Document Type : Original Article

Authors

1 Department of Midwifery, PHD Student in Reproductive Health, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences

2 Department of Biostatistics and Public Health, Faculty of Health, Kashan University of Medical Sciences,

3 Department of Health, Kargar Health Centre, Kashan University of Medical Sciences,

4 Department of Health, Akramian Health Centre, Kashan University of Medical Sciences, Kashan, Iran

Abstract

BACKGROUND: If anxiety and depression do not detect in pregnant women, they may cause
complications for the mother, child, and family, including postpartum depression. With regard to the
administrative capability of relaxation in health centers, this study was conducted to determine the
effect of progressive muscle relaxation and guided imagery on stress, anxiety, and depression in
pregnant women.
MATERIALS AND METHODS: This randomized clinical trial was conducted on pregnant women in
the city of Kashan at 28–36 weeks. At the onset of the study, demographic questionnaire, Edinburgh
Depression Scale, and Depression, Anxiety, and Stress Scale‑21 (DASS‑21) were completed.
Providing obtaining score of mild‑to‑moderate in the stress, anxiety, and depression scale and score
of 10 or higher in Edinburgh Depression Scale, individuals were divided randomized to the intervention
group (n = 33) and control group (n = 33). DASS‑21 was again completed in the 4th–7th weeks of
beginning of the study by all women.
RESULTS: Analysis of variance with repeated measures indicated significant differences in mean
of scores of stress, anxiety, and depression at three different times in relaxation group (P < 0.05)
whereas found no significant differences in the mean of scores of stress, anxiety, and depression
in the control group.
CONCLUSIONS: In this study, relaxation could reduce stress, anxiety, and depression in pregnant
women during six sessions. Due to the simplicity and low cost of this technique, it can be used to
reduce stress and anxiety in pregnant women and improve pregnancy outcomes.

Keywords

1. Smith MV, Shao L, Howell H, Lin H, Yonkers KA. Perinatal
depression and birth outcomes in a healthy start project. Matern
Child Health J 2011;15:401‑9.
2. Dunkel Schetter C, Tanner L. Anxiety, depression and stress in
pregnancy: Implications for mothers, children, research, and
practice. Curr Opin Psychiatry 2012;25:141‑8.
3. World Health Organization. Maternal Mental Health; 2016b.
Available from: http://www.who.int/mental_health/
maternal‑child/maternal_mental_health/en/. [Last accessed
on 2016 Apr 01].
4. Dunkel Schetter C. Psychological science on pregnancy: Stress
processes, biopsychosocial models, and emerging research issues.
Annu Rev Psychol 2011;62:531‑58.
5. Mohamad Yusuff AS, Tang L, Binns CW, Lee AH. Prevalence and
risk factors for postnatal depression in Sabah, Malaysia: A cohort
study. Women Birth 2015;28:25‑9.
6. Woods SM, Melville JL, Guo Y, Fan MY, Gavin A. Psychosocial
stress during pregnancy. Am J Obstet Gynecol 2010;202:61.e1‑7.
7. Musters C, McDonald E, Jones I. Management of postnatal
depression. BMJ 2008;337:a736.
8. Close C, Sinclair M, Liddle SD, Madden E, McCullough JE,
Hughes C, et al. A systematic review investigating the
effectiveness of complementary and alternative medicine (CAM)
for the management of low back and/or pelvic pain (LBPP) in
pregnancy. J Adv Nurs 2014;70:1702‑16.
9. Jorm AF, Morgan AJ, Hetrick SE. Relaxation for depression.
Cochrane Database Syst Rev 2008 Oct 8; (4):CD007142.
10. Alwan M, Zakaria A, Abdul Rahim M, Abdul Hamid N, Fuad M.
Comparison between two relaxation methods on competitive state
anxiety among college soccer teams during pre‑competition stage.
Int J Adv Sport Sci Res 2013;1:90‑104.
11. Varvogli L, Darviri C. Stress management techniques:
Evidence‑based procedures that reduce stress and promote health.
Health Sci J 2011;5:74‑8.12. Chuang LL, Lin LC, Cheng PJ, Chen CH, Wu SC, Chang CL,
et al. Effects of a relaxation training programme on immediate
and prolonged stress responses in women with preterm labour.
J Adv Nurs 2012;68:170‑80.
13. Rafiee B, Akbarzadeh M, Asadi N, Zare N. Comparing the
effects of educating of attachment and relaxation on anxiety in
third trimester of pregnancy and postpartum depression in the
primipara women. Hayat 2013;19:76‑88.
14. Malekzadegan A, Moradkhani M, Ashayeri H, Haghani H. Effect
of relaxation on insomnia during third trimester among pregnant
women. IJN 2010;23:52‑8.
15. Chambers A. Relaxation during Pregnancy to Reduce Stress and
Anxiety and Their Associated Complications. Degree of Doctor
of Philosophy: The University of Arizona; 2007.
16. Ahmadi Nejad FS, Golmakani N, Asghari Pour N, Shakeri M.
Effect of progressive muscle relaxation on depression, anxiety,
and stress of primigravid women. Evid Based Care 2015;5:67‑76.
17. Akbarzadeh M, Toosi M, Zare N, Sharif F. Effect of relaxation and
attachment behaviors training on anxiety in first‑time mothers in
Shiraz city, 2010: A randomized clinical trial. Qom Univ Med Sci
J 2013;6:14‑23.
18. Nasiri S. “Comparing the Effects of Problem‑Solving Skills
and Relaxation on the Severity of Depression Symptoms in the
Postpartum Period.” Degree of Master of Science: The University
of Mashhad; 2010.
19. Smith C, Hancock H, Blake‑Mortimer J, Eckert K. A randomized
comparative trial of yoga and relaxation to reduce stress and
anxiety. Complement Ther Med 2007;15:77‑83.
20. Vélez RR. Pregnancy and health‑related quality of life: A cross
sectional study. Colomb Med 2011;42:476‑81.
21. Ryan A. Interventions to reduce anxiety during pregnancy: An
overview ofresearch. NCT’s J 2013;(19):16‑20.
22. UrechC, FinkNS, HoesliI, WilhelmFH, BitzerJ, AlderJ, et al. Effects
of relaxation on psychobiological wellbeing during pregnancy:
A randomized controlled trial. Psychoneuroendocrinology
2010;35:1348‑55.