Psychosomatic obstetrics and gynecology--a neglected field?

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety

INTRODUCTION

Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety.

METHODS

We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433).

RESULTS

In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta =  - 0.09) and increased disordered eating attitudes during pregnancy (beta =  - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance.

CONCLUSION

Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

Psychometric performance assessment of the Arabic version of the pregnancy experience scale-brief version (PES-brief) in an Arabic-speaking population

OBJECTIVE

Although tools exist to assess psychological distress during pregnancy, a scarcity of instruments are designed to measure maternal perceptions of the more positive, uplifting features of pregnancy in addition to the more negative, hassling aspects. To address this shortcoming, DiPietro et al. developed the Pregnancy Experience Scale-Brief (PES-Brief). We aimed to assess the reliability and psychometric performance of an Arabic translation of the PES-Brief among Lebanese pregnant women.

METHODS

The PES-Brief, the Patient Health Questionnaire, the Lebanese Anxiety Scale, and the Multidimensional Scale of Perceived Social Support were administered to 433 participants. PES-Brief scores were computed as frequency and intensity, with Hassles to Uplifts frequency and intensity ratios.

RESULTS

The PES-Brief was internally consistent, with McDonald's ω = 0.87 for Uplifts and 0.81 for Hassles. Higher PES-Uplifts scores were significantly associated with lower depression and anxiety scores, and higher perceived social support; whereas higher PES-Hassles scores showed inverse correlations. The Hassles to Uplifts frequency and intensity ratios were 0.864 and 0.836, respectively, indicating that pregnant women were more uplifted than hassled. The CFA results confirmed the two-factor structure of the scale.

CONCLUSION

Our findings suggest that the Arabic PES-Brief is a psychometrically valid and reliable scale that may be employed as a legitimate indicator of pregnancy-specific uplifts and hassles among Arabic-speaking populations. Our study prompts clinicians and researchers to benefit from this tool for capturing the integral psychological/emotional experience of women during pregnancy, which may facilitate pregnant women's support when needed.

The pregnancy experience scale-brief version

The role of maternal stress during pregnancy remains a focus of academic and clinical inquiry, yet there are few instruments available that measure pregnancy-specific contributors to maternal psychological state. This report examines the psychometric properties of an abbreviated version of the Pregnancy Experience Scale (PES) designed to evaluate maternal appraisal of positive and negative stressors during pregnancy. The PES-Brief consists of the top 10 items endorsed as pregnancy hassles and 10 pregnancy uplifts from the original scale. The PES-Brief was administered to 112 women with low risk, singleton pregnancies five times between 24 and 38 weeks gestation. Scoring includes frequency and intensity measures for hassles and uplifts, as well as composite measures for the relation between the two. Internal reliability, test-retest reliability and convergent validity were comparable with the original version. The PES-Brief provides an economical source of information on stress appraisal and emotional valence towards pregnancy.