The effect of social support on state anxiety levels during pregnancy
Main Article Content
In this study our aim was to determine the effect of pregnant women’s perception of level of multidimensional social support during pregnancy on their state anxiety level. The sample comprised 160 pregnant women who were pregnant and attending antenatal polyclinics at Corum State Hospital between March 2011 and June 2011. The data were assessed using percentages, arithmetic means, standard deviations, t test, and 1-way analysis of variance (ANOVA). We found a correlation between anxiety levels and the score for social support of a significant person and total social support score. According to our results it may be said that high social support given during pregnancy has the effect of reducing the pregnant woman’s anxiety.
Pregnancy is a crisis or a critical period in women’s lives. During this period, physical changes as well as psychological and social changes are experienced by the pregnant woman. Adaptation to the conditions created by these changes prevents negative emotions during the pregnancy and the perception of pregnancy as a crisis period. Thus, difficulty in adaptation may lead to irreversible psychological problems (Heron et al., 2004; Kelly, Russo, & Katon, 2001). It has been reported that the most common psychological problems during pregnancy are depression and anxiety disorders, and it has been suggested that increased anxiety and intense anxiety experienced during pregnancy aggravate depression and raise the risk of suicide (Heron et al., 2004; Kelly et al., 2001). As well as causing severe somatic problems, psychological symptoms may lead to miscarriage, preterm birth, or other stress-related pregnancy complications (Heron et al., 2004). Therefore, it may be said that the woman’s adaptation to pregnancy is of high importance in coping with psychological problems that may occur during pregnancy.
Chou, Avant, Kuo, and Fetzer (2008) reported that psychological manifestations related to pregnancy are associated with various factors, either individually or combined. These factors are as follows: sociodemographic factors, emotional stability, attitudes towards femininity, relationships with husband and mother, cultural attitudes, preparation for motherhood, previous psychological problems, presence or absence of a child, previous abortion, and whether or not there are medically high risks in the pregnancy (Chou et al., 2008). Another factor that negatively affects coping with psychological problems during pregnancy is lack of social support. Social support is described as financial or spiritual assistance given to the individuals under stress by surrounding people such as husbands, friends, or family members (Chou, Chen, Kuo, & Tzeng, 2006; Jesse, Walcott-McQuigg, Mariella, & Swanson, 2005).
Other researchers have shown that women with poor social support experience difficulties in their adaptation to pregnancy and suffer from psychosocial problems (Jesse et al., 2005; Swallow, Lindow, Masson, & Hay, 2004). Social support during pregnancy helps eliminate emotional tensions by reducing the perceived importance of the stress-causing situations or events. The presence of supportive systems enhances self-control, and positive emotions, and makes some pregnancy-related changes seem less stressful for the pregnant woman (Chou et al., 2008; McKee, Cunningham, Jankowski, & Zayas, 2001).
When we evaluated previous studies in which psychosocial aspects of pregnancy were investigated, we saw that there were a limited number of researchers who had targeted the topic of how psychological problems relate to social support (Akbaş, 2006; Altınay, 1999; Büyükkoca, 2001; Okanlı, Tortumluoğlu, & Kırpınar, 2003), and the lack of empirical data on this relationship was the determining factor in planning our study. Our aim was to determine the effect of pregnant women’s perception of level of multidimensional social support during the period of pregnancy on their state anxiety level. Therefore, we formulated the following hypothesis:
Hypothesis: Social support of husband, family, and friends will have a positive effect on reducing pregnancy anxiety.
Method
We used descriptive research in order to determine the effect of pregnant women’s perception of level of multidimensional social support during the period of pregnancy on their state anxiety level.
Place and Characteristics
We undertook this study at the Medical Monitoring Polyclinic for Pregnant Women at Çorum State Hospital. There were four medical monitoring polyclinics for pregnant women at the hospital. Doctors worked in shifts at the polyclinics and one nurse assisted at each polyclinic. Routine follow-ups and screenings of the pregnant women were performed at the polyclinics, and training and counseling were provided by the polyclinic nurses for the pregnant women according to their gestational week.
