Anxiety and depressive symptoms in women and men from early pregnancy to 30 months postpartum

Predictors of anxiety among pregnant women with gestational diabetes mellitus and their partners: The mediating role of marital satisfaction

AIMS

This study aims to examine the prevalence of anxiety symptoms and identify predictors of anxiety among pregnant women with gestational diabetes mellitus and their partners and explore the mediating role of marital satisfaction between maternal and paternal anxiety.

DESIGN

A cross-sectional study was conducted in Guangzhou, China, from July 2021 to May 2022.

METHODS

A total of 306 dyads of pregnant women with gestational diabetes mellitus and their partners completed the State-Trait Anxiety Inventory, Locke-Wallace Marital Adjustment Test and the socio-demographic and clinical data sheet.

RESULTS

The prevalence of anxiety symptoms was 32.4% and 36.6% in pregnant women with gestational diabetes mellitus and their partners, respectively. The predictors of maternal anxiety were paternal anxiety, maternal marital satisfaction, maternal monthly salary, fasting glucose value and 1-h glucose value. By contrast, the predictors of paternal anxiety were maternal anxiety, paternal marital satisfaction and paternal monthly salary. Moreover, the relationship between maternal and paternal anxiety was mediated by marital satisfaction.

CONCLUSIONS

The anxiety symptoms of pregnant women with gestational diabetes mellitus and their partners influence each other, and this relationship was mediated by marital satisfaction. Every couple should be screened for anxiety symptoms and treated as a team rather than focusing solely on the pregnant woman.

Psychological distress in pregnancy and postpartum: a cross-sectional study of Babol pregnancy mental health registry

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.

Antenatal depression and anxiety in Indian women: A systematic review

There is good evidence to suggest that high prevalence of depression and anxiety in the postpartum period. However, very few studies have focused on antenatal depression and anxiety disorders and their associated risk factors. Further, there are only a handful of studies from India on common antenatal mental health disorders. With this background, we reviewed the existing evidence on antenatal depression and anxiety from the studies conducted in Indian pregnant women during the antenatal period and to explore the associated risk factors. All the major databases were searched systematically for English language studies on prevalence and risk factors for antenatal depression and anxiety in Indian pregnant females, published during the period January 2000 to May 2022. Quality assessment of studies was done with the modified version of Newcastle Ottawa Scale for cross-sectional studies. We found the overall prevalence of antenatal depression was ranged from 3.8% to 65% and antenatal anxiety from 13 to 55%. The most relevant risk factors associated with antenatal depression and anxiety during pregnancy were preference to have a male child, intimate partner violence, history of abortions, marital conflict, poor relationship with the husband/in-laws and lack of social support. To conclude, the systematic review suggests that depressive and anxiety disorders are quite common in Indian pregnant women in antepartum period with varying prevalence depending on various settings and scales used. Steps should be taken to promote obstetricians for regular mental health screening during the antenatal visits and prompt referral to mental health professionals when suspected.

Social and cognitive vulnerability to COVID-19-related stress in pregnancy: A case-matched-control study of antenatal mental health

Emerging evidence shows that compared to pre-pandemic norms pregnant women report significant increases in clinical levels of depressive and anxiety symptoms during COVID-19. This pre-registered study examined cognitive and social vulnerability factors for poor mental health in pregnancy during COVID-19. Understanding vulnerability profiles is key to identifying women at risk for deteriorating peripartum mental health. N = 742 pregnant women and N = 742 age and country-matched controls from the COVID-19 Risks Across the Lifespan Study were included. Using a case-match control design allowed us to explore whether the cognitive vulnerability profiles would differ between pregnant and non-pregnant women. The findings showed that COVID-19-related stress was associated with heightened levels of depression and anxiety during pregnancy. Its impact was greatest in women with cognitive (i.e., higher intolerance of uncertainty and tendency to worry) and social (i.e., higher level of self-reported loneliness) vulnerabilities. Importantly, our data show that the mental health impacts of the pandemic were greater in pregnant women compared to women who were not pregnant, especially those with cognitive and social vulnerabilities. The results highlight the urgent need to prioritize mental health care for pregnant women to mitigate the impact of COVID-19-related stress on women's postpartum mental health and their infants' well-being.

