Prevalence and Risk Factors of Depression and Anxiety among Women in the Last Trimester of Pregnancy: A Cross-Sectional Study

Pregnancy represents a psychologically and emotionally vulnerable period, and research indicates that pregnant women have a higher prevalence of symptoms of anxiety and depression, debunking the myth that hormonal changes associated with pregnancy protect the mother. In recent years, several researchers have focused on the study of prenatal anxiety/depression—emotional disorders manifested by mood lability and low interest in activities—with a high prevalence. The main objective of this research was to conduct an antenatal screening in a cohort of pregnant women hospitalized for delivery in order to assess the prevalence of anxiety and depression. The secondary objective was to identify the risk factors associated with depression and anxiety in women in the third trimester of pregnancy. We carried out a prospective study in which we evaluated 215 pregnant women in the third trimester of pregnancy hospitalized for childbirth at the Obstetrics and Gynecology Clinic of the Târgu-Mureș County Clinical Hospital. The research was carried out between December 2019 and December 2021. The results showed that age and the environment of origin are the strongest predictors of mental health during pregnancy (OR = 0.904, 95%CI: 0.826–0.991; p = 0.029). For women from urban areas, there is an increased probability of falling at a higher level on the dependent variable (moderate depression) (OR = 2.454, 95%CI: 1.086–5.545; p = 0.032). In terms of health behaviors, none of the variables were statistically significant predictors of the outcome variable. The study highlights the importance of monitoring mental health during pregnancy and identifying relevant risk factors to provide appropriate care to pregnant women and the need for interventions to support the mental health of pregnant women. Especially in Romania, where there is no antenatal or postnatal screening for depression or other mental health conditions, these results could be used to encourage the implementation of such screening programs and appropriate interventions.

[1]  D. Haslam,et al.  Depression and anxiety in second and third trimesters among pregnant women in Kenya: a hospital-based prevalence study , 2022, Journal of Affective Disorders Reports.

[2]  F. Alderdice,et al.  Prevalence of perinatal anxiety in low- and middle-income countries: A systematic review and meta-analysis. , 2022, Journal of affective disorders.

[3]  A. Akinsulore,et al.  Pregnancy-related anxiety symptoms and associated factors amongst pregnant women attending a tertiary hospital in south-west Nigeria , 2021, The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa.

[4]  S. Dørheim,et al.  Perinatal mental health around the world: priorities for research and service development in Norway , 2021, BJPsych International.

[5]  B. Akram,et al.  Management of anxiety among pregnant women with serious medical conditions: A multicentre study. , 2020, JPMA. The Journal of the Pakistan Medical Association.

[6]  B. Figueiredo,et al.  Effects of Tobacco Consumption and Anxiety or Depression during Pregnancy on Maternal and Neonatal Health , 2020, International journal of environmental research and public health.

[7]  C. Lebel,et al.  Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic , 2020, Journal of Affective Disorders.

[8]  M. Kramer,et al.  Happy prenatal relationships, healthy postpartum mothers: a prospective study of relationship satisfaction, postpartum stress, and health , 2020, Psychology & health.

[9]  A. Skalkidou,et al.  Perinatal mental health around the world: priorities for research and service development in Sweden , 2020, BJPsych International.

[10]  M. Hynie,et al.  A cross-sectional study of the prevalence and factors associated with symptoms of perinatal depression and anxiety in Rwanda , 2020, BMC Pregnancy and Childbirth.

[11]  V. Plummer,et al.  The risk factors of antenatal depression: a cross-sectional survey. , 2019, Journal of clinical nursing.

[12]  Abate Dargie Wubetu,et al.  Prevalence of risky alcohol use behavior and associated factors in pregnant antenatal care attendees in Debre Berhan, Ethiopia, 2018 , 2019, BMC Psychiatry.

[13]  I. White,et al.  The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. , 2019, The Journal of clinical psychiatry.

[14]  X. Zhong,et al.  Influencing factors for prenatal Stress, anxiety and depression in early pregnancy among women in Chongqing, China. , 2019, Journal of affective disorders.

[15]  B. Duko,et al.  Depression among pregnant women and associated factors in Hawassa city, Ethiopia: an institution-based cross-sectional study , 2019, Reproductive Health.

[16]  D. Stewart,et al.  Postpartum Depression: Pathophysiology, Treatment, and Emerging Therapeutics. , 2019, Annual review of medicine.

[17]  E. González-Mesa,et al.  Cultural factors influencing antenatal depression: A cross-sectional study in a cohort of Turkish and Spanish women at the beginning of the pregnancy. , 2018, Journal of affective disorders.

[18]  M. Zarghami,et al.  Effect of postpartum depression on women's mental and physical health four years after childbirth. , 2018, Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit.

[19]  T. Belachew,et al.  The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study , 2018, BMC Pregnancy and Childbirth.

[20]  C. Dennis,et al.  Maternal Anxiety During Pregnancy and the Association With Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis. , 2018, The Journal of clinical psychiatry.

[21]  M. Mennes,et al.  Prenatal stress and the developing brain: Risks for neurodevelopmental disorders , 2018, Development and Psychopathology.

[22]  A. Ferrari,et al.  A systematic review and meta-regression of the prevalence and incidence of perinatal depression. , 2017, Journal of affective disorders.

[23]  E. Bernad,et al.  Perinatal characteristics and mother's personality profile associated with increased likelihood of postpartum depression occurrence in a Romanian outpatient sample , 2017, Journal of mental health.

[24]  C. Dennis,et al.  Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis , 2017, British Journal of Psychiatry.

