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Kehamilan adalah periode dimana munculnya perubahan psikolosgi, fisik dan hormonal.

Resiko meningkatnya faktor emosional

Menurut Manuaba(1998) persalinan adalah proses pengeluaran hasil konsepsi yang telah
cukup bulan dengan bantuan ataupun tanpa bantuan. Dengan semakin dekatnya jadwal
persalinan, wajar timbul perasaan cemas ataupun takut (Mami, 2011).

Depression and suicide


Women are more susceptible to depression and anxiety than men. Depression is the leading cause of disease
burden for women in both high-income and low- and middle-income countries. Depression following
childbirth, affects 20% of mothers in low- and lower-middle-income countries, which is even higher than
previous reports from high-income countries.
Every year, an estimated 800 000 people die from suicide globally, the majority being men. However, there
are exceptions, for instance in China where the suicide rate in rural areas is higher among women than men.
Attempted suicide, which exceeds suicide by up to 20 times, is generally more frequent among women than
men and causes an unrecognized burden of disability. At the same time, attempted suicide is an important
risk factor for death from suicide and shows the need for appropriate health services for this group.

There is now a growing realization that many women suffer from either new onset or exacer bation of existing anxiety disorders
during perinatal period [4]. Studies of anxiety in pregnancy women show that a significant portion of them are affected [5]. Heron
et al., in a large community sample of pregnant women, found that 21% had clinically significant anxiety symptoms and, of these,
64% continued to have anxiety in postpartum [6]. Other studies have also shown higher prevalence rates of anxiety disorders in
the postnatal period compared with the general population: 20.4% had an anxiety disorder (approximately two thirds with
comorbid depression) and 37.7% of women with a major depressive episode (MDE) had a comorbid anxiety disorder, with a
prevalence rate of CIDI diagnosis of 29.2% [7]; 11.1% screened for PAD and 6.1% for PDD, with comorbidity found in 2.1% [8].
Anxiety and depression often occur together, are often present in pregnancy and persist if not treated [9; 10 among others].
These disorders can have a wide range of effects not only for the mother but on the fetus, the infant, partner and other family
members (11-13).

Anxiety and depression often occur together, are often present in pregnancy and persist if not treated [9; 10 among others].
These disorders can have a wide range of effects not only for the mother but on the fetus, the infant, partner and other family
members (11-13). Several prospective studies have shown that a prenatal anxiety disorder is one of the strongest risk factors for
developing postnatal depression [4;14]

Common themes of severe anxiety during pregnancy include fear of fetal loss or fetal abnor malities. The terrors of parturition
have been greatly reduced by analgesia and obstetric care, but pain and injury are still among the fears expressed by over 50%
of women. Fear of delivery is often expressed, and other intense fears include those of hemorrhaging to death, or being torn or
mutilated. Some women mentioned complication of parturition including maternal death and many are afraid of being alone during
delivery [15]. A variety of poor outcomes are associated with anxiety during pregnancy: pre-eclampsia, increased nausea and
vomiting, longer sick leave during pregnancy, increased number of visits to obstetrician, spontaneous preterm labor, preterm
delivery, low birth weight, low APGAR scores, breastfeeding difficulties, a more difficult labor and delivery with increase of PTSD
symptoms related to birth, admission of infant to neonatal care, elective cesarean section (1; 16-18; 19 and 20 for previous
reviews).

Trans :
Sekarang ada kesadaran yang berkembang bahwa banyak wanita menderita onset baru atau adanya penggambaran
gangguan kecemasan yang ada selama periode perinatal [4]. Studi kecemasan pada wanita hamil menunjukkan bahwa
sebagian besar dari mereka terpengaruh [5]. Heron dkk, dalam sampel masyarakat wanita hamil yang besar,
menemukan bahwa 21% memiliki gejala kecemasan klinis yang signifikan, dan ini, 64% terus mengalami kecemasan
pada postpartum [6]. Penelitian lain juga menunjukkan tingkat prevalensi gangguan kecemasan yang lebih tinggi pada
periode pascakelahiran dibandingkan dengan populasi umum: 20,4% memiliki gangguan kecemasan (sekitar dua pertiga
dengan depresi komorbid) dan 37,7% wanita dengan episode depresi berat (MDE) memiliki gangguan kecemasan
komorbid, dengan tingkat prevalensi diagnosis CIDI sebesar 29,2% [7]; 11,1% diskrining untuk PAD dan 6,1% untuk PDD,
dengan komorbiditas ditemukan pada 2,1% [8]. Kecemasan dan depresi sering terjadi bersamaan, sering hadir pada
kehamilan dan bertahan jika tidak diobati; 10 antara lain]. Gangguan ini dapat memiliki berbagai efek tidak hanya untuk
ibu tapi juga pada janin, bayi, pasangan dan anggota keluarga lainnya (11-13).

