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Jimenez-Barragan M, del Pino Gutierrez A, Garcia JC, Monistrol-Ruano O, Coll-Navarro E, Porta-Roda O, Falguera-Puig G. Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers. BMC Nurs 2023; 22:309. [PMID: 37674184 PMCID: PMC10483870 DOI: 10.1186/s12912-023-01440-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy. METHODS/DESIGN Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated. DISCUSSION This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up. TRIAL REGISTRATION Clinical Trials ID NCT05756205.
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Affiliation(s)
- Marta Jimenez-Barragan
- Fundació Assistencial Mútua Terrassa, (Terrassa), Universitat de Barcelona, Barcelona, Spain
- Research Group Atenció a La Salut Sexual I Reproductiva (GRASSIR), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Amparo del Pino Gutierrez
- Departament de Salut Pública, Salut Mental I Materno-Infantil, Facultat de Medicina I Ciències de La SalutUniversitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad Y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Jorge Curto Garcia
- Departament de Salut Pública, Salut Mental I Materno-Infantil, Facultat de Medicina I Ciències de La SalutUniversitat de Barcelona, Barcelona, Spain
| | - Olga Monistrol-Ruano
- Patient Safety and Research Nurse, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | | | - Oriol Porta-Roda
- Obstetrics and Gynecology Department, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Falguera-Puig
- Research Group Atenció a La Salut Sexual I Reproductiva (GRASSIR), Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Direcció d’Atenció Primària Metropolitana Nord, Atenció a La Salut Sexual I Reproductiva Metropolitana Nord, Institut Català de La Salut, Barcelona, Spain
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Zargar M, Sayyah M, Nikbakht R, Abdipour Z. Comparison of psychological disorders during and after pregnancies caused by assisted reproductive treatments and spontaneous pregnancies. Cent Nerv Syst Agents Med Chem 2023; 23:CNSAMC-EPUB-133742. [PMID: 37592788 DOI: 10.2174/1871524923666230817102216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Mental disorders during pregnancy are one of the major public health problems because of its effect on both mother and child, but the prevalence of psychiatric disorders in infertile women is largely unknown to compare psychiatric disorders during and after pregnancies with assisted reproductive therapies (ART) and spontaneous pregnancies. METHODS This cross-sectional study was conducted on pregnant women referring to midwifery centers in Ahvaz City in 2022. Pregnant women were included in two groups of either pregnancy caused by ART (n= 84) or spontaneous pregnancy (n= 256). The Symptom Checklist-90-R (SCL90-R) was used to assess psychiatric disorders during and after pregnancies. RESULTS A high percentage of women with spontaneous pregnancy (74.6%) and ART (91.7%) had some degree of psychological disorders. The severity of psychological disorders in both groups was higher during pregnancy than after pregnancy (P<0.001). The intensity of various psychological disorders during and after pregnancy in the ART pregnancy group was significantly higher than the control group (P<0.001). An increased risk of psychiatric disorders during pregnancy was associated with the history of psychiatric disorders [odd ratio (OR): 12.393; P= 0.022], family history of psychiatric disorders (OR:26.168; P<0.001), history of infertility (OR: 19.00; P<0.001), primary infertility (OR: 12.714; P=0.004), infertility duration more than three years (OR: 43.424; P<0.001), and frequency of embryo transfer (OR: 18.939; P=0.045). CONCLUSION Psychiatric disorders were prevalent among pregnant women in the study area especially in pregnant women with ART. Regular screening programs for mental health problem should be included in an antenatal care service especially in this high-risk group.
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Affiliation(s)
- Mahvash Zargar
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Sayyah
- Educational Development Center, Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roshan Nikbakht
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Abdipour
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Mirzaee F, Hasanpoor-Azghady SB, Amiri-Farahani L. Investigating and comparing the dimensions of worry of Iranian primiparous women in each trimester of pregnancy. Eur J Med Res 2023; 28:285. [PMID: 37587539 PMCID: PMC10428520 DOI: 10.1186/s40001-023-01258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are considered natural events in the life cycle of women. However, it is also a stressful experience along with physiological and psychological changes. Therefore, it is important to study the dimensions that cause more worry in each of the pregnant trimesters. This study aimed to determine and compare the dimensions of worry of Iranian primiparous women in each trimester of pregnancy. METHODS This cross-sectional study was conducted on 300 primiparous women (n = 100 in each trimester) referred to seven health centers affiliated with the Iran University of Medical Sciences, Tehran, Iran. The sampling was multistage. We collected data from a demographic and fertility questionnaire and the Cambridge Worry Scale (CWS). RESULTS The mean score of worry during the entire pregnancy was 28.16. The mean and standard deviation of the worry score in the first trimester was (27.35 ± 12.22). The second trimester was (27.80 ± 12.53) and the third trimester was (29.34 ± 11.11). The highest mean score of worry in the first and third trimmers was the dimension of own health. The second trimester was the dimension of socio-medical. The lowest mean score of worry in all trimmers was the dimension of relationships. Among CWS-related items, the highest mean score of worry in the first trimester was giving birth (3.34) and the possibility of miscarriage (3.22). In the second trimester was the possibility of going into labour too early (3.3) and the possibility of miscarriage (3.12), and in the third trimester was the possibility of going into labour too early (3.33) and giving birth (3.27). The lowest mean score of worry in all three trimesters was related to problems with the law. CONCLUSION pregnancy worry in the third trimester was more than the other two trimesters, and worrying about own health was the most important dimension of worry for pregnant women. Paying attention to the dimensions of worry of pregnant women helps design appropriate interventions to increase the mental and physical health of pregnant women.
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Affiliation(s)
- Foruzan Mirzaee
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran.
| | - Leila Amiri-Farahani
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran
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Brunton R, Dryer R. Alcohol consumption after pregnancy awareness and the additive effect of pregnancy-related anxiety and child abuse. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
AbstractThis study examined whether pregnant women alter their alcohol consumption upon pregnancy awareness and any additive effect of a maternal history of child abuse and pregnancy-related anxiety in predicting antenatal alcohol consumption. Pregnant women (N = 548, M = 31.44, SD = 4.58) completed an online survey consisting of the Pregnancy-related Anxiety Scale, Adverse Childhood Experience Questionnaire, questions on alcohol consumption and demographics. The Wilcoxon test examined difference scores between pre-pregnancy awareness and post-awareness drinking. More women reduced or ceased drinking after pregnancy awareness (M = 0.15, SD = 1.03) than before pregnancy recognition (M = 3.12, SD = 3.91). Only two women increased their alcohol consumption, with 140 reporting no change. In the hierarchical regression analysis, child abuse was not significant in the model, whereas pregnancy-related anxiety predicted alcohol consumption, with pre-pregnancy drinking the strongest predictor. There was no significant interaction effect between pregnancy-related anxiety and child abuse. While limited by a cross-sectional design and single questions to assess alcohol intake, our findings are consistent with extant literature. Findings related to child abuse were not significant, and likely due to low prevalence in the sample, Despite this, we further established that pregnancy-related anxiety remains a significant predictor of antenatal drinking regardless of how much alcohol a woman may consume pre-pregnancy. This relationship may be explained by drinking used to cope with pregnancy-related anxieties. While current guidelines recommend alcohol screening, many women may not accurately report their alcohol intake screening for pregnancy-related anxiety may provide an avenue to identify women more at risk of drinking during pregnancy.
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Zhang F, Zhou J, Zhang S, Qin X, Li P, Tao F, Huang K. Impact of pregnancy-related anxiety on preschoolers' emotional and behavioral development: Gender specificity, critical time windows and cumulative effect. J Affect Disord 2023; 323:176-184. [PMID: 36471547 DOI: 10.1016/j.jad.2022.11.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies on the gender-specific effect of PrA on children's emotional and behavioral development are limited. Lack of PrA data on the entire pregnancy had caused difficulties in identifying the key time window and cumulative effects. METHODS Based on Ma'anshan Birth Cohort in China, mothers at pregnancy and children followed up to 4 years of age were tested using the PrA questionnaire and the Achenbach Child Behavior Checklist (CBCL) 1.5-5. Finally, 1699 mother-child pairs were included in the study and regression models were developed for analysis. RESULTS Children of mothers with PrA are at significantly elevated risk for abnormal mood/behavior at preschool age. Girls seemed to be more sensitive to maternal PrA than boys, mainly manifested in internalizing problems; The third trimester of pregnancy might be a critical time window when maternal PrA affected children's internalizing problems; Longer the duration women had PrA during pregnancy, more possibilities their children would have to develop internalizing and externalizing problems. LIMITATIONS The PrA questionnaire may be different from PrA questionnaires in other countries such as due to different cultural contexts. Findings need to be interpreted with more caution. Factors such as maternal postpartum depression and care practices of nursing staff were not considered. No data were collected on disease as well as caregiver emotional status, which also impacts the reporting and identification of emotional/behavioral problems in children. CONCLUSIONS Gender-specific and cumulative effect of PrA on preschoolers' emotional/behavioral development is observed. The third trimester of pregnancy might be the critical time window.
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Affiliation(s)
- Fu Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Jixing Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Shanshan Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Xiaoyun Qin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Peixuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, China; Key Laboratory of Population Health Across Life Cycle(AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Hefei 230032, China..
