title: Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women.
abstract: OBJECTIVE
  Perinatal mental health problems have been studied in more than 90% of high income countries but this information is available only for 10% of low and middle income countries. A study on the relationship between anxiety during pregnancy and postpartum depression has not been performed in Iran. This prospective study aimed to investigate whether anxiety and fear of childbirth during pregnancy is an independent predictor of postpartum depressive symptoms.
  
  
  METHODS
  In this prospective longitudinal study participants were 160 women with a gestational age of 28-30 weeks from 10 prenatal care clinics in Qom, Iran. Subjects were interviewed and the State-Trait Anxiety Inventory (STAI) and Childbirth Attitudes Questionnaire (CAQ) were completed at 28 and 38 weeks of gestation. They were followed up 45 days and 3 months after childbirth. Postpartum depression was defined as a score≥13 on the Edinburgh Postpartum Depression Scale (EPDS).
  
  
  RESULTS
  Antenatal state anxiety (odds ratio [OR]=3.2; P=0.002 and OR=2.91; P=0.007 at 28 and 38 weeks of gestation, respectively) and trait anxiety (OR=3.33; P=0.001 and OR=3.30; P=0.003 at 28 and 38 weeks of gestation, respectively) increased the risk of postpartum depression 45 days after birth (P<0.05). Likewise, the presence of antenatal state and trait anxiety at 28 and 38 weeks of gestation significantly increased the risk of postpartum depression during the first three months after childbirth (P<0.05). On the contrary, prenatal fear of childbirth was not a significant predictor of postpartum depression symptoms (P>0.05).
  
  
  CONCLUSIONS
  The findings from this study suggest that antenatal state and trait anxiety, assessed by interview, is an important predictor of postpartum depression. Therefore, it should be routinely screened in order to develop specific preventive interventions.
authors.affiliation: Department of Midwifery and Reproductive Health, Tarbiat Modares University, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Alipour
authors.forename: Minoor
authors.initials: M
authors.lastname: Lamyian
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Hajizadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000523:psychology*; D005239:Fear / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007492:Iran; D016015:Logistic Models; D010298:Parity; D036801:Parturition / Q000523:psychology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology*; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult