Community Factors and Prenatal Depression: Advancing Equity through Resilience and Social Connectedness

Background and Purpose:
Depression during pregnancy affects a substantial proportion of women and is a major risk factor for postpartum depression and child developmental difficulties (Cheng et al., 2021; Urizar et al., 2022). While prior research has primarily focused on individual-level vulnerabilities, scarce attention has been given to the broader community conditions that shape maternal mental health. Drawing on ecological and social capital frameworks, community-level resources, such as perceived community resilience and social-communal connectedness, may play a critical role in shaping psychological outcomes during the perinatal period (Weiss-Dagan et al., .(2024These resources may be particularly relevant for advancing equitable mental health outcomes by strengthening supportive environments and fostering meaningful social participation. This study examined the association between prenatal psychosocial risk and depressive symptoms and tests mediation and moderation pathways involving community-level factors.

Methods:
The sample included 223 pregnant women in their second or third trimester, recruited from childbirth preparation groups and a perinatal mental health clinic at a large tertiary hospital in Israel. Participants completed validated self-report measures assessing depressive symptoms (Edinburgh Postnatal Depression Scale; EPDS), psychosocial prenatal risk [including trauma-related risk and general psychosocial related risk] (ANRQ), perceived community resilience (CCRAM), and social-communal connectedness (i.e., frequency of social contact with friends, family, neighbors, and community members). Data were analyzed using Pearson correlations, hierarchical regression analyses, and PROCESS macro models.

Results:
Higher levels of prenatal psychosocial risk were strongly associated with increased depressive symptoms, explaining a substantial proportion of variance in EPDS scores (R²=.353, p<.001). The addition of community-level variables significantly improved model fit (ΔR²=.024, p=.008), with perceived community resilience emerging as a significant negative predictor of depressive symptoms (B=-1.20, p=.008). Mediation analysis indicated that prenatal risk was negatively associated with perceived community resilience (b=-0.05, p<.001), which in turn was associated with lower depressive symptoms (b=-1.02, p=.011). The indirect effect was small but significant (bootstrap estimate= 0.049, 95% CI [0.006, 0.095]), indicating partial mediation. Moderation analysis revealed a significant interaction between trauma-related prenatal risk (e.g., intimate partner violence) and social-communal connectedness (b=-0.86, p=.005). The association between trauma-related risk and depressive symptoms was stronger among women with lower levels of social contact and attenuated among those with higher levels, suggesting a buffering effect of social connectedness.

Conclusions and Implications:
Findings support a multilevel model of prenatal depression that integrates individual vulnerability with community and social-contextual resources. While psychosocial risk factors were the strongest predictors of depressive symptoms, perceived community resilience functioned as a protective factor beyond individual risk exposure and partially mediated the relationship between risk and mental health outcomes. Furthermore, social-communal connectedness emerged as a protective factor, buffering the effects of trauma-related psychosocial risk on depressive symptoms. These findings highlight the role of community conditions in shaping equitable mental health during pregnancy. Strengthening community resilience and social connectedness, particularly for women at elevated risk, can promote inclusion, reduce disparities, and ultimately decrease levels of depression. Such evidence supports community-based interventions that foster social engagement and supportive and resilient environments.