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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2021

Open Access 01-12-2021 | Mood Disorders | Research article

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image

Authors: Afsaneh Keramat, Mina Malary, Mahmood Moosazadeh, Nastaran Bagherian, Mohammad-Reza Rajabi-Shakib

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

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Abstract

Background

Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI).

Methods

This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R).

Results

Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P <  0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P <  0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score.

Conclusion

Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.
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Literature
1.
Senobari M, Azmoude E, Mousavi M. The relationship between body mass index, body image, and sexual function: a survey on Iranian pregnant women. Int J Reprod BioMed. 2019;17(7):503.PubMedPubMedCentral
2.
Carter D, Kostaras X. Psychiatric disorders in pregnancy. British Columbia Med J. 2005;47(2):96.
3.
Rich-Edwards JW, Kleinman K, Abrams A, Harlow BL, McLaughlin TJ, Joffe H, Gillman MW. Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. J Epidemiol Community Health. 2006;60(3):221–7.PubMedPubMedCentralCrossRef
4.
Pereira PK, Lovisi GM, Pilowsky DL, Lima LA, Legay LF. Depression during pregnancy: prevalence and risk factors among women attending a public health clinic in Rio de Janeiro, Brazil. Cadernos de Saúde Pública. 2009;25(12):2725–36.PubMedCrossRef
5.
Tang X, Lu Z, Hu D, Zhong X. Influencing factors for prenatal stress, anxiety and depression in early pregnancy among women in Chongqing, China. J Affect Disord. 2019;253:292–302.PubMedCrossRef
6.
Zareipour M, Sadaghianifar A, Amirzehni J, Parsnezhad M, Ayuoghi Rahnema V. Exploring of depression, anxiety and stress in pregnant women referred to health centers of Urmia. Rahavard Salamat J. 2017;3(2):19–30.
7.
Kaplan LA, Evans L, Monk C. Effects of mothers’ prenatal psychiatric status and postnatal caregiving on infant biobehavioral regulation: can prenatal programming be modified? Early Hum Dev. 2008;84(4):249–56.PubMedCrossRef
8.
DeRogatis L, Clayton A, Lewis-D’Agostino D, Wunderlich G, Fu Y. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5(2):357–64.PubMedCrossRef
9.
Bartellas E, Crane JM, Daley M, Bennett KA, Hutchens D. Sexuality and sexual activity in pregnancy. BJOG. 2000;107(8):964–8.PubMedCrossRef
10.
Pauls RN, Occhino JA, Dryfhout VL. Effects of pregnancy on female sexual function and body image: a prospective study. J Sex Med. 2008;5(8):1915–22.PubMedCrossRef
11.
Skouteris H, Carr R, Wertheim EH, Paxton SJ, Duncombe D. A prospective study of factors that lead to body dissatisfaction during pregnancy. Body Image. 2005;2(4):347–61.PubMedCrossRef
12.
Bailey L. Gender shows: first-time mothers and embodied selves. Gend Soc. 2001;15(1):110–29.CrossRef
13.
Vannier SA, Rosen NO. Sexual distress and sexual problems during pregnancy: associations with sexual and relationship satisfaction. J Sex Med. 2017;14(3):387–95.PubMedCrossRef
14.
DeMaria AL, Meier SJ, Dykstra C. “It’s not perfect but it’s mine”: genital self-image among women living in Italy. Body Image. 2019;29:140–8.PubMedCrossRef
15.
Baršauskaitė I. Female genital self-image and sexual dissatisfaction: the role of sexual esteem and partner perceived genital dissatisfaction; 2018.
16.
Inanir S, Cakmak B, Nacar MC, Guler AE, Inanir A. Body image perception and self-esteem during pregnancy; 2015.CrossRef