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Bedaso A, Adams J, Peng W, Xu F, Sibbritt D. An examination of the association between marital status and prenatal mental disorders using linked health administrative data. BMC Pregnancy Childbirth 2022; 22:735. [PMID: 36182904 PMCID: PMC9526285 DOI: 10.1186/s12884-022-05045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background International research shows marital status impacts the mental health of pregnant women, with prenatal depression and anxiety being higher among non-partnered women. However, there have been few studies examining the relationship between marital status and prenatal mental disorders among Australian women. Methods This is a population-based retrospective cohort study using linked data from the New South Wales (NSW) Perinatal Data Collection (PDC) and Admitted Patients Data Collection (APDC). The cohort consists of a total of 598,599 pregnant women with 865,349 admissions. Identification of pregnant women for mental disorders was conducted using the 10th version International Classification of Diseases and Related Health Problems, Australian Modification (ICD-10-AM). A binary logistic regression model was used to estimate the relationship between marital status and prenatal mental disorder after adjusting for confounders. Results Of the included pregnant women, 241 (0.04%), 107 (0.02%) and 4359 (0.5%) were diagnosed with depressive disorder, anxiety disorder, and self-harm, respectively. Non-partnered pregnant women had a higher likelihood of depressive disorder (Adjusted Odds Ratio (AOR) = 2.75; 95% CI: 2.04, 3.70) and anxiety disorder (AOR = 3.16, 95% CI: 2.03, 4.91), compared with partnered women. Furthermore, the likelihood of experiencing self-harm was two times higher among non-partnered pregnant women (AOR = 2.00; 95% CI: 1.82, 2.20) than partnered pregnant women. Conclusions Non-partnered marital status has a significant positive association with prenatal depressive disorder, anxiety disorder and self-harm. This suggests it would be highly beneficial for maternal health care professionals to screen non-partnered pregnant women for prenatal mental health problems such as depression, anxiety and self-harm. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05045-8.
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Affiliation(s)
- Asres Bedaso
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, Hawassa, Ethiopia. .,Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jon Adams
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wenbo Peng
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Fenglian Xu
- Data Analysis & Surgical Outcomes Unit, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David Sibbritt
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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The role of body dissatisfaction and self-compassion in pregnancy-related anxiety. J Affect Disord 2022; 313:84-91. [PMID: 35772628 DOI: 10.1016/j.jad.2022.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Women undergo significant physical, physiological, and psychological changes during pregnancy. They are also exposed to sociocultural pressure to meet appearance-related ideals. These pregnancy-related changes and sociocultural appearance-related pressures may place pregnant women at greater vulnerability to developing body dissatisfaction and psychological distress. To date, however, little is known about how sociocultural pressure may influence pregnancy-related anxiety, or factors that may protect against such distress during pregnancy. This study examined whether body dissatisfaction mediated the relationship between appearance-related sociocultural pressure and pregnancy-related anxiety, and whether this relationship was moderated by self-compassion and/or self-criticism. METHOD A cross-sectional sample of 253 pregnant women (Mage = 26.28, SDage = 4.43) completed an online questionnaire measuring sociocultural pressure, body dissatisfaction, pregnancy-related anxiety, and self-compassion. RESULTS Moderated mediation analyses revealed body dissatisfaction fully mediated the relationship between sociocultural pressure and pregnancy-related anxiety. Analyses confirmed the moderating role of self-compassion and self-criticism on the relationship between sociocultural pressure and body dissatisfaction, but not on the relationship between body dissatisfaction and pregnancy-related anxiety. LIMITATIONS The cross-sectional nature of this study limits confirmation of the direction of relationships between sociocultural pressure, body dissatisfaction and pregnancy-related anxiety. CONCLUSIONS While the findings of this study need to be replicated in prospective and longitudinal studies, they suggest that sociocultural pressure to meet appearance-related standards contribute to body dissatisfaction, which in turn may facilitate pregnancy-related anxiety. Self-compassion may protect the body image of pregnant women against negative effects of appearance-related sociocultural pressure.
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Ramos IF, Ross KM, Rinne GR, Somers JA, Mancuso RA, Hobel CJ, Coussons-Read M, Dunkel Schetter C. Pregnancy anxiety, placental corticotropin-releasing hormone and length of gestation. Biol Psychol 2022; 172:108376. [PMID: 35667479 PMCID: PMC10022399 DOI: 10.1016/j.biopsycho.2022.108376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE High pregnancy anxiety is a consistent predictor of earlier labor and delivery. Placental corticotropin-releasing hormone (pCRH) predicts earlier delivery consistently and it has been identified as a biological mediator of the association between pregnancy anxiety and gestational length. However, studies have not examined whether changes in pregnancy anxiety are associated with earlier birth as mediated by changes in pCRH during pregnancy. Accordingly, this study tests whether linear changes in pregnancy anxiety are associated with length of gestation indirectly through nonlinear increases in pCRH over pregnancy. METHODS A sample of pregnant women (n=233) completed prenatal assessments in early pregnancy, second trimester, and third trimester that included a 4-item assessment of pregnancy anxiety and collection of blood samples assayed for pCRH using radioimmunoassay. Length of gestation was abstracted from medical records after birth. RESULTS Increases in pregnancy anxiety from early pregnancy to third trimester predicted shorted length of gestation, as did nonlinear increases in pCRH over pregnancy. However, there was no evidence of an indirect effect of changes in pregnancy anxiety on length of gestation via changes in pCRH. CONCLUSIONS These results indicate that linear changes in pregnancy anxiety and nonlinear changes in pCRH during pregnancy are independent risk factors for shortened gestational length. This study adds to a small but growing body of work on biopsychological processes in pregnancy and length of gestation. Modeling changes in psychological and biological processes during pregnancy could provide more insight into understanding risk for adverse pregnancy outcomes.
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Fairbrother N, Albert A, Collardeau F, Keeney C. The Childbirth Fear Questionnaire and the Wijma Delivery Expectancy Questionnaire as Screening Tools for Specific Phobia, Fear of Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084647. [PMID: 35457513 PMCID: PMC9028446 DOI: 10.3390/ijerph19084647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/14/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022]
Abstract
Background: Perinatal anxiety and related disorders are common (20%), distressing and impairing. Fear of childbirth (FoB) is a common type of perinatal anxiety associated with negative mental health, obstetrical, childbirth and child outcomes. Screening can facilitate treatment access for those most in need. Objectives: The purpose of this research was to evaluate the accuracy of the Childbirth Fear Questionnaire (CFQ) and the Wijma Delivery Expectations Questionnaire (W-DEQ) of FoB as screening tools for a specific phobia, FoB. Methods: A total of 659 English-speaking pregnant women living in Canada and over the age of 18 were recruited for the study. Participants completed an online survey of demographic, current pregnancy and reproductive history information, as well as the CFQ and the W-DEQ, and a telephone interview to assess specific phobia FoB. Results: Symptoms meeting full and subclinical diagnostic criteria for a specific phobia, FoB, were reported by 3.3% and 7.1% of participants, respectively. The W-DEQ met or exceeded the criteria for a “good enough” screening tool across several analyses, whereas the CFQ only met these criteria in one analysis and came close in three others. Conclusions: The W-DEQ demonstrated high performance as a screening tool for a specific phobia, FoB, with accuracy superior to that of the CFQ. Additional research to ensure the stability of these findings is needed.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence: ; Tel.: +1-250-0519-5390 (ext. 36439)
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Fanie Collardeau
- Department of Psychology, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Cora Keeney
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Westerneng M, de Jonge A, van Baar AL, Witteveen AB, Jellema P, Paarlberg KM, Rijnders M, van der Horst HE. The effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding in low-risk women: A pragmatic cluster-randomized controlled trial. Birth 2022; 49:61-70. [PMID: 34288070 PMCID: PMC9290476 DOI: 10.1111/birt.12573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Third-trimester routine ultrasounds are increasingly offered to monitor fetal growth. In addition to limited evidence for its clinical effectiveness, little is known about its importance for pregnancy-specific anxiety and mother-to-infant bonding. METHODS 1275 low-risk women participated in a Dutch nationwide pragmatic cluster-randomized trial and answered questionnaires on pregnancy-specific anxiety (PRAQ-R) and prenatal mother-to-infant bonding (MAAS) before and after a third-trimester routine ultrasound was offered to the intervention group. Linear mixed model regression analyses were performed to examine the effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding. In addition, we examined whether the effect depended on maternal background characteristics and level of satisfaction with the ultrasound procedure. RESULTS We found no effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding. However, interaction analyses showed that women with high levels of depressive symptoms at baseline and women who were very satisfied with the ultrasound procedure benefited somewhat more from offering a third-trimester routine ultrasound in terms of mother-to-infant bonding compared with women with low or no depressive symptoms, or less satisfied women. CONCLUSIONS The relationship between offering a third-trimester routine ultrasound with pregnancy-specific anxiety and mother-to-infant bonding is limited. A beneficial effect only applies to some subgroups of women. This implies that, in terms of psychological outcomes, there are no counterarguments to implementing a third-trimester routine ultrasound. Strong evidence for offering all pregnant women a third-trimester routine ultrasound for psychological reasons, however, is lacking.
