Longitudinal associations between depressive symptoms and professional psychological help-seeking attitudes across pregnancy and early postpartum: A random intercept cross-lagged panel study.

BACKGROUND: Depressive symptoms and attitudes toward seeking professional psychological help are both critical determinants of mental health outcomes during pregnancy and early postpartum. However, their longitudinal and reciprocal associations remain poorly understood. METHODS: This multicenter prospective cohort study enrolled 1250 women during mid-pregnancy (T1) and followed them through late pregnancy (T2), 1 month postpartum (T3), and 3 months postpartum (T4). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, and help-seeking attitudes were assessed with the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form. Random-intercept cross-lagged panel model was applied to disentangle stable between-person differences from within-person temporal dynamics. RESULTS: At the between-person level, depressive symptoms were negatively correlated with help-seeking attitudes (β = -0.371, 95% CI [-0.444, -0.298]). At the within-person level, bidirectional associations emerged in a stage-specific manner. More favorable help-seeking attitudes were associated with lower subsequent depressive symptoms from T2 to T3 (β = -0.105, 95% CI [-0.190, -0.020]) and from T3 to T4 (β = -0.125, 95% CI [-0.202, -0.048]). Conversely, increases in depressive symptoms were associated with less favorable help-seeking attitudes from T3 to T4 (β = -0.126, 95% CI [-0.205, -0.047]). CONCLUSIONS: Depressive symptoms and help-seeking attitudes are dynamically and bidirectionally linked across pregnancy and early postpartum. These findings suggest that help-seeking attitudes may represent one potentially modifiable psychological factor relevant to perinatal mental health. However, given the modest effect sizes and the absence of direct measures of actual help-seeking behaviors, future intervention studies are needed to establish their clinical significance.