Abstract
Purpose
It is recognized that mental disorders in women in the puerperal period have an influence on subsequent childcare. In order to establish effective support measures, the present study aimed to investigate the following: the level of anxiety experienced by women at various stages of pregnancy and the puerperal period, the possibility of predicting the incidence of postpartum depression in the end-stage of pregnancy, and the factors associated with anxiety in each stage of pregnancy and the puerperal period.
Subjects and Methods
Subjects were 189 women who gave birth at one of 3 hospitals in A City. The survey periods were from August 2000 to August 2001, and June 2004 to January 2005. The survey methods adopted were the State-Trait Anxiety Inventory (STAI) for subjects in the end-stage of pregnancy, and on the 5th day, and the 1st and 3rd month of puerperium; the Stein Maternity Blues Score for those on the 5th day of puerperium; and the Edinburgh Postnatal Depression Scale (EPDS) for those on the 5th day, and the 1st and 3rd month of puerperium. A questionnaire survey was conducted in order to investigate the factors that affect various forms of anxiety, such as social anxiety, financial anxiety, and anxiety regarding obstetric issues. The analysis used the multiple-regression analysis.
Results
The level of state anxiety measured by the STAI was found to be higher of trait anxiety, and the levels were higher in the end-stage of pregnancy than in the puerperal period. The maternity blues score was 23% among subjects on the 5th day of puerperium, and those who were at risk for postpartum depression, as indicated by a score of 9 or higher on the EPDS, scored 14.2% in the 3rd month of puerperium. Regarding anxiety-related factors in the end-stage of pregnancy, "childbirth experience," and "support from female siblings (availability)" were extracted from the STAI. Factors that were extracted from more than one of the three scales (STAI, Stain, and EPDS), in the puerperal period were "cooperation from husband (availability)" "financial difficulty" and "opportunity to become pregnant" for the 5th day of puerperium, "opportunity to become pregnant" for the 1st month of puerperium, and "cooperation from husband (availability)" and "opportunity to become pregnant" for the 3rd month of puerperium.
Regarding a prediction system for the prevention of postpartum depression, the STAI, which can be adopted for the pregnancy period, was considered to be preferable because it showed positive correlations with other scales. However, following fact was proven from the multiple regression analysis. In STAI (Trait-anxiety) in the term pregnancy, there puerperal period all trait-anxiety relation. And, there was the relation with EPDS of the 3rd month of puerperium in STAI (Trait-anxiety) in the term pregnancy.
Conclusion
The present study revealed that it is possible to predict the incidence of postpartum depression by identifying mothers at high risk in the end-stage of pregnancy using the STAI (Trait-anxiety). Furthermore, it was found that the related factors extracted according to the mothers' puerperal stages were associated with the living environment, such as cooperation from the husband, and planning for pregnancy. Therefore, it is necessary to develop a support system for both the end-stage of pregnancy and the puerperal period.
