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Anxiety measures validated in perinatal populations: A systematic review
Open accessAbstract
Background Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women.Methods A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women.Results Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State-Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and predictive) or reliability. The STAI shows criterion, discriminant and predictive validity and may be most useful for research purposes as a specific measure of anxiety. The Kessler 10 (K-10) may be the best short screening measure due to its ability to differentiate anxiety disorders. The Depression Anxiety Stress Scales 21 (DASS-21) measures multiple types of distress, shows appropriate content, and remains to be validated against clinical interview in perinatal populations.Limitations Nineteen studies did not report sensitivity or specificity data. The early stages of research into perinatal anxiety, the multitude of measures in use, and methodological differences restrict comparison of measures across studies.Conclusion There is a need for further validation of self-report measures of anxiety in the perinatal period to enable accurate screening and detection of anxiety symptoms and disorders.
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“The IDAS-II has demonstrated excellent psychometric properties in pregnant samples [64, 65]”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [65]
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Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis
Dennis, C., Falah‐Hassani, K., & Shiri, R. (2017) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.116.187179 · Cited by 1,692
“66 Self-report measures do have limitations, such as potentially inflated prevalence estimates, but they also have high clinical utility in obstetric/midwifery, public health and primary care practices, where the majority of perinatal mental health problems are managed.”
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“Although the prevalence of maternal anxiety during pregnancy is heterogeneous, anxiety symptoms and disorders are common in the perinatal period (Meades and Ayers, 2011; Ross and McLean, 2006; Giardinelli et al., 2012).”
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The Perinatal Anxiety Screening Scale: Development and preliminary validation
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Association Between Maternal Mood and Oxytocin Response to Breastfeeding
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“The Spielberger STAI has been validated in for use in perinatal populations.(22) Population normative data shows that the median score for both state and trait anxiety among women ages 19–39 is 34.”
MethodPregnancy-related anxiety: A concept analysis
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“The reviewers restated the need for a welleloped scale with a rigorous theoretical and psychotric basis for the assessment of PrA, a need that has also n identified by other experts in the field (Brunton et al., 5; Littleton et al., 2007; Meades and Ayers, 2011).”
Gong, Y., Zhou, H., Zhang, Y., Zhu, X., Wang, X., Shen, B., Xian, J., & Ding, Y. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.129 · Cited by 269
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Anxiety scales used in pregnancy: systematic review
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“, 2014; Van den Bergh, 1990), and several reviews of the research literature exist (Alderdice et al., 2012; Brunton et al., 2015; Dunkel Schetter and Tanner, 2012; Meades and Ayers, 2011).”
Pregnancy anxiety: A systematic review of current scales
Brunton, R., Dryer, R., Saliba, A. J., & Kohlhoff, J. R. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.01.039 · Cited by 194
The Postpartum Specific Anxiety Scale: development and preliminary validation
Fallon, V., Halford, J., Bennett, K., & Harrold, J. (2016) · Archives of Women's Mental Health · doi:10.1007/s00737-016-0658-9 · Cited by 171
“To investigate the structure of specific fears and worries related to the postpartum period (‘postpartum anxieties’) using this new scale 1 For a comprehensive review of anxiety measures validated in perinatal populations, refer to Meades and Ayers (2011)”
BackgroundMethodInfluentialPostpartum Anxiety and Infant-Feeding Outcomes
Fallon, V., Groves, R., Halford, J. C. G., Bennett, K. M., & Harrold, J. A. (2016) · Journal of Human Lactation · doi:10.1177/0890334416662241 · Cited by 181
Dennis, C., Coghlan, M., & Vigod, S. N. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.05.049 · Cited by 172
“The STAI-State has demonstrated reliability and validity and has been used widely in pregnancy and postpartum studies (Grant et al., 2008; Meades and Ayers, 2011).”
BackgroundMethodLau, Y., Htun, T. P., Wong, S. N., Tam, W. S. W., & Klainin-Yobas, P. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6712 · Cited by 149
“The effect sizes were expressed as Cohen d or standardized mean difference, which were interpreted as small (0.2 d 0.5), medium (0.5 d 0.8), and large ( d ≥0.8) [43].”
