title: Determinants of Antenatal Psychological Distress in Pakistani Women.
abstract: BACKGROUND
  An increasing number of evidence has demonstrated that poor antenatal psychological health can lead to adverse pregnancy outcomes. Studies conducted in various countries demonstrated a wide range of factors associated with psychological distress during pregnancy.
  
  
  METHODS
  A cross-sectional study was conducted between September 2011 and December 2012 in Peshawar, north-west Pakistan. A total of 230 women in their third trimester of pregnancy fulfilled the inclusion criteria. The antenatal psychological health status of women was measured using the Depression Anxiety Stress Scale. Relevant data regarding health and demographic-socioeconomic status were collected through personal interviews using standardized questionnaires.
  
  
  RESULTS
  Overall, 45% (n=104) of women exhibited symptoms for composite depression, anxiety, and stress (composite DAS). In the univariate analysis, maternal age, husband support, monthly income, family size, stressful life events, lack of confidence, domestic violence, and pregnancy-related concerns were strongly associated with antenatal composite DAS (p<0.01). The association of maternal composite DAS symptoms with age, monthly income, family size, and lack of confidence remained significant in the multivariate analysis (p<0.01).
  
  
  CONCLUSIONS
  A major proportion of women exhibited symptoms of antenatal composite DAS, and various factors were found to be related to their psychological distress. A young maternal age, low husband support, low income, large family size, adverse life events, lack of confidence, pregnancy-related concerns, and domestic violence were stronger determinants of poor antenatal psychological status. The study findings concluded that policymakers at the government level should launch special intervention programs to improve maternal perinatal mental and psychological health at the community level.
authors.affiliation: Department of Human Nutrition, The University of Agriculture, Peshawar, Pakistan.
authors.forename: Zia Ud
authors.initials: ZU
authors.lastname: Din
authors.affiliation: Department of Human Nutrition, The University of Agriculture, Peshawar, Pakistan.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Ambreen
authors.affiliation: Department of Agricultural Chemistry, The University of Agriculture, Peshawar, Pakistan.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Iqbal
authors.affiliation: Department of Agricultural Chemistry, The University of Agriculture, Peshawar, Pakistan.
authors.forename: Mudassar
authors.initials: M
authors.lastname: Iqbal
authors.affiliation: Department of Psychology, University of Peshawar, Peshawar, Pakistan.
authors.forename: Summiya
authors.initials: S
authors.lastname: Ahmad
keywords: Antenatal psychological distress; Pakistan; determinants