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The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis
Abstract
Objective: To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates.
Data Sources: An electronic search of PsycINFO and PubMed was conducted from inception until July 2016, without date or language restrictions, and supplemented by articles referenced in the obtained sources. A Boolean search phrase utilized a combination of keywords related to pregnancy, postpartum, prevalence, and specific anxiety disorders.
Study Selection: Articles reporting the prevalence of 1 or more of 8 common anxiety disorders in pregnant or postpartum women were included. A total of 2,613 records were retrieved, with 26 studies ultimately included.
Data Extraction: Anxiety disorder prevalence and potential predictor variables (eg, parity) were extracted from each study. A Bayesian multivariate modeling approach estimated the prevalence and between-study heterogeneity of each disorder and the prevalence of having 1 or more anxiety disorder.
Results: Individual disorder prevalence estimates ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobia, with the prevalence of having at least 1 or more anxiety disorder estimated to be 20.7% (95% highest density interval [16.7% to 25.4%]). Substantial between-study heterogeneity was observed, suggesting that “true” prevalence varies broadly across samples. There was evidence of a small (3.1%) tendency for pregnant women to be more susceptible to anxiety disorders than postpartum women.
Conclusions: Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.
... A total of 215 patients expressed their desire to participate in the study, selected based on the following inclusion criteria: age ≥ or equal to 16 years, with a minimum level of education (be able to read and understand a text), third trimester of pregnancy (week [28][29][30][31][32][33][34][35][36][37][38][39][40], the patient's consent. ...
... (2014)[38] found that prevalence rates of anxiety symptoms in pregnant women in Australia ranged from 6.8% to 59.5%. Similarly, studies in Canada (Dennis et al., 2017; Fawcett et al., 2019) [38,39] and the United Kingdom (Nielsen-Scott et al., 2019) ...
Pregnancy represents a psychologically and emotionally vulnerable period, and research indicates that pregnant women have a higher prevalence of symptoms of anxiety and depression, debunking the myth that hormonal changes associated with pregnancy protect the mother. In recent years, several researchers have focused on the study of prenatal anxiety/depression—emotional disorders manifested by mood lability and low interest in activities—with a high prevalence. The main objective of this research was to conduct an antenatal screening in a cohort of pregnant women hospitalized for delivery in order to assess the prevalence of anxiety and depression. The secondary objective was to identify the risk factors associated with depression and anxiety in women in the third trimester of pregnancy. We carried out a prospective study in which we evaluated 215 pregnant women in the third trimester of pregnancy hospitalized for childbirth at the Obstetrics and Gynecology Clinic of the Târgu-Mureș County Clinical Hospital. The research was carried out between December 2019 and December 2021. The results showed that age and the environment of origin are the strongest predictors of mental health during pregnancy (OR = 0.904, 95%CI: 0.826–0.991; p = 0.029). For women from urban areas, there is an increased probability of falling at a higher level on the dependent variable (moderate depression) (OR = 2.454, 95%CI: 1.086–5.545; p = 0.032). In terms of health behaviors, none of the variables were statistically significant predictors of the outcome variable. The study highlights the importance of monitoring mental health during pregnancy and identifying relevant risk factors to provide appropriate care to pregnant women and the need for interventions to support the mental health of pregnant women. Especially in Romania, where there is no antenatal or postnatal screening for depression or other mental health conditions, these results could be used to encourage the implementation of such screening programs and appropriate interventions.
... Stress and anxiety are frequent occurrences among pregnant women. Peripartum anxiety disorders are more prevalent than previously thought, as 1 in 5 women can suffer from them [14]. Mental disorders can appear before pregnancy, with a changing course during pregnancy and postpartum. ...
... During pregnancy, evidence has been provided regarding the potential beneficial effects that structured dietary interventions based on a MedDiet can have, not only on pregnant women [9,13,14], but also their offspring and the pregnancy itself. In a recent randomized clinical trial, pregnant individuals at high risk for small-for-gestational-age newborns (SGA) who followed a structured MedDiet intervention significantly reduced the incidence of newborns being born small (with birth weight below the 10th percentile) and other perinatal complications [17]. ...
Stress and anxiety are frequent occurrences among pregnant women. We aimed to evaluate the effects of a Mediterranean diet intervention during pregnancy on maternal stress, well-being, and sleep quality throughout gestation. In a randomized clinical trial, 1221 high-risk pregnant women were randomly allocated into three groups at 19–23 weeks’ gestation: a Mediterranean diet intervention, a Mindfulness-Based Stress Reduction program, or usual care. All women who provided self-reported life-style questionnaires to measure their anxiety (State Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS)), well-being (WHO Five Well Being Index (WHO-5)), and sleep quality (Pittsburgh sleep quality index (PSQI)) at enrollment and at the end of the intervention (34–36 weeks) were included. In a random subgroup of 106 women, the levels of cortisol and related metabolites were also measured. At the end of the intervention (34–36 weeks), participants in the Mediterranean diet group had significantly lower perceived stress and anxiety scores (PSS mean (SE) 15.9 (0.4) vs. 17.0 (0.4), p = 0.035; STAI-anxiety mean (SE) 13.6 (0.4) vs. 15.8 (0.5), p = 0.004) and better sleep quality (PSQI mean 7.0 ± 0.2 SE vs. 7.9 ± 0.2 SE, p = 0.001) compared to usual care. As compared to usual care, women in the Mediterranean diet group also had a more significant increase in their 24 h urinary cortisone/cortisol ratio during gestation (mean 1.7 ± SE 0.1 vs. 1.3 ± SE 0.1, p < 0.001). A Mediterranean diet intervention during pregnancy is associated with a significant reduction in maternal anxiety and stress, and improvements in sleep quality throughout gestation.
... A population group that is particularly vulnerable to the negative impacts on mental health caused by the pandemic, deserving special attention, is postpartum women. Extensive pre-pandemic studies have already characterized the puerperium as a period of significant vulnerability to the emergence of mental health disorders, with depression and anxiety being the most common conditions (Fawcett et al., 2019;Nakić Radoš et al., 2018;Shorey et al., 2018;Woody et al., 2017), which often co-occur (Farr et al., 2014). The meta-analysis by Shorey et al. (2018) found a 17% overall prevalence of postpartum depression (PPD) among healthy mothers with no previous history of depression. ...
... Along the same lines, in the systematic review and metaanalysis by Woody et al. (2017), the global prevalence of depression in the perinatal period was 11.9%, with women from low-and middle-income countries more affected than those from high-income countries. The estimated prevalence of suffering from at least one anxiety disorder during the perinatal period is 20.7%, affecting approximately 1 in 5 women (Fawcett et al., 2019). Farr et al. (2014) investigated the comorbidity of anxiety and depression symptoms in a sample of 4451 postpartum women. ...
... As mulheres no puerpério fazem parte de um grupo da população que é particularmente vulnerável aos impactos negativos causados pela pandemia na saúde mental e que merece especial atenção. Uma ampla pesquisa pré-pandemia caracterizava já o puerpério como um período de grande vulnerabilidade para emergência de problemas de saúde mental, sendo a depressão e a ansiedade as condições que ocorrem mais frequentemente (Fawcett et al., 2019;Nakić Radoš et al., 2018;Shorey et al., 2018;Woody et al., 2017) e muitas vezes de forma simultânea (Farr et al., 2014). A metanálise realizada por Shorey et al. (2018) encontrou uma prevalência global de depressão pós-parto (DPP) de 17% entre mães saudáveis, sem história prévia de depressão. ...
... Nessa mesma linha, na revisão sistemática e metanálise de Woody et al. (2017), a prevalência global de depressão no período perinatal foi de 11.9%, sendo as mulheres provenientes de países de baixa e média rendas mais afetadas que as de países de alta renda. Já a prevalência estimada de sofrer de pelo menos um transtorno de ansiedade durante o período perinatal foi de 20.7%, afetando aproximadamente uma em cinco mulheres (Fawcett et al., 2019) e escolaridade, e também informação sobre a gravidez (por exemplo: se era a primeira gravidez e idade do bebê). ...
... Additionally, in accordance with the literature, anxiety symptoms surpassed the diagnostic threshold (GAD-7 score > 9) for nearly 20% of the subjects, with three-fourths of them experiencing moderate anxiety symptoms. These results are similar to those found in previous scienti c research on gestational depression and gestational anxiety [48,49]. Moreover, a 2012 Italian study reported similar data, both with depression and anxiety rates during pregnancy [50]. ...
Introduction. During pregnancy, the body undergoes extreme changes that can lead to dissatisfaction and a loss of self-esteem. This vulnerability arises from objective physical changes and societal pressures to conform to beauty norms. This study aimed to investigate the presence of body dissatisfaction and its association with depression and anxiety in a sample of pregnant women.
Methods. A cross-sectional digital survey was administered between May and June 2022. The survey included sociodemographic, pregnancy, weight-nutritional, and mental health domains. The latter included an exploration of psychiatric self-reported history alongside standardized instruments for evaluating body dissatisfaction (Eating Disorder Examination Questionnaire, EDE-Q), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms (General Anxiety Disorder-7, GAD-7). Subsequently, the dataset underwent descriptive analyses, followed by applying Kendall’s Tau correlations and linear regression models to explore the association between depression, anxiety, and body dissatisfaction.
Results. Within our sample (N = 711), one in ten subjects reported body dissatisfaction during pregnancy, with nearly half experiencing symptoms indicative of anxiety and depression. Body dissatisfaction was found to be associated with anxious-depressive symptoms and with a history of depression.
Conclusions. The conspicuous prevalence of body dissatisfaction, associated with depression and anxiety, suggests considering the issue of body experience as an indicative marker of perinatal emotional distress. This justifies the need for in-depth exploration within clinical settings, where opportunities for therapeutic interventions can be explored.
... Numerous studies have separately examined the prevalence of anxiety and depressive symptoms during pregnancy and postpartum. Approximately 1 in 5 women experience anxiety during these stages [3]. According to the World Health Organization (WHO), around 10% of pregnant women and 13% of postpartum women face mental health issues, predominantly depression or anxiety [4]. ...
Background
Psychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum.
Methods
A cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions.
Results
The prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (β = 1.776, P < 0.001), as well as its three subscales: somatization (β = 1.355, P = 0.019), anxiety symptoms (β = 2.249, P < 0.001), and depressive symptoms (β = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (β = 1.344, P = 0.038) and the somatization subscale (β = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (β = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (β = 1.998, P = 0.012) and depressive symptoms (β = 1.949, P = 0.020).
Conclusion
The high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits.
... Depression and anxiety affect up to 18.4% and 20.7% of pregnant and postpartum people, respectively [1,2], and research has suggested that they increase risk for adverse outcomes, ranging from pre-term delivery [3] to postpartum depression [4]. Prior history of depression and anxiety has been demonstrated as a strong predictor of perinatal (both antenatal and postnatal) mood disorder [5]. ...