InfluentialAssociations Between Postpartum Depression, Breastfeeding, and Oxytocin Levels in Latina Mothers
Lara-Cinisomo, S., McKenney, K. M., Florio, A. D., & Meltzer-Brody, S. (2017) · Breastfeeding Medicine · doi:10.1089/bfm.2016.0213 · Cited by 117
“30 This four-point Likert-type scale includes 40 items to assess state and trait anxiety, with 20 items in each subscale.”
Racine, N. M., Plamondon, A., Hentges, R. F., Tough, S., & Madigan, S. L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.083 · Cited by 152
From prenatal anxiety to parenting stress: a longitudinal study
Huizink, A. C., Menting, B., de Moor, M. H. M., Verhage, M. L., Kunseler, F. C., Schuengel, C., & Oosterman, M. (2017) · Archives of Women s Mental Health · doi:10.1007/s00737-017-0746-5 · Cited by 148
“State anxiety was measured with the Dutch adaptation of the State-Trait Anxiety Inventory (STAI; Spielberger et al. 1970) at t1-t3, which has been shown to be a reliable and valid measure in general populations but also in pregnancy (Gunning et al. 2010; Meades and Ayers 2011).”
MethodWomen’s experiences of postnatal distress: a qualitative study
Coates, R., Ayers, S., & de Visser, R. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-14-359 · Cited by 144
“These unique aspects may affect responses on self-report measures which include items that are not appropriate for the postnatal period [10].”
Self-citationRisk factors of transient and persistent anxiety during pregnancy
Bayrampour, H., McDonald, S., & Tough, S. (2015) · Midwifery · doi:10.1016/j.midw.2015.02.009 · Cited by 141
“This scale has been validated against clinical interviews during both the pregnancy and postpartum period and has been found to have acceptable sensitivity, specificity, and predictive values to determine cases of anxiety among a perinatal population (Grant et al., 2008; Meades and Ayers, 2011).”
MethodOxytocin and HPA stress axis reactivity in postpartum women
Cox, E. Q., Stuebe, A., Pearson, B., Grewen, K., Rubinow, D., & Meltzer-Brody, S. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.02.009 · Cited by 151
“The Spielberger State and Trait Anxiety Inventory (STAI)—The Spielberger State and Trait Anxiety Inventory (STAI), a validated instrument used to assess anxiety and validated for use in the perinatal population, (Meades and Ayers, 2011) was administered at enrollment during the third trimester, as well as at the 2- an…”
MethodClout, D., & Brown, R. F. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.054 · Cited by 152
Screening for Depression and Anxiety Disorders from Pregnancy to Postpartum with the EPDS and STAI
Tendais, I., Costa, R. A., Conde, A., & Figueiredo, B. (2014) · The Spanish Journal of Psychology · doi:10.1017/sjp.2014.7 · Cited by 134
“An overlap between depression and anxiety symptoms has been consistently recognized (e.g., Kennedy et al., 2001; Meades & Ayers, 2011).”
BackgroundAssociation of Serum Vitamin D with Symptoms of Depression and Anxiety in Early Pregnancy
Huang, J. Y., Arnold, D., Qiu, C.-F., Miller, R. S., Williams, M. A., & Enquobahrie, D. A. (2014) · Journal of Women s Health · doi:10.1089/jwh.2013.4598 · Cited by 126
“34 The PHQ-9 is a self-administered questionnaire which asks respondents to rate the frequency of nine Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition depression criteria from 0 (‘‘not at all’’) to 3 (‘‘nearly every day’’) for a score range of 0 to 27.”
