Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress

Abstract

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms. Using a prospective cohort design, a diverse sample of 300 pregnant women from four centers of Aga Khan Hospital for Women and Children in Pakistan were enrolled in the study. Comorbid anxiety and depression during pregnancy were high and numerous factors predicted increased likelihood of comorbidity, including: (1) High level of perceived stress at any time point, (2) having 3 or more previous children, and (3) having one or more adverse childhood experiences. These risks were increased if the husband was employed in the private sector. Early identification and treatment of mental health comorbidities may contribute to decreased adverse birth outcomes in LMI countries.

Comorbid anxiety and depression: Prevalence and associated factors among pregnant women in Arba Minch zuria district, Gamo zone, southern Ethiopia

“…increased the odds of CAD. This finding is in line with the studies conducted in Pakistan 13.5% [6], Spain (9.5%) [7], South Africa (7.6% early and 9.7% in late pregnancy) [9] and a meta-analysis conducted by Falah and coworkers (9.5%) [4]. On the other hand, this finding is higher than the study conducted in Singapore (5.0%) [5] and very much lower than the study in Turkey (47.6%) [7].…”

“…Thiagayson and associates also reported that 5% of Singaporean women had prenatal CAD [ 5 ]. Likewise, studies from Spain, Turkey and Pakistan also demonstrated that 9.5%, 47.6% and 13.5% of pregnant women encountered CAD respectively [ 6 , 7 ].…”

“…Previously published evidences consistently reported that low socioeconomic status, adverse events in life, poor social support, intimate partner violence (IPV), previous episode of CMDs, history of chronic medical illness, unmarried status and unplanned pregnancy increases the odds of perinatal mental disorders [ 2 , 3 , 11 , 12 ]. Also, Premji and associates reported that a high level of perceived stress, having ≥ 3 children and adverse childhood experience increases the odds of CAD [ 6 ]. Household food insecurity also increases the odds of mental health problems during pregnancy [ 13 – 15 ].…”

COVID-19 e as repercussões na saúde mental de gestantes: revisão integrativa

“…(17) Há evidências em outros estudos de que a pandemia por si só age como fator estressor e contribui para o sofrimento psicológico durante a gestação, sendo considerado um forte preditor de ansiedade comórbida e sintomas depressivos leves a graves. (28,29) Os conflitos familiares também foram citados como responsáveis pelo aumento do estresse nas gestantes. (10) Segundo estudo realizado com participantes de todos os estados brasileiros, em tempos de isolamento é comum a observação da ocorrência de algum estresse familiar, havendo relação significante com a quantidade de pessoas vivendo na casa.…”

Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review

“…Biological . Two studies used biological vulnerability in the context of maternal health: risk of comorbid anxiety and depression in pregnancy [ 31 ], and HIV positivity [ 28 ].…”