Literature review

The issue of childbirth and its impact on parents’ psychological health has garnered attention from numerous scholars [6]. The literature in this domain can be categorized into two primary dimensions: the direct effects of childbirth on parents’ mental well-being and the influence of external factors such as societal, cultural, and economic contexts on this relationship.

1. (1). Direct impacts of childbirth on parents’ psychological health.

Numerous studies have focused on the direct effects of childbirth on parents’ mental health. For instance, some research indicates that parents might experience a surge in happiness during the initial period after a child’s birth [7]. However, as the child grows, this feeling may gradually diminish [8,9]. In specific scenarios, like the arrival of a newborn, parents might exhibit temporary symptoms of depression [10,11].Furthermore, for mothers with multiple births, their childbirth experiences might have a more significant impact on their psychological well-being [12,13]. For those becoming parents for the first time, their experiences might differ from parents with prior child-rearing experiences [14,15]. The societal, cultural, and economic backdrop plays a pivotal role in shaping the relationship between childbirth and parents’ psychological health.

While numerous studies have delved into the direct impact of childbirth on mental well-being, the influence of external factors remains relatively under-researched. Racine, Nicole, et al. (2019) [16] examined how societal support mitigates the psychological stress arising from childbirth. Additionally, cultural perceptions about childbirth, which vary across different backgrounds, also significantly influence parents’ mental states. Economic conditions have also been proven to be a vital factor affecting this relationship [17,18]. Especially during the critical moment of childbirth, certain external factors can either amplify or mitigate its impact on parents’ psychological health.

1. (2). The existing literature provides in-depth insights into the relationship between childbirth and parents’ psychological well-being.

However, most current studies focus primarily on overall parental mental health of parents during pregnancy and the neonatal period, often overlooking the unique context of first-time childbirth [19,20]. The psychological, physiological, and societal changes arising from the birth of the first child may differ significantly from those experienced during subsequent childbirths. First-time parents might face more significant lifestyle changes, heightened financial pressures, and a redefinition of roles with their partners [21,22]. Given the backdrop of an aging population, declining birth rates, and increasing instances of people choosing to remain unmarried, studying the transition from no child to one child becomes particularly crucial and unique in the Chinese context. This transition is not just about changes in family structure [23, 24] but also pertains to the establishment and recognition of parental identity [25]. This identity shift could have long-term implications on parents’ psychological health [26], quality of life, and future family planning decisions [27,28].

This paper aims to deepen the understanding of the relationship between childbirth and parents’ psychological health, exploring the channels through which first-time childbirth impacts parents’ mental well-being. Firstly, within the framework of demographic transition theory, this study analyzes the effects of first-time childbirth on parents’ psychological health, measuring it in terms of happiness and depressive symptoms, thereby providing precise data support for relevant policy formulation. Furthermore, by comparing the psychological changes in fathers and mothers after childbirth, we aim to uncover which factors, beyond gender, contribute to the gender differences in the relationship between childbirth and mental health. Identifying these potential influencing factors will further complement and enhance the knowledge base in this field. Lastly, while most related studies utilize cross-sectional data or a mix of multiple periods, lacking observations of the same individual over multiple periods, this paper employs panel data to eliminate biases caused by unobservable individual fixed effects.

Theoretical analysis and research hypotheses

The theory of demographic transition refers to the historical shift from high birth rates and high death rates in societies with lagging technological, educational, and economic development to low birth rates and high death rates in societies with advanced technological, educational, and economic development [29]. The negative correlation between fertility rates and industrial development has become one of the most widely accepted findings in social science [30]. This theory comprises a five-stage model of demographic transition [31]. Stage One: High birth and death rates due to poor medical conditions, prevalent diseases, and the absence of modern medical technology. High birth rates are attributed to the lack of contraception, with children serving as a critical source of labor and high child mortality rates. In this stage, both death and birth rates are high, keeping the overall population relatively stable. Stage Two: High birth rates and declining death rates. Improvements in medical conditions, better nutrition, and advancements in public health and sanitation lead to a decline in death rates. Despite this, birth rates remain high, resulting in rapid population growth. Stage Three: Declining birth and death rates. As the economy develops, opportunities for women’s education increase, leading to smaller family sizes. Contraception becomes more widespread and accepted. Birth rates begin to decline, and as death rates continue to decrease, population growth starts to slow. Stage Four: Low birth and death rates. Family sizes reduce further, women’s societal and economic status improves, and contraception becomes ubiquitous. Both birth and death rates are low, leading to slow or stable population growth. Stage Five: Extremely low birth rates and low death rates. Socio-economic pressures result in even smaller family sizes and reduced fertility desires. Birth rates decline further, falling below death rates, leading to a decreasing population.

