Relationship between Pregnancy Stress and Anxiety in High...

Relationship between Pregnancy Stress and Anxiety in

High-Risk Pregnant Women: The Mediating Effects of

Sense of Mastery

Sung- hee Lee1, Eun-young Lee2*

1Professor, College of Nursing, Kyungpook National University,

Daegu, Korea 2RN, Department of Nursing, Pusan National University Hospital,

Busan, Korea

Abstract. This study aimed to examine the relationship between pregnancy

stress and anxiety and to explore the mediating sense of mastery in this rela-

tionship among high-risk pregnant women in Korea. The data were collected

between March 3 and March 30, 2015, from 118 high-risk pregnant women

through structured questionnaires. Collected data were analyzed using the IBM

SPSS Statistics 22 program. The mediating effect of self-esteem was analyzed

using linear regressions and the Sobel test. Sense of mastery partially mediated

the relationship between pregnancy stress and anxiety. The significance of this

study was to decrease anxiety among increasingly high-risk pregnant women

and to reinforce the need for the development and application of prenatal nurs-

ing intervention to reduce pregnancy stress through a higher sense of mastery.

Keywords: Pregnancy stress, Anxiety, Sense of mastery

1 Introduction

1.1 Background

Recently in Korea, the ages of men and women at their first marriage is getting higher,

as is the age at which women get pregnant. Older age in pregnant women is a strong

risk factor for high-risk pregnancy [1]. High-risk pregnancy refers to conditions

skewed from normal pregnancy and incurs a risk to the health and life of pregnant

women and fetuses, such as premature labor, premature membrane rupture, cervical

incompetence, and placenta previa [2]. According to the statistics of the Health Insur-

ance Review & Assessment Service, the rate of high-risk pregnancy is only 7% in

pregnant women aged 25–30 but rapidly increases to 24% in those aged 35–40 and 39%

in those aged over 40; 42.8% of all pregnancy was high-risk pregnancy [3].

2*Corresponding Author: Eun Young Lee, Kyungpook National University.

Tel: +82-10-4745-0918, E-mail: [email protected]

Advanced Science and Technology Letters Vol.116 (Healthcare and Nursing 2015), pp.35-40

http://dx.doi.org/10.14257/astl.2015.116.08

ISSN: 2287-1233 ASTL Copyright © 2015 SERSC

High-risk pregnant women experience anxiety over such concerns as the health of

fetuses and themselves, physical discomfort, and childbirth prognosis [4]. Anxiety is a

stress reaction that high-risk pregnant women experience and a general emotion oc-

curring in high-risk pregnant women [5]. High-risk pregnant women cannot predict

their own well-being or that of their fetuses related to the condition of high-risk preg-

nancy and, thus, have a difficulty in emotional bonding and express anxiety [6]. Addi-

tionally, they do not perform proper antenatal care as they are anxious about the con-

sequence of pregnancy in the future, and they can encounter more serious health prob-

lems because they lack coping strategies in case the pregnancy is at risk [7].

The factors increasing the anxiety of high-risk pregnant women include stress vari-

ables. A previous study [8] showed that stress plays a significant role in increasing

anxiety. According to the stress-diathesis model, the class of pregnant women with

many vulnerability factors can easily have psychological impairments due to lack of

strength to overcome stress [9]. Particularly, a high-stress experience such as high-

risk pregnancy during a short period of time increases anxiety more and affects both

pregnant women and fetuses and, consequently, can cause obstetrical complications

[10].

On the other hand, sense of mastery refers to a positive attitude and belief that they

are able to lead their lives with will and effort [11]. Particularly, one stress study has

shown that sense of mastery has a great influence on emotional stability, and it has

gained attention as a significant psychological resource [11]. Sense of mastery needs

to be considered in order to relieve stress and anxiety of high-risk pregnant women

with the increasing trend in recent years.

However, among previous domestic or international studies until the present, there

are hardly any studies about sense of mastery in pregnant women experiencing high-

risk pregnancy. Therefore, in exploring the association between stress and anxiety in

high-risk pregnant women along with the mediating effects of sense of mastery, this

study attempted to provide preliminary data for nursing interventions to increase

sense of mastery of high-risk pregnant women and, consequently, alleviate their anxi-

ety.

1.2 Purpose

The purpose of this study is to explore the mediating effects of sense of mastery in the

association between stress and anxiety in high-risk pregnant women.

2 Methods

2.1 Study Design

This descriptive and cross-sectional study attempts to verify the mediating effects of

sense of mastery as well as the association between stress and anxiety in high-risk

pregnant women.

