Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, USA 02115; Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115.
Harvard Medical School, 25 Shattuck Street, Boston, MA, USA 02115; Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Ave. Boston, MA, USA 02115.
Psychiatry Res. 2023 May;323:115169. doi: 10.1016/j.psychres.2023.115169. Epub 2023 Mar 14.
Prenatal generalized anxiety disorder (GAD) is a common and underdiagnosed condition with negative health consequences to both the pregnant individual and child. Here we studied the relationship between diagnosis and treatment status of GAD during pregnancy (no GAD diagnosis, suspected but not diagnosed, diagnosed but not treated, diagnosed and treated) during the COVID-19 pandemic and postpartum mental health outcomes, while considering the potential influence of individual psychological factors such as distress tolerance and resilience and the role of COVID-19-related health worries. In this sample of predominantly highly educated and white birthing individuals, one in five respondents experienced GAD during pregnancy and another one in six suspected GAD but was not diagnosed. Amongst those with a GAD diagnosis, 30% did not receive treatment. We found that those with a GAD diagnosis during pregnancy who did not receive treatment showed the highest levels of postpartum anxiety and depressive symptoms in the postpartum, even after controlling for covariates, and experienced the most COVID-19-related health worries. In comparison, individuals with a GAD diagnosis during pregnancy who received treatment experienced significantly lower anxiety symptom burden and depressive symptom burden, with a symptom burden similar to those without a confirmed or suspected diagnosis after controlling for individual psychological factors. We conclude that clinicians should strongly consider screening for and treating prenatal anxiety to prevent suboptimal postpartum mental health outcomes.
产前广泛性焦虑障碍（GAD）是一种常见且未被充分诊断的疾病，对孕妇和儿童的健康都有负面影响。在这里，我们研究了 COVID-19 大流行期间和产后期间（无 GAD 诊断、疑似但未诊断、诊断但未治疗、诊断且已治疗）GAD 的诊断和治疗状况与产后心理健康结果之间的关系，同时考虑了个体心理因素（如痛苦耐受力和韧性）和与 COVID-19 相关的健康担忧的潜在影响。在这个主要由受过高等教育和白人分娩的个体组成的样本中，五分之一的受访者在怀孕期间经历过 GAD，另有六分之一的人疑似患有 GAD 但未被诊断。在那些被诊断患有 GAD 的人中，有 30%的人未接受治疗。我们发现，那些在怀孕期间未接受治疗的 GAD 患者在产后出现了最高水平的焦虑和抑郁症状，即使在控制了协变量后也是如此，并且经历了最多的与 COVID-19 相关的健康担忧。相比之下，在怀孕期间被诊断患有 GAD 并接受治疗的患者的焦虑症状负担和抑郁症状负担显著降低，在控制了个体心理因素后，其症状负担与未确诊或疑似诊断的患者相似。我们的结论是，临床医生应该强烈考虑对产前焦虑进行筛查和治疗，以预防产后心理健康结果不佳。
