Depression, anxiety, PTSD and comorbidity in perinatal women in Turkey: A longitudinal population-based study

• Published in: Midwifery Vol. 55; pp. 29 - 37
• Main Authors: Dikmen-Yildiz, Pelin, Ayers, Susan, Phillips, Louise
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.12.2017; Elsevier Science Ltd
• Subjects: Adolescent; Adult; Anxiety; Anxiety - epidemiology; Anxiety - psychology; Childbirth & labor; Comorbidity; depression; Depression - epidemiology; Depression - psychology; Emotional disorders; Female; Humans; Longitudinal Studies; Mass Screening - instrumentation; Mass Screening - methods; Mental depression; Nursing; Perinatal Care - statistics & numerical data; Perinatal mental health; Perinatal period; Population-based studies; Post traumatic stress disorder; postpartum; Postpartum depression; Postpartum period; Postpartum women; Pregnancy; Pregnant Women - psychology; Prevalence; Prospective Studies; PSTD; Psychological needs; Psychological well being; Psychometrics - instrumentation; Psychometrics - methods; Psychosocial factors; Psychosocial intervention; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology; Surveys and Questionnaires; Turkey - epidemiology; Womens health; Turkey; anxiety; Perinatal mental health; postpartum; depression; PSTD; pregnancy
• ISSN: 0266-6138; 1532-3099
• DOI: 10.1016/j.midw.2017.09.001

Objective: (a) to assess prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) and their comorbidity among women during the perinatal period (b) to examine course of those disorders from pregnancy to 6 months postpartum (c) to determine the rates of new-onset cases at 4-6 weeks and 6 months postpartum. Design: A longitudinal population-based study in which participants completed psychosocial measures of depression, anxiety and PTSD in pregnancy (n = 950), 4-6 weeks (n = 858) and 6 months (n = 829) after birth. Setting: A consecutive sample of pregnant women were recruited from three maternity hospitals in three cities of Turkey: Istanbul, Ankara and Izmir. Measures: Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS), and Posttraumatic Diagnostic Scale (PDS) were used to assess depression, anxiety and PTSD, respectively. Findings: Depression and PTSD peaked at 4-6 weeks postpartum and then fell at 6 months postpartum, whereas anxiety followed a gradually declining linear-pattern from pregnancy to 6 months postpartum. The prevalence of depression was 14.6% in pregnancy, 32.6% at 4-6 weeks and 18.5% at 6 months postpartum, respectively. The prevalence of PTSD was 5.8% in pregnancy, 11.9% at 4-6 weeks postpartum and 9.2% at 6 months postpartum. Anxiety was highest in pregnancy (29.6%) and then decreased to 24.6% 4-6 weeks after birth and to 16.2% 6 months after birth. New-onset cases were most apparent at 4-6 weeks postpartum: 24.6% for depression; 13.7% for anxiety and 8.9% for PTSD. Key conclusions: A relatively high prevalence of psychological disorders was identified during the perinatal period. Anxiety was most prevalent in pregnancy, and depression and PTSD were highest at 4-6 weeks postpartum. Depression was more common than anxiety 4-6 weeks and 6 months after birth and highly comorbid with anxiety throughout this period. New-onset cases were observed at both 4-6 weeks and 6 months postpartum. Implications: High rates of affective disorders in pregnancy and after birth highlight three main points: first, it is important to have effective perinatal screening to identify women with psychological needs; second, providing early treatment to women experiencing severe psychological problems is essential to ensure psychological well-being of those women and to prevent chronicity; and finally, psychosocial screening and interventions should be offered until at least 6 months after birth to catch new-onset cases. •Perinatal affective disorders are common in Turkey. •Depression and PTSD were most prevalent after birth (32.6% and 11.9%, respectively). •Anxiety was most prevalent in pregnancy (29.6%). •Depression and anxiety were highly comorbid after birth. •New-onset cases were identified at 4–6 weeks and 6-months postpartum.