A Comparative Study to Assess the Anxiety Level of Hospitalized and Non- Hospitalized Antenatal women with High Risk Pregnancy at Selected Hospital, Guntur District, Andhra Pradesh

 

Palaparthi. Kaveri¹, Uppu. Jaya lakshmi²

¹B.Sc (N) Final Year Student, NRI College of Nursing, Chinnakakani, Guntur.

²Associate Professor, Department of Obstetrics and Gynecological Nursing, NRI College of Nursing, Chinnakakani, Guntur.

 

ABSTRACT:

Around the world, an anxiety symptom during pregnancy is associated with the range of negative consequences for mother and child. Pregnancy is one of the most important periods in a women’s life, as it brings along numerous changes, not only in the physical aspects, but also socially and psychologically. Fear of unknown stress, rootless feeling and daily problems connected with physical and hormonal changes can frequently lead to anxiety. Materials and Methods: A quantitative approach and descriptive design was used to assess the anxiety level of hospitalized and non- hospitalized antenatal women with high risk pregnancy at NRI General Hospital in April 2019. Total 100 antenatal mothers are divided into 50 hospitalized antenatal mothers and 50 non- hospitalized antenatal mothers were selected by convenient sampling technique. A structured anxiety questionnaire was used to collect the data. Results: The data was computed by using descriptive and inferential statistics. The results of the study revealed that, majority of the participant’s i.e. In hospitalized antenatal women 58% of them had mild anxiety, 40% of them had moderate anxiety, 2% of them had severe anxiety with a mean and standard deviation of 28.86±0.57. Chi- square had showed association between the anxiety level scores of hospitalized antenatal mother’s occupation (x²=53.11), Gravid status (x²=16.09), Parity (x²=415.28), Income per month (x²=83.19), Sources of health information (x²=387.45) and Reason for admission in the hospital (x²=85.78). As well as the non- hospitalized antenatal women 60% of them had moderate anxiety, 18%of them had mild anxiety, 4% of them had severe anxiety with a mean and standard deviation of 501.4±3. 16 Chi- square had showed association between the anxiety level scores of hospitalized antenatal mother’s Age(x²=13.85), Type of family(x²=12.03), Occupation(x²=23.69), Gravid status (x²=12.56), Parity(x²=62.3) and sources of health information (x²=16.24). Conclusion: The prevalence of antenatal anxiety identified in this study is of concern. Screening tools for detecting antenatal anxiety symptoms in high risk pregnancy is crucial.

 

 

 

 

INTRODUCTION:

Pregnancy involves the nine months or so for which a woman carries a developing embryo and fetus in her womb is for most women a time of great happiness and fulfillment. However in pregnancy, both the women and her developing child face various health risks.

 

Pregnancy is a period in which lot of metabolic and hormonal changes takes place. Individual women will vary this expectations and need during the child bearing process. Pregnancy and childbirth are special events in women’s lives and indeed in the lives of their families. This can be a time of great hope and joyful anticipation. It can also be time of fear, suffering and even death. Although pregnancy is not a disease, but a normal physiological process, it is associated with certain risks to health and survival both for the women and for the fetus she bears. These risks represent in every society and setting. In developed countries they have been largely overcome because every pregnant woman has access to special care during pregnancy and child birth. Such is not in case in many developing countries, where each pregnancy represents a journey into the unknown from which, too many women never return¹.

 

Women are more exposed to anxiety due to a lot more changes in life- First menstruation, pregnancy and then menopause.  Pregnancy is one of the most important periods in a women’s life, as it brings along numerous changes, not only in the physical aspects, but also socially and psychologically. Fear of unknown stress, rootless feeling and daily problems connected with physical and hormonal changes can frequently lead to anxiety^2.

 

Anxiety has been found to be exacerbated by uncertainty during high risk pregnancy in women suffering from a medical disorder. Therefore, a better understanding of the prevalence of Anxiety in high Risk pregnancies especially in population of women who experience hospitalization during pregnancy is essential. Although, numerous studies have examined the prevalence and Risk factors of Anxiety in pregnancy, there are limited studies that have explored the prevalence of Anxiety in high Risk pregnancy³.

 

Anxiety and anxiety disorder is a great health problem, which involves many dimensions including health, finance, family and work. Overtime, symptoms of anxiety may get worse (or) better, but usually it gets exacerbated when stress occurs. According to development of health related issues, and the increase in the cost of health care interventions, a distinct part of household income is allocated to these costs. On other hand, the fall in the value of household income,  due  to  inflation  rates,  and  economic  constraints,  leads  to  double pressure on household. Recent investigations shows that the decline of the socioeconomic level can negatively impact on the health status of individuals, while societies and mortality factors are evolve, the decline in socio-economic status of individual can remove them from access to resources that protect (or) enhance their health against harm caused by dangers. As a result, socio- economic benefits can increase the health, and reduce the health risk factors, education and occupation are two key roles in determining household income, which are important determinants, in the individual and household socio- economic status⁴_.

 

Antenatal depression and anxiety occurs in approximately 13% up of 21.7% of women respectively. Rates of antenatal anxiety among women hospitalized for obstetrical risk can be as high as 19% anxiety during pregnancy have been associated with poor maternal health behavior, including tobacco use and poor maternal weight gain and adverse birth outcomes, including pre-term labor and pre- term delivery. Anxiety during pregnancy may also adversely affect infant and child development. High risk pregnancies can exacerbate depression and anxiety and hospitalization can further increase in the stress of a high risk pregnancy women hospitalized for high risk pregnancies may therefore be at increases risk of anxiety and the subsequent adverse neonatal outcomes. Although women may have access to psychiatric professionals in the hospital settings, psychiatric consultation referral rates in inpatient obstetric settings can be as low as 0.3%⁵.

 

To date, no study in the United States has examined anxiety of life and rates of mental health treatment over the course of hospitalized among women admitted due to high risk pregnancy. In order to better understand the impact of obstetric hospitalization on women’s mental health, we assessed the following among women admitted antenatally for high risk pregnancies; rates of anxiety symptoms and changes in the Anxiety symptoms and quality of life throughout hospitalization and the rates of mental health treatment⁶.

 

OBJECTIVES OF THE STUDY:

1.     To assess the level of anxiety among hospitalized Antenatal women with high risk pregnancy.

2.     To assess the level of anxiety among non-hospitalized Antenatal women with high risk pregnancy.

3.     To compare the level of anxiety among hospitalized and non-hospitalized Antenatal women with high risk pregnancy.

4.     To evaluate the level of anxiety among hospitalized and non- hospitalized antenatal women with high risk pregnancy and their selected demographic variables.

 

HYPOTHESIS:

H₁:   Significant association will be there between the anxiety level of Hospitalized and Non-Hospitalized antenatal mothers with High Risk Pregnancy and their age.

H₂:   There will be Significant association between the anxiety level of Hospitalized and Non-Hospitalized antenatal mothers with High Risk pregnancy and their education.

H₃:   Association will be there between the anxiety level of Hospitalized and Non-Hospitalized antenatal mothers with High Risk pregnancy and their marital status.

H₄:   There will be Significant association between the anxiety level of Hospitalized and Non-Hospitalized antenatal mothers with High Risk pregnancy and their type of family.

H₅:   Significant association will be there between the anxiety level of Hospitalized and Non-Hospitalized antenatal mothers with High Risk pregnancy and their occupation.

H₆:   Association will be between the anxiety level of Hospitalized and Non-Hospitalized antenatal mothers with High Risk pregnancy and their gravid status.

H₇:   Significant association will be there between the anxiety level of Hospitalized and Non- Hospitalized antenatal mothers with High Risk pregnancy and their parity.

H₈:   Association will be between the anxiety level of Hospitalized and Non- Hospitalized antenatal mothers with High Risk pregnancy and their income per month.

H₉: There will be significant association between the anxiety level of Hospitalized and non- Hospitalized antenatal mothers with High Risk pregnancy and their sources of health information.

H₁₀: Association will be between the anxiety level of Hospitalized and non- Hospitalized antenatal mothers with High Risk pregnancy and their reason for admission in the hospital.

 

MATERIALS AND METHODS:

Research approach and design:

Quantitative research approach and descriptive research design was used to conduct the study.

 

Setting of the study:

The study was conducted at NRI General Hospital, Chinakakani, Guntur district.

 

Sample and sampling technique:

A total of 100 antenatal mothers are divided into two groups. 50 hospitalized antenatal mothers and 50 non-hospitalized antenatal mothers with high risk pregnancy were selected by convenient sampling technique.

 

Criteria for sampling selection:

Inclusion Criteria:

The present study included antenatal mother who are:

·       Able to understand read and write Telugu.

·       Available at the time of data Collection.

·       Available at antenatal OPD & WARD, NRIGH.

·       Willing to participate in the study.

 

 

 

Description of the tool:

The present study is conducted in NRI General Hospital at Chinakakani, Guntur District, Andhra Pradesh. NRI General Hospital is 1050 bedded teaching hospital with 46wards nearly 650 nurses are working among them ANM’S are 150, GNM’S are 300 and 150 B.Sc nursing staff and 10 nurses are working as ANS.

 

Score interpretation:

The subjects with the scores 1-15 are considered as having ‘Mild Anxiety’, score between 16-30 as having ‘Moderate Anxiety’, score between 31-45 as having ‘Severe Anxiety’.

