Perinatal anxiety disorder prevalence and incidence
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
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