# When “good enough” is no longer enough: Parenting perfectionism, intolerance of uncertainty, and emotion regulation in postnatal depression

Kelly Saint Denny, Karyn Doba, Laurent Storme, Jean-Louis Nandrino

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Kelly Saint Denny, Karyn Doba, Laurent Storme, Jean-Louis Nandrino. When “good enough” is no longer enough: Parenting perfectionism, intolerance of uncertainty, and emotion regulation in postnatal depression. Personality and Individual Differences, 2025, Personality and Individual Differences, 233, pp.112910. 10.1016/j.paid.2024.112910. hal-05051898

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# When “good enough” is no longer enough: Parenting perfectionism, intolerance of uncertainty, and emotion regulation in postnatal depression

Kelly Saint Denny<sup>a,b,*</sup>, Karyn Doba<sup>a</sup>, Laurent Storme<sup>b</sup>, Jean-Louis Nandrino<sup>a</sup>

## ARTICLE INFO

**Keywords:**

Depression

Postpartum

Perfectionism

Parenting

Uncertainty

Emotional regulation

## ABSTRACT

This study addresses the call for psychological research to examine the impact of social expectations and modern parenting paradigms on parents' mental health. We explore parenting perfectionism as a predictor of postnatal depression, with intolerance of uncertainty and emotion regulation difficulties as mediators. Using Partial Least Square Structural Equation Modelling (PLS-SEM) on a sample of 232 mothers, we examined both direct and indirect effects of parenting perfectionism on postnatal depression symptoms, including mediation analysis of emotion regulation difficulties and intolerance of uncertainty. Findings support that parenting perfectionism predicts the risk of postnatal depression through these mediating mechanisms. Limitations of the study include its cross-sectional design and reliance on self-reported measures. Volunteer bias, higher education and employment levels among participants may limit the generalizability of the results. Despite these limitations, this study shows the importance of emotion regulation difficulties and intolerance of uncertainty as key mechanisms by which parenting perfectionism increases the risk of postnatal depression in mothers during the first year postpartum. This study provides novel and actionable targets for the treatment and prevention of postnatal depression and demonstrates how social and cultural contexts of parenthood can be operationalized for psychological inquiry through complex statistical modelling.

## 1. Introduction

Within contemporary Western societies, parents are striving to achieve higher and higher standards and levels of perfectionism are increasing (Björnsson & Brülde, 2017; Lee et al., 2014). At the same time, despite national policies addressing parental mental health, the prevalence of postnatal depression continues to be a concern in France where rates are among the highest in Europe (16.7 %, National Institute of Health and Medical Research, 2021; for other European countries see Wang et al., 2021). Though previous research points to some form of connection between perfectionism and postnatal depression, it is not straightforward. In this study, we seek to examine the relationship between them through two mediating variables: emotion regulation difficulties and intolerance of uncertainty.

Perfectionism is a multidimensional risk factor for various forms of psychopathology including depression (Limburg et al., 2017; Patterson et al., 2021). Perfectionism has two core dimensions: perfectionistic strivings (closely linked to self-oriented perfectionism), which involve self-orientated efforts in setting and pursuing high standards, and

perfectionistic evaluative concerns, which focus on how (perceived) failures impact feelings of social or self-worth (Gaudreau & Thompson, 2010). Perfectionistic concerns can be considered as the consequence of internalization of socially prescribed perfectionism (Woodfin et al., 2020). An extensive body of scientific literature has shown that parenting perfectionism is associated with adverse developmental outcomes in children (Lilley et al., 2020) as well as deleterious effects on parents themselves (for an overview, see Evans et al., 2022). Prior research on the specific connection between parenting perfectionism and postnatal depression symptoms has yielded mixed results. Some studies reported no significant associations (Dimitrovsky et al., 2002; Maia et al., 2012), while others found significant correlations concerning both socially prescribed (Padoa et al., 2018) and self-orientated parenting perfectionism (Jackman et al., 2017) and postnatal depression symptoms.

