The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review.
OBJECTIVE
to identify and appraise the current international evidence regarding the presence and prevalence of the co-existence of depression, anxiety and post-traumatic stress symptoms in the antenatal and post partum period.


METHODS
using a list of keywords, Medline, CINHAL, Cochrane Library, EMBASE, PsychINFO, Web of Science and the Index of Theses and Conference Proceedings (Jan 1960 - Jan 2015) were systematically searched. Experts in the field were contacted to locate papers that were in progress or in press. Reference lists from relevant review articles were searched. Inclusion criteria included full papers published in English reporting concurrent depression, anxiety and post-traumatic stress symptoms in pregnant and post partum women. A validated data extraction review tool was used.


RESULTS
3424 citations were identified. Three studies met the full inclusion criteria. All reported findings in the postnatal period. No antenatal studies were identified. The prevalence of triple co-morbidity was relatively low ranging from 2% to 3%.


CONCLUSIONS
triple co-morbidity does occur, although the prevalence appears to be low. Due to the presentation of complex symptoms, women with triple co-morbidity are likely to be difficult to identify, diagnose and treat. Clinical staff should be aware of the potential of complex symptomatology.
Department of Obstetrics and Gynaecology, Malta Mater Dei Hospital, Dun Karm Street, Msida MSD 2090, Malta. Electronic address: andee.agius.03@um.edu.mt.
Andee
A
Agius
Faculty of Health Sciences, Mater Dei Hospital, Room 34, Block A, Level 1, Msida MSD 2090, Malta. Electronic address: rita.borg-xuereb@um.edu.mt.
Rita Borg
RB
Xuereb
Nursing Department, School of Medical and Dental Sciences, University of Birmingham, Room EF14, Birmingham, United Kingdom. Electronic address: d.carrick-sen@bham.ac.uk.
Debbie
D
Carrick-Sen
Department of Occupational Therapy, St.Vincent de Paul, Malta. Electronic address: roberta.a.sultana@gov.mt.
Roberta
R
Sultana
Institute of Health & Society, Newcastle University, Baddiley-Clarke Building, Richardson Road, Newcastle upon Tyne NE2 4AX, United Kingdom. Electronic address: judith.rankin@ncl.ac.uk.
Judith
J
Rankin
D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008603:Mental Health / Q000592:standards*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology*
Anxiety; Co-existence; Depression; Post partum; Post-traumatic stress symptoms; Triple co-morbidity