This framework offers a macro perspective, helping us understand how economic, societal, cultural, and health factors collectively influence population structure and growth. In studying the relationship between first-time childbirth and parents’ psychological well-being, it becomes pertinent to consider how these macro factors interact with micro-level family decisions. Broadly speaking, in the demographic transition theory, external factors impact parents through channels like physical health, job income and opportunities, and confidence in the future.

Data source

This study relies on the micro-database of the “China Family Panel Studies” (CFPS). The CFPS is a stratified multi-stage sampling survey that covers 25 provinces (cities, autonomous regions) of mainland China, excluding Xinjiang, Tibet, Inner Mongolia, Ningxia, and Qinghai, representing 94.5% of the mainland Chinese population. This database encompasses a wealth of individual-level information, including socio-economic, demographic, and a range of subjective variables. Notably, the survey for adults includes a depression scale to gauge mental health status, encompassing aspects like depressive symptoms, emotions, and interpersonal relationships. Furthermore, it also incorporates economic data, such as family income and consumption expenditure. The CFPS has been conducted since 2010 and has completed six rounds to date, specifically in 2010, 2012, 2014, 2016, 2018, and 2020. For the purposes of this research, we utilized data from all six rounds spanning 2010–2020. As the United Nations’ population forecast typically defines women of reproductive age as being between 15 and 49 years old, and considering the legal marriage age in China is not earlier than 20 years, we limited the age range of household heads to between 20 and 49 years for data processing. To mitigate the impact of outliers on the results, we adjusted these variables at the 1% and 99% percentiles. After filtering and processing, we obtained an unbalanced panel data spanning six survey rounds, encompassing 119,011 samples.

Variable selection

Descriptive statistics

As shown in Table 1, the full-sample descriptive statistics for key variables include only the dependent variables and core explanatory variables. Over the past decade, both the fertility patterns of Chinese families and the psychological well-being of parents have undergone significant changes. An analysis of Table 1 reveals the following findings: The change in the “Firstchild” variable indicates that the proportion of families experiencing first-time childbirth increased from 35.23% in 2010 to 45.59% in 2012, possibly reflecting a stronger fertility desire under the socio-economic conditions of the time. However, by 2014, this proportion declined to 38.87%, fluctuating in the subsequent years until stabilizing at 37.03% in 2020. This trend may suggest multiple factors behind family fertility decisions, such as pressures from economic slowdown, distribution of educational resources (i.e., how educational opportunities and facilities are allocated across different regions and social groups), shifts in cultural expectations, and the impact of the pandemic.

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Table 1. Summary statistics for key variables.

https://doi.org/10.1371/journal.pone.0334669.t001

The “Happiness” index also underwent notable fluctuations during this decade. It rose from 5.7588 in 2010 to 7.7034 in 2016 and then slightly decreased to 7.4600 in 2020. This rise in happiness might be associated with the nation’s economic growth, improvements in living standards, and changes in social policies. However, the slight decline in 2020 might hint that, although the overall happiness of residents remains relatively high, there are emerging economic and social pressures and challenges.

Concurrently, the “Depression” index reveals that the psychological health of respondents hasn’t been consistently stable. While the average value of depression symptoms slightly decreased from 2010 to 2012, the depression index increased annually up to 2020, reaching a value of 0.0952. This could be attributed to pressures brought about by economic deceleration and the health-related stresses induced by the 2019 COVID-19 pandemic.

The “Confident” variable indicates that respondents’ confidence showed minor fluctuations between 2010 and 2020 but, overall, displayed an upward trend. This might be associated with increased educational opportunities, possibilities of career advancement, and socio-cultural transformations (i.e., changes in the values, norms, and practices of a society that affect its structure and the lifestyles of its members).

From the aforementioned indicators, it’s evident that the fertility patterns of Chinese families and the psychological well-being of parents have undergone significant changes over the past decade. These alterations might have been impacted by macroeconomic factors, policies, socio-cultural influences, as well as internal family decisions, beliefs, and health aspects.