An Overview of Maternal Anxiety During Pregnancy and the Post-Partum Period
Araji, S., Griffin, A., Dixon, L., Spencer, S.-K., Peavie, C., & Wallace, K. (2020) · JOURNAL OF MENTAL HEALTH AND CLINICAL PSYCHOLOGY · doi:10.29245/2578-2959/2020/4.1221 · Cited by 127
Anxiety symptoms and coping strategies in the perinatal period
George, A., Luz, R. F., De Tychey, C., Thilly, N., & Spitz, E. (2013) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-13-233 · Cited by 121
“Therefore, specific measures for anxiety in the perinatal period are strongly recommended [4,5].”
BackgroundSchepper, S. D., Vercauteren, T., Tersago, J., Jacquemyn, Y., Raes, F., & Franck, E. (2015) · Midwifery · doi:10.1016/j.midw.2015.08.010 · Cited by 120
“The association between a birth with complications and PTSD has been reported before (Ayers and Pickering, 2001; Ayers, 2004; Olde et al., 2006; Meades and Ayers, 2011).”
BackgroundOrloff, N. C., & Hormes, J. M. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01076 · Cited by 117
Milgrom, J., Holt, C., Holt, C. J., Ross, J., Ericksen, J., & Gemmill, A. W. (2015) · Archives of Women's Mental Health · doi:10.1007/s00737-015-0512-5 · Cited by 104
Obsessive-compulsive symptoms during the postpartum period. A prospective cohort.
Miller, E. S., Chu, C., Gollan, J. K., & Gossett, D. R. (2013) · PubMed · Cited by 109
Göbel, A., Stuhrmann, L. Y., Harder, S. K., Schulte‐Markwort, M., & Mudra, S. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.07.024 · Cited by 105
The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms
Miller, E. S., Hoxha, D., Wisner, K. L., & Gossett, D. R. (2014) · Archives of Women s Mental Health · doi:10.1007/s00737-014-0476-x · Cited by 102
“While each of the scales used has been previously shown to be associated with clinical diagnosis, the lack of confirmation by a mental health professional limits our ability to confirm comorbid diagnoses (Kroenke et al. 2001;Meades and Ayers 2011; Rosenfeld et al. 1992).”
ResultCOMT Haplotypes Modulate Associations of Antenatal Maternal Anxiety and Neonatal Cortical Morphology
Qiu, A., Tuan, T. A., Ong, M. L., Li, Y., Chen, H., Rifkin-Graboi, A., Broekman, B. F. P., Kwek, K., Saw, S.-M., Chong, Y.-S., et al. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14030313 · Cited by 100
“In regard to the perinatal population, the State-Trait Anxiety Inventory has been shown to have construct validity (30).”
BackgroundObsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder
Miller, E. S., Hoxha, D., Wisner, K. L., & Gossett, D. R. (2015) · Journal of Women s Health · doi:10.1089/jwh.2014.5063 · Cited by 100
“The STAI is a self-reported series of questions pertaining to frequency of various symptoms of state or trait anxiety.(16) A score of more than 100 (of 160) defines a positive screen.”
Prevalence and Risk Factors of Maternal Anxiety in Late Pregnancy in China
Kang, Y., Yao, Y., Dou, J., Guo, X., Li, S.-Y., Zhao, C.-N., Han, H., & Li, B. (2016) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph13050468 · Cited by 100
“Previous researches have shown a high prevalence of psychiatric illness in pregnant women [1,2], not only in the developed countries, but also in developing countries such as Turkey [3].”
BackgroundBindt, C., Appiah‐Poku, J., Bonle, M. T., Schoppen, S., Feldt, T., Barkmann, C., Koffi, M., Baum, J., Nguah, S. B., Tagbor, H. K., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048396 · Cited by 106
“The GAD-7 has been validated in western primary care, but not in antepartum populations or in African settings, as research in antepartum anxiety is still in its early stages [14,15].”
