Skip to main content

Advertisement

SpringerLink
Log in

Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Accumulating evidence suggests that pregnancy does not protect women from mental illness. The aim of this study was to assess the prevalence, sociodemographic correlates, and the risks factors for perinatal depression and anxiety. Five hundred ninety women between 28th and the 32nd gestational weeks were recruited and submitted to a sociodemographic, obstetric, and psychological interview. The Edinburgh Postnatal Depression Scale (EPDS) and the state-trait anxiety inventory (STAI-Y) were also administered in antenatal period and 3 months postnatally. The Structured Clinical Interview for DSM-IV (SCID-I) was used to diagnose mood and anxiety disorders. Three months after delivery, EPDS was administered by telephone interview. Women with an EPDS score ≥10 were 129 in antenatal period (21.9%) and 78 in postnatal period (13.2%). During pregnancy 121 women (20.5%) were positive for STAI-Y state and 149 women (25.3%) for STAI-Y trait. The most important risk factors for antenatal depression are: foreign nationality, conflictual relationship with family and partner, and lifetime psychiatric disorders. The principal risk factors for postnatal depression are: psychiatric disorders during pregnancy and artificial reproductive techniques. Psychiatric disorders, during and preceding pregnancy, are the strongest risk factors for antenatal state and trait anxiety. Antenatal depressive and anxiety symptoms appear to be as common as postnatal symptoms. These results provide clinical direction suggesting that early identification and treatment of perinatal affective disorders is particularly relevant to avoid more serious consequences for mothers and child.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, åStröm M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189(1):148–154

    Article  PubMed  Google Scholar 

  • Appleby L (1991) Suicide during pregnancy and the first post-natal year. BMJ 302:137–140

    Article  PubMed  CAS  Google Scholar 

  • Austin MP (2006) To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects. Psychol Med 36(12):1663–1670, Review

    Article  PubMed  Google Scholar 

  • Austin MP, Priest SR (2004) New developments in perinatal mental health. Guest editorial. Acta Psychiatr Scand 2042:321–322

    Google Scholar 

  • Austin MP, Tully L, Parker G (2007) Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101(1–3):169–174

    Article  PubMed  Google Scholar 

  • Barnett B, Parker G (1986) Possible determinants, correlates and consequences of high levels of anxiety in primiparous mothers. Psychol Med 16(1):177–185

    Article  PubMed  CAS  Google Scholar 

  • Beck CT (1996) A meta-analysis of the relationship between postpartum depression and infant temperament. Nurs Res 45(4):225–230

    Article  PubMed  CAS  Google Scholar 

  • Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285

    Article  PubMed  CAS  Google Scholar 

  • Bennet HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: a systematic review. Obstet Gynecol 103(4):698–709

    Article  Google Scholar 

  • Benvenuti P, Ferrara M, Niccolai C, Valoriani V, Cox JL (1999) The Edinburgh postnatal depression scale: validation for an Italian sample. J Affect Disord 53:137–141

    Article  PubMed  CAS  Google Scholar 

  • Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR (2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 157:824–930

    Article  Google Scholar 

  • Bloch M, Rotenberg N, Koren D, Klein E (2006) Risk factors for early postpartum depressive symptoms. Gen Hosp Psychiatry 28(1):3–8

    Article  PubMed  Google Scholar 

  • Bogetto F, Salvi V, Maina G (2004) Disturbi d’ansia e dell’umore in gravidanza: terapie farmacologiche e non farmacologiche. Psicosomatica in ginecologia e ostetricia. Una Medicina a misura di Donna. CIC Edizioni Internazionali, Roma

    Google Scholar 

  • Bolton HL, Hughes PM, Turton P, Sedgwick P (1998) Incidence and demographic correlates of depressive symptoms during pregnancy in an inner London population. J Psychosom Obstet Gynaecol 19(4):202–209

    Article  PubMed  CAS  Google Scholar 

  • Borri C, Mauri M, Oppo A, Banti S, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Bettini A, Ricciardulli S, Rucci P, Montaresi S, Cassano GB (2008) Axis I psychopathology and functional impairment at the third month of pregnancy: results from the Perinatal Depression-Research and Screening Unit (PND-ReScU) Study. J Clin Psychiatry 69:1617–1624

