The Postpartum Specific Anxiety Scale: development and preliminary validation

Victoria Fallon, Jason Christian Grovenor Halford, Kate Mary Bennett, Joanne Allison Harrold, Victoria Fallon, Jason Christian Grovenor Halford, Kate Mary Bennett, Joanne Allison Harrold

Abstract

Perinatal symptoms of anxiety are increasingly recognised due to their high prevalence and impact. Studies using pregnancy-specific anxiety measures have found that they may predict perinatal outcomes more effectively than general measures. However, no such measure exists to assess anxieties specific to the postpartum. This study aimed to develop and validate a measure (Postpartum Specific Anxiety Scale; PSAS) that accurately represents the specific anxieties faced by postpartum women, using a four-stage methodology: (1) 51 items were generated from interviews conducted with a group of 19 postpartum women at two time points, (2) the scale was reviewed and refined by a diverse expert panel, (3) an online pilot study (n = 146) was conducted to assess comprehensibility and acceptability and (4) an online sample of 1282 mothers of infants up to 6 months old completed the PSAS against a battery of convergent measures. A subsample (n = 262) repeated the PSAS 2 weeks later. The PSAS possessed good face and content validity and was comprehensible and acceptable to postpartum women. PSAS scores were significantly correlated with other measures indicating good convergent validity. Principal component analyses (PCA) revealed a simple four-factor structure. Reliability of the overall scale and individual PSAS factors proved to be good to excellent. A preliminary receiver operating characteristic (ROC) analysis also suggested that the PSAS may be a useful screening tool. The psychometric evidence suggests that the PSAS is an acceptable, valid, and reliable research tool to assess anxieties, which are specific to the postpartum period. Next steps in the iterative validation process are considered for both research and screening purposes.

Keywords: Anxiety; Maternal mental health; Postpartum; Psychometrics; Scale development.

Conflict of interest statement

Compliance with ethical standards The PSAS was developed by a doctoral student under the supervision of two experienced perinatal psychologists in the Department of Psychological Sciences at The University of Liverpool. All stages of the scale development and validation gained ethical approval from the University of Liverpool Institute of Psychology, Health and Society Ethics Committee in August 2015. All aspects of the study were performed in accordance with the 1964 Declaration of Helsinki. Conflict of interest The authors declare that they have no conflicts of interest. Funding The authors have no financial relationships relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
Participant flowchart
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve analysis. Area under the curve 0.77