Intolerance of uncertainty is a transdiagnostic concept whose relevance in the context of various emotional disorders including depression is well established (for a review, see Rosser, 2019). Individuals with high levels of intolerance of uncertainty tend to seek predictability and

<footnote><sup>a</sup> Cognitive and Affective Sciences; SCALab UMR CNRS 9193, University of Lille, Lille, France</footnote>

<footnote><sup>b</sup> Department of Neonatology, Lille University Hospital, Lille, France</footnote>

<footnote>* Corresponding author at: Department of Neonatology, Jeanne de Flandre Hospital, Lille University Hospital Center, Avenue Eugène Avinée, 59000 Lille, France.
E-mail address: kelly.saintdenny@chu-lille.fr (K. Saint Denny).</footnote>
perceive uncertain situations as threatening. The construct comprises two dimensions: prospective anxiety, which involves a preference for predictability and the use of strategies aimed at increasing certainty levels, and inhibitory anxiety, which involves difficulty in functioning when faced with uncertain situations (Sexton & Dugas, 2009). Parenting throughout the first year of a baby's life is an inherently and notoriously uncertain experience, making parents with high intolerance of uncertainty particularly vulnerable. In the related field of perinatal mental health, pregnant women with high degrees of intolerance of uncertainty are more likely to report decreased levels of psychological wellbeing (Çevik & Yağmur, 2018) and worsening of anxiety in the first year postpartum (Furtado et al., 2019). This explains why the Intolerance of Uncertainty Scale (IUS) has been found to be a good screening tool for anxiety in the perinatal period (Furtado et al., 2021).

Scientific examination of the links between intolerance of uncertainty and perfectionism is very recent, and points to intolerance of uncertainty as having a mediating role between perfectionism and negative psychological outcomes (Blom et al., 2023; Reuther et al., 2013). Within the field of parenting, a recent randomized-controlled trial targeting perinatal anxiety showed that treatment worked by specifically modifying the levels of intolerance of uncertainty and parenting perfectionism (Donegan et al., 2022). Cognitive-behavioral theories suggest that perfectionistic individuals are more prone to cognitive rigidity, making them less able to adapt to unexpected situations (Shafran et al., 2002). Furthermore, intolerance of uncertainty is closely linked to the perceived severity of potential negative outcomes (Dugas et al., 1998). These make unknowns particularly aversive for perfectionistic parents as they directly undermine the possibility of control and hinder chances of achieving parenting standards (Carleton, 2016).

Emotion regulation difficulties refer to challenges people face in effectively managing their emotional responses. This encompasses difficulties in recognizing, understanding, accepting, and managing one's emotions (Hayes et al., 1996; McRae & Gross, 2020). While research has consistently shown that these difficulties are significant risk factors in predicting postnatal depression (Cardoso & Fonseca, 2023), their relationship with perfectionism has received limited attention in the context of parenthood. In the general population, there is compelling research to suggest that perfectionism predicts increased difficulties in emotion regulation (Vois & Damian, 2020) and that perfectionists are at risk for psychological distress precisely because they fail to effectively regulate their emotions (Kahn et al., 2022). This connection likely arises because perfectionistic individuals experience heightened negative affect when they anticipate difficulties in achieving their exceptionally high standards. This makes them prone to maladaptive emotional responses, including catastrophizing, self-blame, and rumination, which further impair their ability to regulate emotions effectively (Malivoire et al., 2019; Rudolph et al., 2007).

In this study, we use Partial Least Square Structural Equation Modelling (PLS-SEM) to understand the etiological factors underlying postnatal depression. We posit that parenting perfectionism only predicts postnatal depression symptoms when it increases intolerance of uncertainty and difficulties in emotion regulation.

# 2. Materials and methods

## 2.1. Participants

The original sample comprised 254 mothers, 22 were excluded from the analysis due to missing data on key variables (i.e. no answer to at least one questionnaire). Table 1 presents characteristics of the final sample comprising 232 mothers aged 20 to 46 years (M = 33, SD = 4.75, N = 224) of babies aged 0 to 12 months (M = 6, SD = 3.51) Notably, our sample had higher education levels and a higher proportion of employment than the general population (The National Institute of Statistics and Economic Studies, 2023). Additional information is available in Table S1.