As illustrated in Fig 1, there is a distinct distribution difference between parents who experienced first-time childbirth and those who did not across two major psychological health indicators—“Happiness” and “Depress”. The data in Panel A of Fig 1 shows that parents who had their first child had a much higher proportion of happiness scores below 5 compared to parents who did not have their first child in consecutive observation years. This difference was stable across different years, suggesting it might be a long-term characteristic. In this context, “parents who did not have their first child in consecutive observation years” refers to those who either had subsequent children in later years or did not have any more children after the first one. Therefore, parents who had their first child in 2014 would be part of the “first child” group for that year but would be considered in the “non-first child” group in subsequent years (i.e., in 2016, 2018, and 2020). Panel B displays the annual distribution for depression scores, showing that parents who had their first child generally scored higher in depression than those who did not, with this disparity gradually widening over time. This result implies that the psychological pressures stemming from childbirth might intensify with the passage of time. A deeper investigation into the root causes of this issue, coupled with clearer supportive strategies, can help parents better navigate the psychological challenges brought by childbirth and enhance their willingness to give birth.

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Fig 1. Distribution of Happiness and Depression.

https://doi.org/10.1371/journal.pone.0334669.g001

Model specification

To study the reverse causality, spillover effects, and lagged effects of first-time childbirth on parents’ mental health, we construct the following fixed-effects model:

(1)

Where: represents the individual, represents the family, represents the community, represents time. is the dependent variable, is the independent variable, comprises control variables at the individual, family, and village levels, including age, gender, educational level, family financial status, marital satisfaction, and child-rearing expenses., , respectively represent the fixed effects at the individual, family (village), and time levels. denotes the random error term aggregated at the family level, allowing for correlations among individuals within the same family.

Event study is a tool widely used in the social sciences for causal inference and policy evaluation. We employ the event study method to investigate the core issue of the impact of first-time childbirth on parents’ psychological health, examining the parallel trend hypothesis and the dynamic causal effect of first-time childbirth policies.

(2)

Here, represents the individual, represents the family, represents the community, represents time, stands for the happiness or depressive emotions of parents., where the interval between every two consecutive periods is two years.Period_-1 (, the baseline period) is used as a reference point in the model, and is therefore omitted. Period₀ () is the period of first childbirth. represents the relative period of the family in year T to the baseline period. indicates whether the family was before or after the baseline period in year T,The error term is clustered at the family level. Expropriated period represents the year in which the first child was born.

Endogeneity and instrumental variable selection

First childbirth is a significant event that greatly impacts parents’ psychological health. At the same time, psychological health influences the decision to have a child, suggesting a possible reverse causal relationship between first-time childbirth and parents’ psychological health. Additionally, specific sociocultural contexts and village childbirth trends may directly influence the decision for the first childbirth, leading to omitted variable bias.

To address these endogeneity issues, we use the one-child birth rate in the same village as an instrumental variable for the decision of first-time childbirth. The one-child birth rate in the same village refers to how often families in a particular village have their firstborn in a single year. Here, “village” refers to a smaller community within a town or city.

Our choice is based on empirical results showing that the one-child birth rate in a given village is significantly related to a family’s decision to have their first child. When most families in a village choose to have one child, other families in the same village are more likely to make a similar decision. While the one-child birth rate in the same village is closely related to a family’s decision to have their first child, it does not directly affect the psychological health of the parents in that family. This makes it a suitable instrumental variable.

To validate the effectiveness of this instrumental variable, we conducted a first-stage estimation. The results indicate that the coefficients for the one-child birth rate in the same village are all significant, with F-values in each model far greater than 10. This demonstrates a strong correlation between the instrumental variable and the endogenous explanatory variable. The one-child birth rate in the same village, as used in this study, demonstrates its validity and helps address potential endogeneity concerns, providing a more robust method for estimating the impact of first childbirth on parents’ psychological health.

Examination of non-time-varying and time-varying features

Initially, this paper examines whether there are individual or family factors that influence a family’s decision to have their first child. By conducting a comparative analysis between first-time parent groups’ non-time-varying and time-varying features, we identify which individual or family factors might influence family birth decisions, avoiding confounding factors and reverse causality leading to endogeneity problems.