BackgroundInfluentialSpencer, R. N., Ambler, G., Brodszki, J., Diemert, A., Figueras, F., Gratacós, E., Hansson, S. R., Hecher, K., Huertas‐Ceballos, A., Marlow, N., et al. (2017) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-017-1226-7 · Cited by 102
Redinger, S., Norris, S. A., Pearson, R. M., Richter, L., & Rochat, T. (2017) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s204017441700071x · Cited by 104
“This cut off score was calculated using the same cut-off ratio as the original STAI, >40/80.(31) Using these dichotomous variables for cases of depression and anxiety, univariate analysis was performed to examine associations between depression and anxiety and the women’s socio-demographic, socio-economic, pregnancy a…”
MethodRochat, T., Tomlinson, M., Newell, M., & Stein, A. L. (2013) · Archives of Women s Mental Health · doi:10.1007/s00737-013-0353-z · Cited by 98
“There is increasing evidence of the detrimental role anxiety may play in pregnancy and the importance of screening for anxiety (Matthey et al. 2012; Meades and Ayers 2011); however, this study did not include a clinical measure of anxiety and, hence, the performance of the three-item anxiety…”
BackgroundPatient-provider communication, maternal anxiety, and self-care in pregnancy
Nicoloro-SantaBarbara, J., Rosenthal, L., Auerbach, M. V., Kocis, C., Busso, C. E., & Lobel, M. (2017) · Social Science & Medicine · doi:10.1016/j.socscimed.2017.08.011 · Cited by 97
Fontein‐Kuipers, Y., Nieuwenhuijze, M., Ausems, M., Budé, L., & de Vries, R. (2014) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12500 · Cited by 91
Screening for perinatal anxiety disorders: Room to grow
Fairbrother, N., Corbyn, B., Thordarson, D. S., Ma, A., & Surm, D. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.052 · Cited by 82
Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions
Bayrampour, H., Salmon, C., Vinturache, A., & Tough, S. (2015) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.12683 · Cited by 76
“The STAI has acceptable sensitivity, specificity, and predictive values during the perinatal period.(31,32) Depressive symptoms were measured by the Edinburgh Postnatal Depression Scale (EPDS), a 10-item self-reported questionnaire.”
MethodKunseler, F. C., Willemen, A. M., Oosterman, M., & Schuengel, C. (2014) · Parenting · doi:10.1080/15295192.2014.972758 · Cited by 76
“This research was supported by Grant 400-09-123 from the Netherlands Organization for Scientific Research and a grant from the foundation Stichting tot Steun Nederland.”
MethodAgrati, D., Browne, D. T., Jonas, W., Meaney, M. J., Atkinson, L. R., Steiner, M. S., & Fleming, A. S. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-014-0491-y · Cited by 91
“State anxiety was selected for modeling, as it is more amenable to temporal fluctuation and less analogous to stable personality traits (Spielberger 2010) and its use has been validated in perinatal studies (Meades and Ayers 2011).”
MethodA systematic review of psychological treatments for clinical anxiety during the perinatal period
Loughnan, S. A., Wallace, M., Joubert, A. E., Haskelberg, H., Andrews, G., & Newby, J. M. (2018) · Archives of Women s Mental Health · doi:10.1007/s00737-018-0812-7 · Cited by 85
A psychometric systematic review of self‐report instruments to identify anxiety in pregnancy
Evans, K., Spiby, H., & Morrell, C. J. (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12649 · Cited by 74
“Most antenatal anxiety measures have been adapted from general health questionnaires with very few validated for use in pregnancy (Meades & Ayers 2011).”
MethodLin, B., Kaliush, P. R., Conradt, E. D., Terrell, S., Neff, D., Allen, A. K., Smid, M. C., Monk, C. E., & Crowell, S. E. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000336 · Cited by 73
“The STAI-T has been validated for use in perinatal populations (Meades & Ayers, 2011).”
MethodInsomnia late in pregnancy is associated with perinatal anxiety: A longitudinal cohort study
Osnes, R. S., Roaldset, J. O., Follestad, T., & Eberhard‐Gran, M. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.01.027 · Cited by 72
Can the Edinburgh Postnatal Depression Scale-3A be used to screen for anxiety?
Smith‐Nielsen, J., Egmose, I., Wendelboe, K. I., Steinmejer, P., Lange, T., & Væver, M. S. (2021) · BMC Psychology · doi:10.1186/s40359-021-00623-5 · Cited by 73
“Based on such results, it may be argued that perinatal screening programs should include the detection of women with high levels of anxiety [3, 11].”
