Depression, anxiety, and attachment among women hospitalized on an antepartum unit

Abstract

Objective To examine the prevalence of depression, anxiety, attachment issues, and associated factors among pregnant women hospitalized on an antepartum unit. Method Ninety-eight women hospitalized on an antepartum unit reported demographic and social information and were evaluated with screening tools for depression, anxiety, and maternal–fetal attachment. Data were analyzed using descriptive statistics and logistical regression analysis. Results Over one third (36%) of participants screened at risk for depression. Almost half (47%) reported elevated state anxiety and over one third (37%) reported elevated trait anxiety. Depression and anxiety were frequently comorbid. Positive screens for depression and anxiety were associated with decreased maternal-fetal attachment. Those who screened at risk for depression and anxiety in this sample often had a personal or family history of depression or anxiety or a history of intimate partner victimization. Substance use was common among those with elevated anxiety. Only a minority (15%) of at-risk participants had been referred to mental health treatment. Conclusions Women hospitalized on antepartum units had an elevated risk of depression and anxiety. Depression and anxiety were strongly comorbid in this population. Screening efforts to increase detection of perinatal depression and anxiety are recommended on obstetrical antepartum units.

Prenatal Attachment and Perinatal Depression: A Systematic Review

“…The included studies were mainly conducted in the US (10 papers) [80,[84][85][86][87][88][89][90][91][92] and in Europe (nine papers in Italy [93][94][95][96][97][98][99][100][101], four in Sweden [76,[102][103][104], two in Germany [105,106], one in the Netherlands [22], one in France [107], one in England [79], one in Belgium [108], and one in Portugal [75]). Four studies were carried out in Japan [81,[109][110][111], two in Australia [112,113], two in Iran [74,114], two in Turkey [78,115], one in India [116], one in Israel [117], one in Chile [118], one in Brazil [119], and one in Korea [120] (Figure 2).…”

“…Considering the 45 studies included in the current review, 31 found a negative association between prenatal attachment and perinatal depression [22,74,75,81,84,86,[89][90][91][92]95,[97][98][99]101,102,[104][105][106][107][108][110][111][112][114][115][116][117][118][119][120], while a positive relation between perinatal depression and some dimensions of antenatal attachment was identified in three studies [94,102,106]. Thirteen studies did not highlight significant associations between these variables [76,[78][79][80]85,87,88,93,96,100,103,109,113].…”

“…Thirteen studies did not highlight significant associations between these variables [76,[78][79][80]85,87,88,93,96,100,103,109,113]. Specifically, the majority of the articles (28) observed a negative association between prenatal depressive symptoms and prenatal attachment [22,75,81,84,86,[89][90][91][92]94,97,98,102,[104][105][106][107][108][110][111][112][114][115][116][117][118][119][120]. In contrast, a positive association between prenatal depression and some dimensions of prenatal attachment (i.e., the "physical contact with the fetus and sensitivity to the fetal movement" subscale of the MFAS [102], the "empathy" subscale of the German version of the MFAS [106], and the "fantasy" and the "maternal sensitivity to the fetus" factors of the PAI [94]) was found in three studies…”

“…Nineteen of the 29 studies that administered prenatal attachment instruments in the second or the third trimester of gestation underlined a significant association between the two considered variables [22,74,84,86,[90][91][92]95,97,98,101,102,[104][105][106]112,[115][116][117]: 16 studies confirmed a negative association between prenatal attachment and prenatal depression [22,84,86,[90][91][92]97,98,102,[104][105][106]112,[115][116][117] and six studies identified a negative association between prenatal attachment and postnatal depression [74,95,101,105,116,117], while a positive relation was found between prenatal depression and some factors of prenatal attachment in two studies [102,106]. Even if they assessed prenatal attachment in the recommended gestational period, ten articles did not demonstrate a significant association between prenatal attachment and prenatal depression…”

“…These latter findings emerged within homogeneous samples of women aged 18 or older. Considering this population, 19 studies found a significant negative association between prenatal attachment and prenatal depression [75,81,84,89,90,92,98,102,[104][105][106][107][108]110,111,[114][115][116][117], while nine articles identified a negative association between prenatal attachment and postpartum depression [81,95,99,101,105,110,111,116,117]. However, considering similar groups of participants, ten studies did not support the association between prenatal attachment and prenatal depression [76,80,87,88,93,96,97,100,109,113], and one study did not confirm the relation between prenatal attachment and postpartum depression [85].…”