositional mindfulness during pregnancy may be beneficial, something which mindfulness courses are purported to do [
9]. It appears important to elucidate the relationship between dispositional mindfulness and mood during pregnancy to better understand whether, and how, courses offered during this time may be helpful. Individual difference variables such as dispositional mindfulness may have a greater impact on variables such as worry about labour in those who have no prior experiences of childbirth to pattern their beliefs, fears and expectations. Therefore we divided and analysed the sample for those with and without children. In individuals with pre-existing mental health problems, anxiety about pregnancy and labour may reflect underlying psychopathology in addition to situation specific concerns. As such individual differences in mindfulness may play a different, perhaps lesser role in determining distress in these participants. Therefore we divided and analysed the sample in two groups as a function of their pre-existing mental health problems.
Results
Data checks
One participant was removed (the first answer was always given), leaving 363 completers. PES hassles showed positive kurtosis (4.609) and the Shapiro Wilk’s test was significant for uplifts and hassles with first and third trimester subsamples (sample split into trimesters for analysis (first n = 27, second n = 116, third n = 13), indicating that trimester analyses conducted using this measure should be non-parametric or bootstrapped.
Sample characteristics
Approximately half of the sample (56.5%,
n = 205) had children. Most participants were in their second trimester of pregnancy with 76.6% (
n = 278) in their second, 12.9% (
n = 47) in their first and 10.5% (
n = 38) in their third. Demographic data is shown in Table
1. Most participants were located in the UK, educated to degree level or higher, married or cohabiting and employed.
Table 1
Dispositional Mindfulness Study Participant Sociodemographics
Survey Age (participant age taken in brackets: 18–20 - 46-50) | mode: 26–30, 31.1% n = 113, mean: 31–35 |
UK residents | 77.7% | 282 |
Currently married or cohabiting | 93.7% | 340 (259, 81) |
Relationship length (range 1 month - 21 years) | mean: 6.44 years, mode: 3 years |
Educated to degree level | 36.6% | 133 |
Educated to postgraduate level | 33.9% | 123 |
Currently employed | 69.4% | 252 |
Unemployed status-homemaker | 21.5% | 78 |
Multiparous | 56.5% | 205 |
First trimester | 12.9% | 47 |
Second trimester | 76.6% | 278 |
Third trimester | 10.5% | 38 |
Physical ailments (non-perinatala) | 21.8% | 79 |
Mental health problemsb | 14.3% | 52 |
Practice yoga (mode once per week n = 38) | 19.3% | 70 |
Practice meditation (mode: once per week n = 9) | 10.2% | 37 |
Sample means
Mean scores are presented in Table
2. Sample means were typically above population norms with higher scores for stress, anxiety, TPDS distress (meeting the threshold of 17 for ‘distressed’ [
19]) and depression. The smaller sample (made up of survey and pilot samples,
n = 178) showed moderate pregnancy distress (PDQr [
20]), and discomforts [
21]. Mean mindfulness was 46.88 (
SD 9.57), similar to that found with non-clinical pregnant samples previously (48.10,
SD 7.01) [
12].
Table 2
Baseline mood scores of total sample n = 363
PSS Stress | 19.50 | 7.37 | 11.9–14.7 | |
GAD-7 Anxiety | 7.97 | 5.31 | 2.7–3.8 | |
OWLS Labour Worry | 28.17 | 6.75 | 25.15 | |
TPDS Pregnancy Distress | 19.27 | 8.42 | 10.67 | |
EPDS Pregnancy Depression | 10.72 | 6.05 | 7.6 | |
FFMQ-15 Mindfulness | 46.88 | 9.57 | 48.10 | |
Sample n = 178 |
PDQr Pregnancy Distress | 0.73 | 5.84 | 0.48–0.71 | |
PRD 1st Trimester Discomforts n = 30 | 38.97 | 14.59 | 36.9 | |
PRD 2nd Trimester Discomforts n = 147 | 27.81 | 10.16 | 26 | |
PES Frequency of positive experiences | 8.28 | 2.10 | 6.5–7.5 | |
PES Intensity score, positive | 1.94 | 0.55 | 2.4 | |
PES Frequency of negative experiences | 6.93 | 2.47 | 9.5 | |
PES Intensity score, negative | 1.52 | 0.48 | 1.4 | |
Dispositional mindfulness and general mood
Correlations examining the relationship with dispositional mindfulness and general measures of stress, anxiety and depression showed a negative relationship with PSS stress (r = −.622, p < .001), GAD-7 anxiety (r = −.551, p < .001) and EPDS Depression, (r = −.660, p < .001).
