Depression and anxiety in Singaporean high-risk pregnancies—prevalence and screening
Open accessAbstract
Objective Data on psychiatric morbidity in high-risk pregnant Singaporean women are limited. This study aimed to establish the prevalence of antenatal depression and anxiety in high-risk pregnancies, compare the prevalence of antenatal depression in high-risk pregnancies vs. pregnancies of unspecified obstetric risk and examine the Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI) as screening tools for these disorders.Method Two hundred high-risk pregnant inpatients at a national public maternity hospital were included. Three psychometric assessment tools were used to evaluate all participants: the diagnostic Mini International Neuropsychiatric Interview and the screening EPDS and STAI.Results Rates of major depression, minor depression, anxiety disorder (agoraphobia, generalized anxiety disorder, panic disorder), and comorbid depression and anxiety were 11%, 7%, 12.5% and 5%, respectively. Major depression was more prevalent in high-risk pregnancies than in the historical cohort of unspecified obstetric risk (11% versus 4.3%). EPDS (cutoff 8/9) screens well for depression and anxiety in high-risk pregnancies (area under the receiver operating characteristic curve=0.82-0.87).Conclusion Antenatal depression and anxiety are highly prevalent in a sample of high-risk pregnant Singaporean women. EPDS performs well in screening for depression and anxiety in high-risk pregnant women, with further psychiatric assessment recommended for women with score ≥ 9.
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The depression outcome meta-analysis included 17 studies of 1,998 women.
“Seventeen studies of 1,998 women were included in the meta-analysis of depression outcome42–58 (Table 1) and 7 studies of 851 women included in the anxiety outcome42,43,45–47,58,59 (Table 2).”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [42]
Sample size calculations with power justifications were not reported by 13 included studies.
“Although sample size calculations with power justifications were not reported by 13 investigators42–47,50,51,53–56,58 for their various primary outcomes, this does not diminish the validity of the reported prevalence of included studies.”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [47]
The depression outcome meta-analysis included 17 studies of 1,998 women.
“Seventeen studies of 1,998 women were included in the meta-analysis of depression outcome42–58 (Table 1) and 7 studies of 851 women included in the anxiety outcome42,43,45–47,58,59 (Table 2).”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [47]
Fifteen studies did not measure effect of exposure over time, limiting conclusions about changes in prevalence over hospitalization.
“Fifteen investigators44,46–59 did not measure effect of exposure over time, limiting the conclusions which can be draw regarding changes in prevalence of anxiety or depression over the duration of hospitalization.”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [47]
Sample size calculations with power justifications were not reported by 13 included studies.
“Although sample size calculations with power justifications were not reported by 13 investigators42–47,50,51,53–56,58 for their various primary outcomes, this does not diminish the validity of the reported prevalence of included studies.”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [42]
The anxiety outcome meta-analysis included 7 studies of 851 women.
“Seventeen studies of 1,998 women were included in the meta-analysis of depression outcome42–58 (Table 1) and 7 studies of 851 women included in the anxiety outcome42,43,45–47,58,59 (Table 2).”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [42]
The anxiety outcome meta-analysis included 7 studies of 851 women.
“Seventeen studies of 1,998 women were included in the meta-analysis of depression outcome42–58 (Table 1) and 7 studies of 851 women included in the anxiety outcome42,43,45–47,58,59 (Table 2).”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [47]
Study quality assessment showed 4 studies in the top quartile, 13 in the third quartile, and 1 in the second quartile.
“Study quality assessment using the NIH quality assessment tool demonstrated 4 studies42,43,46,49 in the top quartile (rating ≥ 75%), 13 studies45,47,48,50–59 in the third quartile (with rating ≥ 50–74%), and a single study44 in the second quartile (rating < 50%) (Table 2).”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [47]
Study quality assessment showed 4 studies in the top quartile, 13 in the third quartile, and 1 in the second quartile.
“Study quality assessment using the NIH quality assessment tool demonstrated 4 studies42,43,46,49 in the top quartile (rating ≥ 75%), 13 studies45,47,48,50–59 in the third quartile (with rating ≥ 50–74%), and a single study44 in the second quartile (rating < 50%) (Table 2).”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [42]
Loss to follow-up greater than 20% was reported in 5 studies that measured exposure over time, introducing possible systematic differences.
“Finally, of those investigators who did measure exposure over time, loss to follow-up was reported as > 20% in 5 studies44,47,50–52, introducing the possibility of systematic differences in drop-outs impacting interpretation of longitudinal results.”
From Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications (2021) · cites this paper as [47]
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- Authors
- Thiagayson, P., Krishnaswamy, G., Lim, M. L., Sung, S. C., Haley, C. L., Fung, D. S. S., Allen, J. C., & Chen, H.
- Affiliations
- National University of Singapore (SG)
- KK Women's and Children's Hospital (SG)
- Corresponding author
- Thiagayson, Pavaani
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 35
- Issue
- 2
- Pages
- 112-116
- ISSN
- 0163-8343 (ISSN-L)
- OpenAlex
- W2075852623
- Cited by
- 102
- References
- 68
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 3 · 2023: 12 · 2022: 10 · 2021: 11 · 2020: 6 · 2019: 10 · 2018: 6 · 2017: 6 · 2016: 10 · 2015: 14 · 2014: 3
- FWCI
- 5.25
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- National University of Singapore (submittedVersion)
- Funders
- National Institutes of Health (KL2TR000160)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- antenatal depression, prenatal anxiety, high-risk pregnancy, Edinburgh Postnatal Depression Scale, State-Trait Anxiety Inventory, screening validity, depression prevalence, anxiety disorders, comorbid depression and anxiety, Singaporean women
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Mass Screening, Pregnancy, Pregnancy Complications, Prospective Studies, Psychometrics, Surveys and Questionnaires, Singapore, Prevalence, Confidence Intervals, Odds Ratio, Pregnancy, High-Risk, Risk Assessment, Young Adult
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