Social relations including involvement in household decision making were also found to be significant factor in previous studies [24, 35]. Lack of social support www.selleckchem.com/products/baricitinib-ly3009104.html was found to be as a risk factor in various other studies [49�C51]. The importance of social relations with husband and in-laws has been found in other cultures as well [52].Domestic violence in the form of sexual/physical as well as verbal abuse was strongly associated with antepartum depression/anxiety from a recent study from urban community in Pakistan [27]. Gender-based violence has been described as the most important predictor of depression and anxiety in women. This evidence is well documented in high-income countries [53] and is growing in low-income countries [24, 25, 27, 54].
The main strength of our study was to report the frequency of anxiety and depression as none, anxious only, depressed only, and both anxious and depressed with their associated factors, secondly, the use of clinical psychologist for the collection of data including hospital anxiety and depression scale (HADS).Limitations included hospital-based study in which prevalence cannot be determined, cross-sectional study design in which cause and effect relationship cannot be built between pregnancy and anxiety and depression status, no predetermined sample size as the study was conducted in a prespecified time, self-reported nature of the responses which might be a reason for high frequency of anxiety and depression and for other variables like satisfaction with current life, noninclusion of some important variables like heavy household work, and pregnancy symptoms.
Our study highlights that anxiety and depression are common during pregnancy. Therefore, there is a need to incorporate screening for anxiety and depression in antenatal programs and providing practical support to women during pregnancy, particularly those with a previous history of depression and who have poor family relationship. The study indicates the necessity of integrating mental health with existing maternal and child health program to ensure the health of both mother and baby.AcknowledgmentsWe would like to acknowledge the help of Dr. Hasan Hamza, Ex-Senior Instructor (research), Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan and currently PhD student at Adelaide University, Adelaide, Australia for his help in data management and preliminarily data analysis.
They would also like to acknowledge Dr. Graeme Cane, Head, Centre of English Language, Institute for Educational Development, The Aga Khan University, for reviewing the Dacomitinib paper as native English-speaking colleague. Last but not the least, they wish to acknowledge the cooperation of the respondents without whose participation this study would not have been possible.