روابط علی انعطاف‌پذیری شناختی و کیفیت روابط زناشویی با اضطراب بارداری در سه ماهه اول با میانجی‌گری سبک زندگی ارتقاء دهنده سلامت

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکتری، گروه روان‌شناسی، واحد تبریز، دانشگاه آزاد اسلامی، تبریز، ایران

2 گروه روان‌شناسی، واحد تبریز، دانشگاه آزاد اسلامی، تبریز، ایران

3 گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران

10.22034/jmpr.2023.58642.5859

چکیده

پژوهش حاضر با هدف تعیین رابطه انعطاف­‌پذیری شناختی و کیفیت روابط زناشویی با اضطراب بارداری در سه ماهه اول با میانجی‌گری سبک زندگی ارتقاءدهنده سلامت صورت گرفت. این پژوهش از نوع توصیفی-همبستگی بود. از جامعه‌ زنان باردار شهر تبریز در دوره‌ سه ماهه اول بارداری که در بیمارستان زنان الزهرا و کلینیک میلاد تبریز دارای پرونده‌ی پزشکی بودند، به روش نمونه‌­گیری هدفمند، 250 نفر انتخاب و جهت اندازه‌­گیری متغیرها از پرسشنامه‌­های اضطراب حاملگی (PRAQ)، انعطاف‌پذیری شناختی دنیس و وندروال (۲۰۱۰)، سبک زندگی ارتقادهنده سلامت والکر و کیفیت زندگی زناشویی باسبی و همکاران (1995) استفاده شد. داده‌­ها با استفاده از روش مدل‌یابی معادلات ساختاری مورد تحلیل قرار گرفت. تحلیل داده‌­ها نشان داد کیفیت روابط زناشویی، انعطاف‌­پذیری شناختی و سبک زندگی ارتقاءدهنده سلامت با اضطراب بارداری رابطه منفی و معنی‌­دار دارند که در این میان، کیفیت روابط زناشویی 45 درصد، انعطاف‌­پذیری شناختی 38 درصد و سبک زندگی ارتقاءدهنده سلامت 37 درصد از تغییرات اضطراب بارداری را به طور منفی تعیین می­‌کنند. از سویی، نتایج نشان داد سبک زندگی ارتقاءدهنده سلامت قادر است رابطه کیفیت روابط زناشویی و انعطاف‌­پذیری شناختی با اضطراب بارداری را به‌طور معنی­‌دار میانجی‌گری کند. مبتنی بر یافته‌­ها می­‌توان نتیجه گرفت انعطاف‌­پذیری به عنوان یک توانمندی شناختی قادر است اثرات موقعیت‌های سخت  را تعدیل نماید و ازطرفی، کیفیت روابط زناشویی عامل مهم در کاهش اضطراب بوده و سبک زندگی ارتقاءدهنده سلامت قادر است به عنوان یک عامل حفاظتی در برابر اضطراب و فشارهای دوره بارداری عمل کند.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Relationship Between Cognitive Flexibility, Quality of Marital Relationships and Pregnancy Anxiety in the First Trimester: Mediating Role of Health-Promoting Lifestyle

نویسندگان [English]

  • Farnaz Deyhimi Notash 1
  • Marziyeh Alivandi Vafa 2
  • Laya Farzadi 3
1 PhD student, Department of Psychology, Ta.C., Islamic Azad University, Tabriz, Iran
2 Department of Psychology, Ta.C., Islamic Azad University, Tabriz, Iran
3 Department of Obstetrics and Gynecology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
چکیده [English]

The present study aimed to determine the relationship between cognitive flexibility, quality of marital relationships and pregnancy anxiety in the first trimester by mediating health promoting lifestyle. This research was conducted with a correlational method. Therefore, using purposeful sampling method, 250 subjects were selected from the population of pregnant women in the first trimester of pregnancy who had medical records at Al-Zahra Women's Hospital and Milad Clinic in Tabriz, and they were assessed by Pregnancy Anxiety Questionnaire (PRAQ), Dennis and VanderWaal (2010) cognitive flexibility scale, Walker's health-promoting lifestyle and Busby et al. (1995) quality of marital life questionnaire. Data were analyzed using structural equation modeling method. Findings showed that there were negative and significant relationship between quality of marital relations, cognitive flexibility, health-promoting lifestyle and pregnancy anxiety. Health promoting lifestyle determines 37% of pregnancy anxiety variances negatively. On the other hand, the results showed that the health- promoting lifestyle can significantly mediate the relationship between the quality of marital relationships, cognitive flexibility and pregnancy anxiety. Hence, it can be concluded that flexibility as a cognitive ability can moderate the effects of difficult situations. On the other hand, the quality of marital relationships is an important factor in reducing anxiety, and a health- promoting lifestyle can be a protective factor against anxiety and stress during pregnancy.