Background
Depression and anxiety are highly prevalent within the perinatal period and have been associated with myriad adverse pregnancy and birth outcomes. In this study, we sought to investigate whether population-based data can be used to build complex, longitudinal mental health histories that improve our ability to predict adverse pregnancy and birth outcomes.
Methods
Using population-based, administrative datasets, we examined individual-level mental health services use of all birth parents who delivered a live infant in British Columbia, Canada between April 1, 2000, and December 31, 2013, and who were registered with the provincial Medical Services Plan for over 100 days per year from 10-years preconception to 1-year postpartum. We operationalized variables to proxy severity, persistence, and frequency of depression/anxiety from preconception through pregnancy, then constructed predictive regression models for postpartum depression/anxiety and preterm birth.
Results
Predictive modeling of postpartum depression/anxiety and preterm birth revealed better predictions and stronger performance with inclusion of a more detailed preconception mental health history. Incorporating dichotomous indicators for depression/anxiety across preconception markedly improved predictive power and model fit. Our detailed measures of mental health service use predicted postpartum depression/anxiety much better than preterm birth. Variables characterizing use of outpatient psychiatry care and outpatient visit frequency within the first five years preconception were most useful in predicting postpartum depression/anxiety and preterm birth, respectively.
Conclusion
We report a feasible method for developing and applying more nuanced definitions of depression/anxiety within population-based data. By accounting for differing profiles of mental health treatment, mental health history, and current mental health, we can better control for severity of underlying conditions and thus better understand more complex associations between antenatal mental health and adverse outcomes.
... Postnatal anxiety tends to be more prevalent than postnatal depression in high-income countries [14], whereas higher rates of postnatal depression have been observed in lowto middle-income countries [16]. However, anxiety and depression often co-exist [17,18] or are comorbid with other mental health conditions, such as post-traumatic stress disorder [19,20]. ...
Background
Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input.
Method
Eight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined.
Results
From the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion.
Conclusion
Perinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.
... Maternal mental health problems also impact child health such as adverse birth outcomes [13,14], and emotional, behavioural, and developmental issues in childhood [13,15,16]. Recent reviews have reported the prevalence of antenatal and postnatal anxiety at 15-20% and 10%, respectively [17][18][19], with 17% of mothers experiencing postnatal depression [20]. Young pregnant women are particularly vulnerable to poor mental health and wellbeing [17,21]. ...
Green prescribing is gaining in popularity internationally for the promotion of mental wellbeing. However, the evidence base is limited, particularly in young pregnant women, a population with known risk factors for anxiety and depression. The aim of this mixed-methods study was to provide insights into the availability, processes, and suitability of nature-based interventions for young pregnant women. First, an online mapping survey of nature-based activities in the East Midlands region of the United Kingdom (UK) was undertaken. Second, focus groups (n = 6) were conducted with nature activity providers and young mothers (n = 11). This study found there were many diverse nature-based activities available to promote mental wellbeing. The organisational challenges highlighted include a lack of sufficient funding for service provision and disappointing experiences with some green prescribing programmes. The young women felt that nature-based activities helped to promote their mental wellbeing, and also offered an opportunity for social support. The facilitators, such as having detailed information and being accompanied to initial sessions to ease anxieties, were found to maximise the women’s engagement with nature-based interventions. This study provides new perspectives on nature-based interventions from service providers and young women. Findings on the organisational barriers and facilitators to delivering interventions will inform the design of much needed future experimental research.
... 27 Prevalence among perinatal individuals is similar, with 1 in 5 women experiencing mental health problems like depression, anxiety, PTSD, or obsessive-compulsive disorder. 28 The numbers rise considerably if women experience violence or are from a high-risk group. 29 Byatt et al. 30 reported that 75% of women with mental health problems do not receive treatment. ...
Background
Use of cannabis during pregnancy and breastfeeding is increasing. Mental health concerns are reported as common reasons for maternal cannabis use, but little is known about the use of psychiatric medications in this population.
Objectives
This study aimed to describe psychiatric medication use among pregnant and breastfeeding mothers who used cannabis for mental health concerns.
Design
Anonymous, online cross-sectional survey.
Methods
Data were collected from May 2018 to August 2019 among pregnant and breastfeeding mothers who used cannabis. This study included mothers who reported cannabis use for mental health concerns (n = 1363). The survey assessed the timing of cannabis use (during pregnancy and/or lactation); use of cannabis to address depression, posttraumatic stress disorder, or anxiety; use of psychiatric medications; psychiatric distress (Patient Health Questionnaire-4); and demographic information. Differences between groups were examined using t-test and chi-square test in SPSS.
Results
The mean age was 29.7 years; most were married (62%); 74% were White non-Hispanic, 9% Hispanic, and 17% Black, Indigenous or other People of Color. Mental health symptoms prompting cannabis use included anxiety (96%), depression (75%), and posttraumatic stress disorder (36%). Only 24% of respondents (n = 322) reported concomitant use of psychiatric medications, primarily selective serotonin reuptake inhibitors (72%, n = 232) and benzodiazepines (21%, n = 68). The composite Patient Health Questionnaire-4 showed most respondents had no (61%) or mild (27%) psychological distress; 14% screened positive for depression; and 17% screened positive for anxiety. Respondents who used psychiatric medications more often screened positive mental health concerns.
Conclusion
Most mothers who used cannabis for mental health concerns were not taking psychiatric medications. This may be due to a mismatch between perceived mental health and screening results, un- or under-treated mental illness, or preference for cannabis over psychiatric medications. Improved management of perinatal mental health and effective patient education about risks of cannabis versus medication use are needed.
... [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Maternal mental health conditions, including depression, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar illness, and substance use disorders, are the most common complications of pregnancy and childbirth in the United States, affecting 1 in 5 or 800,000 people each year. [17][18][19] Screening for stress during pregnancy may help identify people who can benefit from stress-reduction interventions to mitigate prenatal stress and associated maternal and fetal outcomes. ...
Background:
Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood.
Objective:
To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration.
Eligibility criteria:
We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool.
Sources of evidence:
We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022.
Charting methods:
Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress.
Results:
An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress.
Conclusions:
Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
... Bipolar disorder and postpartum stress are also higher in pregnant women when compared to non-pregnant women [4]. Despite these reported numbers, up to 70% of cases go untreated and unreported [5]. ...
Background:
Pregnancy and postpartum period are associated with stress and pain. Chronic medical conditions can aggravate depressive and psychotic mental illnesses in the peripartum period.
Aim:
The study aimed to investigate the association between different chronic medical conditions and mental illnesses during pregnancy and the postpartum period using the National Inpatient Sample (NIS).
Methods:
Pregnant women or women in the postpartum period were retrieved from the NIS 2016-2019 database using the International Classification of Diseases (ICD)-10 and set as our targeted population. Postpartum depression, puerperal psychosis, and mental illnesses related to pregnancy were also retrieved as our outcomes of interest. STATA 15 was used to analyze the data and investigate the relationship between chronic medical conditions and pregnancy-related mental illnesses.
Results:
2,854,149 admissions were retrieved from the database with a mean age of 29 ± 6 years old. Univariate and multivariate analyses showed a significant association between chronic medical conditions and postpartum depression, puerperal psychosis, and other mental illnesses. On univariate analysis, heart failure (odds ratio [OR] = 13.9; 95% confidence interval [CI] = 3.5-55.88; P < 0.001), alcohol misuse (OR = 5.3; 95% CI = 1.7-16.4; P = 0.004), and migraine (OR = 3.9; 95% CI = 2.8-5.3; P < 0.001) showed high association with postpartum depression. Epilepsy (OR = 54.37; 95% CI = 7.4-399.34; P < 0.001), systemic lupus erythematosus (OR = 24.66; 95% CI = 3.36-181.1; P = 0.002), and heart diseases (OR = 15.26; 95% CI = 3.6-64.5; P < 0.001) showed the highest association with puerperium psychosis. Alcohol misuse (OR = 8.21; 95% CI = 7.4-9.12; P < 0.001), osteoarthritis (OR = 6.02; 95% CI = 5.41-6.70; P < 0.001), and migraine (OR = 5.71; 95% CI = 5.56-5.86; P < 0.001) showed the highest association with other mental illnesses during pregnancy and the postpartum period.
Conclusion:
Heart diseases, alcohol misuse, migraine, systemic lupus erythematosus, and epilepsy were the most important chronic medical conditions associated with mental diseases during pregnancy and the postpartum period. This investigation recommends integrating management of chronic diseases and mental health care together. Specifically, screening for mental illnesses should be a routine part of care for patients with chronic medical conditions, especially during pregnancy and early postpartum. By identifying and addressing mental health issues early on, healthcare providers can improve the overall health and well-being of these patients, ultimately leading to better maternal and fetal outcomes.
... Evidence suggests that psychopathology during the postpartum period is common (O'Hara & Wisner, 2014;Grekin, O'Hara, 2014;Falah-Hassani et al., 2017). However, while postpartum depression has received significant attention (e.g., Stewart & Vigod, 2019;Shorey et al., 2018), anxiety has been less studied, despite being identified as a significant component of postpartum maternal distress (Dennis et al., 2018;Fawcett et al., 2019). Indeed, postpartum anxiety has a high prevalence, affecting 15-30% of women (Zappas et al., 2021;Cena et al., 2021). ...
Postpartum anxiety is a significant component of postpartum maternal distress and is related to adverse outcomes for both the mother and the child. Although previous research reported higher anxiety symptoms in pregnant women during the Covid-19 pandemic, no studies evaluated the negative impact of pandemic-related perceived stress on postpartum anxiety symptomatology over time. This study aimed to examine the impact of prepartum pandemic-related stress on postpartum anxiety and to evaluate the role of subjective labor and delivery experiences on this relationship. A sample of 172 pregnant women completed an online questionnaire evaluating pandemic-related perceived stress and anxiety symptoms in the second or third trimester of pregnancy. In the postpartum, they completed a second questionnaire retrospectively evaluating their childbirth experience and assessing anxiety symptoms in the last two weeks. A mediation analysis was conducted. Prepartum pandemic-related perceived stress was significantly associated with postpartum anxiety symptoms. Moreover, childbirth experiences significantly and partially mediated this relationship. Findings highlighted the importance of evaluating perceived stress levels during pregnancy to prevent negative consequences on postpartum mental health. Clinicians need to foster better management of factors included in the childbirth experience that may potentially trigger or counteract anxiety risk.
... Anxiety disorders during pregnancy and the postpartum period are quite common. According to various data, 20-30% of women have certain disorders of the anxiety spectrum (Fawcett et al., 2019;Levine et al., 2003). In addition, anxiety and fear are typical emotional reactions to war-related events (Riad et al., 2022); this is especially true for people with psychiatric problems (Nowicka et al., 2023;Sternik et al., 1999). ...
Objective:
Pregnancy and childbirth are related to the experience of distress at their core. However, this distress is significantly increased under war conditions. The study aims to examine the perinatal experience of women during the war in Ukraine.
