Anxiety and depressive disorders are somewhat masked by features of pregnancy; hence many women are ignorant of them and are untreated.
To determine the level of awareness and treatment of anxiety and depression in pregnancy.
The study was carried out at the antenatal clinic of Enugu State University Teaching Hospital, Enugu, Nigeria.
This was a cross-sectional and descriptive study of 200 pregnant women in consecutive attendance of the antenatal clinic using the Hospital Anxiety and Depression Scale (HADS) and a sociodemographic questionnaire.
Of the participants, 23.5% had anxiety and/or depression, 7.5% of them were aware of their condition and only 0.5% of all the participants or 6.7% of those who were aware of their problem received treatment.
Anxiety and depression are prevalent among pregnant women. Because of overlap of symptoms of anxiety and depression with those of pregnancy, the awareness is very low; hence many of them suffer immensely without treatment.
One of the crucial milestones in a woman’s life is pregnancy and childbirth, especially in Africa. Most women look forward to becoming mothers and have positive expectations while pregnant. However, because of the physical, hormonal, neurotransmitter and psychosocial changes that occur, pregnancy can be stressful and overwhelming, and many women present with signs and symptoms. Pregnant women can experience fatigue, sluggishness, heartburn and indigestion, nausea and vomiting (morning sickness), backache, headache, breathlessness, tingling and numbness in the hands, frequent urination, moodiness and crying spells,
Similarly, persons with anxiety disorder may present with features like worries about impending doom, fearfulness, poor attention, forgetfulness, headache, abdominal discomfort, indigestion, fatigue, sweating, tremulousness, breathlessness, tingling and numbness, fainting and dizziness in absence of any other psychiatric or organic disorder. Moreover, individuals with depressive disorder may be experiencing persistent low mood, crying spells, body weakness, poor appetite, loss of interest in previously enjoyed activities, feelings of worthlessness, poor attention, poor memory, loss of sexual interest, and suicidal thoughts or acts.
Pregnancy and anxiety and or depression affect each other and share certain attributes in common:
Women who are already living with chronic stress may find themselves unable to cope with the additional demands of pregnancy.
Women who are living in poverty and/or who already have many children may perceive pregnancy with ambivalence and negative feelings.
In relationships that are under pressure, domestic violence tends to increase during pregnancy and raises the chance of developing anxiety and depression.
Pregnancy-related sex steroids increase the activation of the hypothalamic–pituitary–adrenal axis (cortisol stress system), which is associated with anxiety and depression. Some researchers have opined that elevated levels of cortisol may affect foetal growth and development and may be associated with altered temperament and behavior.
It is worthy of note that anxiety and depressive disorders commonly coexist and the symptoms occur at most times of the day; they are distressful and impair work and interpersonal functioning. Hence they most times require the attention of professional mental health workers, unlike the similar features found in pregnancy, which usually vary with environmental stimuli and are relieved by mere social support and reassurance. The signs and symptoms of antenatal anxiety and depression are not different from those of non-pregnant women. However, psychological symptoms like irrational worries and fear, anhedonia, self-blame, hopelessness and worthlessness seem to be more reliable in pregnancy than the somatic features, such as sweating, breathlessness, fatigue, body ache, headache, dizziness and fainting, which may impair detection and subsequent treatment of the disorders.
Antenatal anxiety and depression are a major public health problem because of their high rate of occurrence.
The impact of anxiety and depression in a pregnant woman can be enormous and often predispose women to postnatal depression,
With the remarkable broad overlap and similarities in clinical presentation of anxiety and depression and the signs and symptoms of pregnancy, many pregnant women and their health workers are unaware of their problems and hence they remain untreated. This study aimed at highlighting the level of awareness and treatment of anxiety and depression among pregnant women.
This was a cross-sectional descriptive study of consecutive attendees of pregnant women who came for routine antenatal care.
The study was carried out at the antenatal clinic of the Department of Obstetrics and Gynaecology, Enugu State University Teaching Hospital, Enugu. The clinic is mainly attended by women within the Enugu metropolis and by a few referrals from the rural areas.
Consecutive attendees of pregnant women who came for a routine check-up at the antenatal clinic were used for the study. Informed consent to take part in the study was obtained before questionnaires were administered to each participant irrespective of gestational age, parity or obstetrics and gynaecological history. In collaboration with other hospital staff, 200 participants were recruited for the study.
A sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) were used to collect data. The sociodemographic questionnaire gave information about the participant’s age, employment status, educational attainment, parity, gestational age, obstetric history and knowledge and treatment of anxiety and depression.
