Archives of Women's Mental Health

, Volume 15, Issue 1, pp 21–30 | Cite as

Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample

  • L. GiardinelliEmail author
  • A. Innocenti
  • L. Benni
  • M. C. Stefanini
  • G. Lino
  • C. Lunardi
  • V. Svelto
  • S. Afshar
  • R. Bovani
  • G. Castellini
  • C. Faravelli
Original Article


Accumulating evidence suggests that pregnancy does not protect women from mental illness. The aim of this study was to assess the prevalence, sociodemographic correlates, and the risks factors for perinatal depression and anxiety. Five hundred ninety women between 28th and the 32nd gestational weeks were recruited and submitted to a sociodemographic, obstetric, and psychological interview. The Edinburgh Postnatal Depression Scale (EPDS) and the state-trait anxiety inventory (STAI-Y) were also administered in antenatal period and 3 months postnatally. The Structured Clinical Interview for DSM-IV (SCID-I) was used to diagnose mood and anxiety disorders. Three months after delivery, EPDS was administered by telephone interview. Women with an EPDS score ≥10 were 129 in antenatal period (21.9%) and 78 in postnatal period (13.2%). During pregnancy 121 women (20.5%) were positive for STAI-Y state and 149 women (25.3%) for STAI-Y trait. The most important risk factors for antenatal depression are: foreign nationality, conflictual relationship with family and partner, and lifetime psychiatric disorders. The principal risk factors for postnatal depression are: psychiatric disorders during pregnancy and artificial reproductive techniques. Psychiatric disorders, during and preceding pregnancy, are the strongest risk factors for antenatal state and trait anxiety. Antenatal depressive and anxiety symptoms appear to be as common as postnatal symptoms. These results provide clinical direction suggesting that early identification and treatment of perinatal affective disorders is particularly relevant to avoid more serious consequences for mothers and child.


