Anxiety, Depression, and Pain in the Perinatal Period: A Review for Obstetric Care Providers

Importance Maternal depression and anxiety may not only increase vulnerability for the development of postpartum depression and anxiety but may increase the perception of obstetric pain. Objective This review focuses on the relationship among depression, anxiety, and pain during pregnancy and postpartum. We will first review common clinical screening tools for depression, anxiety, and pain. Then, the existing evidence describing the relationship of depression, anxiety, and pain will be covered. Evidence Acquisition Queries for publications in PubMed, Google Scholar, and the CINAHL (Cumulative Index to Nursing and Allied Health Literature) were completed. Both searches were limited to publications within the last 20 years. Literatures on subtopics obtained from the references of publications identified in the initial search were not limited by publication year. Results A total of 19 total publications were identified regarding postpartum depression and pain; 17 were identified in the initial search, and 2 related to postpartum depression, anxiety, and pain were found by reviewing references. Eleven studies were identified regarding postpartum anxiety and pain; 4 were found in the original search, and 7 were identified by reviewing the references. Conclusions and Relevance The relationship between postpartum depression and pain is well characterized in the literature. However, the relationship between postpartum anxiety and pain is less well defined, and further research is needed. The interaction between maternal mental health and pain emphasizes the importance of screening for these conditions and also counseling and educating patients about expectations regarding intrapartum and postpartum pain. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the reader should be better able to identify the high prevalence of anxiety and depression in the pregnant and postpartum population; describe the strengths and limitations of the existing tools to screen for depression, anxiety, and pain during pregnancy and the postpartum period; explain the existing literature describing the relationship between depression and pain during pregnancy and the postpartum period, and recommend interventions to reduce the amplifying effect of these 2 exposures; and summarize the limited existing literature describing the relationship between anxiety and pain during pregnancy and the postpartum period, with a goal of designing future interventions to reduce the effect of these 2 exposures.