کلیدواژه‌ها [English]

  • pregnancy anxiety
  • quality of marital relationship
  • cognitive flexibility
  • lifestyle
  • health
Afusat, O.B. (2020). Prevalence and associated factors of anxiety and depression among pregnant women. Open Access J Neurol Neurosurg, 9(2), 555758. doi: 10.19080/OAJNN.2018.09.555758
Albal, E., & Buzlu, S. (2021). The effect of maladaptive schemas and psychological flexibility approaches on the addiction severity of drug addicts. Archives of Psychiatric Nursing, 35(6), 617-624. doi: 10.1016/j.apnu.2021.09.001doi:10.1016/j.apnu.2021.09.001
Alipour, Z., Kheirabadi, G.R., Kazemi, A., & Fooladi, M. (2020). The most important risk factors affecting mental health during pregnancy: a systematic review. East Mediterr Health J, 24(6), 549–59. doi.10.26719/2018.24.6.549
ÁngelRosa, A., Pablo J. O, O., Inmaculada, C. M. E., José LuisParada, N., Ana I. R. A., JoséOlivare, R. (2020). Cognitive flexibility and response inhibition in patients with Obsessive-Compulsive Disorder and Generalized Anxiety Disorder, International Journal of Clinical and Health Psychology, 20(1), 20-28. doi.10.1016/j.ijchp.2019.07.006
Antezana G, Venning A, Blake V, Smith D, Winsall M, Orlowski S, Bidargaddi N. (2021). An evaluation of behaviour change techniques in health and lifestyle mobile applications. Health Informatics J, 26 (1), 104-113. doi.10.1177/1460458218813726
Antunes, R., Frontini, R., Amaro, N., Salvador, R., Matos, R., Morouço, P., & Rebelo-Gonçalves, R. (2020). Exploring lifestyle habits, physical activity, anxiety and basic psychological needs in a sample of Portuguese adults during COVID-19. International Journal of Environmental Research and Public Health, 17(12), 4360. doi.10.3390/ijerph17124360
Arafat, Y., Sial, N., & Zafar, A. (2020). A study of extra marital relations in Urdu dramas: A qualitative analysis. Pakistan Journal of Gender Studies, 20(1), 251-271. doi.10.46568/pjgs.v20i1.63
Armstrong, D. S. (2014). Impact of prior perinatal loss on subsequent pregnancies. Journal of Obstetric, Gynecologic & Neonatal Nursing, 33(6), 765-773. doi.10.1177/0884217504270714
Arsenault, D., & Mahlangu, N. (2008). Impact of perinatal loss on the subsequent pregnancy self: Women’s experiences. Journal of Obstetric, Gynecologic & Neonatal Nursing, 28(3), 274-282.doi.10.1111/j.1552-6909.1999.tb01992.x
Asselmann, E., Hoyer, J., Wittchen, H., & Martini, J. (2016). Sexual problems during pregnancy and after delivery among women with and without anxiety and depressive disorders prior to pregnancy: A prospective-longitudinal study. The Journal of Sexual Medicine13(1), 95-104. doi.10.1016/j.jsxm.2015.12.005
Barakat, R., Pelaez, M., Montejo, R., Luaces, M., & Zakynthinaki, M. (2011). Exercise during pregnancy improves maternal health perception: A randomized controlled trial. American Journal of Obstetrics and Gynecology204(5), 402.e1-402.e7.  doi.10.1016/j.ajog.2011.01.043
Beck, C.T., Driscoll, J. W. (2006). Post-Partum Mood and Anxiety Disorders: A Clinician's Guide. 1ed. USA: Johns and Bartlett.
Bradbury, T. N., Fincham, F. D., & Beach, S. R. (2000). Research on the nature and determinants of marital satisfaction: A decade in review. Journal of Marriage and Family62(4), 964-980. doi.10.1111/j.1741-3737.2000.00964.x
Bredemeier, K.E. (2012). Attention and executive functioning deficits associated with dimensions of anxiety and depression (Unpublished doctoral dissertation). University of Illinois, Urbana Champaign, United States of America.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology84(4), 822-848. doi.10.1037/0022-3514.84.4.822
Busby, D. M., Christensen, C., Crane, D. R., & Larson, J. H. (1995). A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy21(3), 289-308. doi.10.1111/j.1752-0606.1995.tb00163.x
