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General Hospital Psychiatry 32 (2010) 213 – 215

Short Communications
Is pregnancy associated with mood and anxiety disorders?
A cross-sectional study
Faruk Uguz, M.D.a,⁎, Kazim Gezginc, M.D.b , Fatih Kayhan, M.D.a ,
Serap Sarı, M.D.a , Derya Büyüköz, M.D.a
a
Department of Psychiatry, Meram Faculty of Medicine, Selçuk University, 42080 Konya, Turkey
b
Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Selçuk University, 42080 Konya, Turkey
Received 9 September 2009; accepted 3 November 2009

Abstract

Objective: To compare current prevalence of mood and anxiety disorders in pregnant and nonpregnant women.
Method: The study sample included 309 pregnant women and 107 control subjects. Mood and anxiety disorders were determined by
structured clinical interviews.
Results: The rate of any mood or anxiety disorder was 19.4% in the pregnant women. Major depression (5.5%) and obsessive-compulsive
disorder (5.2%) were the most common diagnoses in the pregnant women. There was no significant difference between pregnant and
nonpregnant women with respect to the prevalence rate of mood and anxiety disorders.
Conclusion: The results suggest that pregnancy is not a risk factor for the development of mood and anxiety disorders.
© 2010 Elsevier Inc. All rights reserved.

Keywords: Pregnancy; Mood disorder; Anxiety disorder

1. Introduction disorder at the third month of pregnancy in Italy. This rate

In the last two decades, the relationship between
psychiatric disorders and reproductive events (e.g., menar-
che, pregnancy, delivery and menopause) in women has
been investigated in more detail. However, these associa-
tions have been more frequently examined in women in the
postnatal period compared to pregnant women.
Few available studies indicated that 19–29% of pregnant
women have at least one psychiatric disorder [1–3]. Results
of some previous studies indicate that pregnant women have
a higher prevalence rate of psychiatric disorders than what is
estimated for the general population. For example, Borri et
al. [2] found a 26.5% prevalence rate of current Axis I
⁎ Corresponding author. Selçuk Üniversitesi Meram Tıp Fakültesi,
Psikiyatri Anabilim Dalı, Meram, 42080 Konya, Turkey. Tel.: +90 332
223 6837.
E-mail address: farukuguz@gmail.com (F. Uguz).
0163-8343/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.genhosppsych.2009.11.002
has been estimated to be 4.7% among females in the general
Italian population [4]. The prevalence rate (39.0%) of
anxiety disorders among Nigerian women in late pregnancy
is greater than the 12-month prevalence rate reported in their
general population [5,6]. In addition, a meta-analysis
suggested that the rate of depression during the second and
third trimesters is higher than that observed in the general
female population [7]. On the other hand, other reports
indicate that pregnancy is not associated with an increased
risk of the most prevalent mental disorders [8,9].
When the available data were considered, it was not
clear whether pregnancy could be considered as a risk
factor for the development of psychiatric disorders. A
deficiency of comparative studies between pregnant and
nonpregnant women with respect to psychiatric morbidity
seems to be an important reason of this dichotomy. The
objective of the current study was to compare current
prevalence of mood and anxiety disorders in pregnant and
nonpregnant women.
214 F. Uguz et al. / General Hospital Psychiatry 32 (2010) 213–215

