Stormy clouds in seventh heaven: A study on anxiety and depression around childbirth

Approximately 10-15% of all women experience symptoms of anxiety or depression during the antenatal or postpartum period. Having elevated stress levels in the antenatal period has been associated with adverse outcomes in the child, but the mechanism behind this observation has not been found yet. Amongst the main risk factors for anxiety or depression in the antenatal or postpartum period are having a history of previous symptoms, traumatic events during childhood, recent major life events and specific personality traits. Chapters 2 and 3 of this thesis focus on the influence of traumatic events specifically during pregnancy, delivery or in the immediate postpartum period on the course of anxiety and depression in the antenatal and postpartum period.
Screening for anxiety and depression during pregnancy is generally recommended by guidelines on antenatal and postpartum anxiety or depression, although antenatal screening tools that accurately predict an individual risk on symptoms in the postpartum period are not available yet. Chapters 4 and 5 of this thesis investigate whether two commonly used tools in screening for current symptomatology can be used in predicting later symptomatology.
Treatment options for symptoms of anxiety or depression can be divided into pharmacological and non-pharmacological treatment. During the antenatal and breastfeeding period, women generally prefer non-pharmacological treatment, such as cognitive behavioral therapy. Outside pregnancy, this therapy has been proven to be successful in treating anxiety and depression. Chapter 6 focuses on a randomized controlled trial investigating the effect of cognitive behavioral therapy on pregnant women and their babies.