Biopsychosocial Dimensions of Perinatal Anxiety in Primigravida Women at Primary Health Care: A Mixed Method Study

Dea Pebrianti; Dyah Ayu Utari; Ismarwati; Cesa Septiana Pratiwi

doi:10.56741/hesmed.v5i02.2308

Authors

Dea Pebrianti
deapebrianti19@gmail.com
Universitas Medika Suherman
Dyah Ayu Utari Universitas Muhamadiyah Kudus
Ismarwati Universitas 'Aisyiyah Yogyakarta
Cesa Septiana Pratiwi Universitas 'Aisyiyah Yogyakarta

DOI:

https://doi.org/10.56741/hesmed.v5i02.2308

Keywords:

Biopsychosocial Model, Mixed Methods, Perinatal Anxiety, Primary Health Care, Primigravida

Abstract

Perinatal anxiety among primigravida women is a significant yet frequently overlooked maternal mental health concern. This study analyzed the biopsychosocial dimensions of perinatal anxiety among primigravida women in primary health care settings using a sequential explanatory mixed methods design. The quantitative phase involved 171 primigravida women recruited through stratified proportional random sampling from two primary health care centers, who completed the Perinatal Anxiety Screening Scale (PASS). The qualitative phase included 15 informants with anxiety scores above 21 who participated in in-depth interviews. Quantitative data were analyzed using Chi-Square tests, while qualitative data were processed through NVivo 12 Plus following the Miles and Huberman framework. Ethical clearance was obtained from the Research Ethics Committee of Universitas 'Aisyiyah Yogyakarta (No. 1453/KEP-UNISA/IV/2022). The results showed that 39.2% of respondents experienced anxiety (17.5% mild, 18.7% moderate, and 2.9% severe), with a significant association between gestational trimester and anxiety level (p = 0.041). The second trimester exhibited the highest proportion of anxiety at 56.0%. Qualitative analysis revealed three themes: forms of maternal discomfort, antenatal care access experiences, and biopsychosocial dimensions of anxiety encompassing biological, psychological, socioeconomic, environmental, and social support factors. Pearson correlation identified psychological factors (r = 0.95) and social support (r = 0.85) as dominant determinants. The biopsychosocial model proved effective as a comprehensive framework for understanding perinatal anxiety in primary care. These findings provide an evidence-based foundation for holistic maternal mental health interventions and underscore the necessity of routine anxiety screening, strengthened counseling services, and structured social support programs within antenatal care.

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Author Biographies

Dea Pebrianti, Universitas Medika Suherman

is a midwife and a graduate of the Master of Midwifery Science program at Universitas 'Aisyiyah Yogyakarta, Indonesia. She is currently a lecturer at the Bachelor of Midwifery and Midwifery Professional Education Program, Universitas Medika Suherman. Her research interests include maternal mental health, perinatal anxiety, and the application of biopsychosocial models in midwifery care. She holds a Bachelor of Midwifery degree (S.Tr.Keb.) and has clinical experience in community-based maternal health services. This manuscript was developed from her master's thesis research. (email: deapebrianti19@gmail.com).

Dyah Ayu Utari, Universitas Muhamadiyah Kudus

is a senior lecturer and researcher in the Midwifery Program at Universitas Muhammadiyah Kudus, Indonesia. She holds a Master's degree in Health Sciences (M.Kes.) and has extensive experience in clinical midwifery and maternal health education, with a focus on holistic care across the female life cycle. She is actively involved in supervising academic research and contributing to the development of health sciences through various publications.(email: dyahayuutari@umkudus.ac.id).

Ismarwati, Universitas 'Aisyiyah Yogyakarta

is a lecturer at the Midwifery Department, Faculty of Health Sciences, Universitas 'Aisyiyah Yogyakarta, Indonesia. She earned her Bachelor of Applied Midwifery (S.ST.) and Bachelor of Public Health (S.KM.) before completing her Master of Public Health (M.PH.). Her professional expertise spans reproductive health, community-based midwifery practice, and health promotion strategies. She dedicates her academic career to mentoring students in research methodology and advancing evidence-based midwifery education to improve maternal and child health outcomes (email: ismarwati@unisayogya.ac.id).

Cesa Septiana Pratiwi , Universitas 'Aisyiyah Yogyakarta

is a Midwifery Lecturer at Universitas 'Aisyiyah Yogyakarta, Indonesia. She earned her Master of Midwifery (M.Mid.) and Doctor of Philosophy (Ph.D.) with specialization in maternal mental health, particularly antenatal anxiety and depression. Her research explores psychosocial risk factors and intervention strategies to promote psychological well-being during pregnancy. She is dedicated to advancing evidence-based mental health screening tools and developing midwifery-led psychosocial support programs within antenatal care services to improve maternal and neonatal outcomes (email: cesaseptianapratiwi@unisayogya.ac.id).

