Participants’ characteristics
All the participants were aged 18–40 years (mean=28.3) with a mean gestational age of 25.08 weeks. The mean scores of depression, anxiety, and stress were 8.43±7.40, 10.01±7.61, and 13.13±8.82, respectively. Most (76.3%) of the participants had planned pregnancy, and almost half of them (52.9) were multiparous. Furthermore, most (85.0) of the participants were housewives, 39% had a college degree or above, 50% had a high school education, and 10% had a secondary school degree or below.
The data regarding the other variables such as duration of marriage, satisfaction with income, history of abortion, complications in previous pregnancy, fear of fetal abortion, and satisfaction with foreplay and BI is shown in Table 2.
Table 2 Descriptive statistics for all participant characteristics (n=295)
Participant characteristics
|
N (%)
|
Mean± SD (range)
|
Demographic factors
|
Age(y)
|
-
|
28.3± 5.27 (18-40)
|
Duration of marriage(y)
|
-
|
6.04± 4.75 (1-22)
|
Education level
|
Primary/secondary school
|
31 (10.5)
|
-
|
High school
|
149 (50.5)
|
-
|
Undergraduate/postgraduate
|
115 (39.0)
|
-
|
Women occupation
|
Working
|
44 (14.9)
|
-
|
Housewife
|
251 (85.0)
|
-
|
Satisfaction with income
|
Low
|
73 (24.7)
|
-
|
Moderate
|
212 (71.9)
|
-
|
High
|
10 (3.4)
|
-
|
Obstetric factors
|
Parity
|
Primiparous
|
139 (47.1)
|
-
|
Multiparous
|
156 (52.9)
|
-
|
Planned pregnancy
|
Yes
|
255 (76.3)
|
-
|
No
|
70 (23.7)
|
-
|
History of abortion
|
Yes
|
65 (22)
|
-
|
No
|
230 (78)
|
-
|
Complication in previous pregnancy
|
Yes
|
32 (10.8)
|
-
|
No
|
263 (89.2)
|
-
|
Fear of fetal abortion
|
Yes
|
145 (49.2)
|
-
|
No
|
150 (50.8)
|
-
|
Gestational age
|
-
|
25.08±9.09 (4-40)
|
Psychological factors
|
Satisfaction with BI in pregnancy
|
Low
|
95 (32.5)
|
-
|
Moderate
|
171 (58.0)
|
-
|
High
|
29 (9.8)
|
-
|
Satisfaction with foreplay
|
Yes
|
267 (90.5)
|
-
|
No
|
28 (9.5)
|
-
|
Sexual distress
|
-
|
5.55±6.56 (0-52)
|
Genital Self-Image
|
-
|
19.98±3.97 (7-28)
|
Depression
|
-
|
8.43±7.40 (0-36)
|
Anxiety
|
-
|
10.01±7.61 (0-40)
|
Stress
|
-
|
13.13±8.82 (0-42)
|
Effect of SD and GSI on depression, anxiety, and stress
One-way ANOVA showed significant differences in the average score of SD among the groups with varying degrees of depression, anxiety, and stress. As the SD score increased, the intensity of each of the variables of depression, anxiety, and stress also raised (p< 0.001). Moreover, the mean score of GSI had a significant negative association with the degrees of depression (p= 0.011) and anxiety (p< 0.001). In other words, decreased mean score of GSI (poor GSI) was associated with increased severity of depression and anxiety (Table 3).
Table 3 The relationship between GSI, SD and stress, anxiety, depression
Variables
|
Categories
|
n (%)
|
Genital self-image
|
Sexual distress
|
Mean(SD)
|
p-value
|
ANOVA (F)
|
Mean(SD)
|
p-value
|
ANOVA (F)
|
Stress
|
Normal
|
182(61.7)
|
20.16 (3.8)
|
0.24
|
F=1.36
|
3.97 (4.2)
|
< 0.001
|
F=14.50
|
Mild
|
42(14.2)
|
20.55 (3.1)
|
5.46 (5.5)
|
Moderate
|
38(12.9)
|
19.29 (3.6)
|
7.66 (10.9)
|
Sever
|
26(8.8)
|
18.65 (4.8)
|
11.19 (6.7)
|
Very sever
|
7(2.4)
|
20.57 (3.7)
|
15.29 (8.8)
|
Anxiety
|
Normal
|
117(39.7)
|
20.16 (3.8)
|
< 0.001
|
F=5.33
|
3.50 (6.37)
|
< 0.001
|
F=11.81
|
Mild
|
32(10.8)
|
20.55 (3.1)
|
4.53 (4.3)
|
Moderate
|
77(26.1)
|
19.29 (4.6)
|
6.10 (5.5)
|
Sever
|
38(12.9)
|
18.65 (4.8)
|
6.55 (6.01)
|
Very sever
|
31(10.5)
|
20.57 (3.7)
|
11.74 (8.1)
|
Depression
|
Normal
|
173(58.6)
|
20.60 (4.0)
|
0.011
|
F=3.34
|
3.83 (5.6)
|
< 0.001
|
F=14.2
|
Mild
|
58(19.7)
|
19.41 (3.1)
|
6.79 (7.0)
|
Moderate
|
41(13.9)
|
19.27 (3.9)
|
6.76 (5.5)
|
Sever
|
14(4.7)
|
19.50 (4.2)
|
11.86 (5.7)
|
Very sever
|
9(3.1)
|
18.78 (4.6)
|
15.33 (9.0)
|
ANOVA = Analysis of Variance
There were two exceptions in the relationship between GSI score and stress and anxiety. Therefore, Post Hoc Tukey’s test was used. According to Post Hoc Tukey’s test, the difference between the mean GSI scores in the group with severe anxiety and in the group with very severe anxiety was statistically significant (p=.024), but the difference in the mean GSI scores between the group with severe stress and other groups was not statistically significant (p>0.05).
The factors influencing maternal depression, anxiety and stress during pregnancy
The results of univariate and multivariate linear regression regarding the association between the related variables and depression, anxiety and stress are presented in Tables 4,5, and 6, respectively.
Women's level of education and history of abortion were not significantly associated with antenatal depression and anxiety in the univariate linear regression analysis (p<0.25), so they were not included in the multivariate linear regression analysis. According to multivariate linear regression analysis, a higher (worse) depression score was seen in women with more advanced age (β = 0.218, p=0.001, i.e., 0.218 points higher for each unit higher women's age) and among women with greater SD scores ([β = 0.285, p< 0.001, i.e., 0.285 points higher for each unit higher SD score). Depression score was associated with GSI score (β = -0.118, p=0.023), planned pregnancy (β = -0.128, p=0.014), satisfaction with income (β = -0.122, p=0.023), and satisfaction with BI in pregnancy (β = -0.145, p=0.014) in multivariate linear regression analysis, such that lower (better) depression scores were observed among women with higher (better) GSI score, women with planned pregnancy, moderate satisfaction with income, and moderate satisfaction with BI in pregnancy (Table 4).
Table 4 Univariate and multivariate linear regression examining related factors of depression among Iranian pregnant women (N = 295)
Participant characteristics
|
Univariate linear regression
|
Multivariate linear regression
|
Unstandard/ β
|
Standard/ Beta
|
p-value
|
Unstandard/ β
|
Standard/ Beta
|
p-value
|
Age(y)
|
0.330
|
0.235
|
< 0.001
|
0.307
|
0.218
|
0.001
|
Duration of marriage(y)
|
0.291
|
0.187
|
0.001
|
-0.154
|
-0.099
|
0.152
|
Education level
Primary/secondary school
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
High school
|
1.136
|
0.765
|
0.439
|
Undergraduate/postgraduate
|
0.782
|
0.051
|
0.603
|
Women occupation
Working
|
-
|
-
|
-
|
-
|
-
|
-
|
Housewife
|
1.731
|
0.083
|
0.153
|
1.601
|
0.077
|
0.134
|
Satisfaction with income
Low
|
-
|
-
|
-
|
-
|
-
|
-
|
Moderate
|
-4.715
|
-0.286
|
< 0.001
|
-2.020
|
-0.122
|
0.023
|
High
|
-7.054
|
-0.172
|
0.004
|
-2.747
|
-0.067
|
0.197
|
Parity
Primiparous
|
-
|
-
|
-
|
-
|
-
|
-
|
Multiparous
|
2.903
|
0.196
|
0.001
|
1.655
|
0.111
|
0.064
|
Planned pregnancy
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
-3.523
|
-0.203
|
< 0.001
|
-2.232
|
-0.128
|
0.014
|
History of abortion
No
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
Yes
|
0.676
|
0.038
|
0.517
|
Complication in previous pregnancy
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
5.199
|
0.219
|
< 0.001
|
2.410
|
0.101
|
0.053
|
Fear of fetal abortion
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
3.175
|
0.251
|
< 0.001
|
1.473
|
0.099
|
0.070
|
Gestational age
|
-0.076
|
-0.094
|
0.107
|
-0.099
|
-0.122
|
0.018
|
Satisfaction with BI in pregnancy
Low
|
-
|
-
|
-
|
-
|
-
|
-
|
Moderate
|
-3.429
|
-0.229
|
< 0.001
|
-2.176
|
-0.145
|
0.014
|
High
|
-5.202
|
-0.209
|
0.002
|
-2.189
|
-0.088
|
0.120
|
Satisfaction with foreplay
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
-3.553
|
-0.141
|
0.015
|
-0.446
|
-0.017
|
0.731
|
Sexual distress
|
0.483
|
0.429
|
< 0.001
|
0.322
|
0.285
|
< 0.001
|
Genital Self-Image
|
-0.435
|
-0.234
|
< 0.001
|
-0.221
|
-0.118
|
0.023
|
NI = Not Included in the multivariate linear regression
Regarding anxiety, the following influencing factors were found to be statistically significant in multivariate linear regression analysis: SD score (β = 0.204, p< 0.001), fear of fetal abortion (β = 0.207, p< 0.001) women's age (β = 0.170, p= 0.013), women’s occupation (β = 0.124, p= 0.021), gestational age (β = -0.172, p= 0.001), moderate satisfaction with income (β = -0.154, p= 0.007), moderate satisfaction with BI in pregnancy (β = -0.187, p= 0.003), such that higher (worse) anxiety score was obtained by women with higher (worse) SD scores, women with fear of fetal abortion, housewives, and women with more advanced age; in addition, lower (better) anxiety score was noted among women with increased gestational age and those with moderate satisfaction with income and moderate satisfaction with BI in pregnancy (Table 5).
Table 5 Univariate and multivariate linear regression examining related factors of anxiety among Iranian pregnant women (N = 295)
Participant characteristics
|
Univariate linear regression
|
Multivariate linear regression
|
Unstandard/ β
|
Standard/ Beta
|
p-value
|
Unstandard/ β
|
Standard/ Beta
|
p-value
|
Age(y)
|
0.261
|
0.181
|
0.002
|
0.246
|
0.170
|
0.013
|
Duration of marriage(y)
|
0.313
|
0.196
|
0.001
|
0.054
|
0.033
|
0.641
|
Education level
Primary/secondary school
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
High school
|
-1.322
|
-0.089
|
0.384
|
Undergraduate/postgraduate
|
-1.230
|
-0.078
|
0.426
|
Women occupation
Working
|
-
|
-
|
-
|
-
|
-
|
-
|
Housewife
|
2.847
|
0.133
|
0.022
|
2.655
|
0.124
|
0.021
|
Satisfaction with income
Low
|
-
|
-
|
-
|
-
|
-
|
-
|
Moderate
|
-4.589
|
-.271
|
< 0.001
|
-2.605
|
-0.154
|
0.007
|
High
|
-7.361
|
-.175
|
0.003
|
-3.382
|
-0.080
|
0.140
|
Parity
Primiparous
|
-
|
-
|
-
|
-
|
-
|
-
|
Multiparous
|
1.685
|
0.111
|
0.058
|
0.220
|
0.014
|
0.818
|
Planned pregnancy
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
-2.455
|
1.137
|
0.018
|
-1.099
|
-0.061
|
0.256
|
History of abortion
No
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
Yes
|
-0.057
|
-0.003
|
0.958
|
Complication in previous pregnancy
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
3.981
|
0.163
|
0.005
|
1.111
|
0.045
|
0.406
|