<table><caption>**Table 1**

Descriptive statistics of maternal characteristics.</caption><thead><tr><th></th><th>N</th><th>%</th></tr></thead><tbody><tr><td>In marital relationship</td><td>232</td><td>100</td></tr><tr><td>Number of children in household</td><td></td><td></td></tr><tr><td>1</td><td>117</td><td>50.4</td></tr><tr><td>2</td><td>81</td><td>34.9</td></tr><tr><td>3</td><td>24</td><td>10.3</td></tr><tr><td>≥4</td><td>10</td><td>4.3</td></tr><tr><td>Education</td><td></td><td></td></tr><tr><td>&lt;High school diploma</td><td>21</td><td>9.1</td></tr><tr><td>High school diploma (Baccalauréat)</td><td>37</td><td>15.9</td></tr><tr><td>2 year university level</td><td>41</td><td>17.7</td></tr><tr><td>Bachelor's degree</td><td>42</td><td>18.1</td></tr><tr><td>Master's degree</td><td>76</td><td>32.8</td></tr><tr><td>Ph.D</td><td>15</td><td>6.5</td></tr><tr><td>Employment</td><td></td><td></td></tr><tr><td>Unemployed</td><td>44</td><td>18.9</td></tr><tr><td>Part-time</td><td>70</td><td>30.2</td></tr><tr><td>Full-time</td><td>118</td><td>50.9</td></tr><tr><td>First pregnancy</td><td></td><td></td></tr><tr><td>Yes</td><td>118</td><td>50.9</td></tr><tr><td>No</td><td>114</td><td>49.1</td></tr><tr><td>Baby's term</td><td></td><td></td></tr><tr><td>Full-term</td><td>216</td><td>93.1</td></tr><tr><td>Premature</td><td>16</td><td>6.9</td></tr></tbody></table>

## 2.2. Procedure

Ethical approval (2021-476-S91) was obtained. Inclusion criteria were mothers aged 18+ of babies aged 0–12 months, fluent in French. They completed an online (Limesurvey®) questionnaire. Recruitment occurred through social media and professional networks. Informed consent was obtained and resources for parental mental health support were shared at the end of the survey.

## 2.3. Measures

Emotion regulation difficulties were assessed using the Difficulties in Emotion Regulation Scale (DERS, Gratz & Roemer, 2004; Victor & Klonsky, 2016). The French version has shown good psychometric properties (Dan-Glauser & Scherer, 2013).

Symptoms of postnatal depression were measured using the Edinburgh Postnatal Depression Scale (EPDS, Guedeney & Fermanian, 1998). The most commonly used cut-off score of 12 was applied (Levis et al., 2020) in order to ensure comparison with previous research. Scores of 13 or higher reflect moderate to severe depression symptoms (McCabe-Beane et al., 2016).

Intolerance of uncertainty was evaluated through the Intolerance of Uncertainty Scale 12-item version (IUS-12, Carleton et al., 2007).

Parenting perfectionism was assessed using the Brief Parenting Perfectionism Scale (BPPS, Lin et al., 2023). All scales demonstrated good internal consistency in this study (see Table 3a).

## 2.4. Data analysis

Statistical analyses were conducted using IBM SPSS Statistics 29. Means, standard deviations, percentages and correlations were computed (see Tables S2 and S3). Partial Least Squares Structural Equation Modeling (PLS-SEM) was chosen over classic covariance-based SEM due to the exploratory and explanatory nature of our research objectives, and the necessity of examining both direct and indirect relationships. A minimum sample size of 155 participants was determined (Kock & Hadaya, 2018). Path coefficients (β) and confidence intervals were estimated via bootstrapping using SmartPLS 4 (Ringle et al., 2024). The PLS-SEM algorithm parameters used were standard PLS algorithm using a bootstrap procedure with Bias-Corrected and accelerated (BCa) bootstrapped confidence interval calculations due to data skewness, and a path weighting scheme. Significance level was set at 0.05.
# 3. Results

## 3.1. Descriptive data

### 3.1.1. Psychometric measurements

The results for maternal scores on each scale are presented in Table 2. Measurement scores are not normally distributed (Table S4); however this is unproblematic as PLS-SEM is a nonparametric technique capable of managing complex and nonlinear relationships between variables.

