Early maladaptive schemas as mediators of pronatalist pressures: comparative study of psychological distress in child-free women and mothers

Background
Societal pronatalist ideologies link womanhood to motherhood and create social pressures that often cause psychological distress when unmet. While previous research has documented the impact of these external pressures, much less is known about how women’s internal belief systems shape their responses to societal expectations. Recognising this gap, we examined the perspectives and concerns about motherhood and childlessness among child-free Greek women, their psychological distress and the potential mediating role of early maladaptive schemas (EMS) in this relationship. To provide context, we compared these findings with those of mothers, considering both their mental health and their assessments of similar issues after becoming parents.


Method
We conducted an online, cross-sectional survey comparing child-free Greek women and mothers aged 30–50 years. Through custom-designed questionnaires, we evaluated concerns about motherhood and childlessness among child-free women, and we asked the mother group to assess the same aspects post-motherhood. Mental health was assessed using Depression, Anxiety and Stress Scale 21, while EMS were measured with the Young Schema Questionnaire. We used mediation analysis to examine whether EMS mediated the connection between pronatalist pressures and mental health outcomes.


Results
The study included 1341 women, comprising 503 without children and 838 with children. Child-free women, who were predominantly involuntarily child-free, tended to be younger, more educated and had lower household incomes than mothers. They also reported more diverse sexual orientations, higher levels of depression and anxiety and elevated scores on EMS, which appear to exacerbate distress caused by societal pronatalist pressures. In contrast, mothers were typically older and more financially stable. Although they reported fulfilment from motherhood, they also faced challenges, including demanding caregiving responsibilities and financial or logistical barriers to having more children. Mothers’ psychological profiles were characterised by lower EMS scores and less overall distress.


Conclusions
This study revealed distinct demographic and psychological profile differences between child-free women and mothers. Our findings underscore that women’s mental health in the context of reproduction is shaped by a complex interaction of social pressures, psychological schemas and structural factors. Specifically, EMS – particularly in the domains of Emotional Deprivation, Mistrust/Abuse and Vulnerability to Harm – were identified as a key mechanism, mediating the relationship between pronatalist pressures and psychological distress. Furthermore, occupational disparities emerged as a significant stressor, affecting both child-free women in high-pressure careers and mothers who were home-makers.