Traditional Chinese medicine health literacy and depressive symptoms in postpartum women: the sequential mediating effects of social support and self-efficacy.

BACKGROUND

Postpartum depressive symptoms are common and can adversely affect maternal and infant health. Traditional Chinese medicine health literacy may play an important role in promoting physical and mental recovery during the puerperium. However, evidence regarding the association between traditional Chinese medicine health literacy and postpartum depressive symptoms remains limited, and the underlying mediating mechanisms are unclear.

OBJECTIVE

To explore the relationship between Traditional Chinese Medicine health literacy and depressive symptoms in postpartum women, and to examine the sequential mediating role of social support and self-efficacy.

METHODS

Using convenience sampling, this cross-sectional study was conducted in Chengdu, China from December 2025 to April 2026. A total of 501 postpartum women completed measures of traditional Chinese medicine health literacy, social support, self-efficacy, and depressive symptoms. After adjusting for covariates, sequential mediation was examined by PROCESS 4.1 Model 6. Bias-corrected bootstrap (5,000 resamples) was used to generate 95% confidence intervals; indirect effects were deemed significant if the interval did not include zero. All tests were two-tailed with α = 0.05.

RESULTS

The scores of traditional Chinese medicine health literacy, postpartum social support, self-efficacy, and depressive symptoms were (118.21 ± 14.56), (47.72 ± 11.41), (29.22 ± 6.44), and (7.16 ± 4.99), respectively. Depressive symptoms were significantly negatively correlated with traditional Chinese medicine health literacy, social support, and self-efficacy (all p < 0.001). Traditional Chinese medicine health literacy exerted a direct negative effect on depressive symptoms (β = -0.206, 95% CI: -0.299 to -0.112). In addition, three significant indirect pathways were identified: the independent mediating pathway through social support (β = -0.102, 95% CI: -0.167 to -0.050), the independent mediating pathway through self-efficacy (β = -0.102, 95% CI: -0.148 to -0.059), and the sequential mediating pathway from social support to self-efficacy (β = -0.033, 95% CI: -0.053 to -0.018). The total indirect effect accounted for 53.6% of the total effect.

CONCLUSION

Intervention strategies designed to improve postpartum women's traditional Chinese medicine health literacy, strengthen social support and boost self-efficacy may aid the prevention and control of postpartum depressive symptoms. The actual effectiveness of relevant intervention programs needs to be further verified in subsequent longitudinal studies and intervention trials.