Top

BMC Pregnancy and Childbirth

Published in:

01-12-2021 | Mood Disorders | Research

The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital

Authors: Jiamei Guo, Anhai Zheng, Jinglan He, Ming Ai, Yao Gan, Qi Zhang, Lulu Chen, Sisi Liang, Xiaoyu Yu, Li Kuang

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

Abstract

Background

Antenatal depression has become a common and serious problem, significantly affecting maternal and fetal health. However, evaluation and intervention methods for pregnant women in obstetric clinics are inadequate. This study aimed to determine the prevalence of and risk factors for depression among all pregnant women at their first attending antenatal care in the obstetrics clinic, a comprehensive teaching hospital, southwest of China.

Methods

From June to December 2019, 5780 pregnant women completed online psychological assessments, and data from 5728 of the women were analyzed. The women were categorized into two groups according to the presence or absence of depression. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a cutoff point of 10 for depression. Anxiety and somatic symptoms were measured by the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-15 (PHQ-15), respectively. Univariate analysis and binary logistic regression analysis were used to determine the association among antenatal depression, anxiety, somatic symptoms and participants’ characteristics.

Results

The prevalence of antenatal depression among all the pregnant women at their first attending antenatal care was 16.3%, higher in the first trimester (18.1%). Anxiety symptoms (Mild anxiety AOR = 2.937; 95% CI: 2.448–3.524) and somatic symptoms (Mild somatic symptoms AOR = 3.938; 95% CI: 2.888–3.368) were major risk factors for antenatal depression among women and the risk increased more with the anxiety level or somatic symptoms level. Gestational weeks (second trimester AOR = 0.611; 95% CI: 0.483–0.773; third trimester AOR = 0.337; 95% CI: 0.228–0.498) and urban residence (AOR = 0.786; 95% CI: 0.652–0.947) were protective factors for antenatal depression among women.

Conclusions

About one in six pregnant women would experience depression, and special attention should be paid to some risk factors (i.e., early pregnancy, anxiety symptoms, somatic symptoms, rural residence). Online psychological assessments might be a time-saving and convenient screening method for pregnant women in obstetric clinics.

Malhi GS, Mann JJ. Depression. Lancet. 2018;392(10161):2299–312. https://doi.org/10.1016/S0140-6736(18)31948-2.CrossRefPubMed

Huang YQ, Wang Y, Wang H, Liu Z, Yu X, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2019;6(3):211–24. https://doi.org/10.1016/S2215-0366(18)30511-X.CrossRefPubMed

Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219–21. https://doi.org/10.1503/jpn.150205.CrossRefPubMedPubMedCentral

Sundström Poromaa I, Comasco E, Georgakis MK, Skalkidou A. Sex differences in depression during pregnancy and the postpartum period. J Neurosci Res. 2017;95(1-2):719–30. https://doi.org/10.1002/jnr.23859.CrossRefPubMed

Okagbue HI, Adamu PI, Bishop SA, Oguntunde PE, Opanuga AA, Akhmetshin EM. Systematic review of prevalence of antepartum depression during the trimesters of pregnancy. Open Access Macedonian J Med Sci. 2019;7(9):1555–60. https://doi.org/10.3889/oamjms.2019.270.CrossRef

Dadi AF, Wolde HF, Baraki AG, Akalu TY. Epidemiology of antenatal depression in Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020;20(1):251. https://doi.org/10.1186/s12884-020-02929-5.CrossRefPubMedPubMedCentral

Yin X, Sun N, Jiang N, Xu X, Gan Y, Zhang J, et al. Prevalence and associated factors of antenatal depression: systematic reviews and meta-analyses. Clin Psychol Rev. 2021;02:83. https://doi.org/10.1016/j.cpr.2020.101932.CrossRef

Alhasanat D, Fry-McComish J, Yarandi HN. Risk for postpartum depression among immigrant Arabic women in the United States: a feasibility study. J Midwifery Womens Health. 2017;62(4):470–476.5. https://doi.org/10.1111/jmwh.12617.CrossRefPubMed

Packer CH, Pilliod RA, Chatroux LR, Caughey AB, Valent AM. Increased rates of adverse perinatal outcomes in women with gestational diabetes and depression. J Matern Fetal Neonatal Med. 2019:1–5. https://doi.org/10.1080/14767058.2019.1701647.

10.

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. https://doi.org/10.1371/journal.pone.0227323.CrossRefPubMedPubMedCentral

11.

Li X, Gao R, Dai X, Liu H, Zhang J, Liu X, et al. The association between symptoms of depression during pregnancy and low birth weight: a prospective study. BMC Pregnancy Childbirth. 2020;20(1):147. https://doi.org/10.1186/s12884-020-2842-1.CrossRefPubMedPubMedCentral

12.