Castaneda, A. E., Tuulio-Henriksson, A., Marttunen, M., Suvisaari, J., & Lönnqvist, J. (2008). A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. Journal of Affective Disorders106(1-2), 1-27. doi.10.1016/j.jad.2007.06.006
Chang, W.H., Wu, C.H., Kuo, C.C., & Chen, L.H. (2018). The role of athletic identity in the development of athlete burnout: The moderating role of psychological flexibility. Psychology of Sport and Exercise, 39, 45-51. doi: 10.1016/j.psychsport.2018.07.014
Chen, W.C., Kuo, C.C., Lin, C.C., & Wu, C.C. (2021). A preliminary study on the effects of the Peer-Led Self-Management (PLSM) program on self-efficacy, self-management, and physiological measures in older adults with diabetes: A block randomized controlled trial. Geriatric Nursing, 42(2), 386-396. doi:10.1016/j.gerinurse.2021.01.011
Choi, H., & Marks, N. F. (2008). Marital conflict, depressive symptoms, and functional impairment. Journal of Marriage and Family70(2), 377-390. doi.10.1111/j.1741-3737.2008.00488.x
Condon, J.T. (2011). Altered cognitive functioning in pregnant women: A shift towards primary process thinking. British Journal of Medical Psychology60(4), 329-334.  doi.org/10.1111/j.2044-8341.1987.tb02751.x
Custer, A.K. (2009). The relationship of adult attachment style and interactive conflict styles to marital satisfaction. Doctoral Thesis. Texas A & M University.
Dennis, J. P., & Vanderwal, J.S. (2010).  The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research34(3), 241-253. doi.10.1007/s10608-009-9276-4
Dhillon, A., Sparkes, E., & Duarte, R. V. (2020). Mindfulness-based interventions during pregnancy: A systematic review and meta-analysis. Mindfulness8(6), 1421-1437. doi.10.1007/s12671-017-0726-x
Diamond, A. (2015). Executive functions. Annual Review of Psychology64(1), 135-168.  doi.10.1146/annurev-psych-113011-143750
Dickstein, D. P., Nelson, E. E., McClure, E. B., Grimley, M. E., Knopf, L., Brotman, M. A., Rich, B. A., Pine, D. S., & Leibenluft, E. (2017). Cognitive flexibility in phenotypes of pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry46(3), 341-355. doi.10.1097/chi.0b013e31802d0b3d
Downs, D. S., & Hausenblas, H. A. (2014). Women's exercise beliefs and behaviors during their pregnancy and postpartum. Journal of Midwifery & Women's Health49(2), 138-144. doi.10.1016/j.jmwh.2003.11.009
Entezari, M., Shamsipour Dehkordi, P., & Sahaf, R. (2018). Effect of physical activity on cognitive flexibility and perfectionism in the elderly. Iranian Journal of Ageing12(4), 402-413. (In Persian) doi.10.21859/sija.12.4.402
Erbil, N. (2020). Sexual function of pregnant women in the third trimester. Alexandria Journal of Medicine54(2), 139-142. doi.10.1016/j.ajme.2017.03.004
Farhadi, Elham. (2018). Investigating the role of thought control strategies and metacognitive beliefs in predicting pregnancy anxiety. (Unpublished Master's thesis in Clinical Psychology, Islamic Azad University, Tabriz Branch). (In Persian)
Fernández-Castillo, A., & Vílchez-Lara, M. J. (2014). Anxiety and parent's beliefs about medication in primary pediatric health care. Clínica y Salud25(2), 117-122. doi.10.1016/j.clysa.2014.06.003
Fincham, F. D., & Beach, S. R. (2010). Marriage in the new millennium: A decade in review. Journal of Marriage and Family72(3), 630-649. doi.10.1111/j.1741-3737.2010.00722.x
Gentili, C., Rickardsson, J., Zetterqvist, V., Simons, L.E., Lekander, M., Wicksell, R.K. (2019). Psychological flexibility as a resilience factor in individuals with chronic pain. Frontiers in Psychology, 10, 1-12. doi:10.3389/fpsyg.2019.02016