Perinatal psychopathology Psychosocial screening Maternal Depression/anxiety 


  1. Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, åStröm M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 189(1):148–154PubMedCrossRefGoogle Scholar
  2. Appleby L (1991) Suicide during pregnancy and the first post-natal year. BMJ 302:137–140PubMedCrossRefGoogle Scholar
  3. Austin MP (2006) To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects. Psychol Med 36(12):1663–1670, ReviewPubMedCrossRefGoogle Scholar
  4. Austin MP, Priest SR (2004) New developments in perinatal mental health. Guest editorial. Acta Psychiatr Scand 2042:321–322Google Scholar
  5. Austin MP, Tully L, Parker G (2007) Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101(1–3):169–174PubMedCrossRefGoogle Scholar
  6. Barnett B, Parker G (1986) Possible determinants, correlates and consequences of high levels of anxiety in primiparous mothers. Psychol Med 16(1):177–185PubMedCrossRefGoogle Scholar
  7. Beck CT (1996) A meta-analysis of the relationship between postpartum depression and infant temperament. Nurs Res 45(4):225–230PubMedCrossRefGoogle Scholar
  8. Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285PubMedCrossRefGoogle Scholar
  9. Bennet HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: a systematic review. Obstet Gynecol 103(4):698–709CrossRefGoogle Scholar
  10. Benvenuti P, Ferrara M, Niccolai C, Valoriani V, Cox JL (1999) The Edinburgh postnatal depression scale: validation for an Italian sample. J Affect Disord 53:137–141PubMedCrossRefGoogle Scholar
  11. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR (2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 157:824–930CrossRefGoogle Scholar
  12. Bloch M, Rotenberg N, Koren D, Klein E (2006) Risk factors for early postpartum depressive symptoms. Gen Hosp Psychiatry 28(1):3–8PubMedCrossRefGoogle Scholar
  13. Bogetto F, Salvi V, Maina G (2004) Disturbi d’ansia e dell’umore in gravidanza: terapie farmacologiche e non farmacologiche. Psicosomatica in ginecologia e ostetricia. Una Medicina a misura di Donna. CIC Edizioni Internazionali, RomaGoogle Scholar
  14. Bolton HL, Hughes PM, Turton P, Sedgwick P (1998) Incidence and demographic correlates of depressive symptoms during pregnancy in an inner London population. J Psychosom Obstet Gynaecol 19(4):202–209PubMedCrossRefGoogle Scholar
  15. Borri C, Mauri M, Oppo A, Banti S, Rambelli C, Ramacciotti D, Montagnani MS, Camilleri V, Cortopassi S, Bettini A, Ricciardulli S, Rucci P, Montaresi S, Cassano GB (2008) Axis I psychopathology and functional impairment at the third month of pregnancy: results from the Perinatal Depression-Research and Screening Unit (PND-ReScU) Study. J Clin Psychiatry 69:1617–1624PubMedCrossRefGoogle Scholar
  16. Brockington I, MacDonald E, Wainscott G (2006) Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Arch Women Ment Health 9(5):253–263CrossRefGoogle Scholar
  17. Broen AN, Moum T, Bödtker AS, Ekeberg O (2006) Predictors of anxiety and depression following pregnancy termination: a longitudinal five-year follow-up study. Acta Obstet Gynecol Scand 85(3):317–323PubMedCrossRefGoogle Scholar
  18. Brouwers EP, Van Baar AL, Pop VJ (2001) Does the Edinburgh postnatal depression scale measure anxiety? J Psychosom Res 51:659–663PubMedCrossRefGoogle Scholar
  19. Brown GW, Harris TO (1978) Social origins of depression. A study of psychiatric disorder in women, Tavistock, LondraGoogle Scholar
  20. Buist A, Barnett B (1995) Childhood sexual abuse: a risk factor for postpartum depression? Aust N Z J Psychiatry 29(4):604–608PubMedCrossRefGoogle Scholar
  21. Buist A, Condon J, Brooks J, Craig Speelman C, Milgron J, Hayes B, Ellwood D, Barnett B, Kowalenko N, Matthey S, Austin M-P, Bilzta J (2006) Acceptability of routine screening for perinatal depression. J Affect Disord 93(1–3):233–237PubMedCrossRefGoogle Scholar
  22. Cantwell R, Smith S (2006) Prediction and prevention of perinatal mental illness. Psychiatry 5(1):15–21CrossRefGoogle Scholar
  23. Chaudron LH, Nirodi N (2010) The obsessive-compulsive spectrum in the perinatal period: a prospective pilot study. Arch Womens Ment Health 13(5):403–410PubMedCrossRefGoogle Scholar
  24. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786PubMedCrossRefGoogle Scholar
  25. Cox SJ, Glazebrook C, Sheard C, Ndukwe G, Oates M (2006) Maternal self-esteem after successful treatment for infertility. Fertil Steril 85:84–39PubMedCrossRefGoogle Scholar
  26. Csatordai S, Kozinszky Z, Devosa I, Toth E, Krajcsi A, Sefcsik T, Pal A (2007) Obstetric and sociodemographic risk of vulnerability to postnatal depression. Patient Educ Couns 67:84–92PubMedCrossRefGoogle Scholar
