Is prenatal maternal distress context-dependent? Comparing United States and the Netherlands

Background: Maternal anxiety and depression symptoms during pregnancy can compromise a woman's well-being and affect offspring development. The present study represents a comparison of maternal late-pregnancy internalizing symptoms (i.e., depression and anxiety) between the United States of America (US) and the Netherlands. We hypothesized that women in the US would report higher levels of anxiety and depression during pregnancy compared to their Dutch counterparts, both on individual symptom indicators and overall latent distress, due to more favorable policies/accessible services relevant to perinatal health in the Netherlands.

Methods: Pregnant women were recruited at two comparable sites in the Netherlands (n = 327) and the US (n = 228). Measures included self-reports of internalizing distress and key covariates (i.e., parity, gestational, and maternal age).

Results: Expectant mothers in the US reported higher depressive and anxiety symptoms compared to their Dutch counterparts. Results were consistent across individual internalizing symptom indicators and the overall latent prenatal distress means computed for US and Dutch samples, with an estimated large effect size for the latter after controlling for covariates.

Limitations: Despite their relatively large sizes, our samples were limited in their representativeness of the two cultures and mechanisms contributing to observed differences were not examined.

Conclusions: Pregnant women in the US reported higher levels of depression and anxiety symptoms than women in the Netherlands. Implications concern perinatal policy and clinical services (e.g., emotional health support provided to mothers).