Anxiety Disorders and Phobias: A Cognitive Perspective

Objective The postpartum period is recognized as a time of vulnerability to affective disorders, particularly postpartum depression. In contrast, the prevalence and clinical presentation of anxiety disorders during pregnancy and the postpartum period have received little research attention. In this article, we review the medical literature as it relates to the prevalence and clinical presentation of panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder during pregnancy and the postpartum period. Data sources MEDLINE (1966 to July 2005 week 1) and PsycInfo (1840 to July 2005 week 1) were searched using combinations of the following search terms: pregnancy, childbirth, postpartum, panic disorder, phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. Study selection All relevant papers published in English and reporting original data related to perinatal anxiety disorders were included. Data extraction Studies were examined for data related to the prevalence, presentation, predictors/risk factors, new onset, course, and treatment of anxiety disorders during pregnancy and the postpartum period. Data synthesis Anxiety disorders are common during the perinatal period, with reported rates of obsessive-compulsive disorder and generalized anxiety disorder being higher in postpartum women than in the general population. The perinatal context of anxiety disorders presents unique issues for detection and management. Conclusions Future research is needed to estimate the prevalence of perinatal anxiety disorders more precisely, to identify potential implications of maternal anxiety disorders for maternal quality of life and child development, and to determine safe and effective treatment methods.

Anxiety disorders during pregnancy and the postpartum period: A systematic review.

Posttraumatic stress disorder after childbirth: a cross sectional study.

The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis

Severe fear of childbirth complicates 6% to 10% of parturients and is manifested as nightmares, physical complaints and difficulties in concentrating on work or on family activities. Very often fear of childbirth leads to request for an elective cesarean section (CS). In Finland, Sweden, and the United Kingdom, fear of childbirth or maternal request is the reason for about 7-22% of CS births. Fear of childbirth is as common in nulliparous as in parous women. Fear of labor pain is strongly associated with the fear of pain in general, and a previous complicated childbirth or inadequate pain relief are the most common reasons for requesting a CS among parous women. Previous psychological morbidity and a great number of daily stressors expose a woman to a great risk of fear of childbirth. Fear of childbirth is not an isolated problem but associated with the woman's personal characteristics, mainly general anxiety, low self-esteem, and depression, and dissatisfaction with their partnership, and lack of support. Also the partners of women with fear have a certain pattern of low psychological well-being, resulting in low life-satisfaction, dissatisfaction with partnerships, and depression. A vivid debate about the woman's right to choose the mode of delivery is going on in obstetric literature, but discussion on the reasons for women to request a CS, or on the possibilities to help them overcome the fear of vaginal childbirth is scanty. Preliminary Swedish and Finnish reports demonstrated the results of treatment during pregnancy, when more than half of the women withdrew their request after being able to discuss their anxiety and fear, and vaginal deliveries after treatment were successful.

Fear of childbirth: a neglected dilemma

Up to now it has been difficult to study fear of childbirth because of a shortage of adequate psychological measurements. Therefore the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) w...

Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth

The link between fear of childbirth and theories of anxiety in general is discussed. A possible expression of trait (T-fear) and state (S-fear) aspects of fear of childbirth was investigated in 77 nulliparous and 85 parous women based on data from gestational week 32, at 2 hours and at 5 weeks after childbirth. Data are based on the State Trait Anxiety Inventory and the Wijma Delivery Expectancy/Experience Questionnaire. According to their scores on the Wijma Delivery Expectancy/Experience Questionnaire during late pregnancy, women were divided into 3 groups: high, moderate and low levels of fear of childbirth. In gestational week 32, women in the low level of fear of childbirth group had lower trait anxiety than those in the moderate level of fear of childbirth group, who had lower trait anxiety than the women in the high level of fear of childbirth group. Nulliparous women had a higher level of fear of childbirth but a lower level of trait anxiety than did parous women. There was a significant decreasin...

Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women

In a group of late pregnant women we investigated the prevalence of extreme fear of childbirth and anxiety disorders, both assessed by means of diagnostic interviews. We also explored the relation ...

Relations between anxiety disorders and fear of childbirth during late pregnancy

The aim of the study was to search for bivariate associations between on the one hand samples of background, job-related and well-being characteristics, and on the other hand longitudinally recorded sick-leave in individuals with repeated short-term sick-leave. Out of altogether 123 subjects included, 113 self-rated their well-being at the onset of, and 88 also after, a supportive programme. The well-being rating covered experience of treatment by other people, reservation, loneliness, inferiority, tension, vulnerability, guilt, security and indolence. Socio-demographic and job-related characteristics and attitudes were registered and declared at the initial contact. Correlations between these separate sets of independent variables, and sick-leave occasions and days in each of the two years following the contact were computed. There was an almost complete lack of covariation between background variables and sick-leave. Neither did job-related characteristics correlate. Only an expressed wish for a job cha...

Precursors of repeated short-term sick-leave: an empirical review of some background, job and well-being characteristics.

Consistent associations between self-rated well-being and future sick-leave have previously been noted in a selected group of repeated short-term sick-leavers. The object was to retest those associations after ruling out expected influences of preceding sick-leave. Hypothetically the well-being-sick-leave linkages initially observed would thereby overlap with the behavioural conformity over time. Accordingly, they would possibly be erased in a hierarchical stepwise regression analysis. The study group comprised 61 females and 62 males with diffuse reasons for their high repeated sick-leave. Instead of having to present a doctor's certificate on every new sick-leave occasion, they chose to take part in a support programme. Altogether 8 hierarchical multiple regression analyses were run with sick-leave occasions and days the first and second years after the contact as separate dependent variables. In the first step, long-term behavioural proneness to sickness absence was evaluated, i.e. the correlations between the sick-leave parameters the year before and each of the 2 years after the programme were computed. In the second step, the possible additional impact of well-being ascertained at entrance into as well as exit from the clinical contact was established. Sick-leave correlated strongly over the study periods as expected. Yet, fairly consistent associations between well-being and future sick-leave remained. The well-being parameters accounted for another 4-8% of the entire variance in 5 of the 8 regression analyses performed. That increment corresponded to between 25 and 100% of the proportion initially explained by preceding sick-leave. Thus the independent role of perceived self-image for the long-term inclination to sickness absence in the current 'risk' group was underscored. This was particularly so since the influence of several other background and job-related factors have previously proven to be empirically negligible. Moreover, similar prospective correlations have been seen in other study groups.

/pdf/well-being-and-future-sick-leave-multivariate-analyses-with-4n8dz7h0i8.pdf

Margareta Zar

Papers

Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth

Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women

Relations between anxiety disorders and fear of childbirth during late pregnancy

Precursors of repeated short-term sick-leave: an empirical review of some background, job and well-being characteristics.

Well-being and future sick-leave Multivariate analyses with regard to preceding sick-leave