IntroductionPregnancy is generally viewed as a time of fulfillment and joy; however, for many women it can be a stressful event. In South Asia it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities.MethodologyThis cross-sectional study was done at four teaching hospitals in Lahore from February, 2014 to June, 2014. A total of 500 pregnant women seen at hospital obstetrics and gynecology departments were interviewed with a questionnaire consisting of three sections: demographics, the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). Pearson’s chi-squared test, bivariate correlations and multiple linear regression were used to analyze associations between the independent variables and scores on the HADS and SPS.ResultsMean age among the 500 respondents was 27.41 years (5.65). Anxiety levels in participants were categorized as normal (145 women, 29%), borderline (110, 22%) or anxious (245, 49%). Depression levels were categorized as normal (218 women, 43.6%), borderline (123, 24.6%) or depressed (159, 31.8%). Inferential analysis revealed that higher HADS scores were significantly associated with lower scores on the SPS, rural background, history of harassment, abortion, cesarean delivery and unplanned pregnancies (P < .05). Social support (SPS score) mediated the relationship between the total number of children, gender of previous children and HADS score. Women with more daughters were significantly more likely to score higher on the HADS and lower on the SPS, whereas higher numbers of sons were associated with the opposite trends in the scores (P < .05).ConclusionBecause of the predominantly patriarchal sociocultural context in Pakistan, the predictors of antenatal anxiety and depression may differ from those in developed countries. We therefore suggest that interventions designed and implemented to reduce antenatal anxiety and depression should take into account these unique factors.

Introduction: Pregnancy is generally viewed as a time of fulfillment and joy, however, for many women, it can be a stressful event. In South Asia, it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. It is also associated with several psychiatric problems in women, most notably, depression and anxiety. Methodology: This cross sectional study was undertaken in four teaching hospitals in Lahore from February, 2014 to June, 2014. 500 Pregnant women presenting at the outdoors of obstetrics and gynecology department were interviewed. The questionnaire consisted of three sections: Demographics, Hospital anxiety and depression scale and social provision scale. Data was analyzed in SPSS v.20. Descriptive statistics were analyzed for demographics. Pearson Chi Square, Bivariate Correlations and Partial Correlations were run to analyze associations of independent variables with scores on HAD scale and SPS. Results: There were a total of 500 respondents. Mean age of respondents was 27.41 years (5.65). Anxiety levels of participants were categorized as Normal 145 (29%), borderline 110 (22%) and anxious 245 (49%). Depression levels were categorized as 218 (43.6%) normal, 123 (24.6%) borderline, and 159 (31.8%) depressed. Inferential analysis revealed that higher scores on HAD scale were significantly associated with lower scores on SPS, rural background, history of harassment, abortion, C-sections and unplanned pregnancies (P < .05). Social support also mediated the relationship between total numbers of children, gender of previous offspring and scores on HAD and SPS scales. Women reporting higher numbers of female children were significantly associated with higher scores on HAD scale and lower on SPS scale. Whereas increasing number of male progeny were associated with low scores on these scales (P < .05). Conclusion: Keeping in context the predominantly patriarchal socio-cultural setting, the predictors of antenatal anxiety and depression in Pakistan may differ from those of the developed countries. Rural women and working women showed higher levels of antenatal anxiety and depression, which contradicts studies from western countries. Our study revealed higher number of female progeny was associated with higher levels of depression and anxiety while male progeny had a protective influence. We, therefore, suggest that interventions designed to reduce antenatal anxiety and depression should take these unique factors, operating in developing countries and patriarchal societies, into account in their design and implementation.

Introduction: Pregnancy is generally viewed as a time of fulfillment and joy; however, for many women it can be a stressful event. In South Asia it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. It is also associated with several psychiatric problems in women, most notably depression and anxiety. Methodology: This cross-sectional study was done at four teaching hospitals in Lahore from February, 2014 to June, 2014. A total of 500 pregnant women seen at hospital obstetrics and gynecology departments were interviewed with a questionnaire consisting of three sections: demographics, the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). All data were analyzed with SPSS v. 20. Descriptive statistics were analyzed for demographic variables. Pearson’s chi-squared test, bivariate correlations and multiple linear regression were used to analyze associations between the independent variables and scores on the HADS and SPS. Results: Mean age among the 500 respondents was 27.41 years (5.65). Anxiety levels in participants were categorized as normal (145 women, 29%), borderline (110, 22%) or anxious (245, 49%). Depression levels were categorized as normal (218 women, 43.6%), borderline (123, 24.6%) or depressed (159, 31.8%). Inferential analysis revealed that higher HADS scores were significantly associated with lower scores on the SPS, rural background, history of harassment, abortion, cesarean delivery and unplanned pregnancies (P < .05). Social support (SPS score) mediated the relationship between the total number of children, gender of previous children and HADS score. Women with more daughters were significantly more likely to score higher on the HADS and lower on the SPS, whereas higher numbers of sons were associated with the opposite trends in the scores (P < .05) Conclusion: Because of the predominantly patriarchal sociocultural context in Pakistan, the predictors of antenatal anxiety and depression may differ from those in developed countries. Rural women and working women had higher levels of antenatal anxiety and depression, which contradicts earlier findings in western countries. Our study found that higher numbers of daughters were associated with higher levels of depression and anxiety, whereas sons had a protective influence. We therefore suggest that interventions designed and implemented to reduce antenatal anxiety and depression should take into account these unique factors operating in developing countries and patriarchal societies.

Introduction: Pregnancy is generally viewed as a time of fulfillment and joy, however, for many women, it can be a stressful event. In South Asia, it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. It is also associated with several psychiatric problems in women, most notably, depression and anxiety. Methodology: This cross sectional study was undertaken in four teaching hospitals in Lahore from February, 2014 to June, 2014. 500 Pregnant women presenting at the outdoors of obstetrics and gynecology department were interviewed. The questionnaire consisted of three sections: Demographics, Hospital anxiety and depression scale and social provision scale. Data was analyzed in SPSS v.20. Descriptive statistics were analyzed for demographics. Pearson Chi Square, Bivariate Correlations and linear regression were run to analyze associations of independent variables with scores on HAD scale and SPS. Results: There were a total of 500 respondents. Mean age of respondents was 27.41 years (5.65). Anxiety levels of participants were categorized as Normal 145 (29%), borderline 110 (22%) and anxious 245 (49%). Depression levels were categorized as 218 (43.6%) normal, 123 (24.6%) borderline, and 159 (31.8%) depressed. Inferential analysis revealed that higher scores on HAD scale were significantly associated with lower scores on social provisions scale (SPS), rural background, history of harassment, abortion, C-sections and unplanned pregnancies (P < .05). Social support also mediated the relationship between gender of previous offspring and scores on HAD scale. Women reporting higher numbers of female children were significantly associated with higher scores on HAD scale and lower on SPS scale. Whereas increasing number of male progeny were associated with low scores on depression subscale (P < .05). Conclusion: Keeping in context the predominantly patriarchal socio-cultural setting, the predictors of antenatal anxiety and depression in Pakistan may differ from those of the developed countries. Rural women and working women showed higher levels of antenatal anxiety and depression, which contradicts studies from western countries. Our study revealed higher number of female progeny was associated with higher levels of depression and anxiety while male progeny had a protective influence. We, therefore, suggest that interventions designed to reduce antenatal anxiety and depression should take these unique factors, operating in developing countries and patriarchal societies, into account in their design and implementation.

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