The HADS is a 14-item scale, seven of which relate to anxiety and the other seven determine depression. Each item of the questionnaire is scored from 0 to 3. Hence an individual may have a total score between 0 and 21 for either anxiety or depression. The cut-off point has been taken to be 8/21 for either anxiety or depression. For anxiety, this gave a specificity and sensitivity of 0.78 and 0.9, respectively, while for depression it gave a specificity and sensitivity of 0.79 and 0.83, respectively. A score of 8–10 is considered a borderline case, while a score of 11–21 is regarded as an abnormal case. This instrument has been validated and used in Nigeria.
Data obtained were analysed using SPSS version 16. The frequency distribution of the variables was calculated.
Approval to conduct this study was obtained from the Ethical Committee of Enugu State University Teaching Hospital before data collection commenced.
A total of 200 participants attending the antenatal clinic were studied.
The age of the participants ranged from 17 to 41 years, with a mean of 29.3 ± 4.4 years. One hundred and ninety-nine (99.5%) of them were married and 1 (0.5%) of them was unmarried. Almost half of them were employed and their minimum educational attainment was secondary school education.
Sociodemographic variables of the participants.
Variable | Frequency | % | |
---|---|---|---|
Marriage | Married | 199 | 99.5 |
Unmarried | 1 | 0.5 | |
Employment | Employed | 101 | 50.5 |
Unemployed | 99 | 49.5 | |
Highest level of education | Secondary | 23 | 11.5 |
Tertiary | 177 | 88.5 | |
Age range (years) | 24 | - | - |
Minimum age (years) | 17 | - | - |
Maximum age (years) | 41 | - | - |
Mean age (years) | 29.3 | - | - |
Standard deviation | ±4.4 | - | - |
Awareness and treatment of anxiety and/or depression among the participants.
Variable | Frequency | % |
---|---|---|
Neither anxious nor depressed | 137 | 68.5 |
Anxious and/or depressed | 47 | 23.5 |
Awareness of anxiety and/or depression | 15 | 7.5 |
Receiving treatment (antidepressant) | 1 | 0.5 |
Forty-seven (23.5%) participants were found to be anxious and/or depressed, while 137 (68.5%) were neither anxious nor depressed.
Fifteen (7.5%) participants were aware of their psychological problem.
Only 1(0.5%) of all the participants or 6.7% of those aware of their problem were receiving treatment with antidepressants.
In a cross-sectional survey of 314 pregnant women attending antenatal clinics at Abeokuta North Local Government, Nigeria, using the Edinburgh Postnatal Depression Scale, a prevalence for antenatal depression of 24.5% was found.
About one-quarter of the participants were anxious and/or depressed, less than one-tenth knew about their psychological health status and only 0.5% of them were receiving treatment. This is far lower than what was reported in Alberta, Canada – that 70.5% of pregnant women had knowledge of prenatal mental health and 26.6% of them were able to identify the negative impact of anxiety and/or depression on the foetus.
Some studies using a variety of depression instruments reported antenatal depression prevalences of 9.0% – 28.0% for predominantly middle-class women
Based on the results of this research, it is glaringly obvious that measures should be put in place to enhance the education, detection and treatment of anxiety and depression in pregnant women. Pregnant women should be educated about the signs and symptoms of anxiety and depression while health workers at antenatal clinics should be involved in both education and training programmes to facilitate detection and treatment of anxiety and depression in pregnancy.
This study was a cross-sectional study in which the participants were seen only once. The differences in age of the participants, gestational age and parity were not taken into consideration. The HADS is a self-administered questionnaire, and the information about awareness and treatment of anxiety and/or depression was self-reported. These factors may in one way or the other have affected the results obtained in this study.
Anxiety and depressive disorders are prevalent among pregnant women, with associated distress and adverse foetal outcomes. It is difficult for patients and health workers to distinguish them amidst the signs and symptoms of pregnancy. Hence, all hands should be on deck to improve awareness and treatment by incorporating screening for anxiety and depression into routine antenatal care, especially in developing countries like Nigeria.
We acknowledge the support received from Dr Udegbunam Nkeiru and Dr Esther Okwor during data collection and Dr Odinka PC in the review of the initial draft and supply of articles that helped us in the literature review.
The authors declare that they have no financial or personal relationship(s) that may have inappropriately affected their report of the findings of this research.
M.S.E. conceived the topic and performed the literature search. P.C.O. conducted the results analysis and wrote the discussion, while V.O.D. was involved with collecting the data and entering them into SPSS.