Reliability and validity of three shortened versions of the State Anxiety Inventory scale during the perinatal period

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.

Spatial anxiety contributes to the dizziness-related handicap of adults with peripheral vestibular disease

In subjects with peripheral vestibular disease and controls, we assessed: 1. The relationship between spatial anxiety and perceived stress, and 2. The combined contribution of spatial anxiety, spatial perspective-taking, and individual cofactors to dizziness-related handicap. 309 adults participated in the study (153 with and 156 without peripheral vestibular disease), including patients with bilateral vestibular deficiency, unilateral deficiency (evolution <3 or ≥3 months), Meniere's disease, and Benign Paroxysmal Positional Vertigo. Assessments included: general health, personal habits, spatial anxiety (3-domains), perceived stress, spatial perspective-taking, dizziness-related handicap (3-domains), unsteadiness, sleep quality, motion sickness susceptibility, trait anxiety/depression, state anxiety, depersonalization/derealization. After bivariate analyses, analysis of covariance was performed (p ≤ 0.05). Spatial anxiety was related to unsteadiness and perceived stress, with an inverse relationship with trait anxiety (ANCoVA, adjusted R2 = 0.27-0.30, F = 17.945-20.086, p < 0.00001). Variability on perspective-taking was related to vestibular disease, trait and state anxiety, motion sickness susceptibility, and age (ANCoVA, adjusted R2 = 0.18, F = 5.834, p < 0.00001). All domains of spatial anxiety contributed to the Physical domain of dizziness-related handicap, while the Navigation domain contributed to the Functional domain of handicap. Handicap variability was also related to unsteadiness, spatial perspective-taking, quality of sleep, and trait anxiety/depression (ANCoVA, adjusted R2 = 0.66, F = 39.07, p < 0.00001). Spatial anxiety is related to perceived stress in adults both with and without vestibular disease, subjects with trait anxiety rated lower on spatial anxiety. State anxiety and acute stress could be helpful for recovery after peripheral vestibular lesion. Spatial anxiety and perspective-taking contribute to the Physical and Functional domains of dizziness-related handicap, possibly because it discourages behavior beneficial to adaptation.

The effect of music on the operating surgeon: a pilot randomized crossover trial (the MOSART study)

OBJECTIVE

The experience of stress is common among surgeons while working in the operating theatre (OT). Understanding and finding ways to mitigate this stress is important for optimizing surgical quality and maintaining clinician wellbeing. In this pilot study, we tested the feasibility and reported the outcomes of measuring the effect of background music on intra-operative surgeon stress in the clinical environment.

METHODS

The effect of Music on the Operating Surgeon: A pilot Randomized crossover Trial (the MOSART study) was conducted over a 9-month period in a single-centre. Vascular and general surgeons acting as primary operators (POs) performing elective, general anaesthetic operations were included. The intervention was surgeon-selected music, and the control was the absence of music. Outcome measures were feasibility (recruitment rate, practicability, and completeness of data), heart rate variability (HRV) indices, the Six-Item State-Trait Anxiety Inventory (STAI-6), and the Surgical Task-load Index (SURG-TLX).

RESULTS

Five POs performed 74 eligible randomized cases. The protocol was well tolerated, and no cases were abandoned. Data was incomplete in 8% of cases. The overall mean (SD) operative SURG-TLX score was 48 (±22). Mean HR increased and RMSSD decreased significantly from baseline, suggesting reduced parasympathetic activity while operating. The presence of intra-operative music was not found to affect the psychological or physiological outcomes.

CONCLUSIONS

A music interventional study of this nature is feasible in the operating theatre environment, though no difference was found between in the music and non-music conditions. Follow-up research in a simulated environment with intensive physiological monitoring could be considered.

Changes and predictors of maternal depressive and anxiety symptoms during the COVID-19 pandemic

Longitudinal changes in maternal depressive and anxiety symptoms and predictors of symptom variation among a group of middle-to-upper income Canadian women (n = 2152) were examined prior to the pandemic (2017-2019) and at three pandemic timepoints (May-July 2020, March-April 2021, November-December 2021). Mean maternal depression and anxiety scores were elevated throughout the pandemic. Pre-pandemic depressive symptoms were associated with greater increases in depressive symptoms. Coping and relationship quality were protective factors. Supporting the development of coping strategies may mitigate mental health concerns among mothers.

Physicians' Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions

In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.

The effects of music intervention on anxiety and stress responses in adults with CHD undergoing cardiac catheterisation

INTRODUCTION

This study evaluated the effect of music intervention on the anxiety and stress responses of patients who underwent an interventional cardiac catheterisation.

