Skip to main content

Psychological distress, anxiety, depression, stress level, and coping style in HIV-pregnant women in Mexico



To evaluate the presence of psychological distress (PD) and its association with the mental health and coping styles of pregnant women living with HIV (PWLWH).


An observational, cross-sectional descriptive study was performed. Seventy-three PWLWH were included. Patients responded to a psychometric battery for PD, depression, anxiety, stress, and coping style evaluation. The scales used in the study were: Goldberg’s 30-item General Health Questionnaire (GHQ-30), State-Trait Anxiety Inventory (STAI), Zung Depression Self-Measurement Scale (ZDS), Nowack Stress Profile, Lazarus and Folkman’s Coping Styles Questionnaire.


PD was observed in 31.5% of the participants. PD-positive patients showed a higher probability of presenting traits of depression and anxiety and medium/high stress levels. Besides, they preferentially used emotion-focused coping styles.


PD is associated with a higher probability of presenting anxiety and depression in PWLWH. Emotion-focused coping style could be a factor in decision-making associated with risk behaviors in PWLWH.

Peer Review reports


Human immunodeficiency virus (HIV) infection is a chronic degenerative disease [1]. Since the beginning of the epidemic, it has affected 79 million people [2], and its incidence during 2021 was 1.5 to 2 million people, with a prevalence of 37.7 million people [2]. Mexico presents 10,000 new annual cases. The gender gap indicates that 2/10 new cases correspond to women, and most (3 out of 4), are of reproductive age. Given that the main transmission route is sexual intercourse [3], pregnancy becomes a risk factor to be considered in this population [4]. Besides physical comorbidities, HIV seropositive individuals present psychological alterations. They show a higher depression and anxiety incidence than seronegative people [2].

Pregnancy and motherhood constitute a multifactorial maternal challenge, and HIV infection adds an assumed risk for children’s and women´s health. Physical and psychosocial development is modified [5,6,7] because it supposes increased responsibilities and difficulties that induce the appearance of emotional alterations associated with managing a socially stigmatized chronic disease.

HIV infection shades pregnancy and confuses women’s thinking among a range of emotional manifestations that confront them with the impossibility of achieving several social ideals [8]. These resignations lead women to experience a variety of fluctuating emotional states that might put at risk the mother´s effective role during pregnancy and rearing [9,10,11,12]. The emotional experience could influence health in multiple pathways, ranging from symptom recognition by choosing healthy or unhealthy behaviors as an emotional regulation strategy [13].

It is necessary to contemplate psychiatric alterations, mainly depression and anxiety, associated with perinatal complications such as preeclampsia, intrauterine growth retardation, and altered immune status [13,14,15,16,17,18,19,20]. Clinical evidence has shown that a better psychologically adapted patient improves tolerance to treatment and presents higher adherence rates, which undoubtedly influences pregnancy development [21].

Pregnant women’s initial attempts to cope with their condition could restrict their psychological resources, promoting a set of temporary emotional disturbances known as psychological distress (PD) [19, 22, 23]. PD refers to emotional changes related to a specific event; it is considered a reactive process without effects on personality structure. Patients experience subjective discomfort, decreased ego functions, and temporary restriction of consciousness [24]. This adaptive event includes psychic pain that triggers changes in the perception of affective tonality, mood, and thought, which alter daily performance.

Concern about pregnancy development might depend on each woman´s coping style (CS) [25], which is considered as the behavior and cognitive response related to a stressful circumstance. The person facing a stressful event performs two types of valuations; the first is aimed at checking if the event is threatening, and the second is focused on how to deal with it [26]. Stress arises when the solution to the problem exceeds emotional resources, demanding a cognitive, emotional, and physiological response [27, 28].

We aimed to evaluate PD’s association with depression, anxiety, and stress levels in pregnant women living with HIV (PWLWH) in Mexico. We also studied CS use in these patients.

Materials and methods

A cross-sectional, observational, multivariate study was carried out in third-trimester PWLWH without mental retardation history. All women signed an informed consent to participate in the study. Their participation consisted of answering a semi-structured clinical history and a psychometric battery applied by a clinical psychologist. INPer in México authorized this study through its Ethics and Research Committees (No. 2017-3-128). The sample size was calculated by the proportion estimation formula (Zα = 1.96, p = 5%, d = 0.05) for 70 patients.

