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Despite extensive debates about the mental health impacts of the use of social networking sites (SNSs), including WeChat, the association and mechanisms between social interaction of WeChat use intensity and antenatal depression are unclear.
We aimed to test the mediating roles of upward social comparison on social interaction of WeChat and rumination in the association between social interaction of WeChat use intensity and antenatal depression.
A cross-sectional survey was conducted in four hospitals with the self-reported measures of social interaction of WeChat use intensity, upward social comparison on social interaction of WeChat, rumination, antenatal depression, and control variables. The mediation analysis was performed through Model 6 from the PROCESS macro 4.0 in SPSS 26.
Results from 2661 participants showed that antenatal depression was unrelated to social interaction of WeChat use intensity (
Our findings highlight the necessity of focusing on attitudes toward SNS use, and the importance of upward social comparison and rumination in understanding the effect of SNS use on antenatal depression.
Antenatal depression is typically defined as a nonpsychotic depressive episode of mild to major severity that occurs during pregnancy [
Considering the high prevalence and adverse effects of antenatal depression, it is necessary to explore the comprehensive influencing factors underlying the condition, which is conducive to early detection and further treatment of groups at higher risk of antenatal depression. A recent meta-analysis revealed that the main factors associated with antenatal depression include pregnant women’s demographic characteristics, psychosocial factors, health-related factors, lifestyle, and nutrition [
Since the concept of “Facebook depression” was first proposed, which is a term to simply describe the positive association between time spent on SNSs and depression [
Toward this end, our research focused on investigating the relationship between the intensity of SNS use and antenatal depression, with the aim to further explore the underlying mechanisms from a new perspective by examining the mediating roles of upward social comparison and rumination.
Upward social comparison refers to the process of comparing oneself to others who are considered to be superior [
A recent meta-analysis demonstrated that upward social comparison on SNSs is associated with higher risks of depression, which even exceeds the association for SNS use itself [
However, given that the key factor explaining the causal link between upward social comparison and depression is unclear, at this point, we can only recommend users to abstain from upward social comparisons while on SNSs. Such a recommendation seems futile, because experiencing upward social comparison on SNSs is an inherent part of the human condition. Thus, it is necessary to explore the mechanisms underlying the relationships between upward social comparison on SNSs and depression, including rumination.
Rumination is defined as repetitive thinking about the causes and implications of negative events and/or the symptoms of negative moods [
Notably, a wealth of evidence demonstrates that rumination is a risk and maintenance factor of depression. The Response Styles Theory provides explanations for the mechanisms between rumination and depression [
In addition, research demonstrates differences among the effects of different types of SNSs on individuals; therefore, it is recommended that researchers should clearly specify which SNS is being investigated [
We hypothesized that: (1) upward social comparison on social interactions of WeChat is an independent mediator, (2) and upward social comparison on social interaction of WeChat and rumination are the chain mediators linking social interaction of WeChat use intensity and antenatal depression (see
Hypothesized conceptual model of the chain mediation between upward social comparison on social interaction of WeChat and antenatal depression.
Cross-sectional data were collected from October 2021 to January 2022 using Wenjuanxing (an online data collection platform) through a convenience sampling method. To control the effect of missing data, the questionnaire was designed to ensure that valid respondents need to complete all items before submitting using the features of Wenjuanxing. Therefore, there was no need to apply methods for handling missing data in our study.
We recruited pregnant women from four hospitals in Jiangsu Province, China. Inclusion criteria were (1) having basic understanding and communication skills and (2) voluntary participation. Exclusion criteria were (1) suffering from or with a history of mental illness, (2) receiving psychotherapy or a psychological intervention, and (3) not users of WeChat.
Participants completed the measures, including assessments of social interaction of WeChat use intensity as the independent variable, upward social comparison on social interaction of WeChat and rumination as the two chain mediating variables, antenatal depression as the dependent variable, and control variables.
We assessed the social interaction of WeChat use intensity (independent variable) with the Facebook intensity scale [
Upward social comparison on social interaction of WeChat (mediator 1) was measured with the six-item Chinese version of the upward comparison subscale of Iowa-Netherlands Comparison Orientation Measure (1=strong disagreement, 5=strong agreement) [
Rumination (mediator 2) was measured by the Chinese version of the 22-item Ruminative Response Scale with a 4-point Likert scale (1=not at all, 4=very often) [
Antenatal depression (dependent variable) was measured by the Chinese version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) with each item scored on a scale of 0-3 [
To reduce other possible influences on our model, we considered control variables, which were not the variables of primary interest for this study. To reduce the possible influence of individual differences, demographic information such as education level (below junior college=1, junior college=2, bachelor degree=3, master degree or above=4), job (middle level and above management personnel=1, professional and technical personnel=2, clerks and relevant personnel=3, social production service and life service personnel=4, production and manufacturing personnel and related personnel=5, other unclassifiable jobs=6, have no job=7), advanced maternal age or not (yes=1, no=2), and family income (1=<US $287.60, 2=US $287.60-575.20, 3=US $575.30-862.80, 4=US $862.90-1150.40, 5=US $1150.40-1438.10, 6=US $1438.10-2876.00, 7=>US $2876.00) were considered. To reduce the possible influence of the respondents’ characteristics related to antenatal depression, we also controlled for psychosocial and obstetric variables such as quality of relationship with husband and mother-in-law (very good=1, good=2, general=3, poor=4, terrible=5), whether it is an unplanned pregnancy (yes=1, no=2), living conditions (very good=1, good=2, general=3, poor=4, terrible=5), the main caregivers during pregnancy (mother-in-law=1, mother=2, husband=3, nursemaid=4, others=5), gestational age (early pregnancy=1, second trimester=2, late pregnancy=3), gestation (0=none, 1=once, 2=twice, 3=three times or above), parturition (0=none, 1=once, 2=twice or above), BMI (<18.5=1, 18.5-23.9=2, ≥24=3, ≥28=4), and experiences of abnormal pregnancies and labor (yes=1, no=2).
Ethics approval was granted by the Ethics Committee of Nanjing Maternity and Child Health Care Hospital (approval number 2021KY-086). All procedures conducted in our study were in adherence with the ethical guidelines of the institutional and/or national research committee and the ethical standards of the Helsinki Declaration. Informed consent was obtained from all participants included in the study.
As with all self-reported data, it is important to control and examine the potential common method variance. First, we took actions to minimize potential common method biases [
Data analysis was carried out in IBM SPSS Statistics (version 26). Model 6 in the PROCESS macro for SPSS was used to examine the mediating roles of upward social comparison on social interaction of WeChat and rumination.
We processed the data on the social interaction of WeChat use intensity as follows. First, we evaluated three independent aspects: time spent on social interactions of WeChat, number of WeChat friends, and attitude toward social interaction of WeChat use. Due to different item scale ranges, the eight items were standardized before creating the total scores of social interaction of WeChat use intensity. Therefore, a total of four aspects of WeChat use were considered.
Descriptive statistics were calculated to summarize the characteristics of each variable, including mean, standard deviation, skewness, and kurtosis. Normality was considered adequate if absolute values for skewness and kurtosis were below 3.0 and 10.0, respectively [
We used Cronbach α to represent the internal consistency reliability. A Cronbach α over .70 is considered an indicator of satisfactory item homogeneity.
First, we calculated Pearson correlation coefficients between social interactions of WeChat use, number of WeChat friends, attitude toward social interaction of WeChat use, social interaction of WeChat use intensity, upward social comparison on social interaction of WeChat, rumination, and antenatal depression. We then performed an independent
The STROBE (Strengthening The Reporting of Observational Studies in Epidemiology) checklist for cross-sectional studies was applied in our study (see
There was no single factor emerging from the factor analysis and the variation explained by the first factor was 21.1% (<50%), demonstrating that there was no serious risk of common method bias in our study [
Of the 2661 valid questionnaires included in the analysis, 689 women had an EPDS score above 9.5, indicating that 25.9% of our sample may have antenatal depression.
Descriptive statistics summary (N=2661).
Variable | Mean (SD) | Skewness (SE) | Kurtosis (SE) | Cronbach α |
Number of WeChat friends | 5.4 (2.32) | –0.36 (0.05) | –1.19 (0.10) | —a |
Hours spent on social interaction of WeChat use | 2.65 (1.72) | 0.07 (0.05) | –1.32 (0.10) | — |
Attitude toward social interaction of WeChat use | 16.77 (5.02) | –0.11 (0.05) | –0.50 (0.10) | — |
SIWUIb | 0.00 (0.26) | –1.18 (0.05) | –0.45 (0.10) | .80 |
USCWc | 13.65 (5.04) | 0.21 (0.05) | –0.66 (0.10) | .90 |
Rumination | 36.13 (8.36) | 0.35 (0.05) | 0.68 (0.10) | .94 |
Antenatal depression | 7.72 (3.34) | 0.56 (0.05) | 1.63 (0.10) | .81 |
aNot applicable.
bSIWUI: social interaction of WeChat use intensity; each item was first standardized before taking an average to create the scale due to different item scale ranges.
cUSCW: upward social comparison on social interaction of WeChat.
Correlation analysis (Pearson correlation coefficients and two-tailed
Variable | Number of WeChat friends | Hours spent on social interaction of WeChat use | Attitude toward social interaction of WeChat use | SIWUIa | USCWb | Rumination | Antenatal depression | ||||||||
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1 | 0.22 | 0.15 | 0.65 | 0.08 | 0.00 | –0.06 | |||||||
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—c | <.001 | <.001 | <.001 | <.001 | .70 | .002 | ||||||||
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0.22 | 1 | 0.32 | 0.73 | 0.12 | –0.01 | 0.04 | |||||||
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<.001 | — | <.001 | <.001 | <.001 | .66 | .05 | ||||||||
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0.15 | 0.32 | 1 | 0.70 | 0.37 | 0.09 | 0.05 | |||||||
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<.001 | <.001 | — | <.001 | <.001 | <.001 | .01 | ||||||||
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0.65 | 0.73 | 0.70 | 1 | 0.28 | 0.04 | 0.01 | |||||||
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<.001 | <.001 | <.001 | — | <.001 | .04 | .54 | ||||||||
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0.08 | 0.12 | 0.37 | 0.28 | 1 | 0.39 | 0.31 | |||||||
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<.001 | <.001 | <.001 | <.001 | — | <.001 | <.001 | ||||||||
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0.00 | –0.01 | 0.09 | 0.04 | 0.39 | 1 | 0.60 | |||||||
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.70 | .66 | <.001 | .04 | <.001 | — | <.001 | ||||||||
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–0.06 | 0.04 | 0.05 | 0.01 | 0.31 | 0.60 | 1 | |||||||
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.002 | .05 | .01 | .54 | <.001 | <.001 | — |
aSIWUI: social interaction on WeChat use intensity; each item was first standardized before taking an average to create scale due to different item scale ranges.
bUSCW: upward social comparison on social interaction of WeChat.
cNot applicable.
Among all of the considered control variables, gestational age, education level, gravidity, parity, family income, quality of relationship with husband and mother-in-law, whether it is an unplanned pregnancy, living conditions, and job were significantly correlated with antenatal depression, and were therefore set as covariates.
Attitude toward social interaction of WeChat use, upward social comparison on social interaction of WeChat, rumination, and antenatal depression were significantly correlated with each other, which met the statistical requirements for mediation analysis.
Regression analysis of the relationship among model variables (N=2661).
Variable | βa |
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0.40 | 0.16 | 46.73 (11, 2649) | |||||||||||||
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Attitude to social interaction of WeChat use | .38 | 20.96 (2649) | <.001 |
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Gestational age | .00 | 0.02 (2649) | .98 |
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Education level | .06 | 2.98 (2649) | .003 |
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Gravidity | –.01 | -0.28 (2649) | .78 |
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Parity | .01 | 0.32 (2649) | .75 |
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Family income | –.01 | –0.37 (2649) | .71 |
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Quality of relationship with husband | .08 | 3.71 (2649) | <.001 |
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Quality of relationship with mother-in-law | .04 | 1.97 (2649) | .049 |
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Whether it is an unplanned pregnancy | .03 | 1.41 (2649) | .16 |
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Living conditions | .06 | 3.09 (2649) | .002 |
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Job | –.02 | –0.90 (2649) | .37 |
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0.46 | 0.21 | 58.58 (12, 2648) | |||||||||||||
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Attitude toward social interaction of WeChat use | –.05 | –2.42 (2648) | .02 |
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USCW | .38 | 20.02 (2648) | <.001 |
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Gestational age | .00 | 0.24 (2648) | .81 |
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Education level | .03 | 1.39 (2648) | .16 |
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Gravidity | .02 | 0.86 (2648) | .39 |
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Parity | -.03 | -1.04 (2648) | .30 |
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Family income | .03 | 1.67 (2648) | .09 |
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Quality of relationship with husband | .09 | 4.09 (2648) | <.001 |
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Quality of relationship with mother-in-law | .08 | 3.82 (2648) | <.001 |
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Whether it is an unplanned pregnancy | –.03 | –1.48 (2648) | .14 |
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Living conditions | .12 | 6.20 (2648) | <.001 |
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Job | .07 | 3.67 (2648) | <.001 |
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0.65 | 0.42 | 147.07 (13, 2647) | |||||||||||||
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Attitude toward social interaction of WeChat use | –.03 | –1.94 (2647) | .05 |
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USCW | .11 | 6.59 (2647) | <.001 |
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Rumination | .50 | 30.29 (2647) | <.001 |
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Gestational week | –.01 | –0.92 (2647) | .36 |
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Education level | –.10 | –5.30 (2647) | <.001 |
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Gravidity | .02 | 1.08 (2647) | .28 |
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Parity | –.02 | –0.83 (2647) | .41 |
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Family income | –.05 | –3.08 (2647) | .002 |
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Quality of relationship with husband | .08 | 4.37 (2647) | <.001 |
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Quality of relationship with mother-in-law | .08 | 4.63 (2647) | <.001 |
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Whether it is an unplanned pregnancy | –.03 | –2.13 (2647) | .03 |
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Living conditions | .06 | 3.32 (2647) | <.001 |
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Job | .03 | 1.56 (2647) | .12 |
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aStandardized coefficient.