Scores on the EPDS ranged from 0 to 29 (mean score = 9.82 ± 5.96). In our sample, 26.7 % of participants have a score of 13 or higher, a rate that is 10 points higher than the one found in the general population of French mothers (16.7 %, National Institute of Health and Medical Research (INSERM), 2021). Participants' scores on the BPPS and the IUS-12 were congruent with those found in the validation studies (Carleton et al., 2007; Lin et al., 2023). DERS scores were slightly higher than in the validation literature (Dan-Glauser & Scherer, 2013).

## 3.2. PLS-SEM: structural modelling

Two models were used to describe the PLS-SEM: the outer (measurement) model that connects the manifest variables to their latent variables, and the inner (structural) model relating exogenous variables to the endogenous variable. The structural model is composed of 3 reflective exogenous latent variables represented using the following theoretical entities: (1) parenting perfectionism, (2) emotion regulation difficulties and (3) intolerance of uncertainty. The theoretical model comprised 11 manifest variables loading on these 3 latent variables, and the endogenous variable.

### 3.2.1. Outer model

To achieve the final model, the first step consisted of verifying indicator reliability by assessing the loadings (λ) of manifest variables on each latent variable (acceptable λ > 0.7, Hair et al., 2022). Two manifest variables were removed due to poor loading: first, Awareness was removed (λ = 0.262, p = 0.006) and subsequently, Clarity (λ = 0.612, p = 0.000) was removed, both loaded on emotion regulation difficulties. The final model involved 8 manifest variables loading on the 3 latent variables and 1 endogenous variable (postnatal depression symptoms). All loading values indicate greater convergence. The model satisfied all reflective measurement quality criteria (Tables 3a and 3b): composite reliability (p_a and p_c > 0.70), internal consistency reliability (Cronbach's α > 0.7), convergent validity (AVE > 0.5), no collinearity issues (VIF < 5) and discriminant validity (HTMT < 0.85) for all latent variables (Henseler et al., 2015).

<table><caption>**Table 2**

Description of participant scores on measurement scales.</caption><thead><tr><th>Measurement scale</th><th></th><th>Mean</th><th>SD</th></tr></thead><tbody><tr><td rowspan="7">EPDS</td><td>Total score</td><td>9.82</td><td>5.96</td></tr><tr><td>Strategies</td><td>6.47</td><td>2.83</td></tr><tr><td>Non-acceptance</td><td>7.91</td><td>3.28</td></tr><tr><td>Impulsivity</td><td>6.09</td><td>2.97</td></tr><tr><td>Goals</td><td>8.82</td><td>3.28</td></tr><tr><td>Awareness</td><td>6.95</td><td>2.70</td></tr><tr><td>Clarity</td><td>5.88</td><td>2.43</td></tr><tr><td rowspan="4">DERS</td><td>Total score</td><td>42.11</td><td>11.99</td></tr><tr><td>Prospective anxiety</td><td>15.69</td><td>5.69</td></tr><tr><td>Inhibitory anxiety</td><td>11.11</td><td>4.38</td></tr><tr><td>Total score</td><td>26.80</td><td>9.43</td></tr><tr><td rowspan="3">IUS-12</td><td>Perfectionist strivings</td><td>2.76</td><td>1.13</td></tr><tr><td>Perfectionist concerns</td><td>2.35</td><td>1.18</td></tr><tr><td>Total score</td><td>2.57</td><td>0.99</td></tr></tbody></table>

Abbreviations: EPDS: Edinburgh Postnatal Depression Scale; DERS: Difficulties in Emotion Regulation Scale; IUS-12: Intolerance of Uncertainty Scale; BPPS: Brief Parenting Perfectionism Scale.