PD presence was assessed employing the Goldberg General Health Questionnaire in its 30-item version, validated in HIV-positive women [29]. This instrument explores the inability to function at a normal level perception from the psychic point of view and the psychic distress appearance [30]. A score above seven indicates PD presence [31].

The trait-state anxiety inventory (STAI) developed by Spielberg was used to evaluate the presence of trait anxiety as part of the personality structure and the transitory emotional situation. The cut-off point for pregnant women is 47 for trait anxiety and 43 for state anxiety [32].

The Zung Depression Self-Measurement Scale was chosen for the symptomatic quantification of depressive traits; it consists of twenty statements that relate to depression [33]. The minimum score is 20, and the maximum is 80, establishing 44 as the cut-off point for depressive traits in the obstetric population [34].

The Stress level was assessed utilizing the Nowack stress profile, designed to identify factors that allow tolerating the harmful consequences of everyday stress and those that make someone vulnerable to stress-related illnesses [35]. According to the standardization for the Mexican population, scores above 60 are considered severe; between 41 and 59, moderate; and below 40, mild [28].

Coping was measured employing the Lazarus and Folkman, coping styles instrument consisting of 67 items measuring eight coping styles: confrontational, distancing, self-control, social support, responsibility, escape-avoidance, problem-solving, and positive reappraisal [36, 37].

Additionally, once the women had their babies, we checked their medical records to know their contraceptive selection.

Data analysis. Statistical analysis was executed using the SPSS version 24 statistical package. For sociodemographic variables, descriptive statistics were achieved. The medical variables were analyzed employing the Chi-square test. Furthermore, Odds Ratios (OR) were determined.


Seventy-three pregnant women with HIV underwent prenatal care at the INPer HIV clinic in México. The mean patient´s age was 27.7 years. Their marital status was predominantly civil union with their partner or single cohabiting with their immediate family; the mean time since HIV diagnosis was 5.3 ± 4.7 years (Table 1).

Table 1 HIV-Pregnant Women Demographic Characteristics

Regarding their gynecological history, this group of patients had 2.96 ± 2.4 sexual partners (Table 2). The average number of pregnancies was 2.3±1.2, and 21 patients were in their first pregnancy (Table 2). In all cases, pregnancy was unplanned.

Table 2 Gynecologist and obstetric history of HIV pregnant women

Concerning family planning methods, before pregnancy, 44/73 women reported the use of a contraceptive method, with male condoms being the most common (39/73). By the end of their pregnancy, 49/73 opted for a definitive method, predominantly bilateral tubal occlusion (BTO) (Table 3).

Table 3 Choice of contraceptive methods prior to pregnancy and after childbirth

The predominant HIV transmission route was the sexual intercourse (64/73). Twenty-six patients are still in a relationship with the partner who infected them, while 40/73 are related to a different partner. In both cases, they keep a relationship with the parents of the children they are expecting (Table 4).

Table 4 Infectious history concerning HIV.

Psychological distress

When comparing mental health parameters from women with (n = 29) and without (n = 44) PD, results indicated that 25/29 women with PD had depressive traits (Chi-square, p < 0.001), and 21/29 exhibited medium-high stress levels (Table 5). Pregnant women with PD presented higher trait-anxiety (17/29) (Chi-square, p < 0.001) and state-anxiety (24/29) (Chi-square, p < 0.001) than those without PD.

Table 5 Psychological characteristics of pregnant women with and without psychological distress

An OR analysis was performed between the psychological variables, finding that cases with PD have 9.03 times the probability of presenting depression (IR 95%; 2.68–30.41), 8.97 for trait-anxiety (IR 95%; 8.35-110.68), 4.59 for medium-high stress levels (IR 95%; 1.66–12.74), and 4.47 fair to low-income family dynamics (IR 95%; 1.438–13.90) than patients without PD.

Patients with PD were more likely to choose a contraceptive method once the pregnancy had resolved than patients without PD, who maintained contraceptive use behavior (OR 2.5, IR 95%, 0.348–17.94). Fifty-three percent (39/73) of the patients who previously used contraceptives changed from a temporary to a permanent method.

