Postpartum specific anxiety in a French population: Validation of the French version of the Postpartum Specific Anxiety Scale [PSAS-FR]

Validity and reliability of an Arabic-language version of the postpartum specific anxiety scale research short-form in Jordan

OBJECTIVE

The English-language Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure for postpartum anxiety (PPA), but its 51-item length is a limitation. Consequently, the PSAS Working Group developed the PSAS Research Short-Form (PSAS-RSF), a statistically robust 16-item tool that effectively assesses PPA. This study aimed to assess and validate the reliability of an Arabic-language version of the PSAS-RSF in Jordan (PSAS-JO-RSF).

METHODS

Using a cross-sectional methodological design, a sample of Arabic-speaking mothers (N = 391) with infants aged up to 6 months were recruited via convenience sampling from a prominent tertiary hospital in northern Jordan. Factor analysis, composite reliability (CR), average variance extracted (AVE), McDonald's ω, and inter-item correlation measures were all examined.

RESULTS

Explanatory factor analysis revealed a four-factor model consistent with the English-language version of the PSAS-RSF, explaining a cumulative variance of 61.5%. Confirmatory factor analysis confirmed the good fit of the PSAS-JO-RSF (χ2/df = 1.48, CFI = 0.974, TLI = 0.968, RMSEA = 0.039, SRMR = 0.019, p < 0.001). The four factors demonstrated acceptable to good reliability, with McDonald's ω ranging from 0.778 to 0.805, with 0.702 for the overall scale. The CR and AVE results supported the validity and reliability of the PSAS-JO-RSF.

CONCLUSION

This study establishes an Arabic-language version of the PSAS-JO-RSF as a valid and reliable scale for screening postpartum anxieties in Jordan.

Comparative analysis of general and pregnancy-related prenatal anxiety symptoms: progression throughout pregnancy and influence of maternal attachment

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Mixed-Methods Assessment of Maternal Anxiety During the First 8 Weeks After Birth

OBJECTIVE

To describe and compare the experiences of postpartum anxiety among women with generalized anxiety and postpartum-specific anxiety.

DESIGN

Prospective, longitudinal, mixed methods.

SETTING

Academic tertiary center in the mid-Atlantic United States. Study activities were remote.

PARTICIPANTS

Women at 1 to 8 weeks after birth (N = 34).

METHODS

We used mobile surveys to measure daily anxiety ratings and responses to open-ended, theory-driven questions about anxiety. We used the cutoff scores on the State-Trait Anxiety Inventory and Postpartum Specific Anxiety Scale administered 8 weeks after birth to determine the presence of generalized and postpartum-specific anxiety. Participants' responses were analyzed with qualitative description and sorted by anxiety questionnaire scores at 8 weeks after birth. We compared qualitative findings between participants with generalized anxiety and postpartum-specific anxiety.

RESULTS

Participants with generalized anxiety had high levels of overwhelm and felt ill-equipped to handle daily stressors, whereas those with postpartum-specific anxiety felt adept at coping. Participants with generalized anxiety lacked emotional and physical support, and those with postpartum-specific anxiety reported more physical but variable emotional support. Sources of daily anxiety in participants with postpartum-specific anxiety were infant-centric (e.g., infant health, end of maternity leave, breastfeeding), whereas anxiety sources for participants with generalized anxiety were varied (e.g., self-health, partner concerns). Participants with generalized anxiety versus postpartum-specific anxiety were more likely to be multiparous and have comorbid depression symptoms.

CONCLUSION

Symptoms, levels of perceived support, and sources of anxiety differed between participants with generalized versus postpartum-specific anxiety. Our findings can inform postpartum anxiety screening strategies and support interventions.

