Screening for postpartum anxiety at the first outpatient visit post-delivery: sociodemographic and clinical insights from a Latvian cohort

Introduction: Postpartum anxiety is a critical mental health concern that can impair maternal well-being, hinder child development, and disrupt overall family dynamics. [1] Due to symptom overlap with other mood disorders and infrequent screening, maternal anxiety is often underreported. [2] Approximately 20% of women experience clinically significant anxiety symptoms during pregnancy and the postpartum period, according to statistical data. [3] However, no studies have yet investigated the occurrence or contributing associated factors of postpartum anxiety within the Latvian population.
Aim: To assess the prevalence, severity, and associated sociodemographic and clinical factors of anxiety symptoms in postpartum women at their first outpatient gynaecologist visit, 4–6 weeks after delivery.
Methods: Cross-sectional study of all consecutive women aged 18 and older who attended Riga Maternity Hospital, Latvia’s largest outpatient clinic, for a routine gynaecologist visit, 4–6 weeks after delivery. Participants were screened using the Generalized Anxiety Disorder-7 (GAD-7) scale, with anxiety severity categorised as none (GAD-7 <5), mild (scores 5–9), and moderate-to-severe (scores ≥10). Data on sociodemographic factors (e.g. age, body mass index (BMI), ethnicity, education, residence, employment, family income, financial satisfaction) and clinical/reproductive history (e.g. number of pregnancies, children <18 years, breastfeeding, abortion history, delivery types, assisted reproductive methods, perinatal complications, manipulations used during delivery, chronic and gynaecological illnesses) were collected via medical records and a comprehensive risk assessment questionnaire. Associations were analysed using chi-square tests for mild and moderate-to-severe anxiety groups.
Results: During the first 6 months, 144 women (mean age: 30.58 ± 5.64 years) were screened. GAD-7 scores were divided as follows: no anxiety - 60.4% (n=87), mild – 27.1% (n=39), and moderate-to-severe – 12.5% (n=18). Older maternal age was significantly associated with anxiety severity, with 44.44% of women aged >35 years in the moderate-to-severe group compared to 5.13% in the mild group (χ²=14.87, p=0.002), indicating an 8.6-fold higher likelihood of clinically significant anxiety. Financial dissatisfaction showed marginal significance (4.35% vs. 18.75%, χ²=8.954, p=0.062). Higher education was prevalent in both groups (91.30% vs. 93.75%) but not significantly linked to anxiety levels. A history of gynaecological illness was significantly related to anxiety severity (23% vs. 61%, χ²=7.82, p=0.005). Borderline significance was observed for perinatal complications (36% vs. 61%, χ²=3.18, p=0.075) and use of epidural anaesthesia during delivery (54% vs. 78%, χ²=2.98, p=0.084). Trends toward significance were noted for gestational diabetes (13% vs. 28%, χ2=1.90, p=0.168) and assisted fertilisation (3% vs. 11%, χ2=1.79, p=0.181). No significant associations were found with BMI, residence, ethnicity, reproductive history, or other clinical factors (all p>0.05).
Conclusion: Our findings show a high prevalence of postpartum anxiety. Older maternal age and history of gynaecological illness were identified as key associated factors of severe postpartum anxiety, with financial dissatisfaction and perinatal complications as potential risk factors warranting further research. As maternal age at childbirth rises globally, integrating routine anxiety screening into postpartum care is essential. The lack of associations with other factors may reflect the study’s preliminary nature, small sample size, or sample homogeneity. Despite limitations, these findings contribute to understanding postpartum mental health in Latvia, advocating for targeted screening.

[1] S. Ayers et al., “Assessment of perinatal anxiety: diagnostic accuracy of five measures,” 2023, doi: 10.1192/bjp.2023.174.
[2] M. J. Barry et al., “Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement,” JAMA, vol. 329, no. 24, pp. 2163–2170, Jun. 2023, doi: 10.1001/JAMA.2023.9301.
[3] Emily J. Fawcett, Nichole Fairbrother, Megan L. Cox, Ian R. White, and Jonathan M. Fawcett, “The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis,” J Clin Psychiatry. Accessed: Feb. 17, 2025. [Online]. Available: https://www.psychiatrist.com/jcp/anxiety-disorders-in-pregnant-and-postpartum-women/