Regarding associations between alcohol, drug use, and sociodemographic characteristics, most patients denied alcohol or drug consumption. However, alcohol or drug consumption in their partners was 14/73 and 11/73, respectively. Pregnant women without PD with partners without alcohol or drug consumption history showed a higher proportion of a good family relationship perception (26/30, Chi-square, P = 0.005).

Coping style

Some emotion-focused coping styles were higher in PD HIV women than in the control group: self-control (p < 0.001), responsibility (p = 0.018), and escape avoidance (p < 0.001) (Table 6). Likewise, confrontational coping, a problem-based style, was higher in PD HIV women.

Table 6 Coping style of pregnant women with and without psychological distress


It has been described that HIV infection profoundly affects women’s mental health [38]. When pregnancy occurs in a woman living with HIV, the psychosocial and clinical conditions associated with mental health deterioration can be further increased. Despite this, few studies seek to delve into this issue [39, 40].

Koniak-Griffin (1994) describes that even knowing their HIV infection, most pregnant women in the USA minorities (Latinas and African-Americans) exhibited unprotected sex and other risk-taking behaviors [41]. Gómez Suarez (2016) showed that approximately 38% of unplanned pregnancies occur in the general population because of unmet contraceptive needs, but this number tripled in women living with HIV [42]. These risk-behavior patterns are similar to those in our population; 39.7% of the women studied did not use any contraception method and 53.4% only used a temporary method such as a condom.

Scientific evidence points out a perception of a submissive position and the conception of an inferior role in affective-sexual relationships in women; this inequality has been observed in non-pregnant and PWLWH [43, 44]. Bertagnoli and Figueiredo (2017) identified a difficulty in power distribution as a structural element of vulnerability in HIV-women relationships [45]. These misconceptions may lead to neglected self-healthcare associated with a shorter survival time than men with AIDS [46, 47].

The del-Romero and collaborator´s study (2004) points out that in HIV-positive men, 40% did not use condoms regularly; furthermore, 19% reported having accidents using condoms [48]. Consequently, many of their couples became pregnant [42,43,44, 46,47,48]. In our population of PWLWH, the patterns of behavior described in the del-Romero study were repeated, given that 87.6% of our patients were sexually infected.

Alcohol and drug abuse are other risk behaviors in the HIV population (Rosemary’s study) [49]. Although the women in the study denied a history of alcohol or drug abuse, our results indicate that alcohol or drug abuse in the patient’s partners occurs in a proportion of 1 in 5 (fathers of the children they will give birth to). Considering that with adequate medication and clinical follow-up, the rate of vertical transmission is less than 2%, the high rates of positive serostatus of previous offspring (12%, 9/73) in these patients could be explained by the psychological characteristics of the mothers [50,51,52] and the risk-behavior pattern they display as a consequence.

Regarding the mental health of PWLWH, it has been suggested that a codependency pattern is associated with a higher probability of presenting secondary emotional disturbances [53]. Poorer family dynamics favor maladaptive behaviors that affect women emotionally [43, 44]. Our data showed higher proportions of depression among PWLWH (58.9%) than depression rates in women living with HIV reported in other studies (25–40%). Regarding anxiety, our outcomes of 31.5% were similar to anxiety rates reported for HIV-positive women (23–40%). Finally, our population’s stress levels are comparable to previously reported data (34.8%) [7, 38, 54,55,56].

Although several studies suggest that marital status plays a role in mental health [52, 55, 56], our results did not show differences in depression, anxiety, or stress levels between women who live with their partners and single women. In our sample, educational level neither influenced the proportion of depression nor anxiety; our results match the report of Ogueji and collaborators (2021) on the Nigerian population. The demographic characteristics from different social contexts may influence the development of mental health deteriorating in the PWLWH.

Additionally, inappropriate family and social relationships affect the development of pregnancy and the health of the maternal-fetal dyad. Previous research indicates that infants with absent fathers have an increased risk of unfavorable fetal birth outcomes, particularly in HIV-positive women [57].

