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Depression and anxiety among antenatal and postnatal mothers: A community-based cross-sectional study
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Received: ,
Accepted: ,
How to cite this article: Sindhuri R, Subramaniyan S, Mohan R, Surendran P. Depression and anxiety among antenatal and postnatal mothers: A community-based cross-sectional study. Glob J Health Sci Res. doi: 10.25259/GJHSR_68_2025
Abstract
Objectives:
Emotional disturbances such as anxiety and depression during pregnancy can affect maternal well-being and fetal health. Women experiencing psychological distress during pregnancy often show poor compliance with antenatal advice and irregular follow-up. This study assessed anxiety and depressive symptoms among antenatal and postnatal mothers using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire scales and compared mental health profiles between the groups.
Material and Methods:
A community-based analytical cross-sectional study was conducted for 6 months (October 2021–April 2022) in the rural field practice area of a primary health center under the Department of Community Medicine. Based on previous evidence, 180 participants were enrolled. Data were gathered using a pre-tested structured questionnaire. Ethical principles were adhered to throughout the study. Data entry was carried out in Epi Info 7 and analysis in Statistical Package for the Social Sciences 21. Logistic regression was applied to explore associations.
Results:
Mild depressive symptoms predominated among antenatal mothers, while most postnatal women showed no depressive symptoms. Depression levels differed significantly between the two groups (p = 0.001).
Conclusion:
Incorporating mental health screening into routine antenatal care is essential for early detection of psychological morbidity. Strengthening community-level awareness can help reduce the burden of maternal depression.
Keywords
Antenatal
Anxiety
Depression
Generalized anxiety disorder-7
Patient health questionnaire-9
Postnatal
INTRODUCTION
Pregnancy is conventionally regarded as a positive and fulfilling stage of life; however, the physiological, emotional, and social transitions during this period may predispose women to mental health concerns. Hormonal changes, limited social support, and family-related stressors often contribute to anxiety during pregnancy, which may progress to postpartum blues, depressive disorders, or, rarely, psychosis.[1-6] Despite substantial clinical attention to postpartum mental illness, antenatal depression continues to remain under-recognized.[2] Anxiety during pregnancy in low- and middle-income countries ranges from 1% to 26%. Poor mental health during pregnancy has been linked to adverse outcomes such as preterm birth, fetal growth restriction, miscarriage, and hypertensive disorders. In addition, depressive symptoms may disrupt healthy maternal behaviors, contributing to inconsistent antenatal check-ups and reduced adherence to medical guidance.[7,8]
While routine mental health screening during antenatal visits is more common in high-income nations, limited data exist from developing countries like India. Maternal depression occurs frequently during pregnancy and is a major predictor of postpartum depression.[9-14] Studies indicate prevalence rates ranging from 4% to 25%, with higher levels during early pregnancy and slightly reduced levels postpartum. Multiple determinants contribute to antenatal depression, including inadequate nutrition, socioeconomic disadvantage, intimate-partner violence, pre-existing psychiatric illness, obstetric complications, and lack of family support.[15-19] Factors such as pregnancy planning status, maternal age, and marital stability also play important roles. Despite its significance, Indian literature predominantly emphasizes postpartum depression, highlighting the need for more evidence on antenatal mental health.[20-22] Hence, this study evaluated anxiety and depression among antenatal and postnatal mothers using validated screening tools.
MATERIAL AND METHODS
Study setting
A community-based analytical cross-sectional study was conducted for 6 months (October 2021–April 2022) in the rural field practice area of a primary health center (PHC) affiliated with the department of community medicine. The PHC, located 2.5 km from the institution, covers a population of 36,509 across 14 villages. Antenatal and postnatal services are provided by the Medical Officer and frontline workers, including auxiliary nurse midwives, Anganwadi staff, and accredited social health activists.
Sample size and sampling technique
Referring to a study by Nath et al.,[23] the prevalence of anxiety among pregnant women was estimated at 23%. With an absolute precision of 6.5% and 95% confidence interval, the calculated sample size was 150. Allowing for a 20% non-response rate, the final sample size was 180. After obtaining permission from the PHC Medical Officer, lists of antenatal and postnatal mothers were retrieved from the nominal registers. Participants were selected through simple random sampling.
