Dysfunctional Attitudes Toward Motherhood and Depressive Symptoms in Portuguese Pregnant Women During COVID-19 Pandemic: the Mediating Roles of Self-Compassion and Mindful Self-Care

Depressive symptoms were negatively associated with household income (r = −0.17, p = 0.008) and positively associated with a previous history of psychiatric or psychological problems (r = 0.20, p = 0.002). These variables were included as covariables in the sequential mediation model. Age, marital status, relationship length, number of children, educational level, professional status, type of residence, current physical health problems, and COVID-related variables were not significantly associated with depressive symptoms.

As shown in Table 2, dysfunctional attitudes toward motherhood were negatively associated with self-compassion and mindful self-care and positively associated with depressive symptoms. Self-compassion was positively associated with mindful self-care and negatively associated with depressive symptoms. Mindful self-care was negatively associated with depressive symptoms.

Three significant indirect effects were found in the association between dysfunctional attitudes toward motherhood and depressive symptoms: a through self-compassion (point estimate = 0.65, SE = 0.17, CI = 0.35/1.02), b through mindful self-care (point estimate = 0.26, SE = 0.14, CI = 0.01/0.53), and c through self-compassion and mindful self-care (point estimate = 0.36, SE = 0.09, CI = 0.21/0.55). There was no significant direct effect of dysfunctional attitudes toward motherhood on depressive symptoms after controlling for the mediators (point estimate = 0.42, SE = 0.30, CI = −0.14/1.01). Household income (b = −0.75, p = 0.007) was also found to be associated with depressive symptoms. The serial mediation model was significant (F_5,238 = 32.78, p < 0.001) and explained 41% of the variance in depressive symptoms. All paths for the full process model as well as unstandardized regression coefficients are illustrated in Fig. 1.

In the present study, we aimed to investigate whether dysfunctional attitudes toward motherhood were associated with depressive symptoms in pregnant women during the COVID-19 pandemic and whether this relationship was sequentially mediated by self-compassion and mindful self-care. The results showed that the effect of dysfunctional attitudes toward motherhood on depressive symptoms in pregnant women was mediated by self-compassion and mindful self-care, thus corroborating our hypothesis. Our results were congruent with prior studies (Sockol et al., 2014; Sockol & Battle, 2015) showing that more dysfunctional attitudes toward motherhood were associated with more depressive symptoms during pregnancy. Women with dysfunctional attitudes toward motherhood (typically characterized by themes of failure, personal inadequacy, and a sense of hopelessness about the self, the world, and the future) seem to have a more negatively biased interpretation of daily life situations and parenting-related events. Consequently, this seems to lead them to have more negative automatic thoughts and cognitive biases that may increase their depressive symptoms (Fonseca & Canavarro, 2018; Sockol et al., 2014). It seems reasonable to assume that the uncertainty and fears caused by the lockdown situation and the COVID-19 pandemic–related restrictions (e.g., social isolation, lack of social support, postponement of medical appointments) may have emotionally and psychologically overwhelmed pregnant women in their expectations about adjusting to motherhood, which, in turn, seems to be associated with depressive symptoms experienced during pregnancy.

Our findings were also congruent with the previous literature (Costa et al., 2018; Fonseca & Canavarro, 2018) regarding the negative association between dysfunctional attitudes toward motherhood and self-compassion. According to our findings, more dysfunctional attitudes toward motherhood may be associated with lower levels of self-compassion. This may be because pregnant women with dysfunctional attitudes toward motherhood who had to deal with all the changes related to the pregnancy itself and with all the additional challenges imposed by the COVID-19 pandemic may doubt their personal value as mothers, increasing their tendency to judge themselves harshly and consequently increasing their self-criticism. Nevertheless, it is also important to consider that lower levels of self-compassion in pregnancy can lead to a perception of lower maternal self-efficacy and, consequently, lead pregnant women to have more dysfunctional attitudes about motherhood. Or, it might also be considered that other factors (e.g., childhood maltreatment) could affect women’s dysfunctional attitudes about motherhood and women’s self-compassion itself. In line with this, a negative association between dysfunctional attitudes toward motherhood and mindful self-care was also found.

According to our findings, dysfunctional attitudes or beliefs toward motherhood could contribute to reduce women’s commitment to and engagement in self-care practices such as mindful self-care. Further research is needed to better understand this association; it seems that women with more dysfunctional attitudes toward motherhood were less able to use mindful self-care tools to protect themselves from stress and demands of the pandemic, probably hindering their well-being. Considering the Gilbert model (Gilbert, 2005, 2009, 2010), the activation of the threat system occurs when individuals face potentially threatening situations. The COVID-19 pandemic could contribute to the underactivation of the soothing–affiliative system and overstimulation of the threat system of pregnant women with dysfunctional attitudes toward motherhood, leading them to be more self-critical and unable to act in accordance with their self-imposed standards about motherhood, contributing to lower levels of self-compassion, difficulty in engaging in mindful self-care practices, and, consequently, increased depressive symptoms.

