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Dol J, Campbell-Yeo M, Leahy-Warren P, Hambly LaPointe C, Dennis CL. Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020. J Affect Disord 2024; 351:314-322. [PMID: 38290588 DOI: 10.1016/j.jad.2024.01.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research. METHODS All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts. RESULTS The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression. LIMITATIONS Web of Science was solely used, and manual screening of each publication was required. CONCLUSION This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.
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Affiliation(s)
- Justine Dol
- IWK Health, Halifax, Nova Scotia, Canada; Dalhousie University, Nova Scotia, Canada.
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Nova Scotia, Canada
| | | | | | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada; Lunenfeld-Tannenbaum Research Institute, Sinai Health, Ontario, Canada
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Lykins AD, Bonich M, Sundaraja C, Cosh S. Climate change anxiety positively predicts antenatal distress in expectant female parents. J Anxiety Disord 2024; 101:102801. [PMID: 38086278 DOI: 10.1016/j.janxdis.2023.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/26/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
Clinical and subclinical levels of anxiety and depression are common experiences during pregnancy for expectant women; however, despite rising awareness of significant climate change anxiety around the world, the extent to which this particular type of anxiety may be contributing to overall antenatal psychological distress is currently unknown. Furthermore, the content of concerns that expectant women may have for their existing or future children remains unexplored. To address this gap in knowledge, 103 expectant Australian women completed standardised assessments of antenatal worry and depression, climate change anxiety, and perceived distance to climate change, and responded to several open-ended questions on concerns they had for their children. Results indicated that climate change anxiety accounted for significant percentages of variance in both antenatal worry and depression scores and, unexpectedly, neither child number nor perceived distance to climate change moderated these relationships. Content analysis of qualitative data highlighted the significant health-related anxieties for participants' children related to climate change (e.g., disease, exposure to extreme weather events, food/water insecurity). Given the escalating nature of climate change, further investigation of this relatively new stressor contributing to the experience of anxiety and distress, particularly in uniquely vulnerable groups such as expectant women, is urgently needed.
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Affiliation(s)
- Amy D Lykins
- School of Psychology, University of New England, Armidale, New South Wales, Australia.
| | - Mary Bonich
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Cassandra Sundaraja
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Suzanne Cosh
- School of Psychology, University of New England, Armidale, New South Wales, Australia
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Gerges S, Obeid S, Hallit S. Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety. Ir J Med Sci 2023; 192:2949-2959. [PMID: 37081286 PMCID: PMC10117264 DOI: 10.1007/s11845-023-03371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
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.
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Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal-Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
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Wei Q, Lin W, Zhang H, Lai Y, Zhuang S, Han Z, Wang Q, Wang L, Li W, Wen L, Hou H, Hu Q. Role of antenatal anxiety in the relationship between maternal exposure to nitrogen dioxide and small for gestational age: A birth cohort study. Sci Total Environ 2023; 900:165812. [PMID: 37499810 DOI: 10.1016/j.scitotenv.2023.165812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Both Nitrogen dioxide (NO2) exposure and antenatal anxiety have individually been associated with small for gestational age (SGA). Little is known, however, about whether there is effect modification of antenatal anxiety on NO2-related SGA. METHODS The prospective birth cohort study included 1823 mother-newborn pairs in Guangzhou, China, from January 2017 to April 2020. Exposure to NO2 during the pre-conceptional and prenatal periods was estimated using an inverse distance weighted method. Antenatal anxiety was assessed by Trait Anxiety Inventory. SGA was determined by the Chinese gestational age- and sex-specific birthweight standards. Cox proportional hazards regression models was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for SGA as per 10 μg/m3 increase in NO2. Modifying effects of trait anxiety on NO2-related SGA were identified by stratified analyses, and three-dimensional response surface plots and two-dimensional heat maps. RESULTS Each 10 μg/m3 increase in NO2 exposure during the third trimester was significantly associated with SGA risk among overall participants (HR = 1.221, 95 % CI: 1.014-1.471) and primipara (HR = 1.271, 95 % CI: 1.023-1.579). We found significant effect modification of anxiety level for NO2-related SGA in the third trimester (Pinteraction < 0.05). Pregnant women with higher levels of trait anxiety were more likely to deliver SGA newborns, particularly for those with high trait anxiety (HR = 1.781, 95 % CI: 1.007-2.945). Primiparous women were more susceptible. CONCLUSIONS This study provides evidence that antenatal trait anxiety may modify the effects of maternal NO2 exposure on SGA risk. The third trimester could be a critical window of susceptibility.