2. Methods Whitney U test was used. Statistical significance was

A total of 388 pregnant women attending the Obstetric
Outpatient Clinic of Meram Faculty of Medicine of Selcuk
University were selected for the present study. The selection
included the first four pregnant women who were admitted to
the outpatient clinic in each study day. Fifty-five women
refused to participate in the study. Twenty-four of the
remaining 333 women were excluded from the study due to
the existence of severe medical problems (e.g., uncontrolled
endocrine abnormalities, cardiovascular and pulmonary
system diseases), fetal malformation, uncontrolled pregnan-
cy complications (e.g., preeclampsia, imminent abortion).
The final study sample was therefore composed of 309
pregnant women. The study sample also included 107
control nonpregnant premenopausal women with similar
sociodemographic features to the pregnant women. The
control group was gathered from hospital personnel and their
relatives without gynecological or other medical diseases.
The study was approved by the ethics committee of Meram
Faculty of Medicine of Selcuk University.
Initially, the objectives and procedures of the study were
explained to all participants, and written informed consent
forms were obtained. After the sociodemographic char-
acteristics and results of obstetric evaluation were recorded
at the obstetric outpatient clinic, the participants were
referred to psychiatrists. The Structured Clinical Interview
for the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (SCID-I) [10,11] was performed
for the diagnosis of mood and anxiety disorders during
psychiatric examination. The gestational week was deter-
mined with ultrasound screening on the basis of the last
menstruation date.
The data was analyzed with SPSS 13.0 for Windows
(SPSS, Inc., Chicago, IL, USA). Chi-square test and Fisher's
Exact Tests, as necessary, were performed to compare
categorical variables. Kolmogorov–Smirnov test was used to
analyze whether test distributions were normal. For contin-
uous variables exhibiting abnormal distribution, the Mann–
accepted as Pb.05.
3. Results
Most of the participants were married (99.3%) and
primary school (74.8%) graduates. The mean duration of
pregnancy was 23.26±9.56 weeks. The trimester of the
pregnancy among the pregnant women was follows: first in
58 (18.8%) women, second in 131 (42.4%) women and third
in 120 (38.8%) women. There was no significant difference
for age (P=.181), education (P=.176), marital status
(P=1.000) and numbers of children (P=.364) between the
pregnant and nonpregnant women.
Of the 309 pregnant women, 19.4% (n=60) had at least
one current mood or anxiety disorder, whereas this rate was
18.7% (n=20) in nonpregnant women. Prevalence rates of
any mood and any anxiety disorder were 5.2% and 15.5% in
the first trimester, 4.6% and 7.6% in the second trimester and
13.3% and 24.2% in the third trimester, respectively. Major
depression (5.5%) and obsessive-compulsive disorder
(5.2%) were the most common two disorders in the pregnant
women. Posttraumatic stress disorder and bipolar disorder
were not established in the study groups.
The statistical tests indicated that difference between
pregnant and nonpregnant women with regard to socio-
demographic characteristics and prevalence of mood and
anxiety disorders was not statistically significant (Table 1).
4. Discussion
To our knowledge, this is the first comparative study about
the frequency of psychiatric disorders in pregnant women in
Turkey. Previous reports from clinical studies indicate 8.8%
to 13.4% [1–3,12] and 4.4% to 39.0% [1–3,5,12] current
prevalence of mood and anxiety disorders, respectively, in
pregnant women. These reports are consistent with our

Table 1
Mood and anxiety disorders in the pregnant and nonpregnant women
Pregnant women (n=309) Nonpregnant women (n=107) Odds ratio (95% CI) P valuea
Axis I diagnoses
Major depression 17 (5.5) 5 (4.7) 1.17 (0.44–3.11) 1.000
Dysthymic disorder 8 (2.6) 1 (0.9) 2.77 (0.35–21.89) 0.458
Bipolar disorder – (–) – (–) – –
Panic disorder 6 (1.9) 1 (0.9) 2.07 (0.25–17.06) .683
Obsessive-compulsive disorder 16 (5.2) 3 (2.8) 1.84 (0.55–6.21) .425
Social phobia 10 (3.2) 3 (2.8) 1.15 (0.32–2.92) 1.000
Specific phobia 10 (3.2) 5 (4.7) 0.68 (0.24–1.96) .547
Posttraumatic stress disorder – (–) – (–) – –
Generalized anxiety disorder 11 (3.6) 4 (3.7) 0.95 (0.31–2.92) 1.000
Any mood disorder 25 (8.1) 8 (7.5) 1.04 (0.66–1.64) 1.000
Any anxiety disorder 48 (15.5) 16 (15.0) 1.04 (0.62–1.75) 1.000
Any mood or anxiety disorder 60 (19.4) 20 (18.7) 1.08 (0.50–2.33) 1.000
a
Fisher's Exact Test.
 F. Uguz et al. / General Hospital Psychiatry 32 (2010) 213–215
prevalence rates (8.1% for mood disorders and 15.5% for
anxiety disorders). Similarly, Vesga-López et al. [9] reported
that the 12-month prevalence rate of any mood and any
anxiety disorder was 13.3% and 13.0%, respectively, in
women who were pregnant in the past year and in
nonpregnant women in the general population.
To our knowledge, there is only one study in the literature
that was conducted in a clinical setting and that included a
nonpregnant control group. Adewuya et al. [5] found a
higher prevalence rate of any anxiety disorder and social
phobia in pregnant women compared to control subjects.
Similar to our results, they also noted that the rates of panic
disorder and obsessive-compulsive disorder in pregnant
women were three times higher than those in nonpregnant
controls, although the difference was not found to be
statistically significant. However, Adewuya et al. [5] did not
assess mood disorders in their study.
In conclusion, our results suggest that pregnancy is not
associated with mood or anxiety disorders in our population.
However, a cross-sectional design and relatively small
sample size do not allow for a generalization of this
conclusion. For this reason, multicenter and prospective
controlled studies should be carried out on this topic.
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