Table 2 presents the non-time-varying characteristics of individuals and families who have had their first child compared to the control group. Panel A focuses on individual-level characteristics. Panel B focuses on family-level characteristics. Of note, our analysis compares families who had their first child during the survey year with families who did not have their first child during the survey year, not families with their first child to families with no children at all. The results show that the decision to have the first child is influenced by a combination of various factors, including age, eduy, finance, spouse_work, and child_fee. Therefore, in the model estimation, we need to further control them to account for the influence of individual and family characteristics on the results.

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Table 2. The time-unvarying determinants of first childbirth.

https://doi.org/10.1371/journal.pone.0334669.t002

To delve deeper into how time-varying family factors influence the decision to have a first child, this paper employs panel data of families for empirical testing. Table 3 and Table 4 present the regression relationships between first childbirth and various time-varying family factors. As shown in Table 3, the decision to have the first child is largely positively influenced by the fixed assets owned by the family, such as property. In contrast, other economic factors like net family assets, financing constraints, and financial holding situations have limited influence on the childbirth decision.

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Table 3. The time-varying determinants of first childbirth.

https://doi.org/10.1371/journal.pone.0334669.t003

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Table 4. The time-varying determinants of first childbirth.

https://doi.org/10.1371/journal.pone.0334669.t004

Further, we investigated how individual time-varying factors influence the decision to have a first child. The result shows that families who experienced depressive symptoms in the previous year might be more cautious about deciding to have their first child. For other individual variables from the previous period, such as life satisfaction, health status, marital satisfaction, spouse’s economic and housework contribution, etc., their relationships with the decision to have the first child are mostly insignificant in most models.

Overall, the decision to have the first child is significantly influenced by the family’s depressive symptoms from the previous period. In contrast, other emotional and mental health factors have limited influence on the childbirth decision. This indicates that there’s no reverse causality between individual time-varying factors and the decision to have the first child, providing data support for subsequent research.

Testing for spillover effects

If the mental health of individuals who haven’t experienced first childbirth is influenced by their neighbors having their first child, the baseline estimates would be biased towards zero. To avoid this bias, we will discuss and verify whether there are spillover effects between first childbirth and parental mental health.

The results from Table 5 indicate that first childbirth in other families within the same village does not produce significant spillover effects on the mental health of parents in the subject family. Even after introducing the variable of the subject family’s first childbirth, the spillover effect remains insignificant. At the same time point, there’s no significant difference in mental health changes between the treatment and control groups within the same village. This suggests that while first childbirth directly affects the mental health of mothers, this impact does not significantly spill over into the broader community or region, providing a basis for policy formulation and mental health interventions.

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Table 5. Spillover effects of first childbirth on mental health.

https://doi.org/10.1371/journal.pone.0334669.t005

Baseline estimation results

To further analyze the relationship between first childbirth and parents’ mental health, this paper conducts empirical analysis based on formula 0.1, with results presented in Table 6.

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Table 6. Impact of First Childbirth on Parental Happiness and Depressive Mood.

https://doi.org/10.1371/journal.pone.0334669.t006

Impact on parental happiness. As shown in the upper part of Table 6, first childbirth might have a negative impact on parental happiness. In column (1), the regression coefficient between “Firstchild” and parental happiness is −0.0444, yet it lacks statistical significance. When family and time interaction terms are included in column (2), this coefficient increases to −0.1330 and becomes significant at the 10% level. This suggests that first childbirth may reduce family members’ happiness. To verify the robustness of this relationship, we employed several strategies. In columns (3) to (5), we introduced village and year interaction terms, time-varying control variables, and time-invariant variables with time interaction terms, and these model results further support the baseline regression outcomes. Columns (6) to (8) further test robustness, retaining samples from the most recent two periods, samples of mothers, and samples of fathers. These estimated coefficients are consistent with baseline results, confirming the robustness of the baseline regression.

Impact on parental depressive mood. As can be seen from the lower part of Table 6, first childbirth has a positive correlation with parents’ depressive mood. Column (1) demonstrates a positive relationship between first childbirth and family members’ depressive mood, significant at the 1% level. When only family and time fixed effects are introduced in column (2), the significance of the relationship between first childbirth and depressive mood weakens, but the overall trend remains positive. In columns (3) to (8), we employed various robustness testing methods, including introducing village and year interaction terms, time-varying control variables, time-invariant variables with time interaction terms, retaining the most recent two-period samples, and samples of mothers and fathers. The empirical outcomes from these methods align with the baseline results, confirming their robustness. In conclusion, first childbirth might lead to a decrease in parental happiness and an increase in depressive mood. These findings provide crucial evidence for further studying the potential impact of childbirth decisions on family members’ mental health.

