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Cited by 56Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcarePregnancy-related medical research

Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications

Open access
Toscano, Marika, Royzer, Rebecca, Castillo, Daniel, Li, Dongmei, Poleshuck, Ellen·2021·Obstetrics & Gynecology
DOI 10.1097/aog.0000000000004335PMC PMC8087456
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Abstract

OBJECTIVE: To systematically review the prevalence of antenatal depression and anxiety in women hospitalized in an antepartum unit for obstetric complications. DATA SOURCES: We searched PubMed, EMBASE, CINAHL, PsycINFO, and ClinicalTrials.gov for English-language articles published from database inception through March 2020. METHODS OF STUDY SELECTION: We included cross-sectional, cohort, case–control, quasi-experimental, and randomized controlled studies from any country that reported the proportion of pregnant women with an elevated depression or anxiety screening scale or diagnostic interview during antepartum hospitalization of any duration and at any gestational age. TABULATION, INTEGRATION, AND RESULTS: We identified 8,799 articles and reviewed 79, 39 of which were included in a systematic review and 18 in meta-analysis of the primary outcome. Two raters independently assessed quality of individual studies using a 14-question tool. A random effects meta-analysis model was used to estimate prevalence and 95% CI of depression or anxiety. Heterogeneity was examined with the I 2 test, and funnel plots were used to assess publication bias. After meta-analysis, the estimated prevalence of depression was 34% (95% CI 27–41%) and of anxiety 29% (95% CI 16–43%). There was expected substantial clinical and methodologic heterogeneity between studies that persisted even after planned a priori subgroup analyses and meta-regression. Even so, the direction of effect was consistent across studies. No publication bias was found. CONCLUSION: The current meta-analysis suggests that one in three women hospitalized during pregnancy for obstetric complications report clinical levels of depression or anxiety symptoms, twice the reported prevalence of antenatal depression or anxiety in the general obstetric population. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020172111.

Integrity signals

Registry

Crossref · 10.1097/aog.0000000000004335

Cites

75 of 75 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

34 of 98 cited sources checked · 17 supported · 4 flagged · accuracy not yet measured

  • Findingown data

    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).”
    Quote in the paperNot a substantial claim5 of 10 sources checked
    • cites [42] Byatt N, Hicks-Courant K, Davidson A, Depression and anxiety among high-risk obstetric inpatients. Gen Hosp Psychiatry 2014; 36: 644– 9. 25149040 PMC4399814 source
    • cites [43] Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K. Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth. Arch Gynecol Obstet 2020; 301: 119– 28. 31828434 source
    • cites [44] Barber CC, Panettierre M, Starkey NJ. How am I, really? Perceptions of health and distress by women and their midwives. J Reprod Infant Psychol 2017; 35: 261– 72. 29517313 source
    • cites [45] Weidner K, Bittner A, Junge-Hoffmeister J, A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks. J Psychosom Obstet Gynaecol 2010; 31: 188– 98. 20586556 source
    • cites [46] Doty MS, Chen H-Y, Grace R, Ashimi S, Chauhan SP, Sibai BM. 481: Stress, anxiety and depression among inpatient versus outpatient antepartum women. American Journal of Obstetrics & Gynecology 2020; 222: S314– S5. source

      The cited paper’s Abstract describes a quality-initiative project comparing three groups of pregnant women, not a meta-analysis. Its Results report 180 women who participated in surveys, rather than 17 studies comprising 1,998 women. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [47] Thiagayson P, Krishnaswamy G, Lim ML, Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. General Hospital Psychiatry 2013; 35: 112– 6. 23265951 source
    • cites [48] Tsakiridis I, Dagklis T, Zerva C, Mamopoulos A, Athanasiadis A, Papazisis G. Depression in pregnant women hospitalized due to intrauterine growth restriction: Prevalence and associated factors. Midwifery 2019; 70: 71– 5. 30584971 source
    • cites [49] Araujo WS, Romero WG, Zandonade E, Amorim MH. Effects of relaxation on depression levels in women with high-risk pregnancies: a randomised clinical trial. Rev Lat Am Enfermagem 2016; 24: e2806. 27627126 PMC5048730 source
    • cites [50] Gourounti K, Karapanou V, Karpathiotaki N, Vaslamatzis G. Anxiety and depression of high risk pregnant women hospitalized in two public hospital settings in Greece. International Archives of Medicine 2015; 8. source
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source
  • Study design and conductown data

