Longitudinal course of ante- and postpartum generalized anxiety symptoms and associated factors in West-African women from Ghana and Côte d'Ivoire

J Affect Disord. 2016 Jun;197:125-33. doi: 10.1016/j.jad.2016.03.014. Epub 2016 Mar 9.


Background: Little is known about the course of perinatal anxiety, particularly in low and middle income countries. This study aimed at examining trajectories of ante- and postpartum generalized anxiety symptoms in West-African women and their associations with mother and child characteristics.

Methods: 778 women from Côte d'Ivoire and Ghana were investigated between 04/2010 and 03/2014. Anxiety symptoms were measured using the seven-item Generalized Anxiety Disorder scale (GAD-7) at three months antepartum and three, 12 and 24 months postpartum. Growth mixture modeling was applied to identify latent trajectory classes of anxiety. Multinomial logistic regression was used to investigate the associations of psychosocial, sociodemographic, obstetric and clinical characteristics with different trajectories.

Results: Four distinct trajectories of anxiety were identified. The majority of women (79.8%) had consistent low anxiety symptoms, while 11.4% had elevated anxiety scores before and around childbirth that decreased gradually. 5.4% of women showed increasing anxiety symptoms over time. Few women (3.3%) had transient anxiety with elevated scores at three and 12 months postpartum. Risk factors for elevated anxiety levels around childbirth were antepartum depressive symptoms, higher levels of stress (economic, marital and social stress), lower child birth weight, and multiparity. Partner support was found to be protective.

Limitations: Anxiety symptoms were assessed using a screening instrument and not through a formal diagnostic classification system. Some putative risk factors were not investigated, and some psychosocial factors were assessed retrospectively.

Conclusion: The presence of different trajectories underline the importance of monitoring anxiety symptoms in pregnant women and in mothers with infants/toddlers.

Keywords: Ante- and postpartum; Childbirth; Generalized anxiety disorder; Latent class models; Longitudinal study; Maternal health; Pregnancy; Sub-Saharan Africa.

MeSH terms

  • Adult
  • Anxiety / psychology*
  • Anxiety Disorders / diagnosis*
  • Anxiety Disorders / psychology
  • Cote d'Ivoire
  • Depression / diagnosis
  • Depression, Postpartum / diagnosis*
  • Depression, Postpartum / psychology
  • Female
  • Ghana
  • Humans
  • Longitudinal Studies
  • Mothers / psychology*
  • Postpartum Period / psychology*
  • Pregnancy
  • Pregnant Women / psychology*
  • Risk Factors
  • Severity of Illness Index
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology*