{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:34:09Z","timestamp":1760236449000,"version":"build-2065373602"},"reference-count":81,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Women with assisted reproduction techniques (ART) have a different psychological profile than women with a spontaneous pregnancy. These differences may put the former group at higher risk for depressive symptomatology. Our aim was to determine what sociodemographic factors and psychological variables interact with early depressive symptoms in pregnant women with ART. This is a cross-sectional, non-interventional, and observational study where a total of 324 women were analyzed in the first trimester of pregnancy at the Hospital Universitario Central de Asturias (Spain). Women completed a sociodemographic questionnaire, the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item Scale, the Resilience inventory, the General concerns (ad hoc scale), the Stressful life events, and the prenatal version of Postpartum Depression Predictors Inventory-Revised (PDPI-R), including socioeconomic status, pregnancy intendedness, self-esteem, partner support, family support, friends support, marital satisfaction, and life stress. According to our models, women undergoing ART had significantly increased the PHQ-9 scores (\u03b2 = 6.75 \u00b1 0.74; p-value &lt; 0.001). Being single also increased the PHQ-9 score. Related to the psychological variables, anxiety (\u03b2 = 0.43 \u00b1 0.06; p-value &lt; 0.001) and stressful life events (\u03b2 = 0.17 \u00b1 0.06; p-value = 0.003) increased PHQ-9 scores. In contrast, resilience (\u03b2 = \u22120.05 \u00b1 0.02; p-value = 0.004), self-esteem (\u03b2 = \u22121.21 \u00b1 0.61; p-value = 0.048), and partner support (\u03b2 = \u22121.50 \u00b1 0.60; p-value = 0.013) decreased PHQ-9 scores. We concluded that women undergoing ART need interventions to reduce anxiety and stressful life events, and to improve resilience, self-esteem, and emotional partner support to prevent depressive symptomatology during this important phase in their lives.<\/jats:p>","DOI":"10.3390\/jcm10235672","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:01:11Z","timestamp":1638309671000},"page":"5672","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Early Association Factors for Depression Symptoms in Pregnancy: A Comparison between Spanish Women Spontaneously Gestation and with Assisted Reproduction Techniques"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7442-1586","authenticated-orcid":false,"given":"David","family":"Ramiro-Cortijo","sequence":"first","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universidad Aut\u00f3noma de Madrid, C\/Arzobispo Morcillo 2, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Soto-Balbuena","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario Central de Asturias, Avenida Roma s\/n, 33011 Oviedo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda F.","family":"Rodr\u00edguez-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Psychology, Universidad Nacional de Educaci\u00f3n a Distancia, C\/Juan del Rosal, 10, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.bpobgyn.2020.06.006","article-title":"The Impact of Advanced Maternal Age on Pregnancy Outcome","volume":"70","author":"Attali","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e190","DOI":"10.1016\/j.wombi.2017.09.004","article-title":"The Impact of Delayed Maternity on Foetal Growth in Spain: An Assessment by Population Attributable Fraction","volume":"31","author":"Varea","year":"2018","journal-title":"Women Birth"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.bpobgyn.2020.07.005","article-title":"Advanced Maternal Age and Adverse Pregnancy Outcomes","volume":"70","author":"Frick","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"820","DOI":"10.5603\/GP.2016.0095","article-title":"Assisted Reproductive Technology in Reproductive Medicine\u2014Possibilities and Limitations","volume":"87","author":"Szamatowicz","year":"2016","journal-title":"Ginekol. Pol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/humupd\/dmv016","article-title":"Infertility Around the Globe: New Thinking on Gender, Reproductive Technologies and Global Movements in the 21st Century","volume":"21","author":"Inhorn","year":"2015","journal-title":"Hum. Reprod. Update"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1017\/S0963180109090379","article-title":"Assisted Reproductive Technology in Spain: Considering Women\u2019s Interests","volume":"18","year":"2009","journal-title":"Camb. Q. Healthc. Ethics"},{"key":"ref_7","unstructured":"Ministerio de Sanidad, Consumo y Bienestar Social (2021, September 13). Los Tratamientos de Reproducci\u00f3n Asistida en Espa\u00f1a Aumentan un 28% en los \u00daltimos 5 A\u00f1os, Available online: https:\/\/www.mscbs.gob.es\/gabinete\/notasPrensa.do?id=5067."