title: Longitudinal course of ante- and postpartum generalized anxiety symptoms and associated factors in West-African women from Ghana and Côte d'Ivoire.
abstract: BACKGROUND
  Little is known about the course of perinatal anxiety, particularly in low and middle income countries. This study aimed at examining trajectories of ante- and postpartum generalized anxiety symptoms in West-African women and their associations with mother and child characteristics.
  
  
  METHODS
  778 women from Côte d'Ivoire and Ghana were investigated between 04/2010 and 03/2014. Anxiety symptoms were measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) at three months antepartum and three, 12 and 24 months postpartum. Growth mixture modeling was applied to identify latent trajectory classes of anxiety. Multinomial logistic regression was used to investigate the associations of psychosocial, sociodemographic, obstetric and clinical characteristics with different trajectories.
  
  
  RESULTS
  Four distinct trajectories of anxiety were identified. The majority of women (79.8%) had consistent low anxiety symptoms, while 11.4% had elevated anxiety scores before and around childbirth that decreased gradually. 5.4% of women showed increasing anxiety symptoms over time. Few women (3.3%) had transient anxiety with elevated scores at three and 12 months postpartum. Risk factors for elevated anxiety levels around childbirth were antepartum depressive symptoms, higher levels of stress (economic, marital and social stress), lower child birth weight, and multiparity. Partner support was found to be protective.
  
  
  CONCLUSIONS
  Anxiety symptoms were assessed using a screening instrument and not through a formal diagnostic classification system. Some putative risk factors were not investigated, and some psychosocial factors were assessed retrospectively.
  
  
  CONCLUSIONS
  The presence of different trajectories underline the importance of monitoring anxiety symptoms in pregnant women and in mothers with infants/toddlers.
authors.affiliation: Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: d.barthel@uke.de.
authors.forename: Dana
authors.initials: D
authors.lastname: Barthel
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Levente
authors.initials: L
authors.lastname: Kriston
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Barkmann
authors.affiliation: Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: John
authors.initials: J
authors.lastname: Appiah-Poku
authors.affiliation: Centre de Guidance Infantile, Institut National de Santé Publique, Abidjan BP V 47, Côte d'Ivoire.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Te Bonle
authors.affiliation: Centre de Recherche pour le Développement, Université Alassane Ouattara, Bouaké, Côte d'Ivoire.
authors.forename: Kra Yao
authors.initials: KY
authors.lastname: Esther Doris
authors.affiliation: Unité Pédagogique Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan BP V34, Côte d'Ivoire.
authors.forename: Bony Kotchi
authors.initials: BK
authors.lastname: Carine Esther
authors.affiliation: Unité Pédagogique Psychologie, Université Felix Houphouet Boigny de Cocody, Abidjan BP V34, Côte d'Ivoire.
authors.forename: Koffi Ekissi
authors.initials: KE
authors.lastname: Jean Armel
authors.affiliation: Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Mohammed
authors.affiliation: Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Osei
authors.affiliation: Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fordjour
authors.affiliation: Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Dorcas
authors.initials: D
authors.lastname: Owusu
authors.affiliation: Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Eberhardt
authors.affiliation: Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute for Tropical Medicine, German Armed Forces Hospital Hamburg, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hinz
authors.affiliation: Jean Lorougnon Guede University, Daloa, Côte d'Ivoire.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Koffi
authors.affiliation: Research Unit of Parasitology and Parasite Ecology at Unité de Formation et de Recherche en Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire.
authors.forename: Eliezer
authors.initials: E
authors.lastname: N'Goran
authors.affiliation: Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Samuel Blay
authors.initials: SB
authors.lastname: Nguah
authors.affiliation: Department Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Harry
authors.initials: H
authors.lastname: Tagbor
authors.affiliation: Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schoppen
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ehrhardt
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Carola
authors.initials: C
authors.lastname: Bindt
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D007560:Cote d'Ivoire; D003863:Depression / Q000175:diagnosis; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005869:Ghana; D006801:Humans; D008137:Longitudinal Studies; D009035:Mothers / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology*
keywords: Ante- and postpartum; Childbirth; Generalized anxiety disorder; Latent class models; Longitudinal study; Maternal health; Pregnancy; Sub-Saharan Africa