Effects of an early intervention on perceived stress and diurnal cortisol in pregnant women with elevated stress, anxiety, and depressive symptomatology

Abstract

The goal of the present investigation was to examine effects of a cognitive-behavioral group intervention for pregnant women with subclinically elevated stress, anxiety and/or depression on perceived stress and salivary cortisol levels. Expectant mothers were recruited in gynaecologist practices. They participated in a screening, a standardized diagnostic interview (Munich-Composite Diagnostic Interview, M-CIDI), and were randomly assigned to an intervention (N = 21) and treatment as usual control group (N = 40). The intervention consisted of a manualized cognitive-behavioral group program for expectant mothers with subclinically elevated stress, depression, and/or anxiety symptoms. Stress questionnaire (prenatal distress (PDQ), perceived stress (PSS)) as well as diurnal salivary cortisol assessment took place at T1 (antenatal, preintervention), at T2 (antenatal, post-intervention) and T3 (3-month postpartum). Subjects that participated in the intervention exhibited a significant post-treatment change in morning cortisol (cortisol awakening response, CAR) in contrast to control subjects, F(8,51) = 2.300, p = 0.047. Intervention participants showed a smaller CAR subsequent to the intervention, displaying a lessened stress reaction. This effect was not observed in the control group. In contrast, we failed in discovering a significant difference between the research groups regarding the cortisol area under curve parameter (AUC) and the applied subjective stress questionnaires. Evaluation results were thus heterogeneous. Nevertheless, intervention effects on the CAR are promising. Our results suggest that a cognitive-behavioral intervention might lead to an improvement in the biological stress response of pregnant women with subclinically elevated stress, anxiety, or depressive symptoms.

Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: A prospective-longitudinal study

“…cortisol awakening response) can be reduced during peripartum period by implementing relaxation techniques, psychoeducation, and cognitivebehavioural interventions (Bittner et al, 2014;Kozinszky et al, 2012;Richter et al, 2012;Teixeira et al, 2005;Urech et al, 2010;Urizar et al, 2004). These strategies may also have a positive impact on obstetric and neonatal outcomes (Fink et al, 2012).…”

Relationships of Maternal Stress with Milk Immune Components in African American Mothers of Healthy Term Infants

“…Self-perceived stress is the cognitive appraisal of physical and environmental stressors and has been associated with increased levels of prenatal and postnatal serum cortisol. [38][39][40][41] Prolonged elevation of maternal serum cortisol levels can influence the infant immune system response and potentially the milk immune components (MICs). 42 Groer et al 42,43 reported higher self-perceived stress was associated with higher serum cortisol (r = 0.25, p = 0.040) as well as greater levels of milk secretory immunoglobulin A (SIgA).…”

The Impact of Antenatal Psychological Group Interventions on Psychological Well-Being: A Systematic Review of the Qualitative and Quantitative Evidence

“…The systematic review identified 19 papers describing a total of 15 studies. Fifteen quantitative papers met inclusion criteria; two describe the same study with different outcome measures [ 35 , 36 ]. Four papers describing 3 qualitative studies were identified.…”

“…In one study cultural reasons may have accounted for the high attrition before the intervention started: women did not want to say no even if they had no intention of taking part [ 42 ]. There was speculation that women with symptoms which were just above the baseline threshold were not motivated enough to take part as they did not see the need for the course [ 23 , 35 , 36 ].…”

“…Table 1 gives details of the participants’ demographic characteristics. Most of the participants fall into two categories: (1) women who are mostly white, married/partnered, slightly older and with a medium-high income [ 23 , 28 , 35 , 36 , 40 , 46 , 58 ] and (2) women who are mostly African-American and/or Hispanic, slightly younger and with a low income [ 43 , 44 , 45 , 59 , 60 , 61 , 62 ].…”