The mediating role of resilience and sleep quality between self-efficacy and prenatal anxiety: A mediational analysis

Background and objective: During pregnancy, prenatal anxiety is one of the most common mental disorders that women experience. This study aims to assess the prevalence of prenatal anxiety among Chinese pregnant women and explore the parallel mediating role of resilience and sleep quality in the relationship between self-efficacy and prenatal anxiety.

Methods: Between February and June 2023, a total of 1071 pregnant women were recruited from three hospitals in Nantong, Jiangsu Province, China, using a convenience sampling method. The participants completed general survey questionnaires and were assessed using the Depression Anxiety Stress Scale-21, the Pittsburgh Sleep Quality Index, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the General Self-Efficacy Scale. In addition, a hierarchical multiple regression analysis was employed to investigate the relevant and mediating factors of prenatal anxiety. This study utilized a structural equation model to examine the mediating role of resilience and sleep quality in the relationship between self-efficacy and prenatal anxiety.

Results: Multivariate regression analysis showed that self-efficacy, resilience, and sleep quality were associated with prenatal anxiety (P < 0.05). The results of the mediation analysis indicated that resilience and sleep quality acted as fully mediators between self-efficacy and prenatal anxiety. The mediating effect of resilience was -1.8970 (95% CI -2.5259 to -1.3145), accounting for 72.07% of the total effect, and the mediating effect of sleep quality was -0.5482 (95% CI -0.7450 to -0.3726), accounting for 20.83% of the total effect. While self-efficacy accounted for 7.10% of the total effect (P = 0.5625), resilience, and sleep quality fully mediated prenatal anxiety.

Conclusion: In Chinese pregnant women, the study revealed that sleep quality and resilience played a fully mediating role in the impact of self-efficacy on symptoms of prenatal anxiety. This suggests that enhancing resilience, improving sleep quality, and promoting self-efficacy may help alleviate symptoms of prenatal anxiety.