Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-25T21:06:25.966Z Has data issue: false hasContentIssue false
  • English
  • Français

The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis

Published online by Cambridge University Press:  17 April 2017

K. Falah-Hassani ,
R. Shiri  and
C.-L. Dennis
K. Falah-Hassani*
Affiliation:
Western University, London, ON, Canada University of Toronto, Toronto, ON, Canada
R. Shiri
Affiliation:
Finnish Institute of Occupational Health, Helsinki, Finland
C.-L. Dennis
Affiliation:
University of Toronto, Toronto, ON, Canada Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
*
*Address for correspondence: K. Falah-Hassani, Ph.D., Western University, Faculty of Education, 1137 Western Road, London, ON N6G 1G7, Canada. (Email: kfalahha@uwo.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8–11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8–7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0–14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2–3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5–9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3–7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9–6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.

Keywords

Anxietydepressionperinatal periodpostnatal periodpregnancy
Type
Review Article
Information
Psychological Medicine , Volume 47 , Issue 12 , September 2017 , pp. 2041 - 2053
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaron, E, Bonacquisti, A, Geller, PA, Polansky, M (2015). Perinatal depression and anxiety in women with and without human immunodeficiency virus infection. Women's Health Issues 25, 579–585.Google Scholar
Adewuya, AO, Afolabi, OT (2005). The course of anxiety and depressive symptoms in Nigerian postpartum women. Archives of Women's Mental Health 8, 257–259.Google Scholar
Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lepine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martinez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacin, C, Romera, B, Taub, N, Vollebergh, WA, ESEMeD/MHEDEA 2000 Investigators, European Study of the Epidemiology of Mental Disorders (ESEMeD) Project (2004). 12-Month comorbidity patterns and associated factors in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica. Supplementum 109 (Suppl. s420), 28–37.CrossRefGoogle Scholar
Armijo-Olivo, S, Stiles, CR, Hagen, NA, Biondo, PD, Cummings, GG (2012). Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. Journal of Evaluation in Clinical Practice 18, 12–18.CrossRefGoogle ScholarPubMed
Austin, MP, Hadzi-Pavlovic, D, Priest, SR, Reilly, N, Wilhelm, K, Saint, K, Parker, G (2010). Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Archives of Women's Mental Health 13, 395–401.CrossRefGoogle ScholarPubMed
Bandelow, B, Michaelis, S (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience 17, 327–335.CrossRefGoogle Scholar
Bergink, V, Kooistra, L, Lambregtse-van den Berg, MP, Wijnen, H, Bunevicius, R, van Baar, A, Pop, V (2011). Validation of the Edinburgh Depression Scale during pregnancy. Journal of Psychosomatic Research 70, 385–389.Google Scholar
Biaggi, A, Conroy, S, Pawlby, S, Pariante, CM (2016). Identifying the women at risk of antenatal anxiety and depression: a systematic review. Journal of Affective Disorders 191, 62–77.CrossRefGoogle ScholarPubMed
Bindt, C, Guo, N, Bonle, MT, Appiah-Poku, J, Hinz, R, Barthel, D, Schoppen, S, Feldt, T, Barkmann, C, Koffi, M, Loag, W, Nguah, SB, Eberhardt, KA, Tagbor, H, N'goran, E, Ehrhardt, S; International CDS Study Group (2013). No association between antenatal common mental disorders in low obstetric risk women and adverse birth outcomes in their offspring: results from the CDS study in Ghana and Cote D'Ivoire. PLOS ONE 8, e80711.Google Scholar