  27. Cwikel J, Gidron Y, Sheiner E (2004) Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 117(2):126–131PubMedCrossRefGoogle Scholar
  28. Da Costa D, Dritsa M, Verreault N, Balaa C, Kudzman J, Khalifé S (2010) Sleep problems and depressed mood negatively impact health-related quality of life during pregnancy. Arch Womens Ment Health 13(3):249–257PubMedCrossRefGoogle Scholar
  29. Davis L, Edwards H, Mohay H, Wollin J (2003) The impact of very premature birth on the psychological health of mothers. Early Hum Dev 73(1–2):61–70PubMedCrossRefGoogle Scholar
  30. Dennis CL, Allen K (2009) Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. Cochrane Database Syst Rev 8:4Google Scholar
  31. Eberhard-Gran M, Eskild A, Tambs K, Schei B, Opjordsmoen S (2001) The Edinburgh postnatal depression scale: validation in a Norwegian community sample. Nord J Psychiatry 55(2):113–117PubMedCrossRefGoogle Scholar
  32. Eberhard-Gran M, Garthus-Niegel S, Garthus-Niegel K, Eskild A (2010) Postnatal care: a cross-cultural and historical perspective. Arch Women’s Ment Health 13(6):459–466CrossRefGoogle Scholar
  33. Evans J, Heron JH, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323(7307):257–260PubMedCrossRefGoogle Scholar
  34. Field T (2002) Prenatal depression effects on the foetus and neonate in different ethnic and socio-economic status groups. J Reprod Infant Psychol 20:149–157CrossRefGoogle Scholar
  35. Field T, Diego M, Hernandez-Reif M, Schanberg S, Kuhn C, Yando R, Bendell D (2003) Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate. Depress Anxiety 17(3):140–151PubMedCrossRefGoogle Scholar
  36. Flynn HA, Walton MA, Chermack ST, Cunningham RM, Marcus SM (2007) Brief detection and co-occurrence of violence, depression and alcohol risk in prenatal care settings. Arch Womens Ment Health 10:155–161PubMedCrossRefGoogle Scholar
  37. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083PubMedCrossRefGoogle Scholar
  38. Giardinelli L, Cecchelli C, Innocenti A (2008) disturbi psichistrici in gravidanza. Giorn Ital Psicopat 14:211–219Google Scholar
  39. Grant KA, McMahon C, Austin MP (2008) Maternal anxiety during the transition to parenthood: a prospective study. J Affect Disord 108(1–2):101–111PubMedCrossRefGoogle Scholar
  40. Halbreich U (2004) Prevalence of mood symptoms and depression during pregnancy: implications for clinical practice and research. CNS Spectr 9:177–184PubMedGoogle Scholar
  41. Halbreich U (2010) Women's reproductive related disorders (RRDs). J Affect Disord 122:10–13PubMedCrossRefGoogle Scholar
  42. Hammarberg K, Fisher JRW, Wynter KH (2008) Psychological and social aspects of pregnancy, childbirth and early parenting after assisted conception: a systematic review. Hum Reprod Update 14(5):395–414PubMedCrossRefGoogle Scholar
  43. Harris B, Huckle P, Thomas R, Johns S, Fung H (1989) The use of rating scales to identify post-natal depression. Br J Psychiatry 154:813–817PubMedCrossRefGoogle Scholar
  44. Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Women Ment Health 9:329–337CrossRefGoogle Scholar
  45. Heron J, O’Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73PubMedCrossRefGoogle Scholar
  46. Hynes GJ, Callan VJ, Terry DJ, Gallois C (1992) The psychological well-being of infertile women after a failed IVF attempt: the effects of coping. Br J Med Psychol 65:296–278CrossRefGoogle Scholar
  47. Josefsson A, Berg G, Nordin C, Sydsjo G (2001) Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 80(3):251–255PubMedCrossRefGoogle Scholar
  48. Kammerer M, Adams D, Castelberg B, Glover V (2002) Pregnant women become insensitive to cold stress. BMC Pregnancy Childbirth 19 2(1):8CrossRefGoogle Scholar
  49. Kim YK, Hur JW, Kim KH, Oh KS, Shin YC (2008) Prediction of postpartum depression by sociodemographic, obstetric and psychological factors: a prospective study. Psychiatry Clin Neurosci 62:331–340PubMedCrossRefGoogle Scholar
  50. Kumar R, Robson KM (1984) A prospective study of emotional disorders in childbearing women. Br J Psychiatry 144:35–47PubMedCrossRefGoogle Scholar
  51. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14PubMedCrossRefGoogle Scholar
  52. Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 16:8–24Google Scholar
  53. Llewellyn AM, Stowe ZN, Nemeroff CB (1997) Depression during pregnancy and the puerperium. J Clin Psychiatry 58(15):26–32PubMedGoogle Scholar
  54. Marcus SM (2009) Depression during pregnancy: rates, risks and consequences. Can J Clin Pharmacol 16(1):15–22Google Scholar
  55. Marcus SM, Flynn HA, Blow FC, Barry KL (2003) Depressive symptoms among pregnant women screened in obstetrics settings. J Women's Health 12(4):373–380CrossRefGoogle Scholar