BackgroundMaters, G. A., Sanderman, R., Kim, A. Y., & Coyne, J. C. (2013) · PLoS ONE · doi:10.1371/journal.pone.0070975 · Cited by 72
“And Meades and Ayers [45] referred to cultural or psychometric factors contributing to problems with the internal consistency, factor-structures and cutpoints.”
BackgroundFallon, V., Halford, J. C. G., Bennett, K. M., & Harrold, J. A. (2017) · Archives of Women s Mental Health · doi:10.1007/s00737-017-0775-0 · Cited by 69
“This may lead to erroneous data, inaccurate interpretation, and incomparable results across studies (Meades and Ayers 2011).”
MethodResultMaternal anxiety during pregnancy and newborn epigenome-wide DNA methylation
Sammallahti, S., Hidalgo, A. P. C., Tuominen, S., Malmberg, A., Mulder, R. H., Brunst, K. J., Alemany, S., McBride, N., Yousefi, P., Heiss, J. A., et al. (2021) · Molecular Psychiatry · doi:10.1038/s41380-020-00976-0 · Cited by 63
Silverio, S. A., Davies, S. M., Christiansen, P., García, M. E. A., Bramante, A., Chen, P., Costas-Ramón, N., de Weerth, C., Vedova, A. M. D., Gil, L. I., et al. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03597-9 · Cited by 67
“The STAI-S is a valid and reliable measure used frequently in perinatal samples of women [18].”
BackgroundMethodRobinson, L. R., Bitsko, R. H., O’Masta, B., Holbrook, J. R., Ko, J. Y., Barry, C. M., Maher, B. S., Cerles, A. A., Saadeh, K., MacMillan, L., et al. (2022) · Prevention Science · doi:10.1007/s11121-022-01383-3 · Cited by 78
“…this risk factor category, stress and anxiety were measured in a variety of ways including self-report of distress, anxiety, and exposure to specific stressors; however, this variability in measurement is consistent with the measurement of perinatal anxiety in the field (Meades & Ayers, 2011).”
Fallon, V., Silverio, S. A., Halford, J. C. G., Bennett, K. M., & Harrold, J. A. (2019) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2019.1680960 · Cited by 65
Wernand, J., Kunseler, F. C., Oosterman, M., Beekman, A. T. F., & Schuengel, C. (2013) · Infant Mental Health Journal · doi:10.1002/imhj.21425 · Cited by 65
“The STAI has been shown to be a reliable and valid measure in both pregnancy and the postpartum period (Meades & Ayers, 2011) and has been validated in the”
BackgroundMethodPetzoldt, J. (2017) · Archives of Women s Mental Health · doi:10.1007/s00737-017-0771-4 · Cited by 65
“The results from studies examining possible temporal relationshipswere inconsistent as well (e.g. Çak et al. 2015;Miller et al. 1993), and it remainsunclear towhatextent these inconsistenciesmightbedue todifferences indesigns, definitions andmeasurements throughout pregnancy and early infancy.”
Helle, N., Barkmann, C., Ehrhardt, S., von der Wense, A., Nestoriuc, Y., & Bindt, C. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.01.016 · Cited by 62
“The STAI is a widely used instrument for measuring anxiety in postpartum populations (Meades and Ayers, 2011).”
MethodDepression, Anxiety, Stress and Hyperemesis Gravidarum: Temporal and Case Controlled Correlates
Tan, P. C., Zaidi, S. N. S. J. H., Azmi, N., Omar, S. Z., & Khong, S. Y. (2014) · PLoS ONE · doi:10.1371/journal.pone.0092036 · Cited by 64
“There is a validated Malay language version of DASS-21[12]; the Malay language version has concurrent validity in anxiety and depression components in infertility patients[13] when compared to the Hospital Anxiety and Depression Scale which is validated in perinatal populations[14].”