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/humupd\/dmn030","article-title":"Psychological and Social Aspects of Pregnancy, Childbirth and Early Parenting after Assisted Conception: A Systematic Review","volume":"14","author":"Hammarberg","year":"2008","journal-title":"Hum. Reprod. Update"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"109","DOI":"10.5603\/GP.a2017.0019","article-title":"Anxiety and Depression in Women Undergoing Infertility Treatment","volume":"88","author":"Gdanska","year":"2017","journal-title":"Ginekol. Pol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.ogc.2018.04.006","article-title":"Psychosocial Aspects of Fertility and Assisted Reproductive Technology","volume":"45","author":"Stanhiser","year":"2018","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1093\/humrep\/der076","article-title":"Age at First Birth, Mode of Conception and Psychological Wellbeing in Pregnancy: Findings from the Parental Age and Transition to Parenthood Australia (PATPA) Study","volume":"26","author":"McMahon","year":"2011","journal-title":"Hum. Reprod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ejogrb.2015.11.041","article-title":"Differences in Psychophysical Well-being and Signs of Depression in Couples Undergoing their First Consultation for Assisted Reproduction Technology (ART): An Italian Pilot Study","volume":"197","author":"Valoriani","year":"2016","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Huang, M.Z., Kao, C.H., Lin, K.C., Hwang, J.L., Puthussery, S., and Gau, M.L. (2019). Psychological Health of Women Who have Conceived using Assisted Reproductive Technology in Taiwan: Findings from a Longitudinal Study. BMC Women\u2019s Health, 19.","DOI":"10.1186\/s12905-019-0801-7"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jad.2019.01.021","article-title":"Different Trajectories of Depressive Symptoms during Pregnancy","volume":"248","author":"Boekhorst","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1017\/S003329171600283X","article-title":"Maternal Depressive Symptoms and Early Childhood Cognitive Development: A Meta-Analysis","volume":"47","author":"Liu","year":"2017","journal-title":"Psychol. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jad.2015.11.014","article-title":"Identifying the Women at Risk of Antenatal Anxiety and Depression: A Systematic Review","volume":"191","author":"Biaggi","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1146\/annurev-clinpsy-101414-020426","article-title":"Biological and Psychosocial Predictors of Postpartum Depression: Systematic Review and Call for Integration","volume":"11","author":"Yim","year":"2015","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ajog.2009.09.007","article-title":"Risk Factors for Depressive Symptoms during Pregnancy: A Systematic Review","volume":"202","author":"Lancaster","year":"2010","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ramezanzadeh, F., Aghssa, M.M., Abedinia, N., Zayeri, F., Khanafshar, N., Shariat, M., and Jafarabadi, M. (2004). A Survey of Relationship between Anxiety, Depression and Duration of Infertility. BMC Women\u2019s Health, 4.","DOI":"10.1186\/1472-6874-4-9"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"41","DOI":"10.31887\/DCNS.2018.20.1\/klrooney","article-title":"The Relationship between Stress and Infertility","volume":"20","author":"Rooney","year":"2018","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_21","first-page":"257","article-title":"Incidence, Prevalence and Risk Factors Related to Anxiety Symptoms during Pregnancy","volume":"30","author":"Rodriguez","year":"2018","journal-title":"Psicothema"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1080\/02646838.2019.1705261","article-title":"Prenatal Attachment in Pregnancy Following Assisted Reproductive Technology: A Literature Review","volume":"38","author":"Ranjbar","year":"2020","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1080\/03630242.2015.1074642","article-title":"Psychological Stress and Adjustment in Pregnancy Following Assisted Reproductive Technology and Spontaneous Conception: A Systematic Review","volume":"56","author":"Gourounti","year":"2016","journal-title":"Women Health"},{"key":"ref_24","unstructured":"Lazarus, R.S., and Folkman, S. (1984). Stress, Appraisal, and Coping, Springer Publishing Company."},{"key":"ref_25","unstructured":"Smelser, N.J., and Baltes, P.B. (2001). Stress Management Programs. International Encyclopedia of the Social & Behavioral Sciences, Pergamon."