Methods:
12 Ukrainian women who were pregnant and lived in Kyiv or the suburbs of Kyiv from February to May 2022 took part in the study. In-depth interviews were conducted online in the form of semi-structured interviews, and the thematic analysis technique was used.
Results:
The perinatal experiences of women during the war in Ukraine were divided into 2 basic groups: negative perinatal experiences and positive perinatal experiences during the war. The negative perinatal experiences were grouped into three main themes: 1) negative emotions experienced in association with war, 2) dissatisfaction with medical support during the war, 3) suffering associated with separation from a husband and relatives. The positive perinatal experiences include 6 main themes: 1) the joy of returning or/and staying home, 2) satisfaction with medical support during the war, 3) coping with stress during the war, 4) family relationships and support during the war, 5) positive attitudes towards the child (or unborn child), 6) patriotic sentiments.
Conclusion:
The study revealed negative and positive aspects of the perinatal experience of Ukrainian women during the war. Providing access to medical advice, facilitating uncertainty reduction, and communication between women and their families contribute to positive perinatal experiences of pregnant women and new mothers during the war.
... For example, 10-20% of women experience depression during pregnancy or the early postpartum (Van Niel and Payne, 2020), with up to 37% experiencing some depressive symptoms (Lee et al., 2007). A recent meta-analysis indicated the prevalence of women experiencing any anxiety disorder is between 16.7% and 25.4% during pregnancy and the postpartum period (Fawcett et al., 2019). This research underscores the public health importance of understanding the distress experienced by pregnant and early postpartum women. ...
... It leads to long-term negative effects for infants as well as their mothers and fathers. The data before the COVID-19 pandemic show that 1 in 5 women will develop psychiatric disorders in the perinatal period [14][15][16]. On the other hand, the limited data that have been published so far show that an increase in mental disorders in pregnant and postpartum women has been observed since the beginning of the COVID-19 pandemic [17,18]. ...
... These changes will result in greater milk supply and an easier sucking experience for the infant. 3 The higher the nutritional behaviour score of the infant, which includes the ability to sucking milk, will lead to more pleasant breastfeeding in the initial hours after delivery, in addition to many other advantages, both short-term and long-term, of breastfeeding. 4 According to Maldonado-Duran's research, which was cited by Dokuhaki et al., a mother's stress and unpleasant experiences during pregnancy may have a detrimental impact on the physical growth, motor-behavioral development, and psychological development of their unborn child. 5 In addition, babies born to mothers who did not form a strong relationship to their unborn child during pregnancy and who suffered from postpartum depression were more likely to have delayed cognitive and social development. ...
Objective: frequency of antenatal anxiety in pregnant women undergoing cesarean section Methodology: A total of 100 patients fulfilling selection criteria were enrolled in the study through OPD Department of Obstetrics & Gynaecology, Nishter Medical University, Multan. Demographical information like age, gestational age and parity was recorded. All the cases were evaluated through The Hamilton Anxiety, rating scale (HAM-A) and positive cases (anxiety) were recorded on a pre-designed proforma as described in operational definitions. Severity of anxiety was also recorded. Patients with anxiety were managed as per standard protocols. Results: In our study, of 100 cases, mean age as 30.45+5.02 years, mean gestational age was 39.35+1.17 weeks, mean parity was 2.34+0.93, mean Hamilton Anxiety Rating scale of the patients was 17.48+7.42 with minimum 3.00 and maximum 30.00. Frequency of anxiety status of the patients shows that 13(16.3%) had no anxiety, 29(36.3%) had mild, 20(25%) had moderate and 18(22.4%) had severe anxiety. Practical Implication: determination of the antenatal anxiety in pregnant women undergoing cesarean section would help in the prevention and early management of anxiety in our population. Conclusion: According to this study, 16.3% of pregnant women undergoing cesarean section had antenatal anxiety Keywords: Pregnant women, cesarean section, elective, emergency antenatal anxiety, Hamilton Anxiety, rating scale
... Around 10-20% of women experience prenatal depression and anxiety symptoms which can raise the likelihood of a disrupted mother-infant attachment and delayed cognitive and emotional development of their children. [15][16][17][18] In low-middle income countries, postpartum depression can even increase up to 90% the risk of getting childhood stunting and underweight. 19 In previous research about postpartum depression and a child's mental development, they found a connection between them. ...
Background. Postpartum mothers’ mental health has a significant role in mothers' well-being and child's growth and development. This issue is worsened during a pandemic when social restrictions are regulated, resulting in perceived stress, baby blues, postpartum depression, and other mental health issues. Objective. This study intends to investigate postpartum mothers’ mental health during the COVID-19 pandemic. Methods. This study's methodology is a scoping review using the prism-ScR checklist, the Joanna Briggs Institute critical appraisal tool, and a population, exposure, outcome framework. It uses 4 databases: Pubmed, Willey, Proquest, and ScienceDirect; its inclusion criteria is original English articles that can be accessed in full text between 2020 and 2022. Results. Out of 190 publications, we found 7 that are pertinent to the research goals. Qualitative research, cross-sectional studies, and longitudinal studies make up the research. The mapping result includes 4 themes: the types of mental health problems experienced by postpartum moms during the Pandemic, risk and predictive factors, postpartum mothers’ experiences, and the effects of mothers’ mental health problems. Conclusion. After giving birth, most mothers experience stress, anxiety, and depression. Postpartum mental health concerns are influenced by isolation, social exclusion, and crises. The creation of a customized plan for early assistance for a woman's mental health requirements, as well as the establishment of an accessible mental health provider, including medical personnel and medical facilities, is advised for pregnant and postpartum women.
... Masalah kesehatan mental saat ini cenderung menjadi perhatian di seluruh dunia karena dapat dialami oleh siapa saja, termasuk ibu hamil. Sebagian besar masalah kesehatan mental pada ibu hamil adalah depresi, kecemasan, dan masalah kesehatan mental lainnya seperti stres, penyesuaian, dan somatoform (kondisi psikologis yang menyebabkan satu atau banyak gejala pada tubuh) (Fawcett et al., 2019;Khatri et al., 2019;Mossie et al., 2017;Sheeba et al., 2019). ...
Masalah kesehatan mental pada ibu hamil tidak bisa disepelekan karena dapat menimbulkan berbagai dampak negatif bagi ibu hamil itu sendiri mapun janin. Salah satu strategi yang dapat membantu mencegah atau mengatasi kesehatan mental yaitu Digital Antenatal Care (ANC). Tujuan literature review untuk membahas implementasi Digital ANC terhadap kesehatan mental ibu hamil. Metode pencarian artikel menggunakan database PubMed, Proquest, Cochrane Review dan EBSCOhost tahun 2000-2020. Hasil Artikel yang direview berjumlah sembilan artikel. Hasil menunjukkan mode Digital ANC yang digunakan seperti handphone, komputer, dan kombinasi, sementara ada juga yang menggunakan mode aplikasi, website, software, internet, dan Short Message Services (SMS). Intervensi Digital ANC efektif dapat mendeteksi permasalahan kesehatan mental ibu hamil dan membantu mengatasi masalah kesehatan mental dengan tingkat kepuasaan penggunaan berada pada kategori baik. Selain itu, ada juga beberapa faktor utama yang dapat mempengaruhi keefektifan penggunaan Digital ANC antara lain pendapatan, pendidikan, usia ibu hamil dan usia kehamilan. Kesimpulan Digital ANC dapat menjadi salah intervensi pilihan yang dapat digunakan untuk mencegah bahkan mengatasi masalah kesehatan mental pada ibu hamil terutama pada area moderen saat ini. Kata Kunci: Antenatal Care; ANC; Digital; Ibu Hamil; Kesehatan Mental ABSTRACT Mental health problems in pregnant women cannot be underestimated because they can have various negative impacts on the pregnant woman herself and the fetus. One strategy that can help prevent or treat mental health is Digital Antenatal Care (ANC). The purpose of this study literature review is to discuss implementationDigital ANC on the mental health of pregnant women. The article search method used databases from PubMed, Proquest, Cochrane Review, and EBSCOhost 2000-2020 years. Results The articles reviewed amounted to nine articles. Results show mode Digital ANC used like cellphones, computers, and combinations, while some use application mode, website, software, internet, and Short Message Services (SMS). InterventionDigital ANC can effectively detect mental health problems in pregnant women and help overcome mental health problems with a level of satisfaction of users in the good category. In addition, there are also several main factors that can affect the effectiveness of using Digital ANC including income, education, age of pregnant women, and gestational age. Conclusion Digital ANC can be a choice of intervention that can be used to prevent and even overcome mental health problems in pregnant women, especially in today's modern areas. Keywords: Antenatal Care, ANC, Digital, Mental health, Pregnant
... Anxiety disorders are one of the most common mental health concerns in people's current lifestyle (1,2) and make their health and social performance in danger (3). There are many traditional psychological procedures to control anxiety and stress, such as breathing techniques and muscle relaxation. ...
Background: Anxiety disorders are among the most common mental health concerns in people’s lifestyles. There are many traditional psychological methods to manage anxiety. Heart rate is the most relevant biomarker of the autonomic nervous system among the various physiological markers. Hence, the increase in the heart rate is associated with a wide range of negative psychological events. Objectives: In this study, a wearable device called a "smart bracelet" was developed and tested to make mechanical oscillations similar to normal people’s heart rates, and then the effect of it was evaluated among taekwondo athletes wearing this device before the matches. Methods: In order to evaluate the results, the heart rate was measured five minutes before the competition, with an average of 81 bpm in the group using the bracelet and 84.42 bpm in the group without the bracelet. The average heart rate in the group with the bracelet was 78.5, and without a bracelet was 92.14 bpm. Results: The results of this study showed that wearable technology inducing mechanical waves is similar to normal people’s heartbeat through the radial nerve, which reduces stress significantly and can prevent an increase in stress.
... Mothers experience mental changes in the postpartum stage, and sometimes engage with crises, such as anxiety and depression. Prevalence of postpartum depression, stress, and anxiety among primiparous women (3) was reported 9 -30% (3, 6-8), 10-50% (3)(4)8), and 20-30% (5,8), respectively. On the other hand, large-scale and devastating natural disasters have always been strongly associated with adverse effects on mental health, such as post-traumatic stress disorder, anxiety, depression, and other psychological disorders (9). ...
Background:
Maternal anxiety has been accompanied by many unfavorable effects on breastfeeding in the postpartum period. We aimed to provide scientific evidence in identifying effective interventions for anxiety and breastfeeding self-efficacy (BSE) in a systematic review and meta-analysis.
Methods:
All published studies with inclusion criteria by 2022 were searched in Embase, Cochrane library, Web of Sciences, Google Scholar, PubMed, Scopus, SID and Magiran. The literature search was performed using PRISMA instructions. Further, 20 eligible interventional studies (RCT and pre-posttest) and one case study were included in this systematic review and meta-analysis. Publication bias was checked with Eggers test and funnel plot methods. The collected data were analyzed using stata version16.
