1

Data supplement to Dennis et al. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry doi: 10.1192/bjp.bp.116.187179

Table DS1: PubMed search strategy made on January 13, 2016

Search Query No of items found

#1

Postpartum period[MeSH Terms] OR postpartum[Text Word] OR puerperium[Text Word] OR pregnancy[MeSH Terms] OR pregnancy[Text Word] ORgestation[Text Word] OR postbirth[Text Word] OR post-birth[Text Word] OR antenatal[Text Word] OR prenatal[Text Word] OR postnatal[Text Word]

964,783

#2

Mood disorders[MeSH Terms] OR mood disorders[Text Word] OR depressive disorder[MeSH Terms] OR depression, postpartum[MeSH Terms] OR depression[MeSH Terms] OR depressive symptoms[Text Word] OR depression[Text Word] OR anxiety disorders[MeSH Terms] OR anxiety[MeSH Terms] OR anxiety[Text Word]

477,403

Final #1 AND #2 21,487

2

Table DS2: Characteristics of Included Studies

Author Year Country Study population Sample

size

Anxiety Assessment Quality Rating for Risk of Bias Results

Measure Cut-off Time Selection Detection Attrition

Aaron 2015 1 USA Pregnant women from an obstetrics clinic

affiliated with a hospital in Philadelphia 113 STAI >39 2nd to 3rd trimester

1 to 24 weeks High Moderate Moderate

Anxiety symptoms 2nd -3rd trimester=27.4% 1-24 weeks=21.2%

Cheng 2015 2 Singapore Pregnant women receiving an ultrasound at

two public maternity units (cohort design) 1058 STAI-S STAI-T

>41 >43 2nd trimester High Moderate Low Anxiety symptoms=26.3%

Trait=25.5% Fontein-Kuipers 2015 3

Netherlands Pregnant women from 140 midwife-led primary care practices 458

PRAQ

STAI

>90th percentile

>41 All

trimesters High Moderate Low Anxiety symptoms=11.8% Trait=14.4%

Ibanez 2015 4 France

Pregnant women receiving care from two university maternity units in Nancy and Poitiers (cohort design)

1719 STAI ≥37 2nd trimester High Moderate Low Anxiety symptoms=21.1%

Mahenge 2015 5 Tanzania Pregnant women attending a hospital-based

prenatal clinic in Dar es Salaam 1180 HSCL > 1.75 All trimesters Moderate Moderate Low Anxiety symptoms=8.1%

Pazzagli 2015 6 Italy Pregnant women from a hospital in Perugia 158 STAI >40 3rd trimester Moderate Moderate Low Anxiety symptoms=30%

Trait=25%

Bjørk 2015 7 Norway

Pregnant women without epilepsy and chronic medical conditions (population-based study; control group) (cohort design)

93,422 HSCL >1.75 3rd trimester

24 weeks 18 months

High Moderate Low Anxiety symptoms 3rd trimester=5.8% 24 weeks=4.8%;18 months=5.2%

Dubber 2015 8 Germany Pregnant women from a hospital in

Heidelberg (cohort design) 79 STAI > 40 3rd trimester 12 weeks Moderate Moderate Low

Anxiety symptoms 3rd trimester=29.6%; 12weeks=10.1% Trait 3rdtrimester=23.6%;12 weeks=14.3%

Enatescu 2014 9 Romania Postpartum women from a single clinic in

Timisoara 80 BAI >16 6–8 weeks Moderate Moderate Low Anxiety symptoms=46.3%

Pisoni 2016 10 Italy

Pregnant women with no complications attending a 3rd trimester ultrasound scan in Pavia

37 STAI > 40 3rd trimester Moderate Moderate Low Anxiety symptoms=27.0%

Razurel 2015 11 Switzerland Pregnant women attending their last prenatal

visit at a maternity hospital in Geneva 235 STAI >40 3rd trimester

3 days 6 weeks

Moderate Moderate Low Trait 3rd trimester=35.7% 3 days=30.7%; 6 weeks=27.8%

Rosenthal 2015 12 USA Pregnant women at 7 community hospitals

and health centers across New York City 1230 GAD-7 >10 2nd trimester Moderate Moderate Low Anxiety symptoms= 20%

