Research report
Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: Parity differences and effects

https://doi.org/10.1016/j.jad.2011.02.007Get rights and content

Abstract

This study aimed to investigate both anxiety and depression symptoms from early pregnancy to 3-months postpartum, comparing women and men and first and second-time parents.

Methods

A sample of 260 Portuguese couples (N = 520), first or second-time parents, recruited in an Obstetrics Out-patients Unit, filled in the State-Anxiety Inventory (STAI-S) and the Edinburgh Post-Natal Depression Scale (EPDS) at the 1st, 2nd and 3rd pregnancy trimesters, childbirth, and 3-months postpartum.

Results

A decrease in anxiety and depression symptoms from early pregnancy to 3-months postpartum was found in both women and men, as well as in first and second-time parents. Men presented less anxiety and depression symptoms than women, but the same pattern of symptoms over time. Second-time parents showed more anxiety and depression symptoms than first-time parents and a different pattern of symptoms over time: an increase in anxiety and depression symptoms from the 3rd trimester to childbirth was observed in first-time parents versus a decrease in second-time parents.

Limitations

The voluntary nature of the participation may have lead to a selection bias; women and men who agreed to participate could be those who presented fewer anxiety and depression symptoms. Moreover, the use of self-report symptom measures does not give us the level of possible disorder in participants.

Conclusions

Anxiety and depression symptoms diminish from pregnancy to the postpartum period in all parents. Patterns of anxiety and depression symptoms from early pregnancy to 3-months postpartum are similar in women and men, but somewhat different in first and second-time parents. Second-time parents should also be considered while studying and intervening during pregnancy and the postpartum.

Introduction

From early pregnancy to the postpartum period, several changes occur simultaneously at biological, psychological and social levels. Adjustment to these changes may place both women and men at-risk for psychological difficulties. Literature has been picturing a particularly difficult transition for first-time parents. But for second-time parents adjustment and resultant strain may come from the process of incorporating a new member into a preexisting system and having to take care of two children at the same time.

Empirical studies report high levels of anxiety symptoms in women (Andersson et al., 2006, Breitkopf et al., 2006, DiPietro et al., 2006, Heron et al., 2004, Huizink et al., 2004, Lee et al., 2007) and their partners (Boyce et al., 2007, Condon et al., 2004, Dulude et al., 2002, Perren et al., 2005, Skari et al., 2002) during pregnancy. In both women and men, anxiety levels seem to be higher in the 1st and 3rd compared to the 2nd pregnancy trimesters (Lee et al., 2007, Teixeira et al., 2009), and higher during pregnancy/childbirth compared to the postpartum period (Andersson et al., 2006, Breitkopf et al., 2006, Condon et al., 2004, DiPietro et al., 2006, Heron et al., 2004, Skari et al., 2002).

High levels of depression symptoms have been reported as well, during pregnancy in women (Andersson et al., 2006, Breitkopf et al., 2006, Bunevicius et al., 2009, Caliskan et al., 2007, DiPietro et al., 2008, Evans et al., 2001, Felice et al., 2004, Figueiredo et al., 2007, Heron et al., 2009, Lau and Chan, 2009, Limlomwongse and Liabsuetrakul, 2006, Ross and McLean, 2006, Skouteris et al., 2009, Westdahl et al., 2007, Wu et al., 2002) and their partners (Areias et al., 1996, Buist et al., 2003, Condon et al., 2004, Deater-Deckard et al., 1998, Dulude et al., 2002, Morse et al., 2000, Perren et al., 2005), plus in both postpartum mothers (Dietz et al., 2007, Dørheim et al., 2009, Gorman et al., 2004, Xie et al., 2009) and fathers (Ballard and Davis, 1996, Edhborg et al., 2005). Following many years of interest in postpartum depression, research has been more recently picturing a decrease in depression from the 1st to the 3rd pregnancy trimester (Andersson et al., 2006, Breitkopf et al., 2006, Bunevicius et al., 2009, Felice et al., 2004, DiPietro et al., 2008, Ross and McLean, 2006, Teixeira et al., 2009), and from pregnancy to the postpartum period (Evans et al., 2001, Felice et al., 2004, Figueiredo et al., 2007, Heron et al., 2009, Kinsella and Monk, 2009, Lau and Chan, 2009, Limlomwongse and Liabsuetrakul, 2006, Skouteris et al., 2009), in women, as well as in men (Buist et al., 2003, Condon et al., 2004, Dulude et al., 2002, Morse et al., 2000, Perren et al., 2005). However, higher rates of depression after childbirth compared to pregnancy are still being found in women (Dietz et al., 2007, Gorman et al., 2004), and in men, particularly at the end of the first postpartum year (Matthey et al., 2000).

