Risk factors for depression, anxiety and stress in expectant and new mothers
Creators: name: Clout, Danielle Marie
Publisher: name: The Australian National University
Year: 2015
Subjects: Postpartum Depression
Postpartum Anxiety
Stress
Adjustment to Parenthood

description: The perinatal period represents a time of increased vulnerability to experience psychological distress in many women. Postpartum depression (PPD) is a well-recognised mental health concern that is known to have deleterious effects on some new mothers and their relationship with their spouse and infant. Recently, anxiety and stress have been recognised as symptoms that are commonly comorbid with (or occur independently of) perinatal depression, although less is known about the psychological and non-psychological risk factors for these affective states. Thus, using a community sample of 105 women in their third-trimester of pregnancy, the aim of this thesis was to broaden the current conceptualisation of psychological distress in the perinatal period to include the affective states of psychological stress and anxiety, and to examine a broad range of factors that have previously been identified as risk factors for perinatal depression, and to assess their potential role in the aetiology of perinatal anxiety and stress. Paper 1 examined the relationship between attachment-avoidance, attachment-anxiety, and marital relationship quality during pregnancy, and symptoms of postpartum depression, anxiety, and stress. The study results indicated that marital satisfaction and emotional affection significantly predicted depression levels, and marital satisfaction significantly predicted anxiety levels. In addition, mediational analyses indicated that dyadic satisfaction significantly mediated the relationships between high attachment-anxiety to worse anxiety and depression, and it also mediated the relationship between high attachment-avoidance to later anxiety and depression symptoms. Paper 2 explored the potential contribution of attachment-avoidance and attachment-anxiety in a woman’s relationships with her parents and close friends and the association of these factors to her experience of depression, anxiety, and stress during the third-trimester of pregnancy and 4-6 months postpartum. In addition, changes in the women’s attachment networks were examined across the transition to parenthood. The study results showed that women who were high on attachment-anxiety in relation to their mothers and close friends were more likely to experience depression during pregnancy, but only attachment-anxiety to their mothers predicted high depression levels postpartum. In addition, women’s attachment-anxiety to their mothers and attachment-avoidance to their friends predicted high anxiety levels during pregnancy, and attachment-anxiety to their mothers predicted high stress levels during pregnancy. Further, the size of the women’s attachment networks remained stable from the third-trimester to the postpartum, although they tended to rely less on their partners and close friends for attachment needs in the postpartum. Paper 3 evaluated the different aspects or functions of social support during the third-trimester of pregnancy as potential predictors of depression, anxiety, and stress levels during pregnancy and at 4-6 months postpartum. The study results showed that the perceived unavailability of self-esteem support predicted high depression levels in the third-trimester, whereas less perceived appraisal support predicted high stress and anxiety levels during pregnancy. However, only total social support score predicted high stress and depression levels postpartum, whereas none of the social support variables predicted postpartum anxiety. Lastly, paper 4 examined a range of sociodemographic, pregnancy, obstetric, and postnatal variables as potential risk factors for postpartum depression, anxiety, and stress. The study results showed that caesarean delivery was associated with high postpartum depression, anxiety, and stress levels. In addition, child sleep problems were related to high depression levels, child health problems were related to high anxiety, a greater number of recent stressful life events were related to high stress levels, and maternal sleep problems were related to greater PPD. However, these results became non-significant after controlling for prenatal levels of maternal distress. Nonetheless, the women who underwent caesarean delivery reported higher prenatal stress, anxiety, and depression levels, relative to women who did not undergo the procedure. Taken together, the results of the four studies are likely to have implications for the screening of women during the perinatal period, and they may assist healthcare professionals who work with expectant and new mothers. In particular, the study results suggest that a woman’s relationships with her family and close friends as well as with her spouse may be important in shaping her psychological experiences including perinatal distress. In addition, the totality of social support rather than any particular aspect of social support appears to buffer against the potential to experience maternal distress, although self-esteem and appraisal support may be important. Finally, the women who had a caesarean delivery were more likely to be distressed in the third-trimester of pregnancy and also at 4-6 months postpartum. Thus, the results point to the need to screen pregnant women for mental health problems if they have a marked preference for caesarean delivery.