Open Access

ARTICLE

Longitudinal Pathways between Psychological Distress, Mindfulness, Childbirth Trauma, and Postpartum PTSD among Chinese Postpartum Women: A Three-Wave Cross-Lagged Panel Analysis

Xiaofei Nie^1,2,*, Amir Pakpour^2,3, Yanqiong Ouyang⁴, Maria Björk^2,3
1 School of Nursing, Hubei University of Medicine, Shiyan, China
2 The CHILD research group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
3 Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
4 School of Nursing, Wuhan University, Wuhan, China
* Corresponding Author: Xiaofei Nie. Email:
(This article belongs to the Special Issue: Emotions and Emotional Regulation in Different Populations)

International Journal of Mental Health Promotion https://doi.org/10.32604/ijmhp.2026.078747

Received 07 January 2026; Accepted 25 March 2026; Published online 27 April 2026

Abstract

Objectives: This study aims to examine the temporal associations among psychological distress, mindfulness, childbirth trauma, and postpartum post-traumatic stress disorder (PTSD) symptoms across the first three months postpartum and test whether mindfulness mediates these longitudinal pathways. Methods: This prospective longitudinal cohort study followed Chinese postpartum women at one week (T1), one month (T2), and three months (T3) after childbirth. A total of 210 women completed baseline assessments, with 173 and 148 participants retained at T2 and T3, respectively. Psychological distress, mindfulness, childbirth trauma, and postpartum PTSD symptoms were assessed using validated self-report measures. Cross-lagged panel models (CLPM) with bootstrapping were applied to examine temporal associations and the mediating role of mindfulness. Results: Mindfulness demonstrated a complex mediating role across the postpartum period. Psychological distress at T1 showed a significant negative indirect association with childbirth trauma at T3 via mindfulness at T2 (β = −0.110, 95% CI [−0.188, −0.037]), while simultaneously exerting a positive direct effect (β = 0.151, 95% CI [0.030, 0.272]), resulting in an inconsistent mediation pattern (β = 0.041, 95% CI [−0.158, 0.240]). In contrast, psychological distress at T1 showed a significant indirect longitudinal association with postpartum PTSD symptoms at T3 via mindfulness at T2 (β = −0.206, 95% CI [−0.310, −0.101]). This pattern was consistent with mediation, although the findings should be interpreted cautiously given the CLPM framework and the modest model fit. Conclusions: Mindfulness functions as a central but non-uniform mechanism in postpartum mental health. These findings underscore both its protective potential and the methodological and conceptual complexity of interpreting mindfulness in longitudinal postpartum research.

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Keywords

Postpartum women; psychological distress; mindfulness; childbirth trauma; postpartum post-traumatic stress disorder; prospective longitudinal cohort study

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