A comparison of anxiety, stress and depression, across the perinatal period, in mothers of twins and singletons

Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Psychology


Faculty of Computing, Health and Science


Although efforts have been made to reduce the incidence of multiple pregnancies, the number of confinements resulting in twins continues to increase. Increased maternal age and assisted reproductive technology (ART) are considered to be the major contributing factors. A twin pregnancy poses a higher risk to a woman’s health than a singleton pregnancy; risks to fetuses are also increased and maternal concern about the health of the fetuses is subsequently expected to be intensified.

With a substantial body of research available, the physical risks and potential complications of a twin pregnancy are well understood, yet the psychological risks for mothers of twins are yet to be adequately investigated. This is despite a substantial body of evidence indicating that maternal mental health during the perinatal period may involve significant and complicated outcomes for women and their families.

This PhD hypothesised that twins and ART would place women under additional stress and thus additional risk of anxiety and depression throughout the perinatal period, that is, during pregnancy and in the months following delivery. A total of eight research hypotheses were proposed, and levels of stress, anxiety, and depressive symptomatology were measured with self-report scales in a sample of 53 women pregnant with twins and 53 women pregnant with a singleton (matched on use of ART) twice during pregnancy and once postpartum to examine these hypotheses.

Stress levels were found to be highly correlated with levels of anxiety and depressive symptomatology at each time of assessment, and scores on the anxiety and depression scales were also highly correlated. Women pregnant with twins reported significantly higher levels of state anxiety than women pregnant with a singleton during the second and third trimesters of pregnancy after controlling for the effect of ART, parity, planned pregnancy, and history of depression or anxiety. Further analyses revealed that women pregnant with twins as a result of ART reported significantly higher levels of stress and state anxiety during the third trimester than women pregnant with a singleton who had conceived without assistance.

Furthermore, women expecting twins as a result of ART reported higher levels of pregnancy specific anxiety during the third trimester than women who had not used ART and women having a singleton.

After controlling for parity, history of depression and/or anxiety, planned pregnancy, and ART, significantly higher levels of postpartum stress and depressive symptomatology were recorded by mothers of twins. Interestingly, women who became mothers of twins without ART reported the highest levels of stress, anxiety, and depressive symptomatology postpartum.

LCSH Subject Headings

Strategic alliances (Business)

Information resources management

Grounded theory

Access Note

Access to this thesis is restricted to current ECU staff and students. Email request to library@ecu.edu.au

Access to this thesis is restricted. Please see the Access Note below for access details.