Prevalence of Antenatal Anxiety in European Women: A Literature Review

The presence of anxiety during pregnancy is associated with adverse consequences for both mothers and their babies. The aim of this study was to review the prevalence of anxiety in European pregnant women in order to find out which countries have published the most studies in respect to the presence of anxiety during pregnancy, which countries are the most and least prevalent in terms of anxiety within pregnant women, and which are the most common tools used to assess anxiety during this stage. As such, a literature review was conducted regarding the studies that were published in the last twenty years in the PsycInfo, Medline, and SCOPUS databases. Thirty-eight studies were selected for the purposes of this review. The prevalence of anxiety in pregnancy and generalized anxiety disorder (GAD) varies considerably between studies. The European countries that have carried out the most research on this issue are Spain, Italy, and the United Kingdom. The most widely used assessment instrument is the State Trait Anxiety Inventory (STAI). The lowest prevalence rate of anxiety, using the STAI-E, was found in Poland, 7.7%, and the highest was found in Italy, 36.5%. The prevalence of GAD ranges from 0.3% to 10.8%. This indicates that anxiety in pregnant women is a very relevant mental health problem. It is therefore important to detect and intervene early in order to promote the well-being of both mothers and children.

Depressive Symptoms in Fathers during the First Postpartum Year: The Influence of Severity of Preterm Birth, Parenting Stress and Partners’ Depression

Although preterm birth constitutes a risk factor for postpartum depressive symptomatology, perinatal depression (PND) has not been investigated extensively in fathers of very low (VLBW) and extremely low birth weight (ELBW) infants. This study explored paternal depression levels at 3, 9, and 12 months of infant corrected age, investigating also the predictive role played by the severity of prematurity, maternal and paternal PND levels, and parenting stress. We recruited 153 fathers of 33 ELBW, 42 VLBW, and 78 full-term (FT) infants, respectively. Depression was investigated by the Edinburgh Postnatal Depression Scale (EPDS) and distress by the Parenting Stress Index-Short Form-PSI-SF (Total and subscales: Parental Distress, Parent–Child Dysfunctional Interaction, and Difficult Child). ELBW fathers showed a significant decrease (improvement) in EPDS, total PSI-SF, and Parental Distress mean scores after 3 months. Paternal EPDS scores at 12 months were significantly predicted by VLBW and FT infants’ birth weight categories, fathers’ EPDS scores at 3 and 9 months, Parent–Child Dysfunctional Interaction subscale at 3 months, and Difficult Child subscale at 9 months. This study strengthens the relevance of including early routine screening and parenting support for fathers in perinatal health services, with particular attention to fathers who might be more vulnerable to mental health difficulties due to severely preterm birth.

Factors Related to Psychological Distress in Multiparous Women in the First Trimester: A Cross-Sectional Study

BACKGROUND

The birth rate in Taiwan has declined rapidly; thus, encouraging women to give birth is an important issue in the country. Pregnant women may experience psychological distress, which may negatively impact the health of children and mothers. Prenatal psychological distress is more common in multiparous women than in primiparous women. In addition, compared with that in the second and third trimesters, psychological distress in the first trimester is relatively high. Understanding psychological distress and the associated factors for multiparous women in the first trimester is important to providing early interventions and preventing subsequent maternal and child health problems.

PURPOSE

This study was designed to examine the important predictive factors related to depression, anxiety, and stress among Taiwanese multiparous women in the first trimester.

METHODS

A cross-sectional design was used. In all, 216 multiparous women at 16 weeks of pregnancy were recruited from three hospitals in Taiwan. Self-reported questionnaires were used to gather data on demographic characteristics, the parenting stress of motherhood, spousal support, and psychological distress. A multiple logistic regression analysis was conducted to examine the factors associated with psychological distress.

RESULTS

The prevalence of depression, anxiety, and stress in multiparous women was found to be 31.9%, 42.6%, and 11.1%, respectively. The multiple logistic regression analysis indicated that the stress related to parent-child interaction was a significant predictor of depression and anxiety, the stress related to child-rearing was a significant predictor of anxiety, and low spousal instrumental support was a significant predictor of stress. The model respectively explained 30%, 27%, and 23% of the variance in depression, anxiety, and stress.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Reducing the stress related to parent-child interaction and child-rearing and encouraging spousal instrumental support should be considered during prenatal care when designing interventions to reduce the psychological distress of multiparous women in their first trimester.

