Elsevier

Journal of Affective Disorders

Volume 200, August 2016, Pages 148-155
Journal of Affective Disorders

Perinatal anxiety disorder prevalence and incidence

https://doi.org/10.1016/j.jad.2015.12.082Get rights and content

Highlights

  • Anxiety and related disorders were found to affect more than 15% of pregnant and postpartum women.

  • Anxiety and related disorders were found to be more common than is depression among pregnant and postpartum women.

  • Our findings provide evidence of an increased risk of OCD among pregnant and postpartum women.

Abstract

Background

Anxiety and related disorders (AD) disproportionately affect women, and are the most prevalent of all mental health conditions. The current research represents the first study of maternal postpartum AD prevalence in which all of the AD are assessed, and one of few studies of this type in which maternal prenatal AD incidence is assessed.

Methods

A Canadian sample of pregnant women (N=310) was recruited from a defined geographical area between November 2007 and November 2010. Participants were first administered postnatal mood and anxiety screening measures. Those who scored at or above cutoff on one or more of these measures were administered a diagnostic interview for depression and anxiety at approximately three months postpartum (n=115). Findings from the diagnostic interview were used to estimate the prevalence and incidence of mood and AD in pregnancy, as well as at and during the first three months postpartum. Period prevalence and incidence estimates were obtained retrospectively from interview data collected postnatally.

Results

The prevalence of AD during pregnancy and the early postpartum period (15.8% and 17.1% respectively) exceeded that of depression (3.9% and 4.8% respectively). The prevalence of OCD in our sample exceeded that of OCD among adults aged 18–64. Parity was unrelated to AD prevalence. Slightly less than 5% of participants were comorbid for both AD, and depression.

Limitations

This study is limited by a relatively small sample size for a prevalence study, and non-random sample selection. As only women who scored above cutoff on one or more screening measures were interviewed, prevalence estimates are conservative. Finally, prenatal prevalence estimates are based on retrospective report provided postpartum.

Conclusions

This study provides evidence that, as a group, anxiety and related conditions affect a significant proportion of postpartum women, and are more prevalent than is postpartum depression.

Introduction

Anxiety and their related disorders (AD; i.e., anxiety disorders, obsessive compulsive disorder, posttraumatic stress disorder) are the most prevalent of all psychiatric conditions (Kessler et al., 2005a), yet in contrast with the ongoing research and health service focus on postpartum depression, perinatal AD have received surprisingly little attention (Manassis et al., 1995). Nearly one-third (28.8%) of the adult population will suffer from an AD at some time in their life (Kessler et al., 2005a). This is considerably greater than the prevalence of mood disorders (20.8%), impulse-control disorders (24.8%) and substance use disorders (14.6%) (Kessler et al., 2005a, Manassis et al., 1995). Further, women are approximately 1.5 times more likely to suffer from an AD than are men (Kessler et al., 2005a). The AD frequently result in significant impairment, and are associated with a high level of health care service utilization and indirect health costs (Ahmad et al., 1994, Sutter-dallay et al., 2004). Determining the scope of AD during the perinatal period is critical for well-informed planning with respect to prevention, treatment and resource allocation for this group of women and their infants.The perinatal AD literature suggests a prenatal prevalence of 9–22%, a postpartum prevalence of 11–21%, and a postpartum incidence of 2.2–8.8% (prenatal incidence data are not available) (Borri et al., 2008, Giardinelli et al., 2012, Mota et al., 2008, Reck et al., 2008, Uguz, 2010, Wenzel et al., 2005, Wynter et al., 2013). However, we are aware of no published reports of postpartum AD prevalence/incidence that include all of the following criteria: (a) an assessment of all of the principal AD, (b) the use of samples that are either representative or unselected, and (c) the administration of assessments based on gold standard methods (i.e., diagnostic interviewing). Further, to our knowledge, only two published studies report the prevalence of prenatal AD, and meet the above criteria (Giardinelli et al., 2012, Reck et al., 2008). Consequently, published reports may not accurately estimate the actual prevalence and incidence of perinatal AD Fig. 1.