Usually, women have been described as presenting higher anxiety than their partner, either before (Dulude et al., 2002) or after childbirth (Ballard and Davis, 1996, Skari et al., 2002), but some studies do not show gender differences in levels of postpartum anxiety (Dulude et al., 2002). During pregnancy women have been reported with higher depression levels than men (Dulude et al., 2002, Matthey et al., 2000, Morse et al., 2000, Perren et al., 2005), which is also controversial with studies showing no significant gender differences (Field et al., 2006). Reports of two to three times more postpartum depressed mothers than fathers (Areias et al., 1996, Ballard and Davis, 1996, Edhborg et al., 2005, Matthey et al., 2000, Morse et al., 2000, Perren et al., 2005) are also controversial with research showing no gender differences in postpartum depression rates (Dulude et al., 2002).

First-time mothers and fathers have been described as presenting higher anxiety than second-time mothers and fathers, during pregnancy and the postpartum (Hung, 2004, Giakoumaki et al., 2009), with some studies showing the reverse in pregnancy (DiPietro et al., 2008) and at postpartum (Skari et al., 2002). No differences were found in literature in women's anxiety according to parity in pregnancy (Lee et al., 2007) and postpartum (Breitkopf et al., 2006, DiPietro et al., 2006) as well.

No differences in depression levels according to parity have been generally reported in women during pregnancy (Breitkopf et al., 2006, Bunevicius et al., 2009, Dietz et al., 2007, Lee et al., 2007, Westdahl et al., 2007, Wu et al., 2002) and the postpartum period (Dietz et al., 2007, Wenzel et al., 2005). However, some studies report either lower depression levels in first-time compared to second-time mothers during pregnancy (DiPietro et al., 2008, Vliegen et al., 2006) or the postpartum (Ho-Yen et al., 2007, Righetti-Veltema et al., 1998, Skari et al., 2002), and higher in first-time compared to second-time mothers during the postpartum (Dørheim et al., 2009). Studies have been mostly targeting first-time fathers (e.g., Areias et al., 1996, Matthey et al., 2000, Morse et al., 2000, Perren et al., 2005), and so not much data is available about the association between parity and depression in men, with the exception of one study showing high levels of depression during pregnancy in second-time compared to first-time fathers (Condon and Esuvaranathan, 1990).

High levels of anxiety and depression symptoms have been reported during pregnancy and the postpartum period, typically depression in women 3-months after childbirth. However, a decrease from pregnancy to the postpartum period in anxiety and depression symptoms has been pointed out more recently, in women (Andersson et al., 2006, Breitkopf et al., 2006, DiPietro et al., 2008, Evans et al., 2001, Felice et al., 2004, Field et al., 2008, Figueiredo et al., 2007, Heron et al., 2004, Heron et al., 2009, Limlomwongse and Liabsuetrakul, 2006, Ross et al., 2003, Skouteris et al., 2009) as in men (Buist et al., 2003, Condon et al., 2004, Dulude et al., 2002, Perren et al., 2005, Skari et al., 2002). Usually studies show more anxiety and depression symptoms in women than in their partners either before or after childbirth (Ballard and Davis, 1996, Condon and Esuvaranathan, 1990, Edhborg et al., 2005, Matthey et al., 2000, Morse et al., 2000, Perren et al., 2005, Skari et al., 2002). Controversial results in the literature regarding anxiety and depression during pregnancy and the postpartum period are mainly regarding first and second-time parents. Studies usually found no differences in anxiety and depression symptoms between primipara and multipara mothers (Breitkopf et al., 2006, Bunevicius et al., 2009, Dietz et al., 2007, Figueiredo et al., 2007, Lee et al., 2007, Wenzel et al., 2005, Westdahl et al., 2007, Wu et al., 2002); though, more (Dørheim et al., 2009, Gameiro et al., 2009, Giakoumaki et al., 2009, Hung, 2004), as well as less symptoms (DiPietro et al., 2008, Ho-Yen et al., 2007, Righetti-Veltema et al., 1998, Skari et al., 2002, Vliegen et al., 2006) in first-time mothers than in second-time mothers have also been reported.