    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.”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [44] Barber CC, Panettierre M, Starkey NJ. How am I, really? Perceptions of health and distress by women and their midwives. J Reprod Infant Psychol 2017; 35: 261– 72. 29517313 source
    • cites [46] Doty MS, Chen H-Y, Grace R, Ashimi S, Chauhan SP, Sibai BM. 481: Stress, anxiety and depression among inpatient versus outpatient antepartum women. American Journal of Obstetrics & Gynecology 2020; 222: S314– S5. source
    • cites [47] Thiagayson P, Krishnaswamy G, Lim ML, Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. General Hospital Psychiatry 2013; 35: 112– 6. 23265951 source
    • cites [48] Tsakiridis I, Dagklis T, Zerva C, Mamopoulos A, Athanasiadis A, Papazisis G. Depression in pregnant women hospitalized due to intrauterine growth restriction: Prevalence and associated factors. Midwifery 2019; 70: 71– 5. 30584971 source
    • cites [49] Araujo WS, Romero WG, Zandonade E, Amorim MH. Effects of relaxation on depression levels in women with high-risk pregnancies: a randomised clinical trial. Rev Lat Am Enfermagem 2016; 24: e2806. 27627126 PMC5048730 source

      The Methods (Data analysis) say depression was evaluated between two timepoints. The Results report depression classifications at admission and five days later for both groups, including changes in the number classified as depressed. Contrary to the attributed claim, this study did measure changes during hospitalization, although its intervention was relaxation rather than hospitalization itself. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [50] Gourounti K, Karapanou V, Karpathiotaki N, Vaslamatzis G. Anxiety and depression of high risk pregnant women hospitalized in two public hospital settings in Greece. International Archives of Medicine 2015; 8. source
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source
    • cites [52] Fiskin G, Kaydirak MM, Oskay UY. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice. Worldviews Evid Based Nurs 2017; 14: 55– 64. 27930857 source
    • cites [53] Dagklis T, Papazisis G, Tsakiridis I, Chouliara F, Mamopoulos A, Rousso D. Prevalence of antenatal depression and associated factors among pregnant women hospitalized in a high-risk pregnancy unit in Greece. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 1025– 31. 27138949 source
    • cites [54] Dagklis T, Tsakiridis I, Chouliara F, Antenatal depression among women hospitalized due to threatened preterm labor in a high-risk pregnancy unit in Greece. J Matern Fetal Neonatal Med 2018; 31: 919– 25. 28277908 source
  • Study design and conductown data

    Timing of survey administration relative to exposure was not reported in the majority of studies.

    “Timing of survey administration relative to exposure was not reported in the majority of studies44–46,50–52,56–58.”
    Quote in the paperNot a substantial claim4 of 9 sources checked
    • cites [44] Barber CC, Panettierre M, Starkey NJ. How am I, really? Perceptions of health and distress by women and their midwives. J Reprod Infant Psychol 2017; 35: 261– 72. 29517313 source
    • cites [45] Weidner K, Bittner A, Junge-Hoffmeister J, A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks. J Psychosom Obstet Gynaecol 2010; 31: 188– 98. 20586556 source

      The Sample and data collection process section says questionnaires were given to women while they were hospitalized and returned within two to three weeks, but does not specify when administration occurred relative to hospital admission. This single study cannot establish the citing sentence’s claim about the majority of studies. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [46] Doty MS, Chen H-Y, Grace R, Ashimi S, Chauhan SP, Sibai BM. 481: Stress, anxiety and depression among inpatient versus outpatient antepartum women. American Journal of Obstetrics & Gynecology 2020; 222: S314– S5. source

      The study-design and results passage (Poster Session II, p. S315) reports that 180 women completed stress, anxiety and depression surveys, but does not give the timing of those surveys relative to inpatient or outpatient exposure. This paper can serve as one example of missing timing information; it cannot establish that timing was unreported in a majority of the cited studies. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [50] Gourounti K, Karapanou V, Karpathiotaki N, Vaslamatzis G. Anxiety and depression of high risk pregnant women hospitalized in two public hospital settings in Greece. International Archives of Medicine 2015; 8. source

      The Methods (Procedures; page unavailable) report that investigators visited patients within 72 hours of hospital admission and gave them the self-report measures after consent. Thus, for this cited study, survey timing relative to admission was reported. This paper alone cannot establish what the majority of the other cited studies reported. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source
    • cites [52] Fiskin G, Kaydirak MM, Oskay UY. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice. Worldviews Evid Based Nurs 2017; 14: 55– 64. 27930857 source
    • cites [56] Young D, Preyss M, Sipsma H, Hair S, Siddiqui M. Depression and social support during antepartum hospitalization: A needs assessment. Obstetrics and Gynecology 2017; 129: 24S– 5S. source
    • cites [57] Hermon N, Wainstock T, Sheiner E, Golan A, Walfisch A. Impact of maternal depression on perinatal outcomes in hospitalized women-a prospective study. Arch Womens Ment Health 2019; 22: 85– 91. 29968130 source
    • cites [58] Nagle-Yang S, Phillips M, Albaugh A, Depression, anxiety, and attachment among women hospitalized on an antepartum unit. Int J Psychiatry Med 2019; 54: 395– 407. 30924701 source
  • Study design and conductown data

    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.”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [42] Byatt N, Hicks-Courant K, Davidson A, Depression and anxiety among high-risk obstetric inpatients. Gen Hosp Psychiatry 2014; 36: 644– 9. 25149040 PMC4399814 source
    • cites [43] Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K. Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth. Arch Gynecol Obstet 2020; 301: 119– 28. 31828434 source
    • cites [44] Barber CC, Panettierre M, Starkey NJ. How am I, really? Perceptions of health and distress by women and their midwives. J Reprod Infant Psychol 2017; 35: 261– 72. 29517313 source
    • cites [45] Weidner K, Bittner A, Junge-Hoffmeister J, A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks. J Psychosom Obstet Gynaecol 2010; 31: 188– 98. 20586556 source
    • cites [46] Doty MS, Chen H-Y, Grace R, Ashimi S, Chauhan SP, Sibai BM. 481: Stress, anxiety and depression among inpatient versus outpatient antepartum women. American Journal of Obstetrics & Gynecology 2020; 222: S314– S5. source

      The Study Design and Results in the indexed abstract describe the study and report that 180 women participated, but they do not address sample-size calculations or power justifications. Searches for those terms found no relevant passage. This individual study also does not establish the citing paper’s count of 13 studies. (LLM, conf=0.70)

      Experimental — accuracy not yet measured
    • cites [47] Thiagayson P, Krishnaswamy G, Lim ML, Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. General Hospital Psychiatry 2013; 35: 112– 6. 23265951 source
    • cites [50] Gourounti K, Karapanou V, Karpathiotaki N, Vaslamatzis G. Anxiety and depression of high risk pregnant women hospitalized in two public hospital settings in Greece. International Archives of Medicine 2015; 8. source
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source
    • cites [53] Dagklis T, Papazisis G, Tsakiridis I, Chouliara F, Mamopoulos A, Rousso D. Prevalence of antenatal depression and associated factors among pregnant women hospitalized in a high-risk pregnancy unit in Greece. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 1025– 31. 27138949 source
    • cites [54] Dagklis T, Tsakiridis I, Chouliara F, Antenatal depression among women hospitalized due to threatened preterm labor in a high-risk pregnancy unit in Greece. J Matern Fetal Neonatal Med 2018; 31: 919– 25. 28277908 source
  • Premisecitation

    Women who experience pregnancy complications are at particular risk for onset of perinatal mood disorders or relapse of underlying mood disorders.

    “Women who experience pregnancy complications are at particular risk for onset of perinatal mood disorders or relapse of underlying mood disorders5–8.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [5] Chen J, Cross WM, Plummer V, The risk factors of antenatal depression: A cross-sectional survey. J Clin Nurs 2019; 28: 3599– 609. 31165522 source
    • cites [6] Penticuff JH. Psychologic implications in high-risk pregnancy. Nurs Clin North Am 1982; 17: 69– 78. 6919029 source
    • cites [7] Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord 2016; 191: 62– 77. 26650969 PMC4879174 source

      The Results section on obstetric and pregnancy-related risk factors says women with pregnancy or delivery complications are more likely to experience antenatal depression and anxiety, while noting that some studies found no significant association. The Introduction discusses onset or relapse of mental illness during pregnancy and postpartum generally, but does not link complications specifically to relapse or establish the claimed risk across the full perinatal period. Page numbers were not supplied. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [8] Pampaka D, Papatheodorou SI, AlSeaidan M, Depressive symptoms and comorbid problems in pregnancy - results from a population based study. J Psychosom Res 2018; 112: 53– 8. 30097136 source
  • May combine two claims. 16
  • Classified as probably not a substantial claim. 8
  • The quote only partly states this claim. 1

  • May combine two claims.