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2105\/AJPH.2013.301688","article-title":"Preterm Birth in the United States: The Impact of Stressful Life Events Prior to Conception and Maternal Age","volume":"104","author":"Witt","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.neubiorev.2017.07.003","article-title":"Prenatal Developmental Origins of Behavior and Mental Health: The Influence of Maternal Stress in Pregnancy","volume":"117","author":"Lahti","year":"2020","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_28","first-page":"179","article-title":"Female and Male Lifestyle Habits and IVF: What is Known and Unknown","volume":"11","year":"2005","journal-title":"Hum. Reprod. Update"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Feligreras-Alcala, D., Frias-Osuna, A., and Del-Pino-Casado, R. (2020). Personal and Family Resources Related to Depressive and Anxiety Symptoms in Women during Puerperium. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17145230"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ramiro-Cortijo, D., de la Calle, M., Gila-Diaz, A., Moreno-Jimenez, B., Martin-Cabrejas, M.A., Arribas, S.M., and Garrosa, E. (2021). Maternal Resources, Pregnancy Concerns, and Biological Factors Associated to Birth Weight and Psychological Health. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040695"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e004883","DOI":"10.1136\/bmjopen-2014-004883","article-title":"Risk Factors for and Perinatal Outcomes of Major Depression during Pregnancy: A Population-Based Analysis during 2002\u20132010 in Finland","volume":"4","author":"Raisanen","year":"2014","journal-title":"BMJ Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s11920-016-0664-7","article-title":"Depression during Pregnancy and Postpartum","volume":"18","author":"Becker","year":"2016","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"12","author":"Altman","year":"2014","journal-title":"Int. J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a Brief Depression Severity Measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1159\/000342262","article-title":"Symptom Severity and Guideline-Based Treatment Recommendations for Depressed Patients: Implications of DSM-5\u2019s Potential Recommendation of the PHQ-9 as the Measure of Choice for Depression Severity","volume":"81","author":"Zimmerman","year":"2012","journal-title":"Psychother. Psychosom."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/00006842-200107000-00021","article-title":"Validation and Utility of the Patient Health Questionnaire in Diagnosing Mental Disorders in 1003 General Hospital Spanish Inpatients","volume":"63","author":"Rangil","year":"2001","journal-title":"Psychosom. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1111\/j.1525-1497.2005.0144.x","article-title":"Assessing Depression in Primary Care with the PHQ-9: Can it be Carried out over the Telephone?","volume":"20","author":"Penarrubia","year":"2005","journal-title":"J. Gen. Intern. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.midw.2018.03.011","article-title":"The Structure of the Patient Health Questionnaire-9 in Pregnant Women in Spain","volume":"62","author":"Le","year":"2018","journal-title":"Midwifery"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1007\/s11606-007-0333-y","article-title":"Screening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ): A Diagnostic Meta-Analysis","volume":"22","author":"Gilbody","year":"2007","journal-title":"J. Gen. Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.genhosppsych.2014.09.009","article-title":"A Diagnostic Meta-Analysis of the Patient Health Questionnaire-9 (PHQ-9) Algorithm Scoring Method as a Screen for Depression","volume":"37","author":"Manea","year":"2015","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/02646838.2016.1245413","article-title":"Women\u2019s Views on Anxiety in Pregnancy and the use of Anxiety Instruments: A Qualitative Study","volume":"35","author":"Evans","year":"2017","journal-title":"J. Reprod. Infant Psychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1477-7525-8-8","article-title":"Cultural Adaptation into Spanish of the Generalized Anxiety Disorder-7 (GAD-7) Scale as a Screening Tool","volume":"8","author":"Zamorano","year":"2010","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_44","first-page":"164","article-title":"Validation of the Generalized Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women","volume":"33","author":"Le","year":"2021","journal-title":"Psicothema"},{"key":"ref_45","first-page":"73","article-title":"Validacion Del Inventario De Resiliencia En Una Muestra Del Noroeste De Mexico","volume":"16","year":"2011","journal-title":"Ense\u00f1. E Investig. En Psicol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"167","DOI":"10.25009\/pys.v28i2.2553","article-title":"Apoyo Social Y Resiliencia: Predictores De Bienestar Psicol\u00f3gico En Adolescentes Con Suceso De Vida Estresante","volume":"28","year":"2018","journal-title":"Psicol. Y Salud"},{"key":"ref_47","first-page":"241","article-title":"Autorregulaci\u00f3n, Resiliencia Y Metas Educativas: Variables Protectoras Del Rendimiento Acad\u00e9mico De Bachilleres","volume":"22","year":"2013","journal-title":"Rev. Colomb. Psicol."