References

    1. Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1976.
    1. Beck C, Gable R. Postpartum Depression Screening Scale: development and psychometric testing. Nurs Res. 2000;49:272–282. doi: 10.1097/00006199-200009000-00006.
    1. Beck AT, Rush A, Shaw B, Emery G. Cognitive therapy of depression. New York: Guildford Press; 1979.
    1. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100. doi: 10.1016/0272-7358(88)90050-5.
    1. Bieling PJ, Antony MM, Swinson RP. The state-trait anxiety inventory, trait version: structure and content re-examined. Behav Res Ther. 1998;36:777–788. doi: 10.1016/S0005-7967(98)00023-0.
    1. Britton JR. Postpartum anxiety and breastfeeding. J Reprod Med. 2007;52:689–695.
    1. Britton JR. Maternal anxiety: course and antecedents during the early postpartum period. Depress Anxiety. 2008;25:793–800. doi: 10.1002/da.20325.
    1. Brockington IF, Macdonald E, Wainscott G. Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium. Arch Womens Ment Health. 2006;9:253–263. doi: 10.1007/s00737-006-0134-z.
    1. Burns D, Eidelson R. Why are depression and anxiety correlated? a test of the tripartite model. J Consult Clin Psychol. 1998;66:461–473. doi: 10.1037/0022-006X.66.3.461.
    1. Cattell R. The scree test for the number of factors. Multivar Behav Res. 1966;1:245–276. doi: 10.1207/s15327906mbr0102_10.
    1. Coplan RJ, O’Neil K, Arbeau K (2005) Maternal anxiety during and after pregnancy and infant temperament at three months of age. J Prenat Perinat Psychol Heal 19:199–215, doi:10.1108/17506200710779521
    1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression scale. Br J Psychiatry. 1987;150:782–786. doi: 10.1192/bjp.150.6.782.
    1. Evans JR, Mathur A. The value of online surveys. Internet Res. 2005;15:195–219. doi: 10.1108/10662240510590360.
    1. Field A. Discovering statistics using SPSS. London: Sage Publications; 2009.
    1. George D, Mallery M. Using SPSS for Windows step by step: a simple guide and reference. Boston, MA: Allyn and Bacon; 2003.
    1. Glasheen C, Richardson G, Fabio A. A systematic review of the effects of postnatal maternal anxiety on children. Arch Womens Ment Health. 2010;13:61–74. doi: 10.1007/s00737-009-0109-y.
    1. Glorfeld L. An improvement on Horn’s parallel analysis methodology for selecting the correct number of factors to retain. Educ Psychol Meas. 1995;55:377–393. doi: 10.1177/0013164495055003002.
    1. Graesser AC, Cai Z, Louwerse MM, Daniel F. Question Understanding Aid (QUAID)—a Web facility that tests question comprehensibility. Public Opin Q. 2006;70:3–22. doi: 10.1093/poq/nfj012.
    1. Hair J, Anderson R, Tatham R, Grablowsky B. Multivariate data analysis. Tulsa, Oklahoma: Pipe Books; 1979.
    1. Heron J, O’Connor TG, Evans J, et al. The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004;80:65–73. doi: 10.1016/j.jad.2003.08.004.
    1. Highet N, Stevenson AL, Purtell C, Coo S. Qualitative insights into women’s personal experiences of perinatal depression and anxiety. Women Birth. 2014;27:179–184. doi: 10.1016/j.wombi.2014.05.003.
    1. Hiser P (1991) Maternal concerns during the early postpartum. J Am Assoc Nurse Pract 3(4):166–173
    1. Huizink AC, Robles De Medina PG, Mulder EJH, et al. Psychological measures of prenatal stress as predictors of infant temperament. J Am Acad Child Adolesc Psychiatry. 2002;41:1078–1085. doi: 10.1097/00004583-200209000-00008.
    1. Huizink AC, Robles de Medina PG, Mulder EJH, et al. Stress during pregnancy is associated with developmental outcome in infancy. J Child Psychol Psychiatry. 2003;44:810–8. doi: 10.1111/1469-7610.00166.
    1. Huizink AC, Mulder EJH, Robles de Medina PG, et al. Is pregnancy anxiety a distinctive syndrome? Early Hum Dev. 2004;79:81–91. doi: 10.1016/j.earlhumdev.2004.04.014.
    1. Julian LJ. Measures of anxiety. Arthritis Care Res. 2011;63:0–11.
    1. Levin JS. The factor structure of the Pregnancy Anxiety scale. J Heal Soc Behav. 1991;32:368–381. doi: 10.2307/2137104.
    1. Lonstein JS. Regulation of anxiety during the postpartum period. Front Neuroendocrinol. 2007;28:115–141. doi: 10.1016/j.yfrne.2007.05.002.
    1. Lugina HI, Nystrom L, Christensson K, Lindmark G (2004) Assessing mothers’ concerns in the postpartum period : methodological issues. J Adv Nurs 48(3):279–290
    1. Matthey S. Using the Edinburgh Postnatal Depression scale to screen for anxiety disorders. Depress Anxiety. 2008;25:926–931. doi: 10.1002/da.20415.
    1. Matthey S, Barnett B, Howie P, Kavanagh DJ. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord. 2003;74:139–147. doi: 10.1016/S0165-0327(02)00012-5.
    1. Matthey S, Fisher J, Rowe H. Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations. J Affect Disord. 2013;146:224–230. doi: 10.1016/j.jad.2012.09.009.
    1. Meades R, Ayers S. Anxiety measures validated in perinatal populations: a systematic review. J Affect Disord. 2011;133:1–15. doi: 10.1016/j.jad.2010.10.009.
    1. Mertesacker B, Bade U, Haverkock A, Pauli-Pott U. Predicting maternal reactivity/sensitivity: the role of infant emotionality, maternal depressiveness/anxiety, and social support. Infant Ment Health J. 2004;25:47–61. doi: 10.1002/imhj.10085.
    1. Miller RL, Pallant JF, Negri LM. Anxiety and stress in the postpartum: is there more to postnatal distress than depression? BMC Psychiatry. 2006;6:12. doi: 10.1186/1471-244X-6-12.
    1. Moran TE, Polanin JR, Wenzel A. The postpartum worry scale-revised: an initial validation of a measure of postpartum worry. Arch Womens Ment Health. 2014;17:41–48. doi: 10.1007/s00737-013-0380-9.
    1. Muzik M, Klier CM, Rosenblum KL, et al. Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders? Acta Psychiatr Scand. 2000;102:71–3. doi: 10.1034/j.1600-0447.2000.102001071.x.
    1. O’Connor B. SPSS and SAS programs for determining the number of components using Parallel Analysis and Velicer’s MAP test. Behav Res Methods, Instruments Comput. 2000;1:396–402. doi: 10.3758/BF03200807.
    1. Paul IM, Downs DS, Schaefer EW, et al. Postpartum anxiety and maternal-infant health outcomes. Pediatrics. 2013;131:e1218–24. doi: 10.1542/peds.2012-2147.
    1. Phillips J, Sharpe L, Matthey S. Rates of depressive and anxiety disorders in a residential mother–infant unit for unsettled infants. Aust N Z J Psychiatry. 2007;41:836–842. doi: 10.1080/00048670701579108.
    1. Phillips J, Sharpe L, Matthey S, Charles M. Maternally focused worry. Arch Womens Ment Health. 2009;12:409–418. doi: 10.1007/s00737-009-0091-4.
    1. Ponterotto J, Ruckdeschel D. An overview of coefficient alpha and a reliability matrix for estimating adequacy of internal consistency coefficient with psychological research measures. Percept Mot Skills. 2007;105:997–1014.
    1. Reck C, Struben K, Backenstrass M, et al. Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand. 2008;118:459–468. doi: 10.1111/j.1600-0447.2008.01264.x.
    1. Romano M, Cacciatore A, Giordano R, La Rosa B. Postpartum period: three distinct but continuous phases. J Prenat Med. 2010;4:22–25.
    1. Ross LE, Evans SEG, Sellers EM, Romach MK. Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Womens Ment Health. 2003;6:51–57. doi: 10.1007/s00737-002-0155-1.
    1. Sandman CA, Wadwha PD, Chicz-Demet A, Dunkel-Schetter C, Porto M (1997) Maternal stress, HPA activity, and fetal/infant outcome. Ann N Y Acad Sci 814:266–275
    1. Somerville S, Dedman K, Hagan R, et al (2014) The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Womens Ment Health 443–454. doi: 10.1007/s00737-014-0425-8
    1. Spielberger C, Gorsuch R, Lushene R. Manual for the State-Trait Anxiety Inventory. Palo Alto (CA): Consultant Psychologists Press; 1970.
    1. Streiner D, Norman G, Cairney J. Health Measurement Scales: a practical guide to their development and use. 5. London: Oxford University Press; 2015.
    1. Stuart S, Couser G, Schilder K, et al. Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis. 1998;186:420–424. doi: 10.1097/00005053-199807000-00006.
    1. Swallow B, Lindow S, Masson E, Hay D. The use of the General Health Questionnaire (GHQ-28) to estimate prevalence of psychiatric disorder in early pregnancy. Psychol Heal Med. 2003;8:213–217. doi: 10.1080/1354850031000087591.
    1. Van den Bergh B. The influence of maternal emotions during pregnancy on fetal and neonatal behavior publication date. J Prenat Perinat Psychol Heal. 1990;5(2):119–130.
    1. Walker L, Freeland-Graves J (1998) Lifestyle factors related to postpartum weight gain and body image in bottle- and breastfeeding women. J Obstet Gynecol Neonatal Nurs 27(2):151–160
    1. Wadwha PD, Sandman CA, Porto M, et al. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation. Am J Obstet Gynecol. 1993;169:858–865. doi: 10.1016/0002-9378(93)90016-C.
    1. Warren PL. First-time mothers: social support and confidence in infant care. J Adv Nurs. 2005;50:479–488. doi: 10.1111/j.1365-2648.2005.03425.x.
    1. Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord. 2005;19:295–311. doi: 10.1016/j.janxdis.2004.04.001.
    1. WHO (2016) Gender and women’s mental health. Retrieved January 10, 2016, from

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