Sample
The sample population for the research consisted of pregnant women who applied to the Medical Monitoring Polyclinic for Pregnant Women at Çorum State Hospital between March 2011 and June 2011. Using simple random sampling, we selected 160 pregnant women to comprise the research sample.
Women who lived in the city center of Çorum and agreed to participate voluntarily to participate were included in the research. Those women and/or their babies who developed complications during pregnancy (e.g., hemorrhage, infection, intrauterine growth retardation, congenital anomalies) and the women who had chronic diseases (e.g., heart disease, hypertension, diabetes, and renal disease) were excluded from the study because these problems might have affected the results.
Ethical Considerations of the Research
The Ethical Council of the Medicine Faculty of Erciyes University approved the ethical suitability of the research. The necessary official permission from the hospital management was obtained for both the pretest phase and implementation phase of the research which were performed at the Çorum State Hospital. All women were informed of the purpose of the study with written documents and were told that the information would not be disclosed. The women’s oral consents were obtained and only those who volunteered for the research were included in the study.
Data Collection Tools
The data were collected using the Descriptive Data Collection Form (DDCF) for the Characteristics of the Pregnant Women (Akbaş, 2006; Büyükkoca 2001; Chou et al., 2008), the Multidimensional Scale of Perceived Social Support (MSPSS), and the State Anxiety Inventory (SAI).
Descriptive Data Collection Form for the Characteristics of the Pregnant Women. The DDCF comprises seven questions addressing information about pregnant women’s sociodemographic characteristics of age, educational status, employment status, family type, income status, and harmony between spouses and obstetric information about number of pregnancies and parity, and whether or not it was a desired pregnancy.
Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS was developed by Zimet, Dahlem, Zimet, & Farley (1988). Eker and Aker (1995) validated the factor structure and reliability of the MSPSS in a Turkish cultural context and translated the scale into Turkish. The MSPSS consists of 12 items. There were three subscales of four items and the subscales address the source of the support: family (items 3, 4, 8, and 11), friends (items 6, 7, 9, and 12), and significant others (items 1, 2, 5, and 10). Each item is scored between 1 and 7. Subscale scores were obtained by adding the scores of the four items and the total score of the scale was obtained by adding the scores of the four subscales. The lowest score from the scale was 12, whereas the highest score was 84. High scores indicated high levels of perceived social support and low scores indicated that little support was perceived or that the pregnant woman was deprived of support. Eker and Akar (1995) found that the Cronbach’s alpha coefficient of the scale was .89 and Cronbach’s alpha coefficients for the subscales were .85 for family, .88 for friends, and .92 for significant others.
State Anxiety Inventory (SAI). This inventory was developed by Spielberger, Gorsuch, and Lushene (1970) using Spielberger’s two-factor anxiety theory. The SAI consists of 20 questions addressing how a person feels in a specific situation and at a certain time. Öner and Le Compte (1985) performed the validity and reliability tests of the inventory in a Turkish cultural context and translated the SAI into Turkish. In the test-retest reliability of the inventory, which was administered twice to five different student groups, invariance coefficient calculated using Pearson’s product-moment coefficient was between .71 and .86. Internal consistency and homogeneity coefficients calculated using alpha correlations were between .83 and .87, and internal consistency of the scale was between .34 and .72. The scale was scored according to the frequency of the emotion, thought, or behavior described in each item on a 4-point scale ranging from 1 = almost never to 4 = almost always. There were reversed and nonreversed items. The reversed items signifying positive emotions were scored with 4 demonstrating low anxiety. In nonreversed items signifying negative emotions, the answers scored with 4 demonstrated high anxiety. The state anxiety score was calculated by adding 50 to the difference between total weighted scores of the reversed and nonreversed scores. Higher scores indicated higher anxiety levels and lower scores indicated lower anxiety levels. Scores ≤ 36 indicated no anxiety, scores 37 to 41 indicated mild anxiety, and scores ≥ 42 indicated high anxiety.
Evaluation of the Data
The data obtained from the research were assessed using the SPSS 17.0 statistical package program. Percentages, arithmetic means, and standard deviations were used in the data analysis. We performed a t test for the paired-group comparisons of the parameters that followed normal distribution, and one-way ANOVA test was used for the multigroup comparisons.
