title: Measuring the course of anxiety in women giving birth by caesarean section: a prospective study.
abstract: Women undergoing elective caesarean section experience anxiety. However, course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies.
  
  
  
  This is a monocentric, prospectively planned study in which 47 women with an indication for primary caesarean section took part. Anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI-trait and STAI-state), the visual analogue scale for anxiety (VASA) as well as saliva cortisol at three time points on the day of the caesarean section (at admission, at skin closure and 2 h post surgery).
  
  
  
  Peak anxiety levels for the STAI-state and VASA were highest at admission and showed significant decreases to skin closure (p < .001). The subjective measures correlated significantly at all time points (p-values < .001). For cortisol levels the peak level of anxiety was shown at skin closure with a significant increase from admission to skin closure and a significant decrease from skin closure to 2 h post operation (p-values < .001). Additionally women with STAI-trait scores above the median showed significantly higher levels at the peaks of anxiety.
  
  
  
  The study reveals the course of anxiety on the day of the caesarean section. A strong correlation of STAI-state and VASA was demonstrated. Cortisol showed a different course, which fits into its known biological kinetics. Taking into account all measures, anxiety seems to be most bothersome before surgery until skin closure. In a differentiated approach using STAI-trait scores as a discriminator we showed that the group with STAI-trait levels above the median is particularly prone to develop anxiety in the setting of the caesarean section and might therefore mostly be in need of an intervention against anxiety.
authors.affiliation: Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany. philip.hepp@helios-kliniken.de.|Clinic for Gynecology and Obstetrics, HELIOS Universitätsklinikum Wuppertal, University Witten/Herdecke, Vogelsangstr. 109, 42109, Wuppertal, Germany. philip.hepp@helios-kliniken.de.
authors.forename: Philip
authors.initials: P
authors.lastname: Hepp
authors.affiliation: Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Hagenbeck
authors.affiliation: Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Burghardt
authors.affiliation: Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Jaeger
authors.affiliation: Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Wolf
authors.affiliation: Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Fehm
authors.affiliation: Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Nora K
authors.initials: NK
authors.lastname: Schaal
mesh_terms: D000328:Adult; D001007:Anxiety / Q000378:metabolism / Q000523:psychology*; D002585:Cesarean Section / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D011184:Postoperative Period; D011247:Pregnancy; D057234:Preoperative Period; D011446:Prospective Studies; D012463:Saliva / Q000737:chemistry
chemical_list: D006854:Hydrocortisone
keywords: Anxiety; Caesarean section; STAI questionnaire; Saliva; Saliva cortisol; Visual analog scale