},{"key":"ref_48","first-page":"7","article-title":"Diez Pasos Para La Construccion De Un Test","volume":"31","author":"Muniz","year":"2019","journal-title":"Psicothema"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1177\/13591053030086008","article-title":"Factor Structure, Validity and Reliability of the Cambridge Worry Scale in a Pregnant Population","volume":"8","author":"Green","year":"2003","journal-title":"J. Health Psychol."},{"key":"ref_50","first-page":"378","article-title":"The Influence of Life Events and Social Support in a Psycho-Educational Intervention for Women with Depression","volume":"46","author":"Lara","year":"2004","journal-title":"Salud P\u00fablica M\u00e9x."},{"key":"ref_51","first-page":"429","article-title":"Retention Rates and Potential Predictors in a Longitudinal Randomized Control Trial to Prevent Postpartum Depression","volume":"33","author":"Lara","year":"2010","journal-title":"Salud Mental"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1111\/j.1552-6909.2002.tb00061.x","article-title":"Revision of the Postpartum Depression Predictors Inventory","volume":"31","author":"Beck","year":"2002","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1891\/106137407783095775","article-title":"Psychometric Assessment of the Postpartum Depression Predictors Inventory-Revised","volume":"15","author":"Records","year":"2007","journal-title":"J. Nurs. Meas."},{"key":"ref_54","first-page":"91","article-title":"Psychometric Properties of Postpartum Depression Predictors Inventory- Revised- Prenatal Version in a Sample of Spanish Pregnant Women","volume":"91","author":"Soto","year":"2017","journal-title":"Rev. Esp. Salud Publica"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1177\/1359105316658969","article-title":"Psychometric Properties of the Postpartum Depression Predictors Inventory-Revised for Pregnant Women in Mexico","volume":"23","author":"Lara","year":"2018","journal-title":"J. Health Psychol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1177\/1043659619891234","article-title":"The Prevalence and Risk Factors for Antenatal Depression among Pregnant Immigrant and Native Women in Spain","volume":"31","author":"Le","year":"2020","journal-title":"J. Transcult. Nurs."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ejogrb.2009.05.035","article-title":"Preterm Birth and Low Birth Weight among in Vitro Fertilization Singletons: A Systematic Review and Meta-Analyses","volume":"146","author":"McDonald","year":"2009","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/GCO.0b013e32807fb199","article-title":"Reproductive Outcomes after in-Vitro Fertilization","volume":"19","author":"Mukhopadhaya","year":"2007","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1002\/pd.1419","article-title":"Does Prenatal Screening Influence Anxiety Levels of Pregnant Women? A Longitudinal Randomised Controlled Trial","volume":"26","author":"Kleinveld","year":"2006","journal-title":"Prenat. Diagn."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.infbeh.2012.07.020","article-title":"Disruption to the Development of Maternal Responsiveness? The Impact of Prenatal Depression on Mother-Infant Interactions","volume":"35","author":"Pearson","year":"2012","journal-title":"Infant Behav. Dev."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jpag.2013.09.008","article-title":"Adolescents, Pregnancy, and Mental Health","volume":"27","author":"Siegel","year":"2014","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.jad.2015.01.012","article-title":"Risk Factors and Course Patterns of Anxiety and Depressive Disorders during Pregnancy and After Delivery: A Prospective-Longitudinal Study","volume":"175","author":"Martini","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Waqas, A., Raza, N., Lodhi, H.W., Muhammad, Z., Jamal, M., and Rehman, A. (2015). Psychosocial Factors of Antenatal Anxiety and Depression in Pakistan: Is Social Support a Mediator?. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0116510"},{"key":"ref_64","first-page":"472","article-title":"Antenatal Depression: Prevalence and Risk Factors in a Hospital Based Turkish Sample","volume":"63","author":"Yanikkerem","year":"2013","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1177\/0886260511425247","article-title":"Associations between Intimate Partner Violence and Emotional Distress among Pregnant Women in Durban, South Africa","volume":"27","author":"Groves","year":"2012","journal-title":"J. Interpers. Violence"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s00737-013-0409-0","article-title":"Anxiety in Early Pregnancy: Prevalence and Contributing Factors","volume":"17","author":"Rubertsson","year":"2014","journal-title":"Arch. Women\u2019s Ment. Health"},{"key":"ref_67","first-page":"LC08","article-title":"Assessment of Burden of Depression during Pregnancy among Pregnant Women Residing in Rural Setting of Chennai","volume":"9","author":"Srinivasan","year":"2015","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"393","DOI":"10.4088\/JCP.13m08646","article-title":"The Mental Health Characteristics of Pregnant Women with Depressive Symptoms Identified by the Edinburgh Postnatal Depression Scale","volume":"75","author":"Lydsdottir","year":"2014","journal-title":"J. Clin. Psychiatry"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s12888-015-0452-7","article-title":"Prevalence and Predictors of Antenatal Depressive Symptoms among Chinese Women in their Third Trimester: A Cross-Sectional Survey","volume":"15","author":"Zeng","year":"2015","journal-title":"BMC Psychiatry"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/jpm.12125","article-title":"Characteristics of Jordanian Depressed Pregnant Women: A Comparison Study","volume":"21","author":"Abuidhail","year":"2014","journal-title":"J. Psychiatr. Ment. Health Nurs."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/1477-7525-11-194","article-title":"The Impact of Resilience on Psychological Outcomes in Women after Preeclampsia: An Observational Cohort Study","volume":"11","author":"Mautner","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1007\/s10995-015-1872-1","article-title":"A Multidimensional Approach to Characterizing Psychosocial Health during Pregnancy","volume":"20","author":"Maxson","year":"2016","journal-title":"Matern. Child Health J."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s00737-013-0392-5","article-title":"Resilience in International Migrant Women Following Violence Associated with Pregnancy","volume":"17","author":"Gagnon","year":"2014","journal-title":"Arch. Women\u2019s Ment. Health"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"563432","DOI":"10.3389\/fpsyg.2020.563432","article-title":"Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey","volume":"11","author":"Braeken","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1093\/humrep\/dep185","article-title":"Stressful Life Events are Associated with a Poor in-Vitro Fertilization (IVF) Outcome: A Prospective Study","volume":"24","author":"Ebbesen","year":"2009","journal-title":"Hum. Reprod."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/1753495x12473751","article-title":"Effects of Prenatal Stress on Pregnancy and Human Development: Mechanisms and Pathways","volume":"6","year":"2013","journal-title":"Obstet. Med."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Iliadis, S.I., Comasco, E., Sylven, S., Hellgren, C., Sundstrom Poromaa, I., and Skalkidou, A. (2015). Prenatal and Postpartum Evening Salivary Cortisol Levels in Association with Peripartum Depressive Symptoms. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0135471"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1017\/S1092852900008993","article-title":"Women\u2019s Mental Health during Pregnancy Influences Fetal and Infant Developmental and Health Outcomes","volume":"9","author":"Federenko","year":"2004","journal-title":"CNS Spectr."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1080\/17437199.2012.752659","article-title":"Coping during Pregnancy: A Systematic Review and Recommendations","volume":"8","author":"Guardino","year":"2014","journal-title":"Health Psychol. Rev."},{"key":"ref_80","first-page":"51","article-title":"Stressful Life Events and Women\u2019s Mental Health during Pregnancy and Postpartum Period","volume":"27","author":"Alvarenga","year":"2017","journal-title":"Paid. Cad. Psicol. E Educ."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5093\/clysa2021a2","article-title":"Digital Tools for Prevention and Treatment of Depression: Lessons from the Institute for International Internet Interventions for Health","volume":"32","author":"Pineda","year":"2021","journal-title":"Clin. 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