Prevalence and associated risk factors of depression, anxiety and stress in pregnancy

Background: Pregnancy is considered as state of emotional well-being. However, pregnancy increases the vulnerability to emotional and psychological conditions such as depression, anxiety, stress and psychoses which have implications to the mother and adverse perinatal outcomes. The objective of this study was to estimate the prevalence and identify the obstetrical and socioeconomic risk factors associated with common mental disorders in the antepartum period by screening and clinical diagnostic interview. Methods: This was a cross sectional study of pregnant women receiving antenatal care in two antenatal health clinics at Malaysia. Pregnant women were screened twice (16-22 weeks and 34-36 weeks) for common mental disorders by administering depression anxiety and stress scale (DASS-21). A detailed structured questionnaire was used to obtain information on socio-demographic and obstetric characteristics of subjects. Women who screened positive for common mental disorders (DASS 21 scores: depression > 10, anxiety >8, stress >15) were clinically assessed by trained clinician using mini international neuropsychiatric interview (MINI). Results: Among 288 women screened, the overall prevalence of antenatal depression, anxiety and stress was 23.6% (n=68) in the second trimester and 24.7% (n=71) in third trimester. The commonest mental health problems are anxiety, 18.8% depression 6.9% and stress 4.2%. Diagnostic clinical interview with MINI diagnosed 34% with adjustment disorder, 23% with anxiety spectrum conditions (panic and GAD) and 8.5% major depressive illness. There was no significant difference in developing common mental disorders between second and third trimester (p>0.05). The socio-demographic factors associated with mental health disorders were low socioeconomic status (p<0.02), lack of family support (p<0.028), partner violence (p<0.002) and obstetrics factors include unplanned pregnancy (p<0.01). Conclusions: Anxiety, depression and stress are associated with identifiable socioeconomic and obstetric risk factors.