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Affiliation(s)
- Qiannan Wei
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Weiwei Lin
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Hedi Zhang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Yuming Lai
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Shuling Zhuang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Zhenyan Han
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Qingqing Wang
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Lijie Wang
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Wenzhuo Li
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Li Wen
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Hongying Hou
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, Guangdong, China
| | - Qiansheng Hu
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
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Martinez CA, Marteinsdottir I, Josefsson A, Sydsjö G, Theodorsson E, Rodriguez-Martinez H. Epigenetic modifications appear in the human placenta following anxiety and depression during pregnancy. Placenta 2023; 140:72-79. [PMID: 37549439 DOI: 10.1016/j.placenta.2023.07.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION The future health of the offspring can be influenced by longstanding maternal anxiety and depression disorders during pregnancy. The present study aimed to explore the effect of psychiatric disorders during pregnancy on placental epigenetics. METHODS We measured DNA methylation patterns in term-placentas of women either suffering longstanding anxiety and depression symptoms (Index group, with overt symptoms), or a healthy population (Control, none/only mild symptoms). Whole genome DNA methylation profiling was performed using the TruSeq® Methyl Capture EPIC Library Prep Kit (Illumina, San Diego, CA, USA) for library preparation and NGS technology for genomic DNA sequencing. RESULTS The results of high-throughput DNA methylation analysis revealed that the Index group had differential DNA methylation at epigenome-wide significance (p < 0.05) in 226 genes in the placenta. Targeted enrichment analyses identified hypermethylation of genes associated with psychiatric disorders (BRINP1, PUM1), and ion homeostasis (COMMD1), among others. The ECM (extracellular matrix)-receptor interaction pathway was significantly dysregulated in the Index group compared to the Control. In addition, DNA methylation/mRNA integration analyses revealed that four genes with key roles in neurodevelopment and other important processes (EPB41L4B, BMPR2, KLHL18, and UBAP2) were dysregulated at both, DNA methylation and transcriptome levels in the Index group compared to Control. DISCUSSION The presented results increase our understanding of how maternal psychiatric disorders may affect the newborn through placental differential epigenome, suggesting DNA methylation status as a biomarker when aiming to design new preventive techniques and interventions.
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Affiliation(s)
- Cristina A Martinez
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, SE-58185 , Linköping, Sweden; Department of Animal Reproduction, National Institute for Agriculture and Food Research and Technology (CSIC-INIA), Ctra de la Coruña KM 5.9, 28040, Madrid, Spain.
| | - Ina Marteinsdottir
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Hus Vita, Kalmar, 43157, Sweden.
| | - Ann Josefsson
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, SE-58185 , Linköping, Sweden.
| | - Gunilla Sydsjö
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, SE-58185 , Linköping, Sweden.
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology, Linköping University, Sweden.
| | - Heriberto Rodriguez-Martinez
- Department of Biomedical & Clinical Sciences (BKV), BKH/Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Linköping University, SE-58185 , Linköping, Sweden.
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Yang H, Pan Y, Chen W, Yang X, Liu B, Yuan N, Zhang X. Prevalence of and relevant factors for depression and anxiety symptoms among pregnant women on the eastern seaboard of China in the post-COVID-19 era: a cross-sectional study. BMC Psychiatry 2023; 23:564. [PMID: 37550657 PMCID: PMC10405434 DOI: 10.1186/s12888-023-05059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Antenatal depression and anxiety symptoms may have negative consequences for both mothers and offspring, and upward trends in the prevalence of these symptoms were especially apparent during the COVID-19 epidemic. The purpose of this study was to evaluate the prevalence of and relevant factors influencing depressive and anxiety symptoms in Chinese pregnant women in the post-COVID-19 era. METHODS We conducted an online survey of 1,963 pregnant women in Jiangsu Province, using a cross-sectional design, and collected their general demographic data. The nine-item Patient Health Questionnaire 9 (PHQ-9) was used to evaluate depression symptoms, and the seven-item Generalized Anxiety Disorder 7 (GAD-7) was used to measure anxiety symptoms. RESULTS The prevalence of reported antenatal depressive symptoms, anxiety symptoms, and depression combined with anxiety symptoms was 25.2%, 27.9%, and 18.6%, respectively. Of the respondents, the prevalence of moderate to severe depression, and anxiety was 7.9% and 7.7%, respectively. Binary logistic regression analysis demonstrated that age, low level of education, rural area, unemployment, pregnancy complications, poor marital relationship, and fair household income were positively association with both depressive and anxiety symptoms (all P < 0.05). The proportion of women reporting anxiety symptoms in the third trimester was 1.91-fold higher than in first trimester. Parity was a relevant factor for depression and anxiety symptoms (all P < 0.05). CONCLUSIONS In the post-COVID-19 era, the prevalence of depression and anxiety symptoms in pregnant women was higher than expected, and it is vital to establish hospital, community, and family psychological health screening systems based on relevant factors and enhance early preventive measures.
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Affiliation(s)
- Haidong Yang
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, P.R. China
| | - Yangyang Pan
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, P.R. China
| | - Wanming Chen
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, P.R. China
| | - Xu Yang
- Department of Psychiatry, Beijing Hui Long Guan Hospital, Peking University Hui Long Guan Clinical Medical School, Beijing, 100096, P.R. China
| | - Bin Liu
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, P.R. China
| | - Nian Yuan
- Science and Education Section, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, P.R. China.
| | - Xiaobin Zhang
- Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, P.R. China.