Judgment Bias During Gestation in Domestic Pigs

In humans and rats, changes in affect are known to occur during pregnancy, however it is unknown how gestation may influence mood in other non-human mammals. This study assessed changes in pigs' judgment bias as a measure of affective state throughout gestation. Pigs were trained to complete a spatial judgment bias task with reference to positive and negative locations. We tested gilts before mating, and during early and late gestation, by assessing their responses to ambiguous probe locations. Pigs responded increasingly negatively to ambiguous probes as gestation progressed and there were consistent inter-individual differences in baseline optimism. This suggests that the pigs' affective state may be altered during gestation, although as a non-pregnant control group was not tested, an effect of learning cannot be ruled out. These results suggest that judgment bias is altered during gestation in domestic pigs, consequently raising novel welfare considerations for captive multiparous species.

COVID-19-related anxieties in first-time mothers during the first wave of the COVID-19 pandemic and after 6 months: A descriptive study

BACKGROUND

The changes accompanying the transition to motherhood, joined by the stress aroused by the COVID-19 pandemic, may lead to high levels of parental anxieties. This study, conducted in two phases-in the midst of the first wave of the pandemic and after six months-explores differences in the level of COVID-19-related anxieties of Israeli mothers in their first year of parenthood.

DESIGN AND METHODS

A cross-sectional study carried out with 198 first-time mothers aged 22-48 who completed self-report questionnaires on April 2020 and again on October 2020. The questionnaire was distributed through social networks and included a demographic scale and the COVID-19-related anxieties questionnaire.

FINDINGS

In the first phase, mothers reported higher anxieties concerning economic damage (M = 3.42; 3.11), being in public places (M = 4.34; M = 3.51), using public transportation (M = 4.80; M = 4.31), and going for infant checkups (M = 4.13; M = 3.06). In the second phase, mothers reported higher anxiety about being infected (M = 3.19; M = 3.48).

DISCUSSION

The results suggest the need to be attentive to the double stress of new mothers in a dynamic time of crisis, especially at the beginning of the crisis when anxiety levels may be highest.

APPLICATION TO PRACTICE

The findings may aid in developing interventions for new mothers in times of crisis. The finding that the COVID-19-related anxieties of new mothers may decrease over time points to the urgency of making interventions by health and medical professionals available to women in the first months after the birth of their first child.

Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2-3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2-3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2-3 months postpartum, and 3-4% mothers and fathers both depressive and anxiety symptoms 2-3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2-3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2-3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2-3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: A cross-sectional study

Background

Antenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria.

Aim

To determine the prevalence and factors associated with AD in first half of pregnancy.

Setting

Multicentric health facilities in Southern Nigeria.

Methods

A multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD.

Results

The prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6–32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00–13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48–8.38), poor social support (AOR 4.70; 95% CI 2.99–7.38), past history of depression (AOR 4.67; 95% CI 2.47–8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57–3.89), low socio-economic status (AOR 2.41, 95% CI 1.61–3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47–3.64).

Conclusions

The prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period.

Maternal Psychological Distress and Executive Functions Are Associated During Early Parenthood - A FinnBrain Birth Cohort Study

Parental executive functioning (EF) and parenting behaviors can be affected by the multiple stressors that are often present during early parenthood. However, little is known about how commonly experienced psychological distress during early parenthood is associated with parental EF capacity. We explored the links between psychological distress and EFs in a general population sample of 150 Finnish birth cohort mothers with 2.5-year-old children. The symptoms of depression, anxiety, insomnia, and poor couple relationship adjustment were measured with the self-report questionnaires EPDS, SCL-90, AIS, and RDAS. EFs were assessed with five computerized Cogstate tasks. When the psychological distress measures were added to a hierarchical regression analysis as continuous variables, no significant single or additive associations with EFs were found. When the distress measures were dichotomized to compare symptoms below/above cutoffs indicating clinically elevated levels, single distress domains remained as non-significant predictors, but a cumulative risk index of the number of concurrent clinically elevated distress domains was significantly associated with EFs. Thus, mothers with a higher number of concurrent clinically elevated psychological distress domains (i.e., depression, anxiety, insomnia, and poor couple relationship adjustment) tended to have lower EFs. This association is possibly bi-directional – clinically elevated distress within several domains could have a cumulative, depleting effect on maternal EF capacity, but a lower EF capacity could also increase the vulnerability for experienced distress within several concurrent domains. Longitudinal studies are needed to clarify potential causal links between stressors and EF.

