The Perinatal Anxiety Screening Scale: development and preliminary validation

Abstract

The purpose of this study is to develop a scale (Perinatal Anxiety Screening Scale, PASS) to screen for a broad range of problematic anxiety symptoms which is sensitive to how anxiety presents in perinatal women and is suitable to use in a variety of settings including antenatal clinics, inpatient and outpatient hospital and mental health treatment settings. Women who attended a tertiary obstetric hospital in the state of Western Australia antenatally or postpartum (n = 437) completed the PASS and other commonly used measures of depression and anxiety. Factor analysis was used to examine factor structure, and ROC analysis was used to evaluate performance as a screening tool. The PASS was significantly correlated with other measures of depression and anxiety. Principal component analyses (PCA) suggested a four-factor structure addressing symptoms of (1) acute anxiety and adjustment, (2) general worry and specific fears, (3) perfectionism, control and trauma and (4) social anxiety. The four subscales and total scale demonstrated high to excellent reliabilities. At the optimal cutoff score for detecting anxiety as determined by ROC analyses, the PASS identified 68 % of women with a diagnosed anxiety disorder. This was compared to the EPDS anxiety subscale which detected 36 % of anxiety disorders. The PASS is an acceptable, valid and useful screening tool for the identification of risk of significant anxiety in women in the perinatal period.

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

“…43 Other screening measures for non-GAD anxiety include the Postpartum Worry Scale, 10 the Pregnancy Anxiety Scale, 44 and the Perinatal Anxiety Screening Scale. 45 In clinical practice, healthcare providers rely on a diagnostic interview and available anxiety tools for confirming the diagnosis. Although the GAD-7 43 is not validated for perinatal population, this screening tool appears to capture the symptomatology and severity of the illness in pregnant and postpartum mothers.…”

Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS)

“…However, these measures are limited at indicating the severity of anxiety in the perinatal period because (1) the cut-off scores may not have been validated in perinatal samples, (2) scores may be confounded by physical symptoms that occur commonly in pregnancy or postnatally (Swallow et al, 2003), as scales include items about physical symptoms of anxiety (e.g., 'I experienced breathing difficulty' (Depression, Anxiety and Stress Scale, Lovibond and Lovibond, 1995a), 'discomfort in abdomen', 'difficulty breathing' (Beck Anxiety Inventory;Beck and Steer, 1993)), and (3) pregnancy-specific anxieties (e.g., severe fear of childbirth) are not addressed. Measures developed to assess perinatal anxiety, such as the Pregnancy Anxiety Scale (Levin, 1991), Pregnancy Related Anxiety Questionnaire ( Van den Bergh, 1989), and Pregnancy Related Anxiety Scale (Wadhwa et al, 1993), are also limited at indicating severity of anxiety in the perinatal period because they assess narrow domains of perinatal anxiety such as the mother's fears about the birth, the pregnancy and the baby's health and safety (see Somerville et al (2014) for summary). The Postpartum Worry ScaleRevised (Moran et al, 2014) examines excessive worry in the postpartum period across a range of domains including child care, finances and relationships.…”

“…It does not include potentially confounding physiological symptoms that are common in the perinatal period. A four factor structure of the PASS was shown to effectively screen for symptoms of acute anxiety and adjustment; general worry and specific fears; perfectionism, control, and trauma; and social anxiety (see Somerville et al (2014) for a summary of scale development). The PASS was validated for use in both hospital, mental health and community samples of perinatal women (Somerville et al, 2014).…”

“…A four factor structure of the PASS was shown to effectively screen for symptoms of acute anxiety and adjustment; general worry and specific fears; perfectionism, control, and trauma; and social anxiety (see Somerville et al (2014) for a summary of scale development). The PASS was validated for use in both hospital, mental health and community samples of perinatal women (Somerville et al, 2014). An optimal clinical cut-off score of 26 was established and found to identify significantly more women (68%) at risk of an anxiety disorder than the recommended cut-off score of 6 for the anxiety subscale of the EPDS which identified 36% (Somerville et al, 2014).…”

The Effectiveness of Mindfulness-Based Training on Pregnancy Stress

“…Moreover, rather than depression, the increasing anxiety level is also more common during pregnancy (Mattey, Barnett, Howie, & Kavanagh, in Somerville, Dedman, Hagan, et al, 2014;American Psychiatric Association, in Brunton, Dryer, Saliba, & Kohlhoff, 2015). Heron and colleagues (in Somerville, Dedman, Hagan, et al, 2014) found about 15% of women reported to experience anxiety conditions during pregnancy and 13% of them feel it after childbirth.…”