Dispositional mindfulness and pregnancy-related distress
To examine the hypothesis that higher dispositional mindfulness would be associated with lower levels of pregnancy-related distress, correlations were computed between the FFMQ-15, the TPDS (pregnancy distress) and the OWLS (labour worry). There were significant correlations between mindfulness TPDS distress (r = −.501, p < .001) and OWLS labour worry (r = .180, p < .005).
Mindfulness and other aspects of pregnancy experience
Participants from the survey and pilot study samples, n = 178, completed several additional measures. These showed that mindfulness was significantly negatively correlated with PDQr distress (r = −.430, p < .001), first trimester discomfort (r = −.447, p < .05, n = 30), second trimester discomfort (r = −.373, p < .001, n = 147) and the frequency (bootstrapped based on 1000 samples r = −.360, p < .001, 95% CIs − .469, −.227) and intensity (bootstrapped based on 1000 samples r = −.432, p < .001, 95% CIs − .550, −.296) of negative pregnancy experiences. There was no correlation between mindfulness and the frequency (bootstrapped r = .111, p = .139, 95% CIs − .057, .266) or intensity (bootstrapped r = .118, p .117, 95% CIs − .026, .278) of positive pregnancy experiences.
Mindfulness and pregnancy experiences
Controlling for general mood; the PSS for perceived stress and GAD-7 for anxiety, partial correlations were re-run with FFMQ mindfulness and pregnancy-related measures (n = 363). Mindfulness was still correlated with EPDS depression (rPSS,GAD-7 = −.325, p < .001) and TPDS distress (rPSS,GAD-7 = −.233, p < .001) but not to OWLS labour worry (rPSS,GAD-7 = .026, p = .623).
With the smaller sample (n = 178), mindfulness was correlated with PDQr distress (rPSS,GAD-7 = −.185, p < .05) and negative pregnancy experiences, both in frequency (bootstrapped based on 1000 samples rPSS,GAD-7 = −.235, p < .005, 95% CIs − .360, −.094) and intensity (bootstrapped based on 1000 samples rPSS,GAD-7 = −.176, p < .05, 95% CIs − .315, −.016). There was no relationship with first trimester (rPSS,GAD-7 = −.165, p = .400, n = 30) or second trimester (rPSS,GAD-7 = −.067, p = .423, n = 147) discomforts.
Dispositional mindfulness and pregnancy-specific mood by parity
See Table
3 for the difference in measures by parity.
Table 3
Measure by Parity
PSS stress | 205 | 20.12 | 7.52 | 4–36 | 158 | 18.70 | 7.11 | 1–37 |
GAD-7 anxiety | 205 | 8.38 | 5.36 | 0–21 | 158 | 7.44 | 5.22 | 0–21 |
EPDS depression | 205 | 10.94 | 6.09 | 0–24 | 158 | 10.44 | 6.00 | 0–26 |
TPDS distress | 205 | 18.91 | 8.32 | 2–42 | 158 | 19.73 | 8.54 | 3–40 |
OWLS labour worryA | 205 | 29.85 | 6.34 | 10–40 | 158 | 25.99 | 6.65 | 11–40 |
PDQr distressB | 90 | 10.89 | 5.68 | 0–27 | 88 | 14.09 | 5.59 | 0–27 |
PRD first trimester discomforts | 19 | 36.58 | 13.25 | 17–56 | 11 | 43.09 | 16.50 | 25–69 |
PRD second trimester discomforts | 71 | 27.90 | 10.69 | 4–57 | 76 | 27.72 | 9.70 | 9–57 |
Positive pregnancy experience frequency | 90 | 7.88 | 2.38 | 0–10 | 88 | 8.68 | 1.69 | 3–10 |
Positive pregnancy experience intensity | 90 | 1.86 | 0.57 | 0–3 | 88 | 2.02 | 0.53 | 1–2.9 |
Negative pregnancy experience frequency | 90 | 6.57 | 2.39 | 0–10 | 88 | 7.30 | 2.49 | 0–10 |
Negative pregnancy experience intensity | 90 | 1.56 | 0.50 | 0–2.9 | 88 | 1.48 | 0.45 | 0–2.8 |
FFMQ Mindfulness | 205 | 46.25 | 10.13 | 17–69 | 158 | 47.70 | 8.76 | 23–70 |
Partial correlations, controlling for general PSS stress and GAD-7 anxiety were run to examine any difference in those who already had children (
n = 205) and those who did not (
n = 158), see Table
4.