Placebo test

To further verify the impact of first childbirth on parental happiness and depressive mood, and to ensure that these results are not caused by other unobservable factors, this paper further analyzes the randomness of the impact of first childbirth. Based on the distribution of the “Firstchild” variable in the baseline regression, a placebo test was conducted. By randomly sampling to construct 1,000 “pseudo-childbirth dummy variables” and re-estimating based on the previous model, we paid special attention to the distribution of their coefficients and P-values. The left chart “Happiness” and the right chart “Depression” in Fig 3 respectively display the estimated coefficients and P-values distribution of the “pseudo-childbirth dummy variable” for happiness and depressive mood.

In Fig 3, the average of the estimated coefficients is close to 0, and the distribution of most estimated coefficients aligns closely with a normal distribution. Most of these coefficients are not significant, with P-values mainly distributed above 0.10, meaning they are not significant at the 10% level. This suggests that the impact of first childbirth on the happiness and depressive mood of family members is not coincidental. Through the placebo test, we further confirmed the robustness of the effects of first childbirth on the happiness and depressive mood of family members, ensuring that the empirical results are not caused by other unobservable factors.

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Fig 2. Distribution of placebo test.

Note: Fig 2 displays the results of the placebo test conducted to verify the robustness of the observed effects of first childbirth on parental happiness and depressive mood. The blue line represents the distribution of estimated coefficients for happiness using 1,000 pseudo-childbirth dummy variables, while the orange line represents the distribution of estimated coefficients for depressive mood. The placebo test ensures that the observed effects are not driven by random chance or unobservable factors, confirming the robustness of our findings.

https://doi.org/10.1371/journal.pone.0334669.g002

Estimation of dynamic effects

To systematically study the impact of first childbirth on parental mental health, we used Model 0.2 to estimate its dynamic effects and plotted the estimated coefficients with their respective 95% confidence intervals in Fig 3. Given the varying impacts of first childbirth on parents’ mental health, to address the potential biases caused by heterogeneity, this paper reports the effects separately for fathers and mothers. Fig 3 shows the trends in happiness and depressive mood of parents before and after childbirth. The red line represents mothers, and the green line indicates fathers. The result shows that first childbirth has a significant impact on mothers’ happiness and depressive mood, while the influence on fathers is relatively minor.

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Fig 3. Dynamic effects of first childbirth on mental health.

https://doi.org/10.1371/journal.pone.0334669.g003

Endogeneity test

As shown in Table 7, the impact of first childbirth varies for fathers and mothers in terms of happiness and depressive mood. Each column respectively applies the fixed effects model and the instrumental variable method for estimation. Columns (1), (3), (5), and (7) present results based on the fixed effects model, while columns (2), (4), (6), and (8) show results from the instrumental variable method, aiming to reveal the causal effect of first childbirth on parental mental health. This study uses the one-child birth rate in the same village as an instrument. The results of the first stage further confirm the validity of this instrument. Additionally, the F-value in each model is much greater than 10, indicating a strong correlation between the instrument and the endogenous explanatory variable. In all models, we control for time and individual fixed effects to eliminate unobserved time and individual heterogeneity.

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Table 7. Impact of First Childbirth on Parental Mental Health: An Instrumental Variable Approach.

https://doi.org/10.1371/journal.pone.0334669.t007

By comparing the results of the fixed effects model and the instrumental variable method, we find that the estimates from the instrumental variable method are often larger and more statistically significant. This might be because the instrumental variable method more effectively corrects potential endogeneity issues. First childbirth has a significant positive effect on the depressive mood of parents. For mothers, first childbirth has a significant negative impact on happiness, while the impact on fathers’ happiness is not significant in both model estimates. The results suggest that first childbirth has a significant effect on the depressive mood of both parents and reduces happiness significantly for mothers, but not for fathers. These findings have important implications for policy-making and practice, highlighting the need for greater attention and care for the mental health of new parents, especially mothers.

