OBJECTIVE: To determine the frequency of anxiety and depression among pregnant women during the three trimesters of pregnancy.
METHODS: This cross-sectional study was conducted at Bacha Khan Teaching Hospital and Mardan Medical Complex, Mardan from October 2017 to April 2018. The study included 212 pregnant women during their routine antenatal checkup with the gynecologist in their first, second and third trimester of pregnancy. Convenience sampling method was used and structured interview was conducted to obtain demographic information. Hamilton Depression rating scale and Hamilton anxiety rating scale (HAM-A) was used to assess symptoms of depression and anxiety respectively.
RESULTS: Out of 212 pregnant women, most were uneducated (n=96, 45.3%), housewives (n=182, 85.8%), from rural area (n=114, 53.8%), in 3rd trimester of pregnancy (n=132, 62.3), having planned pregnancy (n=174, 82.1%) and desirous of male child (n=94, 44.3%) having mean age of 25.55±5.52 years (16-40 years). Mild depression was present among 68 (32.1%), moderate depression was found among 64 (30.2%), severe depression was found among 24 (11.3%) and very severe depression among 20 (9.4%). According to HAM-A scores, 70 (33%) of the participants scored in normal range, 44 (20.8%) lied in mild anxiety range, 62 (29.2%) lied in moderate anxiety while 36 (17%) lied in severe anxiety range. Levels of depression and anxiety were highest among women of third trimester.
CONCLUSION: Most were uneducated, housewives, having rural origin, in 3rd trimester and desirous of male child. Symptoms of anxiety and depression were common among pregnant women especially in 3rd trimester.
Patel V, Araya R, De Lima M, Ludermir A, Todd C. Women, poverty and common mental disorders in four restructuring societies. Soc Sci Med 1999 Dec ;49(11):1461-71. DOI: 10.1016/s0277-9536(99)00208-7.
Brancaglion MYM, Rückl S, Couto TC, Viana LE, Nicolato R, Filho HCdS. How Gestational Depression Impacts on Quality of Life. J Depress Anxi-ety. 2016;5(2):1000225. DOI: 10.4172/2167-1044.1000225
National Institute for Health and Care Excellenece (NICE) Clinical Guideline, Depression in Adults: Recognition and Management. 2009 October (Last updated April 2018). [Cited on: Ausust 2018]. Available from URL: https://www.nice.org.uk/guidance/cg90
Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004 Apr 1;103(4):698-709. DOI: 10.1097/01.AOG.0000116689.75396.5f
Rauchfuss M, Maier B. Biopsychosocial predictors of preterm delivery. J Perinat Med 2011 Sep;39(5):515-21. DOI: 10.1515/JPM.2011.067.
Alder J, Fink N, Bitzer J, Hösli I, Holzgreve W. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 2007 Jan 1;20(3):189-209. DOI: 10.1080/14767050701209560
World Health Organization (WHO) and United Nations Population Fund (UNPF). Mental health aspects of women's reproductive health: a global review of the literature. Geneva : World Health Organization 2009. [Cited on: August 2018]. Available from URL: https://apps.who.int/iris/handle/10665/43846
Pereira PK, Lovisi GM. Prevalence of gestational depression and associated factors. Arch Clin Psychiatry (São Paulo). 2008;35(4):144-53. DOI: 10.1590/S0101-60832008000400004
Kazi A, Fatmi Z, Hatcher J, Kadir MM, Niaz U, Wasserman GA. Social environment and depression among pregnant women in urban areas of Pakistan: importance of social relations. Soc Sci Med 2006 Sep 1;63(6):1466-76. DOI: 10.1016/j.socscimed.2006.05.019
Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 2008 Jul 7;65(7):805-15. DOI: 10.1001/archpsyc.65.7.805
Hedlund JL, Vieweg BW. The Hamilton rating scale for depression: a comprehensive review. J Operational Psychiatry 1979;10(2):149-65.
Hamilton MC. Hamilton anxiety scale (HAMA). In: Sourcebook of Adult Assessment: Applied Clinical Psychology. Schutte NS, Malouff JM (eds). Plenum Press, New York 1959. p154-7.
Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 2010 Jan;202(1):5-14. DOI: 10.1016/j.ajog.2009.09.007
Karmaliani R, Asad N, Bann CM, Moss N, Mcclure EM, Pasha O, et al. Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. Int J Soc Psychiatry 2009 Sep;55(5):414-24. DOI: 10.1177/0020764008094645
Shah SM, Bowen A, Afridi I, Nowshad G, Muhajarine N. Prevalence of antenatal depression: comparison between Pakistani and Canadian women. J Pak Med Assoc 2011 Mar 1;61(3):242-6.
Jafri SAM, Ali M, Ali R, Shaikh S, Abid M, Aamir IS. (2017) Prevalence of Depression among Pregnant Women Attending Antenatal Clinics in Pakistan. Acta Psychopathol 2017;3:54. DOI: 10.4172/2469-6676.100126.
Humayun A, Haider II, Imran N, Iqbal H, Humayun N. Antenatal depression and its predictors in Lahore, Pakistan. East Mediterr Health J 2013 Apr;19(4):327-32.
Castro e Couto T, Cardoso MN, Brancaglion MM, Faria GC, Garcia FD, Nicolato R, et al. Antenatal depression: Prevalence and risk factor patterns across the gestational period. J affective disorders. 2016 Mar 1;192:70-5. DOI: 10.1016/j.jad.2015.12.017
Coll CD, da Silveira MF, Bassani DG, Netsi E, Wehrmeister FC, Barros FC, Stein A. Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study. J Affec Disord 2017 Feb;209:140-6. DOI: 10.1016/j.jad.2016.11.031
Thompson O, Ajayi I. Prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Abeokuta North Local Government Area, Nigeria. Depress Res Treat 2016;2016:4518979. DOI: 10.1155/2016/4518979
Park JH, Karmaus W, Zhang H. Prevalence of and risk factors for depressive symptoms in Korean women throughout pregnancy and in postpartum period. Asian Nurs Res (Korean Soc Nurs Sci). 2015 Sep;9(3):219-25. DOI: 10.1016/j.anr.2015.03.004.
Abiodun OA. Postnatal depression in primary care populations in Nigeria. Gen Hosp Psychiatry 2006 Mar-Apr;28(2):133-6. DOI: 10.1016/j.genhosppsych.2005.11.002
Esimai OA, Fatoye FO, Quiah AG, Vidal OE, Momoh RM. Antepartum anxiety and depressive symptoms: A study of Nigerian women during the three trimesters of pregnancy. J Obstet Gynaecol 2008 Jan 1;28(2):202-3. DOI: 10.1080/01443610801912352
Lau Y, Wong DF, Chan KS. The utility of screening for perinatal depression in the second trimester among Chinese: a three-wave prospective longitudinal study. Arch Womens Ment Health. 2010 Apr;13(2):153-64. DOI: 10.1007/s00737-009-0134-x.
Nasreen HE, Kabir ZN, Forsell Y, Edhborg M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC Womens Health 2011 Dec;11(1):22. DOI: 10.1186/1472-6874-11-22
Ali NS, Azam IS, Ali BS, Tabbusum G, Moin SS. Frequency and associated factors for anxiety and depression in pregnant women: a hospital-based cross-sectional study. The ScientificWorldJournal 2012;2012.653098. DOI: 10.1100/2012/653098.
Niaz S, Izhar N, Bhatti MR. Anxiety and depression in pregnant women presenting in the OPD of a teaching hospital. Pak J Med Sci 2004;20(2):117-9.
Hamirani MM, Sultana A, Ibrahim Z, Iqbal H, Sultana S. Frequency of prenatal depression in second and third trimesters of pregnancy in Karachi: a hospital based study. J Liaquat Univ Med Health Sci 2006;5(3):106-9.
Madhavanprabhakaran GK, D’Souza MS, Nairy KS. Prevalence of pregnancy anxiety and associated factors. Int J Africa Nurs Sci 2015;3:1-7. DOI: 10.1016/j.ijans.2015.06.002