The results of this study indicate that pregnant women related to partners with alcohol and drug abuse patterns presented a higher incidence of PD than those with abstemious partners. Substance abuse could affect family welfare since pregnant women without PD, whose couples had no alcohol or drug consumption history, showed better family relationships.

Previous studies have shown that familiar unfavorable contexts could correlate negatively with the development of pregnancy in PWLWH. Hatcher and coworkers reported that one-third of women with HIV in South Africa experienced intimate partner violence, getting a high pregnancy complications rate and a higher viral load [58]. These findings highlight the importance of partner relationships and the role of paternal involvement as a significant component of maternal and fetal health during pregnancy.

The fine-grained description of the factors influencing mental health is relevant since the PWLWH condition has high adverse psychological burdens. Women in this situation show higher risk behaviors on self-care, such as low treatment adherence or an increased proportion of suicidal thoughts, the last one that occurs in nearly 3% of the PWLWH. [59, 60]. These results emphasize the need for closer monitoring of the mental health of women with HIV and more well-defined psychological and psychiatric standards, particularly during pregnancy.

Gómez et al. (2016), studying a population of high-risk pregnant women different to HIV etiology, like gestational diabetes, hypertensive disease of pregnancy, or advanced maternal age, found that the main emotional variations were sadness, emotional devastation, and fear of pregnancy complications [19]. These conditions could lead to the appearance of PD.

The PD usually acts as an adaptive mechanism that could play a role of protective factor [58, 61] because it mobilizes personal resources in search of specialized help, depending on the psychological characteristics of women. In our study, one out of 3 pregnant patients presented PD.

This proportion was lower than PD reported in HIV-positive teenagers (48.2%) or in other studies of PWLWH, which report PD rate until 69% [54, 62].

Our observations suggest that PD is associated with medium-high levels of stress and increased levels of state anxiety and depression. These psychological conditions, added to inadequate family and social background, are associated with adverse pregnancy events [16, 18, 61, 63, 64]. HIV pregnancy entails a substantial change in the psychosocial spheres; therefore, these women present a higher risk for adverse obstetric events than those without HIV [65,66,67]. In addition, high levels of anxiety and depression increase the possibility of postpartum depression, which undoubtedly harms the newborn and affects the mother´s quality of life, interfering in the establishment of the binomial bond and newborn development [68,69,70,71].

Diverse studies suggest that maternal mental health care should extend beyond childbirth and should be accompanied by strategies that permit the woman to adapt to the new challenges according to her psychological characteristics, including her coping style. According to the coping theory, styles that direct their efforts towards emotion are more likely to appear when the resolution perception is limited; therefore, emotions tend to predominate in the response pattern, moving away from the rational plane [26, 72]. According to this theory, PD could increase the scores for emotion-focused styles. Moreover, the scores for the confrontational style are higher in the PD group than in women without PD. The confrontational style is most effective when a stressful event persists over time or in a long-duration process like pregnancy.

It has been demonstrated that in the HIV-positive population, avoidance strategies are predictors of emotional distress that can function as a protector in help-seeking [73]; we propose that this need for help should be at least partly met by the medical services, given that social and family conditions are not always adequate.

Our findings on contraception method choice suggest that the hospital context and counseling influenced self-care behaviors of the PWLWH by increasing the rate of acceptance of a contraceptive method. Medical care could contribute to more reasoned decision-making and trigger the mobilization of adaptive resources, specifically concerning the decision to avoid a new pregnancy. These data imply the change in the decision to use a permanent contraceptive method, as it was observed in our population.

Finally, independent of PD presence, our results indicate that coping style could influence contraceptive choice. When we analyzed the coping pattern as problem-based or emotion-based according to contraceptive choice after the resolution of pregnancy, it was observed that women with higher scores for problem-based coping style selected a permanent contraceptive. More research is needed to understand how coping styles could influence women’s decisions and how clinicians could prepare better strategies according to coping style to affront HIV-pregnancy health.


According to the World Health Organization, HIV infection rates and AIDS cases among women have increased meaningfully in the last ten years. Given the risk behaviors of this population, it is expected that pregnancies in HIV-positive couples will occur. Our results indicate that PD is present in most PWLWH. These patients showed a higher probability of presenting traits of depression, anxiety, and elevated stress levels. In addition, our results indicate that PWLWHI preferentially used emotion-focused coping styles, which could be a factor in decision-making associated with their risky behaviors. It is necessary to establish new lines of clinical research focused on the factors influencing women’s mental health to establish services more responsive to women’s needs.