MethodGawlik, S., Waldeier, L. M., Müller, M., Szabo, A., Sohn, C., & Reck, C. (2012) · Archives of Women s Mental Health · doi:10.1007/s00737-012-0320-0 · Cited by 63
Rodríguez‐Ayllón, M., Acosta‐Manzano, P., Coll‐Risco, I., Romero‐Gallardo, L., Borges‐Cosic, M., Estévez‐López, F., & Aparicio, V. A. (2019) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2019.04.003 · Cited by 62
“Third, although the questionnaires used to assess mental health and the physical fitness tests in this study were valid and reliable for the general population, their psychometric properties have not been extensively tested among pregnant women, except for the STAI-T, whose validity has been previously corroborated at…”
MethodInfluentialThe initial development of the Pregnancy-related Anxiety Scale
Brunton, R. J., Dryer, R., Saliba, A., & Kohlhoff, J. (2019) · Women and Birth · doi:10.1016/j.wombi.2018.05.004 · Cited by 73
Christian, L. M., Iams, J. D., Porter, K. M., & Glaser, R. (2012) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2012.08.006 · Cited by 61
“The STAI shows strong criterion, discriminant, and predictive validity in perinatal populations (Meades and Ayers, 2011).”
Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit
Ong, S. L., Abdullah, K. L., Danaee, M., Soh, K. G., Soh, K. G., & Japar, S. (2018) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2018.1540861 · Cited by 61
“Previous research had reported that mothers in this situation were anxious and stressed (Erdem, 2010; Gueron-Sela et al., 2013; Meades & Ayers, 2011).”
BackgroundMethodInfluentialPredictors of distress and anxiety during pregnancy
Roos, A., Faure, S., Löchner, C., Vythilingum, B., & Stein, D. J. (2013) · African Journal of Psychiatry · doi:10.4314/ajpsy.v16i2.15 · Cited by 61
Gregory, K. D., Chelmow, D. P., Nelson, H. D., Niel, M. S. V., Conry, J. A., García, F., Kendig, S. M., O’Reilly, N., Qaseem, A., Ramos, D., et al. (2020) · Annals of Internal Medicine · doi:10.7326/m20-0580 · Cited by 55
“Nine studies and 1 systematic review (61) evaluated 12 screening instruments in pregnant and postpartum women.”
BackgroundSmith, M. S., Cairns, L., Pullen, L., Opondo, C., Fellmeth, G. L., & Alderdice, F. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.11.011 · Cited by 54
Oxytocin during breastfeeding and maternal mood symptoms
Whitley, J., Wouk, K., Bauer, A. E., Grewen, K., Gottfredson, N. C., Meltzer-Brody, S., Propper, C., Mills-Koonce, R., Pearson, B., & Stuebe, A. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.104581 · Cited by 61
Brik, M., Sandonis, M., Fernández, S., Suy, A., Parramon‐Puig, G., Maíz, N., Dip, M. E., Ramos-Quiroga, J., & Carreras, E. (2021) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.14073 · Cited by 42
Bindt, C., Guo, N., Bonle, M. T., Appiah‐Poku, J., Hinz, R., Barthel, D., Schoppen, S., Feldt, T., Barkmann, C., Mathurin, K., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0080711 · Cited by 56
“The GAD-7 has been validated in western primary care, but not in antepartum populations or in African settings, as research in antepartum anxiety is still in its early stages [26,27].”
BackgroundBarthel, D., Barkmann, C., Ehrhardt, S., & Bindt, C. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.08.004 · Cited by 54
de Vries, N. K. S., van der Veere, C. N., Reijneveld, S. A., & Bos, A. F. (2013) · PLoS ONE · doi:10.1371/journal.pone.0064654 · Cited by 51
“The BDI score during pregnancy correlated highly with the BDI score at the infants’ age of three to four months (Spearman’s rho= 0.62; p , .001); the same was true for the STAI-S score (Spearman’s rho= 0.72; p , .001).”
