Perceived stress and anxiety as mediators linking self-disclosure to post-abortion depressive symptoms

Objective: To examine the mediating roles of anxiety and perceived stress in the relationship between distress disclosure and depressive symptoms among women following induced abortion. Methods: A cross-sectional study was conducted with 359 post-abortion women recruited from a hospital in China. Participants completed self-report measures including the Distress Disclosure Index, Generalized Anxiety Disorder-7, Perceived Stress Scale-4, and Patient Health Questionnaire-9. Multiple mediation and subgroup analyses by marital status were performed using SEM model. Results: Distress disclosure had a significant total effect on depressive symptoms (β = -0.140, P < 0.001), but no direct effect (β = -0.017, P = 0.546). The association was fully mediated by anxiety and perceived stress. Subgroup analyses revealed that this mediating model was significant among unmarried women but not among married women. Conclusion: Distress disclosure is associated with depressive symptoms indirectly by reducing anxiety and perceived stress, particularly among unmarried women. These findings support integrated interventions combining emotional disclosure with anxiety and stress management to optimize psychological recovery for post-abortion women.