The purpose of this mixed-method design study was to examine factors contributing to depression among immigrant Chinese women (primipara and multipara) (n = 22) delivering a child for the first time in Japan. Data were obtained just after hospital discharge by using the Edinburgh Postnatal Depression Scale (EPDS), the Social Support Scale, a new scale to measure crosscultural stressors in the postpartum setting and a visual analogue scale for stress and a demographic survey. The average EPDS score was 9.0 (SD ± 3.7) at 1-3 weeks postpartum; yet, more than half of the subjects (n = 12; 54.5%) were high risk for depression (EPDS ≥ 10). Low household income and primiparous status were associated with depression scores. New mothers with depression also reported more general stress and more cross-cultural stress in the postpartum setting, although social support appeared to mediate cross-cultural stressors. Semi-structured interviews were held with two immigrant women at high risk for depression; these new mothers described additional stress because they could not follow Zuoyuezi, an important postpartum Chinese tradition, in the Japanese hospital. These findings suggest that immigrant Chinese women are at higher risk for postpartum depression when they give birth for the first time in Japan.

Aim: We evaluated the effectiveness of a nursing intervention program for Chinese women who are giving birth in Japan to reduce cross-cultural stressors during the postpartum period and prevent postpartum depressive symptoms. Methods: A prospective, before-and-after study incorporating a longitudinal mixed-method design was conducted. Thirty-eight participants underwent this program from August 2016 to July 2017. The program comprised a maternity class, conversation cards, and a social-network group. Data collection was initially performed using questionnaires administered in the third trimester (T1)-before the intervention-to obtain participants' basic information, stress levels, depressive symptoms, and cognitive appraisals. Then, stress levels, depressive symptoms, and social support were measured during hospitalization after having given birth (T2) and during the first month postpartum (T3). Finally, through semi-structured interviews, cognitive appraisal, coping, stress, social support, participants' evaluations of the intervention were determined. Results: Post-intervention, all participants showed positive cognitive appraisals, although eight also showed some negative appraisals. At T3, 36 participants did not report experiencing stress owing to cross-cultural stressors. Furthermore, post-intervention, participants who returned scores that were suggestive of depression remained identical to that at pre-intervention (21.1%). Among the eight participants who showed postpartum depressive symptoms during T3, seven did not report experiencing cross-cultural stressors, but did report encountering maternity stressors. Conclusion: The nursing intervention program may be effective for preventing postpartum depressive symptoms in Chinese women who give birth in Japan. Since this was a pre-post study in which one group was measured pre-intervention and again post-intervention, we did not register in a publicly assessible database.