bUSCW: upward social comparison on social interaction of WeChat.
The chain mediating effect of upward social comparison on social interaction of WeChat (USCW) and rumination (N=2661). Values on paths are path coefficients (standardized beta coefficients).
Decomposition of effects of variables in structural equation modeling (N=2661).
Path | Effect | BootSEa | BootLLCIb | BootULCIc | |||||
Total effect | 0.04 | 0.01 | 0.00 | 0.02 | |||||
Direct effects | –0.02 | 0.01 | –0.04 | 0.00 | |||||
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Total indirect effects | 0.09 | 0.01 | 0.07 | 0.12 | ||||
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Indirect effect 1d | 0.04 | 0.01 | 0.03 | 0.06 | ||||
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Indirect effect 2e | –0.02 | 0.01 | –0.04 | –0.01 | ||||
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Indirect effect 3f | 0.07 | 0.01 | 0.06 | 0.08 | ||||
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Indirect 1 versus Indirect 2 | 0.07 | 0.01 | 0.04 | 0.09 | ||||
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Indirect 1 versus Indirect 3 | –0.03 | 0.01 | –0.05 | –0.01 | ||||
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Indirect 2 versus Indirect 3 | –0.09 | 0.01 | –0.12 | –0.07 |
aBootSE: bootstrap standard error.
bBootLLCI: bootstrap lower limit of confidence interval.
cBootULCI: bootstrap upper limit of confidence interval.
dIndirect effect path 1: attitude toward social interaction of WeChat use to upward social comparison on social interaction of WeChat to antenatal depression.
eIndirect effect path 2: attitude toward social interaction of WeChat use to rumination to antenatal depression.
fIndirect effect path 3: attitude toward social interaction of WeChat use to upward social comparison on social interaction of WeChat to rumination to antenatal depression.
This study established mediation models to analyze the relationship between social interaction of WeChat use intensity and antenatal depression. The results suggested that there are different relationships between the four aspects of WeChat use and antenatal depression. Attitude toward social interaction of WeChat use influenced antenatal depression through three paths: the mediating role of upward social comparison on social interaction of WeChat and rumination, and the chain mediating roles of upward social comparison on social interaction of WeChat and rumination. These findings reveal the complexities characterizing the relationships between WeChat use and antenatal depression.
First, there was no relationship between antenatal depression and hours spent on WeChat use found in our study. Although recent meta-analyses consistently claim that there exist small, positive associations between hours spent on SNS and depression (
Second, from a simple quantity-centric view, we found that having more WeChat friends was negatively associated with antenatal depression. This is likely because more SNS friends provides individuals with richer social capital benefits [
Finally, we found that antenatal depression was not related to the social interaction of WeChat use intensity, but was positively related to attitude toward social interaction of WeChat use. This seems to be a novel finding of our study, because previous studies on the association between intensity of SNS use and depression did not separately probe into the effect of attitude toward SNS. We can explain this finding from two perspectives. On the one hand, it may be that individuals with antenatal depression tend to score high on attitudinal questions [
The above distinct relations remind us that different aspects of SNS use should not be referred as “SNS use” generally. Only a fine-grained assessment can provide reliable information as to how individuals are influenced by SNSs.
Previous research has shown that SNS use itself does not necessarily cause negative effects (see
Studies demonstrating that social networking site (SNS) use has no direct harmful effects.