Suarez A, Lahti J, Czamara D, Lahti-Pulkkinen M, Knight AK, et al. The epigenetic clock at birth: associations with maternal antenatal depression and child psychiatric problems. J Am Acad Child Adolesc Psychiatry. 2018;57(5):321–328.e322.CrossRefPubMedPubMedCentral

13.

Srinivasan R, Pearson RM, Johnson S, Lewis G, Lewis G. Maternal perinatal depressive symptoms and offspring psychotic experiences at 18 years of age: a longitudinal study. Lancet Psychiatry. 2020;7(5):431–40. https://doi.org/10.1016/S2215-0366(20)30132-2.CrossRefPubMedPubMedCentral

14.

Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, et al. Interventions to prevent perinatal depression: US preventive services task force recommendation statement. JAMA. 2019;321(6):580–7. https://doi.org/10.1001/jama.2019.0007.CrossRefPubMed

15.

Chen J, Cross WM, Plummer V, Lam L, Sun M, Qin C, et al. The risk factors of antenatal depression: a cross-sectional survey. J Clin Nurs. 2019;28(19-20):3599–3609.1. https://doi.org/10.1111/jocn.14955.CrossRefPubMed

16.

Mo Y, Gong W, Wang J, Sheng X, Xu DR. The association between the use of antenatal care smartphone apps in pregnant women and antenatal depression: Cross-sectional study. JMIR mHealth uHealth. 2018;6(11):e11508. https://doi.org/10.2196/11508.CrossRefPubMedPubMedCentral

17.

Dong X, Qu Z, Liu F, Jiang X, Wang Y, Chui CH, et al. Depression and its risk factors among pregnant women in 2008 Sichuan earthquake area and non-earthquake struck area in China. J Affect Disord. 2013;151(2):566–72. https://doi.org/10.1016/j.jad.2013.06.048.CrossRefPubMed

18.

Zimmerman M. Using the 9-item patient health questionnaire to screen for and monitor depression. JAMA. 2019;322(21):2125–6. https://doi.org/10.1001/jama.2019.15883.CrossRefPubMed

19.

He C, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, et al. The accuracy of the patient health Questionnaire-9 algorithm for screening to detect major depression: an individual participant data Meta-analysis. Psychother Psychosom. 2020;89(1):25–37. https://doi.org/10.1159/000502294.CrossRefPubMed

20.

Zhong QY, Gelaye B, Zaslavsky AM, Fann JR, Rondon MB, Sánchez SE, et al. Diagnostic validity of the generalized anxiety disorder - 7 (GAD-7) among pregnant women. PLoS One. 2015;10(4):e0125096. https://doi.org/10.1371/journal.pone.0125096.CrossRefPubMedPubMedCentral

21.

He XY, Li CB, Qian J, et al. Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients. Shanghai Articles Psychiatry. 2010;04:12–5.

22.

Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med. 2002;64(2):258–66. https://doi.org/10.1097/00006842-200203000-00008.CrossRefPubMed

23.

Körber S, Frieser D, Steinbrecher N, Hiller W. Classification characteristics of the patient health Questionnaire-15 for screening somatoform disorders in a primary care setting. J Psychosom Res. 2011;71(3):142–7. https://doi.org/10.1016/j.jpsychores.2011.01.006.CrossRefPubMed

24.

Wang W, Zhou DD, Ai M, Chen XR, Lv Z, Huang Y, et al. Internet addiction and poor quality of life are significantly associated with suicidal ideation of senior high school students in Chongqing, China. PeerJ. 2019;7:e7357. https://doi.org/10.7717/peerj.7357.CrossRefPubMedPubMedCentral

25.

Guizzaro L, Morgan D, Falco A, Gallo C. Hamilton and MADRS scales are interchangeable in meta-analyses but can strongly disagree at trial-level. J Clin Epidemiol. 2020;124:106–17. https://doi.org/10.1016/j.jclinepi.2020.04.022.CrossRefPubMed

26.

Wang Y, Wang X, Liu F, Jiang X, Xiao Y, Dong X, et al. Negative life events and antenatal depression among pregnant women in rural China: the role of negative automatic thoughts. PLoS One. 2016;11(12):e0167597. https://doi.org/10.1371/journal.pone.0167597.CrossRefPubMedPubMedCentral

27.

