Delicate Equilibrium: Understanding the Relationship between
Social Support, Maternal Depression, and Self-efficacy During the
Perinatal Period
Silvana Alfaro-Bordon, B.S., Katherine Guyon-Harris, M.S.,
Gloria Romero, B.S., Alissa Huth-Bocks, Ph.D.
Eastern Michigan University
INTRODUCTION
The perinatal period (i.e., pregnancy through 3-months postpartum) is a time of profound psychological change (Aceti et al., 2012). Depression during
this period might lead a mother to feel less capable of coping with the demands of a newborn (Leahy-Warren et al., 2011).
Mothers with symptoms of perinatal depression may experience anxiety, abrupt mood changes, sleep problems, tiredness, and irritability (Beck &
Indman, 2005) as well as low self-esteem and low confidence in parenting skills. In addition, women may feel a deep sense of guilt and shame for
being depressed as motherhood is usually an event recognized by society as positive and a source of joy (Aceti et al., 2012).
However, higher levels of social support during and after pregnancy help decrease postpartum depression and help the mother develop higher levels of
self-esteem (Dennis et al., 2009; Haslam et al., 2006).
Research Aim:
•  The proposed study will explore how depressive symptoms during the perinatal period impact maternal self-efficacy after birth
•  Additionally, the role of social support will be examined in relation to the association between maternal depression and maternal self-efficacy
during the perinatal period
METHODS
Participants
120 women followed from pregnancy through the first three years of their infants’ life; age range: 18-42, M = 26
•  Race: 47% African–American, 36% Caucasian, 13% Biracial, 4% Other
•  Marital Status: 64% single/never married, 28% married, 4% divorced, 4% separated
•  Education: 20% had a high school diploma or less, 44% some college, 36% college degree
•  Income: Median monthly household income = $1500; 73% receive services from WIC, and 76% have public health insurance
Procedures
Pregnant women were recruited through the posting of flyers in pregnancy agencies and area community organizations. The first interview took place
during the third trimester of pregnancy (T1), with subsequent interviews at 3-months post-partum (T2), 1-year postpartum (T3), and 2-years postpartum
(T4). Retention (n): T1 (120), T2 (119), T3 (115), T4 (99). Data from the T1 and T2 waves were used in this project.
Measures
•  Maternal depression was measured at T1 and T2 using the Edinburgh Postpartum Depression Scale (α = .84; EPDS; Cox, Holden, & Sagovsky,
1987; Wisner, Perry, & Piontek, 2002) at T1 (α = .76) and T2 (α = .84).
•  Perceived social support was measured at T1 using the Perceived Social Support Scale (Procidano & Heller, 1983) at T1, which yields a total
score (α = .92), as well as two subscales: friends (α = .89), and family (α = .93).
•  Maternal self-efficacy was measured at T2 using the Maternal Self Report Inventory-Short Form (Shea & Tronick, 1988) at T2, which yields a
total score (α = .85) as well as 5 subscales: caretaking ability (α = .79), general ability and preparedness for mothering role (α = .73), acceptance
of baby (α = .63), expected relationship with baby (α = .53), and feelings concerning pregnancy, labor, and delivery (α = .84).
RESULTS
Table 1.
Correlations and descriptive statistics for study variables
1
2
3
4
5
6
7
8
1. T1 Depression
1
2. T2 Depression
.43***
1
3. Perceived Social Support Scale
-.33***
-.07 .
1
4. Caretaking ability
-.23
*
-.40***
.03
1
5. Preparedness for mothering role
-.19
*
-.46***
.09
.51***
1
6. Acceptance of baby
-.22
*
-.33***
.04
.65***
.59***
1
7. Expected relationship with the baby
-.19
**
.47***
.01
.63***
.57***
.61***
1
8. Total Self-Efficacy
-.26
**
-.51***
.03
.77***
.71***
-.73***
.79***
1
m
12.77
5.06
30.08
27.25
37.6
13.95
22.92
115.6
sd
3.6
4.36
7.98
3.63
3.29
1.73
2.53
10.84
*
p < .05. ** p < .01. ***p < .001.
Pearson correlation coefficients were computed to assess the relationship between perinatal depression at T1 and T2, maternal self-efficacy at T2, and
perceived social support at T1 (see Table 1). Overall, there was a strong negative correlation between perinatal depression and maternal self-efficacy
such that increases in depressive symptoms were associated with decreases in mothers’ caretaking ability, preparedness for mothering role, acceptance
and expected relationship with the baby, and total self-efficacy.
Perceived social support was not correlated with mothers’ self-efficacy nor with any of the subscales of the maternal self-report inventory. However,
social support was significantly correlated to depressive symptoms during pregnancy, such that more social support was related to less depression.
24
23.5
23
22.5
Postnatal
Expectations of 22
Relationship
21.5
with Baby
Low PSS
Med PSS *
High PSS *
21
20.5
20
Low
Med
High
Prenatal Depression Symptoms
Figure 1. Association between prenatal depression symptoms and postnatal expectations of
the relationship with the baby among those who perceive to have low, moderate, and high
Social Support. *significant slope.
Perceived social support during pregnancy
moderated the relation between symptoms of
depression during pregnancy and the woman’s
expected relationship with the baby at 3-months
postpartum. At low levels of perceived social
support, depressive symptoms do not significantly
impact a mother’s perceptions of her relationship
with her baby 95% CI [-.20, .15]. However, the
impact of depressive symptoms on maternal
postnatal expectations of the relationship with the
baby was statistically significant among mothers
perceiving moderate and high levels of social
support 95% CIs [-.31, -.04], and [-.54, -.11]
respectively (see Figure 1). As depressive
symptoms increase, the mother’s perceptions of
how much her baby loves her decrease in the
presence of moderate and high perceived social
support. Perceived social support did not moderate
the interaction of depressive symptoms and other
aspects of maternal self-efficacy.
DISCUSSION
•  The results of this study indicate that perinatal depressive symptoms are significantly related to maternal self-efficacy at 3 months postpartum. As
depressive symptoms increase, the mother’s confidence in her abilities to take care of her baby decrease and so do her expectations that her baby
will love her. The mother’s perception of her general ability and preparedness to take care of her baby and acceptance of her baby also decrease.
This is consistent with past research indicating that depressive symptoms in the perinatal period may lead a mother to feel less capable of coping
with the demands of child care (Aceti et al., 2012).
•  Perceived social support was significantly related to depressive symptoms prenatally, despite being unrelated to depressive symptoms postnatally.
Social support was measured for friends, family, and the mother’s partner during pregnancy; however, details about the social support network were
not obtained. Another limitation was that perceived social support was not assessed in the postnatal period, which impedes capturing changes in the
perception of social support after delivery.
•  In the presence of moderate or high social support, as depressive symptoms increase, the mother’s expectations of the relationship with her baby
decrease significantly.
•  Further studies could measure social support after delivery. Other forms of social support should be taken into consideration, such as professional
support to help the mother develop coping mechanisms to deal with the challenges of being a new mother, and as a consequence, increase selfefficacy. Future research should inquire more in depth about other forms of social support such as baby care, support groups, and play dates.
•  The results of the present study provide a better understanding of the role of social support in the relationship between maternal depression and
maternal self-efficacy during the perinatal period. This information may help medical staff, social workers, and other mental health professionals to
provide appropriate services to mothers in the perinatal period.