Main Article Content

Ejaz Gul
Pirzada Muhammad Muneeb
Mukhtiar Ul Haq Azeemi
Muhammad Abbas Khan
Sumaira Shah


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.

Article Details

How to Cite
Gul, E., P. M. Muneeb, M. U. H. Azeemi, M. A. Khan, and S. Shah. “ANTENATAL ANXIETY AND DEPRESSION AMONG PREGNANT WOMEN ATTENDING TERTIARY CARE HOSPITAL, MARDAN, PAKISTAN”. KHYBER MEDICAL UNIVERSITY JOURNAL, vol. 11, no. 3, Sept. 2019, pp. 160-4, doi:10.35845/kmuj.2019.18607.
Original Articles
Author Biographies

Ejaz Gul, Department of Psychiatry, Mardan Medical Complex, Bacha Khan Medical College, Mardan, Pakistan

Department of Psychiatry,

Associate Professor

Pirzada Muhammad Muneeb, Department of Psychiatry, Mardan Medical Complex, Bacha Khan Medical College, Mardan, Pakistan

Department of Psychiatry

Clinical Psychologist

Muhammad Abbas Khan, Department of Psychiatry, Mardan Medical Complex, Bacha Khan Medical College, Mardan, Pakistan

Department of Psychiatry,

Medical Officer

Sumaira Shah, Department of Psychiatry, Mardan Medical Complex, Bacha Khan Medical College, Mardan, Pakistan

Department of Psychiatry,

Clinical Psychologist


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 Anxiety 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: August 28; 2018]. Available from URL:

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 28; 2018]. Available from URL:

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

Gul F, Sherin A, Jabeen M, Khan SA. Association of stress with anxiety and depression during pregnancy. J Pak Med Assoc 2017 Dec;67(12):1803-8.

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. 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 Affect Disord 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, et al. 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. ‎Sci World J 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