Results:
It is not possible to provide an explicit and accurate conclusion about the effective intervention method in reducing anxiety and increasing BSE among lactating women during the covid19 pandemic. The results indicated a significant increase in BSE among lactating women after educational and psychological interventions (4.20, 95% CI: 3.61 to 4.80, I2 = 26.38%).
Conclusion:
It is recommended to conduct further studies with a strong methodology and based on intervention methods during the postpartum period, especially in the first month of birth to reduce the symptoms of stress and anxiety in the mother, establish better mother-child attachment, and improve BSE and maternal performance during the Covid-19 pandemic.
... It was concluded that the prevalence of at least one anxiety disorder or more than one disorder was 20.7% (16.7-25.4%) [22]. ...
Background
Maternal anxiety during pregnancy is sometimes considered a normal mechanism to overcome the mother’s mental preoccupation with having a child. However, stress and anxiety might become a medical condition, becoming so severe as to affect the mother’s mental health. Therefore, the present study aimed to investigate factors related to maternal anxiety during pregnancy in women referring to prenatal primary care centers in Tabriz.
Methods
The target population in the present cross-sectional study was the pregnant women referring to primary care centers affiliated with Tabriz University of Medical Sciences in 2018–2019 (n = 533). Sampling was carried out using the random cluster technique (separately for municipal centers). The data were collected using the study tools, including a questionnaire on demographic data, prenatal anxiety screening scale (PASS), and researcher-made questions on maternal anxiety during pregnancy.
Results
In the present study, 37.5% of pregnant women had anxiety. Of all the demographic and background variables, income (P = 0.015), a history of preterm delivery (P = 0.018), and unintended pregnancy (P = 0.022) were significantly related to anxiety. Of the variables of income, a history of preterm delivery, and unintended pregnancy in the regression model, the odds of anxiety were 41% lower in pregnant women with somewhat adequate income than those with inadequate income after correcting for other variables (P = 0.011). In addition, the variable of unintended pregnancy increased the odds of anxiety up to 49% after correcting for other variables (P = 0.023).
Conclusion
The present study showed that income and unintended pregnancy significantly affect maternal anxiety during pregnancy.
Trial registration
The protocol of the study was approved by the Ethics Committee of Tabriz University of Medical Sciences under the code (IR.TBZMED.REC.1398.161).
Objective
Psychiatric disorders burden the peripartum period, often requiring psychopharmacological treatment, including antidepressants. Efficacy and tolerability of antidepressants are influenced by the physiological changes of the peripartum and individual metabolic profiles, which in turn can be modified by pregnancy. The objective of this study is to assess the relationship between antidepressants’ pharmacokinetic profiles during pregnancy and individual metabolic profiles, along with the efficacy of the treatment.
Methods
In total 87 outpatients with diagnoses of bipolar disorder, major depression, anxiety, obsessive-compulsive disorder and post-traumatic stress disorder who required antidepressant treatment during pregnancy were recruited. Genotyping analysis of hepatic cytochrome P450 (CYPs) individual isoforms was performed. Antidepressants’ blood concentrations and psychometric assessments were collected at five time points. Antidepressants’ cord blood concentrations were assessed at birth.
Results
Sertraline showed greater stability in plasma concentrations and a lower placental penetrance index. Most of the antidepressants’ concentrations below the therapeutic range were found in women with an extensive/ultrarapid metabolic profile. Antidepressants mainly metabolized by CYP2C19 were less frequently below the therapeutic range compared with antidepressants metabolized by CYP2D6.
Conclusions
Pregnancy modulates cytochrome activity and drugs’ pharmacokinetics. Genotyping analysis of CYPs isoforms and therapeutic drug monitoring might be used to guide clinicians in a well-tolerated treatment of psychiatric symptoms in pregnant women.
Importance
Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear.
Objective
To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs.
Data Sources
Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023.
Study Selection
Studies conducted in World Bank–defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included.
Data Extraction and Synthesis
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder.
Main Outcomes and Measures
Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs.
Results
At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle–income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle–income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries.
Conclusions and Relevance
These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.
Background
Individuals with an increased body mass index (BMI) (≥ 30 kg/m2) experience higher rates of perinatal mental health disorders than individuals with BMI < 30. Personal experience of decreased control over labor has been associated with the development postpartum mood and anxiety disorders. However, no studies have investigated the association between BMI and experience of control over labor. This study aimed to assess perceived control over labor and compare patients with BMI ≥ 30 to those with BMI < 30.
Methods
We performed a secondary analysis of a cross-sectional study of postpartum patients who delivered at term (37–41 weeks gestation). Postpartum, participants completed the Labour Agentry Scale (LAS), a validated tool to assess perceived control over labor/birth. Demographic, maternal health history and obstetric/neonatal outcomes were abstracted from the patient chart. Bivariate analyses were performed between those with BMI < 30 and those with BMI ≥ 30 using Fisher’s exact test. Continuous LAS scores were compared between patients with BMI < 30 and BMI ≥ 30 using Wilcoxon rank-sum tests. Higher LAS scores indicate higher perceived control over labor. Multivariable linear regression was then performed to account for confounding factors identified a priori.
Results
There was no difference in LAS between those with BMI ≥ 30 and BMI < 30. When stratified by World Health Organization (WHO) class of BMI, those with BMI ≥ 40 had a significantly lower LAS scores than those with BMI < 30 (147 vs. 163, p = 0.02), however, this finding was no longer significant after controlling for length of labor and cesarean birth.
Conclusion
Only participants with the highest BMI experienced decreased control over labor, and this finding was no longer significant after controlling for mode of delivery and length of labor. Further research into the experience of birthing people with BMI ≥ 30 is critical to understand the increased risk of perinatal mood disorders among this population.
The United States has a maternal mortality crisis, and mental health is the leading cause of pregnancy-related death. Perinatal Mood and Anxiety Disorders disproportionately impact people of low socioeconomic status and medically underserved populations. Current government-supported maternal health structures are underfunded, underutilized, and confusing to navigate. Moreover, gaps in the joint federal-state health insurance program, Medicaid, which covers nearly half of birthing people, leave many under- or uninsured. To address the need for robust maternal mental health care, we propose the Department of Health and Human Services (HHS) create a funding source for community-owned maternal mental health centers. These centers would provide mental health services that address immediate needs, underlying causes, and barriers to access. Implementing this program would make significant strides to reduce maternal mortality.
Background:
Pregnancy is marked by physiological and psychosocial changes for women, and event-related potentials (ERP) are comfortable and safe for examining brain function across pregnancy. The late positive potential (LPP) ERP, a measure of allocated attention to emotional stimuli, may provide insight into associations between internalizing symptoms and neural processing of infant emotion cues, which may be particularly salient in this life stage.
Methods:
We developed a task to examine neural and behavioral responses to infant faces in pregnant women (N=120, Mage=31.09, SD=4.81), the impact of auditory infant cries on the LPP to faces, and associations between the LPP and anxiety and depressive symptoms. Participants matched distressed, happy, and neutral infant faces and shapes as a comparison condition with interspersed auditory conditions (infant cry sounds vs. white noise) while electroencephalogram data were collected. Participants also completed self-report measures of anxiety and depressive symptoms.
Results:
Reaction time (RT) was faster for the infant cry vs. white noise condition and when matching shapes vs. infant faces. Depressive symptoms were associated with slower RTs to neutral infant faces. The LPP was enhanced overall to faces vs. shapes, but there was no main effect of auditory condition. Anxiety symptoms were associated with an enhanced LPP to infant distressed faces in the infant cry condition.
Conclusions:
Results support these methods for measuring neural and behavioral responses to infant emotional cues in pregnancy and provide evidence that combinations of auditory and visual stimuli may be particularly useful for capturing emotional processes relevant to anxiety.
Objective:
The objective of this study was to document levels of interest in stress management training (SMT) during pregnancy, including differences in interest in SMT across levels of medical risk in pregnancy. We also sought to assess differences in pregnancy-specific stress, prenatal worry and depressed mood across levels of medical risk in pregnancy and investigate predictors of interest in SMT.
Methods:
We surveyed 379 English-speaking, pregnant people living in Vancouver, Canada, between November 2007 and November 2010. Questionnaires were administered during the third trimester and assessed interest and preferred format of SMT, pregnancy-specific stress, prenatal worry, depressed mood and medical risk in pregnancy.
Results:
Interest in stress management training programmes during pregnancy was common, with 32% of participants being quite-to-very interested. Preference was split between self-guided study (41%), group counselling (38%) and one-on-one counselling (34%). Higher pregnancy-specific stress and depressed mood, but not medical risk in pregnancy, were associated with higher interest in SMT. Participants experiencing higher stress levels or lower medical risk were more interested in one-on-one counselling.
Conclusion:
Findings indicate that subjective distress rather than objective circumstances is a better predictor of interest in SMT. Care providers should inquire early-on about interest in SMT during pregnancy and ensure awareness of SMT options.
In a community sample of trauma‐exposed postpartum individuals ( N = 167; mean age = 30, 90% White; 61.7% completed bachelor's degree or higher) longitudinally completed self‐report measures on PTSD, depressive, and Obsessive‐compulsive disorder (OCD) symptoms (specifically checking, ordering, washing, and obsessing symptoms), preoccupation with intrusive postpartum thoughts/neutralising strategies, and trauma exposure at 4 and 12 weeks postpartum. PTSD symptoms were strongly associated with all OCD symptoms ( r = 0.32‐ 0.49, p < 0.001), preoccupation with postpartum‐specific intrusive thoughts ( r = 0.32−0.45, p < 0.001), and preoccupation with neutralising strategies ( r = 0.21−0.29, p < 0.05) at both time points. PTSD symptoms were also predictive of checking and obsessing symptoms. This study identified PTSD symptoms as a new correlate for preoccupation with postpartum‐specific intrusive thoughts and neutralising strategies in the postpartum period in a community sample. These findings add to the evidence suggesting a strong association between PTSD and OCD symptoms across the lifespan, including in non‐clinical samples. Future research should examine best practices to assess and treat a variety of postpartum psychopathology symptoms, not just depression.
Background and Aims
Studies regarding the risk factors of prenatal anxiety disorders are inconclusive and sometimes contradictory. The current study aimed to define the prevalence and risk factors for anxiety disorders in women during pregnancy.
Methods
This is a cross‐sectional and hospital‐based survey of two public hospitals (Ayatollah Rohani and Yahyanejad) of inpatients/outpatients, obstetric wards/clinics, and four private outpatient obstetric clinics in the city of Babol. Convenience sampling was utilized to recruit 432 pregnant women. A trained clinical psychologist conducted the Structured Clinical Interview for DSM‐5 (SCID‐5) to diagnose anxiety disorders. In addition, the Brief Symptom Inventory 18 (BSI‐18) was completed by the participants to assess the severity of psychological distress.
