Anxiety and depression during pregnancy in Central America: a cross-sectional study among pregnant women in the developing country Nicaragua

Abstract

BackgroundAround the world, maternal psychopathology during pregnancy is associated with a range of negative consequences for mother and child. Nevertheless, in Central America the magnitude of this public health problem is still unknown. The objective of this first explorative study was to investigate the prevalence and severity of anxiety and depression during pregnancy in the Central American developing country Nicaragua, as well as the availability of mental health care and to compare with a developed country.MethodsA population-based cohort of pregnant women in Nicaragua (N = 98) was compared with a parallel cohort in the Netherlands (N = 4725) on symptoms of anxiety (Spielberger State Trait Anxiety Inventory) and depression (Edinburgh Postnatal Depression Scale). Associations with the women’s knowledge how to reach professional psychological support were assessed using multivariable linear regression analyses.ResultsOf the Nicaraguan women, 41 % had symptoms of anxiety and 57 % symptoms of depression, versus 15 % and 6 % of the Dutch women. Symptom scores of both anxiety and depression were significantly higher in Nicaragua (p < 0.001). However, only 9.6 % of the women indicated that professional psychological help was available for the Nicaraguan pregnant women, which was associated with an increased anxiety score.ConclusionsIn Nicaragua, both prevalence and severity of symptoms of antenatal anxiety and depression are substantially higher than in developed countries. However, availability of psychological help is very limited for pregnant Nicaraguan women. These findings indicate that there is need for further research and support for these women, to prevent negative consequences for both mother and child.

Depression and anxiety during pregnancy: The influence of maternal characteristics

“…The PRIDE Study questionnaires in early (weeks [10][11][12] and late (week 34) pregnancy included the Hospital Anxiety Depression Scale (HADS), a 14-item self-completion screening scale to indicate the possible presence of symptoms of depression and anxiety. 19 The questionnaire consists of two subscales, one for symptoms of depression (HADS-D) and one for symptoms of anxiety (HADS-A), with a 4-point rating scale (0-3), adding up to a score range of 0-21 for each subscale.…”

“…7,8 For the latter, one study reported a decrease from 11.0% to 8.5% over the course of pregnancy, 9 while another reported an increase from 7.4% in early pregnancy to 12.8% in middle, and 12.0% in late pregnancy. 8,11 Some reported an increase in anxiety, 12 while others reported a U-shaped pattern, 8,13 or a decrease over the course of pregnancy. 8 Prevalence rates of anxiety and changes over time during pregnancy have been studied less extensively compared with depression, with prevalence rates ranging from 15.0% to 36.3%.…”

Anxiety among women experiencing medically complicated pregnancy: A systematic review and meta‐analysis

“…Symptoms of anxiety have been estimated to affect 16% of pregnant women (first trimester) . Other studies have placed the estimate closer to 10% . There is evidence that symptoms of anxiety may be experienced by as many as 40% of women in developing nations .…”

“…11 Other studies have placed the estimate closer to 10%. 12 There is evidence that symptoms of anxiety may be experienced by as many as 40% of women in developing nations. 12 In one study, symptoms of anxiety appeared to decrease over the course of pregnancy (from the first to third trimesters 17.9% to 14.2%).…”

“…12 There is evidence that symptoms of anxiety may be experienced by as many as 40% of women in developing nations. 12 In one study, symptoms of anxiety appeared to decrease over the course of pregnancy (from the first to third trimesters 17.9% to 14.2%). 13 A medically high-risk pregnancy is defined as "any pregnancy in which there is evidence of actual or potential threat of harm to the life or health of the mother and/or the baby, because of a disorder or situation coincidental with or unique to pregnancy."…”