Fear of fetal abortion
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
4.314
|
0.284
|
< 0.001
|
3.149
|
0.207
|
< 0.001
|
Gestational age
|
-0.147
|
-0.176
|
0.002
|
-0.144
|
-0.172
|
0.001
|
Satisfaction with BI in pregnancy
Low
|
-
|
-
|
-
|
-
|
-
|
-
|
Moderate
|
-2.729
|
-0.177
|
0.005
|
-2.890
|
-0.187
|
0.003
|
High
|
-3.682
|
-0.144
|
0.022
|
-2.214
|
-0.086
|
0.143
|
Satisfaction with foreplay
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
-1.800
|
-0.069
|
0.235
|
1.036
|
0.039
|
0.458
|
Sexual distress
|
0.433
|
0.373
|
< 0.001
|
0.237
|
0.204
|
< 0.001
|
Genital Self-Image
|
-0.167
|
-0.087
|
0.134
|
0.030
|
0.016
|
0.767
|
NI = Not Included in the multivariate linear regression
In the univariate linear regression analysis of antenatal stress, the variables that were not significantly associated with stress score included women's occupation, women's education level, and history of abortion. Finally, the significant factors influencing stress during pregnancy in multivariate linear regression analysis were SD (β = 0.347, p< 0.001), women's age (β = 0.139, p= 0.028), complications in previous pregnancy (β = 0.160, p= 0.002), planned pregnancy (β = -0.194, p< 0.001), and gestational age (β = -0.124, p= 0.016), such that higher (worse) stress scores were found among women with higher (worse) SD scores, more advanced age, and experience of complications in previous pregnancies; besides, lower (better) stress scores were obtained by women with increased gestational age and those with planned pregnancy (Table 6).
Table 6 Univariate and multivariate linear regression examining related factors of stress among Iranian pregnant women (N = 295)
Participant characteristics
|
Univariate linear regression
|
Multivariate linear regression
|
Unstandard/ β
|
Standard/ Beta
|
p-value
|
Unstandard/ β
|
Standard/ Beta
|
p-value
|
Age(y)
|
0.384
|
0.229
|
< 0.001
|
0.233
|
0.139
|
0.028
|
Duration of marriage(y)
|
0.409
|
0.220
|
< 0.001
|
0.113
|
0.061
|
0.368
|
Education level
Primary/secondary school
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
High school
|
1.055
|
0.059
|
0.546
|
Undergraduate/postgraduate
|
1.850
|
0.102
|
0.302
|
Women occupation
Working
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
Housewife
|
0.682
|
0.028
|
0.637
|
Satisfaction with income
Low
|
-
|
-
|
-
|
-
|
-
|
-
|
Moderate
|
-4.360
|
-0.222
|
< 0.001
|
-1.361
|
-0.069
|
0.197
|
High
|
-7.720
|
-0.158
|
0.008
|
-3.895
|
-0.080
|
0.122
|
Parity
Primiparous
|
-
|
-
|
-
|
-
|
-
|
-
|
Multiparous
|
1.584
|
0.090
|
0.124
|
-1.110
|
-0.062
|
0.296
|
Planned pregnancy
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
-4.406
|
-0.213
|
< 0.001
|
-4.033
|
-0.194
|
< 0.001
|
History of abortion
No
|
-
|
-
|
-
|
NI
|
NI
|
NI
|
Yes
|
-0.260
|
-0.012
|
0.835
|
Complication in previous pregnancy
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
6.940
|
0.245
|
< 0.001
|
4.546
|
0.160
|
0.002
|
Fear of fetal abortion
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
4.134
|
0.235
|
< 0.001
|
1.609
|
0.091
|
0.097
|
Gestational age
|
-0.144
|
-0.148
|
0.011
|
-0.120
|
-0.124
|
0.016
|
Satisfaction with BI in pregnancy
Low
|
-
|
-
|
-
|
-
|
-
|
-
|
Moderate
|
-2.830
|
-0.158
|
0.012
|
-1.624
|
-0.091
|
0.124
|
High
|
-3.985
|
-0.134
|
0.032
|
-0.669
|
-0.022
|
0.688
|
Satisfaction with foreplay
No
|
-
|
-
|
-
|
-
|
-
|
-
|
Yes
|
-3.492
|
-0.116
|
0.046
|
-0.934
|
-0.31
|
0.546
|
Sexual distress
|
0.628
|
0.467
|
< 0.001
|
0.467
|
0.347
|
< 0.001
|
Genital Self-Image
|
-0.273
|
-0.123
|
0.034
|
-0.032
|
-0.014
|
0.782
|
NI = Not Included in the multivariate linear regression