References

M. Nikdast, "Research Papers: Writing Tips and Top-Tier Targets", IEEE Potentials, vol. 36, no. 3, pp. 26–29, May 2017, doi: 10.1109/MPOT.2017.2662073. DOI: https://doi.org/10.1109/MPOT.2017.2662073

H. Rosiana Ulfah, H. Al Hasbi, and E. Kurniawati, "The Relationship Of Pregnant Mother’s Anxiety With Parity During The COVID-19 Pandemic", icohetech, pp. 407–414, Sep. 2022, doi: 10.47701/icohetech.v3i1.2242. DOI: https://doi.org/10.47701/icohetech.v3i1.2242

T. Farrell et al., "The impact of the COVID-19 pandemic on the perinatal mental health of women", Journal of Perinatal Medicine, vol. 48, no. 9, pp. 971–976, Nov. 2020, doi: 10.1515/jpm-2020-0415. DOI: https://doi.org/10.1515/jpm-2020-0415

N. Qurniati and E. E. Frety, "Affecttive Development of Children Due to Anxiety During Pregnancy : A Literature Review", Journal of Community Medicine and Public Health Research, vol. 6, no. 1, pp. 101–109, Jun. 2025, doi: 10.20473/jcmphr.v6i1.53818. DOI: https://doi.org/10.20473/jcmphr.v6i1.53818

M. P. A. Kusumo, Y. M. Wijaya, and Y. A. Susilowati, "Knowledge and stress level in pregnant women: A cross-sectional study during the COVID-19 pandemic", Pediomaternal Nurs. J., vol. 10, no. 1, pp. 14–19, Mar. 2024, doi: 10.20473/pmnj.v10i1.45084. DOI: https://doi.org/10.20473/pmnj.v10i1.45084

M. Ghazanfarpour et al., "Prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic: a meta-analysis", J Psychosom Obstet Gynaecol, vol. 43, no. 3, pp. 315–326, Sep. 2022, doi: 10.1080/0167482X.2021.1929162. DOI: https://doi.org/10.1080/0167482X.2021.1929162

I. Cahyani, F. Jannah, and M. Arsyad, "Hubungan Paritas Dengan Tingkat Kecemasan pada Kehamilan Dalam Mengahadapi Persalinan di Puskesmas Kecamatan Cipeucang Pandeglang Banten", Cerdika: Jurnal Ilmiah Indonesia, vol. 2, pp. 786–797, Sep. 2022, doi: 10.59141/cerdika.v2i9.444. DOI: https://doi.org/10.59141/cerdika.v2i9.444

N. Adrianto, J. Caesarlia, and F. B. Pajala, "Depression in pregnant and postpartum women during COVID-19 pandemic: systematic review and meta-analysis", Obstet Gynecol Sci, vol. 65, no. 4, pp. 287–302, Jul. 2022, doi: 10.5468/ogs.21265. DOI: https://doi.org/10.5468/ogs.21265

X. Zhang et al., "Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis", Front Public Health, vol. 11, p. 1102618, 2023, doi: 10.3389/fpubh.2023.1102618. DOI: https://doi.org/10.3389/fpubh.2023.1102618

D. Wulandatika, S. Fatimah, D. S. Hariyono, R. A. N. Afifah, and N. Azkiya, "An Analysis of Pregnancy-Related Anxiety Using a Biopsychosocial Approach", Journal of Public Health Sciences, vol. 4, no. 03, pp. 468–483, 2025, doi: 10.56741/IISTR.jphs.001081. DOI: https://doi.org/10.56741/IISTR.jphs.001081

E. Suryaningsih and C. Horhoruw, "The Relationship between Parity and Anxiety Levels of Pregnant Women in the Third Trimester", Jurnal Kebidanan, vol. 13, p. 23, Feb. 2024, doi: 10.26714/jk.13.1.2024.23-28. DOI: https://doi.org/10.26714/jk.13.1.2024.23-28

S. Wahyuni, N. Pramono, S. Hadisaputro, and A. Ediati, "Factors associated with pregnancy-related anxiety: a health facility-based study", IJPHS, vol. 13, no. 3, p. 1251, Sep. 2024, doi: 10.11591/ijphs.v13i3.24327. DOI: https://doi.org/10.11591/ijphs.v13i3.24327

J. W. Creswell and J. D. Creswell, Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. SAGE Publications, 2017.

World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Accessed: Feb. 12, 2024. [Online]. Available: https://www.who.int/publications-detail-redirect/9789241565585

K. D. Anggraini, "Factors Associated with Anxiety Levels in Pregnant Women in the Third Trimester", International Conference on Multidisciplinary Approaches in Health Science, vol. 2, no. 1, pp. 31–37, Dec. 2024, doi: 10.33992/icmahs.v2i1.3592.