Advanced Science and Technology Letters Vol.116 (Healthcare and Nursing 2015)

36 Copyright © 2015 SERSC

2.2 Participants and Data Collection

This study was conducted from March 3, 2015, to March 30, 2015, with approval of

chief executives of three university hospitals and cooperation of OB/GYN clinics and

labor and delivery departments. Study participants included 118 high-risk pregnant

women admitted in labor and delivery departments as well as high-risk pregnant

women diagnosed with high-risk pregnancy at three university hospitals located in the

cities of B, D, and Y during the gestational age range of 20–38 weeks and who visited

OB/GYN clinics for prenatal care. Sample size was calculated using G*power 3.1. As

a result of calculating sample size with .05 significance level, 80% statistical pow-

er, .15 effect size, and three predictor variables, the minimal number of participants

needed was 77, but 120 were recruited considering a 20% non-response rate. Among

collected questionnaires, 118 were used in data analysis, excluding two with insuffi-

cient responses.

2.3. Instruments

Pregnancy Stress. In order to measure pregnancy stress, the instrument developed by

Ahn [12] for primigravidas and revised and complemented by Jo & Kim [13] was

used. This instrument included a total of 27 questions rated on a five-point Likert

scale. Each question has a score range from one point, “never been stressed,” to five

points, “always stressed,” and the total scores range from 27 to 135 points with higher

scores indicating greater stress. The reliability of the instrument at the time of devel-

opment was Cronbach’s α = .85, and it was Cronbach’s α = .88 in this study.

Anxiety. In order to measure anxiety, the State Trait Anxiety Inventory developed by

Spielberger [14] and adapted by Kim & Shin [15] was used. This instrument consists

of a total of 20 questions rated on a four-point Likert scale. Each question has a total

score range from 20 to 84, including one point, “very much”; two points, “mostly”;

three points, “little”; and four points, “almost never.” Negative questions are reverse-

coded, and higher scores mean greater anxiety. The reliability of this instrument was

Cronbach's α = .92 both at the time of development and in this study.

Sense of Mastery. In order to measure sense of mastery, the sense of mastery-

measuring instrument developed by Pearlin et al [11] and adapted by Korean Geron-

tology [16] was used. This instrument consists of a total of seven questions rated on a

four-point Likert scale. Each question has a range from one point, “strongly agree,” to

four points, “not agree at all,” and the total scores range from 7 to 28. Negative ques-

tions are reverse-coded, and higher scores mean greater sense of mastery. At the time

of development, Cronbach's α of this instrument was .70, and it was.74 in this study.

2.4 Data Analyses

Collected data were analyzed using the IBM SPSS Statistics 22 program. General

features and obstetrical characteristics of participants were analyzed using descriptive


Copyright © 2015 SERSC 37

statistics such as frequency, percentile, mean, and standard deviation. The correlations

of pregnancy stress, anxiety, and sense of mastery of participants were verified using

Pearson's correlation coefficient. Multiple regression analysis was performed in order

to investigate the mediating effects in the relation between pregnancy stress and anxi-

ety of participants, and a Sobel test was used to explore the significance of mediating

effects.

3 Results

It was shown that sense of mastery played a partial mediating role in the association

between pregnancy stress and anxiety in high-risk pregnant women. As a result of

verifying this through the Sobel test, the z-value was 4.74 (p < .001) (Table 2), indi-

cating that the mediating effect was significant—that is, it was verified that sense of

mastery had a significant partial mediating effect in the influential association be-

tween pregnancy stress and anxiety in the participants (Table 1), (Figure 1).

Table 1. Mediating Effects of Sense of Mastery

B Β R2 Adj.R2 F p

Step 1

Pregnancy stress

→ Anxiety .506 .560 .314 .308 53.055 <.001

Step 2

Pregnancy stress

→ Sense of mastery -.429 -.490 .240 .234 36.682 <.001

Step 3

Pregnancy stress

→Anxiety .330 .366 .434 .424 44.024 <.001

Sense of mastery

→ Anxiety -.410 -.397



β=.560***

β=-.490***

β=-.397***

β=.366***

Fig. 1. Mediating Effects of Sense of Mastery

Table 2. Sobel Test for Mediating Effects of Sense of Mastery

Path a(SEa) b(SEb) Zab

Pregnancy stress → Sense of mastery

→ Anxiety

Pregnancy stress → Anxiety

-.429(.071) -.595(.078) 4.74(p<.001)

4 Conclusions

This study verified the mediating effects of sense of mastery in the association be-

tween pregnancy stress and anxiety in high-risk pregnant women. The significance of

this study is in the empirical verification that lower pregnancy stress of high-risk

pregnant women and higher sense of mastery correspond to lower anxiety. Based on

the results of this study, it is necessary to develop prenatal intervention programs to

prevent and manage anxiety in high-risk pregnant women, and further studies are

required to verify the effects.

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mastery

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Copyright © 2015 SERSC 39

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