Results
Nearly half of the participants were between the ages of 26 and 33 years (43.0%), and their educational level was high school graduate or above (41.2%). Most of the women were housewives (82.5%) from nuclear families (73.8%). Approximately half of the women (50.6%) had a total monthly income between 700TL and 1000TL (US$370-US$528), and almost all of them had health insurance (90.6 %). When we analyzed the fertility histories of the women we found that nearly three in five women (60.6%) were multigravida (a woman who is pregnant and has been pregnant at least twice before) and more than half (55.6%) were multipara (a woman who has had two or more pregnancies resulting in viable fetuses; see Table 1). Also, not shown in the table, nearly three in five women (60.6%) had a harmonious relationship with their husband and wanted to be pregnant (66.3%).
Table 1. Sociodemographic Characteristics and Fertility History of Pregnant Women
When we analyzed the women’s mean scores obtained from the MSPSS and the distributions of the MSPSS subscales, we found that the mean score from the MSPSS was 67.06±15.1, which showed high social support. The women received social support mostly from significant others during the pregnancy period, and the least social support came from their friends as shown in Table 2. According to the scores obtained from the SAI, most of the women experienced anxiety (see Table 3). The mean anxiety score obtained from the SAI was 36.95±6.2 (min. = 30, max. = 42).
Table 2. Distribution of Pregnant Women in Terms of MSPSS Scores
Table 3. Anxiety Status of Pregnant Women According to SAI Scores
The analysis of the factors affecting SAI scores indicated that there was no statistically significant difference between mean anxiety scores and age, educational status, employment status, monthly total income, number of pregnancies, and parity (p > .05). However, as is shown in Table 4, a statistically significant difference was found between mean anxiety scores and family type, desired pregnancy, and harmony between spouses (p < .05).
Table 4. Factors Affecting SAI Scores of Pregnant Women
Note. * p < .05.
When we analyzed the anxiety levels of the women according to their mean MSPSS scores, we found that mean family social support scores, mean friend social support scores, mean significant other social support scores, and mean total social support scores of those who were mildly anxious during the pregnancy were lower compared to the scores of those who did not experience anxiety. The analysis demonstrated that there was no statistically significant difference between mean family support scores, mean friend support scores, and the anxiety levels (p > .05), whereas there was a statistically significant difference between mean significant other social support scores, total social support scores, and anxiety levels (p < .05). These findings showed that pregnant women with higher significant other social support scores and pregnant women with higher mean total social support scores, suffered less anxiety than did those with lower scores (see Table 5).
Table 5. Distribution of Pregnant Women’s Anxiety Levels According to Mean MSPSS Scores
Note. * p < 0.05.
Discussion
The pregnancy period is an important time during which significant biological changes are experienced and during which adaptation to new and different roles is necessary (Heron et al., 2004). Researchers have reported that pregnancy is at the top of a list of stressful events in a woman’s life (Heron et al., 2004; Kelly et al., 2001). In the face of stress during pregnancy, women may demonstrate emotional or psychological reactions such as acceptance, resistance, fear, anxiety, or depression, depending on their behavioral patterns and personal or mental characteristics. The most important emotional reaction or problem known during pregnancy is anxiety (Heron et al., 2004; Kelly et al., 2001). Similarly, we found that nearly 70% of the pregnant women who took part in our study suffered from anxiety according to the SAI scores. Yet, when we evaluated the findings regarding the anxiety levels of the participant women, we noted that these women had mild levels of anxiety (36.95±6.2). There were no findings in our study showing that the participant women had moderate or high levels of anxiety. Heron et al.’s (2004) study revealed that pregnant women had mild levels of anxiety. This was similar to our results, whereas Bhagwanani, Seagravesjk, Dierker, and Lax (1997) and Kelly et al. (2001) reported that pregnant women had high levels of state anxiety.