Mechanism ransmission analysis

The baseline regression results indicate that first childbirth has a significant impact on parental mental health. To delve deeper into its potential transmission mechanisms, we conducted phased empirical tests based on literature and real-world observations. This paper identifies the following four key transmission mechanism variables: chronic diseases, work income, job opportunities, and confidence in the future. We examined how first childbirth affects each mechanism variable, followed by a regression analysis on the relationships between these variables and parental mental health.

Chronic diseases.

The relationship between chronic diseases and mental health has been well-documented in previous studies. Engel (1977) [45] proposed that chronic diseases significantly affect mental health, leading to various psychological issues. On the one hand, patients with chronic diseases experience reduced work efficiency due to frequent medical visits or lack of energy [60], and are forced to choose low-intensity and low-income jobs [61]. On the other hand, the direct medical costs incurred by chronic diseases further squeeze the space for income accumulation [62], triggering dual anxiety about health and the economy and falling into a vicious cycle of lacking a sense of control over the future.This severely impacts mental health, giving rise to various psychological issues. According to data from Table 8, after the first childbirth, mothers face a significant increase in the risk of chronic diseases. In contrast, the risk growth for fathers is not evident. Table 9 further reveals the correlation between chronic diseases and feelings of happiness and depression: chronic diseases are significantly negatively correlated with happiness and positively correlated with depressive mood.

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Table 8. Impact of Bearing the first Child on Mechanistic Variables.

https://doi.org/10.1371/journal.pone.0334669.t008

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Table 9. Impact of Mechanistic Variables on Parental Psychological Well-being.

https://doi.org/10.1371/journal.pone.0334669.t009

The childbirth process might lead women to undergo a series of physiological changes, elevating their risk for certain chronic diseases. For instance, Evenson et al. (2009) [63] highlighted that pregnancy and childbirth could induce changes in the endocrine, immune, and metabolic systems, potentially correlating with a rise in the incidence of chronic diseases. Furthermore, the physical and psychological stress after childbirth, combined with the daily care of a newborn, might further impact a woman’s health [13]. This aligns with Engel’s model. Consequently, women might face heightened health risks after childbirth, further adversely affecting their mental health.

Age

Further in this paper, we analyze the impact of the first childbirth on the mental health of parents from different age groups. Referring to the World Health Organization’s age categorization, couples 44 years old and below are defined as “young couples”, while those aged between 45 and 59 are termed “middle-aged couples”. As shown in Table 10, among young couples, women’s happiness significantly decreases after their first childbirth, while the decrease for men is less pronounced. Conversely, among middle-aged couples, women’s happiness after their first childbirth is positively correlated, while the change for men is almost negligible. Regarding depressive moods, young women show a significant increase after their first childbirth. In contrast, among middle-aged couples, women’s depressive moods decrease, and the reduction for men is even more pronounced. These differences may relate to the physical and psychological pressures after childbirth, balancing work and family, and societal expectations for male and female roles.

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Table 10. The Impact of First-time Childbirth on Parents’ Mental Health: age Heterogeneity.

https://doi.org/10.1371/journal.pone.0334669.t010

For young couples, the significant decline in women’s happiness after their first childbirth may be linked to physical changes after childbirth and the pressure to balance family and career. The relatively smaller decrease in men’s happiness might be because they face less pressure in familial roles and societal expectations after childbirth. Conversely, among middle-aged couples, the rise in women’s happiness after their first childbirth might stem from being better prepared and having clearer expectations about childbirth at this age. Additionally, they might have already found a balance between career and family. The negligible change in men’s happiness could be due to life stability at this age and psychological preparedness for childbirth.

In terms of depressive moods, young women exhibit a significant increase after their first childbirth. This might be attributed to the multiple role conflicts they face post-childbirth, physical recovery, and relationship changes with their partners. For middle-aged couples, women’s depressive moods lighten, possibly because they are more psychologically adjusted to childbirth at this age and receive more familial support. The significant decrease in men’s depressive moods might be attributed to increased job and family satisfaction during middle age, coupled with a positive attitude towards childbirth.

Childbirth is not just a physiological process; it’s a complex experience involving physical, psychological, and social factors. As emphasized by Bilgiç et al. (2021) [72], psychological changes during childbirth are particularly evident in urban China. With the experience of childbirth, couples might face role transitions and pressures, especially in young families. Schofield et al. (2013) [73] pointed out in their study that, especially in the post-one-child-policy era, young parents often face role conflicts between family and work. Moreover, for middle-aged families, Gao et al. (2022) [74] found that childbirth has a positive impact on women’s career aspirations, aligning with our findings. This might be because women at this age stage are better prepared for childbirth and might have found a balance between career and family. On the psychological front, Lebano et al. (2020) [75] explored why modern parents feel stressed yet hold optimistic views, termed the “optimism paradox”. Their research offers insights into the psychological changes in parents post-childbirth. Additionally, Eriksen (2022) [76] emphasized the close relationship between hormonal changes post-childbirth, societal pressures, and mental health.

