Risk factors for anxiety and depression in pregnancy - NIPH
BACKGROUND: Recognition of maternal emotional distress during pregnancy and the identification of risk factors for this distress are of considerable clinical-. Keywords: pregnancy, relationship satisfaction, partner satisfaction dissatisfaction was the largest predictor of maternal emotional distress. .. women's relationship satisfaction both before pregnancy, during pregnancy, and after delivery. BACKGROUND Recognition of maternal emotional distress during pregnancy and the identification of risk factors for this distress are of considerable clinical-.
The T1 A model of the hypothesized pathways is presented in Figure 1. Semistructured interviews and ques- prenatal maternal emotional distress and positively influence per- tionnaires were administered by trained interviewers in clinic ceptions of partner support, consistent with prior research Rini et settings within private rooms or areas.
All measures were designed al. We also tested a set of hypotheses regarding indirect MS-BIPS project investigated physiological changes during preg- effects of support via reductions in maternal emotional distress nancy and excluded women using tobacco or controlled substances based on past research Davis et al. A total pants in the current sample.
The main reasons for but reported significantly lower relationship satisfaction, more ineligibility in order of frequency were non-English speaking, prenatal and postpartum anxiety, and marginally more prenatal pregnancy was too far advanced, multiple gestation, and smoking. The protocol was approved by the institutional review boards at all institutions. Twelve percent had a high school diploma or less with closeness e. Response scales for each measure are given in parentheses.
Re- as to how often the person experienced each e. Responses were averaged across all items.
During preg- to 4 strongly agree. Based on factor analyses research Rini et al. Nine items were each rated on a quality and satisfaction. Two items that corresponded to Items were weighted and summed as suggested by Freeston and physical symptoms of pregnancy or the postpartum period i. The remaining 7 items were averaged. One aspect of infant temper- Partner support T2.
It has been found to have This measure asked women to rate partner support quantity and strong psychometric properties and is closely related to indepen- quality e. It has the advantage that mothers observe their infants in provided, and how accessible support was for each of three types many contexts which laboratory studies cannot.
Because not all of support: Task 5 itemsInformational 3 itemsand Emotional items were well suited to the young age of infants in this study, a Support 5 items.
Items were standardized then averaged, with higher range. Reports of depression and anxiety symptoms were low on scores indicating higher pregnancy-specific support quantity and average and intercorrelated as expected, sharing one third to half of quality. The 4 items were highly intercorrelated and formed the their variance. Table 2 contains zero-order correlations among the best index from the set of new items for testing pregnancy-specific primary study variables, which were consistent with hypotheses partner support.
Maternal emotional distress T1, P1. Current emotional distress was measured pre- and postpartum with two validated Data Analytic Plan and Structural Equation Modeling scales for anxious and depressive symptoms. AAS — comfort closeness — 2: AAS — depend on others. AAS — low fear rejection. SSE — Not negative. Bolded groupings represent indicators of latent factors in structural models. Then, we used confirmatory distress were grouped to form five latent factors Table 1.
To factor analysis in EQS 6. This plus the intimacy and closeness item. Similarly, the STAI and approach estimates all parameters simultaneously, controlling for CES-D scales were each split into two arbitrary subsets at each all other effects in the model. The final model was compared to time point to form a four-indicator maternal distress factor, in alternative models to test competing hypotheses.
There- Hypothesized Structural Model fore, it was decided to use only cases that provided complete data. Multiple indices assessed the fit of each model: RMSEA values of less cantly different according to the robust chi-square difference test 2 than. The an overview of fit indices. Robust standard errors were used more parsimonious final model is presented in Figure 2. Final model predicting postpartum maternal emotional distress and infant distress to novelty from prenatal partner relationship variables.
Circles denote latent variables; rectangles denote measured variables. One-headed arrows represent regression paths; two-headed arrows represent correlations. Estimated errors are omitted for visual clarity. However, we maternal emotional distress.
Findings were consistent with the final latent and partner support further predicted significantly lower infant model, with two slight variations worth noting. There were no significant directly associated with infant distress whereas depressive symp- direct effects between T1 and P1 variables other than continuity toms were not.
To determine whether the model in Figure 2 represented the best Decomposition of estimated parameters into direct and indirect fit to the data and to consider competing hypotheses, we tested effects was also examined within EQS to assess the combined three alternative models. A fully saturated model was tested al- influence of T1 variables on postpartum maternal emotional and lowing all paths among latent variables and infant distress to infant distress via intermediary variables.
Interpersonal security, novelty to be freely estimated to ensure no important paths were relationship satisfaction, and prenatal emotional distress each had omitted. No additional significant paths emerged. Another sitive and engaged parenting Feldman et al. These results are newsworthy Evidence was inconsistent with each of these models. Partner support during preg- income, problematic birth outcomes such as preterm delivery, and nancy may contribute to unmeasured mediators, such as better prenatal medical risk factors including hypertension and infec- maternal health behavior e.
None of the paths be- ical mechanisms including reduced maternal stress reactivity tween covariates and these outcomes were significant, and their Martin et al.
These and other possibilities may provider of effective social support during pregnancy.
