New research will improve diagnosis of antenatal anxiety

A landmark study by experts at the University of Stirling will help health professionals improve the identification of severe and problematic anxiety in pregnant women.

Antenatal anxiety can be difficult to identify and current guidance recommends that health professionals apply the same screening tool used to detect anxiety disorders in the general population. Such generic tools cite physical symptoms – such as palpitations or sleep difficulties – which can also be common experiences of pregnancy.

However, the new, multidisciplinary study – from the Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU) at Stirling – has now identified a number of symptoms that are reliable indicators of antenatal anxiety.

Andrea Sinesi, who led the work as part of his PhD, said: “Previous research clearly shows that antenatal anxiety considerably increases the risk of postnatal depression and can negatively affect child development, both in the short and long term. We also know that existing anxiety scales developed for the general population are not reliable in screening for problematic anxiety in pregnant women.

“Our research looked at all of the studies conducted over the last 30 years – that were of good or excellent methodological quality – which used anxiety scales with pregnant women. We examined all of the questions included within each of the scales. It is the first time that both the content and psychometric properties of such studies have been systematically examined and evaluated.

“Through this analysis, we were able to identify a number of symptoms consistently shown to be reliable and valid indicators of antenatal anxiety. These include elevated levels of worry; symptoms of panic; fear of childbirth; and excessive worries about the baby’s health.”

Many women experience some anxiety during pregnancy, but 15 percent of all pregnant women suffer symptoms severe enough to impact negatively on their day-to-day lives. Evidence suggests that a substantial proportion of women experiencing antenatal anxiety are going undetected and, consequently, not receiving any support.

Currently, the National Institute for Clinical Excellence recommends using a generic anxiety-screening tool, which may not be sensitive enough for women during pregnancy.

The symptoms identified by the review as being robust indicators in the diagnosis of antenatal anxiety will form part of a new scale, currently being developed by Mr Sinesi and colleagues.

“The overall aim of the research is to develop a screening scale for antenatal anxiety that can be used by midwives and other health professionals to identify women with elevated levels of anxiety during pregnancy,” Mr Sinesi said. “The symptoms identified are now being used to develop a short and easy-to-complete screening tool to identify women experiencing more serious antenatal anxiety – and rule out women who are experiencing normal pregnancy-related anxiety.”

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Mr Sinesi was supported in the study by Professor Helen Cheyne, Deputy Director at NMAHP-RU and Royal College of Midwives (Scotland) Professor of Midwifery; Professor Margaret Maxwell, Director of NMAHP-RU; and Professor Ronan O’Carroll, a clinical and health psychologist based in Stirling’s Faculty of Natural Sciences.

The paper, Anxiety scales used in pregnancy: systematic review, is published in the British Journal of Psychiatry Open and was funded through a Doctoral Training Fellowship from the Chief Scientist Office, part of the Scottish Government Health Directorates.