Blazer, DG, Kessler, RC, McGonagle, KA, Swartz, MS (1994). The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. American Journal of Psychiatry 151, 979–986.Google Scholar
Broekman, BF, Chan, YH, Chong, YS, Kwek, K, Cohen, SS, Haley, CL, Chen, H, Chee, C, Rifkin-Graboi, A, Gluckman, PD, Meaney, MJ, Saw, SM; GUSTO Research Group (2014). The influence of anxiety and depressive symptoms during pregnancy on birth size. Paediatric and Perinatal Epidemiology 28, 116–126.Google Scholar
Coleman, VH, Carter, MM, Morgan, MA, Schulkin, J (2008). Obstetrician–gynecologists’ screening patterns for anxiety during pregnancy. Depression and Anxiety 25, 114–123.Google Scholar
Couto, ER, Couto, E, Vian, B, Gregório, Z, Nomura, ML, Zaccaria, R, Passini, R Jr. (2009). Quality of life, depression and anxiety among pregnant women with previous adverse pregnancy outcomes. Sao Paulo Medical Journal 127, 185–189.CrossRefGoogle ScholarPubMed
de Graaf, R, Bijl, RV, Smit, F, Vollebergh, WA, Spijker, J (2002). Risk factors for 12-month comorbidity of mood, anxiety, and substance use disorders: findings from the Netherlands Mental Health Survey and Incidence Study. American Journal of Psychiatry 159, 620–629.Google Scholar
de Graaf, R, Bijl, RV, Spijker, J, Beekman, AT, Vollebergh, WA (2003). Temporal sequencing of lifetime mood disorders in relation to comorbid anxiety and substance use disorders – findings from the Netherlands Mental Health Survey and Incidence Study. Social Psychiatry and Psychiatric Epidemiology 38, 1–11.Google Scholar
Dennis, CL, Falah-Hassani, K, Shiri, R (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. British Journal of Psychiatry. Published online 16 March 2017. doi:10.1192/bjp.bp.116.187179.Google Scholar
Edhborg, M, Nasreen, HE, Kabir, ZN (2011). Impact of postpartum depressive and anxiety symptoms on mothers' emotional tie to their infants 2–3 months postpartum: a population-based study from rural Bangladesh. Archives of Women's Mental Health 14, 307–316.Google Scholar
Enatescu, VR, Enatescu, I, Craina, M, Gluhovschi, A, Papava, I, Romosan, R, Marian, C, Oprea, A, Bernad, E (2014). State and trait anxiety as a psychopathological phenomenon correlated with postpartum depression in a Romanian sample: a pilot study. Journal of Psychosomatic Obstetrics and Gynaecology 35, 55–61.CrossRefGoogle Scholar
Enfoux, A, Courtois, R, Duijsens, I, Reveillere, C, Senon, JL, Magnin, G, Voyer, M, Montmasson, H, Camus, V, El-Hage, W (2013). Comorbidity between personality disorders and depressive symptomatology in women: a cross-sectional study of three different transitional life stages. Personality and Mental Health 7, 233–241.Google Scholar
Falah-Hassani, K, Shiri, R, Dennis, CL (2016). Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety. Journal of Affective Disorders 198, 142–147.Google Scholar
Farr, SL, Dietz, PM, O'Hara, MW, Burley, K, Ko, JY (2014). Postpartum anxiety and comorbid depression in a population-based sample of women. Journal of Women's Health 23, 120–128.CrossRefGoogle Scholar
Fichter, MM, Quadflieg, N, Fischer, UC, Kohlboeck, G (2010). Twenty-five-year course and outcome in anxiety and depression in the Upper Bavarian Longitudinal Community Study. Acta Psychiatrica Scandinavica 122, 75–85.Google Scholar
Figueiredo, B, Conde, A (2011). Anxiety and depression in women and men from early pregnancy to 3-months postpartum. Archives of Women's Mental Health 14, 247–255.CrossRefGoogle ScholarPubMed
Fisher, J, Tran, T, La, BT, Kriitmaa, K, Rosenthal, D, Tran, T (2010). Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use. Bulletin of the World Health Organization 88, 737–745.CrossRefGoogle ScholarPubMed