Table 4
Partial Correlations of Mindfulness and Pregnancy-related Mood, controlling for PSS Stress and GAD-7 Anxiety
EPDS depression | 205 | −.443 |
.000
| 158 | −.147 | .067 |
TPDS distress | 205 | −.204 |
.004
| 158 | −.305 |
.000
|
OWLS labour worry | 205 | .011 | .880 | 158 | .084 | .299 |
PDQr distress | 90 | −.074 | .495 | 88 | −.357 |
.001
|
PRD first trimester discomforts | 19 | −.246 | .342 | 11 | .251 | .515 |
PRD second trimester discomforts | 71 | −.035 | .773 | 76 | −.194 | .097 |
Positive pregnancy experience frequencya | 90 | .067 | .535 | 88 | −.024 | .828 |
Positive pregnancy experience intensitya | 90 | −.052 | .629 | 88 | .129 | .235 |
Negative pregnancy experience frequencya | 90 | −.297 |
.005
| 88 | −.145 | .182 |
Negative pregnancy experience intensitya | 90 | −.207 |
.053
| 88 | −.158 | .147 |
In those who had previous children, mindfulness was correlated with EPDS depression (rPSS,GAD-7 = −.443, p < .001) and TPDS distress (rPSS,GAD-7 = −.204, p < .005). OWLS labour worry was not correlated with mindfulness in those with (rPSS,GAD-7 = .011, p = .880) children.
Examining the measures completed by fewer participants (n = 178), comparing those with (n = 90) and without children (n = 88), mindfulness was not correlated with PDQr distress in those with children (rPSS,GAD-7 = −.074, p = .495).
Correlations with mindfulness and pregnancy experience showed that there was still a relationship with the frequency of negative pregnancy experiences and mindfulness in those who already had children (bootstrapped based on 1000 samples rPSS,GAD-7 = −.297, p = .005, 95% CIs − .482, −.116).There was a trend for the intensity of negative pregnancy experiences in those with children (bootstrapped based on 1000 samples rPSS,GAD-7 = −.207, p = .053, 95% CIs − .401, .025). Examining second trimester discomforts, mindfulness was not correlated in those who had children (rPSS,GAD-7 = −.035, p = .773, n = 71).
In those without children, EPDS depression was no longer correlated with mindfulness (rPSS,GAD-7 = −.147, p = .067) and was still correlated with TPDS distress (rPSS,GAD-7 = −.305, p < .001). OWLS labour worry was not correlated with mindfulness in those without children (rPSS,GAD-7 = .084, p = .299).
Examining the measures completed by fewer participants (n = 178), comparing those with (n = 90) and without children (n = 88), mindfulness was correlated with PDQr distress (rPSS,GAD-7 = −.357, p = .001) in those who had no previous children.
In those without prior children, there was no longer a relationship between negative pregnancy experience and mindfulness, either frequency (bootstrapped based on 1000 samples rPSS,GAD-7 = −.145, p = .182, 95% CIs − .309, .017) or intensity (bootstrapped based on 1000 samples rPSS,GAD-7 = −.158, p = .147, 95% CIs − .321, .019). Examining second trimester discomforts, mindfulness was not correlated in those who did not have children (rPSS,GAD-7 = −.194, p = .097, n = 76).
Mindfulness, general mood and current mental health problems
Participants were asked whether or not they had current mental health problems and if so, what they were. Of those who did have mental health problems (
n = 52) a variety of problems were stated including depression (
n = 22), anxiety (
n = 15), bipolar depression (
n = 1) or a mixture of two or more co-morbidities (
n = 14) including issues such as depression, anxiety, obsessive compulsive disorder, borderline personality disorder, bipolar depression and post-traumatic stress disorder.. A conservative effect size of 0.25 (
f) [
27] was used to determine the t-test power with a sample of 52 compared with 311 healthy participants, using G*Power software [
28]. The estimated power for such a test was 80% (
df 361).
Compared with currently well participants (
n = 311), participants with mental health issues (
n = 52) had significantly higher perceived stress,
t (361) = 5.52,
p < .001 and anxiety
t (361) = 6.21,
p < .001. Dispositional mindfulness was also significantly lower for participants experiencing mental health problems,
t (361) = − 5.30,
p < .001. See Table
5.