Data collection
Informed written consent was obtained before data collection. A structured, pre-tested questionnaire was administered to assess anxiety, generalized anxiety disorder (GAD-7), and depression patient health questionnaire (PHQ-9) during the COVID-19 pandemic. Interviews were conducted privately at participants’ homes to ensure confidentiality and to clarify queries during the interview. Sociodemographic details, COVID infection and vaccination history, and breastfeeding knowledge and practices (for postnatal mothers) were documented. Standard ethical guidelines were followed.
Data analysis
Data were entered using Epi Info 7 and analyzed with Statistical Package for the Social Sciences 21. Categorical variables were summarized using frequencies and percentages, while continuous variables were expressed as mean ± standard deviation or median (interquartile range), depending on distribution. Logistic regression was performed to evaluate associations between mental health scores and socio-demographic or clinical variables.
RESULTS
Overall, 180 mothers participated in the study. Antenatal mothers commonly demonstrated mild to moderate anxiety, whereas most postnatal mothers fell within minimal-to-mild levels. Differences across anxiety grades were statistically significant (p = 0.001) [Table 1].
| Over the last two weeks, how often have youbeen bothered by the following problems? | Antenatal mothers | Postnatal mothers | Mann-Whitney U test | ||||
|---|---|---|---|---|---|---|---|
| Mean±SD score | Median (IQR) | Min- Max score | Mean±SD score | Median (IQR) | Min- Max score | p-value | |
| 1. Feeling nervous, anxious or on edge | 0.68±0.71 | 1 (1) | 0–2 | 0.73±0.77 | 1 (1) | 0–2 | 0.535 |
| 2. Not being able to stop or control worrying | 1.0±0.92 | 1 (2) | 0–3 | 0.82±0.93 | 1 (2) | 0–3 | 0.025* |
| 3. Worrying too much about different things | 1.25±1.04 | 1 (2) | 0–3 | 0.85±0.94 | 1 (2) | 0–3 | <0.001* |
| 4. Trouble relaxing | 0.98±0.83 | 1 (2) | 0–3 | 0.76±0.83 | 1 (1) | 0–3 | 0.002* |
| 5. Being so restless that it is hard to sit still | 1.05±0.89 | 1 (2) | 0–3 | 0.77±0.83 | 1 (1) | 0–3 | <0.001* |
| 6. Becoming easily annoyed or irritable | 1.37±0.95 | 1 (1) | 0–3 | 1.00±1.07 | 1 (2) | 0–3 | 0.001* |
| 7. Feeling afraid, as if something awful might happen | 0.76±0.80 | 1 (1) | 0–3 | 0.64±0.84 | 0 (1) | 0–3 | 0.062 |
| Total score | 7.08±4.25 | 7 (6) | 0–15 | 5.58±4.63 | 5 (9) | 0–15 | <0.001* |
Bold and asterisk mark values indicate statistical significance. *p<0.05 based on Mann-Whitney U test. GAD: Generalized anxiety disorder, SD: Standard deviation, IQR: Interquartile range
GAD-7 items revealed significant group differences for several symptoms, including excessive worrying, difficulty relaxing, restlessness, and irritability (p < 0.05). Figure 1 illustrates median GAD-7 scores, which were significantly higher in antenatal mothers (p < 0.001).
Regarding depressive symptoms, both antenatal and postnatal groups showed significant differences across multiple PHQ-9 items, particularly sleep disturbances, fatigue, overeating or poor appetite, negative self-evaluation, concentration issues, agitation, and suicidal thoughts (p < 0.05) [Tables 2-4].
| Anxiety GAD score | Antenatal mothers (n=225) | Postnatal mothers (n=225) | Chi-square test |
|---|---|---|---|
| 0–4 (minimal) | 48 (21.3) | 88 (39.1) | χ2(3)= 16.407 p=0.001* |
| 5–9 (mild) | 88 (39.1) | 85 (37.8) | |
| 10–14 (moderate) | 82 (36.4) | 45 (20.0) | |
| 15–21 (severe) | 7 (3.1) | 7 (3.1) |
GAD: Generalized anxiety disorder, *p<0.05 was considered as statistically significant.
