2.3. Measurements
Anxiety, anxiety, depressive symptoms, depression, Depression
All participants were assessed at 6 weeks after childbirth and at the start of the next pregnancy by completing self-reported questionnaires. A personal link to the questionnaire was sent from the eCRF two weeks before the scheduled study visit.Mental health was assessed by using the Edinburgh Postnatal Depression Scale (EPDS) and the Gotland Male Depression Scale (GMDS) for symptoms of depression, the Spielberger State Trait Anxiety Inventory 6-item (sSTAI-6) and the Edinburgh Depression Scale-3 Anxiety item (EDS-3A) for symptoms of anxiety, the Sense Of Coherence-13item (SOC-13) for measuring the sense of coherence and a Linear Analogue Scale (LAS) for measuring quality of life (QoL). Characteristics and cut-off scores of the mental health questionnaires are presented in The EPDS is suitable for assessing symptoms of depression and anxiety during the postpartum period [The GMDS complemented the EPDS as it is a valid instrument for assessing non-typical suicidality-related symptoms of depression. The use of the GMDS as a supplement on the GMDS can increase the detection rate of depressive symptoms [Previous research indicates that three questions from the EPDS questionnaire are also sensitive to the measurement of anxiety [The SOC is measured with the 13-item short scale (SOC-13), derived from the original 29-item Orientation to Life Questionnaire [QoL was assessed using the Linear Analogue Scale (LAS). Participants were asked to score QoL on a scale from 0 to 100, with 0 representing a poor quality of life and 100 an extremely good quality of life. The LAS was one comprehensive score, summarizing physical, psychological and social aspects.Age, level of education, ethnicity, employment status, family composition, family income, a history of depression and a history of anxiety were self-reported at baseline. Questions on breastfeeding and maternal sleep were based on previous research and self-reported at each time point [Interpregnancy mental health was calculated based on 2 measurement points: 6 weeks after childbirth (start interpregnancy) and at the start of the next pregnancy (end of interpregnancy, defined as the timepoint nearest to the start of the next pregnancy and at least within 1 year preconception).The difference in mental health during the interpregnancy period was calculated as the difference between mental health at 6 weeks after childbirth vs. at the start of the next pregnancy for continuous variables and as a change of group according to the cut-off score (high/low) at 6 weeks after childbirth vs. the start of the next pregnancy for categorical variables.Interpregnancy interval was determined by calculating the difference in months between the start date of the next pregnancy (day of childbirth minus gestational age) minus the date of the previous childbirth.