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Affiliation(s)
- Myrte Westerneng
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ank de Jonge
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Anke B. Witteveen
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Petra Jellema
- Midwifery ScienceAVAGAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | - Henriëtte E. van der Horst
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research InstituteAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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Tarafa H, Alemayehu Y, Nigussie M. Factors associated with pregnancy-related anxiety among pregnant women attending antenatal care follow-up at Bedelle general hospital and Metu Karl comprehensive specialized hospital, Southwest Ethiopia. Front Psychiatry 2022; 13:938277. [PMID: 36213901 PMCID: PMC9537765 DOI: 10.3389/fpsyt.2022.938277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Abstract
Pregnancy-related anxiety (PRA) is an anxiety related to the pregnancy, involving labor and delivery, the well-being of the fetus/infant and the mother, the availability of quality of healthcare resources, and the capacity to parent. There is scarcity of study conducted on magnitude of Pregnancy-related anxiety and its associated factors among pregnant women in Ethiopia. The main objective of this research was to assess factors associated with Pregnancy-related anxiety among pregnant women attending ANC follow-up at Bedelle general and Metu Karl comprehensive specialized hospitals, Southwest Ethiopia. A hospital-based cross-sectional study design was used among pregnant women attending ANC follow-up. Data were collected from 406 sampled pregnant women who were selected through a systematic random sampling technique. Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R2) was used to measure the outcome variable. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) version 26. Logistic regression analyses were done to identify factors associated with Pregnancy-related anxiety and significance level set at p < 0.05. The overall prevalence of PRA in this study was 32.7%. Unwanted pregnancy AOR = 2.77, 95% CI [1.71, 4.54], high perceived stress AOR = 2.39, 95% CI [1.54, 3.62], young age AOR = 2.14, 95% CI [1.49, 2.83], depression AOR = 2.09, 95% CI [1.39, 2.89], low income AOR = 2.01, 95% CI [1.29, 3.14], and poor social support AOR = 1.79, 95% CI [1.14, 3.37] were significantly associated with Pregnancy-related anxiety. The findings of this study showed that the prevalence of Pregnancy-related anxiety was high in the study area and positively associated with young age, low income, poor social support, high perceived stress, depression, and unwanted pregnancy. This finding suggests that clinicians should integrate screening for Pregnancy-related anxiety into clinical standards, more efforts should be made in the future to reduce the anxiety among pregnant women who had an unwanted pregnancy, young women, and poor social support. Also, it is good to encourage the pregnant mother to enhance their social connectedness by creating a self-help group, and increasing early identification of mental health problems throughout their daily ANC follow-up.
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Affiliation(s)
- Hunde Tarafa
- Department of Psychiatry, College of Health Sciences, Metu University, Metu, Ethiopia
| | - Yadeta Alemayehu
- Department of Psychiatry, College of Health Sciences, Metu University, Metu, Ethiopia
| | - Meskerem Nigussie
- Department of Psychiatry, College of Health Sciences, Metu University, Metu, Ethiopia
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12
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Ponting C, Urizar GG, Dunkel Schetter C. Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations. Front Psychiatry 2022; 13:820343. [PMID: 35370831 PMCID: PMC8965279 DOI: 10.3389/fpsyt.2022.820343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Anxiety symptoms are common among pregnant women worldwide. In the United States, prenatal anxiety symptoms tend to be elevated among Black and Latin American women as compared to non-Latina White women. Despite the high prevalence of anxiety and associations with adverse maternal and offspring outcomes, interventions have not been developed or tailored sufficiently to Black women or Latinas who need efficacious treatment. This article provides a scoping review of articles published since 2017 that test the effects of randomized and non-randomized psychological interventions designed to reduce prenatal anxiety in samples comprised primarily of ethnic/racial minority women. We also review published protocols of planned psychological interventions to reduce prenatal anxiety in order to highlight novel approaches. In addition to summarizing intervention efficacy and participant acceptability, we highlight gaps in the literature which, if addressed, could improve perinatal mental health equity. Finally, we discuss future directions in prenatal anxiety intervention science beginning preconception including intervention design and prevention models.
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Guido G Urizar
- Department of Psychology, California State University, Long Beach, Long Beach, CA, United States
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13
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Osman KM, Lara-Cinisomo S, D’Anna-Hernandez KL. Associations between religiosity and perinatal anxiety symptoms among women of Mexican descent. J Affect Disord 2021; 294:77-84. [PMID: 34274791 PMCID: PMC8860167 DOI: 10.1016/j.jad.2021.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over half of pregnant women experience anxiety symptoms, however perinatal mental health disparities exist. Women of Mexican descent exhibit higher levels of anxiety symptoms which may be linked to sociocultural stressors. However, little is known about culturally relevant factors that may protect against anxiety in this fast-growing population, such as religiosity, an important facet of Mexican culture. METHODS Pregnant women of Mexican descent (n = 197) were recruited from a local community clinic and followed into the postpartum period. Women completed surveys assessing religiosity, acculturation, acculturative stress, and anxiety symptoms. RESULTS Higher levels of religiosity were associated with lower levels of anxiety symptoms throughout pregnancy, but not postpartum (b = -1.01, p = .002). Additionally, religiosity significantly buffered the relationship between acculturative stress and anxiety symptoms during early (R2 = .13, b = -.12, p = .041), mid- (R2 = .19, b = -.19, p < .001) and late pregnancy (R2 = .14, b = -.13, p = .023), and at six weeks postpartum (R2 = .08, b = -.12, R2 = .08, p = .016). LIMITATIONS The study was limited to women of Mexican descent and it is possible that other immigrant groups may exhibit different patterns of religiosity and anxiety symptoms. CONCLUSIONS These results suggest that religiosity may be protective against maternal anxiety among women of Mexican descent, which has important implications for culturally relevant perinatal interventions and treatments.
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Affiliation(s)
- Kayla M. Osman
- California State University San Marcos, 333 S Twin Oaks Valley Rd, San Marcos, CA 92096; Phone: (562) 852-9503
| | - Sandraluz Lara-Cinisomo
- University of Illinois at Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA.
| | - Kimberly L. D’Anna-Hernandez
- Department of Psychology, California State University San Marcos, 333 S Twin Oaks Valley Rd, San Marcos, CA 92096; Phone: (760) 750-8275
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14
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Bedaso A, Adams J, Peng W, Sibbritt D. The association between social support and antenatal depressive and anxiety symptoms among Australian women. BMC Pregnancy Childbirth 2021; 21:708. [PMID: 34686140 PMCID: PMC8532351 DOI: 10.1186/s12884-021-04188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Antenatal depression and antenatal anxiety adversely affect several obstetric and foetal outcomes, and increase the rate of postnatal mental illness. Thus, to tackle these challenges the need for social support during pregnancy is vital. However, an extensive literature search failed to show a published study on the relationship between domains of social support and antenatal depressive, as well as antenatal anxiety symptoms in Australia. This study examined the association between domains of social support and antenatal depressive and anxiety symptoms among Australian women. Methods The current study used data obtained from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), focusing upon women who reported being pregnant (n = 493). Depression and anxiety were assessed using the 10 item Center for Epidemiological Studies Depression (CES-D-10) scale, and the 9-item Goldberg Anxiety and Depression scale (GADS) respectively. The 19 item-Medical Outcomes Study Social Support index (MOSS) was used to assess social support. A logistic regression model was used to examine the associations between domains of social support and antenatal depressive and anxiety symptoms after adjusting for potential confounders. Result The current study found 24.7 and 20.9% of pregnant women screened positive for depressive and anxiety symptoms respectively. After adjusting for potential confounders, our study found that the odds of antenatal depressive symptoms was about four and threefold higher among pregnant women who reported low emotional/informational support (AOR = 4.75; 95% CI: 1.45, 15.66; p = 0.010) and low social support (overall support) (AOR = 3.26; 95%CI: 1.05, 10.10, p = 0.040) respectively compared with their counterpart. In addition, the odds of antenatal anxiety symptoms was seven times higher among pregnant women who reported low affectionate support/positive social interaction (AOR = 7.43; 95%CI: 1.75, 31.55; p = 0.006). Conclusion A considerable proportion of pregnant Australian women had depressive symptoms and/or anxiety symptoms, which poses serious health concerns. Low emotional/informational support and low affectionate support/positive social interaction have a significant association with antenatal depressive and anxiety symptoms respectively. As such, targeted screening of expectant women for social support is essential. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04188-4.
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Affiliation(s)
- Asres Bedaso
- Hawassa University, College of Medicine and Health Sciences, School of Nursing, Hawassa, Ethiopia. .,Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jon Adams
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wenbo Peng
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David Sibbritt
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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15
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Ward N, Correia H, McBride N. Maternal psycho-social risk factors associated with maternal alcohol consumption and Fetal Alcohol Spectrum Disorder: a systematic review. Arch Gynecol Obstet 2021; 304:1399-1407. [PMID: 34468822 DOI: 10.1007/s00404-021-06206-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Fetal Alcohol Spectrum Disorder (FASD) is a preventable range of neurocognitive disorders associated with the biological mother's consumption of alcohol during pregnancy. However, on average, 45% of Australian women continue to consume alcohol during pregnancy resulting in a high rate of alcohol-exposed pregnancies and risk of FASD. This level of exposure is higher than the estimated global average of alcohol-exposed pregnancies (9.8%). This systematic literature review aims to identify demographic, health and psycho-social variables associated with alcohol consumption during pregnancy which may lead to FASD. METHODS Using PRISMA principles, this systematic literature review reports on psycho-social factors which increase the risk of alcohol consumption during pregnancy thereby increasing the risk of FASD. RESULTS Fourteen studies were accepted into this review. Studies were conducted across several countries and included a total of 386,067 cases. Seven studies were case-controlled and seven were cross-sectional design. Multiple studies identified the significance of prior mental illness, anxiety, depression, exposure to abuse and/or domestic violence and alcohol consumption behaviours of partners and family members as strong predictors of risky alcohol consumption during pregnancy and therefore associated risk of FASD. CONCLUSION Clinical services may be able to use the evidence-based findings from this review to improve assessment and treatment services for vulnerable women to reduce alcohol-exposed pregnancies.
