Posttraumatic stress symptoms and postpartum anxiety among palestinian women: the mediating roles of self-esteem and social support

BACKGROUND: Women are estimated to develop several mental disorders during pregnancy and/or for up to a year postpartum, with anxiety and depression being the most common co-morbidities. Postpartum anxiety is less well studied compared with postpartum depression in the Palestinian context in terms of risk factors, mental health outcomes and protective factors. PURPOSE: The aim of the current study was to investigate whether self-esteem and social support mediated the association between posttraumatic stress symptoms and postpartum anxiety among Palestinian women. METHODS: Berlin Social Support Scales, Postpartum Specific Anxiety Scale, Impact of the Event Scale, and Rosenberg self-esteem scale were administered to 408 Palestinian women recruited from health centers in northern of the West Banks/ Palestine using a convenience sample. RESULTS: The findings of our study revealed that postpartum anxiety positively correlated with posttraumatic stress symptoms (r = .56, p < .01), and negatively correlated with social support (r = - .30, p < .01), and self-esteem (r = - .27, p < .05). Moreover, posttraumatic stress symptoms negatively correlated with social support (r = - .24, p < .01), and self-esteem (r = - .25, p < .01). Results of structural equation modeling (SEM) showed a good fit of the hypothesized model. CONCLUSIONS: Given this, it is recommended to conduct similar studies with diverse samples in the Palestinian society. It would also be useful for health professionals who work with Palestinian pregnant women (i.e., mental health providers, nurses, midwives, physicians) to assess self-esteem and social support in an effort to identify women who may be at greater risk of developing postpartum anxiety. It may also be worthwhile to develop and implement interventions during pregnancy which serve to enhance a women's sense of self-esteem during this particularly stressful period.