Association between depression, anxiety, stress levels, and pre-pregnancy fear of childbirth among undergraduate midwifery students

Abstract

Aims: This study examined the relationship between depression, anxiety, and stress levels and pre-pregnancy fear of childbirth (FOC) among undergraduate midwifery students. Methods: This descriptive correlational study was conducted among undergraduate midwifery students enrolled at one state university and one private university in Istanbul during the 2023 academic year. Data were collected online using a personal information form, the Depression Anxiety Stress Scale (DASS), and the Pre-Pregnancy FOC Scale (PPFCS). Results: A total of 378 undergraduate midwifery students were included in the study. The mean age was 21.18±1.85 years, and all of the participants were female (100%). Severe depression, moderate anxiety, and severe stress were identified in 37.8%, 34.9%, and 41.8% of participants, respectively. Depression, anxiety, and stress scores differed significantly by academic year and socioeconomic status (p<0.05), with fourth-year students reporting lower levels of psychological symptoms. Students with lower income levels had significantly higher psychological distress scores and greater pre-pregnancy FOC (both p<0.05). In multivariable analysis, stress was identified as a significant predictor of FOC (β=0.220, p=0.014), whereas depression and anxiety were not significant predictors. Correlation analysis revealed a weak but statistically significant positive association between total scores on the DASS and the PPFCS (r=0.337; p<0.05). Conclusions: This study demonstrated that depression, anxiety, and stress are prevalent among undergraduate midwifery students and are associated with pre-pregnancy FOC. Copyright© 2026 The Author(s).