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Affiliation(s)
- Naomi Ward
- School of Psychology and Exercise Sciences, Murdoch University, Perth, WA, Australia
| | - Helen Correia
- School of Psychology and Exercise Sciences, Murdoch University, Perth, WA, Australia
| | - Nyanda McBride
- National Drug Research Institute, Curtin University, Perth, WA, Australia.
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16
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Hildingsson I, Nilsson J, Merio E, Larsson B. Anxiety and depressive symptoms in women with fear of birth: A longitudinal cohort study. Eur J Midwifery 2021; 5:32. [PMID: 34396062 PMCID: PMC8328228 DOI: 10.18332/ejm/138941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Anxiety and depression during pregnancy could imply difficulties in the attachment to the unborn baby. The objective of this study was to investigate the prevalence and change in anxiety and depressive symptoms in pregnant women with fear of birth. Another aim was to explore associations between symptoms of anxiety and depression on prenatal attachment. METHODS This is a longitudinal cohort study of 77 pregnant women with fear of birth in three hospitals in Sweden. Data were collected by three questionnaires in mid and late pregnancy and two months after birth. RESULTS Anxiety symptoms were more often reported than depressive symptoms, significantly decreasing over time in both conditions. Anxiety symptoms were associated with low education level, negative feelings towards the upcoming birth, and levels of fear of birth. Depressive symptoms were associated with levels of fear of birth. One in five women presented with fear of birth, anxiety, and depressive symptoms, suggesting that co-morbidity was quite common in this sample. Depressive symptoms and co-morbidity were negatively associated with prenatal attachment. CONCLUSIONS This study shows that symptoms of anxiety and depression in women with fear of birth vary over time and that co-morbidity is quite common. Lack of emotional well-being was related to prenatal attachment. Healthcare professionals must identify and support women with anxiety and depressive symptoms and fear of birth so that difficulties in the relationship between the mother and the newborn baby might be reduced.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Johanna Nilsson
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Elida Merio
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden.,Department of Health Promoting Science, Sophiahemmet University College, Stockholm, Sweden
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17
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Kurt G, Arslan H. Turkish version of the Pregnancy-related Anxiety Scale: A psychometric study. Perspect Psychiatr Care 2021; 57:157-166. [PMID: 32458429 DOI: 10.1111/ppc.12537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To adapt the Pregnancy-related Anxiety Scale (PrAS) into Turkish and evaluate its psychometric properties. DESIGN AND METHODS This cross-sectional study comprised of 400 pregnant women. The PrAS was translated using the methods of translation, back-translation, consensus meetings, and a trial of potential users. Then, its psychometric properties were evaluated by exploratory factor analysis and confirmatory factor analysis. FINDINGS The PrAS consists of 33 items. Following the exploratory factor analysis, the two items in the scale were discarded because factor loads were less than 0.50, therefore, the number of items decreased from 33 to 31. In the confirmatory factor analysis, the goodness-of-fit indices of the scale were found to be suitable. The internal consistency coefficient calculated for the reliability of the scale was .89. After correlating it with another scale for measuring pregnancy distress, the Turkish version of the PrAS shows discriminant validity. PRACTICE IMPLICATIONS The Turkish version of the PrAS is a valid and reliable instrument that can be used to evaluate pregnancy-related-anxiety. The use of the PrAS in prenatal healthcare services will contribute to the early diagnosis, treatment, and management of pregnancy-related anxiety.
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Affiliation(s)
- Gonul Kurt
- Department of Midwifery, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
| | - Hamide Arslan
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey
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18
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Redinger S, Pearson RM, Houle B, Norris SA, Rochat TJ. Antenatal depression and anxiety across pregnancy in urban South Africa. J Affect Disord 2020; 277:296-305. [PMID: 32858310 DOI: 10.1016/j.jad.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/02/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depression and anxiety in pregnancy have negative consequences for women and their offspring. High adversity places pregnant women at increased mental health risk, yet there is a dearth of longitudinal research in these settings. Little is known about the pathways by which these problems emerge or persist in pregnancy. METHODS Women were enrolled in a prospective pregnancy cohort in Soweto, South Africa (2014-2016) and assessed using validated measures (Edinburgh Postnatal Depression Scale EPDS ≥13; State Trait Anxiety Index STAI ≥12) in early (T1) and later pregnancy (T2). Data was available for n = 649 women. Multinominal regression modelling was used to determine factors associated with transient versus persistent depression and anxiety across pregnancy. Cross-lagged panel modelling explored direction of effect between depression and anxiety, and stressors. RESULTS We found high rates of depression (T1: 27%; T2: 25%) and anxiety (T1: 15%; T2: 17%). Perceiving a partner made one's life harder increased risk of persistent depression (RR 5.92 95% CI [3.0-11.8] p<0.001); family stress increased risk for persistent anxiety (RR 1.71 95% CI [1.1-2.7] p = 0.027). We find evidence of a direct effect of early depression (T1) on later family stress (T2); and early family stress (T1) on later anxiety (T2). LIMITATIONS We used screening measures of depression and anxiety rather than clinical interviews. CONCLUSIONS Studies which focus only on late pregnancy may underestimate risk. Early identification, in the first trimester, is critical for prevention and treatment. Partner and family stressors are a key intervention target.
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Affiliation(s)
- Stephanie Redinger
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa; DSI-NRF Centre of Excellence in Human Development, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
| | - Rebecca M Pearson
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa; Centre for Academic Mental Health, University of Bristol, Bristol, United Kingdom
| | - Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa; Global Health Research Institute, School of Health and Human Development, University of Southampton, United Kingdom
| | - Tamsen Jean Rochat
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 29 Princess of Wales Terrace, Johannesburg, 2193, South Africa; DSI-NRF Centre of Excellence in Human Development, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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19
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Anderson CM, Brunton RJ, Dryer R. Pregnancy‐related anxiety: Re‐examining its distinctiveness†. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12365] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Carla M. Anderson
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Robyn J. Brunton
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Rachel Dryer
- School of Psychology, Charles Sturt University, Bathurst, New South Wales, Australia
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20
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Brunton R, Wood T, Dryer R. Childhood abuse, pregnancy-related anxiety and the mediating role of resilience and social support. J Health Psychol 2020; 27:868-878. [DOI: 10.1177/1359105320968140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Physical, sexual and psychological abuse were examined as risk factors for pregnancy-related anxiety with resilience and social support as mediators. Pregnant women ( n = 638) completed measures of pregnancy-related anxiety, resilience, perceived social support and childhood abuse. Women with an abuse history had higher pregnancy-related anxiety scores ( m = 64.40) than other women ( m = 55.36). All abuse types independently predicted pregnancy-related anxiety; resilience and social support were mediators. Results highlight the value of antenatal screening for pregnancy-related anxiety including specific risk factors such as child abuse. Programs such as the Midwife Continuity of Care are useful in encouraging disclosure.
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21
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Sedov ID, Anderson NJ, Dhillon AK, Tomfohr-Madsen LM. Insomnia symptoms during pregnancy: A meta-analysis. J Sleep Res 2020; 30:e13207. [PMID: 33140514 DOI: 10.1111/jsr.13207] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/28/2022]
Abstract
Reports of sleep disturbances are common during pregnancy, yet estimates of prevalence of insomnia symptoms during pregnancy vary widely. The goals of the current review were to summarize the existing data on prevalence of insomnia symptoms during pregnancy and to explore potential moderators, including trimester, gestational age, maternal age, symptoms of anxiety and symptoms of depression. A systematic search of PubMed, PsycInfo and Web of Science was conducted for articles published from inception up to June 2020. In total, 24 studies with a total of 15,564 participants were included in the analysis. The overall prevalence of insomnia symptoms during pregnancy was 38.2%. Trimester was a significant moderator, such that prevalence of insomnia symptoms was higher in the third trimester (39.7%) compared to first (25.3%) and second (27.2%) trimesters. No other variables significantly moderated the prevalence of insomnia symptoms. The results of the current meta-analysis suggest that the prevalence of insomnia symptoms is higher during pregnancy, particularly in the third trimester. Future research should examine the efficacy and safety of insomnia treatments with this population.
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Affiliation(s)
- Ivan D Sedov
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Ashley K Dhillon
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Lianne M Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute for Child and Maternal Health (ACHRI), Calgary, AB, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
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22
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Pregnancy-related anxiety among Chinese pregnant women in mid-late pregnancy under the two-child policy and its significant correlates. J Affect Disord 2020; 276:272-278. [PMID: 32697709 DOI: 10.1016/j.jad.2020.07.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/17/2020] [Accepted: 07/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pregnancy-related anxiety (PRA) is a global public health concern. This study aims to understand the PRA among Chinese pregnant women at mid-late pregnancy and to explore the significant correlates. METHODS The Chinese PRA scale was used to measure PRA among 342 pregnant women from Zhejiang Province in China at their mid- and late- pregnancy respectively. RESULTS The participants aged from 21 to 42 years old, and their mean age was 30. 1 (SD=4. 0). The average scores of the Chinese PRA scale at mid- and late- pregnancy were 1. 60 (SD=0. 33) and 1. 58 (SD=0. 33) respectively. Unplanned pregnancy (mid-pregnancy: β=0. 18, p<0. 001; late-pregnancy: β=0. 11, p = 0. 024) and gender of the first child being male (mid-pregnancy:β=-0. 20, p = 0. 001; late-pregnancy: β=-0. 14, p = 0. 016) were significantly correlated with PRA among pregnant women at mid- and late- pregnancy. Living with parents-in-law was not associated with the PRA overall and domain scores. LIMITATIONS This study was done among pregnant women at their mid-late pregnancy, and no follow-up was conducted at postpartum. The sample size of this study was relatively small which might affect the generalizability of the findings. CONCLUSIONS The current study found that the correlates of PRA at mid- and late-pregnancy were generally similar. For future studies, special attention should be paid to pregnant women who are in the condition of unplanned pregnancy and those who already have a female child to relieve their anxiety levels.