Data availability

The data and psychometric instruments are available.


  1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV Infection as a chronic Disease. Lancet. 2013;382(9903):1525–33.

    Article  PubMed  PubMed Central  Google Scholar 

  2. UNAIDS. UNAIDS Data. 2021; Available from:

  3. WHO VIH in pregnancy, a review. 1998. 59.

  4. CENSIDA SdS. Vigilancia Epidemiológica de casos de VIH/SIDA en México. 2021 [cited 2022; Available from:

  5. Finocchario-Kessler S, et al. Understanding high fertility desires and intentions among a Sample of Urban Women Living with HIV in the United States. AIDS Behav. 2010;14(5):1106–14.

    Article  PubMed  Google Scholar 

  6. Conde Higuera P, et al. Estigma, discriminación y adherencia al tratamiento en niños con VIH y SIDA: Una Perspectiva bioética. Acta Bioethica. 2016;22:331–40.

    Article  Google Scholar 

  7. Ngocho JS, et al. Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania. PLoS ONE. 2019;14(10):e0224515.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Obiols MJ, Stolkiner AI. Mujeres viviendo la maternidad con VIH/SIDA: la salud mental y el sosténcompartido de los cuidados Perspectivas en Psicología: Revista de Psicología y Ciencias Afines, 2018. 15(2): p. 56–68.

  9. Legere LE, et al. Approaches to health-care provider education and professional development in perinatal depression: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):239.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Einloft Kleinibing R, et al. ESTRATÉGIAS DE CUIDADO À SAÚDE DE GESTANTES VIVENDO COM HIV: REVISÃO INTEGRATIVA. Ciencia Y enfermería. 2016;22:63–90.

    Article  Google Scholar 

  11. Piccinini C, et al. Perceptions and feelings of pregnant women concerning prenatal care. Psicologia: Teoria E Pesquisa. 2012;28:27–33.

    Google Scholar 

  12. Carvalho FTd, et al. Intervenção psicoeducativa para gestantes vivendo com HIV/Aids: uma revisão da literatura. Psicologia: Teoria e prática. 2009;11:157–73.

    Google Scholar 

  13. Meza-Rodríguez MP, FrMorales-Carmona M-RJ. Adaptación psicológica en mujeres con infección por virus de papiloma humano. Perinatol Reprod Hum. 2011;25(1):17–22.

    Google Scholar 

  14. Evans J, et al. Cohort study of depressed mood during pregnancy and after Childbirth. BMJ. 2001;323(7307):257–60.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Diego MA, et al. Prepartum, postpartum, and chronic depression effects on newborns. Psychiatry. 2004;67(1):63–80.

    Article  PubMed  Google Scholar 

  16. Borders AEB, et al. Chronic stress and low Birth Weight neonates in a Low-Income Population of women. Obstet Gynecol. 2007;109(2 Part 1):331–8.

    Article  PubMed  Google Scholar 

  17. Lara MA, Navarro C, Navarrete L. Outcome results of a psycho-educational intervention in pregnancy to prevent PPD: a randomized control trial. J Affect Disord. 2010;122(1–2):109–17.

    Article  PubMed  Google Scholar 

  18. Accortt EE, Cheadle AC, Dunkel C, Schetter. Prenatal depression and adverse birth outcomes: an updated systematic review. Matern Child Health J. 2015;19(6):1306–37.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gomez-Lopez MA, Sugiyama BS. Malestar psicológico en mujeres con embarazo de alto riesgo. Summa Psicol UST. 2016;13(1):89–100.

    Article  Google Scholar 

  20. Chinchilla-Ochoa D, et al. Depressive symptoms in pregnant women with high trait and state anxiety during pregnancy and postpartum. Int J Womens Health. 2019;11:257–65.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Belmar J, Stuardo V. Adherencia Al Tratamiento anti-retroviral para El VIH/SIDA en mujeres: una mirada socio-cultural. Revista Chil De infectología. 2017;34:352–8.