Fontein-Kuipers, Y, Ausems, M, Bude, L, Van Limbeek, E, De Vries, R, Nieuwenhuijze, M (2015). Factors influencing maternal distress among Dutch women with a healthy pregnancy. Women and Birth 28, e36–e43.Google Scholar
Ford, E, Shakespeare, J, Elias, F, Ayers, S (2017). Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review. Family Practice 34, 11–19.Google Scholar
Garthus-Niegel, S, von Soest, T, Knoph, C, Simonsen, TB, Torgersen, L, Eberhard-Gran, M (2014). The influence of women's preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study. BMC Pregnancy and Childbirth 14, 191.Google Scholar
Gavin, NI, Gaynes, BN, Lohr, KN, Meltzer-Brody, S, Gartlehner, G, Swinson, T (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics and Gynecology 106, 1071–1083.CrossRefGoogle ScholarPubMed
Grant, KA, Bautovich, A, McMahon, C, Reilly, N, Leader, L, Austin, MP (2012). Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress. Archives of Women's Mental Health 15, 297–305.CrossRefGoogle ScholarPubMed
Grant, KA, McMahon, C, Austin, MP (2008). Maternal anxiety during the transition to parenthood: a prospective study. Journal of Affective Disorders 108, 101–111.Google Scholar
Higgins, J, Green, S (2009). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration: www.cochrane-handbook.org (accessed January 2017).Google Scholar
Higgins, JP, Thompson, SG (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 21, 1539–1558.Google Scholar
Karmaliani, R, Asad, N, Bann, CM, Moss, N, McClure, EM, Pasha, O, Wright, LL, Goldenberg, RL (2009). Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. International Journal of Social Psychiatry 55, 414–424.Google Scholar
Kessler, RC, Frank, RG (1997). The impact of psychiatric disorders on work loss days. Psychological Medicine 27, 861–873.CrossRefGoogle ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kessler, RC, Nelson, CB, McGonagle, KA, Liu, J, Swartz, M, Blazer, DG (1996). Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey. British Journal of Psychiatry Supplement 30, 17–30.Google Scholar
Khashan, AS, Everard, C, McCowan, LM, Dekker, G, Moss-Morris, R, Baker, PN, Poston, L, Walker, JJ, Kenny, LC (2014). Second-trimester maternal distress increases the risk of small for gestational age. Psychological Medicine 44, 2799–2810.CrossRefGoogle ScholarPubMed
Lamers, F, van Oppen, P, Comijs, HC, Smit, JH, Spinhoven, P, van Balkom, AJ, Nolen, WA, Zitman, FG, Beekman, AT, Penninx, BW (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). Journal of Clinical Psychiatry 72, 341–348.Google Scholar
Lee, AM, Lam, SK, Sze Mun Lau, SM, Chong, CS, Chui, HW, Fong, DY (2007). Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics and Gynecology 110, 1102–1112.CrossRefGoogle ScholarPubMed
Leung, BM, McDonald, SW, Kaplan, BJ, Giesbrecht, GF, Tough, SC (2013). Comparison of sample characteristics in two pregnancy cohorts: community-based versus population-based recruitment methods. BMC Medical Research Methodology 13, 149.Google Scholar
Mahenge, B, Stockl, H, Likindikoki, S, Kaaya, S, Mbwambo, J (2015). The prevalence of mental health morbidity and its associated factors among women attending a prenatal clinic in Tanzania. International Journal of Gynaecology and Obstetrics 130, 261–265.Google Scholar
Mann, JR, McKeown, RE, Bacon, J, Vesselinov, R, Bush, F (2008). Religiosity, spirituality and antenatal anxiety in Southern U.S. women. Archives of Women's Mental Health 11, 19–26.Google Scholar
Matthey, S, Barnett, B, Howie, P, Kavanagh, DJ (2003). Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? Journal of Affective Disorders 74, 139–147.Google Scholar