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Abstract
OBJECTIVES The purpose of the current study was to describe anxious pregnant women's concerns about using pharmacotherapy to treat anxiety symptoms, and the relationship of such concerns to women's willingness to use pharmacotherapy during pregnancy. METHODS Between April 2011 and May 2012, 148 women who were pregnant and reported elevated anxiety symptoms, as measured by the GAD-2, completed an online survey assessing their concerns about, and willingness to use, pharmacotherapy to treat anxiety symptoms during pregnancy. Qualitative responses were coded, and linear regression was used to assess the relationship between concerns and willingness. RESULTS Pregnant women with elevated anxiety symptoms reported low willingness to use pharmacotherapy to treat anxiety symptoms during pregnancy. The most common concerns reported were about negative effects on the baby or the self, and a general opposition to taking any medications during pregnancy. These concerns were significantly related to women's willingness to try pharmacotherapy (ps < .016). CONCLUSION Our findings underscore the importance of a pregnant woman's perceptions of potential side-effects and long-term effects of pharmacotherapy, both for herself and her offspring. These results point to specific factors that may be important to address in communication with patients about pharmacotherapy for anxiety disorders during pregnancy. Such an understanding may help clinicians provide more effective guidance and information about treatment options for anxiety disorders during pregnancy, and increase patients' willingness to engage in those treatments.
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24
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Chandra PS, Nanjundaswamy MH. Pregnancy specific anxiety: an under-recognized problem. World Psychiatry 2020; 19:336-337. [PMID: 32931120 PMCID: PMC7491640 DOI: 10.1002/wps.20781] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Madhuri H Nanjundaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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25
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Pregnancy-Related Anxiety, Perceived Parental Self-Efficacy and the Influence of Parity and Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186709. [PMID: 32942604 PMCID: PMC7557851 DOI: 10.3390/ijerph17186709] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022]
Abstract
Pregnancy-related anxiety is contextualised by pregnancy and is a health concern for the mother and child. Perceived parental self-efficacy is associated with this anxiety and age and parity are identified as influential factors. This research, therefore, predicted that negative perceptions of parental self-efficacy would predict greater pregnancy-related anxiety, moderated by parity and age. Participants (N = 771) were recruited online and assessed for perceived parental self-efficacy, pregnancy-related anxiety, and demographics. Moderation models showed that the psychosocial and sociodemographic factors combined predicted up to 49% of the variance. Parental self-efficacy predicted anxiety in the areas of body image, worry about themselves, baby concerns, pregnancy acceptance, attitudes towards medical staff and childbirth, and avoidance. Parity predicted pregnancy-related anxiety both overall and in childbirth concerns, worry about self, baby concerns and attitudes towards childbirth. Age predicted baby concerns. There was a significant moderation effect for pregnancy acceptance indicating that primiparous women with low perceptions of parental self-efficacy are less accepting of their pregnancy. Results suggest that parity and parental self-efficacy may be risk factors for first-time mothers for pregnancy-related anxiety.
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Chan CY, Lee AM, Koh YW, Tang CSK. Validation of the Chinese version of the Pregnancy-related Anxiety Questionnaire-Revised (PRAQ-R) and its distinction from general anxiety and depression in pregnant women. J Psychosom Obstet Gynaecol 2020; 41:215-223. [PMID: 31290358 DOI: 10.1080/0167482x.2019.1639042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: This study aims to evaluate the reliability and validity of the translated Chinese-Cantonese version of the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) in a sample of pregnant women in Hong Kong, China. It also aims to determine whether pregnancy-related anxiety changes significantly across trimesters and if it is differentiated from general anxiety and depression.Method: This study adopts a prospective longitudinal design with a quantitative approach. A consecutive sample of 186 Chinese pregnant women from hospitals in Hong Kong are assessed using the translated Chinese-Cantonese version of the PRAQ-R and other standardized instruments at three time points during the first to third trimester.Results: A confirmatory factor analysis revealed a three-factor structure of the Chinese-Cantonese version of the PRAQ-R, including fear of giving birth, fear of bearing a physically or mentally handicapped child, and concern about one's appearance. The internal consistency was excellent (α = 0.88 to 0.91) for all of the items in the PRAQ-R across the three trimesters. The average variance extract (AVE) and composite reliability (CR) for each factor were greater than the recommended level of CR > 0.70 and AVE > 0.50. Multiple regression analyses showed that a combination of general anxiety and depression explained a small proportion of the variance (10-29%) in the PRAQ-R subscales during the three trimesters.Conclusions: The Chinese-Cantonese version of the PRAQ-R has good validity and reliability, and the results provide evidence of its relevance for Chinese pregnant women with pregnancy-related anxiety in Hong Kong. The finding also shows that pregnancy-related anxiety is a relatively distinctive form of anxiety that is different from general anxiety and depression.
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Affiliation(s)
- Chui Yi Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,The Felizberta Lo Padilla Tong School of Social Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Antoinette Marie Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Yee Woen Koh
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Center for Family and Population Research, National University of Singapore, Singapore, Singapore
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Özşahin Z. The effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role. Afr Health Sci 2020; 20:1217-1228. [PMID: 33402968 PMCID: PMC7751528 DOI: 10.4314/ahs.v20i3.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Adverse childhood experiences are a factor that may cause physical illness and deterioration of lifelong well-being in addition to many mental and psychiatric problems in the future. It is important to question and treat them. OBJECTIVE This study examined the effects of adverse childhood experiences on pregnancy-related anxiety and acceptance of motherhood role. METHODS This cross-sectional study was conducted on 536 pregnant women. The data were collected using the "Personal Information Form", the "Adverse Childhood Experience Questionnaire (ACEQ)", the "Acceptance of Motherhood Role (AoMR)" subscale of the "Prenatal Self Evaluation Questionnaire (PSEQ)" and the "Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2)". RESULTS It was found that those with high levels of negative childhood experience had higher levels of anxiety in pregnancy and lower acceptance of maternal role than the other groups (p<0.05). Additionally, a one-unit change in the AoMR score led to a 0.23-unit decrease in the ACEQ score, whereas a one-unit change in the PRAQ-R2 score led to a 0.57-unit increase in the ACEQ score (p<0.001). CONCLUSION Adverse childhood events increase pregnancy-related anxiety and negatively affect acceptance of motherhood role.
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Affiliation(s)
- Zeliha Özşahin
- Department of Midwifery, Faculty of Health Sciences Inonu University, Malatya / Turkey
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Reymond C, Derguy C, Wendland J, Loyal D. Validation française d’une échelle d’anxiété spécifique à la grossesse (PRAQ-R2). PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2018.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Dryer R, Graefin von der Schulenburg I, Brunton R. Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress. J Affect Disord 2020; 267:289-296. [PMID: 32217229 DOI: 10.1016/j.jad.2020.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size. OBJECTIVES This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress. METHOD A nonclinical sample of 408 pregnant women (Mage = 28.24 years, SDage = 5.04, range 18-44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology. FINDINGS Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress. CONCLUSIONS The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women.
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Affiliation(s)
- Rachel Dryer
- School of Behavioural & Health Sciences, Australian Catholic University, Strathfield, New South Wales 2135, Australia.
| | | | - Robyn Brunton
- School of Psychology, Charles Sturt University, Bathurst, New South Wales 2795, Australia
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Mudra S, Göbel A, Barkmann C, Goletzke J, Hecher K, Schulte-Markwort M, Diemert A, Arck P. The longitudinal course of pregnancy-related anxiety in parous and nulliparous women and its association with symptoms of social and generalized anxiety. J Affect Disord 2020; 260:111-118. [PMID: 31494362 DOI: 10.1016/j.jad.2019.08.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/26/2019] [Accepted: 08/17/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is evidence that pregnancy-related anxiety (PrA) has a negative impact on birth outcomes and infant development. However, little is known about worrisome levels and individual trajectories of PrA dimensions across pregnancy and their predictive factors, particularly the association of PrA with symptoms of social phobia (SP) and generalized anxiety disorder (GAD). METHODS A sample of 180 pregnant women was assessed three times during pregnancy with the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Linear mixed model analyses were used to investigate the course of different PrA dimensions across pregnancy, and to relate PrA to symptoms of social and generalized anxiety. Additionally, distinct developmental patterns of PrA were explored by latent class growth analyses. RESULTS While the PrA total score remained stable, the different dimensions of PrA varied significantly over time. After controlling for obstetric and sociodemographic factors as well as depression, perceived social support and self-efficacy, symptoms of SP significantly predicted higher levels of fear of childbirth, child-related worries and concerns about mother´s appearance. Symptoms of GAD predicted higher child-related worries. Moreover, two distinct groups of women with either consistently higher or lower PrA scores were identified. LIMITATIONS Our results are limited due to the use of self-report questionnaires and would benefit from a larger sample size and replication in high-risk samples. CONCLUSION Our study suggests that a longitudinal and differentiated investigation of specific forms of prenatal anxiety may improve our understanding of women at high risk for PrA and promote the development of individualized forms of interventions initiated during pregnancy.
