Research Article| Volume 41, P227-233, December 2022

Bi-dimensional acculturation and social support on perinatal depression in marriage-based immigrant women

  • Hung-Hui Chen
    School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan Address: No.1, Sec. 1, Ren'ai Rd., Zhongzheng Dist., Taipei City 100233, Taiwan

    Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan Address: No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan
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  • Jerry Cheng-Yen Lai
    Department of Medical Research, Taitung MacKay Memorial Hospital, Taitung City, Taiwan Address: No.1, Lane 303, Changsha Street, Taitung, 95054, Taiwan
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  • Kung-Liahng Wang
    Department of Obstetrics and Gynecology, Taitung MacKay Memorial Hospital, Taitung, Taiwan Address: No.1, Lane 303, Changsha Street, Taitung 95054, Taiwan

    Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan Address: No.92, Shengjing Rd., Beitou Dist., Taipei City 11272, Taiwan

    Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan Address: No.92, Section 2, Zhongshan N. Rd., Zhongzheng Dist., Taipei City 10449, Taiwan

    Department of Obstetrics and Gynecology, MacKay Medical College, New Taipei City, Taiwan Address: No.46, Section 3, Zhongzheng Rd., Sanzhi District, New Taipei City 25245, Taiwan
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  • Li-Yin Chien
    Corresponding author at: No.155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan.
    Institute of Community Health Care, Collage of Nursing, National Yang Ming Chiao Tung University/Yang-Ming Campus, Taipei, Taiwan Address: No.155, Sec. 2, Linong St., Beitou Dist., Taipei City 112304, Taiwan
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Published:August 13, 2022DOI:


      • Low adaptation to host culture was related to high maternal perinatal depression.
      • High maintenance of heritage culture was related to high depression early postpartum.
      • High maintenance of heritage culture was related to low depression late postpartum.
      • Increased emotional support enhanced protective effect of adaptation to host culture.



      Sociocultural factors play critical roles in the mental health of marriage-based immigrant women. However, the effect of bi-dimensional acculturation (“adaptation to host culture” and “maintenance of heritage culture”) and social support on perinatal depression across time was unknown among them.


      To examine the effect of bi-dimensional acculturation and social support on perinatal depression among marriage-based immigrant women in Taiwan.


      This longitudinal study recruited 310 immigrant mothers to complete structured questionnaires during pregnancy and postpartum periods. Depression was assessed using the Edinburgh Postnatal Depression Scale. Bi-dimensional acculturation was measured using the Bi-dimensional Acculturation Scale for Marriage-Based Immigrant Women. Social support was measured by a three-subscale instrument, namely emotional, instrumental, and informational support.


      Depression scores increased from pregnancy to three months postpartum, and decreased from six to twelve months postpartum. The generalized estimating equation results showed that lower adaptation to host culture, emotional support, and informational support were associated with higher maternal depression scores over time. Maintaining heritage culture has both positive (from pregnancy to three months postpartum) and negative associations (from six to twelve months postpartum) with maternal depression, further, increased emotional support enhanced the protective effect of adaptation to host culture, but decreased the positive effect of maintenance of heritage culture on depression.


      Strategies should be developed to assist perinatal immigrant women to adapt to the host culture, maintain their heritage culture, and resolve potential cultural conflicts to decrease their depression. Respect for immigrant mothers' heritage cultures should be accompanied by increased emotional support.


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