Vilela 2015 13 Brazil Pregnant women at a public health care

centre in Rio de Janeiro 196 STAI ≥ 40 2nd and 3rd trimester

4-6 weeks High Moderate Low

Anxiety symptoms 2nd trimester=43.9%; 3rd trimester=48.2% 4-6 weeks=31.7%

3

Betts 2014 14

Australia

Pregnant women attending their first prenatal care visit at a Brisbane hospital 4891 DSSI Top 10%

1st trimester 3-5 days 24 weeks

Moderate Moderate Moderate Anxiety symptoms 1st trimester=8.9% 3-5 days=11.6%; 24 weeks=10.2%

Broekman 2014 15 Singapore Pregnant women from the two major

hospital maternity units 1034 STAI ≥ 40 2ndtrimester 12 weeks 52 weeks 24 months

Moderate Moderate High

Anxiety symptoms 2nd trimester=30.3%; 12 weeks=28.5% 52 weeks=31.8%; 24 months=30.1% Trait 2nd trimester=35.8%; 12 weeks=35.4% 52 weeks=38.0%; 24 months=38.2%

Ferreira 2014 16 Brazil Pregnant women who had their prenatal care

in Alfenas-MG 203 STAI

> sample mean 3rd trimester High Moderate Low Anxiety symptoms=58.5%

Trait=53.2% Garthus-Niegel 2014 17

Norway Pregnant women who attended a hospital near Oslo for a routine ultrasound (cohort design)

1700 HSCL >1.75 3rd trimester 8 weeks Low Moderate High Anxiety symptoms

3rd trimester=8.4%;8 weeks=4.8%

Guo 2014 18

Ghana Côte d’Ivoire

Postpartum women from two large hospitals in Kumasi and Abidjan (cohort design) 614 GAD-7 > 10

12 weeks 52 weeks 24 months

Moderate Moderate High Anxiety symptoms 12 weeks=5.9%; 52 weeks=6.0% 24 months=3.9%

Huizink 2014 19 Netherlands

Pregnant women attending midwifery practices in the vicinity of Amsterdam (cohort design)

1059 STAI > 40 1st, 2nd and 3rdtrimester Moderate Moderate Low

Anxiety symptoms 1st trimester=16.5%;2nd trimester=13.3% 3rd trimester=15.4%

Khashan 2014 20

UK, NZ, Australia,

Ireland

Pregnant women receiving antenatal care in six centres: Manchester, London, Leeds, Auckland, Adelaide, Cork (cohort design)

4896 STAI >75th percentile 2nd trimester Moderate Moderate Low Anxiety symptoms=20.1%

McDonald 2014 21 Canada

Pregnant women receiving antenatal care across Alberta (population-based; cohort design)

2907 STAI > 40 1st to 2nd trimesters Low Moderate Low

Anxiety symptoms 1st-2nd trimester=15.5%; 16 weeks=14.9%

Meijer 2014 22 Netherlands

Pregnant women from 116 primary and secondary obstetric care centres (cohort design)

1603 STAI 6-item ≥42

1st and 3rd trimesters

Moderate Moderate High

Anxiety symptoms 1st trimester=12% 3rd trimester=14%

Jokic-Begic 2014 23 Croatia Pregnant women attending a prenatal clinic

at a university hospital in Zagreb 200 STAI >40 3rd trimester 4-6 weeks Moderate Moderate Moderate Anxiety symptoms

3rd trimester=35%; 4-6 weeks=20% Polachek 2014 24 Israel Postpartum women from a maternity ward in

Ramat Gan (cohort design) 89 modified STAI > 5 4 weeks Moderate Moderate Low Anxiety symptoms=40.4%

