Discussion
depression, depressive, anxiety
DISORDERS
The objective of this study was to explore the effects of a mindfulness program on psychological distress and mother–infant bonding in perinatal women. The study findings support the feasibility, acceptability, and efficacy of the intervention among women with PMAD. Compared with the control group (standard antenatal care), the intervention group experienced significant reductions in self-reported depression, stress, and anxiety that persisted up to four months postpartum. Furthermore, after the intervention, the anxiety effect was large, except at 36 weeks of gestation (before delivery). Stress and depression effect sizes were moderate and significantly smaller after four months postpartum.In our study, about 66% of the participants had moderate to high perceived stress. However, the mindfulness intervention resulted in not only a decrease in perceived stress but also an improvement in mental health indicators, such as symptoms of anxiety and depression. Individuals with increased mindfulness have been shown to have a more benign approach to cognitive assessments of stressful situations and use more adaptive coping strategies [It is important to note that our findings of improvement in psychological distress are consistent with those of several meta-analyses and review studies conducted in pregnancy and postpartum periods on women with or without pre-existing stress, depressive or anxiety disorders [Bögels et al. [There are several limitations to this study. In spite of the fact that the initial sample size was sufficient for the purposes of this study, there was a high attrition rate (35.29%). The effect size may be overestimated, but there was no significant difference in attrition between the intervention and control groups. To capture the ongoing effects of the course more accurately, future studies should focus on strategies to improve questionnaire retention. The study also had the limitation that participants in this study were women with a predisposition for depression, using an EPDS screening score of 10 or higher; therefore, these results cannot be generalized to all women with PMAD. Thirdly, self-reported outcome measures were utilized to assess depression, stress, anxiety, quality of mother-infant bonding, and mindfulness practice time. The fourth limitation of this study is that the participants were Taiwanese and the study was conducted during the COVID-19 pandemic, which might limit their generalizability to other cultures and periods. Future studies should seek to replicate these results with a more diverse sample and a typical time context.