Psychometric properties of the Hospital Anxiety and Depression Scale in Mexican pregnant women / Propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión en mujeres embarazadas mexicanas

Abstract Introduction Anxiety and depression in pregnant women are a public health problem. Their adequate detection requires valid and reliable instruments that are also useful for prevention and treatment. Objective To identify the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of Mexican pregnant women. Method The HADS was applied to 716 pregnant women between 13 and 46 years old (M = 26.55; SD = 6.56) attended in a public hospital in Mexico City. Results With a sample of 358 participants, a parallel analysis indicated a bifactorial structure for HADS, identified by exploratory factor analysis (Factor 1: anxiety, Factor 2: depression). The factors explained 53% of the variance and correlated positively (r = .36). The global internal consistency (Cronbach's α = .81; ordinal α = .93) and by factor (anxiety: Cronbach's α = .79; ordinal α = .88; depression: Cronbach's α = .79; ordinal α = .87) was acceptable. With data from the remaining 358 participants, a confirmatory factor analysis showed an acceptable fit for the structure detected (χ2/gl = 2.72; RMSEA = .06 [IC .05, .08]; GFI = .93; AGFI = .90; TLI = .90; CFI = .92). Discussion and conclusions The Hospital Anxiety and Depression Scale has adequate psychometric properties to be used in pregnant Mexican women. Its use in routine pregnancy controls would be useful to prevent, detect, and timely treat these conditions.

Resumen Introducción La ansiedad y la depresión en gestantes representan un problema de salud pública. Su adecuada detección requiere de instrumentos válidos y confiables que también sirvan para su prevención y tratamiento. Objetivo Identificar las propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión (HADS) en una muestra de mujeres embarazadas mexicanas. Método Se aplicó la HADS a 716 gestantes de entre 13 y 46 años (M = 26.55; DE = 6.56), atendidas en un hospital público en la Ciudad de México. Resultados Con una muestra de 358 participantes, un análisis paralelo indicó una estructura bifactorial para la HADS, identificada mediante análisis factorial exploratorio (Factor 1: ansiedad, Factor 2: depresión). Los factores explicaron el 53% de la varianza y correlacionaron positivamente (r = .36). La consistencia interna global (α de Cronbach = .81, α ordinal = .93) y por factor (ansiedad: αde Cronbach = .79, α ordinal = .88; depresión: α de Cronbach = .79, α ordinal = .87) fue aceptable. Con los datos de las 358 participantes restantes, un análisis factorial confirmatorio mostró un ajuste aceptable para la estructura detectada (χ2/gl = 2.72; RMSEA = .06 [IC .05, .08]; GFI = .93; AGFI = .90; TLI = .90; CFI = .92). Discusión y conclusión La Escala Hospitalaria de Ansiedad y Depresión posee adecuadas propiedades psicométricas para su empleo en mujeres embarazadas mexicanas. Su uso en controles rutinarios del embarazo sería útil para prevenir, detectar y atender oportunamente estos padecimientos.

Correlation between intake of omega-3 fatty acids and depressive and anxiety symptoms during pregnancy / Correlación entre la ingesta de ácidos grasos omega-3 y los síntomas de depresión y ansiedad en el embarazo

Abstract: Introduction: Anxiety and depression during pregnancy are disabling disorders associated to complications during the pregnancy, delivery, and postpartum period, with a significant prevalence, between 9 and 20%, hence its importance. Nutritional factors, such as omega-3 fatty acids (ω-3FA) deficiency, have been related with both disorders during pregnancy, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Objective: To evaluate the association between dietary intake of EPA and DHA, and anxiety symptoms (AS) and depressive symptoms (DS) in Mexican pregnant women. Method: The sample consisted of 151 women in the second trimester of pregnancy. Instruments included a Food Frequency Questionnaire, the Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. Results: A daily intake of DHA and EPA of 70 mg/d and 30 mg/d, respectively, was found. The prevalence of AS was 44.4%, and 17.9% for DS. We also found the correlation negatively moderate between dietary intake of DHA and EPA and AS (p = .003, p = .017) and DS (p = .001, p = .020) in the group of women who had a severely insufficient intake of ω-3FA. Discussion and conclusion: The statistical significance shows a negative correlation between variables and the dietary intake of ω-3FA explains in a very small percentage the variability of AS and DS, according to their coefficient of determination. These results suggest the need for an investigation of this relationship through interventional studies.