Nyamukoho E, Mangezi W, Marimbe B, Verhey R, Chibanda D. Depression among HIV positive pregnant women in Zimbabwe: a primary health care based cross-sectional study. BMC Pregnancy Childbirth. 2019;19(1):53. https://doi.org/10.1186/s12884-019-2193-y.CrossRefPubMedPubMedCentral

28.

Zhu QY, Huang DS, Lv JD, Guan P, Bai XH. Prevalence of perinatal depression among HIV-positive women: a systematic review and meta-analysis. BMC Psychiatry. 2019;19(1):330. https://doi.org/10.1186/s12888-019-2321-2.CrossRefPubMedPubMedCentral

29.

Tsakiridis I, Bousi V, Dagklis T, Sardeli C, Nikolopoulou V, Papazisis G. Epidemiology of antenatal depression among women with high-risk pregnancies due to obstetric complications: a scoping review. Arch Gynecol Obstet. 2019;300(4):849–59. https://doi.org/10.1007/s00404-019-05270-1.CrossRefPubMed

30.

Jairaj C, Fitzsimons CM, McAuliffe FM, O'Leary N, Joyce N, et al. A population survey of prevalence rates of antenatal depression in the Irish obstetric services using the Edinburgh postnatal depression scale (EPDS). Arch Women Ment Health. 2019;22(3):349–55. https://doi.org/10.1007/s00737-018-0893-3.CrossRef

31.

Kalin NH. The critical relationship between anxiety and depression. Am J Psychiatry. 2020;177(5):365–7. https://doi.org/10.1176/appi.ajp.2020.20030305.CrossRefPubMed

32.

Harding KA, Pushpanathan ME, Whitworth SR, Nanthakumar S, Bucks RS, Skinner TC. Depression prevalence in type 2 diabetes is not related to diabetes-depression symptom overlap but is related to symptom dimensions within patient self-report measures: a meta-analysis. Diabet Med. 2019;36(12):1600–11. https://doi.org/10.1111/dme.14139.CrossRefPubMed

33.

van Hecke O, Hocking LJ, Torrance N, Campbell A, Padmanabhan S, Porteous DJ, et al. Chronic pain, depression and cardiovascular disease linked through a shared genetic predisposition: analysis of a family-based cohort and twin study. PLoS One. 2017;12(2):e0170653. https://doi.org/10.1371/journal.pone.0170653.CrossRefPubMedPubMedCentral

34.

Meier SM, Petersen L, Mattheisen M, Mors O, Mortensen PB, Laursen TM. Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark. Lancet Psychiatry. 2015;2(6):515–23. https://doi.org/10.1016/S2215-0366(15)00092-9.CrossRefPubMedPubMedCentral

35.

Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJLM, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands study of depression and anxiety (NESDA). J Clin Psychiatry. 2011;72(3):341–8. https://doi.org/10.4088/JCP.10m06176blu.CrossRefPubMed

36.

Barthel D, Kriston L, Fordjour D, Mohammed Y, Kra-Yao ED, Bony Kotchi CE, et al. Trajectories of maternal ante- and postpartum depressive symptoms and their association with child- and mother-related characteristics in a west African birth cohort study. PLoS One. 2017;12(11):e0187267. https://doi.org/10.1371/journal.pone.0187267.CrossRefPubMedPubMedCentral

37.

Apter G, Devouche E, Garez V, Valente M, Genet MC, Gratier M, et al. Pregnancy, somatic complaints and depression: a French population-based study. Eur J Obstet Gynecol Reprod Biol. 2013;171(1):35–9. https://doi.org/10.1016/j.ejogrb.2013.08.013.CrossRefPubMed

38.

McMahon AB, Arms-Chavez CJ, Harper BD, LoBello SG. PHQ-8 minor depression among pregnant women: association with somatic symptoms of depression. Arch Womens Ment Health. 2017;20(3):405–9. https://doi.org/10.1007/s00737-017-0715-z.CrossRefPubMed

39.

Hu Y, Amoah AN, Zhang H, Fu R, Qiu Y, Cao Y, Sun Y, Chen H, Liu Y, Lyu Q. Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis. J Matern Fetal Neonatal Med. 2020;1–10. https://doi.org/10.1080/14767058.2020.1712714.

40.

Fejzo MS, Trovik J, Grooten IJ, Sridharan K, Roseboom TJ, Vikanes Å, et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers. 2019;51(1):62. https://doi.org/10.1038/s41572-019-0110-3.CrossRef

41.

Mao R, Zhang C, Chen J, Zhao G, Zhou R, Wang F, et al. Different levels of pro-and anti-inflammatory cytokines in patients with unipolar and bipolar depression. J Affect Disord. 2018;237:65–72. https://doi.org/10.1016/j.jad.2018.04.115.CrossRefPubMed

42.