In summary, to support couples’ mental health post-childbirth, we need to consider their life stage, physiological and psychological preparedness, and socio-cultural background. Especially for young couples, societal and familial support is crucial, assisting them in addressing the multifaceted challenges post-childbirth and achieving harmonious family and career development.

Urban vs. Rural

The economic and social development disparities between urban and rural areas in China remain significant, especially in terms of resident income and living conditions, reflecting evident differentiation. Due to the long-term impacts of the dual economic structure and the household registration system, the issues between urban and rural areas are increasingly pronounced. Against this backdrop, this study further categorizes individuals based on their household registration to delve deeply into the differential impacts of the first childbirth on the mental health of rural and urban residents. Estimation results are shown in Table 11, comparing the effects of first childbirth on the mental health of men and women in urban and rural areas. For this analysis, we consider “rural” and “urban” as two primary residential environment categories.

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Table 11. The Impact of First-time Childbirth on Parents’ Mental Health: Urban-Rural Heterogeneity.

https://doi.org/10.1371/journal.pone.0334669.t011

In terms of happiness: Rural women’s happiness significantly declined by about 13.43% after their first childbirth. This change might be linked to the multiple pressures rural women face post-childbirth concerning physical health, family, and career. This is consistent with the study by Henderson et al. (2005) [77], which pointed out that rural women often face more role transitions and family responsibilities after childbirth. In urban settings, the happiness change for both men and women post-childbirth is not significant. This might be attributed to the abundance of social resources and support in urban areas, allowing individuals to better balance family and career, as emphasized by Hegewisch & Gornick. (2013) [78].

Regarding depressive moods: Depressive symptoms significantly increase among rural women after their first childbirth. This might relate to physiological changes post-childbirth, familial responsibilities, and strained relationships with partners, aligning with findings by Kabir et al. (2014) [79]. Conversely, depressive symptoms among urban men slightly rise post-childbirth, possibly due to economic pressures and career development challenges, as indicated in the research by Nomaguchi & Milkie (2022) [8].

The significant decline in happiness among rural women post-childbirth is substantially more pronounced than that among urban women. Additionally, the increase in depressive symptoms among urban men post-childbirth is much more significant than that among rural men.

Education

Childbirth, as a pivotal moment in life, profoundly impacts everyone. However, is this impact conditioned by an individual’s educational background? To answer this question, we conducted a detailed analysis of post-childbirth mental health based on education levels, as detailed in Table 12. We can make several key observations:

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Table 12. The Impact of First-time Childbirth on Parents’ Mental Health: Educational Heterogeneity.

https://doi.org/10.1371/journal.pone.0334669.t012

1. (1). Differences in Happiness in Low-Education Background.Among those with a low education level, after the first childbirth, women’s happiness slightly decreases, while men’s happiness tends to rise. This aligns with our previous analysis, indicating that in certain cultural and societal contexts, men might perceive childbirth as a familial responsibility, hence possibly feeling more contented after childbirth [80]. For women, the potential role conflicts between family and work, physiological pressures, and changes due to childbirth may lead to a slight drop in happiness [81].
2. (2). Differences in Happiness in High-Education Background.Compared to those with a low education level, both women and men with a high education level experience a significant decline in happiness after the first childbirth. This might be attributed to their higher expectations for life and career. Childbirth can lead to greater role conflicts and pressures, especially between work and family [82].
3. (3). Differences in Depressive Moods in Low-Education Background.Women with a low education background demonstrate a significant rise in depressive moods after the first childbirth. This is in line with our earlier discussion, suggesting that they might face larger multiple role conflicts, pressures of physical recovery, and shifts in relationships with partners [83].
4. (4). Differences in Depressive Moods in High-Education Background.In the high-education background, both men and women show an increase in depressive moods after childbirth, but the increase is more pronounced among men. This could be related to the career pressures and societal expectations that men with higher education backgrounds confront post-childbirth [84].