    Article  Google Scholar 

  22. Fisher JR, Feekery CJ, Rowe-Murray HJ. Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. J Paediatr Child Health. 2002;38(2):140–5.

    Article  PubMed  Google Scholar 

  23. Glazier RH, et al. Stress, social support, and emotional distress in a community sample of pregnant women. J Psychosom Obstet Gynaecol. 2004;25(3–4):247–55.

    Article  PubMed  Google Scholar 

  24. Espíndola Hernández JG, et al. Malestar psicológico: algunas de sus manifestaciones clínicas en la paciente gineco-obstétrica hospitalizada. Perinatología Y reproducción Humana. 2006;20:112–22.

    Google Scholar 

  25. Furber CM, et al. A qualitative study of mild to moderate psychological distress during pregnancy. Int J Nurs Stud. 2009;46(5):669–77.

    Article  PubMed  Google Scholar 

  26. Lazarus RS. F.S., Estrés Y procesos Cognitivos. Mexico: Roca; 1986.

    Google Scholar 

  27. Vargas Castañeda N, García Casós CMJ, Marquez Leyva V. F Stress, coping strategies and academic performance in nursing students of the National University of Trujillo Revista Peruana: Enfermeria, investigación y desarrollo, 2013. 11(1): p. 57–66.

  28. De la Roca-Chiapas JM, et al. Validación Del Perfil de Estrés de nowack en estudiantes universitarios mexicanos. Revista De Salud Pública. 2019;21:146–53.

    Article  PubMed  Google Scholar 

  29. Meza Rodríguez MdP, et al. Validación interna de un Cuestionario General De Salud (CGS – 30)en mujeres seropositivas al VIH. Revista Latinoam De Med Conductual / Latin Am J Behav Med. 2014;4(2):59–66.

    Google Scholar 

  30. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9(1):139–45.

    Article  PubMed  Google Scholar 

  31. Morales-Carmona F, Barroso-Aguirre L-CM. Alteraciones emocionales en una muestra de mujeres mexicanas con eventos ginecoobstétricos. Perinatol Reprod Hum. 2002;16(4):157–62.

    Google Scholar 

  32. González G. Normalización De Un instrumento de ansiedad (IDARE) en mujeres embarazadas. Revista Mexicana De Psicología. 1990;7:75–80.

    Google Scholar 

  33. Zung WW. The Depression Status Inventory: an adjunct to the Self-Rating Depression Scale. J Clin Psychol. 1972;28(4):539–43.

    Article  PubMed  Google Scholar 

  34. González G. Normalización De Un instrumento para medir depresión en mujeres embarazadas. Perinatol Reprod Hum. 1993;7:110–3.

    Google Scholar 

  35. Meza Rodríguez MP, et al. Niveles De estrés en pacientes mexicanas embarazadas seropositivas al VIH. Perinatología Y Reproducción Humana. 2018;32(4):155–9.

    Article  Google Scholar 

  36. Folkman S, Lazarus RS. Coping as a mediator of emotion. J Pers Soc Psychol. 1988;54(3):466–75.

    Article  PubMed  Google Scholar 

  37. Zavala Yoe L, et al. Validación Del instrumento de estilos de enfrentamiento de Lazarus Y Folkman en adultos de la Ciudad De México. Volume 10. Revista Intercontinental de Psicología y Educación; 2008. pp. 159–82. 2.

  38. Levine AB, Aaron EZ, Criniti SM. Screening for depression in pregnant women with HIV Infection. J Reprod Med. 2008;53(5):352–6.

    PubMed  Google Scholar 

  39. Faler CS. Diagnóstico VIH-SIDA: Los Impactos causados en la persona en las relaciones y estructura familiar. Sal Jal. 2016;3(1):24–31.

    Google Scholar 

  40. Vera PVE. Influencia social y familiar en El comportamiento del pacientes con VIH/SIDA ante su diagnóstico y su manejo. Rev Hosp Jua Mex. 2004;71(1):29–35.

    Google Scholar 

  41. Koniak-Griffin D, et al. Risk-taking behaviors and AIDS knowledge: experiences and beliefs of minority adolescent mothers. Health Educ Res. 1994;9(4):449–63.