Resumen: Introducción: La prevalencia de ansiedad y depresión en el embarazo oscilaentre 9 y 20%. Poseen una gran importancia al ser trastornos incapacitantes asociados a complicaciones durante el embarazo, parto y postparto. Factores nutricionales, como la deficiencia de ácidos grasos omega-3 (AGω-3), se han relacionado con ambos trastornos durante el embarazo, especialmente el ácido docosahexaenoico (DHA) y el ácido eicosapentaenoico (EPA). Objetivo: Evaluar la asociación entre la ingesta dietética de EPA y DHA y los síntomas de ansiedad (SA) y depresión (DS) en mujeres embarazadas mexicanas. Método: Se entrevistó a 151 gestantes fueron entrevistadas en el segundo trimestre de embarazo. Los instrumentos de medición utilizados fueron: un Cuestionario de Frecuencia de Consumo de Alimentos, el Inventario de Ansiedad-Rasgo y la Escala de Depresión Postnatal de Edimburgo. Resultados: Se encontró una correlación negativa moderada entre la ingesta de DHA y EPA y los SA (p = .003, p = .017) y SD (p = .001, p = .020) en el grupo de mujeres con ingesta gravemente insuficiente. Se encontró una ingesta dietética diaria de DHA y EPA de 70 mg y 30 mg, respectivamente. La prevalencia de SA fue 44.4% y de SD, 17.9%. Discusión y conclusión: Aunque la significancia estadística mostró una correlación negativa entre variables, de acuerdo con el coeficiente de determinación, la ingesta dietética de AGω-3 explica en un escaso porcentaje la variabilidad de los SA y SD. Estos resultados sugieren la necesidad de investigar dicha relación por medio de estudios de intervención.

Childhood abuse increases the risk of depressive and anxiety symptoms and history of suicidal behavior in Mexican pregnant women

Objective:To explore the relationship between individual and co-occurring childhood sexual, physical, and verbal abuse, prenatal depressive (PDS) and anxiety symptoms (PAS), and history of suicidal behavior (HSB) among Mexican pregnant women at risk of depression.Methods:A sample of 357 women screened for PDS was interviewed using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Beck Depression Inventory (BDI-II), the anxiety subscale of the Hopkins Symptoms Checklist (SCL-90), and specific questions on verbal abuse and HSB.Results:Logistic regression analyses showed that women who had experienced childhood sexual abuse (CSA) were 2.60 times more likely to develop PDS, 2.58 times more likely to develop PAS, and 3.71 times more likely to have HSB. Childhood physical abuse (CPA) increased the risk of PAS (odds ratio [OR] = 2.51) and HSB (OR = 2.62), while childhood verbal abuse (CVA) increased PDS (OR = 1.92). Experiencing multiple abuses increased the risk of PDS (OR = 3.01), PAS (OR = 3.73), and HSB (OR = 13.73).Conclusions:Childhood sexual, physical, and verbal abuse, especially when they co-occur, have an impact on PDS and PAS and lifetime HSB. These findings suggest that pregnant women at risk for depression should also be screened for trauma as a risk factor for perinatal psychopathology.

Prenatal anxiety and cesarean section with non-medical indication / 中南大学学报(医学版)

Objective: To explore the relationship between prenatal anxiety and cesarean section (c-section) with non-medical indication. Methods: Nested case-control study was used to analyze the risk factors for c-section with no medical needs: 433 pregnant women with gestational age longer than 24 weeks were enroled in this study. According to the mode of delivery, we divided them into a vaginal delivery group, a c-section group without medical need and a c-section group with medical need. Results: The c-section rate was 62.1%, 55.8% of which was c-section without medical need at family request. The score of state anxiety (S-AI) and trait anxiety (T-AI) was 42.53±11.04 and 44.40±10.23 respectively, much higher than that of normal population. After the adjustment of maternal social economic status and other prenatal statuses for this pregnancy, the prenatal anxiety was still associated with c-section with non-medical indication. The adjusted odd ratio for prenatal anxiety state, prenatal trait anxiety state and c-section with non-medical indication was 1.41 (95%CI: 1.06-1.87) and 1.23 (95% CI: 1.08-1.40), respectively. Conclusion: Prenatal anxiety state is a risk factor for c-section with non-medical indication.

Related factor analysis of prenatal anxiety and its relationship with delivery mode of primiparae / 中国实用护理杂志

Objective To investigate the prenatal emotional disorder of the primipame and the related factors,and to analyze its influence on the delivery mode.Methods In the prospective cohort study,590 healthy primiparase were asked to complete a self-compiled questionnaires for their general social mental state,state-trait anxiety inventory(STAI)and self-rating depression scale(SDS).Results Questionnaires of 159 patients were selected and these patients were divided into the anxiety group(114 cases)and the control group(455 cases),the depression group(159 cases)and the control group(410 cases).The ratio of selective cesarean section in the anxiety group was significantly higher(45.61%,32.53%,X2=6.85,P＜0.01),while the successful trial of labor were less than that of the control group(19.35%,47.88%,X2=26.30,P＜0.01).The ratio of selective cesarean section in the depression group was significandy higher than that of the control group(46.54%,31.95%,X2=10.21,P＜0.01),while the successful trial of labor were less than that of the control group(31.76%.46.59%,X2=9.13,P＜0.01).Single-factor analysis showed that prenatal anxiety related to the following factors:fear of childbirth,worried about their children,knowledge for childbirth,high economic status,maternal age and their own economic situation.Conclusions Higher incidence and risk factors of anxiety or depression before delivery,such as advanced delivery age,bad economic condition,weak family support,worrying about the safety of babies and themselves,are found in our study.Prenatal emotional disorder would affect the quality of labor and delivery options,and lead the high risk of cesarean section.