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Milgrom J, Hirshler Y, Holt C, Skouteris H, Galbally M, East C, Glover V, Reece J, O'Donnell KJ, Walker SP, Malloy S, Gemmill AW. Early intervention to prevent adverse child emotional and behavioural development following maternal depression in pregnancy: study protocol for a randomised controlled trial. BMC Psychol 2023; 11:222. [PMID: 37542332 PMCID: PMC10401817 DOI: 10.1186/s40359-023-01244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Substantial evidence indicates that maternal depression during pregnancy (i.e., antenatal depression) is associated not only with maternal wellbeing but also with child emotional and behavioural development. Children of antenatally depressed women are at risk of emotional and behavioural problems, including internalising problems (e.g., anxiety and depression) and externalising problems (e.g., attention problems), that may last at least to adolescence. These enduring effects also constitute an enormous economic cost. Despite the seriousness of this problem, until recently there existed very few controlled studies evaluating whether active psychological treatment for antenatal depression can prevent adverse child outcomes. Our previous pilot randomised controlled trial (RCT) exploring the effect of cognitive behavioural therapy (CBT) for antenatal depression on child outcomes showed promising results. We aim to assess whether treating antenatal depression with an evidence-based 8-week structured CBT program can prevent or ameliorate adverse child developmental outcomes at 2 years of age. METHODS Pregnant women ≤ 30 weeks gestation diagnosed with a depressive disorder are recruited and randomised to CBT or treatment as usual (TAU). The target sample size is 230 and the primary outcome measure is the infant Internalising scale of the Child Behaviour Checklist (CBCL) at 24 months of age. Secondary infant outcome measures at 24 months are the Externalising scale of the CBCL and the motor and cognitive development subscales of the Ages & Stages Questionnaire (ASQ-3). Additional secondary outcome measures are subscales of the Revised Infant Behaviour Questionnaire (IBQ-R), ASQ-3 and the ASQ-Socio-Emotional (ASQ-SE) at 3 and 12 months of age and the quality of mother-infant interaction at 3 and 24 months. Maternal measures, including demographic data, depression diagnosis, depressive and anxiety symptoms, perceived stress and parenting stress, are collected across all time points. DISCUSSION The trial is ongoing and recruitment was slowed due to the COVID-19 pandemic. If results suggest a beneficial effect of antenatal depression treatment on infant outcomes, the project could have repercussions for standard antenatal care, for maternal and infant health services and for preventing the intergenerational transmission of mental health disorders. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register: ACTRN12618001925235 Date Registered: 27 November 2018.
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Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Yafit Hirshler
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Charlene Holt
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Megan Galbally
- Health Futures Institute, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
- Mental Health, Program Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Christine East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Plenty Rd & Kingsbury Drive, Bundoora, VIC, 3086, Australia
- Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, Du Cane Road, London, W12 ONN, UK
| | - John Reece
- School of Psychological Sciences, Australian College of Applied Professions, 123 Lonsdale Street, Melbourne, VIC, 3000, Australia
| | - Kieran J O'Donnell
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, USA
- Department of Obstetrics Gynecology and Reproductive Sciences, 230 South Frontage Road, New Haven, CT, 06519, USA
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Susan P Walker
- Mercy Hospital for Women, 163 Studley Road, Heidelberg, VIC, 3084, Australia
- Melbourne Medical School, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | | | - Alan W Gemmill
- Parent-Infant Research Institute, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia.
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Sahoo S, Gill G, Sikka P, Nehra R. Antenatal depression and anxiety in Indian women: A systematic review. Ind Psychiatry J 2023; 32:222-233. [PMID: 38161466 PMCID: PMC10756614 DOI: 10.4103/ipj.ipj_156_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 01/03/2024] Open
Abstract
There is good evidence to suggest that high prevalence of depression and anxiety in the postpartum period. However, very few studies have focused on antenatal depression and anxiety disorders and their associated risk factors. Further, there are only a handful of studies from India on common antenatal mental health disorders. With this background, we reviewed the existing evidence on antenatal depression and anxiety from the studies conducted in Indian pregnant women during the antenatal period and to explore the associated risk factors. All the major databases were searched systematically for English language studies on prevalence and risk factors for antenatal depression and anxiety in Indian pregnant females, published during the period January 2000 to May 2022. Quality assessment of studies was done with the modified version of Newcastle Ottawa Scale for cross-sectional studies. We found the overall prevalence of antenatal depression was ranged from 3.8% to 65% and antenatal anxiety from 13 to 55%. The most relevant risk factors associated with antenatal depression and anxiety during pregnancy were preference to have a male child, intimate partner violence, history of abortions, marital conflict, poor relationship with the husband/in-laws and lack of social support. To conclude, the systematic review suggests that depressive and anxiety disorders are quite common in Indian pregnant women in antepartum period with varying prevalence depending on various settings and scales used. Steps should be taken to promote obstetricians for regular mental health screening during the antenatal visits and prompt referral to mental health professionals when suspected.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gursahiba Gill
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
OBJECTIVE To create a clear and acceptable measure of fear of childbirth with satisfactory content validity for use with English-speaking women in the UK. BACKGROUND Fear of childbirth (FOC) can have a significant impact on a woman's view of her pregnancy, birth and her recovery post birth. Early identification is paramount to ensure that women's needs are recognised so that appropriately tailored care can be provided in pregnancy. Availability of reliable and valid measures to assess FOC in an English-speaking population are sparse, mainly due to issues with definitions of FOC or cultural sensitivity after translation. Recent research from phase one of the Fear of Childbirth study (FOCUS), has established key elements for FOC in an English-speaking UK population, and allows for a culturally sensitive measure of FOC to be developed. The aim was to ensure inclusion of all ten FOC elements and to attend to guidance from women in phase two of the FOCUS study about what would ensure clarity and acceptability. METHOD A multidisciplinary team developed items in accordance with FOCUS. The measure was then piloted with one reviewer and further refined by the team of perinatal researchers. RESULTS The FCQ is a new 20-item fear of childbirth questionnaire, which has been developed and is grounded in fears reported by women in the UK. CONCLUSION A new tool to measure FOC in an English-speaking UK population with good content validity has undergone a preliminary phase of development and now needs testing for reliability and other forms of validity.