    Article  PubMed  Google Scholar 

  42. Gomez-Suarez M. [Meeting contraceptive needs of HIV-positive women: effect on elimination of vertical transmission of HIV]. Rev Panam Salud Publica. 2016;40(6):479–84.

    PubMed  Google Scholar 

  43. Lopez A, et al. HIV Stigma mechanisms Scale: factor structure, reliability, and validity in Mexican adults. AIDS Behav. 2023;27(4):1321–8.

    Article  PubMed  Google Scholar 

  44. Wowolo G, et al. The impact of different parental figures of adolescents living with HIV: an evaluation of Family structures, perceived HIV related stigma, and opportunities for Social Support. Front Public Health. 2022;10:647960.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bertagnoli M, Figueiredo M. Gestantes Soropositivas Ao HIV: Maternidade, Relações Conjugais E Ações Da Psicologia. Volume 37. Psicologia: Ciência e Profissão; 2017. pp. 981–94.

    Google Scholar 

  46. Lea A. Women with HIV and their burden of caring. Health Care Women Int. 1994;15(6):489–501.

    Article  PubMed  Google Scholar 

  47. Tiouiri H, et al. [Study of psychosocial factors in HIV infected patients in Tunisia]. East Mediterr Health J. 1999;5(5):903–11.

    Article  PubMed  Google Scholar 

  48. del Romero J, et al. [Women who are partners of a man infected by HIV: description of their characteristics and appraisal of risk]. Aten Primaria. 2004;34(8):420–6.

    PubMed  PubMed Central  Google Scholar 

  49. Wong M, et al. Depression, alcohol use, and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa. Arch Womens Ment Health. 2017;20(1):149–59.

    Article  PubMed  Google Scholar 

  50. Kafack EVF, et al. Evaluation of plasma viral-load monitoring and the prevention of mother-to-child transmission of HIV-1 in three health facilities of the Littoral region of Cameroon. PLoS ONE. 2022;17(11):e0277271.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Myer L, et al. HIV viraemia and mother-to-child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa. HIV Med. 2017;18(2):80–8.

    Article  PubMed  Google Scholar 

  52. Zijenah LS, et al. Impact of option B(+) combination antiretroviral therapy on Mother-to-child transmission of HIV-1, maternal and infant virologic responses to combination antiretroviral therapy, and maternal and infant mortality rates: a 24-Month prospective Follow-Up study at a Primary Health Care Clinic, in Harare, Zimbabwe. AIDS Patient Care STDS. 2022;36(4):145–52.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Moseholm E, et al. Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in the nordic countries - results from a longitudinal survey study. BMC Pregnancy Childbirth. 2022;22(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Qin S, et al. Survey and analysis for impact factors of psychological distress in HIV-infected pregnant women who continue pregnancy. J Matern Fetal Neonatal Med. 2019;32(19):3160–7.

    Article  PubMed  Google Scholar 

  55. Kwalombota M. The effect of pregnancy in HIV-infected women. AIDS Care. 2002;14(3):431–3.

    Article  PubMed  Google Scholar 

  56. Tibebu NS et al. Depression, anxiety and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic. Trans R Soc Trop Med Hyg, 2022.

  57. Alio AP, et al. Paternal involvement and fetal morbidity outcomes in HIV/AIDS: a population-based study. Am J Mens Health. 2015;9(1):6–14.

    Article  PubMed  Google Scholar 

  58. Hatcher AM, et al. Longitudinal association between intimate partner Violence and viral suppression during pregnancy and postpartum in South African women. Aids. 2021;35(5):791–9.

    Article  PubMed  Google Scholar 

  59. Rodkjaer L, et al. Depression in patients with HIV is under-diagnosed: a cross-sectional study in Denmark. HIV Med. 2010;11(1):46–53.

    Article  PubMed  Google Scholar 

  60. Mikšić Å, et al. Depression and suicidality during pregnancy. Psychiatr Danub. 2018;30(1):85–90.

    Article  PubMed  Google Scholar 

  61. Caballero-Suárez NP, et al. Comparison of levels of anxiety and depression between women and men living with HIV of a Mexico City clinic. Salud Mental. 2017;40(1):15–21.

