<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_sjph-2019-0015_s_007">
<h3>Background</h3>
<p>Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment.</p></sec>

<sec id="j_sjph-2019-0015_s_008">
<h3>Methods</h3>
<p>A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning.</p></sec>

<sec id="j_sjph-2019-0015_s_009">
<h3>Results</h3>
<p>Highly educated nulliparas and those with a higher level of co-workers’ emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers’ support were statistically significantly associated with the level of depression. Attachment anxiety was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth).</p></sec>

<sec id="j_sjph-2019-0015_s_010">
<h3>Conclusions</h3>
<p>The results suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy, accessible to change. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms.</p></sec></abstract>

Background
Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment.


Methods
A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning.


Results
Highly educated nulliparas and those with a higher level of co-workers’ emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers’ support were statistically significantly associated with the level of depression. Attachment anxiety was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth).


Conclusions
The results suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy, accessible to change. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms.

Individual and contextual factors of nulliparas’ levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor?

Slovenian Journal of Public Health

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Individualni in kontekstualni dejavniki ravni depresije, anksioznosti in strahu pred porodom prvesnic v zadnji tretjini nosečnosti: partnerska navezanost kot ključni dejavnik?

Background
Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult...

	Anxiety score Std. B (p-value)	Depression score Std. B (p-value)	Fear of childbirth Std. B (p-value)
Age	-0.08 (0.166)	-0.04 (0.509)	-0.02 (0.727)
Years of education	-0.21 (<0.001)	-0.10 (0.091)	-0.05 (0.389)
Weeks of pregnancy	0.03 (0.586)	-0.08 (0.194)	-0.03 (0.664)
Planned pregnancy	-0.06 (0.347)	0.06 (0.374)	0.19 (0.005)
Multigenerational household	0.12 (0.038)	0.08 (0.172)	0.10 (0.100)
High emotional support from partner	0.05 (0.416)	0.02 (0.805)	0.12 (0.093)
High emotional support from parents	0.04 (0.481)	-0.04 (0.477)	0.06 (0.354)
High emotional support from friends	-0.11 (0.100)	-0.03 (0.708)	-0.02 (0.780)
High emotional support from co-workers	-0.21 (0.002)	-0.14 (0.044)	-0.11 (0.117)
Intimate attachment avoidance	-0.05 (0.552)	-0.01 (0.884)	0.10 (0.209)
Intimate attachment anxiety	0.40 (<0.001)	0.45 (<0.001)	0.32 (<0.001)

	n=325
Mean age±SD	30.8±4.3
Mean years of education (n=321)	16.1±2.4
Mean weeks of pregnancy (n=324)	30.8±3.5)
Planned pregnancy (n=324)	270 (83.3)
Multigenerational household (n=323)	62 (19.2)
High emotional support from partner	295 (90.8) weak to moderate support 9.2%, strong support 19.1%, very strong support 71.7%
High support from parents (n=323)	248 (76.8) weak to moderate support 23.1%, strong support 30.2%, very strong support 46.2%
High support from friends	224 (68.9) weak to moderate support 31.1%, strong support 36.0%, very strong support 32.9%
High support from co-workers (n=310)	141 (45.5) weak to moderate support 52.0%, strong support 24.0%, very strong support 19.4%
Mean attachment avoidance score (n=294)	33.4±12.9
Mean attachment anxiety score (n=285)	32.4±13.6
Mean anxiety score (n=296)	33.7±5.9
Mean depression score (n=310)	6.1±4.2

Individual and contextual factors of nulliparas’ levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor?

Article Category: Original scientific article

Published Online: Jun 26, 2019

Page range: 112 - 119

Received: Oct 20, 2018

Accepted: May 21, 2019

DOI: https://doi.org/10.2478/sjph-2019-0015

Keywords
partner attachment, depression, anxiety, fear of childbirth, nulliparas

© 2019 National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Association between demographic, social and attachment variables and mental-health functioning during the last trimester of pregnancy.

Characteristics of nulliparas (results shown as frequency and percentages if not indicated differently).

Individual and contextual factors of nulliparas’ levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor?

Article Category: Original scientific article

Published Online: Jun 26, 2019

Page range: 112 - 119

Received: Oct 20, 2018

Accepted: May 21, 2019

DOI: https://doi.org/10.2478/sjph-2019-0015

Keywordspartner attachment, depression, anxiety, fear of childbirth, nulliparas

© 2019 National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Association between demographic, social and attachment variables and mental-health functioning during the last trimester of pregnancy.

Characteristics of nulliparas (results shown as frequency and percentages if not indicated differently).

Keywords
partner attachment, depression, anxiety, fear of childbirth, nulliparas