Mass General Hospital

Harvard Medical School

Screening for Peripartum Anxiety Disorders: What Are the Best Screening Tools?

A significant number of women experience anxiety symptoms during pregnancy, with about 8.5% of women meeting criteria for generalized anxiety disorder.  Other anxiety disorders are less common.   The estimated prevalence of panic disorder during pregnancy is 1-2%.   The estimated prevalence of obsessive-compulsive disorder is 0.2-1.2%.  While we use certain tools, including the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression during pregnancy, what are the best tools for indentifying women with clinically significant anxiety symptoms?

Researchers compared two measures of general anxiety (the anxiety subscale of the Edinburgh Depression Scale and the Hospital Anxiety and Depression Scale) and two measures of pregnancy-specific anxiety from Huizink and colleagues and another from Rini and colleagues (both originally called the Pregnancy-Related Anxiety Questionnaire). A generic mood question (Matthey Generic Mood Question) was also tested.

The generic mood question performed the best, detecting 80% of the women with an anxiety disorder.  The wording of the question was ‘‘In the last 2 weeks have you felt very stressed, anxious or unhappy, or found it difficult to cope, for some of the time?’’ Response options are: ‘Yes’, ‘Possibly’, or ‘No’. Those responding ‘Yes’ or ‘Possibly’ then answered a follow-up question: ‘‘How bothered have you been by these feelings?’’ (Response options: ‘Not at all’; ‘A little bit’; ‘Moderately’; ‘A lot’).  The authors point out that while this single question may not have the highest specificity, it would be a simple screening tool that could be used to identify women experiencing depression, anxiety, and/or stress.

The next best measure was the EPDS anxiety subscale using a cut-off score of 5 or more.  The three questions comprising this subscale are:

1.      I have blamed myself unnecessarily when things went wrong

2.      I have been anxious or worried for no good reason

3.      I have felt scared or panicky for no very good reason

As always, it is important to note that these tools are not diagnostic; however, they are highly effective for screening for women with mood or anxiety disorders.  A more thorough clinical evaluation is required to make the diagnosis.

Ruta Nonacs, MD PhD

Matthey S, Valenti B, Souter K, Ross-Hamid C.  Comparison of four self-report measures and a generic mood question to screen for anxiety during pregnancy in English-speaking women.   J Affect Disord. 2013 Feb 2.

Ross LE, McLean LM. Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 3006: 67(8), 1285-1298.

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