Gloster, A.T., Meyer, A.H., & Lieb, R. (2017). Psychological flexibility as a malleable public health target: evidence from a representative sample. Journal of Contextual Behavioral Science, 6(2),166-171. doi:10.1016/j.jcbs.2017.02.003
González-Fernández, S., Fernández-Rodríguez, C., Mota-Alonso, M.J., García-Teijido, P., Pedrosa, I., & Pérez-Álvarez, M. (2017). Emotional state and psychological flexibility in breast cancer survivors. European Journal of oncology nursing, 30, 75-83. doi:10.1016/j.ejon.2017.08.006
Gracia-Gracia, P., & Oliván-Blázquez, B. (2017). Burnout and mindfulness self-compassion in nurses of intensive care units. Holistic Nursing Practice31(4), 225-233. doi.10.1097/hnp.0000000000000215
Haukkala, A., Konttinen, H., Lehto, E., Uutela, A., Kawachi, I., & Laatikainen, T. (2017). Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality. Psychosomatic Medicine75(4), 429-435. doi.10.1097/psy.0b013e31828c3fa4
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2016). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy44(1), 1-25. doi.10.1016/j.brat.2005.06.006
Hill, B., Awoke, M. A., Bergmeier, H., Moran, L. J., Mishra, G. D., & Skouteris, H. (2021). Lifestyle and psychological factors of women with pregnancy intentions who become pregnant: Analysis of a longitudinal cohort of Australian women. Journal of Clinical Medicine10(4), 725. doi.10.3390/jcm10040725
Hutti, M. H. (2019). Social and professional support needs of families after perinatal loss. Journal of Obstetric, Gynecologic & Neonatal Nursing34(5), 630-638. doi.10.1177/0884217505279998
Jung, K. H., & Chun, N. (2020). Influence of stress, social support and lifestyle on health-related quality of life in middle aged women. Journal of Korean Biological Nursing Science21(1), 62-69. doi.10.7586/jkbns.2019.21.1.62
Kazemi, A. F., & Hajian, S. (2020). Experiences related to health promotion behaviors in overweight pregnant women: A qualitative study. Reproductive Health15(1). (In Persian) doi.10.1186/s12978-018-0660-y
Kline, R. B. (2011) Principles and practice of structural equation modeling. Second Edition, New York: The Guilford Press.
Kronmüller, K., Backenstrass, M., Victor, D., Postelnicu, I., Schenkenbach, C., Joest, K., Fiedler, P., & Mundt, C. (2011). Quality of marital relationship and depression: Results of a 10-year prospective follow-up study. Journal of Affective Disorders128(1-2), 64-71. doi.10.1016/j.jad.2010.06.026
Landi, G., Pakenham, K.I., Crocetti, E., Tossani, E., & Grandi, S. (2022). The trajectories of anxiety and depression during the COVID-19 pandemic and the protective role of psychological flexibility: A four-wave longitudinal study. Journal of Affective Disorders, 307, 69-78. doi:10.1016/j.jad.2022.03.067
Larson, J. H. (2018). Premarital predictors of marital quality and stability. Family Relations43(2), 228. doi.10.2307/585327
Lee, J. K., & Orsillo, S. M. (2014). Investigating cognitive flexibility as a potential mechanism of mindfulness in generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry45(1), 208-216. doi.10.1016/j.jbtep.2013.10.008
Leeming, E., & Hayes, S. C. (2016). Parents are people too: The importance of parental psychological flexibility. Clinical Psychology: Science and Practice23(2), 158-160. doi.10.1111/cpsp.12147
Lin, Y-H, Tsai, E-M., Chan, T-F., Chou, F-H., & Lin, Y-L. (2009). Health promoting lifestyles and related factors in pregnant women. Chang Gung Medical Journal, 32(6), 650-661. PMID: 20035645
Lowdermilk, F., & Perry, S. (2018). Maternity & women health care. 8th ed. Washington: Mosby.
Martini, J., Beesdo-Baum, K., Garthus-Niegel, S., & Wittchen, H. (2021). The course of panic disorder during the peripartum period and the risk for adverse child development: A prospective-longitudinal study. Journal of Affective Disorders266, 722-730. doi.10.1016/j.jad.2020.01.018