 

Content Validity:

The prepared tool along with the objectives of a study was submitted to four subjects experts in Obstetrics and Gynecology. Among them 2 person’s are Doctor’s and 2 people’s belongs to nursing faculty in the field of Obstetrics and Gynecological nursing. The suggestions of the experts are incorporated in preparation of the final tool.

 

Reliability:

The reliability was established by split half method. It is found that “r” value of anxiety item is 0.85 which indicates that, the tool is highly reliable.

 

Pilot study:

Pilot study was conducted on 10 antenatal mothers with high risk pregnancy at Samatha multi specialty Hospital, Mangalagiri, Guntur District. The participants have shown interest to complete the tool. It took 30 to 40 minutes to complete the entire tool and no difficulties are expressed by them. These subjects are not included in the main study:

 

Ethical considerations:

Ethical clearance is taken from the institutional ethical committee.

 

Collection of data:

After obtaining prior permission from the hospital authority the investigator informed the purpose of the study and requested sample to co-operate for the study. The consent was taken from the participants, instructions were given to the antenatal mothers, the structured questionnaire was distributed to 100 samples. The investigator had collected back the tool after 40 minutes. It took a period of one week to complete the sample size.

 

Plan of analysis:

The data are analyzed based on objectives and hypothesis of the study by using descriptive and inferential statistics. Frequencies, percentages, mean, standard deviation and chi- square test are used to analyze the data.

 

RESULTS:

The results regarding age of the mother shows that out of 50 hospitalized antenatal mothers, majority of respondents (46%) are in the age group of 22-25 years, followed by (26%) antenatal mothers are in the age group of 18-21 years, (22%) are in the age group of 26-29 years and (6%) in the age group of 30-35 years. As well as the out of 50 non- hospitalized antenatal mothers, majority of respondents (52%) are in the age group of 22-25 years, followed by (32%) antenatal mothers are in the age group of 18-21 years, (10%) are in the age group of 26-29 years and (6%) in the age group of 30-35 years.

 

As per education out of 50 hospitalized antenatal mothers, (16%) mothers knows to read and write, followed by (16%) mothers are with primary education (1-5class), and (30%) mothers are with secondary education (6-10 class), followed by (38%) mothers are with intermediate and above. Whereas out of 50 non- hospitalized antenatal mothers, (8%) mothers knows to read and write, followed by (20%) mothers are with primary education(1-5class), and (40%) mothers are with secondary education (6-10 class), followed by (32%) mothers are with intermediate and above.

 

If see, regarding marital status, 50 hospitalized antenatal mothers (100%) of all mothers are married and (0%) mothers are unmarried. As well as, 50 non- hospitalized antenatal mothers (100%) of all mothers are married and (0%) mothers are unmarried.

 

On the whole half of the hospitalized antenatal mothers (50%) from the nuclear family, followed by (38%) of antenatal mothers are from the joint family, (20%) are from the extended family. If we look into the non- hospitalized antenatal mothers (60%) from the nuclear family, followed by (24%) of antenatal mothers are from the joint family, (16%) are from the extended family.

 

The results regarding gravid status, 50 hospitalized antenatal mothers (64%) are home makers, followed by (4%) antenatal mothers are skilled workers, followed by (12%) are unskilled workers and (20%) women are working as an employee. Whereas the 50 non- hospitalized antenatal mothers (60%) are home makers, followed by (10%) antenatal mothers are skilled workers, followed by (6%) are unskilled workers and (24%) women are working as an employee.

 

Majority of the hospitalized antenatal mothers (50%) are with secondary gravida, followed by (40%) respondents are with primigravida, (10%) respondents are with multi gravida. Most of the non- hospitalized antenatal mothers (42%) are with secondary gravida, followed by (44%) respondents are with primigravida, (14%) respondents are with multi gravida.

 

On the whole of 50 hospitalized antenatal mothers (70%) are with primipara, followed by (26%) mothers are with para 2 and (2%) are with para 3 and (2%) of hospitalized antenatal mothers are with para 4 above. As well as the 50 non- hospitalized antenatal mothers (62%) are with primipara, followed by (22%) mothers are with para 2 and (14%) are with para 3 and (2%) of non- hospitalized antenatal mothers are with para 4 above.

 

Out of 50 hospitalized antenatal mothers, (42%) mothers were earn income per month from RS.5,000-RS.10,000, followed by (38%) were earn from RS.10,001-RS.20,000, followed by (12%) were earn from RS.20,001-RS.30,000 and (8%) mothers earn money from RS.30,001 and above. If we look into the 50 non- hospitalized antenatal mothers, (52%) mothers were earn income per month from RS.5,000-RS.10,000, followed by (40%) were earn from RS.10,001-RS.20,000, followed by (8%) were earn from RS.20,001-RS.30,000 and (0%) mothers earn money from RS.30,001 and above.

