Anxiety During Pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression

Abstract

Previous findings on peripartum anxiety are inconsistent in respect to the prevalence and course of peripartum anxiety with comorbidity of depression. Our aim was threefold: (1) to examine the course of elevated anxiety during pregnancy, immediately after childbirth, and six weeks postpartum; (2) to establish comorbidity of postpartum anxiety and postpartum depression (PPD); and (3) to examine predictors of anxiety 6 weeks postpartum. A sample of women (N=272) who were below the cut-off score for clinical depression during pregnancy were assessed in the third trimester of pregnancy, then 2 days and 6 weeks postpartum. Questionnaires on anxiety, pregnancy specific distress, stress, coping styles, social support, and depression were administered at each assessment. Obstetric data were collected from the participants' medical records. The estimated rate of high anxiety was 35% during pregnancy, 17% immediately after childbirth, and 20% six weeks postpartum, showing a decrease in anxiety levels after childbirth. Comorbidity of anxiety and PPD was 75%. Trait anxiety and early postpartum state anxiety are significant predictors of postpartum anxiety. Anxiety is a common peripartum psychological disturbance. Anxiety symptoms overlap with PPD, but not com-pletely, indicating that screening for postpartum mental difficulties should include both depression and anxiety.

Keywords: Anxiety; Comorbidity; Depression; Depression, postpartum; Depressive disorder; Medical records; Pregnancy, predictors; Prognosis; Risk factors; Surveys and questionnaires.

Fig. 1

Flow chart of the State-Trait Anxiety Inventory as a measure of state anxiety (STAI-S) scores from pregnancy to 6 weeks postpartum. At each time point, the sample is divided into groups of women who scored below the cut-off for anxiety (square) and those who scored above the cut-off (round). In each cell, numbers represent the number of participants in the subsample, percent of the total sample (N=272), and mean STAI-S score for the subsample (the data presented were obtained in the current study, however, the flow chart was made on the model presented in Heron et al. (26)).