Prevalence and risk factors of preoperative anxiety among obstetric patients undergoing cesarean section under spinal anesthesia: a cross-sectional study

Abstract

BACKGROUND: Preoperative anxiety is a common and significant concern among obstetric patients scheduled for cesarean section (CS). This anxiety may negatively affect perioperative outcomes for both mother and child. We aimed to determine the incidence of and identify risk factors associated with preoperative anxiety in this population. METHODS: A cross-sectional study was conducted among women scheduled for elective CS under spinal anesthesia at two specialized hospitals in Addis Ababa, Ethiopia, from October 2024 to January 2025. Pregnant women (≥ 18 years) were systematically recruited. The State-Trait Anxiety Inventory (STAI) was used to measure anxiety. Bivariate and multivariable logistic regression were used, with p < 0.05 considered statistically significant. RESULTS: The prevalence of clinically significant preoperative anxiety was 54.0% (95% CI: 49.2-58.8%). Independent predictors identified by multivariable logistic regression included: younger age (< 25 years) (AOR = 2.1;95%CI:1.3-3.5;p = 0.002), lower educational attainment (AOR = 1.8;95%CI:1.1-2.9;p = 0.016), previous negative surgical experience (AOR = 2.5;95%CI:1.4-4.6;p = 0.004), lack of preoperative counseling (AOR = 3.2;95%CI:2.0-5.1;p < 0.001), and poor social support (AOR = 2.0;95%CI:1.2-3.3;p = 0.008). CONCLUSION: Preoperative anxiety is highly prevalent. Anxiety in this population is highly preventable through targeted, cost-effective interventions. The strong predictive capacity of modifiable factors (counseling and social support) provides a clear blueprint for clinical action, particularly in settings with resource limitations. Implementation should focus on establishing a standardized anesthetist consultation, a supportive social network or pathway, and maintaining educational accessibility.