Paternal coping and psychopathology during the perinatal period: A mixed studies systematic review and meta-analysis

How fathers cope with stress may be critical to their mental health during the perinatal period. Using a sequential explanatory design for systematic review and meta-analysis, we aimed to identify associations and causal relations between higher- and lower-order avoidant and approach coping strategies and paternal psychopathology. We searched five electronic databases and grey literature, and used random-effects models to calculate pooled effects from 11 quantitative studies. Meta-analytic results were integrated with findings from 18 qualitative studies. Fathers' avoidant coping was positively associated with global psychopathology and depression. Approach-oriented coping, particularly problem-solving, was associated with positive affect but not psychopathology. Qualitative findings indicate distressed fathers employ avoidant coping strategies such as suppression, distraction, and social withdrawal. Approach-oriented coping strategies such as problem-solving and cognitive reappraisals appeared to be constructive components of men's coping repertoires supporting adaptation to fatherhood. Different coping strategies and approaches may reflect enactment of constrictive, moderate, or reinterpreted masculine norms. Study designs did not allow conclusions about causal relations between coping and psychopathology. Screening for, and targeting of, high avoidant coping among expectant and new fathers may help detect men at risk of or experiencing mental health difficulties and inform clinical response to psychopathology. Research examining whether different patterns of avoidant and approach coping are associated with psychopathology over time could inform interventions to support men's mental health and adaptation to fatherhood.

Effects of a Home-Based Intervention on HIV Prevention Health Behaviors in Pregnant/Postpartum Kenyan Women: Estimating Moderating Effects of Depressive Symptoms

We estimated effects of maternal depressive symptoms, utilizing the Patient Health Questionnaire-8 (PHQ-8), on women's HIV prevention behaviors in Migori County, Kenya. Pregnant women ≥ 18 years old, with gestational age of < 37 weeks, were randomized into standard care or three home visits (2 during pregnancy, 1 postpartum) promoting couple HIV testing and counseling (CHTC) and HIV prevention. Of 105 female participants, 37 (35.24%) reported depressive symptoms and 50 (47.62%) were HIV-positive. Three Poisson regressions with robust variance (univariable, multivariable, and multivariable with depressive symptoms/study arm interaction) were modeled for three outcomes: CHTC, infant HIV testing, health-seeking postpartum. In multivariable analysis with interaction, a moderating trend for the interaction between depressive symptoms and individual health-seeking was observed (p-value = 0.067). Women scoring ≤ 9 (n = 68) on the PHQ-8 and participating in home visits were 1.76 times more likely to participate in individual health-seeking compared to participants in standard care (ARR 1.76, 95% CI 1.17-2.66).

Paternal postnatal depression and received midwife, child health nurse, and maternal support: A cross-sectional analysis of primiparous and multiparous fathers

BACKGROUND

Fathers want more professional and social support during the transition to fatherhood. It is unclear if these supports are associated with decreased depressive symptoms in fathers of infants.

AIM

The aim of the current study was to assess if fathers' self-reported received professional and social support were related to changes in the odds for having depressive symptoms, with interaction terms focusing on differences of support based on the fathers' parity.

METHODS

In total, 612 fathers from Sweden completed a Facebook-advertised anonymous online survey. The Edinburgh Postnatal Depression Scale was used to detect depressive symptoms (≥10 points). Multiple imputation of missing data was performed. Logistic regressions were used, with interaction terms for fathers' parity.

RESULTS

Around 21% of fathers had depressive symptoms. There were no associations between depressive symptoms frequencies and paternal parity. Fathers reported fewer depressive symptoms when they received professional support from the prenatal midwife (OR = .39, p = .007), labor/birth midwife/nurse team (OR = .42, p = .021), and child health nurse (OR = .25, p = .001), as well as social support from their partner and if they had a higher income (odds ratios vary in different models). Multiparous fathers received significantly less professional and social support and were less frequently invited to child health visits than primiparous fathers.