    Study design and conductown data

    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.”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [44] Barber CC, Panettierre M, Starkey NJ. How am I, really? Perceptions of health and distress by women and their midwives. J Reprod Infant Psychol 2017; 35: 261– 72. 29517313 source
    • cites [47] Thiagayson P, Krishnaswamy G, Lim ML, Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. General Hospital Psychiatry 2013; 35: 112– 6. 23265951 source
    • cites [50] Gourounti K, Karapanou V, Karpathiotaki N, Vaslamatzis G. Anxiety and depression of high risk pregnant women hospitalized in two public hospital settings in Greece. International Archives of Medicine 2015; 8. source

      The Results (Prevalence of Depression; page unavailable) report that 24 of 57 women (42%) who screened positive were discharged or delivered before a subsequent diagnostic interview. The Discussion (Limitations; page unavailable) raises the possibility that depression affected participation. These passages support concern about missing assessments, but they do not describe repeated measurement of exposure or establish loss to follow-up in five longitudinal studies. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source

      The Methods (Participants and study design; page unavailable) say that all women with threatened premature labor were followed up at 6–8 weeks postpartum. The Discussion (page unavailable) calls this a cross-sectional study. Rather than reporting more than 20% loss to follow-up in a study measuring exposure over time, this paper says the women were followed up and does not describe longitudinal exposure measurement. (LLM, conf=0.83)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [52] Fiskin G, Kaydirak MM, Oskay UY. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice. Worldviews Evid Based Nurs 2017; 14: 55– 64. 27930857 source

  • May combine two claims.

    Study design and conductown data

    Selection bias was possible in 7 studies that did not report participation rate and in 1 study with less than 50% participation.

    “Selection bias was possible in 7 studies43,49,51,52,55–57 which did not report the participation rate of eligible subjects and one study44 which reported < 50% participation rate.”
    Quote in the paperNot a substantial claim3 of 8 sources checked
    • cites [43] Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K. Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth. Arch Gynecol Obstet 2020; 301: 119– 28. 31828434 source
    • cites [49] Araujo WS, Romero WG, Zandonade E, Amorim MH. Effects of relaxation on depression levels in women with high-risk pregnancies: a randomised clinical trial. Rev Lat Am Enfermagem 2016; 24: e2806. 27627126 PMC5048730 source

      The citation to this trial is attached to the claim that it reported a participation rate below 50%. The Methods sections on Population and sample and Data collection describe 50 enrolled women and how they were selected, but give neither a participation rate nor the number of eligible women from which to calculate one. Searches for participation rate and eligible subjects found no passage establishing the claimed figure. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source
    • cites [52] Fiskin G, Kaydirak MM, Oskay UY. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice. Worldviews Evid Based Nurs 2017; 14: 55– 64. 27930857 source
    • cites [55] Brandon AR, Trivedi MH, Hynan LS, Prenatal depression in women hospitalized for obstetric risk. The Journal of Clinical Psychiatry 2008; 69: 635– 43. 18312059 PMC2680504 source

      The Discussion (Limitations; page unavailable) says eligible women refused to participate and that depression may have influenced their refusal, supporting concern about possible selection bias. The Methods (Participants; page unavailable) gives a sample of 129, but our copy does not report the number of eligible women needed to verify the cited study’s claim of less than 50% participation. The seven other studies are attributed to other citations, not this paper. (LLM, conf=0.79)

      Experimental — accuracy not yet measured
    • cites [56] Young D, Preyss M, Sipsma H, Hair S, Siddiqui M. Depression and social support during antepartum hospitalization: A needs assessment. Obstetrics and Gynecology 2017; 129: 24S– 5S. source
    • cites [57] Hermon N, Wainstock T, Sheiner E, Golan A, Walfisch A. Impact of maternal depression on perinatal outcomes in hospitalized women-a prospective study. Arch Womens Ment Health 2019; 22: 85– 91. 29968130 source
    • cites [44] Barber CC, Panettierre M, Starkey NJ. How am I, really? Perceptions of health and distress by women and their midwives. J Reprod Infant Psychol 2017; 35: 261– 72. 29517313 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The review followed PRISMA 2009 methodology and registered its protocol in PROSPERO.