Results
Of 432 pregnant women, 132 (30.5%) were diagnosed with anxiety disorders. Anxiety disorders included 61 cases of pregnancy adjustment disorder (47.7%), 52 cases of generalized anxiety disorder (40.6%), and 15 cases of specific phobia (to delivery) (11.7%). The logistic regression results showed that the age, pregnancy, education, parity, and high‐risk pregnancy variables predicted 28% of the variance of anxiety disorders. Furthermore, as the age ( β = 0.94, p = 0.003) and gestational age ( β = 0.9, p < 0.001) increased, the probability of anxiety disorders in pregnancy decreased. Moreover, university education ( β = 1.65, p = 0.049) and high‐risk pregnancy ( β = 1.72, p = 0.02) were recognized as risk factors for developing anxiety disorders during pregnancy.
Conclusion
The high incidence of anxiety disorders in pregnant women suggests that obstetricians should pay more attention to identifying and treating anxiety disorders in all pregnant women, especially in high‐risk pregnancies.
PURPOSE
To assess the evidence regarding safety and efficacy of psychiatric medications to treat mental health conditions during pregnancy and lactation. The conditions reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, and acute psychosis. For information on screening and diagnosis, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 4, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum” (1).
TARGET POPULATION
Pregnant or postpartum individuals with mental health conditions with onset that may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time.
METHODS
This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal–fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.
RECOMMENDATIONS
This Clinical Practice Guideline includes recommendations on treatment and management of perinatal mental health conditions including depression, anxiety, bipolar disorders, and acute postpartum psychosis, with a focus on psychopharmacotherapy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
PURPOSE
To review evidence on the current understanding of mental health conditions in pregnancy and postpartum, with a focus on mood and anxiety disorders, and to outline guidelines for screening and diagnosis that are consistent with best available scientific evidence. The conditions or symptoms reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis. For information on psychopharmacologic treatment and management, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 5, “Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum” (1).
TARGET POPULATION
Pregnant or postpartum individuals with mental health conditions. Onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time.
METHODS
This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal–fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.
RECOMMENDATIONS
This Clinical Practice Guideline includes recommendations on the screening and diagnosis of perinatal mental health conditions including depression, anxiety, bipolar disorder, acute postpartum psychosis, and the symptom of suicidality. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
Objective:
To perform a systematic review and evaluate the psychometric measurement properties of instruments in postpartum anxiety using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines and identify the best available patient-reported outcome measure.
Data sources:
We searched 4 databases (CINAHL, Embase, PubMed, and Web of Science in July 2022) including studies which evaluated at least one psychometric measurement property of a patient reported outcome measurement instrument. The protocol was registered with PROSPERO CRD42021260004 and followed the COSMIN guidelines for systematic reviews.
Study eligibility:
Studies eligible for inclusion included those that assessed a patient-reported outcome measure examining postpartum anxiety. We included studies where the instruments had undergone some form of psychometric property assessment in the postpartum maternal population, consisted of at least 2 questions, and were not subscales.
Study appraisal and synthesis methods:
This systematic review used COSMIN and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to identify the best patient reported outcome measurement instrument for postpartum anxiety. A risk of bias assessment was performed, and a modified GRADE approach used to assess the level of evidence with recommendations being made for the overall quality of each instrument.
Results:
A total of 28 studies evaluating 13 instruments in 10,570 patients were included. Content validity was sufficient in 9, with 5 instruments receiving a class A recommendation (recommended for use). Postpartum Specific Anxiety Scale, Postpartum Specific Anxiety Scale Research Short Form, Postpartum Specific Anxiety Scale Research Short Form Covid, Postpartum Specific Anxiety Scale- Persian and State-Trait Anxiety Inventory demonstrated adequate content validity and sufficient internal consistency. Nine instruments received a recommendation of class B (further research required). No instrument received a class C recommendation (not recommended for use).
Conclusions:
Five instruments received a class A recommendation, all with limitations such as not being specific to the postpartum population, not assessing all domains, lacking generalizability or evaluation of cross-cultural validity. There is currently no freely available instrument assessing all domains of postpartum anxiety. Future studies are needed to determine the optimum current instrument or development and validation of a more specific measure for maternal postpartum anxiety.
Background
Anxiety and depression are among the most significant disorders to affect parents of newborn babies. Research shows that anxiety and depression have comorbidity with parenting confidence and the postnatal sense of security. Little is known, however, about the dynamic interactions between mothers’ and fathers’ parenting confidence, postnatal sense of security, and anxiety and depression. This study aimed to identify the actor and partner effects of parenting confidence and postpartum anxiety and depression via postnatal sense of security within one week after birth of mother-father dyad in China.
Methods
A cross-sectional design was used. A total of 204 mother-father dyads in Wuhan, China completed measures of parenting confidence, postnatal sense of security, anxiety and depression. The actor-partner interdependence mediation model was used to examine the dyadic relationships among the variables.
Results
Both fathers’ and mothers’ parenting confidence was negatively associated with their anxiety and depression through their own postnatal sense of security. Moreover, individuals’ parenting stress was indirectly related to their spouse’s anxiety and depression through their spouse’s postnatal sense of security.
Conclusions
The findings highlight the important roles of individuals’ parenting confidence in affecting their own and their spouse’s postnatal sense of security, contributing to the symptoms of anxiety and/or depression within Chinese parents of newborn babies. Thus, support plans and training programs are encouraged to be developed in couple-involved ways to facilitate fathers’ engagement and further promote positive experience for both fathers and mothers.
Objective:
The co-existence of chronic pain conditions with anxiety and/or depression is common in the general population but poorly described during pregnancy. In this study, we sought to describe trends in chronic pain among a sample of delivering people and describe the co-existence of chronic pain with anxiety and/or depression among delivering people.
Methods:
This cross-sectional study used data from Optum's de-identified Clinformatics® Data Mart Database between 2008 and 2021, for delivering persons with coverage by single employer-based health plan. We computed predicted margins from generalized estimating equations to determine the marginal predicted probability of chronic pain among all delivering and non-delivering persons who identify as women with and without diagnosed anxiety and/or depression.
Results:
Musculoskeletal and pelvic pain occurred most often regardless of delivering status. Delivering persons with anxiety and/or depression had higher marginal predicted probabilities of chronic pain compared to all delivering persons. Between 2008 and 2021, the predicted probabilities ranged from 0.400 to 0.527 and 0.221-0.261, respectively.
Conclusion:
Chronic pain conditions are common in pregnancy and nearly two times higher among individuals with anxiety and/or depression. The frequency of comorbid depression and/or anxiety with pain disorders among delivering persons highlights the importance of proper detection, coordination of care, and safe treatment options for this population.
Background:
One in five pregnant and postpartum individuals experience an anxiety, depressive, and/or trauma-related disorder. Emotion dysregulation (ED) underlies the development and maintenance of various mental health disorders. The Difficulties in Emotion Regulation Scale (DERS) is the most comprehensive and commonly used measure of emotion dysregulation, yet limited evidence supports its use in the perinatal population. The present study aims to evaluate the validity of the DERS and its six subscales in a perinatal sample and to assess its predictive utility in identifying perinatal individuals with a disorder characterised by emotion dysregulation.
Methods:
Pregnant and postpartum individuals (N = 237) completed a diagnostic clinical interview and self-report measures of anxiety, depression, and perceived social support.
Results:
The DERS subscales demonstrated good internal consistency and construct validity, as it strongly correlated with measures of anxiety and depression and failed to correlate with a measure of perceived social support. Results from an exploratory factor analysis supported a 6-factor solution, suggesting structural validity. An ROC analysis revealed good to excellent discriminative ability for the DERS full scale and four of the subscales. Finally, an optimal clinical cut-off score of 87 or greater was established with a sensitivity of 81% for detecting a current anxiety, depressive, and/or trauma-related disorder.
Conclusions:
This study provides evidence for the validity and clinical utility of the DERS in a treatment-seeking and community sample of pregnant and postpartum individuals.
Background
Perinatal anxiety (PNA), anxiety that occurs during pregnancy and/or up to 12 months post-partum, is estimated to affect up to 21% of women, and may impact negatively on mothers, children and their families. The National Institute for Health and Care Excellence has called for further research around non-pharmacological interventions in primary care for PNA.
Aim
To summarise the available international evidence on non-pharmacological interventions for women with PNA in a primary care population.
Design & setting
A meta-review of systematic reviews (SRs) with narrative synthesis was performed following PRISMA guidance.
Method
Systematic literature searches were conducted in eleven health-related databases up to June 2022. Titles, abstracts and full text articles were dual-screened against pre-defined eligibility criteria. A variety of study designs are included. Data were extracted about study participants, intervention design and context. Quality appraisal was performed using the AMSTAR2 tool. A patient and public involvement group informed and contributed towards this meta-review.
Results
24 SRs included in the meta-review. Interventions were grouped into six categories for analysis purposes: psychological therapies, mind-body activities, emotional support from healthcare professionals, peer support, educational activities and alternative/complementary therapies.
Conclusion
In addition to pharmacological and psychological therapies, this meta-review demonstrates that there are many more options available for women to choose from which might be effective to manage their PNA. Evidence gaps are present in several intervention categories. Primary care clinicians and commissioners should endeavour to provide patients with a choice of these management options, promoting individual choice and patient-centred care.
Perinatal anxiety is a prevalent mental health issue associated with deleterious effects; however, factors that affect treatment outcomes have yet to be identified. We examined predictors of treatment completion and moderators of treatment outcome among individuals receiving six weeks of group Cognitive-Behavioral Therapy for Perinatal Anxiety (CBT-PA) via retrospective chart review. Among 98 women (Mean age = 32.36, SD = 4.79; 87% postpartum), pregnancy (versus postpartum), comorbid depression, and greater pre-treatment anxiety symptoms, as measured by the Perinatal Anxiety Screening Scale, were predictive of treatment attrition. Among treatment completers, older maternal age was associated with greater number of sessions completed. Overall, anxiety symptom scores significantly reduced from pre- to post-treatment. Obsessive-compulsive symptoms, comorbid depression, and two or more comorbid diagnoses at pre-treatment were each significantly associated with higher overall anxiety scores across both time points. Further, women with versus without health anxiety at pre-treatment showed a greater reduction in anxiety from pre- to post-treatment. These results are important for informing clinicians of factors that may enhance overall treatment completion and effectiveness for perinatal populations.
Background:
The global prevalence of peripartum mental illness is 20%, though estimates have increased since the start of the COVID-19 pandemic. Chronic illnesses affect one in five pregnancies and may be associated with higher rates of peripartum mental illness. Though pharmacists are well-positioned to facilitate appropriate and timely care of co-occurring mental and physical health conditions during this period, little is understood regarding their potential roles.
Objectives:
To understand the current evidence examining the role of pharmacists to improve the outcomes of women with peripartum mental illness, with and without chronic illness.
Methods:
A scoping review was performed with assistance from an interdisciplinary team following the Joanna Briggs Institute framework. MEDLINE, Embase, PsychNet and International Pharmaceutical Abstracts databases were searched. English-language articles (published up to May 30, 2022) were screened and assessed for eligibility, and data were charted to collate results, by dual independent reviewers.
