Screening for perinatal anxiety disorders: Room to grow
Abstract
Background The anxiety and their related disorders (AD) are the most prevalent of all mental health conditions, disproportionately affecting women. The value of perinatal AD screening is well established but there is very limited evidence to support the applicability of existing anxiety screening instruments. To our knowledge, no previous studies have evaluated an AD screening instrument in a perinatal population using full gold standard methodology.Objective To assess the accuracy of the most commonly used and/or recommended screening tools for perinatal AD (i.e., the Edinburgh Postnatal Depression Scale (EPDS) and its anxiety subscale (EPDS-3A), and the Generalized Anxiety Disorder 7 and 2-item Scales (GAD-7 and GAD-2) alongside a clinically derived alternative; the Anxiety Disorder - 13 (AD-13).Methods 310 Canadian women completed mood and anxiety questionnaires at approximately 3-months postpartum. Those scoring at/above cut-off on one or more questionnaire completed a diagnostic interview for depression and all AD (n = 115). The accuracy of each scale was assessed via ROC analyses.Results Only the AD-13 met the standard of a clinically useful screening measure, with an area under the curve (AUC) above 0.8. This was achieved with and without the inclusion of the related disorders. No other measure demonstrated an AUC above 0.8, either including or excluding the related disorders.Conclusions Neither the EPDS/EPDS 3-A, nor the GAD-7/GAD-2 can be recommended for widespread use as a perinatal AD screening tool. The high performance of the AD-13 is a good indication that an effective alternative is well within reach.
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Current screening tools for perinatal anxiety do not reliably or accurately identify women in need of further assessment and treatment.
“Further, extant research suggests that current screening tools for perinatal anxiety do not reliably or accurately identify women in need of further assessment and treatment [88].”
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 [88]
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- Authors
- Fairbrother, N., Corbyn, B., Thordarson, D. S., Ma, A., & Surm, D.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Fairbrother, Nichole
- ORCID
- Fairbrother, Nichole
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2019-05
- Volume
- 250
- Pages
- 363-370
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2920835406
- Cited by
- 82
- References
- 62
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 9 · 2023: 14 · 2022: 11 · 2021: 14 · 2020: 10 · 2019: 1
- FWCI
- 8.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Vancouver Foundation
- National Institute for Health Research
- 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 › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- anxiety screening, Edinburgh Postnatal Depression Scale, GAD-7, GAD-2, postpartum anxiety, diagnostic accuracy, receiver operating characteristic
- MeSH terms
- Patient Health Questionnaire, Adult, Anxiety Disorders, Canada, Female, Humans, Mass Screening, Psychiatric Status Rating Scales, Risk Factors, ROC Curve, Stress, Psychological, Prevalence, Women's Health, Depression, Postpartum, Postpartum Period
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