LIMITATIONS

The data collected was cross-sectional; therefore, causal links cannot be determined.

CONCLUSIONS

Both primiparous and multiparous fathers should receive postnatal depression screenings and interventions to help reduce their depressive symptoms.

Anxiety and depressive symptoms effects on cortisol trajectories from pregnancy to postpartum: Differences and similarities between women and men

Anxiety and depressive symptoms may influence cortisol trajectories in women and men during pregnancy and the postpartum period. Using a multilevel approach, anxiety and depressive symptoms effects on 24-hour urinary free cortisol trajectories from the 2nd trimester to 3-months postpartum were examined in a sample of 66 women and 65 men with no known psychosocial or medical risk (N = 131; 33 (50%) of them were couples that participated in the same assessment waves). Results showed that both anxiety and depressive symptoms influence women's and men's cortisol trajectories from mid-pregnancy to 3-months postpartum. Women with high depressive symptoms and men with high anxiety or high depressive symptoms exhibited less accentuated variations in the 24-hour urinary free cortisol trajectories compared with women with low depressive symptoms and men with low anxiety or depressive symptoms, respectively. These effects were significant for women's cortisol trajectories from the 2nd to the 3rd pregnancy trimester and for men's cortisol trajectories throughout the entire period. The effect of anxiety and depressive symptoms on HPA axis functioning and cortisol production during pregnancy and postpartum, seems to be sex-specific. Reproductive-related alterations (associated with gestation, parturition and lactation) in women's HPA axis functioning may explain these sex-specific effects.

Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care

Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.

The psychological burden of routine prenatal ultrasound on women's state anxiety across the three trimesters of pregnancy

OBJECTIVE

Although obstetric ultrasound examination has recognizable clinical and psychological benefits, it also involves some psychological burdens, mainly in terms of the woman's state anxiety, the level of which can change during pregnancy. This research aimed to study the influence of routine ultrasound examination on the woman's state anxiety and its relation with her personality background in the three trimesters of pregnancy.

STUDY DESIGN

This work was a prospective interventional study. Women who underwent routine-screening ultrasound examinations in the first, second, or third trimester of pregnancy were recruited. The state anxiety level was assessed using the State-Trait Anxiety Inventory - subscale S (S-Anxiety), administered immediately before and after the exams. More stable personality characteristics were evaluated before ultrasound, assessing trait anxiety by State-Trait Anxiety Inventory - subscale T (T-Anxiety) and psychological coping by Coping Orientations to Problem Experienced (COPE). The S-Anxiety scores, collected immediately before and after the exams, were compared by two-tailed paired t-test. Moreover, S-Anxiety scores collected in each one of the three-trimester groups immediately before and after the exams were compared by one-way between groups ANOVA. Relations among S-Anxiety scores with more stable aspects of personality (T-Anxiety and COPE scores) were also studied, by correlation analysis.

RESULTS

A total of 285 women were recruited. In all trimesters, S-Anxiety scores decreased significantly after the exam (P < 0.001), with a more relevant reduction in women with higher T-Anxiety scores (P < 0.001). A gradual decrease in S-Anxiety scores before the examination was seen across the three trimesters, with significantly higher scores in the first trimester (P = 0.016). Before ultrasound, S-Anxiety score resulted positively correlated with avoidance coping strategies (P < 0.001), while it was inversely related to active coping style (P < 0.001) and positive aptitude (P < 0.001).

CONCLUSIONS

The psychological burden of prenatal ultrasound in the different trimesters of pregnancy was studied. Clinicians should be sensitive to women's state anxiety during prenatal routine-screening ultrasound examination, using a personalized approach. Particular attention should be paid to the psychological burden associated with ultrasound evaluation of the first trimester, when the level of the anxiety state is higher.