Results:
The search strategy produced 922 articles. After screening, 12 articles were included (5 narrative reviews, 7 primary research). There was limited discussion or empirical data regarding specific interventions (screening, counseling), opportunities (accessibility, managing stigma, forming trusting relationships and building rapport with patients) or barriers (lack of privacy, time constraints, adequate remuneration, training) associated with an expanded role of pharmacists in peripartum mental health care. The clinical complexity arising from co-occurring mental health and chronic illnesses was not explored, other than a small pilot study involving pharmacists screening for depression among pregnant women with diabetes.
Conclusions:
This review highlights the limited evidence available on the explicit role of pharmacists in supporting women with peripartum mental illness, including those with comorbidity. More research, including pharmacists as study participants, is required to fully understand the potential roles, barriers, and facilitators of integrating pharmacists into peripartum mental healthcare to improve the outcomes of women in the peripartum period.
Background:
Findings on racial and ethnic differences in perinatal depression/anxiety are mixed.
Methods:
We assessed racial and ethnic differences in depression, anxiety, and comorbid depression/anxiety diagnoses in the year before, during, and the year after pregnancy (n = 116,449) and depression severity during (n = 72,475) and in the year after (n = 71,243) pregnancy among patients in a large, integrated healthcare delivery system.
Results:
Compared to Non-Hispanic White individuals, Asian individuals had lower risk of perinatal depression and anxiety (e.g., depression during pregnancy relative risk [RR] = 0.35, 95 % confidence interval [CI]:0.33-0.38) and postpartum moderate/severe (RR = 0.63, 95 % CI:0.60-0.67) and severe (RR = 0.66, 95 CI:0.61-0.71) depression but higher risk of moderate/severe depression during pregnancy (RR = 1.18, 95 % CI:1.11-1.25). Non-Hispanic Black individuals had higher risk of perinatal depression, comorbid depression/anxiety, and moderate/severe and severe depression (e.g., depression diagnoses during pregnancy RR = 1.35, 95 % CI:1.26-1.44). Hispanic individuals had lower risk of depression during pregnancy and perinatal anxiety (e.g., depression during pregnancy RR = 0.86, 95 % CI:0.82-0.90) but higher risk of postpartum depression (RR = 1.14, 95 % CI:1.09-1.20) and moderate/severe and severe depression during and after pregnancy (e.g., severe depression during pregnancy RR = 1.59, 95 % CI:1.45-1.75).
Limitations:
Information on depression severity was unavailable for some pregnancies. Findings may not generalize to individuals without insurance or outside of Northern California.
Conclusions:
Non-Hispanic Black individuals of reproductive age should be targeted with prevention and intervention efforts aimed at reducing and treating depression and anxiety. Asian and Hispanic individuals of reproductive age should be targeted with campaigns to destigmatize mental health disorders and demystify treatments and systematically screened for depression/anxiety.
Background:
Generalized anxiety disorder (GAD)-characterised by excessive and uncontrollable worry-is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis.
Methods:
One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD.
Results:
The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated.
Conclusions:
This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period.
Objective
Epidemiological research plays an important role in public health, facilitated by the meta‐analytic aggregation of epidemiological trials into a single, more powerful estimate. This form of aggregation is complicated when estimating the prevalence of a superordinate category of disorders (e.g., “any anxiety disorder,” “any cardiac disorder”) because epidemiological studies rarely include all of the disorders selected to define the superordinate category. In this paper, we suggest that estimating the prevalence of a superordinate category based on studies with differing operationalization of that category (in the form of different disorders measured) is both common and ill‐advised. Our objective is to provide a better approach.
Methods
We propose a multivariate method using individual disorder prevalences to produce a fully Bayesian estimate of the probability of having one or more of those disorders. We validate this approach using a recent case study and parameter recovery simulations.
Results
Our approach produced less biased and more reliable estimates than other common approaches, which were at times highly biased.
Conclusion
Although our approach entails additional effort (e.g., contacting authors for individual participant data), the improved accuracy of the prevalence estimates obtained is significant and therefore recommended.
Maternal anxiety is common during the perinatal period, and despite the negative outcomes of anxiety on the mother and infant, its treatment has received limited attention. This paper describes the first review of psychological interventions for clinical anxiety during the perinatal period. A systematic search was carried out of six electronic databases. Five studies which evaluated psychological interventions for clinical anxiety in perinatal women were identified. Of the five studies included, four were open trials and one was a randomised controlled trial. Three studies evaluated group-based interventions; one study evaluated an online-delivered intervention; and one study a combined pharmacologic-psychological intervention. All participants demonstrated significant reductions in anxiety symptom severity from pre- to post-treatment. However, this review was limited to published literature evaluating treatments for clinical anxiety in perinatal women, which may have excluded important intervention studies and prevention programs, and unpublished literature. This review identifies an area of research that needs urgent attention, as very few studies have evaluated psychological treatments for perinatal anxiety. The studies included in this review demonstrate that symptoms of anxiety during the perinatal period appear to improve during treatment. Future research is needed to establish the efficacy of perinatal anxiety interventions in randomised controlled trials, whether reductions persist long term and whether benefits extend to other outcomes for the mother, infant and family.
Importance:
Women are 2 to 3 times more likely than men to experience depression in their lifetime, and the greatest risk occurs during the reproductive years. As an obstetrics and gynecology physician or provider, you will likely encounter women who are at risk of development or relapse of a mental disorder during this vulnerable time.
Objective:
The aim of this review is to examine theory and research on mood and anxiety disorders during the perinatal period with an emphasis on screening recommendations.
Evidence acquisition:
A PubMed and PsycINFO search for English-language publications about perinatal mood and anxiety disorders and screening was performed and included studies on subtopics.
Results:
The literature reviewed suggests that perinatal mood and anxiety symptoms are prevalent and have significant consequences, and best practices for early detection are through routine depression and anxiety screening in the obstetrics setting. This includes overcoming barriers to care and use of liaison services to potentially reduce risk.
Conclusions and relevance:
High-quality prenatal care systems should develop the capacity for depression and anxiety risk assessment and treatment. Providers should routinely screen using validated screening tools, provide maternal mental health education, and be aware of the various medical, psychological, and complementary approaches for treating mood and anxiety disorders, to best guide and refer patients. The use of this practice will increase the quality of life in pregnant women with depression and anxiety and may help to reduce the likelihood of adverse birth outcomes, postpartum mental health problems, and adverse effects on offspring.
Background
Calgary, Alberta has the fourth highest immigrant population in Canada and ethnic minorities comprise 28 % of its total population. Previous studies have found correlations between minority status and poor pregnancy outcomes. One explanation for this phenomenon is that minority status increases the levels of stress experienced during pregnancy. The aim of the present study was to identify specific types of maternal psychosocial stress experienced by women of an ethnic minority (Asian, Arab, Other Asian, African, First Nations and Latin American). MethodsA secondary analysis of variables that may contribute to maternal psychosocial stress was conducted using data from the All Our Babies prospective pregnancy cohort (N = 3,552) where questionnaires were completed at < 24 weeks of gestation and between 34 and 36 weeks of gestation. Questionnaires included standardized measures of perceived stress, anxiety, depression, physical and emotional health, and social support. Socio-demographic data included immigration status, language proficiency in English, ethnicity, age, and socio-economic status. ResultsFindings from this study indicate that women who identify with an ethnic minority were more likely to report symptoms of depression, anxiety, inadequate social support, and problems with emotional and physical health during pregnancy than women who identified with the White reference group. Conclusions
This study has identified that women of an ethic minority experience greater psychosocial stress in pregnancy compared to the White reference group.
Background:
Common mental disorders (CMD) during pregnancy can have a clearly harmful influence on both mothers and children. Some studies have reported related factors for mental disorders, such as region-specific background. This study examined the prevalence of CMD and its related factors in mid-pregnancy in Japan.
Methods:
Pregnant women between 12 and 24 weeks gestation and aged ≥20 years were consecutively recruited at a maternity hospital in Japan between May 2014 and September 2014. CMD were diagnosed using the Mini-International Neuropsychiatric Interview (MINI), self-rated depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and interpersonal traumatic experience was measured using the Life Events Checklist.
Results:
Among 297 eligible pregnant women, 177 participated in the study. Two participants (1.1 %) met the criteria for major depressive disorder. The most frequent diagnosis was agoraphobia (n = 7; 3.9 %). Eleven participants (6.2 %) met the criteria for one or more diagnoses, with 2 participants having two mental disorders and 3 having three mental disorders. Six participants developed CMD after gestation. Logistic regression analysis revealed history of psychiatric disorder, past interpersonal traumatic experience, and feeling pressure to have a child were associated with CMD.
Conclusion:
These findings indicate a lower prevalence of CMD in mid-pregnancy in Japan than reported in most other countries. Besides the related factors reported previously, feeling pressure to have a child might increase risk for CMD among pregnant women in Japan. Asian cultural background might be related to the lower CMD prevalence and risk factors identified in this study.
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.
Objective To assess whether use of specific selective serotonin reuptake inhibitors (SSRIs) or venlafaxine in early pregnancy is associated with an increased risk of birth defects, with emphasis on cardiovascular birth defects even when accounting for lifestyle or other familial confounding.
Design Multicountry population based cohort study, including sibling controlled design.
Setting Nordic population (Denmark, Finland, Iceland, Norway, and Sweden) identified from nationwide health registers at different periods in 1996-2010.
Population The full study cohort included women giving birth to 2.3 million live singletons. The sibling cohort included 2288 singleton live births. The sibling controlled analyses included sibling pairs who were discordant for exposure to SSRIs or venlafaxine and birth defects.
Main outcome measure Prevalence of birth defects, including subtypes of cardiac defects. Odds ratio of birth defects from logistic and conditional logistic regression.
Results Among 36 772 infants exposed to any SSRI in early pregnancy, 3.7% (n=1357) had a birth defect compared with 3.1% of 2 266 875 unexposed infants, yielding a covariate adjusted odds ratio of 1.13 (95% confidence interval 1.06 to 1.20). In the sibling controlled analysis the adjusted odds ratio decreased to 1.06 (0.91 to 1.24). The odds ratios for any cardiac birth defect with use of any SSRI or venlafaxine were 1.15 (95% confidence interval 1.05 to 1.26) in the covariate adjusted analysis and 0.92 (0.72 to 1.17) in the sibling controlled analysis. For atrial and ventricular septal defects the covariate adjusted odds ratio was 1.17 (1.05 to 1.31). Exposure to any SSRI or venlafaxine increased the prevalence of right ventricular outflow tract obstruction defects, with a covariate adjusted odds ratio of 1.48 (1.15 to 1.89). In the sibling controlled analysis the adjusted odds ratio decreased to 0.56 (0.21 to 1.49) for any exposure to SSRIs or venlafaxine and right ventricular outflow tract obstruction defects.
Conclusions In this large Nordic study no substantial increase was found in prevalence of overall cardiac birth defects among infants exposed to SSRIs or venlafaxine in utero. Although the prevalence of septal defects and right ventricular outflow tract defects was higher in exposed infants, the lack of an association in the sibling controlled analyses points against a teratogenic effect of these drugs.