### 3.2.2. Inner model

The final PLS-SEM model fit quality criteria (for a description, see Table S5). It is visually depicted in Fig. 1.

Results showed that the direct path between parenting perfectionism and postnatal depression symptoms was not significant (β = 0.057, CI [-0.066, 0.165]). However, parenting perfectionism was positively and significantly associated with emotion regulation difficulties (β = 0.261, CI [0.111, 0.382]), as well as with intolerance of uncertainty (β = 0.432, CI [0.307, 0.524]). Positive and significant direct associations were also observed between emotion regulation difficulties and postnatal depression symptoms (β = 0.391, CI [0.230, 0.520]) as well as between intolerance of uncertainty and postnatal depression symptoms (β = 0.291, CI [0.136, 0.454]).

We examined mediation effects using Zhao et al.'s (2010) guidelines. The indirect effect of parenting perfectionism on postnatal depression symptoms was small, positive, and significant through both emotion regulation difficulties (β = 0.101, CI [0.045, 0.173]) and intolerance of uncertainty (β = 0.125, CI [0.055, 0.224]). Both variables are therefore full mediators of parenting perfectionism on postnatal depression symptoms, with a moderate total indirect effect (β = 0.226, CI [0.137, 0.313]). Indirect and direct path coefficients (β) as well as direct effect size estimates (F²) are displayed in Tables 4a and 4b.

Because PLS-SEM models are primarily assessed on their predictive and explanatory power, covariance-based goodness-of-fit measures are not suitable. Therefore, as well as analyzing the significance and relevance of the path coefficients (β), the overall quality of the model was assessed by its explanatory (R²) and predictive powers (Q² and Root Mean Square Error (RMSE) or Mean Absolute Error (MAE) comparison with Linear Model (LM) results) using the PLSPredict procedure (Shmueli et al., 2019). For reference, the Standardized Root Mean Square residual (SRMR) value showed acceptable fit (0.73), All values are available in Tables 5a and 5b.

Examination of path coefficients' relative importance shows that the strongest effect is that of parenting perfectionism on intolerance of uncertainty (β = 0.432) followed by emotion regulation difficulties on postnatal depression symptoms (β = 0.391), intolerance of uncertainty on postnatal depression symptoms (β = 0.291) and finally parenting perfectionism on emotion regulation difficulties (β = 0.261). The specific indirect effect values of each mediation path were very similar, revealing that emotion regulation difficulties (β = 0.101) and intolerance of uncertainty (β = 0.125) have roughly equivalent mechanistic importance in explaining the link between parenting perfectionism and postnatal depression symptoms.

Overall, the explanatory power of parenting perfectionism on postnatal depression symptoms through both mediators is of moderate strength and the model's predictive power can be considered as either low (RMSE comparison) or medium (MAE comparison) (Table 5b).

### 3.2.3. Control for direction of effects

The PLS-SEM bootstrap procedure run on a reversed model showed that the direct path between postnatal depression symptoms and parenting perfectionism was not significant (β = 0.065, p = 0.417, CI [-0.096, 0.221]), nor was the indirect effect through emotion regulation difficulties (β = 0.032, p = 0.461, CI [-0.056, 0.117]). However, the indirect effect of postnatal depression symptoms on parenting perfectionism through intolerance of uncertainty was significant (β = 0.179, p = 0.000, CI [0.101, 0.269]) indicating that intolerance of uncertainty is also a mediator in the relationship between postnatal depression symptoms and parenting perfectionism.

### 3.2.4. Verification of control variable effects

Following the guidelines provided by Bernerth and Aguinis (2016) we did not identify any possible control variables that might have an effect in this model.
<table><caption>**Table 3a**

Results summary for the latent variables' quality assessment of the Outer Measurement Models.</caption><thead><tr><th>Latent variable</th><th>Convergent validity (AVE)</th><th>Internal consistency (Cronbach's α)</th><th>Reliability (ρ<sub>c</sub>)</th><th>Discriminant validity: HTMT<br>Significantly lower than 0.85–0.90?</th></tr></thead><tbody><tr><td>Parenting perfectionism</td><td>0.756</td><td>0.872</td><td>0.859</td><td>Yes</td></tr><tr><td>Intolerance of uncertainty</td><td>0.877</td><td>0.900</td><td>0.934</td><td>Yes</td></tr><tr><td>Emotion regulation difficulties</td><td>0.668</td><td>0.882</td><td>0.889</td><td>Yes</td></tr></tbody></table>

Abbreviations: AVE: average variance extracted; HTMT: heterotrait-monotrait ratio.