BackgroundMethodInfluentialMindfulness interventions during pregnancy: A narrative review
Lucena, L. D. R., Frange, C., Pinto, A. C. A., Andersen, M. L., Tufik, S., & Hachul, H. (2020) · Journal of Chinese Integrative Medicine · doi:10.1016/j.joim.2020.07.007 · Cited by 52
Functional Impairment in Patients with Major Depressive Disorder and Comorbid Anxiety Disorder
Gili, M., Garcı́a-Toro, M., Armengol, S., García‐Campayo, J., Castro, A., & Roca, M. (2013) · The Canadian Journal of Psychiatry · doi:10.1177/070674371305801205 · Cited by 50
Harrison, V., Moore, D., & Lazard, L. (2020) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-020-02990-0 · Cited by 57
Antenatal depression and anxiety across pregnancy in urban South Africa
Redinger, S., Pearson, R. M., Houle, B. C., Norris, S. A., & Rochat, T. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.08.010 · Cited by 49
“This scale has been validated for use in perinatal populations (Meades and Ayers, 2011), and was previously found to have an acceptable level of reliability in this population (Cronbach's α 0.64) (Redinger et al., 2018).”
MethodInfluentialChristian, L. M., Iams, J. D., Porter, K. M., & Leblebicioğlu, B. (2013) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9521-7 · Cited by 44
“The STAI shows strong criterion, discriminant, and predictive validity in perinatal populations [46].”
Yang, L., Sun, J., Nan, Y., Waqas, A., Nisar, A., Wang, D., Rahman, A., & Li, X. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.11.075 · Cited by 47
Bayrampour, H., McDonald, S., Fung, T. S., & Tough, S. (2014) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.3109/0167482x.2014.950218 · Cited by 44
“The STAI has been validated against clinical interviews during both pregnancy and the postpartum period and has been found to have acceptable sensitivity, specificity, and predictive values to identify cases of anxiety among the perinatal population [17,21].”
MethodGuo, N., Bindt, C., Bonle, M. T., Appiah‐Poku, J., Tomori, C., Hinz, R., Barthel, D., Schoppen, S., Feldt, T., Barkmann, C., et al. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-156 · Cited by 51
“The GAD-7 has been validated in western primary care, but not in African populations, as research in maternal anxiety in sub-Saharan Africa is still in its early stages [46,47].”
BackgroundBarber, C. C., & Starkey, N. J. (2015) · Midwifery · doi:10.1016/j.midw.2015.04.017 · Cited by 39
“, 2008) groups, and the scale has been widely used in studies of childbearing (Littleton et al., 2007; Meades and Ayers, 2011).”
MethodAziz, H. A., Yahya, H. D. B., Ang, W. W., & Lau, Y. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.11.070 · Cited by 59
Lauš, K. N. (2017) · Acta Clinica Croatica · doi:10.20471/acc.2017.56.04.05 · Cited by 42
Dudek, J., Colasante, T., Zuffianò, A., & Haley, D. W. (2018) · Child Development · doi:10.1111/cdev.13182 · Cited by 43
Measures Assessing the Quality of Case Conceptualization: A Systematic Review
Bucci, S., French, L., & Berry, K. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22280 · Cited by 41
“…is valid, but we acknowledge that these factors do not provide a complete picture of case conceptualization and it is important that measures are validated against a clinical conceptualization session or sessions, particularly when they are being used in a new population (Meades & Ayers, 2011).”