McFarland, J, Salisbury, AL, Battle, CL, Hawes, K, Halloran, K, Lester, BM (2011). Major depressive disorder during pregnancy and emotional attachment to the fetus. Archives of Women's Mental Health 14, 425–434.Google Scholar
McPhie, S, Skouteris, H, Fuller-Tyszkiewicz, M, Hill, B, Jacka, F, O'Neil, A (2015). Relationships between mental health symptoms and body mass index in women with and without excessive weight gain during pregnancy. Midwifery 31, 138–146.Google Scholar
Meijer, JL, Bockting, CL, Stolk, RP, Kotov, R, Ormel, J, Burger, H (2014). Associations of life events during pregnancy with longitudinal change in symptoms of antenatal anxiety and depression. Midwifery 30, 526–531.Google Scholar
Merikangas, KR, Zhang, H, Avenevoli, S, Acharyya, S, Neuenschwander, M, Angst, J; Zurich Cohort, Study (2003). Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study. Archives of General Psychiatry 60, 993–1000.Google Scholar
Milgrom, J, Gemmill, AW, Bilszta, JL, Hayes, B, Barnett, B, Brooks, J, Ericksen, J, Ellwood, D, Buist, A (2008). Antenatal risk factors for postnatal depression: a large prospective study. Journal of Affective Disorders 108, 147–157.CrossRefGoogle ScholarPubMed
Miller, ES, Hoxha, D, Wisner, KL, Gossett, DR (2015). The impact of perinatal depression on the evolution of anxiety and obsessive–compulsive symptoms. Archives of Women's Mental Health 18, 456–461.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG; PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine 6, e1000097.Google Scholar
Moscati, A, Flint, J, Kendler, KS (2016). Classification of anxiety disorders comorbid with major depression: common or distinct influences on risk? Depression and Anxiety 33, 120–127.CrossRefGoogle ScholarPubMed
Moss, KM, Skouteris, H, Wertheim, EH, Paxton, SJ, Milgrom, J (2009). Depressive and anxiety symptoms through late pregnancy and the first year post birth: an examination of prospective relationships. Archives of Women's Mental Health 12, 345–349.Google Scholar
Nakayama, R, Koyanagi, A, Stickley, A, Kondo, T, Gilmour, S, Arenliu, A, Shibuya, K (2014). Social networks and mental health in post-conflict Mitrovica, Kosova. BMC Public Health 14, 1169.Google Scholar
Nguyen, TT, Tran, TD, Tran, T, La, B, Nguyen, H, Fisher, J (2015). Postpartum change in common mental disorders among rural Vietnamese women: incidence, recovery and risk and protective factors. British Journal of Psychiatry 206, 110–115.Google Scholar
Norhayati, MN, Hazlina, NH, Asrenee, AR, Emilin, WM (2015). Magnitude and risk factors for postpartum symptoms: a literature review. Journal of Affective Disorders 175, 34–52.Google Scholar
Olariu, E, Forero, CG, Castro-Rodriguez, JI, Rodrigo-Calvo, MT, Alvarez, P, Martin-Lopez, LM, Sanchez-Toto, A, Adroher, ND, Blasco-Cubedo, MJ, Vilagut, G, Fullana, MA, Alonso, J (2015). Detection of anxiety disorders in primary care: a meta-analysis of assisted and unassisted diagnoses. Depression and Anxiety 32, 471–484.CrossRefGoogle ScholarPubMed
Pazzagli, C, Laghezza, L, Capurso, M, Sommella, C, Lelli, F, Mazzeschi, C (2015). Antecedents and consequences of fear of childbirth in nulliparous and parous women. Infant Mental Health Journal 36, 62–74.Google Scholar
Polachek, IS, Harari, LH, Baum, M, Strous, RD (2014). Postpartum anxiety in a cohort of women from the general population: risk factors and association with depression during last week of pregnancy, postpartum depression and postpartum PTSD. Israel Journal of Psychiatry and Related Sciences 51, 128–134.Google Scholar