Postpartum-Specific Anxiety and Maternal-Infant Bonding: A Predictive Validity Study amongst Italian Women

The role of anxiety is unknown in relation to postpartum bonding, unlike the well-known detrimental effect that postpartum depression has on the relationship between a mother and child. This study investigates how anxiety affects mother-infant bonding after childbirth, comparing the Italian version of the Postpartum Specific Anxiety Scale (PSAS-IT) with generalized measures of anxiety. Examining 324 non-randomly-selected participants responding to various scales, including the Edinburgh postnatal depression scale (EPDS), generalized anxiety disorder (GAD), postpartum-specific anxiety scale (PSAS-IT), postpartum bonding questionnaire (PBQ), and baby care questionnaire (BCQ-2), initial results suggest a link between certain postpartum anxiety symptoms and attachment problems. Surprisingly, anxiety measured with the PSAS has no direct influence on attachment; however, it is a strong predictor of bonding, even when maternal age, general anxiety, and depression are taken into account, explaining 3% of the variance in scores (β = 0.26, p < 0.001). This emphasizes the importance of early identification and intervention of postpartum anxiety in promoting bonding between mother and child.

The Italian language postpartum specific anxiety scale [PSAS-IT]: translation, psychometric evaluation, and validation

Introduction

While often positive, the lifecourse transition to motherhood is susceptible to the risk for developing mood disorders. Postpartum anxiety has often been overshadowed by other perinatal-specific mental health disorders, such as postpartum depression, and therefore has not been at the forefront or center of as much empirical study. This has meant there is a lack of effective and reliable tools with which to measure it, despite growing evidence suggesting its detrimental impact on mothers, their babies, wider family and social contacts, and on healthcare systems. This current study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] into the Italian language, and to validate the tool for its use in detecting anxiety specific to motherhood.

Methods

The study (N = 457) comprised 4 stages: English-Italian translation and back-translation to obtain the Italian version [PSAS-IT]; a preliminary pilot study to adapt the PSAS to the characteristics of the Italian population; measurement invariance; and internal reliability of subscales.

Results

The PSAS-IT demonstrates similar psychometric properties as the original English-language PSAS, with acceptable acceptability, construct and convergent validity, and internal consistency. Confirmatory factor analysis for multiple groups (Italy and United Kingdom) showed that the factor structure of the PSAS was valid for both groups [χ2 (2436) = 4679.481, p < 0.001, TLI = 0.969, CFI =0.972, RMSEA = 0.045, SRMR =0.064].

Discussion

The resulting findings offer a reliable measure of postpartum anxiety in Italian language up to six months after birth.

Psychometric evaluation and validation of the Postpartum Specific Anxiety Scale for the Spanish-speaking population: PSAS-ES

OBJECTIVE

The transition to motherhood is a period of risk for the development of mood disorders. Postpartum anxiety has not been as thoroughly studied as other emotional disorders despite its impact on mothers and their babies. The absence of standardized programmes for early detection and specific tools for its diagnosis means postpartum anxiety is often underestimated or overshadowed. This study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] for the Spanish population and to analyse its reliability as an exploratory tool for specific anxiety in mothers.

METHOD

Four stages were followed in this research: translation and back-translation to obtain the Spanish version [PSAS-ES]; preliminary pilot study to explore the comprehensibility and ease of responding the items (n = 53); convergent validity analyses (n = 644); and test-retest reliability (n = 234).

RESULTS

The PSAS-ES has shown to have good acceptability, convergent validity and high internal consistency with a Cronbach's α coefficient of 0.93 for the overall scale of PSAS. The four factors had good reliability. The results of test-retest was 0.86, indicating excellent stability over time in the first 16 weeks.

CONCLUSION

The psychometric results show that the PSAS-ES is a valid tool to explore and detect anxiety in Spanish mothers between 0 and 16 weeks postpartum.

Descriptive Exploratory Study to Understand Postpartum Anxiety Using Multiple Measures

OBJECTIVE

To compare a general anxiety instrument plus a depression instrument with a specific postpartum anxiety instrument plus a depression instrument to detect postpartum anxiety and to explore trends in daily postpartum anxiety.

DESIGN

Prospective, longitudinal cohort study.

SETTING

Academic tertiary center in the mid-Atlantic United States. Study activities were remote.

PARTICIPANTS

Pregnant women (N = 73) in the third trimester of pregnancy.