Risk factors for anxiety and depression in pregnancy
Future research exploring relationship satisfaction on maternal postpartum emotional distress these potential mediators and other theoretically derived mecha- were mediated by the perceived quantity and quality of partner nisms is necessary to follow-up these findings. It should also be support. The current data support conceptual distinctions emotional distress. Of partner relationships and more secure attachment styles are likely the various types of support measured here, emotional support to have better mental health in pregnancy and postpartum.
However, the current both earlier in pregnancy and into postpartum. Furthermore, these study differed from the earlier one in important ways. First, we findings were obtained in a more diverse sample than is typically utilized structural equation modeling and included interpersonal seen in the transition to parenthood literature, and the final model relationship variables in the current model.
When the relationship showed similar fit to the data when covariates such as ethnicity, context was considered here, maternal prenatal distress exerted parity or pregnancy risks and complications were included. This is only an indirect influence on infant distress to novelty.
In addition, consistent with an earlier study, which found that ethnicity did not Davis et al. However, we note that attrition over time somewhat infant distress to limitations and fear. Thus, our results add to and influenced the sociodemographic distribution of our sample, and complement the earlier findings and provide evidence that rela- findings may not generalize to very low-income or low-educated tionship factors might account for some of the association between populations.
Although this study is not experimental and cannot affirm A few methodological and conceptual aspects of the current causality, the results provide evidence that perceived partner sup- study are worth noting. Our study design involved multiple, de- port during pregnancy may contribute to less fearful or emotion- tailed assessments of many constructs in a relatively large and ally reactive infant temperament.
One potential indirect mecha- somewhat diverse sample of pregnant women followed prospec- nism is that the effective partner support and lower maternal tively into the first few months postpartum. Therefore, the current findings provide additional effects of prenatal partner support on postpartum outcomes while impetus for exploring prenatal partner support together with re- controlling for prenatal maternal emotional state and important lated aspects of the partner relationship as potential avenues to relationship factors.
Temporal ordering enhances the ability to improve postpartum maternal mental health and child develop- infer causality; nonetheless, these results cannot firmly establish ment. Past randomized controlled trials designed to increase the causality, and some associations may be bidirectional or involve well-being of mothers and infants through social support interven- third variables. The infant distress expectations, may be more effective in reducing maternal postpar- variable, for example, may be argued to be, at least in part, a tum anxiety and depression than attempts to increase general social function of maternal affective symptoms Pauli-Pott, Mertesacker, support.
However, our final model support and infant temperament and further investigation into the continued to show significant direct associations between prenatal proposed mechanisms underlying associations between prenatal support and infant distress after controlling for the association partner support and infant temperament are needed.
'Pre-baby blues' due to lack of support from partner
This line of between maternal postpartum emotional distress and infant dis- research has potential to produce more effective interventions to tress. In addition, observed zero-order and final modeled associa- reduce the burden of perinatal maternal postpartum depression and tions between maternal emotional distress and ratings of infant anxiety and their contributions to child stress reactivity.
While we cannot rule Abramowitz, S. Marital adjustment and sex out the possibility that reliance on maternal reports are responsible therapy outcome.
The Journal of Sex Research, 16, — Predictors of postpartum depression: Continuity and discontinuity logically. Future research should include the perspectives of both in infant negative and positive emotionality: Family antecedents and attachment consequences.
Developmental Psychology, 27, — EQS 6 Structural Equations program manual adjustment. Other indicators of infant temperament should also be [computer software]. In addition, attrition of participants of lower socioeco- Bentler, P. Annual Review of Psychology, ity to the entire population of pregnant women and emphasizes the 47, — Maternal stress during pregnancy predicts cognitive ability and fearful- The measures used to assess maternal depression and anxiety ness in infancy.
Early father involvement moderates biobehavioral average, this sample reported mild to moderate symptoms of susceptibility to mental health problems in middle childhood.
Partner relationship satisfaction and maternal emotional distress in early pregnancy - Dimensions
Journal of emotional distress. Psychological Bulletin,3— Tests of partner support in a sample of women with higher Bradbury, T. Research on symptom levels or from a treatment-seeking population would be the nature and determinants of marital satisfaction: A decade in review. Journal of Marriage and the Family, 62, — A paradigmatic application based during pregnancy is associated with improved maternal mental on the Maslach Burnout Inventory. Multivariate Behavioral Research, health and may contribute to less distressed infant temperament.
It 29, — Attachment security and heightened reactivity to stress, set the stage for later emotion marital satisfaction: This strengthens our positive bias hypothesis — it could be that while the pregnant women are relatively more satisfied with their relationship, their partners are relatively less satisfied.
Future studies should therefore question both partners about their levels of satisfaction. A third potential limitation is that we did not investigate the possibility that some women in our sample of nonpregnant women might be experiencing fertility difficulties which might have affected their relationship satisfaction negatively. Thus, the fact that the group of nonpregnant women in our research might have included women with fertility problems, would not necessarily have affected the relationship satisfaction in this group negatively.
To conclude, the current study investigated how pregnant and nonpregnant women viewed their partner and their relationship, and whether there were any differences between these groups.
It was found that pregnant women reported feeling significantly more happy with both their partner and their relationship, and that these differences could not be attributed to differences in self-esteem. Predictors of postpartum depression: Nursing Research, 50, Marital change across the transition to parenthood.
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