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Affiliation(s)
- Pauline Slade
- Department of Mental Health and Primary Care, Institute of Public Health, University of Liverpool, Liverpool, UK
| | - Katie Balling
- Department of Mental Health and Primary Care, Institute of Public Health, University of Liverpool, Liverpool, UK
| | | | - Kayleigh Sheen
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
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Xu K, Zhang Y, Zhang Y, Xu Q, Lv L, Zhang J. Mental health among pregnant women under public health interventions during COVID-19 outbreak in Wuhan, China. Psychiatry Res 2021; 301:113977. [PMID: 34020217 PMCID: PMC8088032 DOI: 10.1016/j.psychres.2021.113977] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/25/2021] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become a pandemic. As the first city struck by the COVID-19 outbreak, Wuhan had implemented unprecedented public health interventions. The mental health of pregnant women during these anti-epidemic controls remains unknown. A total of 274 pregnant women living in Wuhan during the COVID-19 outbreak took part in our investigation online. The data on mental health conditions were evaluated using Edinburgh Postnatal Depression Scale (EPDS), Self-Rating Anxiety Scale (SAS), Chinese Perceived Stress Scale (CPSS), and Pittsburgh Sleep Quality Index (PSQI). We also collected the information on physical health status and precautionary measures against COVID-19. The prevalence of depression, anxiety, stress, and poor sleep quality was 16.1%, 13.9%, 42.7%, 37.6%, respectively. Comparing to SAS, PSQI score in pregnant women who participated in the survey after April 8 (date of Wuhan reopening), those data collected before April 8 were significantly higher. High levels of stress, severe health concerns over the fetus, and poor hygienic practices were negatively associated with mental health conditions. In conclusion, a large proportion of pregnant women reported psychological symptoms during the epidemic, which negatively related to the severe health concerns over fetus and poor hygienic practices. More psychological support during the epidemic would promote maternal mental well-being.
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Affiliation(s)
- Ke Xu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei, China
| | - Ya Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei, China
| | - Yuanyuan Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei, China
| | - Qiao Xu
- Maternal and Child Health Hospital of Jianghan District, 50 Machangjiao Rd, Wuhan, Hubei, China
| | - Lan Lv
- Maternal and Child Health Hospital of Jianghan District, 50 Machangjiao Rd, Wuhan, Hubei, China
| | - Jianduan Zhang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan, Hubei, China.
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11
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Frigerio A, Nazzari S. Antenatal maternal anxiety, maternal sensitivity and toddlers' behavioral problems: An investigation of possible pathways. Early Hum Dev 2021; 157:105364. [PMID: 33813323 DOI: 10.1016/j.earlhumdev.2021.105364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/14/2021] [Accepted: 03/20/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND While evidence exists of an association between maternal antenatal anxiety and offspring's behavioral outcomes, the role played by maternal care in explaining this link has been poorly investigated. AIM The current study aimed to investigate the mediating/moderating role of maternal sensitivity in the association between maternal antenatal trait anxiety and toddlers' behavioral problems and temperament, taking also into account potential confounders. Analyses were also replicated for maternal antenatal state anxiety and depression. METHODS Ninety women filled in the State-Trait Anxiety Questionnaire and the Edinburgh Postnatal Depression Scale to assess anxiety/depressive symptoms during the third trimester of pregnancy (34-36 weeks of gestation) and 14 months post-partum. They also filled in the Child Behavior Checklist and the Infant Behavior Questionnaire to evaluate their 14-month-olds' behavioral problems and negative affectivity, respectively. Maternal sensitivity was assessed through the Emotional Availability Scales. RESULTS Maternal antenatal trait anxiety was associated with internalizing, but not externalizing, problems. Interestingly, maternal sensitivity moderated the association between antenatal trait anxiety and externalizing problems. Conversely, antenatal maternal depression was significantly associated with toddlers' negative affectivity. CONCLUSIONS Our findings contribute to shed light on the association between maternal antenatal anxiety and child behaviors, as well as on the role played by parenting in moderating this link, with promising implications for targeted interventions.
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Affiliation(s)
- Alessandra Frigerio
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy.
| | - Sarah Nazzari
- Scientific Institute, IRCCS Eugenio Medea, Child Psychopathology Unit, Bosisio Parini, Lecco, Italy
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12
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Chan CY, Lee AM, Chung KF, Koh YW, Lam SK, Lee CP, Leung KY, Tang CSK. Hypomanic symptoms in early pregnancy: prevalence and associated factors. Arch Womens Ment Health 2021; 24:463-71. [PMID: 33094351 DOI: 10.1007/s00737-020-01078-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Bhushan NL, Krupp K, Jaykrishna P, Ravi K, Khan A, Shidhaye R, Kiplagat S, Srinivas V, Madhivanan P. The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1323-1333. [PMID: 32146484 PMCID: PMC7483323 DOI: 10.1007/s00127-020-01854-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety. METHODS Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale. RESULTS The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. CONCLUSIONS ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.
