What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion
Open accessAbstract
Background Not all women presenting risk factors for postpartum depression (PPD) develop depressive symptoms. Research has shown that acceptance-focused processes (nonjudgmental appraisal of thought content, psychological flexibility) and self-compassion play an important protective role in the development of psychological symptoms. However, considering the perinatal period, little is known about what variables can modify the negative impact of risk.Methods The sample consisted of 185 postpartum women at risk of developing PPD (Postpartum Depression Predictors Inventory-Revised > 5.5). Data were collected regarding depressive (Edinburgh Postnatal Depression Scale) and anxiety symptoms (Hospital Anxiety and Depression Scale), psychological flexibility (Acceptance and Action Questionnaire-II), nonjudgmental appraisal of thought content (Postnatal Negative Thoughts Questionnaire) and self-compassion (Self-Compassion Scale-Short Form).Results Women not presenting depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion than women presenting depressive and anxiety symptoms. Hierarchical logistic regression showed that women with higher levels of psychological flexibility (OR = 1.06, CI: 1.01-1.12) and nonjudgmental appraisal of thought content (OR = 1.33, CI: 1.15-1.53) had a significantly higher likelihood of not presenting depressive and anxiety symptoms.Limitations The limitations of this study were the cross-sectional design, the use of self-report questionnaires and the self-selected bias in recruitment.Conclusions This study emphasizes the important role of acceptance-based processes, suggesting that at-risk women who are more accepting of their private events may be more protected from developing psychological symptoms. Preventive interventions should consider the promotion of these processes to improve women's adjustment to this period.
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Psychological flexibility has been shown to protect against postpartum depression and anxiety.
“In fact, psychological flexibility has been shown to protect against postpartum depression and anxiety [24].”
From Acceptance-based process variables on postpartum well-being and distress: The mediating role of psychological flexibility (2024) · cites this paper as [24]
Only one study, to date, has examined the role of psychological flexibility within postpartum women.
“Despite the relevance of these processes, only one study, to date, has examined the role of psychological flexibility within postpartum women [24].”
From Acceptance-based process variables on postpartum well-being and distress: The mediating role of psychological flexibility (2024) · cites this paper as [24]
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Shehta, M. S., Mohamed, M. A.-E., Abdelmenam, S. O., & Salama, A. M. (2023) · Journal of Nursing Science Benha University/Journal of Nursing Science Benha University · doi:10.21608/jnsbu.2023.278956 · Cited by 5 · see citing works
Whittingham, K., & Mitchell, A. E. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.04.004 · Cited by 5 · see citing works
Muramoto, M., Kita, S., Tobe, H., Ikeda, M., & Kamibeppu, K. (2022) · Japan Journal of Nursing Science · doi:10.1111/jjns.12494 · Cited by 5 · see citing works
“Monteiro et al. (2019) hypothesized that psychological resources, such as self-compassion, mediate cognitive experiences.”
BackgroundAndrei, A., Webb, R., & Enea, V. (2023) · Psihologija · doi:10.2298/psi220422002a · Cited by 4 · see citing works
Saleh, A. S. E. M. (2019) · Evidence-Based Nursing · doi:10.1136/ebnurs-2019-103081 · Cited by 4 · see citing works
Application of the Cognitive-Behavior Therapy principles in the development of e-mental health tools
Fonseca, A., Branquinho, M., & Canavarro, M. C. (2020) · Psychologica · doi:10.14195/1647-8606_63-2_6 · Cited by 4 · see citing works
“It is important to note that interpersonal maintenance factors are particularly relevant for PPD.”
BackgroundInfluentialMahamid, S., & Chasson, M. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.09.026 · Cited by 4 · see citing works
Walls, J., Farewell, C. V., Traikoff, K., Burns, H., Whalen, J., Shefferman, M., & Leiferman, J. A. (2022) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2203038 · Cited by 3 · see citing works
Davis, J. A., Ohan, J. L., Bear, N., Gibson, L. Y., Silva, D. T., Prescott, S. L., & Finlay‐jones, A. L. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-07002-z · Cited by 3 · see citing works
Caldwell, J., Meredith, P. J., Whittingham, K., & Ziviani, J. M. (2022) · OBM Integrative and Complementary Medicine · doi:10.21926/obm.icm.2203028 · Cited by 3 · see citing works
Raneberg, A., & MacCallum, F. (2025) · Sex Roles · doi:10.1007/s11199-025-01621-2 · Cited by 2 · see citing works
“…has a buffering effect against stress, self-criticism, depression, and anxiety in parents (Felder et al., 2016 ; Gouveia et al., 2016 ; Monteiro et al., 2019 ; Neff & Faso, 2015 ; Pedro et Previous research has linked unrealistically high mother - hood standards with poor maternal…”
Topal, C. A., Mert-Karadas, M., Karakurt, İ., & Boztepe, H. (2025) · Journal of Health Psychology · doi:10.1177/13591053251401689 · Cited by 2 · see citing works
“Monteiro et al. (2019) examine the self-compassion among at-risk postpartum women presenting and not presenting clinically relevant depressive symptoms.”
Oliveira, F. S. E., Mota, D. D. C. D. F., Guimarães, J. V., Cavalcante, Á. M. R. Z., & VIEIRA, F. V. M. (2023) · Issues in Mental Health Nursing · doi:10.1080/01612840.2023.2243332 · Cited by 2 · see citing works
“…soft technologies, such as therapeutic interpersonal relationships and nonviolent communication, health-care professionals can significantly impact mothers experiencing guilt and questioning their maternal abilities, often hindering their search for help (Monteiro et al., 2019; Pedro et al., 2019).”
