Prevalence and Associated Factors of Depression and Anxiety Among Pregnant Women Attending Tertiary Care Hospitals: A Multicentre Cross-Sectional Study

Abstract

Background: Depression and anxiety are among the most prevalent yet under-recognized mental health problems during pregnancy, with a particularly high burden reported in low- and middle-income countries, including Pakistan.

Objective: To estimate the prevalence of probable antenatal depression and anxiety and identify sociodemographic, obstetric, and psychosocial factors independently associated with these outcomes among pregnant women attending tertiary-care hospitals.

Materials and Methods: This multicentre analytical cross-sectional study was conducted over six months in the Obstetrics and Gynaecology outpatient departments of two tertiary-care teaching hospitals in Khyber Pakhtunkhwa, Pakistan: Qazi Hussain Ahmed Medical Complex, Nowshera, and Kuwait Teaching Hospital, Peshawar. A total of 450 consenting pregnant women were recruited using non-probability consecutive sampling, with 225 participants enrolled from each centre. Questionnaires were available in Urdu, English, and Pashto and were completed with assistance from doctors according to each participant’s language preference and feasibility. Probable depression and anxiety were assessed using the Edinburgh Postnatal Depression Scale (EPDS; cut-off ≥13) and Generalized Anxiety Disorder-7 scale (GAD-7; cut-off ≥10), respectively. Chi-square tests and ridge-penalized multivariable logistic regression with bootstrap 95% confidence intervals were used for analysis; p<0.05 was considered statistically significant.

Among the 450 participants, 25.3% screened positive for both probable depression and anxiety, 6.4% for probable depression only, 12.9% for probable anxiety only, while 55.3% screened negative for both conditions (Figure 1).

Conclusion: Probable antenatal depression and anxiety were common among pregnant women attending the two tertiary-care hospitals. Positive screening results were strongly associated with psychosocial factors, particularly lifetime partner violence within marriage, unplanned pregnancy, and poor spousal/family support. These findings support consideration of routine antenatal mental health screening together with appropriate psychosocial assessment, support, and referral pathways in tertiary-care settings.

Keywords: antenatal depression; anxiety; pregnancy; tertiary care; cross-sectional study; associated factors.