Association between psychological distress during previous childbirth and depressive symptoms in subsequent pregnancy: A cross-sectional study in Shanghai, China

Background Mothers in labor experience extreme stress, activating the hypothalamic-pituitary-adrenal (HPA) axis and prompting large-scale cortisol secretion. If labor is fraught with pain, the HPA axis may dysregulate, disrupting cortisol secretion rhythms. This impairs maternal emotional regulation and increases the risk of post-traumatic stress disorder (PTSD), which can solidify traumatic memories and elevate depression risk during subsequent pregnancies. This study investigated the correlation between depressive symptoms in subsequent pregnancy and previous childbirth experiences. Methods A total of 1,297 women with prior childbirth experience and a second pregnancy, who had registered in 2022 across 14 towns/streets in a Shanghai district, were enrolled. Demographic data and lifestyle habits were collected via self-report questionnaires. Labor-related psychological distress was assessed using the Psychological Distress Scale (PAS), while depressive symptoms were evaluated via the Patient Health Questionnaire-9 (PHQ-9). A hierarchical regression model was employed to analyze the association between previous childbirth experiences and second-pregnancy depressive symptoms. Results Household size, residential status, alcohol/tea consumption, and physical activity significantly influenced PHQ-9 scores. Specifically, larger household size was associated with higher depression incidence (P = 0.044), whereas living with relatives, abstaining from alcohol/tea, and increasing physical activity reduced depression risk (P < 0.001). After controlling for confounders, PAS scores explained an additional 9.1% of PHQ-9 score variance (ΔR² = 0.091) and showed a significant positive correlation with PHQ-9 scores (P < 0.001). Conclusion Psychological distress during previous childbirth was significantly associated with depressive symptoms in subsequent pregnancy.