A Study on the Effectiveness of Positive Psychological Intervention Based on the PERMA Model in Postpartum Depression and Breastfeeding Self-Efficacy Among Primiparous Women

Abstract

To examine the effects of a positive psychological intervention based on the PERMA model on postpartum depression and breastfeeding self-efficacy among primiparous women, providing evidence-based support for optimizing postpartum care interventions, a prospective randomized controlled trial was conducted in a tertiary hospital in southwest part of China. A total of 120 primiparous women who delivered at the Obstetrics Department between January and June 2025 were randomly assigned to either an intervention group (n=60) or a control group (n=60). The control group received routine postpartum care, while the observation group additionally underwent an 8-week PERMA-based positive psychological intervention (comprising 5 modules: positive emotion cultivation, engagement experiences, relationship building, meaning pursuit, and achievement documentation). Assessments were conducted using the Edinburgh Postnatal Depression Scale (EPDS) and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) at 3 time points: pre-intervention (T0), 4 weeks post-intervention (T1), and 8 weeks post-intervention (T2). Results showed that at 8 weeks post-intervention, the observation group exhibited lower EPDS scores (7.32 ± 2.15) than the control group (10.68 ± 3.42), while the BSES-SF score (58.46 ± 6.83) was higher than that of the control group (48.72 ± 7.95). Both differences were statistically significant (t = −6.384, 7.216; P < 0.001). The exclusive breastfeeding rate at 8 weeks postpartum was higher in the observation group (68.3%) than in the control group (45.0%), with statistically significant differences (χ²=6.736, P=0.009). Repeated measures ANOVA revealed statistically significant time effects, between-group effects, and interaction effects for both EPDS and BSES-SF scores across groups (P<0.05). In conclusion, positive psychological intervention based on the PERMA model could effectively alleviate postpartum depression in primiparous women, enhance breastfeeding self-efficacy, and increase exclusive breastfeeding rates. Its application in postpartum care is highly recommended in a larger scale in China and across the globe.