Two's Company, Three's a Crowd? Maternal and Paternal Talk About Their Infant Differs in Associations With Wellbeing, Couple Relationship Quality, and Caregiving Sensitivity

Problems of depression and anxiety are common in early parenthood and adversely affect parenting quality (1). Rumination is closely linked to poor wellbeing (2), suggesting that self-focus may be one mediator of the association between wellbeing and caregiving [e.g., (3)]. Framed within an international study of first-time mothers and fathers (4), the current study included 396 British mothers and fathers (in 198 heterosexual cohabiting couple relationships) of first-born 4-month-old infants. Parents reported on their symptoms of depression, anxiety and satisfaction in their couple relationship. Five-minute speech samples were transcribed and coded for parents' pronoun use (i.e., "I" and either infant- or partner-inclusive use of "We"), whilst observations in the Still-Face paradigm were coded for parental sensitivity to infants' cues. Our first goal was to test whether new parents' self-focus was associated with wellbeing and couple relationship quality. We also examined whether (i) self-focus mediated the expected association between wellbeing and caregiving sensitivity and (ii) couple relationship quality moderated the expected association between self-focus and caregiver sensitivity. Finally, we compared results for mothers and fathers. Our results illustrate gender-specific associations. First, although mean levels of self-focus and partner-inclusive talk were similar for mothers and fathers, infant-inclusive use of the "we" pronoun was higher in mothers than fathers. Second, self-focus was unrelated to either mothers' or fathers' wellbeing, but was associated with fathers' report of reduced couple relationship quality. In addition, poor perinatal wellbeing was associated with reduced partner-inclusive talk for fathers, but with reduced use of infant-inclusive talk for mothers. Third, mediation models suggest that reduced infant-inclusive talk underpins the association between poor wellbeing and reduced sensitivity in mothers, but not fathers. Fourth, in the context of good couple relationship quality, mothers' elevated partner-inclusive talk was associated with reduced caregiving sensitivity. These findings are discussed in terms of their implications for interventions to support new mothers and fathers, who may benefit from distinct strategies to foster attention to their developing infant.

Longitudinal Study of Dyadic Adjustment in a Sample of Spanish Fathers

The objectives of this study were to examine the evolution of fathers’ long-term dyadic adjustment after the birth of a child and to analyze their evolution considering related factors. A total of 113 Spanish fathers with a mean age of 35.72 years (SD = 3.84 years) participated. In general, there was a decline in the dyadic adjustment of the fathers until 6–12 months after childbirth, after which their level of adjustment remained stable until 13–24 months. We observed different patterns when analyzing the evolution by subgroups formed based on these different variables, previous experience of paternity, and anxiety. The intrinsic differences between fathers should also be considered because these differences can influence the way in which men face the parental process as well as the evolution of the quality of their relationship with their partner.

Prevalence and determinants of perinatal depression among labour migrant and refugee women on the Thai-Myanmar border: a cohort study

BACKGROUND

Perinatal depression is a significant contributor to maternal morbidity and mortality globally. Migrant women, particularly those living in low- and middle-income settings, represent a particularly vulnerable group due to stressors experienced before, during and after migration. The vast majority of global migration flows occurring within and between low- and middle-income regions, yet existing evidence focuses predominantly on migrants in high-income destinations. This study aimed to redress this significant gap in the evidence by determining the prevalence and determinants of perinatal depression among migrant women on the Thai-Myanmar border.

METHODS

A cohort of labour migrant and refugee women was followed-up from the first trimester of pregnancy to one month post-partum. Depression status was assessed in the first, second and third trimesters of pregnancy and at one month post-partum using the Structured Clinical Interview for the Diagnosis of DSM-IV Disorders. Women diagnosed with depression had immediate access to care. Data on potential demographic, social and clinical associated factors was collected using a questionnaire. Prevalence and incidence of any depressive disorder and moderate-severe depressive disorder was calculated. Univariable and multivariable logistic regression using complete case analysis was used to estimate odds ratios (OR) of association between exposure variables and depression status.

RESULTS

Five hundred sixty-eight women participated. Period prevalence (from first trimester of pregnancy to one month post-partum) of moderate-severe perinatal depression was 18.5% (95% CI 15.4-21.9%). Overall, 15.4% (95% CI 11.8-19.6%) of women developed new-onset moderate-severe depression during the study period. Forty-two participants received treatment for depression. Risk factors were interpersonal violence (OR 4.5; 95% CI 1.9-11.1); history of trauma (OR 2.4; 95% CI 1.4-4.3); self-reported history of depression (OR 2.3; 95% CI 1.2-4.2); labour migrant status (OR 2.1; 95% CI 1.1-4.0); low social support (OR 2.1; 95% CI 1.1-3.7); and maternal age (OR 1.1 per year; 95% CI 1.0-1.1). Limitations of the study include that culturally specific manifestations of depression may have been missed.