The primary objective of this research is to document the prevalence and incidence of maternal AD in the first three months postpartum. Secondary objectives are to: (a) estimate the prevalence/incidence of maternal AD in pregnancy, (b) compare the prevalence of depression to the prevalence of AD in pregnancy and the first three months postpartum, (c) estimate the prevalence of the specific AD in pregnancy and the first three months postpartum, (d) compare the prevalence and incidence of the AD in pregnancy and the first three months postpartum, among nulliparous and multiparous women, (e) estimate the prevalence and incidence of OCD in pregnancy and the first three months postpartum, and (f) estimate the level of comorbidity of depression and AD in pregnancy and the first three months postpartum.

Section snippets

Materials and methods

Full study methods have been published in BMC Psychiatry (Fairbrother et al., 2015). Consequently, only those study methods relevant to the current publication are presented here.

Participants

On average, women were 33.9 years old (SD=6.3), and 27.6 weeks pregnant (SD=8.6) at the time of enrollment. The vast majority were married (80.5%) or living with a romantic partner (14.1%). The remainder were single (3.4%), divorced (0.3%) or separated (0.7%). The majority of participants are Caucasian (71.8%) or Asian (19.2%). The remainder are First Nations Canadians, Hispanic, or Middle Eastern (3.4%) or did not provide data regarding race/ethnicity (5.6%). Participants were well educated,

Discussion

This is the first published report of both the prevalence and incidence of maternal postpartum AD in which a representative sample was studied, and all of the principal AD were assessed using gold standard assessment methods (i.e., diagnostic interviews). The results of this study echo those of other reports of maternal, perinatal AD prevalence and incidence: namely that maternal perinatal AD affect between 9% and 22% of pregnant and postpartum women, a proportion greater than the prevalence of

References (54)

  • B.F. Rodriguez et al.

    Psychometric characteristics of the Mobility Inventory in a longitudinal study of anxiety disorders: replicating and exploring a three component solution

    J. Anxiety Disord.

    (2007)
  • A.L. Sutter-dallay et al.

    Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort

    Eur. Psychiatry

    (2004)
  • F. Uguz

    Is pregnancy associated with mood and anxiety disorders? A cross-sectional study

    Gen. Hosp. Psychiatry

    (2010)
  • F. Uguz et al.

    Course of obsessive-compulsive disorder during early postpartum period: a prospective analysis of 16 cases

    Compr. Psychiatry

    (2007)
  • V. Vorstenbosch et al.

    Assessing dog fear: evaluating the psychometric properties of the Dog Phobia Questionnaire

    J. Behav. Ther. Exp. Psychiatry

    (2012)
  • E.A. Walker et al.

    Validation of the PTSD checklist in an HMO sample of women

    Gen. Hosp. Psychiatry

    (2002)
  • A. Wenzel et al.

    Anxiety symptoms and disorders at eight weeks postpartum

    J. Anxiety Disord.

    (2005)
  • K. Wynter et al.

    Common mental disorders in women and men in the first six months after the birth of their first infant: a community study in Victoria, Australia

    J. Affect. Disord.

    (2013)
  • C.F. Zambaldi et al.

    Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics

    Compr. Psychiatry

    (2009)
  • J.S. Abramowitz et al.

    Measuring change in OCD: sensitivity of the obsessive-compulsive inventory-revised

    J. Psychopathol. Behav.

    (2005)
  • T.F.E. Ahmad et al.

    Mixed anxiety depression in pregnancy: (the influence of misconceptions)

    Arab J. Psychiatry

    (1994)
  • A.T. Beck et al.

    An inventory for measuring clinical anxiety: psychometric properties

    J. Consult Clin. Psychol.

    (1988)
  • C. Borri et al.

    Axis I psychopathology and functional impairment at the third month of pregnancy: results form the Perinatal Depression-Research and Screening Unit (PND-ReScU) study

    J. Clin. Psychiatry

    (2008)
  • British Columbia Perinatal Database Registry, 2005. British Columbia Reproductive Care Program – April 1, 2003 to March...
  • T.A. Brown et al.

    Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders

    J. Abnorm Psychol.

    (2001)
  • K.M. Connor et al.

    Psychometric properties of the Social Phobia Inventory (SPIN): new self-rating scale

    Br. J. Psychiatry

    (2000)
  • K.M. Connor et al.

    Mini-SPIN: a brief screening assessment for generalized social anxiety disorder

    Depression Anxiety

    (2001)
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