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J Affect Disord. 2016 Jun;197:125-33. doi: 10.1016/j.jad.2016.03.014. Epub 2016 Mar 9.

Longitudinal course of ante- and postpartum generalized anxiety symptoms and associated factors in West-African women from Ghana and Côte d'Ivoire.

Author information

1
Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: d.barthel@uke.de.
2
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
3
Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
4
Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
5
Centre de Guidance Infantile, Institut National de Santé Publique, Abidjan BP V 47, Côte d'Ivoire.
6
Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.
7
Unité Pédagogique Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan BP V34, Côte d'Ivoire.
8
Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
9
Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute for Tropical Medicine, German Armed Forces Hospital Hamburg, Germany.
10
Jean Lorougnon Guede University, Daloa, Côte d'Ivoire.
11
Research Unit of Parasitology and Parasite Ecology at Unité de Formation et de Recherche en Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire.
12
Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
13
Department Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
14
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

BACKGROUND:

Little is known about the course of perinatal anxiety, particularly in low and middle income countries. This study aimed at examining trajectories of ante- and postpartum generalized anxiety symptoms in West-African women and their associations with mother and child characteristics.

METHODS:

778 women from Côte d'Ivoire and Ghana were investigated between 04/2010 and 03/2014. Anxiety symptoms were measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) at three months antepartum and three, 12 and 24 months postpartum. Growth mixture modeling was applied to identify latent trajectory classes of anxiety. Multinomial logistic regression was used to investigate the associations of psychosocial, sociodemographic, obstetric and clinical characteristics with different trajectories.

RESULTS:

Four distinct trajectories of anxiety were identified. The majority of women (79.8%) had consistent low anxiety symptoms, while 11.4% had elevated anxiety scores before and around childbirth that decreased gradually. 5.4% of women showed increasing anxiety symptoms over time. Few women (3.3%) had transient anxiety with elevated scores at three and 12 months postpartum. Risk factors for elevated anxiety levels around childbirth were antepartum depressive symptoms, higher levels of stress (economic, marital and social stress), lower child birth weight, and multiparity. Partner support was found to be protective.

LIMITATIONS:

Anxiety symptoms were assessed using a screening instrument and not through a formal diagnostic classification system. Some putative risk factors were not investigated, and some psychosocial factors were assessed retrospectively.

CONCLUSION:

The presence of different trajectories underline the importance of monitoring anxiety symptoms in pregnant women and in mothers with infants/toddlers.

KEYWORDS:

Ante- and postpartum; Childbirth; Generalized anxiety disorder; Latent class models; Longitudinal study; Maternal health; Pregnancy; Sub-Saharan Africa

PMID:
26991367
DOI:
10.1016/j.jad.2016.03.014
[Indexed for MEDLINE]

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