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Affiliation(s)
- Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janina Goletzke
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Göbel A, Arck P, Hecher K, Schulte-Markwort M, Diemert A, Mudra S. Manifestation and Associated Factors of Pregnancy-Related Worries in Expectant Fathers. Front Psychiatry 2020; 11:575845. [PMID: 33362598 PMCID: PMC7759496 DOI: 10.3389/fpsyt.2020.575845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: During the last decades, fathers have increasingly participated in prenatal care, birth preparation classes, and childbirth. However, comparably little is known about the prenatal emotional well-being of fathers, particularly content and extent of broader paternal concerns that may arise during pregnancy beyond those focusing on childbirth. Thus, the aims of this study were to investigate the manifestation of paternal pregnancy-related worries in a population-based sample and to identify relevant associated factors. Materials and Methods: As part of a longitudinal pregnancy cohort at the University Medical Center Hamburg-Eppendorf, Germany, N = 129 expectant fathers were assessed once during pregnancy. Pregnancy-related worries centering around medical procedures, childbirth, health of the baby, as well as socioeconomic aspects were assessed with the Cambridge Worry Scale (CWS). Additionally, paternal socioeconomic background and maternal obstetrical history, symptoms of generalized anxiety and depression, and level of hostility were investigated, as well as perceived social support. The cross-sectional data were analyzed based on multiple regression analyses. Results: The level of reported worries was overall low. Some fathers reported major worries for individual aspects like the health of a significant other (10.9%) and the baby (10.1%), as well as the current financial (6.2%) and employment situation (8.5%). Pregnancy-related worries were negatively associated with household income and positively associated with anxious and depressive symptoms and low perceived social support. Associations varied for specific pregnancy-related worries. Limitations: Due to the cross-sectional data examined in this study, a causal interpretation of the results is not possible. The sample was rather homogeneous regarding its socioeconomic background. More research needs to be done in larger, more heterogeneous samples. Conclusion: Though overall worries were rather low in this sample, specific major worries could be identified. Hence, addressing those fathers reporting major worries regarding specific aspects already in prenatal care might support their psychosocial adjustment. Fathers with little income, those with elevated levels of general anxious and depressive symptoms, and those with less social support reported higher pregnancy-related worries. Our results indicate the relevance of concerns beyond health- and birth-related aspects that could be relevant for fathers. Measurements developed specifically for expectant fathers are needed to properly capture their perspective already during pregnancy.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ali E, Letourneau N, Benzies K, Ntanda H, Dewey D, Campbell T, Giesbrecht G. Maternal Prenatal Anxiety and Children’s Externalizing and Internalizing Behavioral Problems: The Moderating Roles of Maternal-Child Attachment Security and Child Sex. Can J Nurs Res 2019; 52:88-99. [DOI: 10.1177/0844562119894184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Prenatal anxiety is associated with child behavioral problems. Prenatal anxiety is predictive of postnatal anxiety which can interfere with the security of maternal-child attachment and further raise the risk of child behavior problems. Secure maternal-child attachment is essential for optimal emotional health. Sex influences the type of behavior problem experienced. There is a gap in understanding whether attachment security and the sex of the child can moderate association between prenatal anxiety and children’s behavioral problems. Purpose To examine the association between prenatal anxiety and child behavioral problems and to test the moderating effects of attachment security and child sex on the association between prenatal anxiety and child behavioral problems. Methods Secondary analysis of data from 182 mothers and their children, enrolled in the Alberta Pregnancy Outcomes and Nutrition Study using Hayes' (2013) conditional process modeling. Results Prenatal anxiety was associated with both externalizing ( b = −0.53; standard error ( SE) = 0.20; p = 0.009) and internalizing ( b = −0.32; SE = 0.13; p = 0.01) behaviors only in children with an insecure style of attachment. Child sex did not moderate the association between prenatal anxiety and children's behavioral problems. Conclusions Attachment security moderated the association between prenatal anxiety and children’s externalizing and internalizing behavioral problems.
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Affiliation(s)
- Elena Ali
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Faculty of Nursing, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Henry Ntanda
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Deborah Dewey
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tavis Campbell
- Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Gerry Giesbrecht
- Faculty of Pediatrics, University of Calgary, Calgary, AB, Canada
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Reiser SJ, Wright KD. Fetal health anxiety: development and psychometric properties of the fetal health anxiety inventory. J Psychosom Obstet Gynaecol 2019; 40:264-273. [PMID: 30089227 DOI: 10.1080/0167482x.2018.1490722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: To develop a measure to assess fetal health anxiety and examine its factor structure, convergent and divergent validity. Methods: In Study 1, the Short Health Anxiety Inventory-14 item version (SHAI) (Salkovskis et al., Psychol Med. 2002;32:843-853) was adapted for use with pregnant women to examine fetal health anxiety named the Fetal Health Anxiety Inventory (FHAI). Four pregnant women and three subject matter experts (SMEs) reviewed the FHAI. In Study 2, 100 pregnant women completed the FHAI and related self-report measures. Results: In Study 1, both reviewer groups provided feedback directing minor changes to the FHAI. In Study 2, a revised version was used. The revised FHAI demonstrated excellent internal consistency (α = 0.91). Results from an EFA suggested that the FHAI may be conceptualized as a one- or two-factor scale. Convergent (pregnancy-related anxiety [r = 0.56, p = .0001], parental health anxiety [r = 0.53, p = .0001], anxiety [r = 0.57, p = .0001], anxiety sensitivity [r = 0.28, p = .004] and intolerance of uncertainty [r = 0.29, p = .003]) and divergent (parental depression [r = 0.16, p = .12]) validity was evidenced with additional measures of interest. Conclusion: Preliminary findings suggest that the FHAI represents a psychometrically sound instrument to measure the construct of fetal health anxiety. Practical and theoretical implications of the present results are discussed.
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Affiliation(s)
- Sarah J Reiser
- Department of Psychology, University of Regina , Regina , SK , Canada
| | - Kristi D Wright
- Department of Psychology, University of Regina , Regina , SK , Canada
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Mudra S, Göbel A, Barthel D, Hecher K, Schulte-Markwort M, Goletzke J, Arck P, Diemert A. Psychometric properties of the German version of the pregnancy-related anxiety questionnaire-revised 2 (PRAQ-R2) in the third trimester of pregnancy. BMC Pregnancy Childbirth 2019; 19:242. [PMID: 31296168 PMCID: PMC6625049 DOI: 10.1186/s12884-019-2368-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy-related anxiety (PrA) has been identified as a construct distinct from general stress and anxiety with a negative impact on birth and child outcomes. Validated instruments with good psychometric properties to assess pregnancy-related anxiety in German-speaking expectant mothers are still lacking. The Pregnancy-Related Anxiety Questionnaire revised for its use independent of parity (PRAQ-R2) assesses fear of giving birth (FoGB), worries of bearing a physically or mentally handicapped child (WaHC) and concerns about own appearance (CoA). The aim of this study was to investigate the psychometric properties of the PRAQ-R2 in a German sample of pregnant women in their third pregnancy trimester. Methods The PRAQ-R2 and several questionnaires measuring different forms of anxiety as well as depressive symptoms and perceived general self-efficacy were administered cross-sectionally in a sample of nulliparous and parous women (N = 360) in the third trimester of pregnancy. Results Reliability was satisfactory to excellent for the PRAQ-R2 total scale (Cronbach’s α = .85) and the subscales (α = .77 to .90). Confirmatory and exploratory factor analysis confirmed the three-factorial structure of the instrument. The three factors together explained 68% of variance. Construct validity was confirmed by positive low- to moderate-sized correlations of the PRAQ-R2 total score and the subscales with measurements of anxiety and depression and by negative low correlations with general self-efficacy. Conclusions The German version of the PRAQ-R2 is a valid and feasible measurement for pregnancy-related anxiety for research and clinical practice.
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Affiliation(s)
- S Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - A Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - D Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - M Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - J Goletzke
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - P Arck
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Ayu IP, Rachmawati IN, Ungsianik T. Maternal age as a main factor influencing prenatal distress in Indonesian Primigravida. ENFERMERIA CLINICA 2019. [PMID: 31255447 DOI: 10.1016/j.enfcli.2019.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pregnancy is a maturation crisis, especially for primigravida, which affects both mother and fetus well-being. This study aimed to identify prenatal distress in primigravida and its relationship with maternal age, educational background, income level, gestational age, social support, previous traumatic experiences, satisfaction with paternal support, and pregnancy planning. METHODS This cross-sectional study involved 214 primigravidas in Serang City, Banten Province, Indonesia. Translated instruments, such as a socio-demographic questionnaire, PTSD Symptom Scale (PSS), the Multidimensional scale of perceived social support (MSPSS), London Measure of Unplanned Pregnancy Instrument (LMUP), Marital Adjustment Test (MAT), and Prenatal Distress Questionnaire (PDQ), were applied. RESULTS The results revealed that most respondents experienced severe distress (55.6%). Maternal age is the most dominant factor influencing prenatal distress in primigravida (OR=10.31; 95% CI: 4.7-22.6). CONCLUSIONS The younger the mother, the greater the extent of the psychosocial problems. A higher maternal age is assumed to be associated with greater adaptation to the changes occurring during pregnancy. Healthcare providers should be aware that pregnancy can lead to distress, especially in young primigravidas. Programs to maintain mental health during pregnancy should be implemented.
