Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period: a systematic review

Women's Mental Health and Addiction Research Section, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
The Journal of Clinical Psychiatry (Impact Factor: 5.14). 09/2006; 67(8):1285-98. DOI: 10.4088/JCP.v67n0818
Source: PubMed

ABSTRACT The postpartum period is recognized as a time of vulnerability to affective disorders, particularly postpartum depression. In contrast, the prevalence and clinical presentation of anxiety disorders during pregnancy and the postpartum period have received little research attention. In this article, we review the medical literature as it relates to the prevalence and clinical presentation of panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder during pregnancy and the postpartum period.
MEDLINE (1966 to July 2005 week 1) and PsycInfo (1840 to July 2005 week 1) were searched using combinations of the following search terms: pregnancy, childbirth, postpartum, panic disorder, phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder.
All relevant papers published in English and reporting original data related to perinatal anxiety disorders were included.
Studies were examined for data related to the prevalence, presentation, predictors/risk factors, new onset, course, and treatment of anxiety disorders during pregnancy and the postpartum period.
Anxiety disorders are common during the perinatal period, with reported rates of obsessive-compulsive disorder and generalized anxiety disorder being higher in postpartum women than in the general population. The perinatal context of anxiety disorders presents unique issues for detection and management.
Future research is needed to estimate the prevalence of perinatal anxiety disorders more precisely, to identify potential implications of maternal anxiety disorders for maternal quality of life and child development, and to determine safe and effective treatment methods.

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Available from: Linda M Mclean, Aug 28, 2015
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    • "Since the last three decades in the 20th century, some empirical evidence has associated this biopsychosocial process with the onset, relapse or exacerbation of different mental disorders in women, with much research focusing on the onset of depressive episodes and psychotic symptoms during the puerperium (Hudak & Wisner, 2012; Spinelli, 2009; Steiner, Dunn, & Bom, 2003). In this general context, anxious psychopathology did not arouse much clinical interest until the mid-1990s, when incipient literature started to develop with the assessment of obsessive-compulsive disorder being the main focus of attention (Matthey, Barnett, Howie, & Kavanagh, 2003; Ross & McLean, 2006). "
    Anales de Psicología 10/2014; · 0.55 Impact Factor
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    • "In Western nations, psychological morbidity in childbearing women is a major public health problem (Munk-Olsen et al., 2006; Ross and McLean, 2006). Between 10% and 15% of women suffer postnatal depression although recent studies suggest the rate of postnatal depression may be climbing (Brown and Lumley, 1998; Saurel-Cubizolles et al., 2000; Austin et al., 2010; Beyondblue, 2011). "
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    ABSTRACT: Background Around 20% of women suffer childbirth fear causing them significant distress and often leading to requests for caesarean section. In Sweden, fearful pregnant women are offered counselling, however in Australia no dedicated service caters for the specific needs of these women. Indeed scant research has been conducted in Australia and little is known about women's concerns and if these align to those reported in the international literature. Aim To describe the sources, responses and moderators of childbirth fear in a group of pregnant women assessed as having high levels of childbirth fear. Method Comparative analysis was used to identify common concepts and generate themes that represented women's perspectives of childbirth fear. Data consisted of 43 tape recorded telephone conversations with highly fearful pregnant women who were participating in a large randomised controlled trial known as BELIEF (Birth Emotions, Looking to Improve Expectant Fear). Findings Women's fears were conceptualised into three themes: fear stimuli; fear responses; and fear moderators. Lack of confidence to birth, fear of the unknown, internalising other women's negative stories, perineal tearing and labour pain were common concerns for first time mothers. For multiparous women: not having had personal feelings resolved following their previous birth and negative experiences of last birth; influenced current expectations for their upcoming birth. Themes common to both groups were; unmet information and support needs, feelings of loss of control and lack of input in to decision-making. Some women however, chose to avoid birth planning in order to cope during pregnancy. Conclusion Australian women had similar childbirth concerns to those reported in the international literature. However unique to this study was finding two opposing discourses; one of preoccupation with negative events and the other; avoidance of planning for labour and birth. Provision of woman centred maternity models that minimise obstetric intervention, offer personalised conversations following birth, and are sensitive to identifying; listening and assisting women to modify their fears in early pregnancy are required to promote positive anticipation and preparation for birth.
    Midwifery 09/2014; 31(1). DOI:10.1016/j.midw.2014.09.003 · 1.71 Impact Factor
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    • "Alors que la dépression postnatale a fait l'objet de très nombreuses recherches, et affecte environ 19 % des femmes dans les semaines qui suivent l'accouchement à terme [8], les troubles anxieux survenant en période du post-partum ont été moins étudiés [9]. À ce jours, les résultats concernant la prévalence de ces troubles sont inconsistants [4], cependant il a été suggéré qu'environ 13 % des parturientes pourraient souffrir de symptômes cliniques d'anxiété post-accouchement tels que des préoccupations exagérées ou des difficultés d'endormissement 6—10. Le caractère potentiellement traumatique de l'accouchement est largement admis 1—3 et peut conduire les femmes à développer un état de stress post-traumatique (ESPT). "
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    ABSTRACT: Objectives Empirical data regarding depressive, anxiety and posttraumatic stress disorder (PTSD) symptom profile following premature birth are lacking. The present study aims to: firstly, identify the typology of women who delivered prematurely based on anxiety, depressive and PTSD symptoms; and secondly, examine whether these profiles differ on maternal perception of infant temperament, mother–infant bond and maternal involvement in infant care during the hospitalization process. Participants and method Within four weeks of a preterm infant's hospital discharge, 110 French mothers (mean age [SD] = 29.5 [4.3] years) completed questionnaires assessing PTSD symptoms, depressive and anxiety symptoms, maternal involvement in infant care, maternal perception of infant temperament and mother–infant bound. Results Three profiles were highlighted: a first one labeled “resilient group” (n = 41, 37 % of the sample), a second one labeled “depressive group” (n = 23, 21 % of the sample), and a third one labeled “depressive-anxious-traumatized group” (n = 46, 42 % of the sample). Our findings also highlight a negative impact of postpartum depressive symptoms on mother–infant bond. Discussion Within four weeks of infant's hospital discharge, only a third of mothers exhibited a resilient profile, while depressive symptom severity seems to have a negative impact on mother–infant bond. Further research focusing on the impact of postpartum depression using direct observation and developing is warranted.
    Journal de Pédiatrie et de Puériculture 09/2014; DOI:10.1016/j.jpp.2014.03.003
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