METHODS

We administered the State-Trait Anxiety Inventory (STAI), Postpartum Specific Anxiety Scale (PSAS), and Edinburgh Postnatal Depression Scale (EPDS) at 1 and 8 weeks after birth. We used mobile ecological momentary assessment prompts to measure daily anxiety levels (0-10) from 1 to 8 weeks after birth. We defined the presence of anxiety and depression by using the established instrument cutoff scores. We used repeated-measures analysis of variance and dependent-samples t tests to determine the stability of the determined anxiety instruments during the study time frame. We used linear mixed modeling to explore mobile ecological momentary assessment anxiety trends.

RESULTS

The PSAS and EPDS detected more participants with anxiety and/or depression (26.8%, 19/71) than the STAI and EPDS (23.9%, 17/71) at 8 weeks after birth. PSAS scores increased from 1 to 8 weeks after birth (p = .003); STAI scores decreased (p = .01). Daily anxiety ratings changed nonlinearly during the study period, were greatest at 2 weeks, declined and stabilized, and then trended upward toward Week 8.

CONCLUSION

Detection of postpartum anxiety in clinical settings can be improved through addition of the PSAS in routine screening. Timing of anxiety assessment should be considered between 6 to 8 weeks after birth.

Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences

INTRODUCTION

Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time.

METHODS AND ANALYSIS

An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences.

ETHICS AND DISSEMINATION

Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.

The Postpartum Specific Anxiety Scale: Confirmatory factor analyses and relationships with birth experience

The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and examine these domains of anxiety in relation to subjective and objective birth experiences. Postpartum mothers (≤ 12-months; N = 500) completed the PSAS alongside measures of subjective birth satisfaction and objective obstetric interventions/complications. Confirmatory factor analyses [CFA] tested eight models, theoretically derived from the preceding exploratory work. Structural equation modelling [SEM] tested associations between each PSAS factor and birth experience variables in the best-fitting model. An identical 51-item four-factor model fits the data well. SEM analyses revealed associations between lower perceptions of quality of intrapartum care and increased maternal competence and attachment anxieties, practical infant care anxieties, and infant safety and welfare anxieties. High subjective stress and negative emotional response to labour were associated with increased psychosocial adjustment to motherhood anxieties. Specific associations were found between neonatal care unit admission and practical infant care anxieties; and infant asphyxia and infant safety and welfare anxieties. Findings confirm construct and convergent validity of the four-factor PSAS and its use in measuring postpartum anxiety. Unique associations were also identified, indicating specific subjective and objective experiences occurring during birth may elicit a differential anxiety response, in that they are related to specific forms of postpartum anxiety which occur during the first postpartum year.

The Impact of Perceived Social Support During Pregnancy on Postpartum Infant-Focused Anxieties: A Prospective Cohort Study of Mothers in Northern Jordan

Objective

This study aimed to evaluate the association between perceived social support during pregnancy and levels of anxiety among postpartum women using an anxiety-specific screening instrument.

Methods

Using a prospective cohort design, a two-stage methodology was conducted to collect data from women seeking maternal care at the King Abdullah University Hospital in northern Jordan. In the first stage, perceived social support was assessed among pregnant women using the Medical Outcomes Study Social Support Survey. During the first six months after childbirth, postpartum women were contacted to complete the second stage, wherein their perceptions of infant-focused anxieties were assessed using the Postpartum Specific Anxiety Scale. In our study, two types of infant-focused anxieties were investigated among a final sample of 419 mothers: infant safety and welfare anxieties and practical infant care anxieties.

Results

The results of multivariate linear regression analysis indicated that providing pregnant women with high levels of emotional support from close social networks (β= −0.08, p= 0.01) and perceiving informational support from health care providers (β= −0.71, p< 0.01) were protective factors for reducing the levels of postpartum anxiety concerning infant safety and welfare. Our findings also demonstrated that pregnant mothers who perceived high informational support from health care providers had a lower level of postpartum anxiety about practical infant care (β= −0.20, p< 0.01). In contrast, mothers who reported receiving high tangible support from close social networks during pregnancy had a significantly higher level of perceived anxiety concerning practical infant care after delivery (β= 0.13, p= 0.02).

Conclusion

Our study suggests that postpartum anxiety would be reduced if effective informational support were readily available for pregnant women. There is a clear need for building bridges between women, their families, and providers to distinguish the specific type and amount of support that should be provided to mothers during pregnancy.