Anxiety and Induction of Labor: Measuring Scales and Associated Factors

BACKGROUND: Anxiety scores are higher in women being induced compared with women who are in spontaneous labor. There are limited published reports addressing anxiety associated with the induction of labor (IOL).

OBJECTIVES: The aim is to measure anxiety scores that are associated with IOL using two measuring scales and identify women’s characteristics and obstetrics variables that are associated with higher anxiety scores.

METHODS: A cross-sectional study was conducted between October 20, 2019, and October 20, 2020. Inclusion criteria required women to be 18 years or older, have a viable pregnancy, and have been admitted for IOL. Anxiety scores were measured using the visual analog scale for anxiety (VASA) first and then the State-Trait Anxiety Inventory (STAI). The factor analysis for mixed data was used to identify the independent variables that contributed the most to the variation among participants. These variables were then tested for association with the different anxiety variables using multivariate analysis of variance (MANOVA).

RESULTS: In this study, 300 women with a mean age of 28 years and a mean fetal gestational age of 39.4 weeks were recruited. A factor analysis with a principal component analysis method on the STAI state subscale revealed two components with high internal consistency, designated Component 1 and Component 2. Women had anxiety scores above the mean as measured on VASA (48.7%) and Component 1 (50.3%) and Component 2 (70.7%) of the STAI state subscale. There were statistically significant correlations between the two components of the STAI state subscale and VASA (Spearman’s rank correlation: VASA with STAI State Component 1 = −.239, p-value = 2.8 × 10⁻⁵; VASA with STAI State Component 2 = .296, p-value = 1.7 × 10⁻⁷). The three outcome anxiety variables (VASA and Components 1 and 2 of the STAI state subscale) in nonparametric MANOVA analysis showed significant associations with a prior history of subfertility (Wilk’s lambda test statistic = 3.668, df1 = 3, df2 = 296, p-value = .014) and higher parity (Wilk’s lambda test statistic = 2.100, df1 = 6, df2 = 590, p-value = .043).

CONCLUSION: High anxiety scores are prevalent among women who are being induced. The VASA and STAI state subscales are correlated, and VASA may be an alternative to the lengthy STAI. Antenatal identification of women at high risk may help in implementing strategies to reduce anxiety scores.