17.
Earle S. “bumps and boobs”: fatness and women’s experiences of pregnancy. Women’s Stud Int Forum. 2003;26(3):245–52.
18.
Motosko CC, Bieber AK, Pomeranz MK, Stein JA, Martires KJ. Physiologic changes of pregnancy: a review of the literature. Int J Womens Dermatol. 2017;3(4):219–24.PubMedPubMedCentralCrossRef
19.
Silveira ML, Ertel KA, Dole N, Chasan-Taber L. The role of body image in prenatal and postpartum depression: a critical review of the literature. Arch Womens Mental Health. 2015;18(3):409–21.CrossRef
20.
Roomruangwong C, Kanchanatawan B, Sirivichayakul S, Maes M. High incidence of body image dissatisfaction in pregnancy and the postnatal period: associations with depression, anxiety, body mass index and weight gain during pregnancy. Sex Reprod Healthc. 2017;13:103–9.PubMedCrossRef
21.
Sweeney AC, Fingerhut R. Examining relationships between body dissatisfaction, maladaptive perfectionism, and postpartum depression symptoms. J Obstet Gynecol Neonatal Nurs. 2013;42(5):551–61.PubMedCrossRef
22.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–7.CrossRef
23.
Nik-Azin A, Nainian MR, Zamani M, Bavojdan MR, Bavojdan MR, Motlagh MJ. Evaluation of sexual function, quality of life, and mental and physical health in pregnant women. J Family Reprod Health. 2013;7(4):171.PubMedPubMedCentral
24.
Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther. 1995;33(3):335–43.PubMedCrossRef
25.
Oei TP, Sawang S, Goh YW, Mukhtar F. Using the depression anxiety stress scale 21 (DASS-21) across cultures. Int J Psychol. 2013;48(6):1018–29.PubMedCrossRef
26.
Crawford JR, Henry JD. The depression anxiety stress scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(2):111–31.PubMedCrossRef
27.
Moradipanah F, Mohammadi E, Mohammadil A. The effect of music on anxiety stress and mild depression patients undergoing cardiac catheterization [Dissertation]. Tehran: Tarbiyat Modarres University; 2005.
28.
Yazdanpanahi Z, Beygi Z, Akbarzadeh M, Zare N. To investigate the relationship between stress, anxiety and depression with sexual function and its domains in women of reproductive age. Int J Med Res Health Sci. 2018;5(10):223–31.
29.
Nowosielski K, Wróbel B, Sioma-Markowska U, Poręba R. Sexual dysfunction and distress—development of a polish version of the female sexual distress scale-revised. J Sex Med. 2013;10(5):1304–12.PubMedCrossRef
30.
Nekoo EA, Burri A, Ashrafti F, Fridlund B, Koenig HG, Derogatis LR, Pakpour AH. Psychometric properties of the Iranian version of the female sexual distress scale-revised in women. J Sex Med. 2014;11(4):995–1004.CrossRef
31.
Aydın S, Onaran ÖI, Topalan K, Aydın ÇA, Dansuk R. Development and validation of Turkish version of the female sexual distress scale-revised. Sex Med. 2016;4(1):e43–50.PubMedPubMedCentralCrossRef
32.
Herbenick D, Reece M. Outcomes assessment: development and validation of the female genital self-image scale. J Sex Med. 2010;7(5):1822–30.PubMedCrossRef
33.
Herbenick D, Reece M. Development and validation of the female genital self-image scale. J Sex Med. 2010;7(5):1822–30.PubMedCrossRef
34.
Felix GD, Nahas FX, Marcondes GB, dos Santos AG, de Brito MJ, Ferreira LM. Brazilian Portuguese version of the female genital self image scale (FGSIS) for women seeking abdominoplasty. J Plast Reconstr Aesthet Surg. 2017;70(12):1786–7.PubMedCrossRef
35.
Pakpour AH, Zeidi IM, Ziaeiha M, Burri A. Cross-cultural adaptation of the female genital self-image scale (FGSIS) in Iranian female college students. J Sex Res. 2014;51(6):646–53.PubMedCrossRef
36.
Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970–8.PubMedCrossRef
37.