 

The results regarding sources of health information, 50 hospitalized antenatal mothers (32%) are getting health information from the mass media, followed by (16%) mothers are getting information from health personal, (44%) are getting information from neighbors and (8%) antenatal mothers are getting information from family members. If we look into the sources of health information,50 non- hospitalized antenatal mothers (32%) are getting health information from the mass media, followed by (14%) mothers are getting information from health personal, (42%) are getting information from neighbors and (12%) antenatal mothers are getting information from family members.

 

Whereas the reason for admission in the hospital, 50 hospitalized antenatal mothers (22%) are admitted in the hospital because of the medical problems, (6%) are attending to the antenatal ward with surgical problems and (60%) are with obstetrics problems and (12%) antenatal mothers are attending to the antenatal ward. If we see regarding reason for admission in the hospital, 50 non- hospitalized antenatal mothers (38%) are admitted in the hospital because of the medical problems, (10%) are attending to the antenatal OPD with surgical problems and (44%) are with obstetrics problems and (8%) antenatal mothers are attending to the antenatal OPD.

 

SECTION-II

Table-1: The mean anxiety score of the sample with standard deviation.

S. No.	Item	Mean	Standard Deviation
1. 2.	Anxiety level of hospitalized antenatal women with high risk pregnancy. Anxiety level of non- hospitalized antenatal women with high risk pregnancy	28.86 501.04	0.57 3.16

 

 

The mean scores of hospitalized antenatal mothers are 28.86 with standard deviation 0.57. As well as the anxiety scores of non- hospitalized antenatal mothers are 501.4 with standard deviation 3.16.

 

Fig: 1 Distribution of sample by their level of anxiety with regard to high risk pregnancy

 

SECTION-II

It identifies the association between anxiety scores of hospitalized and non- hospitalized antenatal mothers with their demographic variables regarding high risk pregnancy.

 

There was significant association found between anxiety levels of hospitalized antenatal mothers with high risk pregnancy with their mother’s occupation (x²=53.11), Gravid status (x²=16.09), Parity (x²=415.28), Income per month (x²=83.19), Sources of health information (x²=387.45) and Reason for admission in the hospital (x²=85.78) at p<0.05. Hence H₅,H₆,H₇,H₈,H_9, and H₁₀ is retained and null hypothesis H0_5,H0₆,H0_7,H0_8,H0_9,H0₁₀ is rejected. As well as the anxiety level of non- hospitalized antenatal mothers with high risk pregnancy with their mother’s Age(x²=13.85), Type of family(x²=12.03), Occupation(x²=23.69), Gravid status (x²=12.56), Parity(x²=62.3) and Sources of health information (x²=16.24) at p<0.05. Hence H₁,H₄,H₅,H₆,H₇ and H₉ is retained and null hypothesis H0_1,H0₄,H0_5,H0_6,H0_7,H0₉ is rejected.

 

DISCUSSION:

The present study was conducted with an aim to assess the anxiety level of hospitalized and non- hospitalized antenatal women with high risk pregnancy. The results revealed that a substantial number (58%) of hospitalized antenatal mothers are having mild anxiety, (40%) mothers are having moderate anxiety and (2%) mothers are having severe anxiety. As well as the (60%) of non-hospitalized antenatal mothers are having moderate anxiety, (36%) mothers are having mild anxiety, (4%) mothers are having severe anxiety.

 

CONCLUSION:

1)    The study findings concluded that the hospitalized antenatal mothers had mild anxiety on high risk pregnancy. As well as non- hospitalized antenatal mothers had moderate anxiety on high risk pregnancy.

2)    Therefore the prevalence of antenatal anxiety identified in this study is of concern. Screening tools for detecting antenatal anxiety symptoms in high risk pregnancy is crucial.

 

REFERENCES:

1.      Pregnancy health topics, by world health organization, partnership for maternal, newborn and child health.

2.      Andhra Horvath Marques, Thomas G. O’ Connor, Christine Roth, EZRA susser, Anne- lisebjorke- Monsen (2013). The influence of maternal prenatal and early child.

3.      Denis A, michauxp, callohan s. (2012) factors Implicated in moderating the risk for depression and anxiety in high risk pregnancy. Journal of reproductive and Infant psychology, 30(2) : 124-134.

4.      Naseiri H, fathalilavasani F(2015) guide for general anxiety disorder management ministry health and medical Education Iran.

5.      Stress and the Neurobehavioral development of the fetus and child: links and possible mechanisms .A review Neurosis Biobehave Rev. 2005; 29(2): 237-58. [ pubmed:15811496).

6.      J Objstet Gynecol 2007; 196 (5) : 424-32.[pubmed:1746693].

 

 

Received on 01.08.2019         Modified on 23.08.2019

Accepted on 11.09.2019      ©A&V Publications All right reserved