Objective
The postnatal period represents a critical phase for mothers because of physiological hormonal changes, the increase of emotional reactions and a greater susceptibility for the onset/recrudescence of psychiatric disorders. Despite the evidence of an increasing utilization of antidepressant drugs during breastfeeding, there is still few reliable information on the neonatal safety of the selective serotonin reuptake inhibitors (SSRIs) and selective noradrenergic reuptake inhibitors (SNRIs) [serotonin reuptake inhibitors (SRIs)] in nursing mothers. The aim of this study is to provide a systematic review on the neonatal safety profile of these drugs during breastfeeding, also assessing the limits of available tools.
Methods
MEDLINE and PubMed databases were searched without any language restrictions by using the following set of keywords: ((SSRIs OR selective serotonin inhibitor reuptake OR SNRIs OR selective serotonin noradrenaline inhibitor reuptake) AND (breastfeeding OR lactation OR breast milk)). A separate search was also performed for each SSRIs (paroxetine, fluvoxamine, fluoxetine, sertraline, citalopram and escitalopram) and SNRIs (venlafaxine and duloxetine).
Results
Sertraline and paroxetine show a better neonatal safety profile during breastfeeding as compared with other SRIs. Less data are available for fluvoxamine, escitalopram and duloxetine. Few studies followed up infants breastfeed for assessing the neurodevelopmental outcomes.
Conclusions
Literature review clearly indicates paroxetine and sertraline as the drugs that should be preferred as first line choice in nursing women who need an antidepressant treatment.
Background:
Whether the use of selective serotonin-reuptake inhibitors (SSRIs) and other antidepressants during pregnancy is associated with an increased risk of congenital cardiac defects is uncertain. In particular, there are concerns about a possible association between paroxetine use and right ventricular outflow tract obstruction and between sertraline use and ventricular septal defects.
Methods:
We performed a cohort study nested in the nationwide Medicaid Analytic eXtract for the period 2000 through 2007. The study included 949,504 pregnant women who were enrolled in Medicaid during the period from 3 months before the last menstrual period through 1 month after delivery and their liveborn infants. We compared the risk of major cardiac defects among infants born to women who took antidepressants during the first trimester with the risk among infants born to women who did not use antidepressants, with an unadjusted analysis and analyses that restricted the cohort to women with depression and that used propensity-score adjustment to control for depression severity and other potential confounders.
Results:
A total of 64,389 women (6.8%) used antidepressants during the first trimester. Overall, 6403 infants who were not exposed to antidepressants were born with a cardiac defect (72.3 infants with a cardiac defect per 10,000 infants), as compared with 580 infants with exposure (90.1 per 10,000 infants). Associations between antidepressant use and cardiac defects were attenuated with increasing levels of adjustment for confounding. The relative risks of any cardiac defect with the use of SSRIs were 1.25 (95% confidence interval [CI], 1.13 to 1.38) in the unadjusted analysis, 1.12 (95% CI, 1.00 to 1.26) in the analysis restricted to women with depression, and 1.06 (95% CI, 0.93 to 1.22) in the fully adjusted analysis restricted to women with depression. We found no significant association between the use of paroxetine and right ventricular outflow tract obstruction (relative risk, 1.07; 95% CI, 0.59 to 1.93) or between the use of sertraline and ventricular septal defects (relative risk, 1.04; 95% CI, 0.76 to 1.41).
Conclusions:
The results of this large, population-based cohort study suggested no substantial increase in the risk of cardiac malformations attributable to antidepressant use during the first trimester. (Funded by the Agency for Healthcare Research and Quality and the National Institutes of Health.).
The purpose of this study is to develop a scale (Perinatal Anxiety Screening Scale, PASS) to screen for a broad range of problematic anxiety symptoms which is sensitive to how anxiety presents in perinatal women and is suitable to use in a variety of settings including antenatal clinics, inpatient and outpatient hospital and mental health treatment settings. Women who attended a tertiary obstetric hospital in the state of Western Australia antenatally or postpartum (n = 437) completed the PASS and other commonly used measures of depression and anxiety. Factor analysis was used to examine factor structure, and ROC analysis was used to evaluate performance as a screening tool. The PASS was significantly correlated with other measures of depression and anxiety. Principal component analyses (PCA) suggested a four-factor structure addressing symptoms of (1) acute anxiety and adjustment, (2) general worry and specific fears, (3) perfectionism, control and trauma and (4) social anxiety. The four subscales and total scale demonstrated high to excellent reliabilities. At the optimal cutoff score for detecting anxiety as determined by ROC analyses, the PASS identified 68 % of women with a diagnosed anxiety disorder. This was compared to the EPDS anxiety subscale which detected 36 % of anxiety disorders. The PASS is an acceptable, valid and useful screening tool for the identification of risk of significant anxiety in women in the perinatal period.
Many women experience anxiety during pregnancy with potential negative effects on maternal, birth, and child outcomes. Because of potential risks of fetal exposure to psychotropic medications, efficacious non-pharmacologic approaches are urgently needed. However, no published studies of psychotherapeutic treatments for anxiety in pregnancy exist. Mindfulness-based cognitive therapy (MBCT) may substantially reduce anxiety and co-morbid symptoms in people with anxiety disorders. Coping with Anxiety through Living Mindfully (CALM) Pregnancy is an adaptation of MBCT designed to address anxiety in pregnant women. This study examined the feasibility, acceptability, and clinical outcomes of the CALM Pregnancy intervention in pregnant women anxiety. Twenty-four pregnant women with generalized anxiety disorder (GAD) or prominent symptoms of generalized anxiety participated in an open treatment trial of the CALM Pregnancy group intervention. Psychiatric diagnoses were determined by structured clinical interview, and self-report measures of anxiety, worry, depression, self-compassion, and mindfulness were completed at baseline and post-intervention. Qualitative feedback was elicited via questionnaire. Twenty-three participants completed the intervention with high attendance and good compliance with home practice. Completers showed statistically and clinically significant improvements in anxiety, worry, and depression, and significant increases in self-compassion and mindfulness. Of the 17 participants who met GAD criteria at baseline, only one continued to meet criteria post-intervention. Participants regarded their experience in the intervention to be overwhelmingly positive. MBCT in the form of the CALM Pregnancy intervention holds potential to provide effective, non-pharmacological treatment for pregnant women with anxiety. These promising findings warrant further testing of the intervention with a randomized controlled trial.
Family-genetic studies suggest that anxiety disorders run in families and that mechanisms of familial transmission might act as early as during pregnancy. The aims of the Maternal Anxiety in Relation to Infant Development (MARI) Study are to prospectively investigate the course of pregnancy in women with and without anxiety disorders prior to conception from early pregnancy to postpartum focussing on (a) maternal psychopathology, (b) maternal perinatal health, and (c) offspring outcomes that are supposed to be early indicators/ antecendents for later anxiety disorders. The MARI Study is a prospective-longitudinal study program with seven waves of assessment: T1 (baseline: week 10 to 12 of gestation), T2 (week 22 to 24 of gestation), T3 (week 35 to 37 of gestation), T4 (10 days postpartum), T5 (2 months postpartum), T6 (4 months postpartum), and T7 (16 months postpartum). Overall, N = 306 pregnant women were enrolled during early pregnancy (T1) and allocated to one of the following initial diagnostic groups: no AD: no anxiety nor depressive disorder prior to pregnancy (N = 109), pure D: pure depressive disorder(s) prior to pregnancy (N = 48), pure A: pure anxiety disorder(s) prior to pregnancy (N = 84), and comorbid AD: comorbid anxiety and depressive disorders prior to pregnancy (N = 65). Overall, N = 284 mothers could be retained until T6 (retention rate: 92.8 %) and N = 274 until T7 (retention rate: 89.5 %). Clinical and psychosocial measures were used including a standardized diagnostic interview (CIDI-V) with dimensional scales and standardized observation paradigms (mother-infant-relationship, infant temperament and neuropsychological development). Dimensional anxiety and depression liability indices were developed to reflect the severity of anxiety and depressive disorders prior to pregnancy and to ease longitudinal modelling. Findings from this study will contribute to improved knowledge about the natural course of anxiety disorders during transition to parenthood and associated outcomes that are assumed to be early indicators of later psychopathology in the offspring. Results are expected to provide new insights into mechanisms of familial transmission and clues for targeted prevention and early intervention.
Background
The objective was to examine the course and longitudinal associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in mothers over the postpartum 2 years.
Method
Using a prospective naturalistic design, 296 mothers recruited from a large community pool were assessed for GAD and MDD at 3, 6, 10, 14, and 24 months postpartum. Structured clinical interviews were used for diagnoses, and symptoms were assessed using self-report questionnaires. Logistic regression analyses were used to examine diagnostic stability and longitudinal relations, and latent variable modeling was employed to examine change in symptoms.
Results
MDD without co-occurring GAD, GAD without co-occurring MDD, and co-occurring GAD and MDD, displayed significant stability during the postpartum period. Whereas MDD did not predict subsequent GAD, GAD predicted subsequent MDD (in the form of GAD + MDD). Those with GAD + MDD at 3 months postpartum were significantly less likely to be diagnosis free during the follow-up period than those in other diagnostic categories. At the symptom level, symptoms of GAD were more trait-like than those of depression.
Conclusions
Postpartum GAD and MDD are relatively stable conditions, and GAD is a risk factor for MDD but not vice versa. Given the tendency of MDD and GAD to be persistent, especially when comorbid, and the increased risk for MDD in mothers with GAD, as well as the potential negative effects of cumulative exposure to maternal depression and anxiety on child development, the present findings clearly highlight the need for screening and treatment of GAD in addition to MDD during the postpartum period.
Background:
The literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study. Method A systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.
Results:
The prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8-10.9%) and ranged from 5.3% (3.5-8.1%) in African cultures to 10.4% (7.0-15.5%) in Euro/Anglo cultures.
Conclusions:
Anxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.
There are numerous scientific articles of studies on the prevalence of disorders with non-standardised examination and diagnostic protocols. Because their quality is heterogeneous, a new instrument has been developed for the assessment of such studies. The new instrument is based mainly on statistical criteria. The points assigned for each of the main criteria according to the information gained from each paper are summed up to form a Total Quality Score (TQS). The interrater reliability of the instrument was tested by employing Kappa and Interrater Correlation Coefficient (ICC) statistics. The latter was assessed on the results of three independent investigators. The new quality instrument appeared to be easy to use, and the instructions were comprehensible. The ICC((2,1)) for the TQS ranged between 0.94 and 1.00 indicating almost perfect agreement between the investigators. The reliability of the new instrument enables its use for scientific review purposes. In this way, its validity will also be tested. The instrument could be adopted for assessment of scientific articles of studies on the prevalence of disorders in many, similar, scientific areas.