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Affiliation(s)
- Nivedita L. Bhushan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | | | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA,Division of Infectious Diseases & Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
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15
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Slade P, Balling K, Sheen K, Houghton G. Identifying fear of childbirth in a UK population: qualitative examination of the clarity and acceptability of existing measurement tools in a small UK sample. BMC Pregnancy Childbirth 2020; 20:553. [PMID: 32962652 PMCID: PMC7510144 DOI: 10.1186/s12884-020-03249-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 09/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background Fear of childbirth is related to but not synonymous with general anxiety, and represents a superior predictor for maternal and infant outcomes. There is a need to improve the identification and provision of support for women experiencing high fear of childbirth. However it is uncertain as to whether existing measurement tools have appropriate content validity (i.e. cover the relevant domains within the construct), practical utility, and whether they are acceptable for use with a UK population. This study aimed to (1) identify the utility and acceptability of existing measures of fear of childbirth (FOC) with a small UK sample and (2) map the content of existing measures to the key concepts of fear of childbirth established by previous research. Methods Ten pregnant women; five with high and five with low fear of childbirth participated in a cognitive interview covering four most commonly used measures of fear of childbirth: 1. The Wijma Delivery Expectancy Questionnaire (WDEQ A), 2. The Oxford Worries about Labour Scale (OWLS), 3. The Slade-Pais Expectations of Childbirth Scale – fear subscale (SPECS) and 4. The Fear of Birth scale (FOBS). Each measure was also reviewed by participants for ease and clarity of understanding and acceptability. The measures were then reviewed against the key domains identified in the fear of childbirth literature to ascertain the adequacy of content validity of each measure. Interviews were analysed using thematic analysis for each scale item. Results All measures except the FOBS, included items that either women did not understand or, if where there was understanding the meanings were inconsistent across women. All measures demonstrated limited acceptability and content validity for the specific construct of FOC. Therefore, none of the measurement tools currently used within the UK met criteria for understanding, acceptability and content validity for measurement of FOC. Conclusions Findings emphasise a need to develop a specific fear of childbirth tool with good clarity which demonstrates appropriate content validity, and that is acceptable in presentation and length for pregnant women in a UK population.
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Affiliation(s)
- P Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - K Balling
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - K Sheen
- Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - G Houghton
- Liverpool Women's Hospital Foundation Trust, Crown Street, Liverpool, L8 7SS, UK
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16
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Lu MJ, Huang K, Yan SQ, Zhu BB, Shao SS, Zhu P, Tao FB. [Association of antenatal anxiety with preterm birth and low birth weight: evidence from a birth cohort study]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1072-1075. [PMID: 32741173 DOI: 10.3760/cma.j.cn112338-20190927-00709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the impacts of antenatal anxiety on preterm birth and low birth weight. Methods: Women in early pregnancy were recruited for follow-up, antenatal anxiety in three trimesters was screened using Self-Rating Anxiety Scale and the score ≥50 was regarded as anxiety. Logistic regression analysis was conducted to evaluate the associations of the anxiety in three trimesters, new onset anxiety in the second and third trimesters with infant birth outcomes, such as preterm birth and low birth weight. Results: The rates of anxiety in the first, second and third trimesters of pregnancy were 12.5%, 3.7%, and 7.4% respectively. We found that there was no statistical association between anxiety in the first and second trimester and preterm birth. The anxiety in the third trimester was associated with increased odds for preterm birth (OR=3.55, 95%CI: 1.62-7.82). Associations between anxiety in all three trimesters and low birth weight were not significant. New onset anxiety in the third trimester was associated with significant increased risk of premature delivery (OR=5.20, 95%CI: 1.84-14.70) and low birth weight (OR=6.93, 95%CI: 2.42-19.88). Conclusions: Our study showed that anxiety in the third trimester is an important risk factor for premature delivery, new onset anxiety symptoms in the third trimester can significantly increase the incidence of premature birth and low birth weight of infant.
