Comorbid Anxiety and Depression among Pregnant and Postpartum Women: A Longitudinal Population-Based Study

Abstract

Background. Longitudinal studies investigating the prevalence of comorbid anxiety and depression (CAD) and its risk factors during the perinatal period are limited. The objective of this longitudinal study was to describe the prevalence and risk factors of CAD among pregnant and postpartum women in China. Methods. From the Population Health Data Archive of the National Population Health Data Center, 1,941 Chinese pregnant or postpartum women who were surveyed for both depressive and anxiety symptoms during and after pregnancy were included in the study. This population-based longitudinal study was conducted between March 2017 and March 2022. The self-rating anxiety scale and self-rating depression scale were used to assess anxiety and depression symptoms at four time points throughout the perinatal period. The generalized estimation equation model was used to identify sociodemographic, obstetric, and mental health factors for CAD. Results. The prevalence of CAD was 15.67%, 8.36%, 11.64%, and 13.24% in the first, second, and third trimesters and postpartum, respectively. A higher proportion of women reporting, compared to women with single anxiety or depression, CAD during and after pregnancy were primiparas ($\text{OR}=1.32$, 95% CI 1.06-1.65), having a smoking history ($\text{OR}=1.5$1, 95% CI 1.05-2.18), and having dissatisfied marital relationship ($\text{OR}=1.97$, 95% CI 1.28-3.06). Women conceived with assisted reproductive treatment were reported to be less likely to have CAD ($\text{OR}=0.69$, 95% CI 0.55-0.86). Conclusions. These findings highlight that CAD is relatively common in pregnant and postpartum women and recommend targeted interventions for higher risk women, specifically primiparas with a history of smoking and dissatisfied marital relationships.