    Article  PubMed  Google Scholar 

  • Brockington I, MacDonald E, Wainscott G (2006) Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Arch Women Ment Health 9(5):253–263

    Article  CAS  Google Scholar 

  • Broen AN, Moum T, Bödtker AS, Ekeberg O (2006) Predictors of anxiety and depression following pregnancy termination: a longitudinal five-year follow-up study. Acta Obstet Gynecol Scand 85(3):317–323

    Article  PubMed  Google Scholar 

  • Brouwers EP, Van Baar AL, Pop VJ (2001) Does the Edinburgh postnatal depression scale measure anxiety? J Psychosom Res 51:659–663

    Article  PubMed  CAS  Google Scholar 

  • Brown GW, Harris TO (1978) Social origins of depression. A study of psychiatric disorder in women, Tavistock, Londra

    Google Scholar 

  • Buist A, Barnett B (1995) Childhood sexual abuse: a risk factor for postpartum depression? Aust N Z J Psychiatry 29(4):604–608

    Article  PubMed  CAS  Google Scholar 

  • Buist A, Condon J, Brooks J, Craig Speelman C, Milgron J, Hayes B, Ellwood D, Barnett B, Kowalenko N, Matthey S, Austin M-P, Bilzta J (2006) Acceptability of routine screening for perinatal depression. J Affect Disord 93(1–3):233–237

    Article  PubMed  Google Scholar 

  • Cantwell R, Smith S (2006) Prediction and prevention of perinatal mental illness. Psychiatry 5(1):15–21

    Article  Google Scholar 

  • Chaudron LH, Nirodi N (2010) The obsessive-compulsive spectrum in the perinatal period: a prospective pilot study. Arch Womens Ment Health 13(5):403–410

    Article  PubMed  Google Scholar 

  • Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786

    Article  PubMed  CAS  Google Scholar 

  • Cox SJ, Glazebrook C, Sheard C, Ndukwe G, Oates M (2006) Maternal self-esteem after successful treatment for infertility. Fertil Steril 85:84–39

    Article  PubMed  Google Scholar 

  • Csatordai S, Kozinszky Z, Devosa I, Toth E, Krajcsi A, Sefcsik T, Pal A (2007) Obstetric and sociodemographic risk of vulnerability to postnatal depression. Patient Educ Couns 67:84–92

    Article  PubMed  Google Scholar 

  • Cwikel J, Gidron Y, Sheiner E (2004) Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 117(2):126–131

    Article  PubMed  CAS  Google Scholar 

  • Da Costa D, Dritsa M, Verreault N, Balaa C, Kudzman J, Khalifé S (2010) Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy. Arch Womens Ment Health 13(3):249–257

    Article  PubMed  Google Scholar 

  • Davis L, Edwards H, Mohay H, Wollin J (2003) The impact of very premature birth on the psychological health of mothers. Early Hum Dev 73(1–2):61–70

    Article  PubMed  Google Scholar 

  • Dennis CL, Allen K (2009) Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database Syst Rev 8:4

    Google Scholar 

  • Eberhard-Gran M, Eskild A, Tambs K, Schei B, Opjordsmoen S (2001) The Edinburgh postnatal depression scale: validation in a Norwegian community sample. Nord J Psychiatry 55(2):113–117

    Article  PubMed  CAS  Google Scholar 

  • Eberhard-Gran M, Garthus-Niegel S, Garthus-Niegel K, Eskild A (2010) Postnatal care: a cross-cultural and historical perspective. Arch Women’s Ment Health 13(6):459–466

    Article  Google Scholar 

  • Evans J, Heron JH, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323(7307):257–260

    Article  PubMed  CAS  Google Scholar 

  • Field T (2002) Prenatal depression effects on the foetus and neonate in different ethnic and socio-economic status groups. J Reprod Infant Psychol 20:149–157

    Article  Google Scholar 

  • Field T, Diego M, Hernandez-Reif M, Schanberg S, Kuhn C, Yando R, Bendell D (2003) Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate. Depress Anxiety 17(3):140–151

