Impact of maternal baseline depressive symptoms in modulating the Mindfulness-Based Childbirth and Parenting program’s efficacy: An Individual Participant Data Review

Abstract

Introduction

Postpartum depression is a common psychiatric morbidity with family-wide consequences. Mindfulness-Based Childbirth and Parenting (MBCP) program is a low-risk and cost-effective intervention suitable for Hong Kong’s work-oriented mothers. However, its unclear efficacy across mothers with varying levels of depressive symptoms limits its adoption.

Objectives

This post-hoc analysis examines whether baseline depressive symptoms moderated MBCP efficacy.

Method 

Data were analyzed from a published two-arm randomized controlled trial involving 164 pregnant women randomized to MBCP or an attention-matched control, Antenatal Childbirth Education and Support (ACES) program. Participants were stratified by baseline depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) (score ≥16, n=28; score<16, n=136). CES-D, Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), and Perceived Stress Scale (PSS) were assessed at baseline (T1), last antenatal session (T2), 6–8 weeks postpartum (T3), and 6 months postpartum (T4). A linear mixed model assessed outcome differences between groups, reporting standardized β coefficients for the interaction term, with T1 and ACES as referents.

Results 

Compared to ACES, MBCP implicated greater reductions in postpartum depressive symptoms among participants with higher baseline depressive symptoms, with pronounced effects at T4 for EPDS (β = −6.11, p = 0.007) and CES-D (β = −10.55, p = 0.007). MBCP improved stress, trait anxiety, and most effectively state anxiety (β = −14.07, p < 0.001) at T4, suggesting sustained benefits on postpartum mental health. In contrast, only EPDS at T2 showed a significant benefit (β = −1.64, p = 0.039) for MBCP participants with lower levels of baseline depressive symptoms. 

Conclusion

MBCP significantly improved postpartum mental health among mothers with higher baseline depressive symptoms, with effects most pronounced at later follow-ups. The subgroup-specific effects suggest MBCP’s long-term benefits, underscoring its potential as a sustainable and accessible intervention for postpartum mental health. 

Keywords

Mindfulness-Based Childbirth and Parenting, postpartum mental health, accessibility