    “We followed PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2009 methodology17 for this review and registered the protocol in the PROSPERO International Prospective Register of Systematic Reviews (CRD42020172111).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] Liberati A, Altman DG, Tetzlaff J, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700. 19622552 PMC2714672 source

      The cited paper’s Background and Discussion discuss methodological quality and risk-of-bias assessment tools, not whether the citing authors followed PRISMA 2009 or registered their protocol. Searches of our copy for PRISMA, PROSPERO, and the stated registration number found no passage addressing those claims. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Study quality was assessed by two independent investigators using the NIH quality assessment tool, with disagreements adjudicated.

    “Study quality was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies18,19. The quality of each study was evaluated by two independent investigators (MT and RR) and disagreements were resolved by adjudication by the same two reviewers.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [18] Ma L-L, Wang Y-Y, Yang Z-H, Huang D, Weng H, Zeng X-T. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Medical Research 2020; 7: 7. 32111253 PMC7049186 source
    • cites [19] NIH quality assessment tool for observational cohort and cross-sectional studies. Accessed March 5, 2020. www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Alongside medication, interpersonal therapy and cognitive behavioral therapy are the best-studied and most effective ways to treat and prevent perinatal mood disorders.

    “It is important to recognize that in addition to pharmacologic treatment, interpersonal therapy (IPT) and cognitive behavioral therapy (CBT) interventions are the most well studied and most effective treatment85,86 and prevention strategies87 for perinatal mood disorders.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [85] Bright KS, Charrois EM, Mughal MK, Interpersonal psychotherapy for perinatal women: a systematic review and meta-analysis protocol. Systematic Reviews 2019; 8: 248. 31665077 PMC6819345 source

      The Background (page not provided) describes promising perinatal IPT studies, including treatment of depression during pregnancy and prevention of postpartum depression. It says CBT and IPT have been studied extensively and appear equally effective for depression in adult populations, but it does not establish that both are the most-studied or most-effective treatment and prevention strategies for perinatal mood disorders broadly. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [86] Sockol LE, Epperson CN, Barber JP. A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 2011; 31: 839– 49. 21545782 PMC4108991 source

      The Study characteristics section identifies IPT and CBT as the two most commonly studied psychological interventions for perinatal depression, and the Discussion reports that interventions reduced depressive symptoms. But the paper does not establish both as the most effective treatments: it describes only preliminary evidence favoring IPT over CBT and calls for further research. In the citing sentence, prevention has a separate citation (87); this paper assesses treatment, not prevention. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [87] O’Connor E, Senger CA, Henninger ML, Coppola E, Gaynes BN. Interventions to Prevent Perinatal Depression: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 321: 588– 601. 30747970 source

  • May combine two claims.

    Findingown data

    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).”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [42] Byatt N, Hicks-Courant K, Davidson A, Depression and anxiety among high-risk obstetric inpatients. Gen Hosp Psychiatry 2014; 36: 644– 9. 25149040 PMC4399814 source
    • cites [43] Hanko C, Bittner A, Junge-Hoffmeister J, Mogwitz S, Nitzsche K, Weidner K. Course of mental health and mother-infant bonding in hospitalized women with threatened preterm birth. Arch Gynecol Obstet 2020; 301: 119– 28. 31828434 source
    • cites [46] Doty MS, Chen H-Y, Grace R, Ashimi S, Chauhan SP, Sibai BM. 481: Stress, anxiety and depression among inpatient versus outpatient antepartum women. American Journal of Obstetrics & Gynecology 2020; 222: S314– S5. source

      The source’s Abstract (AJOG supplement, p. S315) describes a study comparing stress, anxiety, and depression among antepartum women. Searches for the NIH quality assessment tool and the stated quartile counts found no quality ratings or assessment of 18 studies in our copy. The cited study therefore cannot verify the citing paper’s assessment results. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [49] Araujo WS, Romero WG, Zandonade E, Amorim MH. Effects of relaxation on depression levels in women with high-risk pregnancies: a randomised clinical trial. Rev Lat Am Enfermagem 2016; 24: e2806. 27627126 PMC5048730 source
    • cites [45] Weidner K, Bittner A, Junge-Hoffmeister J, A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks. J Psychosom Obstet Gynaecol 2010; 31: 188– 98. 20586556 source
    • cites [47] Thiagayson P, Krishnaswamy G, Lim ML, Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. General Hospital Psychiatry 2013; 35: 112– 6. 23265951 source
    • cites [48] Tsakiridis I, Dagklis T, Zerva C, Mamopoulos A, Athanasiadis A, Papazisis G. Depression in pregnant women hospitalized due to intrauterine growth restriction: Prevalence and associated factors. Midwifery 2019; 70: 71– 5. 30584971 source
    • cites [50] Gourounti K, Karapanou V, Karpathiotaki N, Vaslamatzis G. Anxiety and depression of high risk pregnant women hospitalized in two public hospital settings in Greece. International Archives of Medicine 2015; 8. source
    • cites [51] Nie C, Dai Q, Zhao R, Dong Y, Chen Y, Ren H. The impact of resilience on psychological outcomes in women with threatened premature labor and spouses: a cross-sectional study in Southwest China. Health Qual Life Outcomes 2017; 15: 26. 28143536 PMC5282797 source

      The cited paper’s Methods describe questionnaires and statistical analyses for a cross-sectional study; its Results report participant characteristics and psychological outcomes, not an NIH assessment of study quality. Searches for the NIH tool, quality ratings, and the claimed quartile counts found no passage in our copy that verifies the 4, 13, and 1 study counts or this paper’s assigned rating. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [52] Fiskin G, Kaydirak MM, Oskay UY. Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice. Worldviews Evid Based Nurs 2017; 14: 55– 64. 27930857 source

  • The quote only partly states this claim.

    Findingown data

    In the meta-analysis, the pooled prevalence of the depression outcome among women hospitalized on an antepartum unit for obstetric complications was 34% (95% CI 27-41%).

    “After meta-analysis, the estimated prevalence of depression was 34% (95% CI 27–41%) and of anxiety 29% (95% CI 16–43%).”
    • Also stated in: § Results: · hedged
      “The estimated prevalence of the depression outcome was 34% (95% CI 27–41%) (Figure 2).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Random-effects meta-regression found no observable differences in depression prevalence by study design, depression scale type, publication year, country, or quality score.

    “There were no observable differences among studies in the random-effects meta-regression for study design type, type of depression scale used, year of publication, country of origin, or quality assessment score and therefore heterogeneity was not arising from these systematic differences.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    About 18% of included subjects were screened on the day of admission and 34% within 72 hours, while timing was not reported for over half of the studies.

    “About 18% of included subjects (358/1998) were screened on the day of hospital admission and 34% within 72 hours of admission (680/1998), whereas timing of survey administration relative to hospital admission was not reported in over half of the studies (58%; n=1168 subjects).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Subjects were admitted for a wide variety of antepartum complications for varying durations of hospitalization.

    “Subjects were admitted for a wide variety of antepartum complications for varying durations of hospitalization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two reviewers independently screened titles, abstracts, and full manuscripts, with disagreements resolved by adjudication.

    “The screening title search, subsequent abstract screening, and application of eligibility and inclusion criteria with full manuscript review were performed by independently by two reviewers (MT & RR). Any disagreements between the two reviewers was settled via adjudication by the same two reviewers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    A priori hypotheses for study heterogeneity were developed, and sensitivity analyses were performed for design, population, scale, and quality score.

    “A priori hypotheses for study heterogeneity were developed.”
    • Also stated in: § Study selection: · plain
      “We therefore performed a sensitivity analysis for these additional contributors to heterogeneity.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A priori inclusion and exclusion criteria were established.

    “A priori inclusion and exclusion criteria were established.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the general obstetric population, reported antenatal depression prevalence is 12-18% and antenatal anxiety prevalence is 13-21%.

    “In the general obstetric population, between 12% and 18% of women are reported to experience antenatal depression and 13 to 21% experience antenatal anxiety, though estimates vary widely and are higher in certain groups of women with additional risk factors, such as women with obstetric complications9–12.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [9] Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 2004; 103: 698– 709. 15051562 source
    • cites [10] Giardinelli L, Innocenti A, Benni L, Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample. Arch Womens Ment Health 2012; 15: 21– 30. 22205237 source
    • cites [11] Underwood L, Waldie K, D’Souza S, Peterson ER, Morton S. A review of longitudinal studies on antenatal and postnatal depression. Arch Womens Ment Health 2016; 19: 711– 20. 27085795 source
    • cites [12] Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005; 106: 1071– 83. 16260528 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Quality assessment was used descriptively only, and no studies were excluded from analysis based on quality.

    “Quality assessment was used for descriptive purposes only, and no studies were withheld from analysis on the basis of quality appraisal.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The review's findings emphasize that education, support, and interventions matter for women on antenatal units.

    “Our results highlight the importance of education, support and interventions for women on antenatal units.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Most included studies relied on screening tools of symptom severity and did not include clinical diagnoses of depression and anxiety disorders.

    “Moreover, most of the studies relied on screening tools of symptom severity and do not include clinical diagnoses of depression and anxiety disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Screening rates for antenatal mood disorders are low both on antenatal units and in outpatient settings.

    “Screening rates for antenatal mood disorders, on antenatal units and in the outpatient setting, are low.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [69] Lyell DJ, Chambers AS, Steidtmann D, Antenatal identification of major depressive disorder: a cohort study. Am J Obstet Gynecol 2012; 207: 506 e1– 6. 23099192 source
    • cites [70] Connell T, Barnett B, Waters D. Barriers to antenatal psychosocial assessment and depression screening in private hospital settings. Women Birth 2018; 31: 292– 8. 29031647 source

  • May combine two claims.

    Premisecitation

    As many as half of patients are either not screened or misdiagnosed before delivery.

    “Studies show that as many as 50% of patients are not screened or are misdiagnosed prior to delivery69,70.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [69] Lyell DJ, Chambers AS, Steidtmann D, Antenatal identification of major depressive disorder: a cohort study. Am J Obstet Gynecol 2012; 207: 506 e1– 6. 23099192 source
    • cites [70] Connell T, Barnett B, Waters D. Barriers to antenatal psychosocial assessment and depression screening in private hospital settings. Women Birth 2018; 31: 292– 8. 29031647 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Antenatal screening and referral is recommended by ACOG, ACNM, USPSTF, and other international societies.

    “antenatal screening and referral is recommended by the American College of Obstetricians and Gynecologists, American College of Nurse Midwives, United States Preventative Services Task Force71–73, as well as other international societies74–76.”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [71] Screening for perinatal depression. ACOG Committee Opinion No 757. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 132: e208– 12. 30629567 source
    • cites [72] American College of Nurse Midwives. Position Statement: Depression in Women. Accessed on November 23, 2020. http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000061/Depression%20in%20Women%20May%202013.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [73] Siu AL, Bibbins-Domingo K, Grossman DC, Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. Jama 2016; 315: 380– 7. 26813211 source
    • cites [74] Royal College of Obstetricians and Gynecologists. Management of Women with Mental Health Issues during Pregnancy and the Postnatal Period. Accessed on November 23, 2020. https://www.rcog.org.uk/globalassets/documents/guidelines/managementwomenmentalhealthgoodpractice14.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [75] National Institute for Health and Care Excellent. Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance: Updated edition. Accessed on November 23, 2020. https://www.nice.org.uk/guidance/cg192 31990493

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [76] Scottish Intercollegiate Guidelines Network. Management of perinatal mood disorders. Accessed on November 23, 2020. https://www.sign.ac.uk/assets/sign127_update.pdf

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: Postpartum depression and anxiety frequently represent a continuation of antenatal mood disorders that were underdiagnosed or undertreated.
20 of 20

  • The paper relies on this without support.

    Elevated scores on validated depression or anxiety screening scales correspond to clinical levels of depression or anxiety symptoms.

    “The current meta-analysis suggests that one in three women hospitalized during pregnancy for obstetric complications report clinical levels of depression or anxiety symptoms, twice the reported prevalence of antenatal depression or anxiety in the general obstetric population.”
    “Moreover, most of the studies relied on screening tools of symptom severity and do not include clinical diagnoses of depression and anxiety disorders.”

  • The paper relies on this without support.

    Postpartum depression and anxiety frequently represent a continuation of antenatal mood disorders that were underdiagnosed or undertreated.

    “Because evidence suggests that postpartum depression and anxiety disorders are often a continuum of underdiagnosed or undertreated antenatal mood disorders”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Existing studies suggest that hospitalized pregnant women with severe maternal or fetal risk have prevalence rates of up to 39-44% for symptoms of anxiety and depression.

    “Existing studies suggest that these women represent a particularly vulnerable group with prevalence rates of up to 39–44% for symptoms of anxiety and depression (5–8).”

    From Acceptance, experiences, and needs of hospitalized pregnant women toward an electronic mindfulness-based intervention: A pilot mixed-methods study (2022) · cites this paper as [8]

    The Results (page not provided) support the claim that hospitalized pregnant women with obstetric complications have substantial rates of depression and anxiety symptoms. However, the paper reports pooled prevalences of 34% for depression and 29% for anxiety, not 39–44%; its 42% anxiety estimate applies only to a screening-tool subgroup. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • There are few studies examining the trajectory of mental health symptoms and postpartum outcomes specific to hospitalized antepartum patients.

    “Specific to hospitalized antepartum patients, there are few studies examining the trajectory of mental health symptoms and postpartum outcomes [14].”

    From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [14]

  • One in three hospitalized antepartum patients screen positive for depression or anxiety during their hospitalization, approximately twice the prevalence in the general obstetric population.

    “One in three hospitalized antepartum patients screen positive for depression or anxiety during their hospitalization, approximately twice the prevalence in the general obstetric population [14].”

    From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [14]

  • Hospitalized antepartum patients are at increased risk for perinatal mental health conditions, with one in three screening positive for depression or anxiety, twice the prevalence in the general obstetric population.

    “Hospitalized antepartum patients are at risk for development or exacerbation of a mental health condition, with one in three screening positive for depression or anxiety.”

    From Mental health needs among patients experiencing extended antepartum hospitalization: A qualitative study (2026) · cites this paper as [14]

  • The few existing longitudinal studies report conflicting findings regarding the trajectory of mental health symptoms throughout the antepartum hospital stay.

    “The few existing longitudinal studies report conflicting findings regarding the trajectory of mental health symptoms throughout the antepartum hospital stay [14].”

    From Mental health needs among patients experiencing extended antepartum hospitalization: A qualitative study (2026) · cites this paper as [14]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Five studies are described as both measuring and not measuring change over time

    Minor

    Studies 44, 47, and 50-52 appear in the list said not to measure effects over time, but are then identified as studies that did so and had follow-up losses.

  • Only half of the meta-analysis studies lacked survey-timing information

    Minor

    The cited ranges identify nine studies. Nine of the 18 studies in the meta-analysis is half, not a majority.

2 of 2

Cites

Flagged first, then by citations

1 of the 76 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Pinar, 2017, Mental health status of the women with risky pregnancies in the hospital and affecting factors, Int J Caring Sci, 10, 1426
  2. Florez-Alarcon, 2001, Evaluation of the impact of a psychological care program for pregnant women with pre-eclampsia, Int J Clin Health Psychol, 1, 259

Cited by

Sorted by citations

Related

Authors
Toscano, M., Royzer, R., Castillo, D., Li, D., & Poleshuck, E.
Affiliations
University of Rochester Medicine (US)
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-04-06
Volume
137
Issue
5
Pages
881-891
ISSN
0029-7844 (ISSN-L)
DOI
10.1097/aog.0000000000004335
PMC
PMC8087456
OpenAlex
W3142894194
Semantic Scholar
d2b13520cc88aaa110634efd404e97fb194a2d91
Cited by
55
References
76
Citations by year
2026: 10 · 2025: 16 · 2024: 11 · 2023: 9 · 2022: 4 · 2021: 5
FWCI
5.65
Type
journal article
Language
en
Open access
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
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, depression prevalence, anxiety prevalence, antepartum hospitalization, pregnancy complications, pregnant women, maternal mental health
MeSH terms
Adult, Depressive Disorder, Female, Hospitalization, Humans, Pregnancy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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