Social support is one of the key factors that reduce anxiety and stress during pregnancy. It is thought that supportive relations play an important role in both protecting against and reinforcing the efforts to cope with the effects of stress experienced by pregnant women (Chou, Chen, Kuo, & Tzeng, 2006; Jesse et al., 2005). In our study we found that the participant women belonged to a group who had high social support according to the mean MSPSS scores (67.06±15.1). Therefore, the fact that participant women generally belonged to a group with high social support reduced the mean state anxiety scores. In addition, our results showed that family social support scores, significant other social support scores, and mean total social support scores of women who were anxious during pregnancy were lower compared to the scores of those who were not experiencing anxiety during pregnancy. Similarly, McKee et al. (2001) reported that state anxiety means of pregnant women with high social support were lower than those of women with low social support. Chou et al. (2008) also indicated that the perceived stress of the women decreased as their scores of the perceived level of social support during pregnancy increased.
Social support mechanisms assist in improving adaptation and emotional support. Chou et al. (2008) and McKee et al. (2001) reported that as the perceived social support increased, psychological problems created by stressful experiences were reduced. The husband’s attitude and the psychosocial environment directly affected the psychological state of the women who took part in our study. Support from significant people in the social environment positively affected the pregnancy experience (Chou et al., 2006; Jesse et al., 2005). In this sense, the most important support sources for pregnant women are close family members, especially husbands. Good communication with friends, relatives, and their husband positively affects the woman’s transition to the motherhood role. In previous research it has been found that women whose motherhood role is supported by their husbands and who can share problems with their husbands experience fewer problems than do those who do not have this support (Chou et al., 2008; Jesse et al., 2005; McKee et al., 2001).
As in previous studies, we found that there was a negative correlation between anxiety levels and both significant other social support scores and mean total social support scores. In other words, as the scores of significant other social support and mean total social support scores increased, anxiety levels of the women decreased. We also found that there was a negative correlation between both harmony between spouses and desiring the baby, and mean state anxiety scores; women who did not have a harmonious relationship with their husband and for whom the pregnancy was unplanned and the baby was unwanted had higher mean state anxiety scores than did those who had a harmonious relationship with their husband and for whom the pregnancy had been planned and the baby was wanted. Chou et al. (2008) also indicated that those whose pregnancy was unplanned had higher state anxiety levels compared to those whose pregnancy was planned. McKee et al. (2001) reported that those who did not have a harmonious relationship with their husband had higher depression scores. Previous researchers have reported that lack of social support and disharmony between spouses are among the most significant causes of depression and anxiety during pregnancy and the postpartum period (Chou et al., 2006; Jesse et al., 2005). Affonso et al. (1991) found that the most important factor that increased depression risk was disharmony between spouses, poor marital relations, and poor social support from husband.
In addition, we found that there was a positive correlation between family type and mean state anxiety scores, in that women living with extended families had higher mean state anxiety scores compared to the scores of those living in nuclear families. Akbaş (2006) reported similar results. The psychological pressures possibly created by authority figures of the traditional family structure, such as a mother-in-law or a father-in-law, may result in problems in self-expression and communication for the pregnant daughter-in-law. Therefore, because the nuclear family type is more open to intrafamilial communication and spouse relations are warmer in the nuclear family compared to those in the extended family type, we concluded that pregnant women living in nuclear families were likely to experience less anxiety than did those in extended families (Akbaş, 2006).
Conclusion
In our study we found that 70% of the pregnant women were experiencing mild anxiety. We also noted that pregnant women with higher significant other social support scores and mean total social support scores had lower mean state anxiety scores. The analysis we conducted demonstrated that there was a statistically significant correlation between anxiety levels and mean scores of significant other social support and mean total social support scores, but the correlation between mean scores of family social support and friend social support and anxiety levels was not statistically significant. Based on these findings, we concluded that social support of significant others and total social support during pregnancy affected anxiety levels more than did family and friend support. Based on the results of the study, we made following recommendations:
- The risk factors that facilitate depression and other anxiety disorders among women attending clinics at health institutions during pregnancy should be explored, and the necessary initiatives for those women at risk should be initiated so that their social support systems can be reinforced.
- Psychosocial support systems such as husbands, friends, and families should be integrated with training and counseling during the prebirth period.
- Counseling about issues such as open communication, empathy, and methods for coping with stress should be provided for the pregnant women and their husbands in order to alleviate communication problems in the family.
