Research reportAnxiety and depression during pregnancy in women and men
Introduction
Pregnancy and the transition to parenthood involve major psychological and social changes in future parents. These changes have been linked to an increase in anxiety rates and depression symptoms (Condon et al., 2004). Medical and obstetric complications, as well as adverse effects on child development due to the presence of psychopathology during pregnancy have also been pointed out (e.g. Buitelaar et al., 2003).
The prevalence of anxiety disorders in pregnancy varies according to studies and evaluation moments. In a recent study by Lee et al. (2007), 54% of the women had antenatal anxiety during at least one trimester. Estimated anxiety in the 2nd pregnancy trimester was found to be lower; in most studies, it was found to be from 6.6% to about 15% (Andersson et al., 2003, Andersson et al., 2006, Heron et al., 2004). Anxiety levels seem to be higher in the 1st and 3rd trimesters, when compared with the 2nd pregnancy trimester (Lee et al., 2007). In fact, a non linear pattern for anxiety has been pointed out in women, with the 1st and 3rd pregnancy trimesters being identified as high risk periods (Lee et al., 2007). As far as men are concerned, the peak of distress seems to be at mid-pregnancy (18%) and decreases steadily in the postpartum period (Buist et al., 2003, Condon et al., 2004). There is some evidence that multiparity is a risk factor for high-anxiety levels in pregnancy (DiPietro et al., 2008), and that having another child constitutes an environmental stressor (Glazier et al., 2004). However, this is not consensual (Faisal-Cury and Rossi Menezes, 2007, Andersson et al., 2006, Fatoye et al., 2004), and most studies only include women.
The prevalence of mood symptoms during pregnancy seems to be higher than in other periods of a woman's life (Halbreich, 2004). Also, rates of depression seem to be higher during pregnancy than in the postpartum period (Da Costa et al., 1999). In a recent cohort study (Evans et al., 2001), 13.5% of the women were depressed at 32 weeks of pregnancy and 9.1% at 8 weeks postpartum. A substantial amount of women who had a postnatal depression were already depressed during pregnancy (Evans et al., 2001, Gorman et al., 2004, Figueiredo et al., 2006). Depression rates seem to decrease throughout pregnancy (Perren et al., 2005). A depression point prevalence of 15.5% was found at early and mid-pregnancy, 11.1% in the 3rd pregnancy trimester and 8.7% in the postpartum period (Felice et al., 2004). During pregnancy women usually present higher depression rates (12–20%) than men (4–6%) (Matthey et al., 2000). However, this is not consensual (Areias et al., 1996b), and depression scores in depressed pregnant women and men do not differ significantly in some reports (e.g., Field et al., 2006). The influence of parity on pregnancy depression is also not consensual. While some studies show that multiparity is a risk factor for pregnancy depression (Halbreich, 2004, Glazier et al., 2004, DiPietro et al., 2008), others reveal no association between parity and pregnancy depression (Pajulo et al., 2001, Andersson et al., 2006, Fatoye et al., 2004).
Comorbidity between anxiety and depression symptoms is common and has been frequently reported during pregnancy (Field et al., 2003, Heron et al., 2004, Wenzel et al., 2005, Matthey, 2007, Matthey et al., 2003, Littleton et al., 2007, Austin et al., 2007). In a study by Ross et al. (2003), nearly 50% of clinically depressed pregnant and postpartum women had clinically significant comorbid anxiety; and according to Andersson et al. (2006) 20.5% of women who were given a psychiatry diagnosis in the 2nd pregnancy trimester presented comorbid anxiety and depression symptoms. The overlap of anxiety and depression symptoms in pregnancy has also been reported as a risk factor for postnatal depression (Heron et al., 2004).
The aim of this was to analyze anxiety, depression, comorbid anxiety and depression during pregnancy in a sample of primiparous and multiparous pregnant women and their partners. Specifically, it was our aim to analyze the differences between: 1) the 1st, 2nd and 3rd trimesters; 2) women and men; 3) primiparous and multiparous.
Section snippets
Participants
A sample of 300 women and their partners were recruited in an Obstetrics Out-patients Unit (Oporto, Portugal), during their first appointment, up to 14 weeks of gestation. Participation in the study involved the following criteria for inclusion: 1) knowing how to read/write in Portuguese, 2) gestational age less than 15 weeks to the date of the first contact; 3) resident in Portugal for over a year, in the case of foreign participants.
The great majority of the participants were Portuguese
Differences between the 1st, 2nd and 3rd pregnancy trimesters
High rates of anxiety, depression and comorbid anxiety and depression were found during pregnancy. Anxiety symptoms and rates (STAI-S ≥ 45) were higher in the 1st and 3rd pregnancy trimesters and lower at the 2nd trimester. Regarding depression symptoms and rates (EPDS ≥ 10), higher values were found in the 1st trimester, decreasing in the 2nd and again in the 3rd pregnancy trimester (see Table 2).
As regards comorbidity, higher values of STAI-S ≥ 45 ∩ EPDS ≥ 10 were found during the 1st pregnancy
Discussion
Significant changes were observed in anxiety and depression symptoms throughout pregnancy. Symptoms of anxiety followed a U pattern in pregnancy, being higher at the 1st trimester, registering a significant decrease in the 2nd trimester and an increase in the 3rd one, results which are consistent with previous literature (Da Costa et al., 1999, Lee et al., 2007). Symptoms of depression decreased throughout pregnancy, with a significant decrease occurring from the 1st to the 2nd trimester and
Role of funding source
Funding for this work was supported by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and supported by the European Community Fund FEDER. (POCI/SAU-ESP/56397/2004; Anxiety and depression in women and men during the transition to parenthood: Effects on fetal and neo-natal behavior and development).
The sponsors had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in
Conflict of interest
This work has no conflict of interest.
Acknowledgements
This work was supported by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER. (POCI/SAU-ESP/56397/2004; Anxiety and depression in women and men during the transition to parenthood: Effects on fetal and neonatal behavior and development). We gratefully acknowledge the work of Filomena Louro of the Scientific Editing Programme of Universidade do Minho for revising this article.
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