Razurel, C, Kaiser, B (2015). The role of satisfaction with social support on the psychological health of primiparous mothers in the perinatal period. Women's Health 55, 167–186.CrossRefGoogle ScholarPubMed
Reck, C, Struben, K, Backenstrass, M, Stefenelli, U, Reinig, K, Fuchs, T, Sohn, C, Mundt, C (2008). Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatrica Scandinavica 118, 459–468.Google Scholar
Rosenthal, L, Earnshaw, VA, Lewis, TT, Reid, AE, Lewis, JB, Stasko, EC, Tobin, JN, Ickovics, JR (2015). Changes in experiences with discrimination across pregnancy and postpartum: age differences and consequences for mental health. American Journal of Public Health 105, 686–693.CrossRefGoogle ScholarPubMed
Rush, AJ, Zimmerman, M, Wisniewski, SR, Fava, M, Hollon, SD, Warden, D, Biggs, MM, Shores-Wilson, K, Shelton, RC, Luther, JF, Thomas, B, Trivedi, MH (2005). Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features. Journal of Affective Disorders 87, 43–55.Google Scholar
Sato, Y, Kato, T, Kakee, N (2008). A six-month follow-up study of maternal anxiety and depressive symptoms among Japanese. Journal of Epidemiology 18, 84–87.Google Scholar
Siu, AL; US Preventive Services Task Force (USPSTF), Bibbins-Domingo, K, Grossman, DC, Baumann, LC, Davidson, KW, Ebell, M, Garcia, FA, Gillman, M, Herzstein, J, Kemper, AR, Krist, AH, Kurth, AE, Owens, DK, Phillips, WR, Phipps, MG, Pignone, MP (2016). Screening for depression in adults: US Preventive Services Task Force Recommendation Statement. Journal of the American Medical Association 315, 380–387.Google Scholar
Sockol, LE, Battle, CL (2015). Maternal attitudes, depression, and anxiety in pregnant and postpartum multiparous women. Archives of Women's Mental Health 18, 585–593.Google Scholar
Swanson, LM, Pickett, SM, Flynn, H, Armitage, R (2011). Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment. Journal of Women's Health 20, 553–558.Google Scholar
Taporoski, TP, Negrão, AB, Horimoto, AR, Duarte, NE, Alvim, RO, de Oliveira, CM, Krieger, JE, Schantz, M, Vallada, H, Pereira, AC (2015). Shared genetic factors of anxiety and depression symptoms in a Brazilian family-based cohort, the Baependi Heart Study. PLOS ONE 10, e0144255.Google Scholar
Tavares, D, Quevedo, L, Jansen, K, Souza, L, Pinheiro, R, Silva, R (2012). Prevalence of suicide risk and comorbidities in postpartum women in Pelotas. Revista Brasileira de Psiquiatria 34, 270–276.Google Scholar
Tendais, I, Costa, R, Conde, A, Figueiredo, B (2014). Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI. Spanish Journal of Psychology 17, E7.CrossRefGoogle ScholarPubMed
van Bussel, JC, Spitz, B, Demyttenaere, K (2009). Depressive symptomatology in pregnant and postpartum women. An exploratory study of the role of maternal antenatal orientations. Archives of Women's Mental Health 12, 155–166.Google Scholar
van Dijk, AE, van Eijsden, M, Stronks, K, Gemke, RJ, Vrijkotte, TG (2010). Cardio-metabolic risk in 5-year-old children prenatally exposed to maternal psychosocial stress: the ABCD study. BMC Public Health 10, 251.Google Scholar
Verreault, N, Da Costa, D, Marchand, A, Ireland, K, Dritsa, M, Khalife, S (2014). Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset. Journal of Psychosomatic Obstetrics and Gynaecology 35, 84–91.Google Scholar
Wenzel, A, Haugen, EN, Jackson, LC, Brendle, JR (2005). Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders 19, 295–311.CrossRefGoogle ScholarPubMed
Yelland, J, Sutherland, G, Brown, SJ (2010). Postpartum anxiety, depression and social health: findings from a population-based survey of Australian women. BMC Public Health 10, 771.Google Scholar
Supplementary material: PDF

Falah-Hassani supplementary material

Appendix

Download Falah-Hassani supplementary material(PDF)
PDF 133.4 KB