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Affiliation(s)
- Ike Puspasari Ayu
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia; Bachelor of Nursing Program, Institute of Health Sciences Faletehan, Serang, Banten, Indonesia
| | | | - Titin Ungsianik
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
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Sun Y, Huang K, Hu Y, Yan S, Xu Y, Zhu P, Tao F. Pregnancy-specific anxiety and elective cesarean section in primiparas: A cohort study in China. PLoS One 2019; 14:e0216870. [PMID: 31091276 PMCID: PMC6519904 DOI: 10.1371/journal.pone.0216870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/30/2019] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to investigate the association between pregnancy-specific anxiety and elective cesarean section, and identify the critical period in which pregnancy-specific anxiety will affect the elective cesarean section. Primiparous women in the 1st trimester of pregnancy were invited to participate in the cohort. General information on maternal socio-demographic characteristics and environmental exposure were collected using questionnaires. Pregnancy-specific anxiety was assessed by using pregnancy-specific anxiety questionnaire in the 1st, 2nd and 3rd trimester, respectively. Delivery modes and pregnancy complications were abstracted from medical notes. Structural equation modeling (SEM) was adopted to examine the relationship between pregnancy-specific anxiety and elective cesarean section. Results indicated the overall elective cesarean section rate in this study was 45%. Among 1 874 pregnant women, 30.9% women experienced anxiety at least once during pregnancy, and 6.9% women suffered from anxiety in all three trimesters. Anxiety in the 2nd trimester was a significant predictor for elective cesarean section. Young maternal age and low educational level had indirect effects on women’s choice of elective caesarean section through affecting pregnancy-specific anxiety. More attention should be paid to maternal psychological problems, and professional counseling needs to be strengthened to protect women from pregnancy-specific anxiety.
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Affiliation(s)
- Yuanfang Sun
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
- * E-mail:
| | - Yabin Hu
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Center, Ma'anshan, China
| | - Yeqing Xu
- Ma'anshan Maternal and Child Health Center, Ma'anshan, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, Anhui Medical University, Hefei, Anhui Province, China
- Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, Anhui Province, China
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Orsolini L, De Berardis D, Bellantuono C. The ‘hidden' and ‘forgotten' psychiatry: The Perinatal Psychiatry. ACTA ACUST UNITED AC 2019. [DOI: 10.3280/rsf2019-001003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brunton R, Dryer R, Saliba A, Kohlhoff J. Re-examining pregnancy-related anxiety: A replication study. Women Birth 2019; 32:e131-e137. [DOI: 10.1016/j.wombi.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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Novak Lauš K, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat 2019; 57:39-51. [PMID: 30256010 DOI: 10.20471/acc.2017.56.04.05] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.
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Affiliation(s)
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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Nakić Radoš S, Tadinac M, Herman R. Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat 2019. [PMID: 30256010 PMCID: PMC6400346 DOI: 10.20471/acc.2018.57.01.05] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.
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Affiliation(s)
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
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Göbel A, Stuhrmann LY, Harder S, Schulte-Markwort M, Mudra S. The association between maternal-fetal bonding and prenatal anxiety: An explanatory analysis and systematic review. J Affect Disord 2018; 239:313-327. [PMID: 30031251 DOI: 10.1016/j.jad.2018.07.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/23/2018] [Accepted: 07/08/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prenatal period can be associated with an increase in distress and anxiety. Research indicates that impaired mental well-being influences the development of prenatal maternal-fetal bonding, which manifests in representations, emotions and behaviors. However, the impact of prenatal anxieties on maternal-fetal bonding is still not fully understood, partly due to heterogeneity in the conceptualization and the measurement of both constructs. The aims of this review were to identify studies assessing the relation between both constructs and to investigate direction and size of effects for different types of prenatal anxiety and conceptualizations of maternal-fetal bonding. METHODS A systematic search was carried out on January 7, 2017, and updated on October 23, 2017, based on four electronic databases and a targeted reference search. Of the 3845 identified publications, K = 31 studies fit the eligibility criteria. RESULTS While components of maternal-fetal bonding centering around pregnancy or maternal role were not affected, the quality of perceived emotional proximity to the child, as assessed by the Maternal Antenatal Attachment Scale, was impaired by anxieties across studies. Associations were overall negative and of low to moderate size. LIMITATIONS Studies focusing on high-risk subpopulations were excluded. Included studies mostly assessed samples from Western societies, which limits the generalizability of results to non-Western cultures. CONCLUSION The quality of perceived emotional proximity to the fetus was consistently impaired by anxiety. Nevertheless, varying effect sizes indicate a more complex association that is influenced by underlying confounders. Multivariate analyses are needed to improve the understanding of the interacting factors that influence maternal-fetal bonding.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany.
| | - Lydia Yao Stuhrmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
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Bayrampour H, Vinturache A, Hetherington E, Lorenzetti DL, Tough S. Risk factors for antenatal anxiety: A systematic review of the literature. J Reprod Infant Psychol 2018; 36:476-503. [PMID: 30293441 DOI: 10.1080/02646838.2018.1492097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the prevalence of antenatal anxiety and its consistent associations with adverse pregnancy and child outcomes, early detection and management of anxiety are essential. OBJECTIVE The aim was to identify risk factors for anxiety among pregnant women by systematically reviewing original research. METHODS Cross-sectional, case-control and cohort studies that examined associations between antenatal anxiety and at least one potential risk factor prospectively or retrospectively and measured anxiety independent from other mental health conditions were included. Studies rated strong/moderate in methodological quality appraisal were used to synthesise the evidence. RESULTS Factors associated with greater risk of anxiety included previous pregnancy loss, medical complications, childhood abuse, intimate partner violence, denial/acceptance coping styles, personality traits, inadequate social support, history of mental health problems, high perceived stress and adverse life events. CONCLUSIONS Several risk factors identified in this review are detectable in routine prenatal care visits (e.g. previous pregnancy loss, pregnancy complications), potentially modifiable (e.g. coping styles, social support, partner factors) and can be identified prior to pregnancy (e.g. psychosocial factors), underlining the significance of pre-conception mental health screening.
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Affiliation(s)
- Hamideh Bayrampour
- a Department of Family Practice , University of British Columbia , Vancouver , Canada
| | - Angela Vinturache
- b Department of Pediatrics , University of Calgary , Calgary , Canada
| | - Erin Hetherington
- c Department of Community Health Sciences , University of Calgary , Calgary , Canada
| | - Diane L Lorenzetti
- c Department of Community Health Sciences , University of Calgary , Calgary , Canada
| | - Suzanne Tough
- d Departments of Pediatrics and Community Health Sciences , University of Calgary , Calgary , Canada
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Xu J, Chen P, Ma X. The relationship among preconception depression, anxiety, and social support of the reproductive-aged women in China. Arch Womens Ment Health 2018; 21:429-436. [PMID: 29445909 DOI: 10.1007/s00737-018-0817-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/06/2018] [Indexed: 11/26/2022]
Abstract
The reproductive-aged women have to face physiological and psychological challenges as long as they plan to conceive. However, most previous studies focused on depression and anxiety during pregnancy. This study aimed to investigate the association among preconception depression, anxiety, and social support of the Chinese reproductive-aged women. Nine-hundred five reproductive-aged women who planned to conceive for the first or second time in the next three months were recruited through the Maternity and Child Healthcare Hospital and Obstetrics and Gynecology Hospital from three provinces in China. Social Support Rating Scale, Self-Rating Depression Scale, and Self-Rating Anxiety Scale were used in this study. The hierarchical regression model was employed to examine the prediction effect of the three sub-dimensions of social support on preconception depression and anxiety. Of the reproductive-aged women, 25.86 and 13.04% had preconception depression and anxiety symptoms. Nearly all reproductive-aged women had moderate and high social support before pregnancy. The significant differences in depression and anxiety among different levels of occupation and monthly income were found. For depression and anxiety, objective support, support availability, and subjective support simultaneously entered into the model still could significantly explain 5.9 and 6.7% of variations after controlling for the demographic variables, respectively. According to this study, there were significant correlations among preconception depression, anxiety, and social support. And objective support, support availability, and subjective support could negatively predict preconception depression and anxiety. Attaching importance to the preconception mental health and social support can provide effective scientific support for helping women fully understand and effectively use the social resources, and scientifically prepare for pregnancy.