[25]  T. Steingrimsdottir,et al.  Partner relationship, social support and perinatal distress among pregnant Icelandic women. , 2017, Women and birth : journal of the Australian College of Midwives.

[26]  A. Stein,et al.  Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study , 2017, Journal of affective disorders.

[27]  I. Ajayi,et al.  Prevalence of Antenatal Depression and Associated Risk Factors among Pregnant Women Attending Antenatal Clinics in Abeokuta North Local Government Area, Nigeria , 2016, Depression research and treatment.

[28]  Jian-Pei Huang,et al.  Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety , 2016, BMC Public Health.

[29]  I. Liebaers,et al.  Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using preimplantation genetic diagnosis. , 2016, Human reproduction.

[30]  K. Beyer,et al.  The Effects of Geographic Isolation and Social Support on the Health of Wisconsin Women. , 2016, WMJ : official publication of the State Medical Society of Wisconsin.

[31]  H. Corrêa,et al.  Antenatal depression: Prevalence and risk factor patterns across the gestational period. , 2016, Journal of affective disorders.

[32]  V. Patel,et al.  Maternal mental health in primary care in five low- and middle-income countries: a situational analysis , 2016, BMC Health Services Research.

[33]  M. Al-Azri,et al.  Prevalence and Risk Factors of Antenatal Depression among Omani Women in a Primary Care Setting: Cross-sectional study. , 2016, Sultan Qaboos University medical journal.

[34]  G. Sydsjö,et al.  Effect of maternal stress during pregnancy on the risk for preterm birth , 2016, BMC Pregnancy and Childbirth.

[35]  J. Probst,et al.  Obesity and obesity-related behaviors among rural and urban adults in the USA. , 2015, Rural and remote health.

[36]  B. Kirkwood,et al.  Prevalence and determinants of antenatal depression among pregnant women in a predominantly rural population in Ghana: the DON population-based study. , 2014, Journal of affective disorders.

[37]  Z. Rihmer,et al.  Prevalence and psychosocial background of anxiety and depression emerging during the first trimester of pregnancy: data from a Hungarian population-based sample. , 2013, Psychiatria Danubina.

[38]  J. Malouff,et al.  Sourcebook of Adult Assessment Strategies , 2013 .

[39]  M. Coussons‐Read Effects of prenatal stress on pregnancy and human development: mechanisms and pathways , 2013, Obstetric medicine.

[40]  Tina L Bloom,et al.  Rural Pregnant Women's Stressors and Priorities for Stress Reduction , 2012, Issues in mental health nursing.

[41]  Anne B Wallis,et al.  Validation of a Romanian scale to detect antenatal depression , 2012 .

[42]  C. Dunkel Schetter,et al.  Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice , 2012, Current opinion in psychiatry.

[43]  M. Kringelbach,et al.  Postnatal depression and its effects on child development: a review of evidence from low- and middle-income countries. , 2012, British medical bulletin.

[44]  E. Davis,et al.  Prenatal maternal stress programs infant stress regulation. , 2011, Journal of child psychology and psychiatry, and allied disciplines.

[45]  J. Kemppainen,et al.  Postpartum Depression Among White, African American, and Hispanic Low-Income Mothers in Rural Southeastern North Carolina , 2011, Journal of community health nursing.

[46]  Satish Iyengar,et al.  A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. , 2010, Archives of general psychiatry.

[47]  H. Flynn,et al.  Risk factors for depressive symptoms during pregnancy: a systematic review. , 2010, American journal of obstetrics and gynecology.

[48]  C. Marchesi,et al.  Major and Minor Depression in Pregnancy , 2009, Obstetrics and gynecology.

[49]  Jennifer E. Graham,et al.  Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. , 2008, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[50]  Jeannette Milgrom,et al.  Antenatal risk factors for postnatal depression: a large prospective study. , 2008, Journal of affective disorders.

[51]  Siu Keung Lam,et al.  Prevalence, Course, and Risk Factors for Antenatal Anxiety and Depression , 2007, Obstetrics and gynecology.

[52]  T. Einarson,et al.  Prevalence of Depression During Pregnancy: Systematic Review , 2004, Obstetrics and gynecology.

[53]  J. Cox,et al.  Detection of Postnatal Depression , 1987, British Journal of Psychiatry.

[54]  R. Snaith,et al.  The Hospital Anxiety And Depression Scale , 2003, Health and quality of life outcomes.

[55]  M. Hamilton,et al.  Development of a rating scale for primary depressive illness. , 1967, The British journal of social and clinical psychology.

[56]  M. Hamilton A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[57]  M. Hamilton The assessment of anxiety states by rating. , 1959, The British journal of medical psychology.

[58]  S. Ethirajan,et al.  ASSESSMENT OF THE PREVALENCE OF DEPRESSION, ANXIETY AND STRESS SYMPTOMS IN TERM ANTENATAL WOMEN– A TERTIARY CARE CENTER EXPERIENCE DURING COVID-19 PANDEMIC , 2021 .

[59]  B. Sapkota,et al.  Prenatal Anxiety among Pregnant Women Visiting in Antenatal Care Outpatient Department at Paropakar Maternity and Women's Hospital , 2019 .

[60]  K. Tabb,et al.  Rurality and Risk of Perinatal Depression Among Women in the United States. , 2019, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[61]  S. Shrestha,et al.  Anxiety on Primigravid Women Attending Antenatal Care: A Hospital Based Cross-sectional Study. , 2018, Kathmandu University Medical Journal.

[62]  G. Kheirabadi,et al.  Perinatal depression in a cohort study on Iranian women , 2010, Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences.

[63]  A. Adewuya,et al.  Prevalence and correlates of depression in late pregnancy among Nigerian women , 2007, Depression and anxiety.