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Affiliation(s)
- M J Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle, Ministry of Education; Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - K Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle, Ministry of Education; Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - S Q Yan
- Ma'anshan Maternal and Child Health Care Hospital, Ma'anshan 243000, China
| | - B B Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle, Ministry of Education; Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - S S Shao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle, Ministry of Education; Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - P Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle, Ministry of Education; Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - F B Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University; Key Laboratory of Population Health Across Life Cycle, Ministry of Education; Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
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Chan CY, Lee AM, Koh YW, Lam SK, Lee CP, Leung KY, Tang CSK. Associations of body dissatisfaction with anxiety and depression in the pregnancy and postpartum periods: A longitudinal study. J Affect Disord 2020; 263:582-592. [PMID: 31744745 DOI: 10.1016/j.jad.2019.11.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/27/2019] [Accepted: 11/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pregnancy is a time of increasing vulnerability to the development of body dissatisfaction, anxiety, and depression. The present study aims to examine associations of body dissatisfaction with anxiety and depression at the following points: 6 months before pregnancy (retrospective report); in the first, second, and third trimesters of pregnancy; and up to 6 weeks postpartum. METHODS A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 1,371 Chinese pregnant women in Hong Kong was assessed using standardized instruments at four time points. RESULTS A mixed-effects model with repeated measures revealed that body dissatisfaction and depression symptoms changed across different stages of pregnancy. Hierarchical multiple regressions showed that, after adjusting for the identified risk factors, body dissatisfaction before and during pregnancy were positively associated with antenatal anxiety and depression symptoms. Concurrent body dissatisfaction was positively associated with postpartum depression symptoms. LIMITATIONS There was a high attrition rate in the follow-up assessments. Antenatal anxiety symptoms were assessed using the scale for general anxiety, which may not adequately capture the experience of anxiety among pregnant women. CONCLUSIONS Primary healthcare practitioners should be made aware of body dissatisfaction among pregnant women in order to facilitate early intervention for anxiety and depression, because untreated psychological disturbance during pregnancy may persist into the postpartum period.
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Affiliation(s)
- Chui Yi Chan
- Department of Psychiatry, 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, 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, The University of Hong Kong, Hong Kong, China; Centre of Family and Population Research, The National University of Singapore, Singapore City, Singapore
| | - Siu Keung Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Chin Peng Lee
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong, China
| | - Catherine So Kum Tang
- Department of Psychology, The National University of Singapore, Singapore City, Singapore
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Grigoriadis S, Graves L, Peer M, Mamisashvili L, Tomlinson G, Vigod SN, Dennis CL, Steiner M, Brown C, Cheung A, Dawson H, Rector NA, Guenette M, Richter M. A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes. Arch Womens Ment Health 2019; 22:543-556. [PMID: 30523416 DOI: 10.1007/s00737-018-0930-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/13/2018] [Indexed: 01/14/2023]
Abstract
To systematically review and meta-analyze research investigating the association between maternal anxiety during pregnancy and outcomes for mother and baby following the immediate delivery period. MEDLINE, Medline In-Process & Other Non-Indexed Citations, PsycINFO, Embase, CINAHL, and the Cochrane library were searched. English-language, prospective studies providing data on outcomes following delivery in women with and without antenatal anxiety (defined by clinical diagnosis or score on validated scale) were included. Three-hundred-fifty-eight articles were retrieved and 13 were included. Titles and abstracts were screened; two reviewers independently reviewed full text articles, conducted quality assessments, extracted, and checked the data. Where available for > 2 studies, random effect meta-analysis was conducted and heterogeneity was quantified. Subanalyses explored moderators, regardless of heterogeneity, including type of anxiety assessment and timing, among others. There were two outcomes that were amenable to meta-analysis. Antenatal anxiety was significantly associated with postpartum depression (PPD) measured within 6 months postpartum (pooled odds ratio [OR] = 2.64, 95% CI 2.02-3.46; 8 studies), regardless of restricting analyses to those studies controlling for prenatal depression (2.45, 1.77-3.39; 6 studies). Associations were also significant when PPD was measured at 1-3 months (2.57, 1.94-3.40; 7 studies) and 6-10 months (4.42, 1.45-13.49; 3 studies). Maternal anxiety was also associated with reduced odds of breastfeeding (0.63, 0.53-0.74; 5 studies). Antenatal anxiety is associated with PPD up to the first 10 months, independent of prenatal depression, and with lower odds of breastfeeding.
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Affiliation(s)
- Sophie Grigoriadis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Women's Mood and Anxiety Clinic: Reproductive Transitions, Department of Psychiatry, FG 29, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Lisa Graves
- Department of Family and Community Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI, 49008-8017, USA
| | - Miki Peer
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, F111 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lana Mamisashvili
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, F111 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - George Tomlinson
- Biostatistics and Department of Medicine, Toronto General Hospital and the University of Toronto, Eaton North 13th Fl., Rm. 238 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Simone N Vigod
- Department of Psychiatry, Women's College Hospital and the University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - Meir Steiner
- Departments of Psychiatry and Behavioural Neurosciences, St. Joseph's Healthcare Hamilton and McMaster University, West 5th Campus, 100 West 5th St., Level 1 - Room G112, Hamilton, ON, L8N 3K7, Canada
| | - Cara Brown
- Department of Psychiatry, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Amy Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Hiltrud Dawson
- Health Promotion Consultant, Health Nexus, 180 Dundas Street West, Suite 301, Toronto, ON, M5G 1Z8, Canada
| | - Neil A Rector
- Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Melanie Guenette
- Division of Neurology, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Margaret Richter
- Department of Psychiatry, Sunnybrook Health Sciences Centre and the University of Toronto, FG29 - 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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19
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Fischbein RL, Nicholas L, Kingsbury DM, Falletta LM, Baughman KR, VanGeest J. State anxiety in pregnancies affected by obstetric complications: A systematic review. J Affect Disord 2019; 257:214-40. [PMID: 31301626 DOI: 10.1016/j.jad.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Maternal mental health status remains an important area of study due to its influence on maternal health outcomes. Past reviews on anxiety in pregnancy have included multiple mental health diagnoses and pre-existing conditions. A systematic review was performed to understand maternal state anxiety during pregnancies affected by obstetrical complications. METHODS A systematic search of electronic databases was performed including quantitative, primary studies in the English language. The population of interest was women whose pregnancies were affected by maternal and/or fetal obstetric (not pre-existing) complications with state anxiety as the outcome. Twenty-six studies met the inclusion and methodological criteria and were included in the review. RESULTS The review revealed that 20% to 100% of women experiencing pregnancies affected by obstetric complications had high levels of state anxiety, and these rates are negatively influenced by complication type and severity, demographic characteristics, and maternal perceptions and expectations. Overall, antenatal state anxiety was shown to improve over the course of the pregnancy, though levels remained above clinical thresholds. LIMITATIONS This review was based only on English peer-reviewed articles, many of which used convenience sampling with homogenous samples, limiting generalizability. Additional limitations include how anxiety prevalence was aggregated due to differences in measurement across studies. CONCLUSIONS Anxiety is prevalent among women experiencing pregnancies affected by obstetric complications. Based on this review, we recommend that all women treated for obstetric complications are screened for anxiety; facilitating detection, referral, and treatment, ultimately contributing to optimal maternal outcomes.
