Depression and anxiety among high-risk obstetric inpatients

Abstract

Objective To assess the following among women hospitalized antenatally due to high-risk pregnancies: (1) rates of depression symptoms and anxiety symptoms, (2) changes in depression symptoms and anxiety symptoms and, (3) rates of mental health treatment. Methods Sixty-two participants hospitalized for high-risk obstetrical complications completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD-7) and Short-Form 12 weekly until delivery or discharge, and once postpartum. Results Average length of total hospital stay was 8.3±7.6days for women who completed an initial admission survey (n=62) and 16.3±8.9 (n=34), 25.4±10.2 (n=17) and 35±10.9 days (n=9) for those who completed 2, 3 and 4 surveys, respectively. EPDS was ≥10 in 27% (n=17) and GAD-7 was ≥10 in 13% (n=8) of participants at initial survey. Mean anxiety (4.2±6.5 vs. 5.2±5.1, p=.011) and depression (4.4±5.6 vs. 6.9±4.8, p=.011) scores were lower postpartum compared to initial survey. Past mental health diagnosis predicted depression symptoms [odds ratio (OR)=4.54; 95% confidence interval (CI) 1.91–7.17] and anxiety symptoms (OR=5.95; 95% CI 3.04–8.86) atinitial survey; however, 21% (n=10) with no diagnostic history had EPDS ≥10. Five percent (n=3) received mental health treatment during pregnancy. Conclusion Hospitalized high-risk obstetrical patients may commonly experience depression symptoms and/or anxiety symptoms and not receive treatment. A history of mental health treatment or diagnosis was associated with depression symptoms or anxiety symptoms in pregnancy. Of women with an EPDS ≥10, >50% did not report a past mental health diagnosis.

Psychosocial stress in high risk pregnancy

“…Two of the 7 studies were prospective cohort studies [13,15], and six were cross-sectional studies [10,14,16,17,18]. Both of the prospective studies had assessment points both antenatally and postnatally [13,15].…”

“…Both of the prospective studies had assessment points both antenatally and postnatally [13,15]. The majority of studies included high-risk pregnant women who were hospitalized in a hospital or a health centre.…”

“…The majority of studies used specific inclusion criteria for controlling certain confounding psychosocial (e.g., no previous history of psychological illness) variables. In addition some [13,16] studies also incorporated statistical analyses, such as regression analyses, for controlling confounding variables.…”

“…Three of the 7 studies took place in United States of America [13,14,15] ; three studies were conducted in Europe [10,16,17] and one study conducted in Asia [18].…”

“…The size of the samples ranged from 20 women to 367 couples, and the size of the control samples ranged from 55 to 200. The vast majority of studies included < 100 women [13,15,16,17], while three studies included more than 100 high-risk pregnant women [10,14,18]. Only one study in this review [15] provided a power calculation.…”