- Future researchers should include a control group and a bigger sample in their studies so that the findings in our study may be further confirmed and supported with more data.
References
Affonso, D., Lovett, S., Paul, S., Arizmendi, T., Nuusbaum, R., Newman, L., & Johnson, B. (1991). Predictors of depression symptoms during pregnancy and postpartum. Journal of Psychosomatic Obstetrics & Gynecology, 12, 255-271. http://doi.org/cq778b
Akbaş, E. (2006). Investigation of the relation between pregnant women’s depression and anxiety levels and social support (Master’s thesis). Retrieved from http://www.belgeler.com/blg/tp5/gebe-kadinlarda-depresyon-ve-anksiyete-duzeylerinin-sosyal-destek-ile-iliskisinin-incelenmesi-investigation-of-the-relation-between-pregnant-women-s-depression-and- anxiety-levels-and-social-support
Altınay, S. (1999). Association between sociodemographic variables with the levels of depression and anxiety in pregnancy (Master’s thesis). Retrieved from http://www.noropsikiyatriarsivi.com/tr/makale/2622/389/Tam-Metin
Bhagwanani, S. G., Seagravesjk, K., Dierker, L. J., & Lax, M. (1997). Relationship between prenatal anxiety and perinatal outcome in nulliparous women: A prospective study. Journal of the National Medical Association, 89, 93-98.
Büyükkoca, M. (2001). To investigate the association between perceived social support and postpartum depression. Master’s thesis, Dokuz Eylül University, Izmir, Turkey.
Chou, F.-H., Avant, K. C., Kuo, S. H., & Fetzer, S. J. (2008). Relationships between nausea and vomiting, perceived stress, social support: Pregnancy planning and psychosocial adaptation in a sample of mothers: A questionnaire survey. International Journal of Nursing Studies, 45, 1185-91. http://doi.org/dsbfb5
Chou, F.-H., Chen, C.-H., Kuo, S.-H., & Tzeng, Y.-L. (2006). Experience of Taiwanese women living with nausea and vomiting during pregnancy. Journal of Midwifery & Women’s Health, 51, 370-375. http://doi.org/c668vb
Eker, D., & Akar, H. (1995). Factorial structure, validity, and reliability of revised form of the Multidimensional Scale of Perceived Social Support. Turkish Journal of Psychiatry, 10, 45-55.
Heron, J., O’Connor, T. G., Evans, J., Golding, J., & Glover, V. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73. http://doi.org/dntp8n
Jesse, D. E., Walcott-McQuigg, J., Mariella, A., & Swanson, M. S. (2005). Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy. Journal of Midwifery & Women’s Health, 50, 405-410. http://doi.org/dpkbpb
Kelly, R. H., Russo, J., & Katon, W. (2001). Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptom amplification revisited? General Hospital Psychiatry, 23, 107-13. http://doi.org/cvds6h
McKee, M. D., Cunningham, M., Jankowski, K. R., & Zayas, L. (2001). Health-related functional status in pregnancy: Relationship to depression and social support in a multi-ethnic population. Obstetrics & Gynecology, 97, 988-993. http://doi.org/b7wsqk
Okanlı, A., Tortumluoğlu, G., & Kırpınar, İ. (2003). The relationship between pregnant women’s perceived social support from family and problem-solving skills. Journal of Anatolian Psychiatry, 4, 98-105.
Öner, N., & Le Compte, A. (1985). State-Trait Anxiety Inventory handbook. İstanbul: Boğaziçi University Publications.
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Pres.