CONCLUSIONS

Perinatal depression represents a significant burden among migrant women on the Thai-Myanmar border. Programmes to address the determinants along with early case identification and effective treatment and referral systems are key to addressing perinatal depression in this low-resource setting.

Couples becoming parents: Trajectories for psychological distress and buffering effects of social support

BACKGROUND

Becoming a parent is a time of both joy and stress. Associations between exposure to postnatal depression and negative child outcomes underscore the importance of understanding trajectories and correlates of perinatal depression and anxiety.

METHODS

In a study of 438 expectant couples (from the UK, USA and Netherlands) tracked across four time-points (third trimester, 4, 14 and 24 months), we used dyadic latent growth curve modeling (LGCM) of self-reported symptoms of anxiety and depression (CES-D, GHQ, STAI) to investigate the affective impact of becoming a parent.

RESULTS

Confirmatory factor analyses of anxious-depressive symptoms revealed a single latent factor with measurement invariance across time and parent. Dyadic LGCM intercepts showed greater prenatal problems in mothers compared with fathers. LGCM slopes revealed stable maternal problems but worsening paternal problems. Both intercepts and slopes showed significant within-couple associations. Controlling for prenatal salivary cortisol levels and perinatal couple relationship quality, support from friends attenuated mothers' psychological distress and support from family reduced fathers' psychological distress across the transition to parenthood.

LIMITATIONS

Our sample was low risk (i.e., predominantly well-educated and affluent and no history of serious mental illness), limiting the generalizability of findings. In addition, the inverse association between psychological distress and social support may, in part, reflect the use of self-report for both measures.

CONCLUSIONS

The international dyadic longitudinal design strengthens conclusions regarding variation in trajectories of psychological distress in both mothers and fathers. Crucially, social support appears pivotal in enabling new parents to flourish.

Psychosocial working conditions and depressive disorder: disentangling effects of job control from socioeconomic status using a life-course approach

PURPOSE

Job control, the combination of skill discretion and decision authority, is considered a central component of the psychosocial working environment. This longitudinal study examines the relation between job control and risk of incident depressive disorder using a life-course approach.

METHODS

We analyze data from The Danish Work Life Course Cohort study, including all Danish individuals aged 15-30 who entered the Danish labor market during 1995-2009 and were free from depressive disorder at entry (955,573 individuals). We measured job control using a job exposure matrix. Depressive disorders were measured using information from nationwide registers of psychiatric in- and outpatient admissions. Using Cox regression models we estimated the prospective association between job control and risk of incident depressive disorders. Analyses accounted for a range of potential confounders prior to workforce entry including socioeconomic status in adolescence and parental psychiatric and somatic diagnoses prior to labor market entry, together with potential confounders in adulthood including income, education, and demographics.

RESULTS

Lower levels of past year job control were associated with a higher risk of depressive disorder after adjustment for all covariates (HR = 1.27, 95% CI 1.16-1.38). Results stratified by gender showed associations for both men (HR = 1.38, 95% CI 1.19-1.61) and women (HR = 1.19, 95% CI 1.08-1.32).

CONCLUSIONS

Our findings suggest that the level of job control at work affects the risk of clinically diagnosed depressive disorder, and that this association is not due to confounding by socioeconomic status.

Reciprocal Influence of Depressive Symptoms Between Mothers and Fathers During the First Postpartum Year: A Comparison Among Full-Term, Very Low, and Extremely Low Birth Weight Infants