Patterns of anxiety and depression symptoms change throughout pregnancy and the postpartum period according to gender and parity have not been as highly studied, and therefore are the principal novelties of the present study. Additionally, studies targeting men's psychological adjustment during pregnancy and the postpartum period have almost only considered first-time fathers (Areias et al., 1996, Boyce et al., 2007, Buist et al., 2003, Condon et al., 2004, Matthey et al., 2000, Morse et al., 2000, Perren et al., 2005). Some controversial results in the literature may come from the fact that research has been mostly designed to study postpartum depression in first-time mothers, while men and second-time parents may have a different pattern of symptoms over time. Studying simultaneously women and men and first and second-time parents from early pregnancy to 3-months postpartum could help to explain controversial results concerning levels of anxiety and depression symptoms throughout pregnancy and the postpartum period.

This study was aimed to investigate anxiety and depression symptoms in first and second-time mothers and fathers at the 1st, 2nd and 3rd pregnancy trimesters, childbirth and 3-months postpartum, chiefly looking at parity differences and effects.

We hypothesized that the transition to parenthood is mainly the same developmental process, generating the same psychological challenges and difficulties for women and men and for first and second-time parents. But we also hypothesized that some different patterns of psychological adjustment throughout pregnancy and the postpartum period may occur in women and in men and in first and second-time parents, according to specific strains and difficulties that the transition may have implied for women and men and for first and second-time parents (e.g., DiPietro et al., 2008, Gameiro et al., 2009, Teixeira et al., 2009).

Section snippets

Participants

Three hundred pregnant women were randomly recruited in an Obstetrics Out-patients Unit (Porto, Portugal) (84% of the contacted pregnant women). The exclusion criteria were: not reading or writing Portuguese and multiple gestations. A sample of 260 couples (N = 520) was considered, when the partner also agreed to participate; 91.4% of women and 82.6% of men completed all five assessments.

Nearly all the participants were Portuguese (91.4%). The majority of participants was aged between 20 and 39 

From early pregnancy compared to 3-months postpartum

Repeated measures ANOVA revealed significant changes over pregnancy and the postpartum period [F(8, 2750) = 5.24, p < 0.001], both for anxiety [F(4, 1376) = 6.00, p < 0.001] and depression symptoms [F(4, 1376) = 7.51, p < 0.001].

Post hoc contrasts for anxiety symptoms showed a significant increase from the 3rd trimester to childbirth. However, changes observed from the 1st to the 2nd trimester, the 2nd to the 3rd trimester, and from childbirth to 3-months postpartum were not significant. Pair wise

Discussion

Anxiety and depression symptoms were present during the entire studied period, supporting psychological morbidity during pregnancy and the postpartum period suggested in the literature, regarding women's anxiety (Boyce et al., 2007, Buist et al., 2003, Ross et al., 2003, Wenzel et al., 2003) and depression (Felice et al., 2004, Ross et al., 2004, Wu et al., 2002), as well as men's anxiety (Quinlivan and Condon, 2005, Huizink et al., 2004) and depression (Ross et al., 2003). But, higher levels

Role of funding source

Funding for this work was provided by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and supported by the European Community Fund FEDER. (POCI/SAU-ESP/56397/2004; Anxiety and depression in women and men during the transition to parenthood: effects on fetal and neo-natal behavior and development).

The sponsors had no further role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the

Conflict of interest

This work has no conflict of interest.

Acknowledgements

This work was supported by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III and by the European Community Fund FEDER (POCI/SAU-ESP/56397/2004; anxiety and depression in women and men during the transition to parenthood: effects on fetal and neo-natal behavior and development). We gratefully acknowledge the proofreading of this manuscript by the Scientific Editing Program of University of Minho.

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