Anğın AD, Özkaya E, Çetin M, Gün I, Sakin O, Ertekin LT, Denizli R, Koyuncu K, Akalın EE. Comparison of female sexual function and sexual function of their partners between groups of pregnant and non-pregnant women. Ginekol Pol. 2020;91(5):235–9.PubMedCrossRef
38.
Witting K, Santtila P, Varjonen M, Jern P, Johansson A, Von Der Pahlen B, Sandnabba K. Female sexual dysfunction, sexual distress, and compatibility with partner. J Sex Med. 2008;5(11):2587–99.PubMedCrossRef
39.
Brown A, Rance J, Warren L. Body image concerns during pregnancy are associated with a shorter breast feeding duration. Midwifery. 2015;31(1):80–9.PubMedCrossRef
40.
Lordelo P, Brasil C, Lerche J, Gomes T, Martins P, Castro M. Relationship between female genital self-image and sexual function: cross-sectional study. Obstet Gynecol Int J. 2017;7(4):00253.CrossRef
41.
Jawed-Wessel S, Herbenick D, Schick V. The relationship between body image, female genital self-image, and sexual function among first-time mothers. J Sex Marital Ther. 2017;43(7):618–32.PubMedCrossRef
42.
Biratu A, Haile D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015;12(1):99.PubMedPubMedCentralCrossRef
43.
Brittain K, Myer L, Koen N, Koopowitz S, Donald KA, Barnett W, Zar HJ, Stein DJ. Risk factors for antenatal depression and associations with infant birth outcomes: results from a S outh a frican birth cohort study. Paediatr Perinat Epidemiol. 2015;29(6):505–14.PubMedCrossRef
44.
Karaçam Z, Ançel G. Depression, anxiety and influencing factors in pregnancy: a study in a Turkish population. Midwifery. 2009;25(4):344–56.PubMedCrossRef
45.
Nagandla K, Nalliah S, Yin L, Majeed Z, Ismail M, Zubaidah S, Ragavan U, Krishnan S. Prevalence and associated risk factors of depression, anxiety and stress in pregnancy. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):2380–8.CrossRef
46.
Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62–77.PubMedPubMedCentralCrossRef
47.
Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, Le Roux I, Mbewu N, Rotheram-Borus MJ. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8(1):9.PubMedPubMedCentralCrossRef
48.
Mohamad Yusuff AS, Tang L, Binns CW, Lee AH. Prevalence of antenatal depressive symptoms among women in Sabah, Malaysia. J Matern Fetal Neonatal Med. 2016;29(7):1170–4.PubMedCrossRef
49.
Chou F-H, Kuo S-H, Wang R-H. A longitudinal study of nausea and vomiting, fatigue and perceived stress in, and social support for, pregnant women through the three trimesters. Kaohsiung J Med Sci. 2008;24(6):306–14.PubMedCrossRef
50.
Fekadu Dadi A, Miller ER, Mwanri L. Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: a systematic review and meta-analysis. PLoS One. 2020;15(1):e0227323.PubMedPubMedCentralCrossRef
51.
Fadzil A, Balakrishnan K, Razali R, Sidi H, Malapan T, Japaraj RP, Midin M, Nik Jaafar NR, Das S, Manaf MRA. Risk factors for depression and anxiety among pregnant women in Hospital Tuanku Bainun, Ipoh, Malaysia. Asia Pac Psychiatry. 2013;5:7–13.PubMedCrossRef
52.
Silva MMdJ, Nogueira DA, Clapis MJ, Leite EPRC: Anxiety in pregnancy: prevalence and associated factors. Revista da Escola de Enfermagem da USP. 2017;51:e03253.
53.
Giardinelli L, Innocenti A, Benni L, Stefanini M, Lino G, Lunardi C, Svelto V, Afshar S, Bovani R, Castellini G. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Mental Health. 2012;15(1):21–30.CrossRef
Metadata
Title
Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image
Authors
Afsaneh Keramat
Mina Malary
Mahmood Moosazadeh
Nastaran Bagherian
Mohammad-Reza Rajabi-Shakib
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-021-03575-1

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