  56. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, Ericksen J, Ellwood D, Buist A (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157PubMedCrossRefGoogle Scholar
  57. Monti F, Agostini F, Marano G, Lupi F (2008) The course of maternal depressive symptomatology during the first 18 months postpartum in an Italian sample. Arch Womens Ment Health 11(3):231–238PubMedCrossRefGoogle Scholar
  58. Moraes IG, Pinheiro RT, Silva RA, Horta BL, Sousa PL, Faria AD (2006) Prevalence of postpartum depression and associated factors. Rev Saud Publ 40:65–70CrossRefGoogle Scholar
  59. Murray L, Carothers AD (1990) The validation of the Edinburgh postnatal depression scale on a community sample. Br J Psychiatry 157:288–290PubMedCrossRefGoogle Scholar
  60. Murray L, Cooper P (1997) postpartum depression and child development. Psychol Med 27:253–260PubMedCrossRefGoogle Scholar
  61. O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a-meta-analysis. Int Rev Psychiatr 8:37–54CrossRefGoogle Scholar
  62. Oppo A, Mauri M, Ramacciotti D, Camilleri V, Banti S, Borri C, Rambelli C, Montagnani MS, Cortopassi S, Bettini A, Ricciardulli S, Montaresi S, Rucci P, Beck CT, Cassano GB (2009) Risk factors for postpartum depression: the role of the postpartum depression predictors inventory-revised (PDPI-R). Results from the Perinatal Depression-Research & Screening Unit (PNDReScU) study. Arch Womens Ment Health 12(4):239–249PubMedCrossRefGoogle Scholar
  63. Pajulo M, Savonlahti E, Sourander A, Helenius H, Piha J (2001) Antenatal depression, substance dependency and social support. J Affect Disord 65(1):9–17PubMedCrossRefGoogle Scholar
  64. Patten SB (1991) Are the Brown and Harris “Vulnerability Factors” risk factors for depression? J Psychiatr Neurosci 16(5):267–271Google Scholar
  65. Phillips J, Charles M, Sharpe L, Matthey S (2009) Validation of the subscales of the Edinburgh postnatal depression scale in a sample of women with unsettled infants. J Affective Disord 118(1–3):101–112CrossRefGoogle Scholar
  66. Repokari L, Punamaki RL, Poikkeus P, Vilska S, Unkila-Kallio L, Sinkonnen J, Almqvist F, Tiitinen A, Tulppala M (2005) The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: a prospective controlled study. Hum Reprod 20:3238–3247PubMedCrossRefGoogle Scholar
  67. Ritter C, Hobfoll SE, Lavin J, Cameron RP, Hulsizer MR (2000) Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women. Health Psychol 19(6):576–585PubMedCrossRefGoogle Scholar
  68. Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295PubMedCrossRefGoogle Scholar
  69. Rodgers CS (2003) Sexual trauma and pregnancy: a conceptual framework. J Women's Health 12:961–970CrossRefGoogle Scholar
  70. Rubertsson C, Waldenstrom U, Wickberg B (2003) Depressive mood in early pregnancy: prevalence and women at risk in a national Swedish sample. J Reprod Infant Psychol 21:113–123CrossRefGoogle Scholar
  71. Ryan D, Milis L, Misri N (2005) Depression during pregnancy. Can Fam Physician 51:1087–1093PubMedGoogle Scholar
  72. Saucier GF (1986) Prediction Durant la grossese de la possibilitè d’ une depression nevrotique du postpurtum. Comunication. 3eme congré de l’Association Mondiale de Psychiatrie de Nourrisson et des discilplines affiliees, StockholmGoogle Scholar
  73. Soares CN (2010) DSM-V and reproductive-related psychiatric disorders: a closer look at windows of vulnerability. Arch Womens Ment Health 13:15–16PubMedCrossRefGoogle Scholar
  74. Spielberger CD, Gorsuch RL, Luschene R, Vagg PR, Jacobs GA (1983) Manual for the state–trait anxiety inventory (STAI) form Y. Consulting Psychologist, Palo AltoGoogle Scholar
  75. Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H (2004) Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 19:459–463PubMedCrossRefGoogle Scholar
  76. Swalm D, Brooks J, Doherty D, Nathan E, Jaques A (2010) Using the Edinburgh postnatal depression scale to screen for perinatal anxiety. Arch Womens Ment Health 13(6):515–522PubMedCrossRefGoogle Scholar
  77. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65(7):805–815PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • L. Giardinelli
    • 1
    Email author
  • A. Innocenti
    • 1
  • L. Benni
    • 1
  • M. C. Stefanini
    • 1
  • G. Lino
    • 2
  • C. Lunardi
    • 2
  • V. Svelto
    • 2
  • S. Afshar
    • 1
  • R. Bovani
    • 1
  • G. Castellini
    • 1
  • C. Faravelli
    • 3
  1. 1.Psychiatric Unit, Department of Neuropsychiatric SciencesFlorence University School of MedicineFlorenceItaly
  2. 2.Department of Obstetrics and GynecologyFlorence University School of MedicineFlorenceItaly
  3. 3.Department of PsychologyUniversity of FlorenceFlorenceItaly

Personalised recommendations