Abstract
BackgroundWomen undergoing elective caesarean section experience anxiety. However, course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies.MethodsThis is a monocentric, prospectively planned study in which 47 women with an indication for primary caesarean section took part. Anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI-trait and STAI-state), the visual analogue scale for anxiety (VASA) as well as saliva cortisol at three time points on the day of the caesarean section (at admission, at skin closure and 2 h post surgery).ResultsPeak anxiety levels for the STAI-state and VASA were highest at admission and showed significant decreases to skin closure (p < .001). The subjective measures correlated significantly at all time points (p-values < .001). For cortisol levels the peak level of anxiety was shown at skin closure with a significant increase from admission to skin closure and a significant decrease from skin closure to 2 h post operation (p-values < .001). Additionally women with STAI-trait scores above the median showed significantly higher levels at the peaks of anxiety.ConclusionThe study reveals the course of anxiety on the day of the caesarean section. A strong correlation of STAI-state and VASA was demonstrated. Cortisol showed a different course, which fits into its known biological kinetics. Taking into account all measures, anxiety seems to be most bothersome before surgery until skin closure. In a differentiated approach using STAI-trait scores as a discriminator we showed that the group with STAI-trait levels above the median is particularly prone to develop anxiety in the setting of the caesarean section and might therefore mostly be in need of an intervention against anxiety.
Highlights
Women undergoing elective caesarean section experience anxiety
It distinguishes between two questionnaires with 20 items each, one measuring anxiety perceived in the current situation (STAI-state) and the other evaluating a general tendency towards anxiety (STAI-trait)
Planned post-hoc pairedsample t-tests for State-Trait Anxiety Inventory” (STAI)-state and visual analogue scale depicting anxiety (VASA) showed that subjective anxiety levels were highest at admission before the caesarean (STAI-state 47.13 [standard deviation (SD) = 9.57]; VASA 5.01 cm [SD = 3.14]) and that anxiety levels significantly decreased (p < .001 for both measures) from admission to skin suture (STAI-state 33.49 [SD = 7.49]; VASA 1.56 cm [SD = 2.06])
Summary
Women undergoing elective caesarean section experience anxiety. course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies. Tools for the quantification of anxiety are at hand, one of the most frequently used being the “State-Trait Anxiety Inventory” (STAI), an introspective inventory comprising 40 self-report items pertaining to anxiety [6] It distinguishes between two questionnaires with 20 items each, one measuring anxiety perceived in the current situation (STAI-state) and the other evaluating a general tendency towards anxiety (STAI-trait). A correlation of VASA and STAI-state has not been shown in the context of CS
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