Swallow, B. L., Lindow, S. W., Masson, E. A., & Hay, D. M. (2004). Psychological health in early pregnancy: Relationship with nausea and vomiting. Journal of Obstetrics & Gynaecology, 24, 28-32. http://doi.org/cb6nhd
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41. http://doi.org/dt7nqw
Affonso, D., Lovett, S., Paul, S., Arizmendi, T., Nuusbaum, R., Newman, L., & Johnson, B. (1991). Predictors of depression symptoms during pregnancy and postpartum. Journal of Psychosomatic Obstetrics & Gynecology, 12, 255-271. http://doi.org/cq778b
Akbaş, E. (2006). Investigation of the relation between pregnant women’s depression and anxiety levels and social support (Master’s thesis). Retrieved from http://www.belgeler.com/blg/tp5/gebe-kadinlarda-depresyon-ve-anksiyete-duzeylerinin-sosyal-destek-ile-iliskisinin-incelenmesi-investigation-of-the-relation-between-pregnant-women-s-depression-and- anxiety-levels-and-social-support
Altınay, S. (1999). Association between sociodemographic variables with the levels of depression and anxiety in pregnancy (Master’s thesis). Retrieved from http://www.noropsikiyatriarsivi.com/tr/makale/2622/389/Tam-Metin
Bhagwanani, S. G., Seagravesjk, K., Dierker, L. J., & Lax, M. (1997). Relationship between prenatal anxiety and perinatal outcome in nulliparous women: A prospective study. Journal of the National Medical Association, 89, 93-98.
Büyükkoca, M. (2001). To investigate the association between perceived social support and postpartum depression. Master’s thesis, Dokuz Eylül University, Izmir, Turkey.
Chou, F.-H., Avant, K. C., Kuo, S. H., & Fetzer, S. J. (2008). Relationships between nausea and vomiting, perceived stress, social support: Pregnancy planning and psychosocial adaptation in a sample of mothers: A questionnaire survey. International Journal of Nursing Studies, 45, 1185-91. http://doi.org/dsbfb5
Chou, F.-H., Chen, C.-H., Kuo, S.-H., & Tzeng, Y.-L. (2006). Experience of Taiwanese women living with nausea and vomiting during pregnancy. Journal of Midwifery & Women’s Health, 51, 370-375. http://doi.org/c668vb
Eker, D., & Akar, H. (1995). Factorial structure, validity, and reliability of revised form of the Multidimensional Scale of Perceived Social Support. Turkish Journal of Psychiatry, 10, 45-55.
Heron, J., O’Connor, T. G., Evans, J., Golding, J., & Glover, V. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73. http://doi.org/dntp8n
Jesse, D. E., Walcott-McQuigg, J., Mariella, A., & Swanson, M. S. (2005). Risks and protective factors associated with symptoms of depression in low-income African American and Caucasian women during pregnancy. Journal of Midwifery & Women’s Health, 50, 405-410. http://doi.org/dpkbpb
Kelly, R. H., Russo, J., & Katon, W. (2001). Somatic complaints among pregnant women cared for in obstetrics: Normal pregnancy or depressive and anxiety symptom amplification revisited? General Hospital Psychiatry, 23, 107-13. http://doi.org/cvds6h
McKee, M. D., Cunningham, M., Jankowski, K. R., & Zayas, L. (2001). Health-related functional status in pregnancy: Relationship to depression and social support in a multi-ethnic population. Obstetrics & Gynecology, 97, 988-993. http://doi.org/b7wsqk
Okanlı, A., Tortumluoğlu, G., & Kırpınar, İ. (2003). The relationship between pregnant women’s perceived social support from family and problem-solving skills. Journal of Anatolian Psychiatry, 4, 98-105.
Öner, N., & Le Compte, A. (1985). State-Trait Anxiety Inventory handbook. İstanbul: Boğaziçi University Publications.
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Pres.
Swallow, B. L., Lindow, S. W., Masson, E. A., & Hay, D. M. (2004). Psychological health in early pregnancy: Relationship with nausea and vomiting. Journal of Obstetrics & Gynaecology, 24, 28-32. http://doi.org/cb6nhd
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41. http://doi.org/dt7nqw
Table 1. Sociodemographic Characteristics and Fertility History of Pregnant Women
Table 2. Distribution of Pregnant Women in Terms of MSPSS Scores
Table 3. Anxiety Status of Pregnant Women According to SAI Scores
Table 4. Factors Affecting SAI Scores of Pregnant Women
Note. * p < .05.
Table 5. Distribution of Pregnant Women’s Anxiety Levels According to Mean MSPSS Scores
Note. * p < 0.05.
Nuriye Büyükkayaci Duman, Hitit University, School of Health, Çorum 19000, Turkey. Email: [email protected]