Mohammadi Zeidi, Isa. (2011). Validity and reliability of the Persian version of the Health Promoting Lifestyle Profile. Journal of Mazandaran University of Medical Sciences, 21(1), 102-113. (In Persian) URL http://jmums.mazums.ac.ir/article-1-955-fa.html
Mudra, S., Göbel, A., Barkmann, C., Goletzke, J., Hecher, K., Schulte-Markwort, M., Diemert, A., & Arck, P. (2020). The longitudinal course of pregnancy-related anxiety in parous and nulliparous women and its association with symptoms of social and generalized anxiety. Journal of Affective Disorders260, 111-118. doi.10.1016/j.jad.2019.08.033
Nasrollahi, Z., & Biderafsh, A. (2020). Relationship of Islamic lifestyle with depression and anxiety among the students of Qom University of medical sciences in 2018. Health, Spirituality and Medical Ethics7(3), 51-55. doi.10.52547/jhsme.7.3.51
Nevanperä, N., Lappalainen, R., Kuosma, E., Hopsu, L., Uitti, J., & Laitinen, J. (2013). Psychological flexibility, occupational burnout and eating behavior among working women. Open Journal of Preventive Medicine03(04), 355-361. doi.10.4236/ojpm.2013.34048
Ozcan, H., Ustundag, M. F., Yilmaz, M., Aydinoglu, U., Ersoy, A. O., & Yapar Eyi, E. G. (2020). The relationships between prenatal attachment, basic personality traits, styles of coping with stress, depression, and anxiety, and marital adjustment among women in the third trimester of pregnancy. The Eurasian Journal of Medicine51(3), 232-236. doi.10.5152/eurasianjmed.2019.15302
Phipps, W.J., & Sands, J.K. (2003). Medical-surgical nursing: Concepts and clinical practice. Philadelphia: Mosby.
Price, R. B., & Mohlman, J. (2007). Inhibitory control and symptom severity in late life generalized anxiety disorder. Behaviour Research and Therapy45(11), 2628-2639. doi.10.1016/j.brat.2007.06.007
Puolakanaho, A., Tolvanen, A., Kinnunen, S. M., & Lappalainen, R. (2020). A psychological flexibility-based intervention for Burnout: a randomized controlled trial. Journal of Contextual Behavioral Science, 15, 52-67. doi:10.1016/j.jcbs.2019.11.007
Raeisi Nassehi, Sepideh, Dehghani, Akram, Moradi Manesh, Fardin, & Haghaiegh, Seyed Abbas. (2020). Predicting health-promoting lifestyle based on sense of coherence, psychological flexibility, and impulsivity in obese cardiovascular patients. Journal of Excellence in Counseling and Psychotherapy, 9(33), 1-13. (In Persian) URL https://sanad.iau.ir/Journal/jci/Article/931783
Reilly, K. (2012). Nutrition, exercise, work, and sex in pregnancy. Primary Care: Clinics in Office Practice27(1), 105-115. doi.10.1016/s0095-4543(05)70150-0
Resende, C. M., Rocha, L. G., Paiva, R. P., Cavalcanti, C. D., Almeida, E. O., Roncalli, A. G., & Barbosa, G. A. (2020). Relationship between anxiety, quality of life, and sociodemographic characteristics and temporomandibular disorder. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology129(2), 125-132. doi.10.1016/j.oooo.2019.10.007
Roberts, R. M., Muller, T., Sweeney, A., Bratkovic, D., & Gannoni, A. (2014). Promoting psychological well-being in women with phenylketonuria: Pregnancy-related stresses, coping strategies and supports. Molecular Genetics and Metabolism Reports1, 148-157. doi.10.1016/j.ymgmr.2014.03.002
Ruiz, F. J., & Odriozola-González, P. (2017). The predictive and moderating role of psychological flexibility in the development of job burnout. Universitas Psychologica16(4), 1. doi.10.11144/javeriana.upsy16-4.pmrp
Salehi, Habibe, Simbar, Masoumeh, Abolghasemi, Abbas, & Abedi, Alireza. (2013). Comparison of postpartum depression in women with emotion-focused and problem-focused stress coping strategies in low-risk pregnancies. Journal of Qom University of Medical Sciences, 7(2), 91-96. (In Persian) URL https://www.sid.ir/fileserver/jf/49913920205