Rubertsson 2014 25 Sweden Pregnant women attending their first

antenatal visit in 25 clinics in mid-Sweden 916 HADS-A > 8 1st trimester Moderate Moderate Low Anxiety symptoms=15.6%

Sanchez 2014 26 Peru Women who delivered in two hospitals in

Lima 480 DASS-21 >10 Immediate

post-birth Moderate Moderate Low Anxiety symptoms=8.1%

Tan 2014 27 Malaysia Pregnant women attending routine antenatal care at a university hospital in Kuala Lumpur

113 DASS > 8 3rd trimester High Moderate Low Anxiety symptoms=61.1%

Verreault 2014 28 Canada Pregnant women attending a hospital

antenatal clinic or an ultrasound in Montreal 364 STAI >40 3rd trimester

12 weeks 24 weeks

Moderate Moderate Moderate Anxiety symptoms 3rd trimester=26.6% 12 weeks=18%; 24 weeks=19.7%

Bindt 2013 29

Ghana Côte d’Ivoire

Pregnant women from two large hospitals in Kumasi and Abidjan 716 GAD-7 > 10 3rd trimester Moderate Moderate Low Anxiety symptoms=14.2%

Bödecs Hungary Pregnant women receiving prenatal care in the district nurse office in Szombathely 498 STAI > 48 1st trimester

(M=8.2weeks) High Moderate Low Trait=14.2%

4

2013 30 (cohort design)

Dennis 2013 31 Canada

Postpartum women from a health region near Vancouver, British Columbia (cohort design)

565 STAI > 40 1,4 and 8 weeks Moderate Moderate Low

Anxiety symptoms 1 week=22.6%; 4 weeks=17.2% 8 weeks=14.8%

Fadzil 2013 32 Malaysia Pregnant women at an antenatal clinic from

a tertiary hospital in Ipoh 175 HADS MINI

> 8 DSM-IV

1st, 2nd, and 3rd trimesters Moderate

Moderate for HADS

low for MINI

Low Anxiety symptoms=23.4% Any anxiety disorder=9.1%

Farias 2013 33 Brazil Pregnant women at a public health centre in

Rio de Janeiro 239 MINI DSM-IV 1sttrimester Moderate Low Low Generalized anxiety=10.5%

George 2013 34 France

Pregnant women who attended hospital birth preparation classes or a midwifery consultation in Lorraine

400 HADS > 10 3rd trimester 6-8 weeks High Moderate High Anxiety symptoms

3rd trimester=18.5%; 6-8 weeks=20.2%

Makara –Studzińska 2013 35

Poland Pregnant women attending state or private obstetric clinics in the Lublin and Mazoviaprovinces (cohort design)

314 HADS > 11 1st, 2nd, and 3rdtrimesters Moderate Moderate Low

Anxiety symptoms 1st trimester=13.4%;2nd trimester=7.3% 3rd trimester=4.6%

Martini 2013 36 Germany Pregnant women from outpatient clinics in

the area of Dresden (cohort design) 306 CIDI DSM-IV

1st, 2nd and 3rd trimesters

8 and 16 weeks

16 months

Moderate Low Low

Any anxiety disorder 1st trimester=21.2%; 2nd trimester=13.3% 3rd trimester=9.4%; 8weeks=7.5%; 16 weeks=6.4%; 16 months=12.7% Generalized anxiety 1st trimester=1.3%; 2nd trimester=0.3% 3rd trimester=1.8%; 8 weeks=0.4% 16 weeks=1.8%; 16 months=1.9%

Paul 2013 37 USA Postpartum women who delivered in

Hershey, Pennsylvania (cohort design) 1123

STAI >40 3-5 days;

2, 8, and 24 weeks

Moderate Moderate Low Anxiety symptoms 3-5 days=17.1%; 2 weeks=6.9% 8 weeks=5.8%; 24 weeks=7.2%

Roos 2013 38

South Africa

Pregnant women attending midwifery/ obstetric units in the East Metro region of the Western Cape (random sample)