<table><caption>**Table 3b**

Results summary for the indicators' quality assessment of the Outer Measurement Models.</caption><thead><tr><th rowspan="2">Latent variable</th><th rowspan="2">Indicator</th><th colspan="2">Convergent validity</th><th rowspan="2">Collinearity (VIF)</th></tr><tr><th>Loadings (λ)</th><th>Indicator reliability (λ<sup>2</sup>)</th></tr></thead><tbody><tr><td rowspan="3">Parenting perfectionism</td><td>Concerns</td><td>0.957</td><td>0.916</td><td>1.458</td></tr><tr><td>Strivings</td><td>0.776</td><td>0.602</td><td>1.458</td></tr><tr><td>Inhibitory anxiety</td><td>0.933</td><td>0.870</td><td>2.328</td></tr><tr><td rowspan="2">Intolerance of uncertainty</td><td>Prospective anxiety</td><td>0.940</td><td>0.884</td><td>2.328</td></tr><tr><td>Impulsivity</td><td>0.811</td><td>0.658</td><td>1.870</td></tr><tr><td rowspan="3">Emotion regulation difficulties</td><td>Goals</td><td>0.736</td><td>0.542</td><td>1.620</td></tr><tr><td>Strategies</td><td>0.897</td><td>0.805</td><td>2.369</td></tr><tr><td>Non acceptance</td><td>0.820</td><td>0.672</td><td>1.757</td></tr></tbody></table>

Abbreviation: VIF: variance inflation factor.

## 4. Discussion

Our study shows that emotion regulation difficulties and intolerance of uncertainty are full mediators of the relationship between parenting perfectionism and symptoms of postnatal depression. More specifically, they represent mechanisms that underlie the predictive relationship between parenting perfectionism and postnatal depression symptoms. Parenting perfectionism increases both emotion regulation difficulties and intolerance of uncertainty which, in turn, increase the risk of

postnatal depression.

Many parents find it psychologically taxing to regulate their own emotions while caring for their child (Rutherford et al., 2015). Because perfectionistic parents tend to be excessively self-critical, they have heightened perceptions of a discrepancy between their standards and their parenting performance (Donahue et al., 2018; Macedo et al., 2017). Findings suggest this impacts the emotion regulation processes that are already and especially taxed during the post-partum period.

Furthermore, feelings of inadequacy are facilitated by contemporary societal expectations of parenting. Socially prescribed perfectionism has been found to predict emotion regulation difficulties in various populations (Vois & Damian, 2020). Today's parents are exposed to high parenting expectations as well as a myriad of opportunities for social

<table><caption>**Table 4a**

Significance and relevance analysis and size estimation of direct effects.</caption><thead><tr><th>Relationship</th><th>β</th><th>Sig.</th><th>Effect size (F<sup>2</sup>)</th></tr></thead><tbody><tr><td>Parenting perfectionism → postnatal depression symptoms</td><td>0.057</td><td>0.316</td><td>0.004</td></tr><tr><td>Parenting perfectionism → emotion regulation difficulties</td><td>0.261</td><td><strong>0.000</strong></td><td>0.073</td></tr><tr><td>Emotion regulation difficulties → postnatal depression symptoms</td><td>0.391</td><td><strong>0.000</strong></td><td>0.186</td></tr><tr><td>Parenting perfectionism → intolerance of uncertainty</td><td>0.432</td><td><strong>0.000</strong></td><td>0.225</td></tr><tr><td>Intolerance of uncertainty → postnatal depression symptoms</td><td>0.291</td><td><strong>0.000</strong></td><td>0.092</td></tr></tbody></table>

Significant p-values are highlighted in bold.