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Slade P, Balling K, Sheen K, Houghton G. Establishing a valid construct of fear of childbirth: findings from in-depth interviews with women and midwives. BMC Pregnancy Childbirth 2019; 19:96. [PMID: 30885153 PMCID: PMC6423809 DOI: 10.1186/s12884-019-2241-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Fear of childbirth (FOC) can have a negative impact on a woman’s psychological wellbeing during pregnancy and her experience of birth. It has also been associated with adverse obstetric outcomes and postpartum mental health difficulties. However the FOC construct is itself poorly defined. This study aimed to systematically identify the key elements of FOC as reported by women themselves. Methods Semi-structured interviews with pregnant women (n = 10) who reported to be fearful of childbirth and telephone interviews with consultant midwives (n = 13) who regularly work with women who are fearful of childbirth were conducted. Interviews were analysed using thematic analysis for each group independently to provide two sources of information. Findings were reviewed in conjunction with a third source, a recently published meta-synthesis of existing literature of women’s own accounts of FOC. The key elements of FOC were determined via presence in two out of the three sources at least one of which was from women themselves, i.e. the reports of the women interviewed or the meta-synthesis. Results Seven themes were identified by the women and the consultant midwives: Fear of not knowing and not being able to plan for the unpredictable, Fear of harm or stress to the baby, Fear of inability to cope with the pain, Fear of harm to self in labour and postnatally, Fear of being ‘done to’, Fear of not having a voice in decision making and Fear of being abandoned and alone. One further theme was generated by the women and supported by the reports included the meta-synthesis: Fear about my body’s ability to give birth. Two further themes were generated by the consultant midwives and were present also in the meta-synthesis: Fear of internal loss of control and Terrified of birth and not knowing why. Conclusions Ten key elements in women’s FOC were identified. These can now be used to inform development of measurement tools with verified content validity to identify women experiencing FOC, to support timely access to support during pregnancy. Electronic supplementary material The online version of this article (10.1186/s12884-019-2241-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P Slade
- Institute of Health and Life Sciences, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - K Balling
- Institute of Health and Life Sciences, University of Liverpool, Ground Floor Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - K Sheen
- Natural Sciences and Psychology, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - G Houghton
- Liverpool Women's Hospital Foundation Trust, Crown Street, Liverpool, L8 7SS, UK
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Abstract
OBJECTIVE The current study aimed to explore student midwives' awareness, knowledge, and experiences of supporting women with antenatal anxiety (ANA) within clinical practice. BACKGROUND ANA is associated with negative outcomes for mother and baby. Midwives play a key role in the screening of antenatal mental health and care of women suffering from ANA. METHODS This study was conducted with student midwives at one UK university in the north-west of England. Twenty-five midwifery students completed a brief online survey informed by National Institute of Health and Care Excellence (NICE) guidelines. Of these, seven volunteered to participate in semi-structured interviews exploring the survey data. The interview topic guide was designed based on the findings of the survey. RESULTS Thematic analysis of the seven interviews revealed four overarching themes: Perpetuating factors, Barriers to care, Skills required in role and Suggestions for future directions. Midwives had a varied knowledge and understanding of ANA and expressed a desire to learn more about their role in supporting women with ANA. CONCLUSION Although a small study, the results highlight the need for education to be improved in order to best prepare student midwives for cases of ANA, with emphasis on integrating psychology and mental health information into teaching as well as time spent in clinical practice. Midwives are key in the screening of women for ANA and are in an ideal position to signpost for specialist care.