105 STAISCID

>40 DSM-IV

2nd and 3rd trimesters Moderate Moderate Low

Anxiety symptoms 2nd trimester=4.3%;3rd trimester=48.6% Trait: All trimester=56% Any anxiety disorder: All trimesters=6% Generalized anxiety: All trimesters=1%

Taylor 2013 39 Australia

Postpartum women at two public tertiary hospitals, one private hospital, and one birth centre (cohort design)

504 STAI >40 1, 6, 12 and 24 weeks High Moderate Low

Anxiety symptoms 1 week=9.6%; 6 weeks=9.6% 12 weeks=9.5%; 24 weeks=9.6%

Bouris 2012 40 Canada

Postpartum women at six hospitals in Montreal, one hospital in Vancouver and five hospitals in Toronto (cohort design)

507 HSCL >1.75 16 weeks High Moderate Low Anxiety symptoms=10.7%

Da Silva 2012 41 Brazil

Pregnant women attending an ultrasound examination in the Hospital do Servidor Publico Estadual

146 STAI > 40 1st to 2nd trimester High Moderate Low Anxiety symptoms=47.3%

O’Hara 2012 42 USA Postpartum women in four rural and urban

counties in Iowa (cohort design) 1077 BAI (6 items)

> 6 DSM-IV

Across 1st year High Moderate Low Anxiety symptoms=15.6%

Generalized anxiety=15.7%

5

SCID (M=21 weeks) Tavares 2012 43

Brazil Postpartum women in Pelotas (cohort design) 919 MINI DSM-IV 4-12 weeks Low Low Low

Any anxiety disorder=18.5% Generalized anxiety=12.3%

Alder 2011 44 Switzerland Pregnant women from a university hospital

obstetric department in Basel 39 STAI > 40 3rd trimester High Moderate Low Trait=28.2%

Buist 2011 45 USA

Pregnant women from obstetric services throughout Connecticut and Western Massachusetts

2793 CIDI DSM–IV 1st, 2nd and 3rd trimester Low Low Low

Generalized anxiety 1st trimester=5.4% 2nd to 3rd trimesters=4.2% All trimesters=9.6%

Edhborg 2011 46 Bangladesh

Women in two rural areas of Mymensingh district(cohort design)

674 STAI >46 8-12 weeks Moderate Moderate Low Anxiety symptoms=38.3%

Figueiredo 2011 47 Portugal

Pregnant women at a public obstetrics out-patient unit in Porto (random sample) (cohort design)

260 STAI > 45

1st, 2nd and 3rd trimesters

Post-birth 12 weeks

Moderate Moderate Low

Anxiety symptoms 1st trimester=13.1%; 2nd trimester=12.3% 3rd trimester=18.1% Post-birth=18.6%; 12 weeks=4.7%

Ibanez 2012 48 France Pregnant women from two university

maternity units in Nancy and Poitiers 1719 STAI ≥37 2nd trimester High Moderate Low Anxiety symptoms=7.9%

Keim 2011 49 USA

Pregnant women in North Carolina who participated in the PIN (Pregnancy, Infection, and Nutrition) study (cohort design)

358 STAI >40 1st to 2nd trimester Moderate Moderate High Trait=24.9%

Mohammad 2011 50 Jordan Pregnant women from a teaching hospital

and five health centres in Irbid 353 DASS-21 >10

3rd trimester 6 and 24 weeks

Moderate Moderate Low Anxiety symptoms 3rd trimester=14.4% 6 weeks=22.7%; 24 weeks=24.4%

Nasreen 2011 51 Bangladesh

Pregnant women in a pregnancy registration from two rural areas in the Mymensingh district

720 STAI ≥45 3rd trimester Moderate Moderate Low Trait=29.4%

Ajslev 2010 52 Denmark

Postpartum women participating in the Danish National Birth Cohort (DNBC)(cohort design)

21121 SCL-90

(3 items)

> 4 24 weeks Moderate Moderate Moderate Anxiety symptoms=2.6%

Amr 2010 53

Saudi Arabia

Postpartum women attending primary health care centres in Al-Ahsa 190 MINI DSM–IV Within 8

weeks Moderate Low Low Any anxiety disorder=15.3% Generalized anxiety=2.6%

Austin 2010 54 Australia Postpartum women who delivered at

midwife-based clinics in Sydney 1549 CIDI DSM-IV 24-32 weeks Moderate Low Moderate Generalized anxiety=3.1%

Catov, 2010 55 USA Pregnant women from a hospital in

Pittsburgh, Pennsylvania 667 STAI > 75th percentile

2nd trimester (M=18weeks) Moderate Moderate Low Trait=24.4%

Fisher 2010 56 Vietnam Pregnant women in two northern

Vietnamese provinces (random sample) 199 SCID DSM–IV 3rd trimester 4-8 weeks Low Low Low Generalized anxiety

3rd trimester=6.5%; 4-8 weeks=8.5%

Fisher 2010 57 Australia

Postpartum women from 3 rural areas in Victoria and from 4 metropolitan areas in Melbourne (control group)(cohort design)

196 CIDI DSM-IV 1-24 weeks Moderate Low Low Any anxiety disorder=10.2%

6

Feldman 2009 58 Israel Postpartum women from two hospitals in a

large metropolitan area (cohort design) 971 STAI > 43 Post-birth Moderate Moderate Low Trait=12.2%

Giakoumaki 2009 59 Greece Postpartum women from a public perinatal

centre in Athens (cohort design) 235 STAI > 40 2–3 days 12 weeks Moderate Moderate Moderate

Anxiety symptoms 2-3 days=22.9%; 12 weeks=2.6% Trait 2-3 days=24.6%; 12 weeks=14.3%

Goodman 2010 60 USA Pregnant women attending two obstetrical

clinics in Boston 491 PHQ DSM-IV 3rd trimester 6 weeks High Moderate Moderate Any anxiety disorder

3rd trimester=4.3%; 6 weeks=3.4% Reck 2009 61 Germany Postpartum women at six clinics in

Heidelberg and Darmstadt (cohort design) 853 SCID DSM-IV 1-12 weeks Moderate Low Low Any anxiety disorder=2.7%

Uguz 2010 62 Turkey Pregnant women attending a university

affiliated obstetric clinic in Selcuk 309 SCID DSM-IV 1st, 2nd and 3rd trimester Moderate Low Low

Any anxiety disorder 1st trimester=15.5%;2nd trimester=7.6% 3rdtrimester=24.2%; All trimesters=15.5% Generalized anxiety All trimesters=3.6%

Yelland 2010 63 Australia Postpartum women who delivered in

Victoria and South Australia 4269 DASS-21 >10 24 weeks High Moderate Low Anxiety symptoms=8.4%

Couto 2009 64 Brazil

Pregnant women receiving routine prenatal care at two municipal healthcare clinics in Campinas (control group)

120 HADS ≥ 8 2nd trimester Moderate Moderate Low Anxiety symptoms=33.3%

Faisal-Cury 2009 65 Brazil

Pregnant women in 10 public primary health care units in Butanta, Rio Pequeno and Raposo Tavares in São Paulo

831 CIS-R > 12 2nd to 3rd trimester Low Moderate Low Any anxiety disorder=33.3%

Hall 2009 66 Canada

Pregnant women from communities across British Columbia with 150 births or more annually

650 STAI >40 3rd trimester Moderate Moderate Low Anxiety symptoms=29.4%

van Batenburg-Eddes 2009 67

Netherlands Pregnant women in Rotterdam whose delivery data was between April 2002 and January 2006 (population-based study; cohort design)

2451 BSI >

85thpercentile

2nd trimester 8 weeks Moderate Moderate High

Anxiety symptoms 2nd trimester=8.7%; 8 weeks=6.6%

Zanardo 2009 68 Italy Postpartum women before hospital discharge

in the north-eastern Veneto region 204 STAI >45 3-4 days Moderate Moderate Low Trait=39.15%

Anderson 2008 69 Canada Postpartum women from seven ultrasound

clinics in London, Ontario (cohort design) 651 STAI ≥ 90th percentile 8-52 weeks Moderate Moderate Moderate Anxiety symptoms=8.8%

Britton 2008 70 USA

Postpartum women from a university medical center in Salk Lake City (cohort design)

359 STAI > 40 Post-birth 4 weeks High Moderate Moderate Anxiety symptoms

Post-birth=24.3%; 4 weeks=30.7%

DiPietro 2008 71 USA Pregnant women with an uncomplicated

pregnancy in Baltimore 137 STAI > 40 3rd trimester

6 weeks 24 months

High Moderate Moderate

Anxiety symptoms:3rd trimester=28.5% 6 weeks=24.2%; 24 months=19.4% Trait: 3rd trimester=28.5% 6 weeks=24.2%; 21.4%

Grant 2008 Australia Pregnant women recruited during routine 100 STAI > 40 All High Moderate Moderate Anxiety symptoms: 1-28 weeks=33%

7

72 antenatal care at an obstetric hospital in Sydney (cohort design)

MINI DSM-IV trimesters (M=16weeks)

1-28 weeks

Trait: 1-28 weeks=26% Any anxiety disorder All trimester=21%; 1-28 weeks=20%

Keeton 2008 73 USA Pregnant women attending hospital prenatal

classes in western New England 153 STAI > 40 3rd trimester 4, 16, 24 and

52 weeks Moderate Moderate Low

Anxiety symptoms 3rd trimester=36% 4 weeks=19.6; 16 weeks=30.2% 24 weeks=36.1%; 52 weeks=27.4%

Mann 2008 74 USA

Pregnant women at two obstetrics practices in a south-eastern state capital and one practice in a gulf south state capital

344 HADS > 10 All

trimesters (M=10weeks)

Moderate Moderate Low Anxiety symptoms=6.7%

Rowe 2008 75 Australia Postpartum women attending a mother-baby

unit or health service centre in Melbourne 138 CIDI DSM-IV M=29 ± 10.3 weeks Moderate Low Low Any anxiety disorder=25.4%.

Generalized anxiety=10.9% Sato 2008 76 Japan Postpartum women from 25 collaborating

birth centres (cohort design) 1348 HADS >10 12-16 weeks 40-44 weeks High Moderate High Anxiety symptoms

12-16 weeks=9.6%;40-44 weeks=10.6%

Vesga-Lopez 2008 77

USA Subsample of pregnant women who were part of a national survey (cohort design)

994

AUDADIS-IV DSM-IV

All trimesters

1-52 weeks Low Low Low

Any anxiety disorder All trimesters=13.0%;1-52 weeks=12.3% Generalized anxiety All trimester=1.3%; 1-52 weeks=1.5%

Faisal-Cury 2007 78 Brazil Pregnant women in a private obstetric clinic

in Osasco, São Paulo 432 STAI > 40 2nd to 3rd trimester Moderate Moderate Low Anxiety symptoms=59.5%

Trait=45.3% Goebert 2007 79 USA Pregnant women at prenatal clinics and

private physicians offices on Oahu, Hawaii 84 STAI > 40 1st trimester Moderate Moderate Low Anxiety symptoms=27%

Gonidakis 2007 80 Greece Postpartum women at a university

department of obstetrics in Athens 405 STAI >40 1st day post-birth Moderate Moderate Low Anxiety symptoms=16.0%

Trait=7.4%

Lee 2007 81 Hong Kong

Pregnant women attending an antenatal clinic of a regional hospital (cohort design) 335 HADS > 7 1st, 2nd and

3rd trimesters Moderate Moderate Low Anxiety symptoms 1sttrimester=36.3%;2ndtrimester=32.3% 3rdtrimester=35.8%

Orr 2007 82 USA Pregnant women who attended four hospital-based prenatal clinics in Baltimore (cohort design)

1820 PSEI 6 items > 4 1st and 2nd

trimester Moderate Moderate Low Anxiety symptoms=28%

Shi 2007 83 China Pregnant women from two obstetrical hospitals in Shanghai (cohort design) 522 HADS > 9

2nd and 3rd trimesters

1, 6, and 12 weeks

Moderate Moderate Moderate

Anxiety symptoms 2nd trimester=5.0%;3rd trimester =6.6% 1 week=4.4%; 6 weeks=4.1% 12 week=2.2%

Clifford 2006 84 Canada

Postpartum women from two hospitals in London, Ontario (cohort design)

733 STAI ≥75th

percentile 1 and 24 weeks Moderate Moderate Moderate

Anxiety symptoms 1 week=27.2%; 24 weeks=24.6% Trait 1 week=26.7%; 24 weeks=23.8%

Adewuya 2005 85 Nigeria Postpartum women who delivered in 5

government health centres in Ilesa 631 SAS >40 1, 4, 8, 12, 24, and 36

weeks Moderate Moderate Moderate

Anxiety symptoms 1 week=28.1%; 4 weeks=17.9% 8 weeks=10.2%;12 weeks=10.1% 24 weeks=8.2%; 36 weeks=6.3%

Austin 2005 86 Australia Women at midwife-based hospital clinics in

Sydney (random sample; cohort design) 964 STAI > 40 3rd trimester (M=32 Moderate Moderate Moderate Trait=25.3%

8

weeks)

Berle 2005 87 Norway Population-based general health survey

(cohort design) 680 HADS > 8 1st, 2nd and 3rd trimester Moderate Moderate Low

Anxiety symptoms 1st trimester=11.6%;2nd trimester=7.5% 3rd trimester=12.3%; All trimesters=10.4%

Coates 2004 88 USA

Postpartum women who were members of the Kaiser Permanente Medical Care Program in the northern California

25,296 ICD-9 Physician diagnosis 1-52 weeks Moderate Low Low

Any anxiety disorder 1-8 weeks=0.7%; 9-16 weeks=0.5% 17-32 weeks=1.2%; 33-52 weeks=1.3% Across postpartum=3.7%

Heron 2004 89

UK Pregnant women living in the geographical area of Avon, England (cohort design) 8323 CCEI ≥ 9 (top

15%)

2nd and 3rd trimesters 8 and 23 weeks

Low Moderate Moderate Anxiety symptoms 2nd trimester=14.6%;3rd trimester=15.6% 8 weeks=8.1%; 32 weeks=9.1%

Sutter-Dallay 2004 90 France

Pregnant women attending antenatal clinics at a university affiliated hospital in Bordeaux (cohort design)

497 MINI DSM-IV 3rd trimester 6, 12, and 24

weeks High Low Low

Any anxiety disorder:3rd trimester=24% Generalized anxiety:3rd trimester=8.5% 6 weeks=5.4%; 12 weeks=4.3% 24 weeks=4.2%

Andersson 2003 91 Sweden Pregnant women attending a routine

ultrasound at two northern hospitals 1556 PRIME-MD DSM-IV 2nd trimester Moderate Low Low Any anxiety disorder=6.6%

Generalized anxiety=0.3%

Dole 2003 92 USA

Pregnant women attending prenatal clinics in central North Carolina who participated in the PIN (Pregnancy, Infection, and Nutrition) study (cohort design)

1703

Pregnancy-

related anxiety, 6 items

low medium

high 2nd trimester High Moderate Low Anxiety symptoms=17.9%

Eberhard-Gran 2003 93

Norway Postpartum women from two municipalities northeast of Oslo (population-based; cohort design)

416 SCL-25 > 18 6 weeks Moderate Moderate Low Anxiety symptoms=4.9%

Matthey 2003 94 Australia Pregnant women attending hospital-based

antenatal classes in Sydney (cohort design) 408 DIS DSM-IV 6 weeks Moderate Low Low Any anxiety disorder=16.67%

Rondó 2003 95

Brazil Pregnant women who attended antenatal care in 12 health units and 5 hospitals in Jundiai, São Paulo

865 STAI >40 1st, 2nd and 3rd trimesters Moderate Moderate Low

Anxiety symptoms 1sttrimester=31.7%;2nd trimester=26.5% 3rd trimester=29.2% Trait 1st trimester=52.9%;2nd trimester=45.8% 3rd trimester=44.3%

Ross 2003 96 Canada

Pregnant women attending a university affiliated obstetric or midwifery clinics in Toronto (cohort design)

150 BSI Top 10% anxiety subscale

3rd trimester 6 and 16 weeks

Moderate Moderate Low Anxiety symptoms 3rd trimester=10% 6 weeks=7.3%; 16 weeks=8.7%

Zar 2002 97 Sweden Pregnant women attending nine obstetric clinics in Jönköping 453 ADIS-

R DSM-IV 3rd trimester Moderate Low Low Generalized anxiety=0.9%

McMahon 2001 98 Australia

Postpartum women from the residential care unit of a parentcraft hospital and a comparison group from a private obstetric practice (cohort design)

186 STAI > 40 16-22 weeks Moderate Moderate Low

Anxiety symptoms Residential care mothers=35% Comparison mothers=9%

9

ADIS-R, Anxiety Disorder Interview Schedule-Revised AKUADS, Aga Khan University Anxiety Depression Scale AUDADIS-IV, Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV BAI, Beck Anxiety Inventory BSI, Brief Symptom Inventory CCEI, Crown-Crisp Experiential Index CIDI, Composite International Diagnostic Interview CIS-R, Clinical Interview Schedule Revised DASS, Depression, Anxiety and Stress Scales DIS, Diagnostic Interview Schedule DSSI, Delusions-Symptoms-States Inventory EPDS, Edinburgh Postnatal Depression Scale HADS, Hospital Anxiety and Depression Scales HSCL, Hopkins Symptoms Checklist GADS, Generalized Anxiety Disorder Scale GDAS, Goldberg Depression and Anxiety Scales IPAT, IPAT Anxiety Scale (Self-Analysis Form) MINI, Mini-International Neuropsychiatric Interview PRAQ, Pregnancy-related Anxiety Questionnaire PRIME-MD Primary Care Evaluation of Mental Disorders PSEI, Prenatal Social Environment Inventory PHQ, Patient Health Questionnaire SAS, Zung Self-Rating Anxiety Scale SCL, Symptom Distress Checklist SCID, Structured Clinical Interview for DSM Disorders STAI, State-Trait Anxiety Inventory

Teixeira 1999 99 UK Pregnant women attending parent craft

classes in London 100 STAI > 40 3rd trimester (M=32weeks) High Moderate Low Anxiety symptoms=15%

Trait=32% Stuart 1998 100

USA Postpartum women from a local county in Iowa (cohort design) 107 BAI >10 14 and 30

weeks Moderate Moderate Low Anxiety symptoms 14 weeks=8.7%; 30 weeks=16.8% 14-30 weeks=10.3%

Bhagwanani 1997 101 USA Pregnant women attending a prenatal clinic

at a hospital in Cleveland (cohort design) 88 STAI > 46 All trimesters Moderate Moderate Low Anxiety symptoms=19.3%

Crandon 1979 102 UK Pregnant women - Not reported 146 IPAT > 7 3rd trimester Moderate Moderate Low Anxiety symptoms=23.3%

10

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17

Figure DS1: Prevalence of antenatal and postnatal (1-24 weeks) any anxiety disorder

18

Figure DS2: Prevalence of antenatal and postnatal (1-24 weeks) generalised anxiety

19

Figure DS3: Prevalence of postnatal anxiety symptoms (1-24 weeks)