The analysis indicates that the psychological impact of childbirth on individuals with a low educational background (especially women) is more pronounced. This suggests that, especially against the backdrop of pressures from childbirth, groups that are already relatively vulnerable in socio-economic status experience more intense psychological shocks. It underscores the importance of tailoring support mechanisms considering educational backgrounds to ensure mental well-being during such transformative life events.

Child’s gender

From Table 13, we can discern several key insights:

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Table 13. The Impact of First-time Childbirth on Parents’ Mental Health: child gender Heterogeneity.

https://doi.org/10.1371/journal.pone.0334669.t013

1. (1). Child’s Gender and Mother’s Happiness.Association between a mother’s happiness and the gender of the child: If the newborn is a boy, the data shows a slight increase in the mother’s happiness, though this change is not statistically significant (coefficient = 0.0159, standard error = 0.0823). This could be related to the traditional family notion of preferring sons over daughters, where sons are often seen as the inheritors of the family lineage. However, accompanying this could be economic responsibilities for the offspring, such as purchasing property or covering wedding expenses, which might influence the mother’s sense of well-being [85]. If the newborn is a girl, the data indicates a significant decline in the mother’s happiness (coefficient = −0.2076, standard error = 0.0844). This might be tied to societal expectations and role perceptions of daughters. In some cultural contexts, daughters might require more care and support, thereby adding more pressure on mothers [86].
2. (2). Association between a father’s happiness and the gender of the child. Regardless of whether the child is a boy or a girl, there is no significant change in the father’s happiness. This might be tied to traditional roles of men in the family, suggesting that their emotional experience isn’t notably influenced by the gender of the child [87].

1. (3). Association between a mother’s depressive moods and the child’s gender. Mothers show a significant increase in depressive moods irrespective of the child’s gender. Especially when the child is a girl, her depressive mood significantly rises (coefficient = 0.1151, standard error = 0.0266). This could be associated with post-birth physiological and psychological recovery, changes in familial roles, and expectations and responsibilities towards daughters [88].
2. (4). Association between a father’s depressive moods and the child’s gender: When the child is a boy, the father’s depressive mood rises, and this change is significant (coefficient = 0.0869, standard error = 0.0304). This might be due to the societal expectations and pressures on fathers with sons. For instance, in certain cultural perspectives, boys are seen as the economic pillars of the family, possibly inducing psychological pressure on the fathers [89].

In summary, Table 13 reveals how a child’s gender impacts the psychological health of parents. The family concept of “valuing sons over daughters” and the accompanying economic pressures, such as buying a house or wedding expenses, influence parents’ psychological states to some degree. These insights provide a fresh perspective on the relationships between childbirth, familial roles, and psychological health.

Heterogeneity in effects. Contrary to the traditional view, younger parents may find it more challenging to adapt to the arrival of a newborn due to lower psychological maturity and economic stability. They may experience higher levels of anxiety and financial stress. In contrast, middle-aged and older parents often have more stable economic conditions and greater life experience, enabling them to handle the responsibilities of parenthood more effectively. Their well-established social support networks also provide additional assistance, reducing psychological stress and enhancing their parenting confidence and capabilities.Urban parents, generally equipped with better economic and educational resources, might also grapple with intensified work and life pressures. In contrast, rural parents might face significant economic challenges but could benefit from greater support from their community and extended family. Highly-educated parents might have easier access to child-rearing information and resources but might also have loftier parenting expectations. In contrast, parents with lower educational attainment might face challenges in accessing child-rearing knowledge and skills but might find more robust support within their families and communities. In certain regions, owing to traditional gender preferences (“preference for boys over girls”), the birth of a girl might impose added psychological stress on parents, affecting their happiness and mood. While both fathers and mothers are influenced by first-time childbirth, due to physiological, cultural, and societal role differences, mothers often bear a heavier burden, especially when the child is a girl.Differences between fathers and mothers. Throughout the demographic transition, while both fathers and mothers feel the impacts of first-time childbirth, mothers, due to physiological, cultural, and societal differences, often endure greater stress.

In summary, the demographic transition has not only profoundly influenced the structure and economy of nations and societies but has also ushered in significant changes in the lifestyles, values, and mental health of families and individuals. Approaching from the perspective of first-time childbirth, this study offers deep insights into how this transformation affects the psychological well-being of parents.