In our study, self-compassion was positively associated with mindful self-care. Pregnant women who have higher levels of self-compassion and therefore have a nurturing and caring relationship toward themselves seem to also be more prone to engage in mindful self-care practices (e.g., healthy and intuitive eating, exercise, yoga, rest, and intentionally spending time with friends), probably because they are more able to generate positive attitudes of kindness, understanding, and care that help them cope with negative emotions, behaviors, and situations. Additionally, women with lower levels of self-compassion may be more critical toward themselves and feel guilty when involved in self-care activities; such activities are usually viewed by some mothers with dysfunctional beliefs toward motherhood as selfish, and they may feel unworthy of such care.

A negative association between self-compassion and depressive symptoms was also found. Literature has shown that self-compassion is an indicator of psychological health, can improve quality of life, and has an important role in reducing levels of depression. This is consistent with previous studies (Fourianalistyawati et al., 2018; Mohamadirizi & Kordi, 2016) and suggests that self-compassion may protect pregnant women against depressive symptoms in response to significant stress challenges, such as the COVID-19 pandemic. In this context, if pregnant women with dysfunctional attitudes toward motherhood can experience higher levels of self-compassion, they could be less critical and judgmental about themselves and better manage their dysfunctional attitudes, which could subsequently protect them from the development of and/or an increase in depressive symptoms. Finally, in line with the results found in a study by Webb et al. (2019), our results showed a negative association between mindful self-care and depressive symptoms. It seems that a regular and intentional practice of mindful self-care could improve pregnant women’s physical and psychological well-being (Cook-Cottone & Guyker, 2018; Hotchkiss & Cook-Cottone, 2019). On the other hand, it might be considered that pregnant woman’s physical and psychological well-being could also improve their interest in self-care. In the context of COVID-19, the practice of mindful self-care could help pregnant women maintain a balance between self-needs and external demands, thus reducing depressive symptoms and improving well-being.

Moreover, our study added to previous research showing that self-compassion and mindful self-care fully explained the association between pregnant women’s dysfunctional attitudes toward motherhood and depressive symptoms during the COVID-19 pandemic. According to these findings, it seems reasonable to expect that if pregnant women with dysfunctional attitudes and beliefs toward motherhood can have more compassionate attitudes toward themselves, then they would also be more able to engage in additional practices of mindful self-care and could experience fewer depressive symptoms. However, it is also important to note that self-compassion and mindful self-care practices mediated the association between dysfunctional attitudes toward motherhood and depressive symptoms both sequentially and individually.

We can suggest that pregnant women with more dysfunctional attitudes and beliefs toward motherhood tend to have lower levels of self-compassion. Consequently, they may experience low self-worth, a low sense of self-efficacy, and a lack of self-confidence and think less of themselves (Neff & Vonk, 2009), thus experiencing higher levels of depressive symptoms. More research is also needed regarding the indirect effect of dysfunctional attitudes toward motherhood on depressive symptoms through mindful self-care. Women with dysfunctional attitudes toward motherhood are expected to have difficulties engaging in mindful self-care behaviors that bring awareness and commitment (Cook-Cottone & Guyker, 2018; Hotchkiss & Cook-Cottone, 2019) and that require a shift from a judgmental attitude over concerns with maternity toward loving self-care. These difficulties seem to increase levels of depressive symptoms in these women.

In sum, according to our findings, women with negative thoughts and attitudes toward motherhood who have more self-compassionate attitudes and/or more mindful self-care practices may notice these thoughts and attitudes in a nonjudgmental way and accept them as part of their maternity experience (Pedro et al., 2019). Taking into account the concerns about COVID-19 and the demands of motherhood, if pregnant women with dysfunctional beliefs toward motherhood adopt a nonjudgmental position concerning their attitudes and limitations regarding their role as mothers, accept these limitations as part of the human condition and take part in self-care experiences in times such as the pandemic, they could experience lower depressive symptoms. These findings highlight the importance of considering self-compassion and mindful self-care in psychological interventions to prevent and/or treat depressive symptoms in pregnant women with dysfunctional attitudes and beliefs toward motherhood. This seems to be particularly relevant during stressful public health crises such as the COVID-19 pandemic.