<figure><img src="image_4.png" /><figcaption>**Fig. 1.** Visual representation of the final PLS-SEM model.</figcaption></figure>

Partial least squares structural equation model showing direct and indirect effects of parenting perfectionism on postnatal depression symptoms, mediated by emotion regulation difficulties and intolerance of uncertainty.
<table><caption>**Table 4b**
Significance and relevance analysis of indirect effects.</caption><thead><tr><th>Type</th><th>Relationship</th><th>β</th><th>Sig.</th></tr></thead><tbody><tr><td rowspan="2">Specific</td><td>Parenting perfectionism → emotion regulation difficulties → postnatal depression symptoms</td><td>0.101</td><td><strong>0.002</strong></td></tr><tr><td>Parenting perfectionism → intolerance of uncertainty → postnatal depression symptoms</td><td>0.125</td><td><strong>0.003</strong></td></tr><tr><td rowspan="2">Total</td><td>Parenting perfectionism → emotion regulation difficulties → postnatal depression symptoms</td><td rowspan="2">0.226</td><td rowspan="2"><strong>0.000</strong></td></tr><tr><td>+ Parenting perfectionism → intolerance of uncertainty → postnatal depression symptoms</td></tr></tbody></table>

Significant p-values are highlighted in bold.

<table><caption>**Table 5a**
Results of the PLSPredict procedure showing explanatory and predictive powers of latent variables of the final PLS-SEM model.</caption><thead><tr><th>Latent variable</th><th>Explanatory power (R<sup>2</sup>)</th><th>Predictive power (Q<sup>2</sup>)</th></tr></thead><tbody><tr><td>Postnatal depression symptoms</td><td>0.355 [0.242, 0.438]</td><td>0.066</td></tr><tr><td>Intolerance of uncertainty</td><td>0.180 [0.091, 0.271]</td><td>0.172</td></tr><tr><td>Emotion regulation difficulties</td><td>0.064 [0.011, 0.148]</td><td>0.056</td></tr></tbody></table>

<table><caption>**Table 5b**
Results of the PLSPredict procedure showing the predictive power of each indicator of the final PLS-SEM model.</caption><thead><tr><th rowspan="2">Latent variable</th><th rowspan="2">Indicators</th><th colspan="3">Predictive power</th></tr><tr><th>Q<sup>2</sup></th><th>RMSE larger than LM?<sup>a</sup></th><th>MAE larger than LM?<sup>a</sup></th></tr></thead><tbody><tr><td rowspan="2">Intolerance of uncertainty</td><td>Prospective anxiety</td><td>0.135</td><td>No</td><td>Yes</td></tr><tr><td>Inhibitory anxiety</td><td>0.167</td><td>Yes</td><td>No</td></tr><tr><td rowspan="3">Emotion regulation difficulties</td><td>Goals</td><td>-0.019</td><td>No</td><td>Yes</td></tr><tr><td>Strategies</td><td>0.048</td><td>No</td><td>Yes</td></tr><tr><td>Non acceptance</td><td>0.083</td><td>No</td><td>No</td></tr><tr><td></td><td>Impulsivity</td><td>0.028</td><td>Yes</td><td>Yes</td></tr></tbody></table>

Abbreviations: RMSE: root mean square error; LM: linear regression model; MAE: mean absolute error.

<sup>a</sup> The PLS-SEM procedure results yield lower prediction errors than the Linear Regression Model procedure results for:

1) A minority of indicators (RMSE values) indicating low predictive power;

2) A majority of indicators (MAE values) indicating medium predictive power.

comparison, with perfectionistic parents suffering the most (Padoa et al., 2018). As well as struggling with emotion regulation, this interpersonal aspect of parenting perfectionism may predispose them to feelings of not being “as good as” other parents, making them especially vulnerable to developing postnatal depression symptoms. This is corroborated by recent research showing that mothers who experienced greater incongruence between their maternal self-concept and “good mother” ideals experienced more severe postnatal depression symptoms and this association was mediated by domain specific (maternal) feelings of shame (Sonnenburg & Miller, 2021).

