ObjectivesThe current study examines the mediating roles of resilience and self-efficacy and the moderating role of gender in the association between neuroticism and psychological distress in Chinese freshman nursing students (FNSs).MethodsA total of 1220 FNSs were enrolled from the Be Resilient to Nursing Career (ChiCTR2000038693) Programme and the following instruments were administered to them: NEO Five-Factor Inventory, General Self-Efficacy Scale, Connor-Davidson Resilience Scale and Kessler Psychological Distress Scale. A moderated mediation analysis and a generalised additive model analysis were performed.ResultsThe direct and indirect effects of neuroticism on psychological distress were significantly mediated by self-efficacy (B = 0.200, 95% CI 0.001 to 0.039), resilience (B = 0.021, 95% CI 0.007 to 0.038) and the interaction between self-efficacy and resilience (B = 0.016, 95% CI 0.005 to 0.028). The interactions between neuroticism and gender (β = 0.102, 95% CI 0.001 to 0.203, p<0.05) and between resilience and gender were significant (β = 0.160, 95% CI 0.045 to 0.275, p<0.01). A non-linear and positive association was confirmed between neuroticism and psychological distress.ConclusionsSelf-efficacy and resilience significantly mediate the relationship between neuroticism and psychological distress. Gender moderates the relationships between neuroticism and resilience and between resilience and psychological distress.

IntroductionPrenatal psychological distress is prevalent during pregnancy. This study aimed to estimate the associations among fear of childbirth, resilience and psychological distress.MethodsA total of 1,060 Chinese pregnant women were enrolled from Be Resilient to Postpartum Depression (ChiCTR2100048465) and the following instruments were administered to them: Childbirth Attitudes Questionnaire, Connor-Davidson Resilience Scale, Perceived Social Support Scale, General Self-Efficacy Scale, Adverse Childhood Experience scale and Hospital Anxiety and Depression Scale. A dominance, a response surface analysis and a moderated mediation analysis were performed.ResultsIn terms of psychological distress, resilience and fear of childbirth could explain 41.6% (0.148/0.356) and 33.1% (0.118/0.356), respectively. Pregnant women with high resilience-low fear of childbirth had significantly lower levels of psychological distress than those with low resilience-high fear of childbirth. The indirect effects of fear of childbirth on psychological distress through resilience was significantly (B = 0.054, 95% CI 0.038 to 0.070). The interactions between fear of childbirth and adverse childhood experiences (β = 0.114, 95% CI −0.002 to 0.231, p = 0.054) and between resilience and adverse childhood experiences (β = −0.118, 95% CI −0.222 to −0.012, p &lt; 0.05) were significant.ConclusionResilience, fear of childbirth and adverse childhood experiences may be three important factors to psychological distress in Chinese pregnant women.

Objectives The aim of this study is to examine the explore the associations among fear of childbirth, psychological distress, resilience and sleep quality among Chinese pregnant women. Methods 768 pregnant women participated in the Be Resilient to Postpartum Depression program (BRPD, Registration number: ChiCTR2100048465) and administered with Childbirth Attitudes Questionnaires (CAQ), Hospital Anxiety and Depression Scale (HADS), Connor-Davidson Resilience Scale (CD-RISC) and Pittsburgh Sleep Quality Index (PSQI). Generalized additive model and moderated mediation analysis were conducted. Results A non-linear and negative association between fear of childbirth and sleep quality was founded in the second trimester and antenatal period. Psychological distress significantly mediated the relationship between fear of childbirth and sleep quality (first trimester: B = 0.044, 95% CI = 0.022–0.071; second trimester: β = 0.029, 95%CI = 0.009–0.056; third trimester: β = 0.064, 95%CI = 0.046–0.088; antenatal period: β = 0.050, 95%CI = 0.037–0.063). The moderation role of resilience between fear of childbirth and sleep quality were significant (second trimester: β=-0.006, 95%CI=-0.012 - -0.001, P = 0.025; antenatal period: β=-0.004, 95%CI=-0.007 - -0.001, P = 0.014;), FoC and psychological distress (first trimester: β=-0.016, 95%CI=-0.026 - -0.005, P = 0.004; antenatal period: β=-0.005, 95%CI=-0.009 - -0.001, P = 0.014) . Conclusions Fear of childbirth, psychological distress and resilience are three important factors affecting sleep quality in Chinese pregnant women.