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Affiliation(s)
- Jihong Xu
- Research Center for Mental Health and Behavior Big Data, National Research Institute for Family Planning, No. 12 Dahuisi Road, Hai Dian District, Beijing, 100081, China.
| | - Ping Chen
- Beijing Normal University, Beijing, 100875, China
| | - Xu Ma
- Research Center for Mental Health and Behavior Big Data, National Research Institute for Family Planning, No. 12 Dahuisi Road, Hai Dian District, Beijing, 100081, China
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Wall V, Premji SS, Letourneau N, McCaffrey G, Nyanza EC. Factors associated with pregnancy-related anxiety in Tanzanian women: a cross sectional study. BMJ Open 2018; 8:e020056. [PMID: 29866722 PMCID: PMC5988139 DOI: 10.1136/bmjopen-2017-020056] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/13/2018] [Accepted: 04/12/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To identify factors predictive of pregnancy-related anxiety (PRA) among women in Mwanza, Tanzania. DESIGN A cross-sectional study was used to explore the relationship between psychosocial health and preterm birth. SETTING Antenatal clinics in the Ilemela and Nyamagana districts of Mwanza, Tanzania. PARTICIPANTS Pregnant women less than or equal to 32 weeks' gestational age (n=212) attending the two antenatal clinics. MEASURES PRA was measured using a revised version of the 10-item PRA Questionnaire (PRA-Q). Predictive factors included social support (Multidimensional Scale of Perceived Social Support), stress (Perceived Stress Scale), depression (Edinburg Postpartum Depression Scale) and sociodemographic data. Bivariate analysis permitted variable selection while multiple linear regression analysis enabled identification of predictive factors of PRA. RESULTS Twenty-five per cent of women in our sample scored 13 or higher (out of a possible 30) on the PRA-Q. Perceived stress, active depression and number of people living in the home were the only statistically significant predictors of PRA in our sample. CONCLUSIONS Our findings were contrary to most current literature which notes socioeconomic status and social support as significant factors in PRA. A greater understanding of the experience of PRA and its predictive factors is needed within the social cultural context of low/middle-income countries to support the development of PRA prevention strategies specific to low/middle income countries.
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Affiliation(s)
- Vanessa Wall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Shahirose Sadrudin Premji
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Graham McCaffrey
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Elias Charles Nyanza
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza, Tanzania
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45
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Field T. Prenatal anxiety effects: A review. Infant Behav Dev 2017; 49:120-128. [PMID: 28886563 DOI: 10.1016/j.infbeh.2017.08.008] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 12/20/2022]
Abstract
This review is based on literature on prenatal anxiety effects that was found on Pubmed and PsycINFO for the years 2010-2016. Prenatal anxiety is thought to have distinct features, although it has been measured both by specific prenatal anxiety symptoms as well as by standardized anxiety scales. Its prevalence has ranged from 21 to 25% and it has been predicted by a number of pregnancy - related variables such as unintended pregnancy, demographic variables such as low acculturation and income and psychosocial factors including pessimism and partner tension. Prenatal anxiety effects on pregnancy include increased cortisol levels, pro-inflammatory cytokines, obstetric problems and cesarean section. Effects on the neonate include lower gestational age, prematurity, less insulin-like growth factor in cord blood, less exclusive breast-feeding and less self-regulation during the heelstick procedure. Prenatal anxiety effects continue into infancy and childhood both on physiological development and emotional/mental development. Among the physiological effects are lower vagal activity across the first two years, and lower immunity, more illnesses and reduced gray matter in childhood. Prenatal anxiety effects on emotional/mental development include greater negative emotionality and in infants, lower mental development scores and internalizing problems. Anxiety disorders occur during childhood and elevated cortisol and internalizing behaviors occur during adolescence. Interventions for prenatal anxiety are virtually nonexistent, although stroking (massaging) the infant has moderated the pregnancy - specific anxiety effects on internalizing behaviors in the offspring. The limitations of this literature include the homogeneity of samples, the frequent use of anxiety measures that are not specific to pregnancy, and the reliance on self-report. Nonetheless, the literature highlights the negative, long-term effects of prenatal anxiety and the need for screening and early interventions.
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Affiliation(s)
- Tiffany Field
- University of Miami/Miller School of Medicine, United States; Fielding Graduate University, United States.
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Shapiro GD, Séguin JR, Muckle G, Monnier P, Fraser WD. Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort. J Psychosom Obstet Gynaecol 2017; 38:121-132. [PMID: 28079434 PMCID: PMC5383417 DOI: 10.1080/0167482x.2016.1271979] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Pregnancy anxiety is an important psychosocial risk factor that may be more strongly associated with adverse birth outcomes than other measures of stress. Better understanding of the upstream predictors and causes of pregnancy anxiety could help to identify high-risk women for adverse maternal and infant outcomes. The objective of the present study was to measure the associations between five past pregnancy outcomes (live preterm birth (PTB), live term birth, miscarriage at <20 weeks, stillbirth at ≥20 weeks, and elective abortion) and pregnancy anxiety at three trimesters in a subsequent pregnancy. METHODS Analyses were conducted using data from the 3D Cohort Study, a Canadian birth cohort. Data on maternal demographic characteristics and pregnancy history for each known previous pregnancy were collected via interviewer-administered questionnaires at study entry. Pregnancy anxiety for the index study pregnancy was measured prospectively by self-administered questionnaire following three prenatal study visits. RESULTS Of 2366 participants in the 3D Study, 1505 had at least one previous pregnancy. In linear regression analyses with adjustment for confounding variables, prior live term birth was associated with lower pregnancy anxiety in all three trimesters, whereas prior miscarriage was significantly associated with higher pregnancy anxiety in the first trimester. Prior stillbirth was associated with greater pregnancy anxiety in the third trimester. Prior elective abortion was significantly associated with higher pregnancy anxiety scores in the first and second trimesters, with an association of similar magnitude observed in the third trimester. DISCUSSION Our findings suggest that the outcomes of previous pregnancies should be incorporated, along with demographic and psychosocial characteristics, into conceptual models framing pregnancy anxiety.
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Affiliation(s)
- Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada,CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Canada
| | - Jean R. Séguin
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Canada,Department of Psychiatry, Université de Montréal, Montreal, Canada
| | - Gina Muckle
- Centre de Recherche du Centre hospitalier universitaire de Québec, Quebec, Canada,École de psychologie, Université Laval, Quebec, Canada
| | - Patricia Monnier
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, Canada
| | - William D. Fraser
- CHU Sainte-Justine Research Centre, Université de Montréal, Montreal, Canada,Department of Obstetrics and Gynaecology, Université de Sherbrooke, and Centre de recherche du CHUS, Sherbrooke, Canada
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Pregnancy-specific anxiety and its association with background characteristics and health-related behaviors in a low-risk population. Compr Psychiatry 2017; 75:6-13. [PMID: 28279817 DOI: 10.1016/j.comppsych.2017.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/29/2016] [Accepted: 02/02/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pregnancy-specific anxiety is an important risk factor for adverse pregnancy outcomes. It is therefore needed to gain insight in which women are at risk for elevated levels (> 85th percentile) of pregnancy-specific anxiety. Additionally, given that unhealthy behaviour has been suggested as a possible pathway linking pregnancy-specific anxiety to adverse pregnancy outcomes, it is important to examine whether higher levels of pregnancy-specific anxiety are associated with negative health-related behaviours (smoking, alcohol use and too much weight gain). METHODS Using a study sample of 4541 low-risk pregnant women who filled in the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R), we first examined which socio-demographic, pregnancy-related and psychological background characteristics were significantly associated with a PRAQ-R score above the 85th percentile. Secondly, we examined the association between pregnancy-specific anxiety and self-reported health-related behaviours (smoking, alcohol use and too much weight gain) while controlling for significant background characteristics. For both research questions, backward regression analysis was applied. RESULTS Results showed that nulliparity (OR=2.33, 95% confidence interval (CI)=1.97-2.77), anxious or depressed mood (OR=3.29, 95% CI=2.74-3.94) and non-Dutch ethnicity, especially Turkish (OR=3.47, 95% CI=2.16-5.59) or Moroccan (OR=2.97, 95% CI=1.84-4.81), were most strongly associated with elevated pregnancy-specific anxiety levels. Women with higher pregnancy-specific anxiety levels were more likely to gain too much weight during pregnancy (odds ratio (OR) linear term=1.49, 95% CI=1.21-1.83), while both very low and high levels of pregnancy-specific anxiety were associated with smoking (OR linear term=0.13, 95% CI=0.04-0.45, OR quadratic term=1.81, 95% CI=1.32-2.47). No association with alcohol use was found. CONCLUSIONS In conclusion, our results show nulliparity, anxious or depressed mood and non-Dutch ethnicity as three major vulnerability factors for elevated levels of pregnancy-specific anxiety. Furthermore, our results show an association between pregnancy-specific anxiety and negative health-related behaviours, which is worth examining in future studies.
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Hain S, Oddo-Sommerfeld S, Bahlmann F, Louwen F, Schermelleh-Engel K. Risk and protective factors for antepartum and postpartum depression: a prospective study. J Psychosom Obstet Gynaecol 2016; 37:119-129. [PMID: 27376660 DOI: 10.1080/0167482x.2016.1197904] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD. METHODS We conducted a prospective study with three measurement time points: six weeks antepartum (N = 297), as well as six weeks (N = 278) and twelve weeks (N = 266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience. RESULTS Predictors for APD were high DSC, high concerns about one's appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD. DISCUSSION The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.
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Affiliation(s)
- Sarah Hain
- a University of Frankfurt , Institute of Psychology , Frankfurt , Germany.,b Division of Psychology in Obstetrics and Fetomaternal Medicine , University Hospital Frankfurt , Frankfurt , Germany
| | - Silvia Oddo-Sommerfeld
- b Division of Psychology in Obstetrics and Fetomaternal Medicine , University Hospital Frankfurt , Frankfurt , Germany
| | - Franz Bahlmann
- c Department of Gynecology and Obstetrics , Buergerhospital Frankfurt , Frankfurt , Germany
| | - Frank Louwen
- b Division of Psychology in Obstetrics and Fetomaternal Medicine , University Hospital Frankfurt , Frankfurt , Germany
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Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.32526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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50
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Kalayil Madhavanprabhakaran G, Sheila D’Souza M, Nairy K. Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal32526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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