Pregnancy specific anxiety (PSA) is defined as nervousness and fear about the baby’s health, mother’s health and appearance, health care system, and social and financial issues related to pregnancy, childbirth, and parenting accompanied by excessive worry and somatic symptoms. The DSM-V recognizes various categories of anxiety disorders, each with different clinical presentations, however a considerable amount of variation in anxiety during pregnancy cannot be explained with other types of anxiety or comorbidity with depression. PSA also has shown independent and stronger predictive utility for various adverse maternal and child outcomes than general anxiety or depression, even after controlling for medical risk. Anxiety disorders share excessive fear and behavioral disturbances but differ from one another in the type of situations and cognitive ideation that provoke anxiety and avoidant behaviors. Because general measures of anxiety do not account for the specific concerns related to pregnancy and childbirth some pregnant women with clinically significant anxiety are not identified by these tools, resulting in under-diagnosing anxiety. Additionally, the reliability and validity of general measures to use with pregnant population has been criticized due to their reliance on somatic symptoms of excessive anxiety that may overlap with physiological changes of pregnancy, resulting in inflated scores.
Seven scales have been developed to measure PSA. However, narrow scope, absence of known dimensions, and lack of indicators of severity of PSA call into question the psychometric properties and clinical utility of the extant scales. A 2015 systematic review restated the need for a theoretically, psychometrically, and clinically sound tool to measure PSA, a critical gap identified by several other experts in the field. Built on a fundamental preliminary work (development of conceptual framework, qualitative interviews, and input from stakeholders) and using principles of Patient Reported Outcomes (PROs), we aim to develop a clinically valid and reliable tool– the Pregnancy Specific Anxiety Scale (PSAS). The specific objectives of the study are to:
a) generate items for the PSAS and develop its initial structure (Phase 1- completed)
b) conduct face and content validity assessment (Phase 1-completed)
c) perform factor analysis of the PSAS to determine final items and dimensions (Phase 2- ongoing)
d) conduct psychometric testing of the PSAS to establish its reliability, validity, sensitivity, specificity, and predictive values and to determine its clinical cutoffs (Phase 3).
Our research team includes experts in maternal and child health, instrument development, perinatal anxiety, perinatal epidemiology, and statistics. Given the distinct impact of PSA on perinatal outcomes, noted limitations of the current tools and effectiveness of non-pharmacologic interventions during pregnancy, development of PSAS represents an important methodological advance for the detection of anxiety during pregnancy. Considering recent initiatives across the country to embed mental health services into primary care practice, availability of valid and reliable tools will enhance the optimum use of these specialized resources within the health care system.