Association between subjective feelings of distress, plasma cortisol, anxiety, and depression in pregnant women

Abstract Objective Psychosocial stressors are consistently associated with antenatal anxiety and depression, while the impact of cortisol has proved inconsistent. Most studies have focused either on psychological or physiological stress indices. We investigated both subjective and endocrinologic indices of distress in the same subjects. Study design We performed a cross-sectional study in late pregnancy in 79 women to investigate associations between the factors involved in anxiety and depression. Outcome measures were the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Perceived Stress Scale, a Likert-like scale for fear of delivery, a structured interview to assess health and socioeconomic status, and fasting plasma cortisol levels measured in the morning. Results High BDI and STAI scores were associated with high levels of perceived stress and fear of delivery, but not with levels of plasma cortisol typical of the gestation phase. A multiple regression analysis revealed that subjective feelings of distress explained over 50% of the variation in BDI and STAI scores. Plasma cortisol was not a significant predictor of psychometric scores and did not show significant correlation with them in correlation analyses, and subjects with low and high cortisol levels showed similar psychometric scores. Conclusion Antenatal depression and anxiety were significantly associated with subjective feelings of distress but not with increased cortisol. This finding may be explained by the blunted cortisol stress responses characteristic of pregnancy. The mechanisms mediating the effects of subjective distress remain obscure: likely candidates include monoamine neurotransmission, and/or stress-induced changes in glucocorticoid receptor expression or distribution.