    Article  Google Scholar 

  62. Kesande C, et al. Prevalence and factors associated with psychological distress among pregnant and non-pregnant youth living with HIV in rural Uganda: a comparative study. Psychol Health Med. 2023;28(2):344–58.

    Article  PubMed  Google Scholar 

  63. Wolff L, Alvarado CR M, and, Wolff M, Prevalencia R., factores de riesgo y manejo de la depresión en pacientes con infección por VIH: Revisión de la literatura Revista chilena de infectología, 2010. 27: p. 65–74.

  64. Moos RH, Schaefer JA. Coping resources and processes: Current concepts and measures 1993.

  65. Alder J, et al. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med. 2007;20(3):189–209.

    Article  PubMed  Google Scholar 

  66. Hoffman S, Hatch MC. Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychol. 2000;19(6):535–43.

    Article  PubMed  Google Scholar 

  67. Ravid E, et al. Is there an association between maternal anxiety propensity and pregnancy outcomes? BMC Pregnancy Childbirth. 2018;18(1):287.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Lara-Cinisomo S, Griffin BA. Factors associated with major depression among mothers in Los Angeles. Womens Health Issues. 2007;17(5):316–24.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Dubber S, et al. Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy. Arch Womens Ment Health. 2015;18(2):187–95.

    Article  PubMed  Google Scholar 

  70. Nakic Rados S, Tadinac M, Herman R. Anxiety during pregnancy and Postpartum: Course, Predictors and Comorbidity with Postpartum Depression. Acta Clin Croat. 2018;57(1):39–51.

    Article  PubMed  Google Scholar 

  71. Rusanen E, et al. Prenatal expectations and other psycho-social factors as risk factors of postnatal bonding disturbance. Infant Ment Health J. 2021;42(5):655–71.

    Article  PubMed  Google Scholar 

  72. Stanton AL, et al. Coping through emotional approach: scale construction and validation. J Pers Soc Psychol. 2000;78(6):1150–69.

    Article  PubMed  Google Scholar 

  73. Brown MJ, et al. Ways of coping and perceived HIV-related stigma among people living with HIV: moderation by sex and sexual orientation. Psychol Health Med. 2020;25(7):867–78.

    Article  PubMed  Google Scholar 

Download references


We thank nurse Virginia Elena Santillán Palomo and the invaluable staff member of our HIV clinic care program. We also thank Dr. Karina Hernández-Ortega from Facultad de Química, Departamento de Biología, Universidad Nacional Autónoma de México for her technical support.


The research leading to these results received funding from Instituto Nacional de Perinatología under Grant Agreement No 2017-3-128.

Author information

Authors and Affiliations



Conceptualization: María del Pilar Meza-Rodríguez; Methodology: Ricardo Figueroa-Damian, Noemí Plazola Camacho, Gabriela Pellón-Díaz, Braulio Alfonso Ríos-Flores, Phillipe Leff Gelman; Formal analysis: Blanca Farfán-Labonne, Miroslava Avila-García, Efraín Olivas-Peña; Writing - original draft preparation: María del Pilar Meza-Rodríguez, Blanca Farfán-Labonne, Miroslava Avila-García; Writing - review and editing: Ignacio Camacho-Arroyo; Funding acquisition: Meza-Rodríguez María del Pilar. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ignacio Camacho-Arroyo.

Ethics declarations

Ethics approval and consent to participate

The research leading to these results was approved by the Ethics Committee from Instituto Nacional de Perinatología, Research Number 2017-3-128. Informed consent was obtained from all individual participants included in the study; if the participants were under 18 years old, the parents or legal guardian supported the informed consent. This study was evaluated by the Research, Ethics, and Biosafety committees, clarifying there is no sampling of tissues, blood, or any human fluids from our participants. Nevertheless, we performed our interventions in accordance with the Helsinki Declaration.

Consent for publication

The informed consent also includes all subjects and their legal guardian(s) for publication of identifying information, results, and images in an online open-access publication. All authors allow to publish the results of the current research.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meza-Rodríguez, M., Farfan-Labonne, B., Avila-García, M. et al. Psychological distress, anxiety, depression, stress level, and coping style in HIV-pregnant women in Mexico. BMC Psychol 11, 366 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: