Family concerns and relationship problems in anxious pregnant women and their associations with postnatal functional disability in Pakistan

Soim Park; Carlued Leon; Ahmed Zaidi; Abid Malik; Atif Rahman; Pamela J Surkan

doi:10.1016/j.jpsychores.2024.111674

Family concerns and relationship problems in anxious pregnant women and their associations with postnatal functional disability in Pakistan

J Psychosom Res. 2024 Apr 15:181:111674. doi: 10.1016/j.jpsychores.2024.111674. Online ahead of print.

Authors

Soim Park¹, Carlued Leon², Ahmed Zaidi³, Abid Malik⁴, Atif Rahman⁵, Pamela J Surkan⁶

Affiliations

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: soim.park@jhu.edu.
² Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: cleonal1@jhu.edu.
³ Human Development Research Foundation, Islamabad, Pakistan. Electronic address: ahmed.zaidi@hdrfoundation.org.
⁴ Department of Public Mental Health, Health Services Academy, Chak Shahzad, Islamabad, Pakistan. Electronic address: abid.malik@hsa.edu.pk.
⁵ Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom. Electronic address: atif.rahman@liverpool.ac.uk.
⁶ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: psurkan@jhu.edu.

PMID: 38663268
DOI: 10.1016/j.jpsychores.2024.111674

Abstract

Objective: Expanding on existing research suggesting that strategies to reduce prenatal anxiety can decrease functional disability (e.g., difficulties in performing everyday activities and social participation), we examined if this effect varied by type of anxiety-producing problem (i.e., having family concerns and relationship problems versus other problems) reported during pregnancy. Further, we explored if perceived social support mediated this relationship.

Methods: We used longitudinal data on 310 anxious Pakistani women who received any psychosocial intervention sessions as part of a program that was based on Cognitive Behavioral Therapy. The Psychological Outcome Profiles (PSYCHLOPS) was used to assess whether women had 'family concerns and relationship problems' or 'other problems.' The WHO Disability Assessment Schedule 2.0 assessed functional disability at six-weeks after delivery. Lack of support was measured using a 12-item Multi-dimensional Scale of Perceived Social Support. We employed linear regression to examine associations between types of problems reported during pregnancy and postnatal functional disability. Causal mediation analysis was used to assess whether postnatal social support mediated this relationship.

Results: Of anxious pregnant women, 34% reported family concerns or relationship problems as primary problems in pregnancy. They were more likely to report higher functional disability at six-weeks after delivery than women who reported other problems (adjusted B = 2.40, 95% CI: 0.83-3.97). Lack of overall social support (Estimate_indirect = 0.69, 95% CI: 0.04-1.38) and lack of support from friends (Estimate_indirect = 0.62, 95% CI: 0.01-1.29) significantly mediated the relationship.

Conclusions: Findings suggest that complementing pre- and post-natal care with support programs and services that address family concerns and relationship problems, as well as enhancing social support is important to functional disability.

Keywords: Causal mediation analysis; Family concerns; Functional disability; Low-and-middle-income countries; Pregnant women; Prenatal anxiety; Relationship problems.