Several studies suggest that postpartum anxiety is relatively common among postpartum women and may even be more common than depression. Emerging evidence also suggests that a large number of postpartum women who do not meet diagnostic criteria for a specific anxiety disorder yet experience a clinically significant anxiety symptoms which are distinct from anxiety experienced at other times of life (Huizink 2004; Phillips 2009).
In their recent review and meta-analysis, Goodman and colleagues (2016) reveal postpartum prevalence estimates ranging from 0.03% for specific phobias to 3.5% for GAD, with an estimated 8.5% of postpartum mothers experiencing one or more anxiety disorders. However, they highlight the limitations of many studies because of diagnostic instruments which have been used.
For some years now maternal mental health researchers have been working to improve knowledge of perinatal anxiety and to develop screening tools for the identification of specific anxiety symptoms. A better understanding of postpartum anxiety disorders is of key importance in order to design better preventive interventions and treatment strategies. Furthermore, maternal psychopathology may negatively affect the child (Glasheen 2010).
Fallon and colleagues have recently proposed a new instrument to assess anxiety symptoms specific to the postpartum period (Fallon 2016). The Postpartum Specific Anxiety Scale (PSAS) has been designed using a four-stage methodology. First, 51 items were generated from interviews conducted with a sample of 19 postpartum women at two time points. Then, the scale was reviewed and refined by an expert panel, and, after a pilot study, an online sample of 1282 mothers of infants up to 6 months of age completed the PSAS against a battery of other measures. A subsample of 262 women repeated the PSAS two weeks later.
The PSAS has a simple four-factor structure which can be distinguished as:
- Competence and attachment anxieties
- Infant safety and welfare anxieties
- Practical baby care anxieties
- Psychosocial adjustment to motherhood
At the optimal cut-off score of 112, 75 % of women with a current clinical diagnosis of anxiety and/or depression were detected, which surpasses other scales and performed better than other general and postpartum-specific measures. The study design precluded the differentiation between anxiety and depression within the sample.
Fallon and colleagues suggest that the PSAS is an acceptable, valid, and reliable research tool to assess postpartum anxiety and may be a useful screening tool. Future work in clinical samples across the full spectrum of anxiety disorders is necessary to continue the development and evaluation of this new tool.
Lavinia DeChiara, MD
Fallon V, Halford JC, Bennett KM, Harrold JA. The Postpartum Specific Anxiety Scale: development and preliminary validation. Arch Womens Ment Health. 2016 Dec;19(6):1079-1090. Epub 2016 Aug 29.
Goodman JH, Watson GR, Stubbs B. Anxiety disorders in postpartum women: A systematic review and meta-analysis. J Affect Disord. 2016 Oct;203:292-331. Epub 2016 Jun 1.