Table 5
Outcomes by Current Mental Health Problems
FFMQ-15 Mindfulness | 40.60 | 9.04 | 47.93 | 9.26 |
PSS Stress | 24.52 | 6.84 | 18.66 | 7.13 |
GAD-7 Anxiety | 12.00 | 5.19 | 7.30 | 5.03 |
EPDS Depression | 14.85 | 5.94 | 10.04 | 5.80 |
TPDS Distress | 21.38 | 9.50 | 18.91 | 8.18 |
OWLS Labour Worry | 28.08 | 7.35 | 28.19 | 6.65 |
Correlations examining the relationship with mindfulness and mood in participants with (n = 52) and without (n = 311) current mental health problems showed that perceived stress was correlated with mindfulness in the two groups, r = −.455, p < .005 and r = −.612, p < .001 respectively and so was anxiety, r = −.355, p < .05 and r = −.536, p < .001.
Participants with mental health issues (n = 52) had significantly higher EPDS pregnancy-related depression, t (361) = 5.52, p < .001 and pregnancy-related TPDS distress t (361) = 1.97, p = .05 compared with their currently healthy counterparts (n = 311).
Correlations split by current mental health problems (n = 52) or not (n = 311) showed that, in those without problems, mindfulness was correlated with pregnancy-related depression, r = −.665, p < .001, distress, r = −.57, p < .001 and labour worry, r = .244, p < .001. For participants with current problems, mindfulness was correlated with pregnancy-related depression, r = −.433, p < .005 but not correlated with distress, r = −.78, p = .58, nor labour worry, r = −.140, p = .32.
Partial correlations in those with no current mental health problems (n = 311), controlling for general mood (PSS stress, & GAD-7 anxiety) showed that mindfulness was correlated with pregnancy-related depression, r (PSS, GAD-7) = −.359, p < .001 and distress, r (PSS, GAD-7) = −.333, p < .001 and not with labour worry, r (PSS, GAD-7) = .078, p = .17. Examining participants with current problems (n = 52), mindfulness was not correlated with pregnancy-related depression, r (PSS, GAD-7) = −.133, p = .36, distress, r (PSS, GAD-7) = .136, p = .35, nor labour worry, r (PSS, GAD-7) = −.192, p = .18.
Discussion and conclusions
The intention of this study was to evaluate the relationship between mood and mindfulness in a cross-sectional analysis of pregnant women to further limited research.
The level of dispositional mindfulness had a significant association with mood such that higher mindfulness scores were related to lower scores of general stress and anxiety and controlling for general mood, pregnancy-related depression, distress and rates of negative pregnancy experiences.
For participants who had children, when accounting for levels of general stress and anxiety, higher mindfulness scores were associated with lower scores of pregnancy-related depression, distress and negative pregnancy experiences. In those without children, higher mindfulness was associated with lower pregnancy-related distress.
Higher levels of mindfulness were related to lower levels of general stress and anxiety whether or not participants had current mental health problems. In those without current problems, when controlling for general stress and anxiety, higher mindfulness scores were associated with lower levels of pregnancy-related depression and distress but for participants who had current mental health problems, there was no relationship.
The current findings show that, in a sample with higher scores of negative mood overall, higher levels of dispositional mindfulness are associated with lower levels of general and pregnancy-related negative mood, but that the background of the participants should be taken into account. The current analysis, being correlational in nature, can only show a relationship and not causality, i.e. it is unclear whether lower levels of mindfulness incur higher levels of stress etc. or that higher levels of stress incur lower levels of mindfulness. While the current findings suggest that offering a mindfulness-based stress reduction course to women during pregnancy may be beneficial, more research should be conducted to investigate the relationship and potential benefits in more detail. This paper presents an initial exploration of how mood and mindfulness relate to each other during pregnancy and is a precursor to future studies investigating mindfulness interventions for pregnant populations.
Research has found that higher dispositional mindfulness during pregnancy was associated with improved mood during and after pregnancy if it was maintained or increased [
2]. Potentially, sustaining levels of mindfulness over pregnancy could be beneficial for low mood. Offering a course with mindfulness-based elements, specifically aimed at alleviating low mood during pregnancy, may be most beneficial.
This study has limitations. First, the study is cross-sectional with no follow-up data so it is difficult to posit how these women would have felt later in pregnancy. While splitting the sample by trimester gives an indication of mood during different times, it would be more informative to investigate how mood changes during pregnancy. Second, measures of pregnancy-specific anxiety and stress were not included to limit participant burden; while pregnancy-specific and general anxiety and stress may reflect different emotional constructs, potential differences cannot be currently evaluated because of this omission and it may be helpful to include them in future studies.
This is one of the first studies to explore mood and dispositional mindfulness during pregnancy and as such, is a good precursor to future studies. Proceeding studies should investigate whether mindfulness mediates mood improvement and use this work to improve the rationale and research surrounding the utility of mindfulness courses for use in this population.
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