Background: Perinatal depression (PND) in mothers and fathers of very low and extremely low birth weight (VLBW and ELBW) infants has not been studied extensively. In particular, no studies investigated the reciprocal influence of depressive symptoms during the first 12 months postpartum. This study aimed at exploring the impact of the severity of prematurity on maternal and paternal PND during the first postpartum year; specifically, we used an Actor-Partner Interdependence Model (APIM) to test the interdependence of both partners on depressive symptoms. Methods: A total of 177 mothers and 177 fathers were recruited, divided into 38 couples with ELBW infants, 56 with VLBW, and 83 of full-term (FT) infants. PND was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) at 3, 9, and 12 months postpartum (corrected age for preterm infants). Results: Maternal depressive symptoms at 3 months were positively related to those at 9 and 12 months in the 3 groups. Conversely, paternal depressive symptoms assessed at 3 months were positively related to those measured at 9 months for the ELBW group, 12 months for the VLBW group, 9 and 12 months for FT condition. Furthermore, a significantly positive partner effect was observed regarding the influence of 3 month maternal depressive symptoms on paternal depressive symptoms at 9 months, but only in the case of the VLBW group. Conclusion: Prematurity represents a very specific scenario in the transition to parenthood, leading to specific reactions in mothers and fathers, especially in high-risk conditions. Results should be deepened given the relevance of their clinical implications.

Effects of a home follow-up program in Turkey for urban mothers of premature babies

OBJECTIVE

To examine the effects of a home follow-up program in Turkey on care problems, anxiety, and depression levels of mothers after the birth of a premature baby.

METHODS

A semi-experimental study with a pretest-posttest control group design. Eighty premature newborns and their mothers were included in the study. Nursing care was given to mothers and babies in the study group through a total of four home visits on weeks 1, 2, 3, and days 40-42 in Kırıkkale, Turkey guided by the Nursing Diagnosis System and Nursing Interventions Classification (NIC) system of the North American Nursing Diagnosis Association (NANDA). Data were collected from a sociodemographics form, home care needs evaluation form, Edinburgh Postpartum Depression Scale, and State Anxiety Inventory.

RESULTS

There were no significant differences between groups for nursing diagnoses at baseline, while the study group resulted in significantly fewer problems on days 40-42, compared to the control group. Mothers had a comparatively lower depression and state anxiety risk in the study group compared to the control group.

CONCLUSIONS

Providing home-based nursing care for preterm mothers and babies during the first 40-42 days has the potential to decrease postnatal care problems, including maternal depression and state anxiety levels.

Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit

OBJECTIVE

This study aims to determine maternal stress and anxiety as perceived by mothers whose premature infants were admitted to the neonatal intensive care unit (NICU) and to identify maternal stress and its relationship with maternal and infant characteristics and anxiety.

BACKGROUND

Vulnerable premature infants commonly require special care in the NICUs. In most cases, prolonged hospitalization results in stress and anxiety for the mothers.

METHODS

A non-probability convenience survey was used in a public hospital, with 180 mothers completing the 26-item Perceived Stress Scale (PSS) and a 40-item State-Trait Anxiety Inventory (STAI).

RESULTS

56.5% of mothers had high levels of stress, 85.5% of mothers had a high level of state-anxiety and 67.8% of mothers had a high level of trait-anxiety. The stress experienced by these mothers had a significant relationship with anxiety, and was found to be associated with state and trait anxiety levels, but not with maternal and infant characteristics.

CONCLUSION

Mothers in this setting revealed high levels of stress and anxiety during their premature infants' NICU admission. An immediate interventional programme focusing on relieving mothers' anxiety and stress is needed to prevent maternal stress and anxiety at an early stage.

Impact of Prenatal Depressive Symptoms on Postpartum Depressive Symptoms: Mediation Effect of Perinatal Health

To analyze the mediation effect of perinatal health on the association between prenatal depressive symptoms and postpartum depressive symptoms 180 women filled the Edinburgh Postnatal Depressive Scale (EPDS) at 35 weeks of gestation and two months after childbirth. Perinatal health data was collected during the first 4 days after childbirth, using the Optimality Index. 25.6% of the mothers-to-be presented clinically significant depressive symptoms, and of these, 80.4% still show clinically significant depressive symptoms at 2-months postpartum. Prenatal depressive symptoms predict higher postpartum depressive symptoms. Additionally, results also showed that the effect of prenatal depressive symptoms on postnatal depressive symptoms is not mediated by perinatal health. Mothers-to-be with prenatal depressive symptoms seem to be at risk for postnatal depression, even when perinatal health is not compromised. This highlights the importance of early screening of prenatal depressive symptoms in order to promote an early intervention on women’s mental health, leading to a better transition to parenthood and to a decrease of the burden of this public health problem on children and families.