Association between antenatal depression and quality of life in pregnant women with hypertensive disorders of pregnancy: Mediating effects of pregnancy stress and psychological resilience.

Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of antenatal depression (AD), but the pathways linking AD to quality of life (QoL) remain insufficiently understood. In this single-center retrospective study, 301 pregnant women with HDP completed the Edinburgh Postnatal Depression Scale (EPDS), Perceived Stress Scale, Resilience Scale, and 36-Item Short Form Health Survey (SF-36). Correlation and linear regression analyses were performed, and a chain mediation model (PROCESS Model 6; 5,000 bootstrap samples) was tested with adjustment for age, education, and adverse pregnancy history. The mean EPDS score was 7.17±3.48, and 26.25% exceeded the clinical cut-off (>9.5). AD was significantly associated with poorer QoL (total effect = -0.788, P<0.001). Pregnancy stress and psychological resilience jointly mediated this association, with indirect effects accounting for 53.7% of the total effect via stress (30.0%), resilience (17.1%), and the stress→resilience chain pathway (6.7%). In women with mild preeclampsia (n=123), the total indirect effect increased to 70.0%. We conclude that antenatal depression appears to impair quality of life in women with hypertensive disease of pregnancy largely through heightened pregnancy stress and reduced resilience, supporting integrated interventions that address depressive symptoms, stress management, and resilience enhancement.