| Over the last 2 weeks, how often have you been bothered by the following problems? | Antenatal mothers | Postnatal mothers | Mann-Whitney U test | ||||
|---|---|---|---|---|---|---|---|
| Mean±SD score | Median (IQR) | Min- Max score | Mean±SD score | Median (IQR) | Min-max score | p-value | |
| 1. Little interest or pleasure in doing things | 0.74±0.69 | 1 (1) | 0–2 | 0.81±0.73 | 1 (1) | 0–3 | 0.352 |
| 2. Feeling down, depressed, or hopeless | 0.96±0.80 | 1 (2) | 0–2 | 0.89±0.89 | 1 (2) | 0–3 | 0.249 |
| 3. Trouble falling or staying asleep, or sleeping too much | 1.29±1.04 | 1 (2) | 0–3 | 0.96±0.97 | 1 (2) | 0–3 | 0.001* |
| 4. Feeling tired or having little energy | 1.24±0.82 | 1 (1) | 0–3 | 1.02±0.97 | 1 (1) | 0–3 | 0.002* |
| 5. Poor appetite or overeating | 0.99±0.77 | 1 (1) | 0–3 | 0.76±0.82 | 1 (1) | 0–3 | 0.001* |
| 6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down | 0.58±0.72 | 0 (1) | 0–3 | 0.40±0.67 | 0 (1) | 0–3 | 0.002* |
| 7. Trouble concentrating on things, such as reading the newspaper or watching TV | 0.80±0.77 | 1 (1) | 0–3 | 0.57±0.82 | 0 (1) | 0–3 | <0.001* |
| 8. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual | 0.72±0.85 | 0 (1) | 0–3 | 0.48±0.71 | 0 (1) | 0–3 | 0.002* |
| 9. Thoughts that you would be better off dead or of hurting yourself in some way | 0.48±0.71 | 0 (1) | 0–3 | 0.28±0.54 | 0 (0) | 0–3 | 0.001* |
| Total score | 7.82±4.01 | 8 (5) | 0–17 | 6.17±4.79 | 6 (7) | 0–18 | <0.001* |
Bold and asterisk mark values indicate statistical significance.*p<0.05 based on Mann-Whitney U test. PHQ-9: Patient health questionnaire, IQR: Interquartile range
| Depression PHQ-9 score | Antenatal mothers (n=225) | Postnatal mothers (n=225) | Chi-square test |
|---|---|---|---|
| 0–4 (normal) | 66 (29.3) | 105 (46.7) | χ2(3)=22.596 p<0.001* |
| 5–9 (mild) | 92 (40.9) | 59 (26.2) | |
| 10–14 (moderate) | 63 (28.0) | 57 (25.3) | |
| 15–19 (mod severe) | 4 (1.8) | 4 (1.8) | |
| 20–27 (severe) | 0 (0) | 0 (0) |
PHQ-9: Patient health questionnaire, *p<0.05 was considered as statistically significant.
Most antenatal mothers reported mild depression, while nearly half of the postnatal women had normal scores. The difference in depression categories was significant (p < 0.001). Figure 2 displays the PHQ-9 score distribution between groups.
DISCUSSION
This study highlights that antenatal women had higher levels of anxiety and depression than their postnatal counterparts. These findings reflect the heightened psychological vulnerability during pregnancy compared to the postpartum period. The overlap of symptoms such as irritability, sleep problems, and persistent worry suggests frequent coexistence of anxiety and depressive features, complicating clinical differentiation.[24-26]
The results are consistent with earlier research showing that women with postpartum depression often demonstrate concurrent anxiety symptoms. Studies using alternative screening tools, such as the Hamilton Scale, have also identified high antenatal anxiety and depression levels.[27]
Sociodemographic factors, including age and education, influenced depression scores. Higher levels of education may improve coping mechanisms and health-seeking behavior, contributing to lower depressive symptoms. However, as the study was conducted in a single PHC population, broader generalizability is limited.[28,29]
Overall, the findings reiterate that perinatal mental health concerns are common and necessitate early screening, timely intervention, and strengthened community awareness programs.
CONCLUSION
Anxiety is frequently observed among pregnant women and significantly contributes to postpartum depressive disorders. Routine screening for anxiety and depression during antenatal visits can aid in early detection and timely management. Strengthening community awareness and integrating mental health assessment into standard maternal healthcare services may help reduce the overall burden of perinatal mental illness.
Ethical approval:
The Institutional Ethics Committee, [Sri Manakula Vinayagar Medical College and Hospital], waived ethical approval for this community-based analytical cross-sectional study involving minimal-risk human participants. (Waiver number: EC/15/2021).
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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