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Affiliation(s)
- Alex McGookin
- a Division of Psychology and Mental Health , University of Manchester , Manchester , UK
| | - Christine Furber
- b School of Nursing, Midwifery & Social Work , University of Manchester , Manchester , UK
| | - Debbie M Smith
- a Division of Psychology and Mental Health , University of Manchester , Manchester , UK
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Akiki S, Avison WR, Speechley KN, Campbell MK. Determinants of maternal antenatal state-anxiety in mid-pregnancy: Role of maternal feelings about the pregnancy. J Affect Disord 2016; 196:260-7. [PMID: 26945124 DOI: 10.1016/j.jad.2016.02.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 02/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current state of research into antenatal anxiety is lacking in a comprehensive understanding of determinants. This study aims to expand knowledge in this area, with the main objective being to determine potential determinants of maternal antenatal state-anxiety. METHODS Data used for this cross-sectional study were obtained from the Prenatal Health Project: a population cohort study of 2357 women in London, Ontario. 1992 women in their second trimester met inclusion criteria for this study. The primary hypothesis was that "feelings about the pregnancy" would be a determinant of antenatal state-anxiety after controlling for other potential covariates. The abbreviated version of the Spielberger State and Trait Anxiety Inventory (STAI) was used to measure state-anxiety. Univariate analyses and multiple linear regression were performed to identify variables predictive of state-anxiety. RESULTS Stress, feeling unsure/unhappy about the pregnancy and having low self-esteem, low mastery and low social support from one's partner and family were statistically significant determinants of state-anxiety during the second trimester. In addition, anxiety was found to be inversely related to gestational age. LIMITATIONS The two main limitations of the study were the use of a self-report screening tool (STAI) as the measure of anxious symptoms rather than a clinical diagnosis, and possible recall bias of feelings about the pregnancy. CONCLUSIONS We concluded that how a woman feels about her pregnancy was a determinant of state-anxiety. This study contributes knowledge aiming to help women improve their mental health during pregnancy by identifying important determinants of state-anxiety.
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Affiliation(s)
- Salwa Akiki
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - William R Avison
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Department of Paediatrics, University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Department of Sociology, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Kathy N Speechley
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Department of Paediatrics, University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - M Karen Campbell
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada; Department of Paediatrics, University of Western Ontario, London, Ontario, Canada; Department of Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
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Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord 2016; 191:62-77. [PMID: 26650969 PMCID: PMC4879174 DOI: 10.1016/j.jad.2015.11.014] [Citation(s) in RCA: 792] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression. METHODS A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected. RESULTS The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss. LIMITATIONS The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period. CONCLUSIONS The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.
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Affiliation(s)
- Alessandra Biaggi
- PO63 Section of Perinatal Psychiatry, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Susan Conroy
- Section of Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Susan Pawlby
- Section of Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Carmine M Pariante
- Section of Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
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Kingston D, Austin MP, Heaman M, McDonald S, Lasiuk G, Sword W, Giallo R, Hegadoren K, Vermeyden L, van Zanten SV, Kingston J, Jarema K, Biringer A. Barriers and facilitators of mental health screening in pregnancy. J Affect Disord 2015; 186:350-7. [PMID: 26281038 DOI: 10.1016/j.jad.2015.06.029] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Access to mental health services during pregnancy is most commonly mobilized through formal mental health screening. However, few studies to date have identified barriers and facilitators that affect pregnant women's responses to mental health screening. The objective was to identify barriers and facilitators that influence pregnant women's responses to the screening process and factors associated with their identification. METHODS This multi-site, cross-sectional survey recruited pregnant women >16 years of age who spoke/read English in Alberta, Canada. Main outcomes were barriers and facilitators of mental health screening. Descriptive statistics were generated to identify the most common barriers and facilitators and multivariable logistic regression models were conducted to determine factors associated with barriers and facilitators. RESULTS Study participation rate was 92% (460/500). Women's most common barriers were: significant others normalizing their emotional difficulties; desiring to handle mental health problems on their own; preferring to discuss feelings with significant others; and not knowing what emotions were 'normal'. Women who identified these barriers were more likely not to have been treated previously for mental illness, were primiparous, and could not be completely honest with their provider. Main facilitators were provider characteristics (sensitive, interested), reassurance that mental healthcare is a part of routine prenatal care, hearing that other women have emotional problems during pregnancy and knowing that help was available. LIMITATIONS The sample comprised largely Caucasian, well-educated, and partnered women, which limits generalizability of the findings. CONCLUSIONS Personal and stigma-related barriers influence pregnant women's responses to mental health screening. Efforts to minimize barriers and enhance facilitators should be explored as potential strategies for optimizing prenatal mental health screening.
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Abstract
Women's antenatal anxiety, especially if paired with significant life stressors or comorbid physical or mental health disorders, can predict adverse birth outcomes, defined in terms of birth weight, gestational age at birth and obstetric complications. Here, we tested for an impact of moderate anxiety symptoms on these outcomes because many women experience these kinds of symptoms during pregnancy, and even subtle differences in birth outcomes can have significant effects on children's development. We also tested for moderation of anxiety effects by infant gender. The sample comprised 219 women with anxiety symptoms ranging from none to moderate levels on the Beck Anxiety Inventory. Multivariate models estimated main effects of Group (no/minimal versus moderate symptoms) and interactions between Group and infant Gender. Results indicate that moderate anxiety predicted more obstetric complications, particularly among mothers of daughters. Results also demonstrate a Group × Gender interaction on BW, indicating that sons of anxious mothers weighed more than sons of controls; whereas, daughters of anxious mothers weighed less than daughters of controls. These findings show that moderate anxiety symptoms may affect some birth outcomes, and differently for males and females.
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Affiliation(s)
- Marsha Kaitz
- Department of Psychology, Hebrew University , Mount Scopus, Jerusalem , Israel
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