MethodThe pregnancy-related anxiety scale: A validity examination using Rasch analysis
Brunton, R., Dryer, R., Krägeloh, C., Saliba, A. J., Kohlhoff, J. R., & Medvedev, O. N. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.04.116 · Cited by 41
Porter, E., Lewis, A. J., Watson, S., & Galbally, M. (2019) · Infant Behavior and Development · doi:10.1016/j.infbeh.2019.101336 · Cited by 46
McDonald, S., Hicks, M., Rasmussen, C., Nagulesapillai, T., Cook, J. L., & Tough, S. (2014) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12579 · Cited by 39
Saligheh, M., Hackett, D. A., Boyce, P. M., & Cobley, S. P. (2017) · Archives of Women s Mental Health · doi:10.1007/s00737-017-0750-9 · Cited by 46
“At this time, women often experience mental and physical fatigue (Dennis and Ross 2005), disrupted sleep (Meades and Ayers 2011), mood disturbance, social isolation (O’Hara and Swain 1996), lowered self-esteem (Beck 2001), anxiety (including those related to parenting) and can subsequently lead to postnatal depression…”
BackgroundDennis, C.-L., Brown, H. K., Wanigaratne, S., Fung, K., Vigod, S. N., Grigoriadis, S., Marini, F., & Brennenstuhl, S. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717720689 · Cited by 40
A Brief Prenatal Intervention of Behavioral Change to Reduce the Risk of Maternal Cytomegalovirus
Hughes, B. L., Gans, K. M., Raker, C., Hipolito, E. R., & Rouse, D. J. (2017) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000002216 · Cited by 40
Cena, L., Mirabella, F., Palumbo, G., Gigantesco, A., Trainini, A., & Stefana, A. (2020) · European Psychiatry · doi:10.1192/j.eurpsy.2020.82 · Cited by 40
“Furthermore, its criterion, discriminant and predictive validity [44], and ease of use can provide a reasonably accurate estimate of prevalence, and its widespread use in research studies [1,16] can enable more accurate comparisons among nations.”
BackgroundGuo, C., Moses‐Kolko, E. L., Phillips, M. L., Swain, J. E., & Hipwell, A. E. (2018) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-017-0516-x · Cited by 41
“The STAI state subscale has good internal reliability and validity (Metzger, 1976; Okun, Stein, Bauman, & Silver, 1996; Spielberger et al., 1983), and have been shown to have good criterion, discriminant and predictive validity for perinatal populations (Meades & Ayers, 2011).”
BackgroundRamakrishna, S., Cooklin, A., & Leach, L. (2019) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2019.1578870 · Cited by 35
“The total scale score ranges from 20 to 80, and a threshold of 45 has been used as an indicator of probable Generalised Anxiety Disorder or Adjustment Disorder in perinatal samples (Dennis, Janssen, & Singer, 2004; Figueiredo & Conde, 2011; Meades & Ayers, 2011).”
MethodAutistic mothers’ perinatal well-being and parenting styles
Hampton, S., Allison, C. L., Aydin, E., Baron‐Cohen, S., & Holt, R. (2022) · Autism · doi:10.1177/13623613211065544 · Cited by 46
“The STAI has good validity and internal consistency in pregnant and postnatal populations (Meades & Ayers, 2011).”
BackgroundNazzari, S., Molteni, M., Valtorta, F., Comai, S., & Frigerio, A. (2020) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.06.015 · Cited by 38
Kaasen, A., Helbig, A., Malt, U. F., Næs, T., Skari, H., & Haugen, G. N. (2013) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-13-147 · Cited by 35
Metadata
- Authors
- Meades, R., & Ayers, S.
- Affiliations
- University of Sussex (GB)
- ORCID
- Ayers, Susan
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2011-09
- Volume
- 133
- Issue
- 1-2
- Pages
- 1-15
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2114696206
- Cited by
- 329
- References
- 103
- Citations by year
- 2026: 16 · 2025: 18 · 2024: 20 · 2023: 16 · 2022: 23 · 2021: 36 · 2020: 28 · 2019: 31 · 2018: 25 · 2017: 26 · 2016: 14 · 2015: 22 · 2014: 27 · 2013: 21 · 2012: 6
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- perinatal anxiety, anxiety screening, psychometric validation, General Health Questionnaire, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Kessler K10, DASS-21, criterion validity, discriminant validity, perinatal women
- MeSH terms
- Anxiety, Anxiety Disorders, Female, Humans, Pregnancy, Pregnancy Complications, Psychometrics, Surveys and Questionnaires, Sensitivity and Specificity, Weights and Measures, Reproducibility of Results, Postpartum Period
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