Psychological science on pregnancy is advancing rapidly. A major focus concerns stress processes in pregnancy and effects on preterm birth and low birth weight. The current evidence points to pregnancy anxiety as a key risk factor in the etiology of preterm birth, and chronic stress and depression in the etiology of low birth weight. Key mediating processes to which these effects are attributed, that is neuroendocrine, inflammatory, and behavioral mechanisms, are examined briefly and research on coping with stress in pregnancy is examined. Evidence regarding social support and birth weight is also reviewed with attention to research gaps regarding mechanisms, partner relationships, and cultural influences. The neurodevelopmental consequences of prenatal stress are highlighted, and resilience resources among pregnant women are conceptualized. Finally, a multilevel theoretical approach for the study of pregnancy anxiety and preterm birth is presented to stimulate future research.
To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam.
We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression.
Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20-34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19-3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12-3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05-10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44-7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care.
Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential antenatal preventive care appears to be compromised.
Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR).
To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. Data Sources and
We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria.
Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error.
Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States.
Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
Universal interventions to prevent postnatal mental disorders in women have had limited success, perhaps because they were insufficiently theorized, not gender-informed and overlooked relevant risk factors. This study aimed to determine whether an innovative brief psycho-educational program for mothers, fathers and first newborns, which addressed salient learning needs about infant behaviour management and adjustment tasks in the intimate partner relationship, prevented postpartum mental health problems in primiparous women.
A before and after controlled study was conducted in primary care in seven local government areas in Victoria, Australia. English-speaking couples with one-week old infants were invited consecutively to participate by the maternal and child health nurse at the universal first home visit. Two groups were recruited and followed sequentially: both completed telephone interviews at four weeks and six months postpartum and received standard health care. Intervention group participants were also invited to attend a half-day program with up to five couples and one month old infants, facilitated by trained, supervised nurses. The main outcome was any Composite International Diagnostic Interview (CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors associated with the outcome were established by logistic regression controlling for potential confounders and analysis was by intention to treat.
In total 399/646 (62%) women were recruited; 210 received only standard care and 189 were also offered the intervention; 364 (91%) were retained at follow up six months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%) were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood, Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107 (15%) in the intervention group. In those without a psychiatric history, the adjusted odds ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in the intervention group compared to the control group.
A universal, brief psycho-educational group program for English-speaking first time parents and babies in primary care reduces de novo postpartum mental disorders in women. A universal approach supplemented by an additional program may improve effectiveness for women with a psychiatric history.
ACTRN 12605000567628.
Although guided self-help for depression and anxiety disorders has been examined in many studies, it is not clear whether it is equally effective as face-to-face treatments.MethodWe conducted a meta-analysis of randomized controlled trials in which the effects of guided self-help on depression and anxiety were compared directly with face-to-face psychotherapies for depression and anxiety disorders. A systematic search in bibliographical databases (PubMed, PsycINFO, EMBASE, Cochrane) resulted in 21 studies with 810 participants.
The overall effect size indicating the difference between guided self-help and face-to-face psychotherapy at post-test was d=-0.02, in favour of guided self-help. At follow-up (up to 1 year) no significant difference was found either. No significant difference was found between the drop-out rates in the two treatments formats.
It seems safe to conclude that guided self-help and face-to-face treatments can have comparable effects. It is time to start thinking about implementation in routine care.
The objectives of this study were: (1) to examine Composite International Diagnostic Interview (CIDI) period prevalence and comorbidity for depression and anxiety disorder in a cohort of women assessed during the first 6-8 months postpartum and (2) to examine the benefits of combining the Edinburgh Postnatal Depression Scale (EPDS) with a simple "interval symptom" question to optimize screening postpartum. Women aged over 18 (N = 1,549) were assessed during late pregnancy and reviewed at approximately 2, 4, and 6-8 months postpartum using the EPDS and an "interval symptom" question. The latter asked about any depressive symptoms in the interval since the last EPDS. Women who scored >12 on the EPDS and/or positive on the "interval symptom" question were then administered the CIDI. A further 65 randomly selected women that screened negative were also administered the CIDI. Loss to postnatal follow-up was very significant, and returns rates were inconsistent across the three postnatal time points. Almost 25% of those who screened positive did not complete a CIDI. For screen-positive status, a total of 314 (24.4%) of those that returned questionnaires (N = 1,289) screened positive at least once across the 6- to 8-month interval. Of these, 79 were lost to follow-up; thus, 235 (74.8%) completed a CIDI. In this group, 34.7% had been positive both on the EPDS and the "interval" question, 15.9% on the EPDS alone, and 49.4% on the "interval" question alone. For the CIDI diagnosis and estimated 6- to 8-month period CIDI prevalence, among those 235 women who screened positive and completed a CIDI, 67.2% met the criteria for a CIDI diagnosis, as did 16.9% of those who screened negative. The breakdown in CIDI diagnoses in the 235 women was 32.8% major depression (± anxiety disorder); 26.4% minor depression alone; and 8.1% with a primary anxiety disorder (approximately half with minor depression). Put another way, 20.4% of these women had an anxiety disorder (approximately two thirds with comorbid depression) and 37.7% of women with a major depressive episode (MDE) had a comorbid anxiety disorder. The estimated 6- to 8-month prevalence rate for a CIDI diagnosis of anxiety or depression (major or minor) was 29.2% (95% CI 26.7%-31.7%). The use of the "interval symptom" question alone was 1.7 times more likely to identify positive CIDI cases than the EPDS alone. Almost 40% of postnatal women with a diagnosis of MDE have a comorbid diagnosis of anxiety disorder. The estimated 6- to 8-month period prevalence for CIDI cases of anxiety and depression was 29.2%. Screening for anxiety and depression using the EPDS alone was associated with a lesser capacity to identify CIDI caseness than a simple "interval symptom" question (for the 2 months prior) which almost doubled the yield. This paper demonstrates that combining the EPDS with the "interval symptom" question improves detection of CIDI caseness.
The efficacy of cognitive-behavioral therapy (CBT) for anxiety in adults is well established. In the present study, the authors examined whether CBT tested under well-controlled conditions generalizes to less-controlled, real-world circumstances. Fifty-six effectiveness studies of CBT for adult anxiety disorders were located and synthesized. Meta-analytic effect sizes are presented for disorder-specific symptom measures as well as symptoms of generalized anxiety and depression for each disorder, and benchmarked to results from randomized controlled trials. All pretest-posttest effect sizes for disorder-specific symptom measures were large, suggesting that CBT for adult anxiety disorders is effective in clinically representative conditions. Six studies included a control group, and between-groups comparisons yielded large effect sizes for disorder-specific symptoms in favor of CBT. Benchmarking indicated that results from effectiveness studies were in the range of those obtained in selected efficacy trials. To test whether studies that are more representative of clinical settings have smaller effect sizes, the authors coded studies for 9 criteria for clinical representativeness. Results indicate an inverse relationship between clinical representativeness and outcome, but the magnitude of the relationship is quite small.
Recent studies indicate that the prevalence and 12-month incidence of mental disorders during pregnancy are similar to those of age-matched nonpregnant women. The aim of this study is to assess the prevalence, sociodemographic correlates, and functional impairment associated with Axis I disorders in women at the third month of pregnancy.
1066 women presenting at the Department of Obstetrics and Gynecology of the Azienda Ospedaliera Universitaria Pisana (Pisa, Italy) for the first ultrasound examination between the 12th and the 15th gestational weeks were recruited for participation in the Program "Perinatal Depression-Research and Screening Unit (PND-ReScU)" and were administered the Structured Clinical Interview for DSM-IV Axis I Disorders and the Work and Social Adjustment Scale. Study recruitment began in February 2004 and ended in March 2007.
The prevalence of lifetime Axis I disorders at the third month of pregnancy was 50.4%. 255 women (23.9%) had 2 or more lifetime comorbid disorders. 26.3% met criteria for current Axis I disorders. Current comorbidity between depressive and anxiety disorders was found in 47 women (4.4%).
One in 5 women presented with a current Axis I disorder, and a higher percentage met criteria for a lifetime Axis I disorder. Early detection of psychopathology at the beginning of pregnancy may help to plan an adequate treatment in order to achieve a better postpartum adjustment and to reduce the risk of adverse obstetrical and psychopathological outcome.
The study presents data on the 3-month prevalences of postpartum anxiety disorders (PAD) and postpartum depressive disorders (PDD) and their comorbidity in a German community sample. Associations with sociodemographic variables and previous history of psychopathology were analysed.
Data were gathered in a longitudinal study over the first 3 months postpartum. In a two-stage screening procedure, a population-based representative sample of 1024 postpartum women was assessed for symptoms of anxiety and depression using DSM-IV-based screening instruments.
The estimated rates of DSM-IV disorders were 11.1% for PAD and 6.1% for PDD. Comorbidity was found in 2.1%. The rate for PAD with postpartum onset was 2.2% and for PDD 4.6%. Young mothers and mothers with a low education level had a heightened risk of developing depression following delivery.
Because of the clinical relevance of PAD, controlled studies and specialized programmes for prevention and treatment are urgently required.
Background:
Even though more than 20% of women meet diagnostic criteria for an anxiety disorder during the perinatal period, very little is known about the predictors of these problems. As a result, we systematically reviewed the literature on risk factors for new onset anxiety and maternal anxiety exacerbation in the perinatal period.
Methods:
PubMed, MEDLINE, PsycINFO, CINAHL, Ovid, ProQuest Portal, and Web of Science were searched for studies assessing risk factors for the development of new onset anxiety or anxiety worsening in women during pregnancy and the postpartum period.
Results:
11,759 citations were identified, with 11 studies meeting eligibility criteria. New onset anxiety was assessed in 7 studies, anxiety worsening in 3, and 1 assessed both. Lower educational attainment, living with extended family members, multiparity, a family history of psychiatric disorders, hyperemesis gravidarum, comorbid sleep disorders, and prenatal oxytocin exposure were risk factors for new onset perinatal anxiety, while presence of comorbid psychiatric disorders and prenatal oxytocin were risk factors for anxiety worsening.
Limitations:
Studies not explicitly stating whether participants had pre-existing anxiety disorders were excluded. As a result, meta-analysis was not possible for several risk factors.
Conclusions:
Risk factors for new onset anxiety and anxiety worsening during the perinatal period include psychological, social, and biological exposures. Given the lack of studies differentiating women with and without pre-existing anxiety disorders, additional research is required in order to determine whether these factors differ from the non-puerperal population, as well as from each other.
Background: Maternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.
Aims: To establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.
Method: We searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.
Results: We reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6–22.8) in the first trimester, 19.1% (95% CI 15.9–22.4) in the second trimester and 24.6% (95% CI 21.2–28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0–21.4) and 4.1% (95% CI 1.9–6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms was high initially but overall between 1 to 24 weeks was 15.0% (95% CI 13.7–16.4). The prevalence for any anxiety disorder was 9.9% (95% CI 6.1–13.8) and 5.7% (95% CI 2.3–9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.
Conclusions: Results suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.
Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.