    Article  PubMed  Google Scholar 

  • Flynn HA, Walton MA, Chermack ST, Cunningham RM, Marcus SM (2007) Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings. Arch Womens Ment Health 10:155–161

    Article  PubMed  CAS  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. Obstet Gynecol 106(5 Pt 1):1071–1083

    Article  PubMed  Google Scholar 

  • Giardinelli L, Cecchelli C, Innocenti A (2008) disturbi psichistrici in gravidanza. Giorn Ital Psicopat 14:211–219

    Google Scholar 

  • Grant KA, McMahon C, Austin MP (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108(1–2):101–111

    Article  PubMed  Google Scholar 

  • Halbreich U (2004) Prevalence of mood symptoms and depression during pregnancy: implications for clinical practice and research. CNS Spectr 9:177–184

    PubMed  Google Scholar 

  • Halbreich U (2010) Women's reproductive related disorders (RRDs). J Affect Disord 122:10–13

    Article  PubMed  Google Scholar 

  • Hammarberg K, Fisher JRW, Wynter KH (2008) Psychological and social aspects of pregnancy, childbirth and early parenting after assisted conception: a systematic review. Hum Reprod Update 14(5):395–414

    Article  PubMed  CAS  Google Scholar 

  • Harris B, Huckle P, Thomas R, Johns S, Fung H (1989) The use of rating scales to identify post-natal depression. Br J Psychiatry 154:813–817

    Article  PubMed  CAS  Google Scholar 

  • Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Women Ment Health 9:329–337

    Article  CAS  Google Scholar 

  • Heron J, O’Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73

    Article  PubMed  Google Scholar 

  • Hynes GJ, Callan VJ, Terry DJ, Gallois C (1992) The psychological well-being of infertile women after a failed IVF attempt: the effects of coping. Br J Med Psychol 65:296–278

    Article  Google Scholar 

  • Josefsson A, Berg G, Nordin C, Sydsjo G (2001) Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 80(3):251–255

    Article  PubMed  CAS  Google Scholar 

  • Kammerer M, Adams D, Castelberg B, Glover V (2002) Pregnant women become insensitive to cold stress. BMC Pregnancy Childbirth 19 2(1):8

    Article  Google Scholar 

  • Kim YK, Hur JW, Kim KH, Oh KS, Shin YC (2008) Prediction of postpartum depression by sociodemographic, obstetric and psychological factors: a prospective study. Psychiatry Clin Neurosci 62:331–340

    Article  PubMed  Google Scholar 

  • Kumar R, Robson KM (1984) A prospective study of emotional disorders in childbearing women. Br J Psychiatry 144:35–47

    Article  PubMed  CAS  Google Scholar 

  • Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14

    Article  PubMed  Google Scholar 

  • Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 16:8–24

    Google Scholar 

  • Llewellyn AM, Stowe ZN, Nemeroff CB (1997) Depression during pregnancy and the puerperium. J Clin Psychiatry 58(15):26–32

    PubMed  Google Scholar 

  • Marcus SM (2009) Depression during pregnancy: rates, risks and consequences. Can J Clin Pharmacol 16(1):15–22

    Google Scholar 

  • Marcus SM, Flynn HA, Blow FC, Barry KL (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Women's Health 12(4):373–380

    Article  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. J Affect Disord 108(1–2):147–157

    Article  PubMed  Google Scholar 

  • Monti F, Agostini F, Marano G, Lupi F (2008) The course of maternal depressive symptomatology during the first 18 months postpartum in an Italian sample. Arch Womens Ment Health 11(3):231–238

    Article  PubMed  Google Scholar 

  • Moraes IG, Pinheiro RT, Silva RA, Horta BL, Sousa PL, Faria AD (2006) Prevalence of postpartum depression and associated factors. Rev Saud Publ 40:65–70

    Article  Google Scholar 

  • Murray L, Carothers AD (1990) The validation of the Edinburgh postnatal depression scale on a community sample. Br J Psychiatry 157:288–290

    Article  PubMed  CAS  Google Scholar 

  • Murray L, Cooper P (1997) postpartum depression and child development. Psychol Med 27:253–260

    Article  PubMed  CAS  Google Scholar 

  • O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a-meta-analysis. Int Rev Psychiatr 8:37–54

    Article  Google Scholar 

  • Oppo A, Mauri M, Ramacciotti D, Camilleri V, Banti S, Borri C, Rambelli C, Montagnani MS, Cortopassi S, Bettini A, Ricciardulli S, Montaresi S, Rucci P, Beck CT, Cassano GB (2009) Risk factors for postpartum depression: the role of the postpartum depression predictors inventory-revised (PDPI-R). Results from the Perinatal Depression-Research & Screening Unit (PNDReScU) study. Arch Womens Ment Health 12(4):239–249

    Article  PubMed  CAS  Google Scholar 

  • Pajulo M, Savonlahti E, Sourander A, Helenius H, Piha J (2001) Antenatal depression, substance dependency and social support. J Affect Disord 65(1):9–17

    Article  PubMed  CAS  Google Scholar 

  • Patten SB (1991) Are the Brown and Harris “Vulnerability Factors” risk factors for depression? J Psychiatr Neurosci 16(5):267–271

    CAS  Google Scholar 

  • Phillips J, Charles M, Sharpe L, Matthey S (2009) Validation of the subscales of the Edinburgh postnatal depression scale in a sample of women with unsettled infants. J Affective Disord 118(1–3):101–112

    Article  Google Scholar 

  • Repokari L, Punamaki RL, Poikkeus P, Vilska S, Unkila-Kallio L, Sinkonnen J, Almqvist F, Tiitinen A, Tulppala M (2005) The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: a prospective controlled study. Hum Reprod 20:3238–3247

    Article  PubMed  CAS  Google Scholar 

  • Ritter C, Hobfoll SE, Lavin J, Cameron RP, Hulsizer MR (2000) Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women. Health Psychol 19(6):576–585

    Article  PubMed  CAS  Google Scholar 

  • Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295

    Article  PubMed  Google Scholar 

  • Rodgers CS (2003) Sexual trauma and pregnancy: a conceptual framework. J Women's Health 12:961–970

    Article  Google Scholar 

  • Rubertsson C, Waldenstrom U, Wickberg B (2003) Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample. J Reprod Infant Psychol 21:113–123

    Article  Google Scholar 

  • Ryan D, Milis L, Misri N (2005) Depression during pregnancy. Can Fam Physician 51:1087–1093

    PubMed  Google Scholar 

  • Saucier GF (1986) Prediction Durant la grossese de la possibilitè d’ une depression nevrotique du postpurtum. Comunication. 3eme congré de l’Association Mondiale de Psychiatrie de Nourrisson et des discilplines affiliees, Stockholm

  • Soares CN (2010) DSM-V and reproductive-related psychiatric disorders: a closer look at windows of vulnerability. Arch Womens Ment Health 13:15–16

    Article  PubMed  Google Scholar 

  • Spielberger CD, Gorsuch RL, Luschene R, Vagg PR, Jacobs GA (1983) Manual for the state–trait anxiety inventory (STAI) form Y. Consulting Psychologist, Palo Alto

    Google Scholar 

  • Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H (2004) Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 19:459–463

    Article  PubMed  CAS  Google Scholar 

  • Swalm D, Brooks J, Doherty D, Nathan E, Jaques A (2010) Using the Edinburgh postnatal depression scale to screen for perinatal anxiety. Arch Womens Ment Health 13(6):515–522

    Article  PubMed  Google Scholar 

  • Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65(7):805–815

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Florence, Italy

    L. Giardinelli, A. Innocenti, L. Benni, M. C. Stefanini, S. Afshar, R. Bovani & G. Castellini

  2. Department of Obstetrics and Gynecology, Florence University School of Medicine, Florence, Italy

    G. Lino, C. Lunardi & V. Svelto

  3. Department of Psychology, University of Florence, Florence, Italy

    C. Faravelli

Authors
  1. L. Giardinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Innocenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Benni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. C. Stefanini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Lino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Lunardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. V. Svelto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Afshar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R. Bovani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Castellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. C. Faravelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Giardinelli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Giardinelli, L., Innocenti, A., Benni, L. et al. Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health 15, 21–30 (2012). https://doi.org/10.1007/s00737-011-0249-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-011-0249-8

Keywords

Search

Navigation