Reference | Conclusion |
Lin et al [ |
The problematic social media effects on psychological distress and mental quality of life were only indirect effects via generalized trust and perceived social support |
Wang et al [ |
There is a significant mediating effect of SNS addiction between SNS use and mental health status, while the direct effect was insignificant |
Niu et al [ |
Qzone use intensity is positively related to depression, and this relationship is fully mediated by negative social comparison on Qzone |
In our study, attitude toward social interaction of WeChat use influenced antenatal depression through three paths: upward social comparison on social interaction of WeChat, rumination, and upward social comparison on social interaction of WeChat to rumination. First, attitude toward social interaction of WeChat use could increase risks of antenatal depression through increasing upward social comparison on social interaction of WeChat. This finding should come as no surprise as current evidence suggests that upward social comparison acts as a mediator between (subtypes of) SNS use and depression [
Furthermore, after exposure to upward social comparison on social interaction of WeChat, rumination occurred, which could also increase risks of antenatal depression. This finding provides new insight to explain why upward social comparison on SNSs increases the risk of depression. Future research is needed to determine the characteristics of individuals that are most susceptible to rumination after upward social comparison on SNSs, which can help to implement preventive interventions targeted at this subgroup.
An intriguing finding was that attitude toward social interaction of WeChat use could decrease the risk of antenatal depression by decreasing rumination. Previous studies found that compared to general SNS use (such as time spent on SNS), high dependence on SNSs has the special potential to build and maintain multiform social capital [
Compared to upward social comparison on social interaction of WeChat, rumination has stronger ability to increase levels of antenatal depression. This is probably because compared to upward social comparison on social interaction of WeChat, rumination is a more constant risk factor of depression. It is clear that rumination is the trigger and maintaining factor of depression [
The cross-sectional nature of this study is a major limitation. Future studies should adopt longitudinal designs to explore potential causality. In addition, all of the questionnaires used in this study are based on self-reports. These results need to be verified and enriched by qualitative and/or experimental research to better understand how individuals are influenced by SNSs. Furthermore, this study only focused on the chain mediating roles of upward social comparison on social interaction of WeChat and rumination, omitting other meaningful variables, which need to be investigated through more studies. Finally, our study only demonstrates that upward social comparison on social interaction of WeChat and rumination can increase antenatal depression, whereas demonstrating the magnitude of these effects requires further research.
In sum, our main goal is to explore the mediating role of upward social comparison on social interaction of WeChat and rumination between social interaction of WeChat use intensity and antenatal depression. The results of this study indicate that attitude toward social interaction of WeChat use (but not social interaction of WeChat use time and intensity) is associated with higher antenatal depression, which highlights that attitude toward SNS use should be valued and widely explored. Furthermore, the effect of attitude toward SNS use on antenatal depression depends on three pathways: the mediating roles of upward social comparison on social interaction of WeChat and rumination, and the chain mediating effect of upward social comparison on social interaction of WeChat and rumination. According to our results, intervention strategies focusing on lower upward social comparison and rumination may be helpful to reduce the risk of SNS use for depression. Moreover, it is assumed that SNS friends from an individual’s actual life (not the total number of SNS friends) are beneficial to decreasing depression. Although these findings need to be validated by longitudinal or experimental studies, they are helpful for researchers, health care professionals, and the public to better understand the inherent relationship between SNS use and antenatal depression.
Construct measurement.
STROBE (Strengthening The Reporting of Observational Studies in Epidemiology) Statement—Checklist of items that should be included in reports of cross-sectional studies.
Edinburgh Postnatal Depression Scale
social networking site
Strengthening The Reporting of Observational Studies in Epidemiology
We would like to express sincere gratitude to the Women’s Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Lishui Maternity and Child Health Care Hospital, Xinghua Maternity and Child Healthcare Hospital, and Changzhou Maternity and Child Healthcare Hospital for the endeavors to collect data, and all the participants who were willing to share their feelings. We also acknowledge funding from the 2022 Science and Technology (the Key Research and Development for Social Development) Program Supported by the Special Fund of Jiangsu Province of China (grant number BE2022676).
RW: Conceptualization, Methodology, Formal analysis, Investigation, Writing—original draft, Visualization; SC, XS, LS, ZR, and JF: Conceptualization, Methodology, Formal analysis, Supervision, Writing—revising; RZ, JW, XT, DZ, QZ, and XF: Investigation, Data curation, Supervision, Writing—revising; AZ: Methodology, Resources, Writing—review & editing, Project administration, Funding acquisition. All authors approved the final submitted version.
None declared.