Shinko Y, Otsuka I, Okazaki S, Horai T, Boku S, Takahashi M, et al. Chemokine alterations in the postmortem brains of suicide completers. J Psychiatr Res. 2020;120:29–33. https://doi.org/10.1016/j.jpsychires.2019.10.008.CrossRefPubMed

43.

Boeschoten RE, Braamse AMJ, Beekman ATF, Cuijpers P, van Oppen P, Dekker J, et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci. 2017;372:331–41. https://doi.org/10.1016/j.jns.2016.11.067.CrossRefPubMed

44.

Enache D, Pariante CM, Mondelli V. Markers of central inflammation in major depressive disorder: a systematic review and meta-analysis of studies examining cerebrospinal fluid, positron emission tomography and post-mortem brain tissue. Brain Behav Immun. 2019;81:24–40. https://doi.org/10.1016/j.bbi.2019.06.015.CrossRefPubMed

45.

Beyazit F, Öztürk FH, Pek E, Ünsal MA. Evaluation of the hematologic system as a marker of subclinical inflammation in hyperemesis gravidarum: a case control study. Ginekol Pol. 2017;88(6):315–9. https://doi.org/10.5603/GP.a2017.0059.CrossRefPubMed

46.

Tayfur C, Burcu DC, Gulten O, Betul D, Tugberk G, Onur O, et al. Association between platelet to lymphocyte ratio, plateletcrit and the presence and severity of hyperemesis gravidarum. J Obstet Gynaecol Res. 2017;43(3):498–504. https://doi.org/10.1111/jog.13228.CrossRefPubMed

47.

Tunc SY, Agacayak E, Budak S, Tunc N, Icen MS, Findik FM, et al. Serum levels of neopterin, inflammatory markers and oxidative stress indicators in hyperemesis gravidarum. J Obstet Gynaecol Res. 2016;42(6):618–24. https://doi.org/10.1111/jog.12949.CrossRefPubMed

48.

Engin-Ustun Y, Tonguç E, Var T, Deveer R, Yilmaz N, Danisman N, et al. Vaspin and C-reactive protein levels in hyperemesis gravidarum. Eur Rev Med Pharmacol Sci. 2013;17(1):138–40.PubMed

49.

Kurt RK, Güler A, Silfeler DB, Ozçil MD, Karateke A, Hakverdi AU. Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum. Ginekol Pol. 2014;85(8):589–93. https://doi.org/10.17772/gp/1776.CrossRefPubMed

50.

Zhu CS, Tan TC, Chen HY, Malhotra R, Allen JC, Østbye T. Threatened miscarriage and depressive and anxiety symptoms among women and partners in early pregnancy. J Affect Disord. 2018;237:1–9. https://doi.org/10.1016/j.jad.2018.04.012.CrossRefPubMed

51.

Al-Memar M, Vaulet T, Fourie H, Nikolic G, Bobdiwala S, Saso S, et al. Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study. Ultrasound Obstet Gynecol. 2019;54(4):530–7. https://doi.org/10.1002/uog.20262.CrossRefPubMed

52.

Tay CT, Teede HJ, Boyle JA, Kulkarni J, Loxton D, Joham AE. Perinatal mental health in women with polycystic ovary syndrome: a cross-sectional analysis of an australian population-based cohort. J Clin Med. 2019;8(12). https://doi.org/10.3390/jcm8122070.

53.

Chuma BT, Sagaro GG, Astawesegn FH. Magnitude and predictors of antenatal depression among pregnant women attending antenatal Care in Sodo Town, southern Ethiopia: facility-based Cross-sectional study. Depress Res Treat. 2020;6718342:1–8. https://doi.org/10.1155/2020/6718342.CrossRef

Title: The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital
Authors: Jiamei Guo
Anhai Zheng
Jinglan He
Ming Ai
Yao Gan
Qi Zhang
Lulu Chen
Sisi Liang
Xiaoyu Yu
Li Kuang
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Mood Disorders
Care
Affective Disorder
Anxiety
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-04090-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Knowledge and practice to prevent COVID-19 and its associated factors among pregnant women in Debre Tabor Town Northwest Ethiopia, a community-based cross-sectional study

Pro-poor policies and improvements in maternal health outcomes in India

Group problem solving therapy for perinatal depression in primary health care settings in rural Uganda: an intervention cohort study

Prevalence, socioeconomic factors and obstetric outcomes associated with adolescent motherhood in Ceará, Brazil: a population-based study

Non-haemorrhagic uterine rupture at 28 weeks of pregnancy following previous caesarean section: a case report

Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe