Measuring the course of anxiety in women giving birth by caesarean section: a prospective study

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Abstract

Background

Women undergoing elective caesarean section experience anxiety. However, course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies.

Methods

This is a monocentric, prospectively planned study in which 47 women with an indication for primary caesarean section took part. Anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI-trait and STAI-state), the visual analogue scale for anxiety (VASA) as well as saliva cortisol at three time points on the day of the caesarean section (at admission, at skin closure and 2 h post surgery).

Results

Peak anxiety levels for the STAI-state and VASA were highest at admission and showed significant decreases to skin closure ( p < .001). The subjective measures correlated significantly at all time points ( p-values < .001). For cortisol levels the peak level of anxiety was shown at skin closure with a significant increase from admission to skin closure and a significant decrease from skin closure to 2 h post operation ( p-values < .001). Additionally women with STAI-trait scores above the median showed significantly higher levels at the peaks of anxiety.

Conclusion

The study reveals the course of anxiety on the day of the caesarean section. A strong correlation of STAI-state and VASA was demonstrated. Cortisol showed a different course, which fits into its known biological kinetics. Taking into account all measures, anxiety seems to be most bothersome before surgery until skin closure. In a differentiated approach using STAI-trait scores as a discriminator we showed that the group with STAI-trait levels above the median is particularly prone to develop anxiety in the setting of the caesarean section and might therefore mostly be in need of an intervention against anxiety.

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Most cited references 18

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Salivary cortisol as a biomarker in stress research.

Dirk Hellhammer, Stefan Wüst, Brigitte Kudielka (2009)

Salivary cortisol is frequently used as a biomarker of psychological stress. However, psychobiological mechanisms, which trigger the hypothalamus-pituitary-adrenal axis (HPAA) can only indirectly be assessed by salivary cortisol measures. The different instances that control HPAA reactivity (hippocampus, hypothalamus, pituitary, adrenals) and their respective modulators, receptors, or binding proteins, may all affect salivary cortisol measures. Thus, a linear relationship with measures of plasma ACTH and cortisol in blood or urine does not necessarily exist. This is particularly true under response conditions. The present paper addresses several psychological and biological variables, which may account for such dissociations, and aims to help researchers to rate the validity and psychobiological significance of salivary cortisol as an HPAA biomarker of stress in their experiments.

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The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns.

Amy C. Harms, C Kindler, Daniel Scholl … (2000)

The advent of managed care, reduction of costs, and advances in medical technology place increasing demands on anesthesiologists. Preoperative anxiety may go unnoticed in an environment that stresses increased productivity. The present study compares different methods for measuring preoperative anxiety, identifies certain patient characteristics that predispose to high anxiety, and describes the quantity and quality of anxiety that patients experience preoperatively. Seven hundred thirty-four patients participated in the study. We assessed aspects of anxiety by means of visual analog scales (VAS) and the State Anxiety Score of the Spielberger State-Trait Anxiety Inventory (STAI). The mean STAI anxiety score was 39 +/- 1 (n = 486) and the mean VAS for fear of anesthesia was 29 +/- 1 (n = 539). Patients feared surgery significantly more than anesthesia (P < 0.001). The VAS measuring fear of anesthesia correlated well with the STAI score (r = 0.55; P < 0.01). Young patients, female patients, and patients with no previous anesthetic experience or a previous negative anesthetic experience had higher anxiety scores. Patients worried most about the waiting period preceding surgery and were least concerned about possible awareness intraoperatively. Factor analysis of various anxiety items showed three distinct dimensions of fear: 1) the fear of the unknown 2) the fear of feeling ill, and 3) the fear for one's life. Among these dimensions, fear of the unknown correlated highest with the anxiety measuring techniques STAI and VAS. The simple VAS proved to be a useful and valid measure of preoperative anxiety. The study of qualitative aspects of anxiety reveals three distinct dimensions of preoperative fear: fear of the unknown, fear of feeling ill, and fear for one's life. Groups of patients with a higher degree of preoperative anxiety and their specific anesthetic concerns can be identified using the visual analog scale.

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Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety.

Rany Abend, Orrie Dan, Keren Maoz … (2014)

Assessment of state anxiety is frequently required in clinical and research settings, but its measurement using standard multi-item inventories entails practical challenges. Such inventories are increasingly complemented by paper-and-pencil, single-item visual analog scales measuring state anxiety (VAS-A), which allow rapid assessment of current anxiety states. Computerized versions of VAS-A offer additional advantages, including facilitated and accurate data collection and analysis, and applicability to computer-based protocols. Here, we establish the psychometric properties of a computerized VAS-A.

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Author and article information

Contributors

Philip Hepp: +49 (0202) 299-30 10 , philip.hepp@helios-kliniken.de

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 18 May 2016

Publication date PMC-release: 18 May 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 113

Affiliations

[ ]Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany

[ ]Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany

[ ]Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany

[ ]Clinic for Gynecology and Obstetrics, HELIOS Universitätsklinikum Wuppertal, University Witten/Herdecke, Vogelsangstr. 109, 42109 Wuppertal, Germany

Article

Publisher ID: 906

DOI: 10.1186/s12884-016-0906-z

PMC ID: 4870728

PubMed ID: 27188222

SO-VID: 49c0a4e9-bda6-4d5e-aa4c-fc95fddce59b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 January 2016

Date accepted : 13 May 2016

Funding

Funded by: Anton-Betz-Stiftung

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: caesarean section,anxiety,stai questionnaire,visual analog scale,saliva cortisol,saliva

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: caesarean section, anxiety, stai questionnaire, visual analog scale, saliva cortisol, saliva

Measuring the course of anxiety in women giving birth by caesarean section: a prospective study

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Abstract

Background

Methods

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Conclusion

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Karger: Oncology

Most cited references 18

Salivary cortisol as a biomarker in stress research.

The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns.

Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety.

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