Psychosocial Factors of Antenatal Anxiety and Depression in Pakistan: Is Social Support a Mediator?

Abstract

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.

Anxiety in pregnancy: prevalence and associated factors

“…Similar to what is shown in the literature, in this study the risk of anxiety in pregnancy was higher among pregnant women who did not perform paid work activities (20) , highlighting employment as a protective factor for their mental health. This finding contrasts a Pakistani study, which showed that pregnant women working outside the household were more anxious and depressed than housewives who did not engage in labor activity (8) . Several factors may elucidate the findings of this study.…”

“…Although maternal anxiety indexes during pregnancy are heterogeneous, anxiety symptoms and disorders are common in the perinatal period (3)(4) , and the symptoms may range from mild to severe (5) . National and international studies point to variable anxiety indexes around 23% in a study conducted in Alberta, Canada (6) , 15.6% in a study carried out in Germany (7) and 49% in Pakistan (8) .…”

“…The evidence suggests that the likelihood of anxiety during pregnancy increases in cases of psychiatric comorbidity, stressful events (6,9) , social disadvantage, history of abortion, fetal loss, preterm delivery or early neonatal loss (8,10) , previous history of mental illness or a history of psychiatric treatment during an earlier pregnancy or throughout life (9,11) . Considering the belief among many societies that the psychological state of the mother can affect the child in her womb, anxiety disorder is considered one of the risk factors in pregnancy development, since its onset may compromise the fetus in being associated with negative neonatal outcomes, such as prematurity, low birth weight (12) , lower Apgar scores, fetal development deficit, in addition to lasting effects on the physical and psychological development of the child (13) and obstetric complications, such as vaginal bleeding and the risk of abortion (3) .…”

Psychosocial Factors Associated with Anxiety and Delivery Pain

“…In addition, parity showed a direct and indirect relationship with psychological stress, therefore, parity can lead to anxiety through coping mechanism and psychological stress. The result of this study was in line with a study by Waqas et al, (2015). Parity is the condition of women related to the birth of a living child (Dorland, 2002).…”

“…Family support, age, parity, stress, low economic status, birth history, history of violence are frequently reported predictors (Waqas et al, 2015;Meulen, 2016). Prenatal depression, poor pregnancy history, poor family relationships, low socioeconomic status, low education level, unwanted pregnancies, complications during pregnancy are the determinants of anxiety and labor pain (Meulen, 2016).…”