Perinatal mental health problems – The development of a screening scale for antenatal anxiety

Andrea Sinesi

NMAHP-RU – University of Stirling

Project funded by a CSO Scotland Doctoral Training Fellowship

Overview

o Perinatal mental health problems: beyond postnatal depression

o The importance of early identification and support

o The costs of perinatal mental health problems

o Anxiety in pregnancy

o A new screening tool for antenatal anxiety: development and

validation

PERINATAL MENTAL HEALTH PROBLEMS – BEYOND POSTNATAL DEPRESSION

Perinatal mental health problems: a range of mental health difficulties that women can experience in the perinatal period, from mild and moderate depression or anxiety to postpartum psychosis.

Perinatal mental health problems are common, affecting between 10% and 20% of women (Gavin et al., 2005; Ross et al., 2006)

Anxiety disorders are at least as common as depression, both in pregnancy and in the postnatal period (Matthey et al., 2003, Stein et al, 2014).

Shift from the focus on Postnatal Depression to the idea of “perinatal stress”

(Austin et al., 2004)

Prevalence rates of perinatal mental health problems

Depression – 12% across pregnancy, approximately 13% in the postpartum period (Gavin et al., 2005)

Anxiety – 14.8% during pregnancy in the largest UK study (over 8000 women),

varying prevalence rates between 11% and 18% postnatally (Heron et al., 2004)

Postpartum psychosis – 1 to 2 women per 1000 births (Rothschild et al., 2006)

But…

• Growing recognition that perinatal mental health problems, particularly anxiety disorders, often go undetected and untreated (NICE, 2014)

• Only half of all cases of perinatal depression and anxiety are identified (Centre for Mental

Health, 2015; Bauer et al., 2014), even less receive evidence-based forms of treatment

Reasons for the importance of early identification and support

Relative stability of mood and anxiety disorders over the perinatal period (Heron et al., 2004)

Increasing evidence that perinatal mental health problems affect not only women’s wellbeing but also child development, both short- and long-term (Sutter-Dallay et al., 2011).

Adverse outcomes in children can include (Stein et al., 2014):

Poorer emotional regulation, ADHD, behavioural problems

Language delay

Poorer self-reported mental health in adolescence

ANXIETY IN PREGNANCY

Why is it particularly important to identify and support women experiencing elevated (clinical) levels of anxiety in pregnancy?

The estimated prevalence of antenatal anxiety is approximately 15% (Heron et al. 2004)

Antenatal anxiety is associated with:

An increased risk of developing postnatal depression (Milgrom et al., 2008)

A number of adverse obstetric outcomes including increased risk of preterm birth and low birth weight (Kramer et al., 2009; Dunkel et al., 2011)

Long-term, detrimental effects on neurodevelopmental, cognitive and emotional outcomes (Van Der Berg et al., 2005; Talge et al., 2007)

THE DEVELOPMENT OF A SCREENING SCALE FOR ANTENATAL ANXIETY

STAGE 1 – SCALE DEVELOPMENT 1. Questions were formulated based on evidence from multiple sources:

• Research literature: Systematic review of anxiety measures

• Target population: Qualitative interviews with women with experience of AA • Expert opinion: Delphi study with health professionals working in perinatal mental health

to determine questions to be included in the scale 2. Preliminary version of the scale piloted on 62 women

STAGE 2 – SCALE VALIDATION

3. Final scale testing (Dec ‘17 – May ‘18) – A psychometric validation study with 200 women to determine the screening accuracy of the scale.

Given that:

• Mental health problems affect 1 woman in 6 in the perinatal period

• There is evidence of the potential adverse effects on both mother and child

• The antenatal period is a time of almost universal access to healthcare service

• Successful management of symptoms during pregnancy is likely to aid in the

reduction of postnatal mood and anxiety disorders

The perinatal period, in particular

pregnancy, provides an important

opportunity for screening and

early identification of problems

as they arise

An ideal time for preventive

interventions that can improve

women’s emotional wellbeing

and promote healthy child

development

A valuable opportunity for prevention

REFERENCES

Bauer, A., Parsonage, M., Knapp, M., et al. (2014). Costs of perinatal mental health problems. London: London School of Economics and Political Science

Diego MA, Jones NA, Field T, Hernandez-Reif M, Schanberg S, et al. 2006. Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom. Med. 68:747–53

Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology, 106(5), 1071-1083.

Glynn LM, Dunkel Schetter C, Hobel C, Sandman CA. Pattern of perceived stress and anxiety in pregnancy predict preterm birth. Health Psychology. 2008;27(1):42–51

Heron, J., O’Connor, T.G., Evans, J., et al. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73

Dunkel-Schetter, C., & Lobel, M. (2011). Pregnancy and birth: a multilevel analysis of stress and birth weight. In: Revenson, T., Baum, A., Singer, J. editors. Handbook of health psychology 2. Mahwah, NJ: Lawrence Erlbaum, 427-453.

Talge, N. M., Neal, C., Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry 48(3/4), 245-261.

REFERENCES

Kramer, M. S., Lydon, J., & Seguin, L. (2009). Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress and stress hormones. American Journal of Epidemiology, 169, 367-371.

Matthey S, Barnett B, Howie P, Kavanagh DJ (2003) Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74:139–147

Milgrom, J., Gemmil, A, Bilszta, J. L. et al. (2008). Antenatal risk factors for postnatal depression: a large prospective study. Journal of Affective Disorders, 108(1-2), 147-157.

NICE National Institute for Health and Care Excellence (2014). Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 192, Issued: December 2014

Stein, A., Pearson, R. M., Goodman, S. H, et al (2014). Effects of perinatal mental disorders on the fetus and child. Lancet, 384, 1800-1819.