Schulz, M. S., Cowan, C. P., & Cowan, P. A. (2018). Promoting healthy beginnings: A randomized controlled trial of a preventive intervention to preserve marital quality during the transition to parenthood. Journal of Consulting and Clinical Psychology74(1), 20-31. doi.10.1037/0022-006x.74.1.20
Sepahvand, Touraj., & Moradi, Fatemeh. (2018). Comparison of emotion regulation and cognitive flexibility in non-clinical samples of adolescents with generalized anxiety disorder and social anxiety disorder symptoms. Clinical Psychology, 10(4, Serial No. 40), 23-34. (In Persian) doi:10.22075/jcp.2019.15988.1530
Soltani, E., Shareh, H., Bahrainian, S., & Farmani, A. (2013). The mediating role of cognitive flexibility in correlation of coping styles and resilience with depression. Pejouhandeh, 18(2), 88-96. URL http://pajoohande.sbmu.ac.ir/article-1-1518-en.html
Tol, A., Tavassoli, E., Shariferad, G., & Shojaeezadeh, D. (2013). Health-promoting lifestyle and quality of life among undergraduate students at School of health, Isfahan University of medical sciences. Journal of Education and Health Promotion2(1), 11. doi.10.4103/2277-9531.108006
Troxel, W.M. (2006). Marital quality, communal strength, and physical health. Doctoral Thesis. University of Pittsburgh.
Umberson, D., & Williams, K. (2005). Marital quality, health, and aging: Gender equity? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences60(Special_Issue_2), S109-S113.doi.10.1093/geronb/60.special_issue_2.s109
Van den Bergh, B. R. H. (1990). The influence of maternal emotions during pregnancy on fetal and neonatal behavior. Journal of Prenatal & Perinatal Psychology and Health5(2), 119-130. URL https://pure.uvt.nl/ws/portalfiles/portal/1041624/INFLUEN2.PDF
Vinikoor-Imler, L., Messer, L., Evenson, K., & Laraia, B. (2011). Neighborhood conditions are associated with maternal health behaviors and pregnancy outcomes. Social Science & Medicine73(9), 1302-1311. doi.10.1016/j.socscimed.2011.08.012
Viswasam, K., Eslick, G. D., & Starcevic, V. (2020). Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis. Journal of Affective Disorders255, 27-40. doi.10.1016/j.jad.2019.05.016
von Sydow, K. (2019). Sexuality during pregnancy and after childbirth. Journal of Psychosomatic Research47(1), 27-49. doi.10.1016/s0022-3999(98)00106-8
Walker, S. N., Sechrist, K. R., & Pender, N. J. (1987). The health-promoting lifestyle profile. Nursing Research36(2), 76-81. doi.10.1097/00006199-198703000-00002
Wersebe, H., Lieb, R., Meyer, A.H., Hofer, P., & Gloster, A.T. (2018). The link between stress, well-being, and psychological flexibility during an acceptance and commitment therapy self-help intervention. International Journal of Clinical and Health Psychology, 18(1), 60-68. doi:10.1016/j.ijchp.2017.09.002
Williams, K. (2003). Has the future of marriage arrived? A contemporary examination of gender, marriage, and psychological well-being. Journal of Health and Social Behavior44(4), 470. doi.10.2307/1519794
Wulandari, L.P.L., & Whelan, A.K. (2011). Beliefs, attitudes and behaviours of pregnant women in Bali. Midwifery27(6), 867-871. doi.10.1016/j.midw.2010.09.005
Yu, Y., Yu, Y., & Lin, Y. (2021). Anxiety and depression aggravate impulsiveness: The mediating and moderating role of cognitive flexibility. Psychology, Health & Medicine25(1), 25-36. doi.10.1080/13548506.2019.1601748
Yu, M., Qiu, T., Liu, C., Cui, Q., & Wu, H. (2020). The mediating role of perceived social support between anxiety symptoms and life satisfaction in pregnant women: A cross-sectional study. Health and Quality of Life Outcomes18(1). doi.10.1186/s12955-020-01479-w