Coping with the inherent uncertainty of the parenting experience can be perceived as impeding cognitive and behavioral attempts to meet parenting standards. This might be especially true and problematic for perfectionistic parents who combine highly idealized images of parenthood as well as a sense of identity that is particularly prone to the effects of self-criticism (Hewitt et al., 2003). Indeed, for many, being perceived by others as a “happy parent” (Schmidt et al., 2023) through positive affect, emotional stability and control is a crucial identity issue (Collett, 2005, DeGroot & Vik, 2021). Alongside efforts to measure up to impossible standards, perfectionistic parents might excessively strive to

maintain a positive outwardly image (Desnoyers & Arpin-Cribbie, 2015). The characterization of uncertainty as a threat to parental achievement, and the scarcity of psychological resources left to deal with it might explain increased intolerance of uncertainty in perfectionistic individuals.

Our findings should be interpreted within Western societies' risk-based discourses on parenthood (Ballantyne et al., 2016) where early life is framed as a vulnerable time and parental practices determine their child's future (Görlitz & Tamm, 2020; Yerkes et al., 2021). This deterministic narrative can fuel perfectionistic tendencies and intensify intolerance of uncertainty. This is supported by findings showing that internal locus of control strengthens the association between socially prescribed perfectionism and postnatal depression symptoms (Jackman et al., 2017).

From a clinical perspective, therapeutic treatment of people with high levels of perfectionism can be difficult (Miller et al., 2017). Our findings show that treatment options could involve cognitive-behavioral therapy aiming to reduce perfectionistic tendencies (Mikail et al., 2022) and emotion regulation difficulties and build skills to manage uncertainty. Importantly, our results suggest these are also valid therapeutic targets in mothers who are already experiencing depressive symptoms. In practice, healthcare providers should seek to promote a cultural shift that normalizes the idea that parents need not be perfect and increase awareness about how messages can inadvertently perpetuate an “ideologically infused moral discourse about what it means to be a ‘good [parent]’” (Knaak, 2010).

Future research should include other genders and adopt longitudinal designs. The mediation pathways found should be further investigated alongside other potential mediators, such as infant temperament, social support, or the quality of parental dyadic coping. The specific roles of the two core components of perfectionism should be examined in more detail as should the secondary finding of a possible self-reinforcing feedback loop.

Another direction could involve identifying individuals at risk of developing parenting perfectionism. Factors of interest could be being raised by perfectionistic parents (Soenens et al., 2005), personality traits associated needing order and control such as high conscientiousness, and individual responses to cultural norms and expectations (Limburg et al., 2017; Malteeva, 2015). Beyond the usual limitations associated with observational research, our study's primary limitation stems from participant selection bias. This bias results from the recruitment method as the study likely attracted mothers who already held a particular interest in parental mental health. This might be one reason for the above-average levels of postnatal depression symptoms in our sample. The mothers in our sample had higher education and employment levels than the general French population limiting generalizability to mothers from different socio-economic backgrounds.

## Ethical approval

Prior to undertaking the study, ethical clearance was obtained from the Ethics Committee of Behavioral Sciences of Lille University under the reference number 2021-476-S91. All aspects were in compliance with the regulations of the French National Commission on Computer Technology and Freedom (CNIL).

## Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

## CRediT authorship contribution statement

**Kelly Saint Denny:** Writing – review & editing, Writing – original draft, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. **Karyn Doba:** Methodology,
Formal analysis. **Laurent Storme:** Writing – review & editing, Validation, Supervision. **Jean-Louis Nandrino:** Writing – review & editing, Validation, Supervision, Resources, Methodology, Conceptualization.

## Data availability

Data will be made available on request.

## Acknowledgments

We would like to show our gratitude to all the mothers who participated in this study as well as to all our colleagues who helped with the recruitment process by sharing the study presentation and the link to the online survey.

# Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.paid.2024.112910.

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