Fear of childbirth; the relation to anxiety and depression

Objective. To study the associations of anxiety and depression with fear of childbirth. Design. A cross-sectional questionnaire study. Setting. Prenatal public healthcare in Norway. Sample. Pregnant women (n=1642) recruited during November 2008 until April 2010. Methods. Data were collected by a postal questionnaire at pregnancy week 32. Fear of childbirth was measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ) and by a numeric rating scale. Symptoms of anxiety were measured by the Hopkins Symptom Check List (SCL-25) and symptoms of depression by the Edinburgh Postnatal Depression Scale (EPDS). Main outcome measure. Fear of childbirth. Results. Eight per cent (137 of 1642) of the women had fear of childbirth (W-DEQ=85), 8.8% (145 of 1642) had anxiety (SCL-anxiety=18) and 8.9% (146 of 1642) had depression (EPDS=12). More than half (56.2%) of the women with fear of childbirth did not have anxiety or depression; however, presence of anxiety or depression increased the prevalence of fear of childbirth (odds ratio 2.4, 95% confidence interval 1.15.2 and odds ratio 8.4, 95% confidence interval 4.814.7, respectively). Women with both anxiety and depression had the highest prevalence of fear of childbirth (odds ratio 11.0, 95% confidence interval 6.618.3). Similar associations of anxiety and depression were estimated by using the numerical rating scale for measuring fear of childbirth. Conclusions. Presence of anxiety and depression increased the prevalence of fear of childbirth; however, the majority of women with fear of childbirth had neither anxiety nor depression.