BackgroundLin, Y., Zhang, X., Zhou, T., Xu, F., Zhu, X., Zhou, H., Wang, X., & Ding, Y. (2023) · Early Intervention in Psychiatry · doi:10.1111/eip.13462 · Cited by 2 · see citing works
Women's experiences of the transition to motherhood and self-compassion
Hunter, S., & Dickson, C. A. W. (2024) · Journal of Family and Child Health · doi:10.12968/jfch.2024.1.1.28 · Cited by 2 · see citing works
Skibniewski-Woods, D. (2023) · doi:10.23889/suthesis.63447 · Cited by 1 · see citing works
Afrashteh, M. Y., & Masoumi, S. (2023) · Research Square · doi:10.21203/rs.3.rs-3210974/v1 · Cited by 1 · see citing works
Editor’s essay: From anxiety to action
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Exploring the Use of Self-Compassion in the Transition to Motherhood: A Thematic Analysis
Felton, B. (2021) · UEL Research Repository (University of East London) · doi:10.15123/uel.8993y
Pîrcălabu, G., Chiracu, A., & Golu, F. (2021) · Applied Science and Innovative Research · doi:10.22158/asir.v5n3p17
“Numerous studies have revealed the importance of these factors in maintaining a high level of well-being (David, Cotet, et al., 2018; Fonseca & Canavarro, 2019; Jibeen, 2017; Liu et al., 2017; Monteiro et al., 2019; Sansinenea et al., 2020; Zhou & Xu, 2019).”
BackgroundThe Experience of Primiparous Mothers in Regulating Emotions during the Postpartum Period
Layyinah, N. U., & Abidin, Z. (2023) · Bulletin of Counseling and Psychotherapy · doi:10.51214/bocp.v5i1.475
Zargar, F., Mansouri, R., & Tarrahi, M. J. (2023) · Iranian Rehabilitation Journal · doi:10.32598/irj.21.2.1861.1
Self-Compassion Pada Ibu Dengan Postpartum Depression: Kajian Literatur
Amalia, S., Kurniawati, D., & Rahmawati, I. (2023) · Alauddin Scientific Journal of Nursing · doi:10.24252/asjn.v5i1.40174
“…mengungkapkan perolehan nilai koefisien korelasi Pearson Product Moment ( r ) yang bervariasi, antara lain − 0,52 (Pedro et al., 2019), − 0,54 (Fernandes et al., 2021), − 0,58 (Fonseca dan Canavarro, 2018), − 0,59 (Fernandes et al., 2021; Monteiro et al., 2019), dan − 0,6 (Fernandes et al., 2022a).”
BackgroundInfluentialPilcher, S. A., Bird, A. L., Carey, C., Liddle, S. K., & Pickard, J. A. (2025) · Clinical Psychologist · doi:10.1080/13284207.2025.2533126 · Cited by 1 · see citing works
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“Accepting one’s situation, such as not having the desired support from family, may lead to increased self-efficacy, 64,65 as demonstrated by the participant who felt empowered when she learned she could cope on her own.”
Williamson, S. P., Moffitt, R. L., Broadbent, J., Lee, I., & Hamblin, P. S. (2025) · Midwifery · doi:10.1016/j.midw.2025.104669
Postpartum Depression from the Perspective of Third-Wave Psychotherapies
Hamarat, H., Fidantek, H., Özdem, M., & Ertürk, İ. Ş. (2025) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.1636688
“Over time, these strategies can exacerbate negative experiences (Monteiro et al. 2019).”
InfluentialAvcı, İ. K., Mahmutoğlu, S., & Avcı, M. (2026) · BMC Psychology · doi:10.1186/s40359-026-04864-0
“For instance, a recent study highlighted that women exhibiting higher levels of psychological flexibility reported fewer symptoms of depression and anxiety [22].”
Haney, J. R., & Steinman, S. A. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122234
Obstetric Violence and Postpartum Adjustment: Exploration of Risk and Resilience Factors
O’Neill, H., Dodd, J. C., Byerley, S., & Venkat, S. (2026) · Women's Reproductive Health · doi:10.1080/23293691.2026.2692119
Herrera, J. A. M., Duplessis-Marcotte, F., & Gosselin, P. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.101022
An Examination of Psychosocial Processes Related to Quality of Life in Pregnancy
Sauer, E., Block‐Lerner, J., Marks, D. R., & Giordano, K. (2026) · Journal of Prenatal and Perinatal Psychology and Health · doi:10.62858/apphe37301
- Authors
- Monteiro, F., Fonseca, A., Pereira, M., Alves, S., & Canavarro, M. C.
- Affiliations
- Universidade de Coimbra Centro de Investigação em Neuropsicologia e Intervenção Cognitivo-Comportamental (PT)
- Corresponding author
- Monteiro, Fabiana
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 246
- Pages
- 522-529
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2906455551
- Cited by
- 61
- References
- 63
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 15 · 2022: 11 · 2021: 8 · 2020: 5 · 2019: 2 · 2018: 1
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Funders
- Fundação para a Ciência e a Tecnologia (IF/00402/2014, SFRH/BD/102717/2014, SFRH/BD/115585/2016, SFRH/BPD/93996/2013)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- postpartum depression, postpartum anxiety, acceptance and commitment therapy, psychological flexibility, self-compassion, protective factors, women at risk, perinatal mental health, risk factors
- MeSH terms
- Adult, Anxiety, Cross-Sectional Studies, Depression, Empathy, Female, Humans, Pregnancy, Psychiatric Status Rating Scales, Surveys and Questionnaires, Depression, Postpartum, Postpartum Period, Young Adult, Self Report, Protective Factors
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