Anxiety Disorders During Pregnancy and the Postpartum Period

Women's Mental Health and Addiction Research Section, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 09/2006; 67(8):1285-98. DOI: 10.4088/JCP.v67n0818
Source: PubMed


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

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Available from: Linda M Mclean, Nov 29, 2015
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    • "The prevalence of antepartum anxiety disorders varies considerably between different studies (see Goodman et al., 2014 for a review) from 12-25% (Bennett et al., 2004; Ross and McLean, 2006) to 50-60% (Faisal-Cury and Menezes, 2007; Lee et al., 2007). Yet, there is little data on postpartum anxiety (PPA) prevalence. "
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    ABSTRACT: Background: There is first evidence that some personality characteristics raise the risk of postpartum depression (PPD). The present longitudinal study investigates whether dysfunctional perfectionism and avoidant personality style predict PPD, postpartum anxiety (PPA) and bonding impairment (BI) directly or indirectly through antepartum anxiety (APA) and antepartum depression (APD). Methods: Pregnant women were recruited in two obstetric departments in Germany. The assessment occurred at two measurement time points: In the third trimester of pregnancy (N = 297) and twelve weeks postpartum (N = 266). Six questionnaires were administered during pregnancy: perfectionism, personality styles, anxiety, and depression. Postpartum, data on PPA, PPD and BI were collected. We conducted two path analyses in order to examine direct and indirect effects of the two personality characteristics on postpartum disorders. Results: Testing for direct effects of dysfunctional perfectionism and avoidant personality style on PPD, PPA, and BI did not yield significant results. Instead, significant indirect effects were found: PPD, PPA, and BI were influenced indirectly by dysfunctional perfectionism and avoidant personality style via APD and APA. This model explained high portions of the variance of PPD, PPA, and impaired bonding. Each of the two personality characteristics explained a unique part of the outcome measures. The influence on BI was mediated by PPD. APD affected PPD and PPA more strongly than APA. Limitation: Path models with manifest (observed) variables may lead to measurement errors. Self-rating questionnaires may raise the problem of social desirability. Conclusion: Dysfunctional perfectionism and avoidant personality style are significant risk factors for PPD, PPA, and BI. Screenings of both variables, as well as of APA and APD, which mediated the effect of personality traits on postpartum syndromes, are necessary.
    Full-text · Article · Nov 2016 · Journal of Affective Disorders
    • "). We note that the DSM-V does not include OCD, PTSD, and AADA within the anxiety disorders section (they are now in the Obsessive Compulsive and Trauma related sections), however they have been included in this review as the literature to date has typically classified them as 'anxiety disorders' (American PsychiatricAssociation, 2013; Ross et al., 2006). When investigating anxiety symptomology (e.g. "
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    ABSTRACT: Background: Men's experiences of anxiety within the perinatal period can adversely impact themselves, their partner and infant. However, we know little about the prevalence and course of men's anxiety across the perinatal period. The current review is one of the first to systematically review the published literature. Methods: Five databases (PubMed, PsycINFO, Cochrane, SCOPUS, and Web of Science) were searched to identify relevant papers published prior to April 2015. The literature search identified articles with data for expectant fathers (prenatal period) and/or fathers of an infant aged between 0 and 1 (postnatal period). The following data were extracted: (a) anxiety disorder prevalence (diagnostic clinical interviews), (b) 'high' anxiety symptom prevalence (above thresholds/cut-points on anxiety symptom scales) and (c) mean anxiety levels (anxiety symptom scales). Initially, 537 unique papers were identified. Subsequently, 43 papers met criteria for inclusion in the review. Results: Prevalence rates for 'any' anxiety disorder (as defined by either diagnostic clinical interviews or above cut-points on symptom scales) ranged between 4.1% and 16.0% during the prenatal period and 2.4-18.0% during the postnatal period. The data reviewed suggest the course of anxiety across the perinatal period is fairly stable with potential decreases postpartum. Limitations: Wide variation in study measurement and methodology makes synthesis of individual findings difficult. Anxiety is highly comorbid with depression, and thus measures of mixed anxiety/depression might better capture the overall burden of mental illness. Conclusions: Anxiety disorders are common for men during the perinatal period. Both partners should be included in discussions and interventions focused on obstetric care and parent mental health during the perinatal period.
    No preview · Article · Oct 2015 · Journal of Affective Disorders
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    • "This suggests that unfavorable peripartum (changes in) PC among women with pure D and comorbid AD prior to pregnancy partially occurred due to persistent or recurrent anxiety and/or depressive disorders during the peripartum period. These findings are consistent with previous evidence that pre-and postpartum anxiety and depressive disorders are common, especially among women with a previous history of psychopathology (Beck 1996; 2001; Martini et al. 2010, 2015; Milgrom et al. 2008; O'Hara and Swain 1996; Reck et al. 2008; Robertson et al. 2004; Ross and McLean 2006; Vesga-Lopez et al. 2008; Webster et al. 2000, 2003). On one hand, women with current anxiety and depressive disorders might have more negatively evaluated their partnership (irrespective of actual changes in PC). "
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    ABSTRACT: The purpose of this study is to prospectively examine peripartum changes in partnership characteristics among women with and without anxiety and depressive disorders prior to pregnancy. In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) study, n = 306 expectant mothers completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Lifetime anxiety and depressive disorders according to the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) were evaluated at baseline using the Composite International Diagnostic Interview for Women (CIDI-V, Martini et al. 2009). Partnership characteristics were assessed during pregnancy as well as 4 and 16 months postpartum using the Partnership Questionnaire (Hahlweg 1996). Linear regressions were applied to test associations between diagnostic status prior to pregnancy and peripartum partnership characteristics. Compared to women without anxiety and depressive disorders prior to pregnancy, women with comorbid anxiety and depressive disorders reported less tenderness during pregnancy, less postpartum tenderness, satisfaction, and overall partnership quality as well as a lower decrease in communication from pre- to postpartum. Women with pure depressive disorders and comorbid anxiety and depressive disorders prior to pregnancy indicated a higher increase in quarreling from pre- to postpartum. Findings suggest that women with depressive (and comorbid anxiety) disorders prior to pregnancy are at elevated risk for an unfavorable peripartum partnership development and might thus profit from targeted family interventions during this period.
    Full-text · Article · Aug 2015 · Archives of Women s Mental Health
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