M. Zhang et al., "Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey", Bmj, vol. 380, 2023, Accessed: Jun. 30, 2025. [Online]. Available: https://www.bmj.com/content/380/bmj-2022-071952.abstract DOI: https://doi.org/10.1136/bmj-2022-071952

S. M. K. Nisa, I. Qadrijati, and B. Murti, "Psychosocial Factors Associated with Anxiety and Delivery Pain", JMCH, vol. 3, no. 1, pp. 44–58, 2018, Accessed: May 18, 2026. [Online]. Available: https://www.neliti.com/publications/235325/

M. Pasinringi, A. Burhanuddin, F. Cholisa, N. Musa, and E. Safrina, "Kontribusi Regulasi Emosi terhadap Kecemasan pada Ibu Hamil di Kehamilan Pertama", Jurnal Health Sains, vol. 2, pp. 1469–1478, Nov. 2021, doi: 10.46799/jhs.v2i11.335. DOI: https://doi.org/10.46799/jhs.v2i11.335

J. G. Y. Luc et al., "Cardiac surgeons’ concerns, perceptions, and responses during the COVID-19 pandemic", J Card Surg, vol. 36, no. 9, pp. 3040–3051, Sep. 2021, doi: 10.1111/jocs.15681. DOI: https://doi.org/10.1111/jocs.15681

A. J. Jakimiuk et al., "Absence of SARS-CoV-2 RNA in Peritoneal Fluid During Surgery in Pregnant Women Who Are COVID-19 Positive", Journal of Minimally Invasive Gynecology, Jun. 2021, doi: 10.1016/j.jmig.2021.06.006. DOI: https://doi.org/10.1016/j.jmig.2021.06.006

M. Xie, X. Wang, J. Zhang, and Y. Wang, "Alteration in the psychologic status and family environment of pregnant women before and during the COVID-19 pandemic", Int J Gynaecol Obstet, vol. 153, no. 1, pp. 71–75, Apr. 2021, doi: 10.1002/ijgo.13575. DOI: https://doi.org/10.1002/ijgo.13575

D. G. Adnan, and M. A. Latief, "Penelitian Kuantitatif, Penelitian Kualitatif, Penelitian Tindakan Kelas".

L. K. Somerville, K. Basile, D. E. Dwyer, and J. Kok, "The impact of influenza virus infection in pregnancy", Future microbiology, vol. 13, no. 2, pp. 263–274, 2018. DOI: https://doi.org/10.2217/fmb-2017-0096

A. Kajdy et al., "Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: A web-based cross-sectional survey", Medicine, vol. 99, no. 30, p. e21279, Jul. 2020, doi: 10.1097/MD.0000000000021279. DOI: https://doi.org/10.1097/MD.0000000000021279

S. K. Tikka et al., "Anxiety among pregnant women during the COVID-19 pandemic in India - A multicentric study", Asian J Psychiatr, vol. 66, p. 102880, Dec. 2021, doi: 10.1016/j.ajp.2021.102880 DOI: https://doi.org/10.1016/j.ajp.2021.102880

A. Moyer, S. D. Compton and L. Kasovan, “Psychosocial risk factors for anxiety among pregnant women during the COVID-19 pandemic,” Journal of Affective Disorders, vol. 277, pp. 25-32, 2020, doi: 10.1016/j.jad.2020.07.135. DOI: https://doi.org/10.1016/j.jad.2020.07.135

Y. Ding, Y. Xu and S. Yang, “Sleep quality and anxiety in pregnant women: a cross-sectional study,” Sleep Medicine, vol. 84, pp. 99-105, 2021, doi: 10.1016/j.sleep.2021.05.021. DOI: https://doi.org/10.1016/j.sleep.2021.05.021

M. Nowacka, M. Sierdzinski and J. Mazur, “Anxiety levels in pregnant women during the COVID-19 pandemic: a systematic review and meta-analysis,” International Journal of Gynecology & Obstetrics, vol. 153, no. 2, pp. 243-252, 2021, doi: 10.1002/ijgo.13736. DOI: https://doi.org/10.1002/ijgo.13736

M. B. Engel, “The biopsychosocial model and women’s health during pregnancy,” Obstetrics and Gynecology Clinics, vol. 50, no. 2, pp. 201-215, 2023, doi: 10.1016/j.ogc.2023.02.001. DOI: https://doi.org/10.1016/j.ogc.2023.02.001

K. K. Patel and D. T. Majumdar, “Biopsychosocial model in contemporary obstetrics: a holistic approach to maternal care,” Journal of Obstetrics and Gynaecology Research, vol. 49, no. 5, pp. 891-899, 2023, doi: 10.1111/jog.15523. DOI: https://doi.org/10.1111/jog.15523