Psychological flexibility buffers the impact of negative anticipation and fear of childbirth on prenatal depressive symptoms: Insights from the first phase of the flexi-prep cohort study

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OBJECTIVE: To determine the psychological factors associated with antenatal depressive symptoms and to assess whether psychological flexibility moderates the relationship between negative anticipation and fear of childbirth and depressive symptoms during pregnancy. DESIGN: Cross-sectional analysis of baseline data from the Flexi-PREP longitudinal study. SETTING: Three French maternity hospitals. POPULATION: A cohort of 395 pregnant women recruited in their third trimester of pregnancy. MEASUREMENTS AND FINDINGS: Participants completed an online survey assessing fear of childbirth (W-DEQ-A), psychological flexibility (AAQ-II), coping strategies (Brief-COPE), and depressive symptoms (EPDS). Pearson correlations, hierarchical multiple regression and moderation analyses were conducted. Higher levels of fear of childbirth were positively associated with depressive symptoms, whereas greater psychological flexibility was negatively associated. Avoidant coping strategies were linked to higher depressive symptoms, while problem-focused coping showed a marginal protective effect. In hierarchical regression, fear of childbirth, psychological flexibility and avoidant coping emerged as significant independent predictors. The moderation analysis indicated that psychological flexibility did not significantly buffer the association between fear of childbirth and depressive symptoms. However, conditional effects suggested that among women with low flexibility, fear of childbirth was more strongly related to depressive symptoms. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Psychological flexibility appears to act as a protective factor for emotional adjustment in pregnancy, while avoidant coping contributes to vulnerability. Interventions that strengthen flexibility could help reduce depressive symptoms, particularly in women reporting high childbirth-related fear.

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