Depression and anxiety trajectories among women who undergo an elective cesarean section.
BACKGROUND
Depression and anxiety are important mood changes in childbearing women. However, changes in depression and anxiety over time in women who undergo an elective cesarean section (CS) have not yet been elucidated. We aimed to characterize the trajectories of depressive and anxiety symptoms, and patterns of co-occurrence, and examined the associated predictors of depression and anxiety courses.


METHODS
A prospective longitudinal study of childbearing women (N = 139) who underwent a CS was conducted. Depressive and anxiety symptoms were respectively assessed using the Edinburgh Postnatal Depression Scale and State Anxiety Inventory, in the third trimester and at 1 day, 1 week, and 1 and 6 months postpartum.


RESULTS
Group-based modeling identified three distinct trajectories of depressive symptoms: group 1 (low, 30.9%), group 2 (mild, 41.7%), and group 3 (high, 27.3%). Four group trajectories of anxiety symptoms were identified: group 1 (low, 19.4%), group 2 (mild, 44.6%), group 3 (high, 28.8%), and group 4 (very high, 7.2%). Mild symptoms of both depression and anxiety were the most common joint trajectory. Depression trajectories were significantly related to anxiety trajectories (p<0.001). Predictors of the joint trajectory included the pre-pregnant body mass index (odds ratio (OR): 2.42, 95% confidence interval (CI): 1.1 ∼ 6.3) and a poor sleep score (OR: 3.2, 95% CI: 1.4 ∼ 7.3) in the third trimester.


CONCLUSIONS
Distinctive trajectories and co-occurrence patterns of depressive and anxiety symptoms were identified. Our findings suggest a need for greater attention to continuous assessment of psychological well-being among women who undergo an elective CS.
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Shu-Yu
SY
Kuo
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Su-Ru
SR
Chen
School of Nursing, China Medical University, and an Adjunct Supervisor in the Department of Nursing, China Medical University Hospital, Taichung, Taiwan.
Ya-Ling
YL
Tzeng
D000328:Adult; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology*; D002585:Cesarean Section / Q000009:adverse effects; D019052:Depression, Postpartum / Q000175:diagnosis*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012307:Risk Factors; D055815:Young Adult