title: Longitudinal study of perinatal maternal stress, depressive symptoms and anxiety.
abstract: OBJECTIVE
  to understand the trends in, and relationships between, maternal stress, depressive symptoms and anxiety in pregnancy and post partum.
  
  
  METHODS
  a prospective longitudinal survey study was undertaken to explore maternal psychological distress throughout the perinatal period. The participants were recruited after 24 completed weeks of gestation, and were followed-up monthly until one month post partum (four surveys in total).
  
  
  METHODS
  participants were recruited from a single hospital in southern Taiwan, and asked to complete questionnaires in the hospital waiting area.
  
  
  METHODS
  inclusion criteria were: age ≥18 years, able to read and write Chinese, ≥24 weeks of gestation, singleton pregnancy and no pregnancy complications (including a diagnosis of antenatal depression or anxiety disorder). In total, 197 women completed all four surveys (response rate 74.62%).
  
  
  RESULTS
  stress was measured with the 10-item Perceived Stress Scale, depressive symptoms were measured with the Center for Epidemiologic Studies' Depression scale, and anxiety was measured with the Zung Self-reported Anxiety Scale. Participants were followed-up at four time points: T1 (25-29 gestational weeks), T2 (30-34 gestational weeks), T3 (>34 gestational weeks) and T4 (4-6 weeks post partum). Appointments for data collection were made in accordance with the participants' antenatal and postnatal check-ups. The three types of maternal distress had different courses of change throughout the perinatal period, as levels of depressive symptoms remained unchanged, anxiety levels increased as gestation advanced but declined after birth, and stress decreased gradually during pregnancy but returned to the T1 level after birth. There was a low to high degree of correlation in maternal stress, depressive symptoms and anxiety in pregnancy and post partum.
  
  
  CONCLUSIONS
  around one-quarter of the study participants had depressive symptoms during pregnancy and post partum. Stress and anxiety showed opposing courses during the perinatal period. Regardless of the trend, maternal mental distress returned to the T1 level after birth.
  
  
  CONCLUSIONS
  effective survey questionnaires are suggested for use as primary screening for possible psychological distress among pregnant and post partum women. It is suggested that health care professionals involved in obstetrics and midwifery should pay attention to the psychological needs of pre- and postnatal women, provide women with sufficient information about their mental well-being, and make appropriate and timely referrals to psychiatric or psychological care.
authors.affiliation: School of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan.
authors.forename: Shwu-Ru
authors.initials: SR
authors.lastname: Liou
authors.affiliation: Department of Obstetrics and Gynaecology, Chia-Yi Christian Hospital, Taiwan.
authors.forename: Panchalli
authors.initials: P
authors.lastname: Wang
authors.affiliation: School of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan. Electronic address: chingyuus@gmail.com.
authors.forename: Ching-Yu
authors.initials: CY
authors.lastname: Cheng
mesh_terms: D000328:Adult; D019052:Depression, Postpartum / Q000523:psychology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008880:Midwifery; D011181:Postnatal Care; D011247:Pregnancy; D011446:Prospective Studies; D011594:Psychometrics; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013624:Taiwan; D055815:Young Adult
keywords: Maternal anxiety; Maternal depressive symptoms; Maternal stress; Perinatal