Kecemasan dan depresi sering terjadi bersamaan, sering hadir pada kehamilan dan bertahan jika tidak diobati; 10
antara lain]. Gangguan ini dapat memiliki berbagai efek tidak hanya untuk ibu tapi juga pada janin, bayi, pasangan dan
anggota keluarga lainnya (11-13). Beberapa penelitian prospektif menunjukkan bahwa gangguan kecemasan prenatal
adalah salah satu faktor risiko terkuat untuk mengembangkan depresi pascakelahiran [4; 14]

Tema umum kecemasan berat selama kehamilan meliputi ketakutan kehilangan janin atau kelainan janin. Teror dari
parturisi telah sangat dikurangi oleh analgesia dan perawatan kebidanan, namun rasa sakit dan luka masih merupakan
ketakutan di antara lebih dari 50% wanita. Ketakutan akan persalinan sering diungkapkan, dan ketakutan kuat lainnya
termasuk pendarahan sampai mati, atau dicabik atau dimutilasi. Beberapa wanita menyebutkan komplikasi parturisi
termasuk kematian ibu dan banyak yang takut sendirian saat melahirkan [15]. Berbagai hasil buruk dikaitkan dengan
kegelisahan selama kehamilan: preeklampsia, mual dan muntah meningkat, cuti sakit yang lebih lama selama kehamilan,
peningkatan jumlah kunjungan ke dokter kandungan, persalinan prematur spontan, kelahiran prematur, berat lahir
rendah, skor APGAR rendah, menyusui kesulitan, persalinan dan persalinan yang lebih sulit dengan meningkatnya gejala
PTSD yang terkait dengan kelahiran, pengenalan bayi ke perawatan neonatal, bedah sesar pilihan (1; 16-18; 19 dan 20
untuk ulasan sebelumnya).

.
In addition, prevalence of anxiety disorders during pregnancy ranges from 12.2% to 39%
with panic disorder and obsessivecompulsive disorder being three times more common
among pregnant women than in the general population. Furthermore, generalized anxiety
disorder and anxiety disorder due to medical condition were found to be twice as common
during pregnancy than in non-pregnant women (Adewuya et al. 2006, Goodman et al.
2014)

Trans :

Selain itu, prevalensi kegelisahan Gangguan selama kehamilan berkisar antara


12,2% sampai 39% dengan gangguan panik dan obsesifkompulsif Gangguan yang
tiga kali lebih umum terjadi pada wanita hamil daripada pada umumnya
populasi. Selanjutnya, gangguan kecemasan umum dan gangguan kecemasan
akibat medis Kondisi ditemukan dua kali lebih umum selama kehamilan
dibandingkan pada wanita yang tidak hamil (Adewuya et al 2006, Goodman et
al., 2014).
The risks related with antenatal anxiety and depression cannot be ignored. Shorter than average
gestation period and adverse consequences for fetal neurodevelopment and child developmental
outcomes are associated with anxiety disorders during pregnancy (Dunkel & Tanner 2012). The
negative events during pregnancy and delivery, including, preeclampsia, preterm delivery and
operative deliveries are also associated with antenatal depression (Kurki et al. 2000, Chung et al.
2001, Orr et al. 2002). The effects of anxiety and depression during pregnancy are seen in the long
term in cognitive impairment and emotional problems in children, as well as serious illnesses such as
asthma and coronary disease during different life phases (Shahhosseini et al. 2015). The offspring of
mothers who experienced anxiety during pregnancy were also 1.39 times more likely to be
diagnosed with comorbid anxiety and depression at age of 18 years (Capron et al. 2015). Anxiety and
depression during pregnancy remain underdiagnosed and undertreated. Although many studies
have shown that antenatal anxiety and depression affect the unborn child and increase the risk of
adverse birth outcomes, cognitive impairment and other disorders, obstetric medicine often ignores
the emotional aspect of pregnant women, which thus remains neglected (Bowen & Muhajarine
2006). In particular, comorbidity of anxiety and depression is a critical condition as the effects of
comorbid anxiety and depression on neonates have been suggested to be higher than those of
anxiety alone or depression alone (Field et al. 2010). 11 In other words, anxiety and depression
during pregnancy appear to lead to several pregnancy and delivery complications compared to
either conditions alone. However, there are very few studies on the associations between comorbid
anxiety and depression and the birth outcomes. The aim of this cohort study was to investigate the
influence of comorbid anxiety and depression during pregnancy on birth outcomes.

Trans :

Risiko yang terkait dengan kegelisahan dan depresi antenatal tidak dapat
diabaikan. Lebih pendek dari rata-rata masa kehamilan dan konsekuensi buruk
bagi perkembangan saraf janin dan perkembangan anak Hasil dikaitkan dengan
gangguan kecemasan selama kehamilan (Dunkel & Tanner 2012). Itu kejadian
negatif selama kehamilan dan persalinan, termasuk preeklamsia, persalinan
prematur dan persalinan operatif juga dikaitkan dengan depresi antenatal (Kurki
et al., 2000, Chung et al. 2001, Orr dkk. 2002). Efek kecemasan dan depresi selama
kehamilan terlihat dalam waktu lama Istilah dalam gangguan kognitif dan
masalah emosional pada anak-anak, serta penyakit serius semacam itu sebagai
penyakit asma dan koroner selama fase kehidupan yang berbeda (Shahhosseini et
al., 2015). Itu

Keturunan ibu yang mengalami kecemasan saat hamil juga 1,39 kali lebih mungkin

untuk didiagnosis dengan kegelisahan komorbid dan depresi pada usia 18 tahun
(Capron dkk., 2015).

Kecemasan dan depresi selama kehamilan masih kurang terdiagnosis dan diobati.
Meskipun banyak penelitian telah menunjukkan bahwa kegelisahan dan depresi
antenatal mempengaruhi anak yang belum lahir dan meningkat risiko hasil
kelahiran buruk, gangguan kognitif dan gangguan lainnya, kedokteran
kebidanan sering mengabaikan aspek emosional ibu hamil, yang karenanya tetap
terbengkalai (Bowen & Muhajarine 2006). Secara khusus, komorbiditas kecemasan
dan depresi merupakan kondisi kritis Efek kecemasan komorbid dan depresi pada
neonatus telah disarankan untuk lebih tinggi dari kecemasan saja atau depresi saja
(Field et al., 2010).

11

Dengan kata lain, kecemasan dan depresi selama kehamilan nampaknya


mengarah pada beberapa kehamilan dan komplikasi pengiriman dibandingkan
dengan kondisi baik saja. Namun, hanya ada sedikit penelitian pada asosiasi
antara kecemasan komorbid dan depresi dan hasil kelahiran. Tujuan dari Studi
kohort ini adalah untuk mengetahui pengaruh kecemasan komorbid dan depresi
selama kehamilan pada hasil kelahiran
2.4.1. Prevalence Globally, around 10% of women during pregnancy and 13% of women after a child
birth experience mental disorders, particularly depression. The prevalence rates for mental disorders
in developing countries are even higher with 15.6% during pregnancy and 19.8% during the
postpartum period (WHO 2016b). The severe cases might lead to suicide as the suicidal ideation is
detected among 13.1% to 33% of pregnant women (Frautschi et al. 1994, Newport et al. 2007).
Psychiatric morbidity is common during pregnancy with 18.4% of women experiencing depressive
symptoms during pregnancy, and 12.7% having an episode of major depression (Gavin et al. 2005).
The prevalence of depression is however different among various studies. In high income countries,
the prevalence of depression during pregnancy is found to be from 7% to 20% (Evans et al. 2001,
Andersson et al. 2003, Marcus et al. 2003, Gavin et al. 2005, Lee et al. 2007, Melville et al. 2010),
while it is 20% or more in low and middle income countries (Faisal-Cury et al. 2009, Golbasi et al.
2010, Husain et al. 2011). Additionally, depression may cause an impairment of the mothers general
functioning, resulting in a deterioration of the newborns health (WHO 2016b). 16 In addition,
anxiety disorders have been reported in 24% of pregnant women (Sutter-Dallay et al. 2004). The
prevalence of anxiety disorders during pregnancy ranges from 12.2% to 39% with panic disorder and
obsessive-compulsive disorder being three times more common among pregnant than in non-
pregnant women. Furthermore, the prevalence of generalized anxiety disorder and anxiety disorder
due to medical condition were found to be double in pregnant women than in the general
population (Adewuya et al. 2006, Goodman et al. 2014).

Trans :

2.4.1. Prevalensi

Secara global, sekitar 10% wanita selama kehamilan dan 13% wanita setelah
melahirkan anak mengalami gangguan mental, terutama depresi. Tingkat
prevalensi gangguan mental di Indonesia negara berkembang bahkan lebih tinggi
dengan 15,6% selama kehamilan dan 19,8% selama periode pascapersalinan (WHO
2016b). Kasus yang parah bisa menyebabkan bunuh diri sebagai ide bunuh diri
terdeteksi antara 13,1% sampai 33% wanita hamil (Frautschi et al 1994, Newport et
al 2007). Morbiditas kejiwaan umum terjadi pada kehamilan dengan 18,4% wanita
mengalami depresi gejala selama kehamilan, dan 12,7% mengalami episode depresi
berat (Gavin et al 2005).

Prevalensi depresi bagaimanapun berbeda di antara berbagai penelitian. Di


negara berpenghasilan tinggi, prevalensi depresi selama kehamilan ditemukan dari
7% sampai 20% (Evans et al., 2001, Andersson dkk. 2003, Marcus dkk. 2003, Gavin
dkk. 2005, Lee et al. 2007, Melville dkk. 2010), sementara itu 20% atau lebih di
negara berpenghasilan rendah dan menengah (Faisal-Cury et al 2009, Golbasi et
al. 2010, Husain dkk. 2011). Selain itu, depresi dapat menyebabkan kerusakan
pada ibu berfungsi secara umum, mengakibatkan kemerosotan kesehatan bayi
baru lahir (WHO 2016b).

16
Selain itu, gangguan kecemasan telah dilaporkan pada 24% wanita hamil (Sutter-
Dallay et al. 2004). Prevalensi gangguan kecemasan selama kehamilan berkisar
antara 12,2% sampai 39% dengan kepanikan gangguan dan gangguan obsesif-
kompulsif menjadi tiga kali lebih umum di kalangan hamil daripada pada wanita
yang tidak hamil. Selanjutnya, prevalensi gangguan kecemasan umum dan
kecemasan Kelainan karena kondisi medis ditemukan dua kali lipat pada wanita
hamil daripada di jenderalpopulasi (Adewuya et al 2006, Goodman et al., 2014).

Depression and anxiety are highly comorbid during pregnancy (Lancaster et al. 2010, Verreault et al.
2014). Anxious women during their pregnancy are highly at risk for antenatal depression (Edwards et
al. 2008). A study by Mohammad Yusuff et al. (2015) revealed that women experiencing anxiety
during pregnancy are at a three-fold risk of being depressed compared to women who are not
anxious during pregnancy. Anxiety during pregnancy also increases the likelihood of postnatal
depression, even after controlling for depression from the antenatal period (Heron et al. 2004).

Comorbidity of depression and anxiety during pregnancy yield even more complications and
increased risk to the newborn child (Ibanez et al. 2012). Field et al. (2010) studied the four different
groups of pregnant women: with anxiety disorder, depressive disorder, comorbid anxietydepressive
disorder, and with no diagnosis of anxiety or depression, and their newborns. They found that the
effects of comorbid anxiety and depression on the offspring were more severe with greater
incidence of prematurity than with depression alone or anxiety alone. The neonates from this group
also had higher cortisol and norepinephrine and lower dopamine and serotonin levels. The pregnant
women belonging to comorbid group had higher scores of anxiety, anger and daily hassles with
relationship problems, sleep disturbances and lowered dopamine levels.

Trans :

Depresi dan kecemasan sangat komorbid selama kehamilan (Lancaster et al., 2010,
Verreault et

Al. 2014). Wanita yang cemas selama kehamilan mereka sangat berisiko
mengalami depresi antenatal

(Edwards et al 2008). Sebuah studi oleh Mohammad Yusuff dkk. (2015)


mengungkapkan bahwa wanita mengalami kegelisahan selama kehamilan
berisiko tiga kali mengalami depresi dibandingkan dengan kehamilan Wanita
yang tidak cemas saat hamil. Kecemasan saat hamil juga meningkat Kemungkinan
depresi pascamelahirkan, bahkan setelah mengendalikan depresi dari masa
antenatal

(Heron dkk., 2004).

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