title: Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator?
abstract: BACKGROUND
  Pregnancy is generally viewed as a time of fulfillment and joy; however, for many women it can be a stressful event. In South Asia it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities.
  
  
  METHODS
  This cross-sectional study was done at four teaching hospitals in Lahore from February, 2014 to June, 2014. A total of 500 pregnant women seen at hospital obstetrics and gynecology departments were interviewed with a questionnaire consisting of three sections: demographics, the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). Pearson's chi-squared test, bivariate correlations and multiple linear regression were used to analyze associations between the independent variables and scores on the HADS and SPS.
  
  
  RESULTS
  Mean age among the 500 respondents was 27.41 years (5.65). Anxiety levels in participants were categorized as normal (145 women, 29%), borderline (110, 22%) or anxious (245, 49%). Depression levels were categorized as normal (218 women, 43.6%), borderline (123, 24.6%) or depressed (159, 31.8%). Inferential analysis revealed that higher HADS scores were significantly associated with lower scores on the SPS, rural background, history of harassment, abortion, cesarean delivery and unplanned pregnancies (P < .05). Social support (SPS score) mediated the relationship between the total number of children, gender of previous children and HADS score. Women with more daughters were significantly more likely to score higher on the HADS and lower on the SPS, whereas higher numbers of sons were associated with the opposite trends in the scores (P < .05).
  
  
  CONCLUSIONS
  Because of the predominantly patriarchal sociocultural context in Pakistan, the predictors of antenatal anxiety and depression may differ from those in developed countries. We therefore suggest that interventions designed and implemented to reduce antenatal anxiety and depression should take into account these unique factors.
authors: CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan.
authors: Ahmed
authors: A
authors: Waqas
authors: CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan.
authors: Nahal
authors: N
authors: Raza
authors: CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan.
authors: Haneen Wajid
authors: HW
authors: Lodhi
authors: CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan.
authors: Zerwah
authors: Z
authors: Muhammad
authors: CMH-Lahore Medical College and Institute of Dentistry, Shami Road, Lahore Cantt, Pakistan.
authors: Mehak
authors: M
authors: Jamal
authors: Allama Iqbal Medical College, Lahore, Pakistan.
authors: Abdul
authors: A
authors: Rehman
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D010154:Pakistan; D010549:Personal Satisfaction; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000523:psychology*; D037841:Pregnant People / Q000523:psychology*; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
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