Chronic Stress in Pregnancy: Implications on Maternal Mental Health in Lower Manya Krobo Municipality, Ghana

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2020-07

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University of Ghana

Abstract

Background: Chronic stress causes adverse effects both physiologically and psychologically. Research indicates that chronic stress during pregnancy may be significantly associated with high levels of antenatal depression and anxiety. Many factors may cause chronic stress for a pregnant woman. Moreover, extant literature indicates that pregnancy itself can be a source of chronic stress and that there are pregnancy-specific stressors that could contribute to depression and anxiety during pregnancy. In Ghana and other parts of sub-Saharan Africa, there are limited scientific data on chronic stress exposure during pregnancy and its implications on maternal mental health outcomes of depression and anxiety. Objective: This study first catalogued the types of chronic stressors and pregnancy-specific stressors and determined the prevalence of these types of stressors. Secondly, it examined the association between chronic stress and (1) antenatal depression and (2) antenatal anxiety. Lastly, it identified factors associated with chronic stress and pregnancy-specific stress. Methods: An analytical cross-sectional study in three health facilities in the Lower Manya Krobo Municipality of Ghana was conducted. Chronic stressors were assessed using survey tools. The Perceived Stress Scale (PSS-14) was administered to determine the prevalence of chronic stress. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7(GAD-7) scales were used to assess for depression and anxiety respectively. Mean scores of the 3 scales were taken and categorized into levels of stress, anxiety and depression. The Fischer’s exact test was used to test the association between chronic stress, as the main exposure variable, and depression and anxiety and other characteristics. Multivariate logistic regression was used to identify independent predictors of chronic stress, pregnancy- specific stress, depression, and anxiety. Results: A total of 603 women were recruited into the study. Financial (65.9%, n=392), work- related (47.6%, n=287), and marital/relationship (25.2%, n=152) factors were the primary self- reported stressors. Fear of childbirth (61.2%, n=369), fear of giving birth to a child with a congenital anomaly (22.3%, n= 134), were primary pregnancy-specific stressors. The prevalence of stress, depression and anxiety were (49.9%, n= 301), (37%, n=223), and (17.4%, n=105) respectively. After adjustment for maternal socio-demographic and obstetric factors, the logit multivariate regression model revealed that marital status and pregnancy concerns about the ability to care for and nurture the child were predictors of chronic stress and pregnancy-specific stress. Participants who had high chronic stress had 83% increased odds of depression compared to those with lower stress (AOR: 1.83, 95% CI: 1.15-2.9). Depression increased by approximately one and a third times higher (AOR: 1.30, 95% CI: [1.02-1.67]) for each increase in the number of pregnancies a woman had had. For pregnant women who reported fear of birthing a child with a congenital anomaly as a pregnancy-specific stressor, the odds of anxiety were 64% higher (AOR: 1.64, 95% CI: [1.04-2.58]) compared to those who did not report this stressor. Conclusion: Chronic stress in pregnancy is influenced by several critical factors: marital status, education, employment and socioeconomic status. Pregnancy-specific factors like fear of childbirth and fear of a child with a congenital anomaly are key concerns of pregnant women. As hypothesized, chronic stress is a significant contributory factor to antenatal depression and anxiety and its ensuing adverse health outcomes.

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PhD. Public Health

Keywords

Chronic stress, Pregnant women, Ghana, Depression, Mental Health outcomes, Anxiety

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