Understanding and measuring pregnancy-related anxiety in low- and middle-income contexts: A pilot study in northern Ghana

妇女在怀孕期间的焦虑是普遍存在的，并且与母亲及其子女的精神和身体健康状况不佳有关。有一种焦虑似乎尤其成问题，那就是对怀孕本身的焦虑。我们对低收入和中等收入国家（LMICs）的这类焦虑知之甚少。然而，我们所知道的表明，与高收入国家的妇女相比，中低收入国家的妇女与妊娠相关的焦虑可能有所不同：中低收入国家的妇女更关心医疗保健、疾病和孕产妇死亡率。尽管高收入人群和低收入人群在妊娠相关焦虑方面存在这些差异，但在任何低收入人群中都没有这种结构的测量方法得到验证。综上所述，这表明：1)孕产妇死亡率可能对中低收入国家妇女的妊娠相关焦虑更为重要；2)在不同的背景下，妊娠相关焦虑的领域存在差异；3)用于测量高收入国家孕妇妊娠相关焦虑的量表可能无法有效测量中低收入国家妇女的妊娠相关焦虑，因为它们可能无法捕捉到这种焦虑的所有当地相关成分。拟议的项目将通过以下研究问题来解决这个问题：1。妊娠相关焦虑的程度在不同地区以及孕产妇和新生儿死亡率之间有何差异？在加纳北部的背景下，怀孕相关焦虑是如何被概念化的？在加纳北部地区，我们如何有效地衡量与怀孕有关的焦虑？为了回答这些问题，我们将首先系统地回顾有关产前焦虑的研究。这将使我们能够清楚地了解与怀孕有关的焦虑程度，包括澄清我们在知识方面的地理差距，并了解其与死亡率的关系。然后，我们将采用自下而上的方法，与150名妇女进行焦点小组讨论，调查加纳妇女怀孕相关焦虑的领域。我们将利用这种增强的理解来告知妊娠相关焦虑量表的适应性。我们将根据具体情况调整这一措施，然后通过对加纳北部575名孕妇的调查研究对其进行验证。这种适应文化的措施将允许对加纳妇女的妊娠相关焦虑进行更准确和可靠的筛查。我们将以加纳北部地区作为解决目标2和3的范例。我们选择这里是因为：1)焦虑症状在怀孕的加纳妇女中很常见，其中11%患有广泛性焦虑症。2)本区域孕产妇和新生儿死亡率高。了解并最终解决她们在怀孕期间的心理健康问题，可能会降低这些比率。3) 97.7%的北部地区妇女接受产前保健。减少妊娠相关焦虑的干预措施通常在卫生保健机构进行，因此本区域非常适合开展今后的干预工作。4)我们的研究团队在该地区有许多合作，因此在交付这个项目方面处于有利地位。本项目的结果将是更清楚地了解妊娠相关焦虑的基础，以及如何在低收入和中等收入国家背景下准确地测量它。如果不清楚这种焦虑背后的原因，我们就无法制定有效的干预措施，如果没有对这种焦虑的良好测量，我们就无法测试这些干预措施是否有效。该项目直接解决这两个问题，从而为今后促进怀孕期间的心理健康和福祉以及降低相关的孕产妇死亡率和发病率的工作铺平道路。这显然符合联合国可持续发展目标3——促进健康和福祉。

Background Women's anxiety during pregnancy is widespread and has been associated with poor mental and physical health outcomes for both mothers and their children. One type of anxiety which seems to be particularly problematic is anxiety about the pregnancy itself. We know little about this type of anxiety in low- and middle-income countries (LMICs). However, what we do know suggests that pregnancy-related anxiety may differ for women in LMICs as compared to women in high-income countries: women in LMICs are more concerned about healthcare access, disease, and maternal mortality. Despite these differences in pregnancy-related anxiety between high-income and LMIC contexts, no measures of this construct have been validated in any LMIC. Together, this suggests that: 1) maternal mortality may be more important to the pregnancy-related anxiety of women in LMICs, 2) there is variation in domains of pregnancy-related anxiety in different contexts, and 3) the scales which are developed to measure pregnancy-related anxiety in pregnant women in high-income countries may not be effective in measuring this anxiety in women in LMICs because they may not be capturing all locally-relevant components of this anxiety. Objectives The proposed project will address this through the following research questions: 1. How do levels of pregnancy-related anxiety differ by region and by maternal and neonatal mortality rates?2. How is pregnancy-related anxiety conceptualized in the northern Ghanaian context?3. How can we effectively measure pregnancy-related anxiety in the Northern Region of Ghana?To answer these questions, we will first systematically review research on prenatal anxiety. This will allow us to get a clear overview of levels of pregnancy-related anxiety, including clarifying geographic gaps in our knowledge and understanding its links with mortality. We will then apply a bottom-up approach, using focus group discussions with 150 women to investigate the domains of pregnancy-related anxiety in Ghanaian women. We will use this enhanced understanding to inform the adaptation of the Pregnancy-Related Anxiety Scale. We will adapt this measure to context and then validate it using a survey study of 575 pregnant women in northern Ghana. This culturally-adapted measure will allow for more accurate and reliable screening for pregnancy-related anxiety in Ghanaian women. We will use Northern Region of Ghana as an exemplar in addressing Objectives 2 and 3. We have chosen this location because: 1) Symptoms of anxiety are common among pregnant Ghanaian women, with 11% having a generalized anxiety disorder.2) Rates of maternal and neonatal mortality are high in this Region. Understanding - and ultimately, addressing - their mental health during pregnancy has the potential lead to reductions in these rates.3) 97.7% of women in the Northern Region receive antenatal care. Interventions to reduce pregnancy-related anxiety are commonly conducted in healthcare settings, and so this Region is well-suited for future intervention work.4) Our study team have a number of collaborations together in this Region, and thus are well-placed to deliver this project. Significance The outcome of this project will be a clearer understanding what underlies pregnancy-related anxiety and how to accurately measure it in LMIC contexts. Without a clear understanding of what underlies this anxiety, we cannot develop effective interventions, and without good measures of this anxiety, we cannot test whether those interventions are effective. This project directly addresses both of those issues and thus will pave the way for future work promoting mental health and wellbeing during pregnancy and reducing associated maternal mortality and morbidity. It is clearly aligned with the UN Sustainable Development Goal #3 of promoting health and wellbeing.