METHODS

The study design was a pre- and post-test randomised controlled trial that included 94 patients who underwent a transcatheter atrial septal defect closure. Patients were allocated to receive either music intervention (n = 47) or usual care (n = 47) during the interventional cardiac catheterisation. Music intervention effectiveness was examined in terms of anxiety, salivary cortisol level, and heart rate variability.

RESULTS

The average age of participants was 45.40 years (±16.04) in the experimental group and 47.26 years (±13.83) in the control group. Two-thirds (66.0%) of the participants in each group were women. State anxiety (F = 31.42, p < 0.001), anxiety-numerical rating scale (F = 20.08, p < 0.001), salivary cortisol levels (F = 4.98, p = 0.021), and low-frequency component/high-frequency component ratio (F = 17.31, p < 0.001) in the experimental group were significantly reduced compared with those in the control group at the end of the music intervention.

CONCLUSION

This study provides practical evidence of a reduction in anxiety and stress response from music intervention preceding an interventional cardiac catheterisation, indicating that this intervention should be considered in clinical management.

Child and family factors associated with child mental health and well-being during COVID-19

Understanding the implications of the COVID-19 pandemic on the current generation of youth is critical for post-pandemic recovery planning. This study aimed to identify the most salient child (i.e., connectedness to caregivers, screen time, sleep, physical activity, peer relationships, and recreational activities) and family (i.e., COVID-19 financial impact, maternal depression and anxiety) factors associated with children's mental health and well-being during the COVID-19 pandemic, after controlling for pre-pandemic mental health. This study included 846 mother-child dyads (child age 9-11) from the All Our Families cohort. Mothers reported on the child's pre-pandemic mental health at age 8 (2017-2019) and during COVID-19 (May-July 2020), the family's financial impact due to COVID-19, and maternal depression and anxiety. During COVID-19 (July-August 2020), children reported on their screen time, sleep, physical activity, peer and family relationships, and recreational activities, as well as their happiness, anxiety and depression. After controlling for pre-pandemic anxiety, connectedness to caregivers (B - 0.16; 95% CI - 0.22 to - 0.09), child sleep (B - 0.11; 95% CI - 0.19 to - 0.04), and child screen time (B 0.11; 95% CI 0.04-0.17) predicted child COVID-19 anxiety symptoms. After controlling for pre-pandemic depression, connectedness to caregivers (B - 0.26; 95% CI - 0.32 to - 0.21) and screen time (B 0.09; 95% CI 0.02-0.16) predicted child COVID-19 depressive symptoms. After controlling for covariates, connectedness to caregivers (B 0.36; 95% CI 0.28-0.39) predicted child COVID-19 happiness. Fostering parent-child connections and promoting healthy device and sleep habits are critical modifiable factors that warrant attention in post-pandemic mental health recovery planning.

The acceptability of cervical electrical impedance spectroscopy within a multi-modal preterm birth screening package: a mixed methods study

BACKGROUND

Reducing the rate of preterm birth is a cornerstone of global efforts to address child mortality, however existing screening tests offer imperfect prediction. Cervical electrical impedance spectroscopy (EIS) is a novel technique to quantify the ripening changes which precede labour. Mid-trimester EIS measurements have been shown to accurately predict preterm birth in asymptomatic women. This study aimed to comprehensively evaluate the acceptability of cervical EIS to low and high-risk women as part of a package of screening tests performed during a larger prospective trial.

METHODS

In this parallel convergent mixed methods study, 40 women completed questionnaires before and after screening tests (EIS, cervical length measurement and fetal fibronectin quantification). Quantitative outcomes were anxiety levels before and after screening (Spielberger State Trait Anxiety Inventory, STAI-6), pain (Short Form McGill Pain Questionnaire) and ratings of EIS device appearance and test acceptability (visual analogue scales). Twenty-one women (11 high-risk, 10 low-risk) also attended a semi-structured qualitative interview. Interviews were recorded and transcribed, then thematic analysis was performed. A convergence coding matrix was constructed to enable triangulation of quantitative and qualitative results.

RESULTS

High risk women demonstrated a significant reduction in anxiety following screening (mean STAI-6 score 34.5 vs. 29.0, p = 0.002). A similar trend was observed among low-risk participants. Ratings of pain, EIS device appearance and procedural acceptability did not differ between groups. Mean pain ratings were low (visual analogue scale 0.97 and 1.01), comparing favourably to published evaluations of conventional screening tests. Qualitative analysis provided insight into both the physical consequences and emotional experiences of screening. Additional determinants of the screening experience included device design, pre-existing perspectives on intimate examination, attitudes to knowledge in pregnancy and interaction with clinical staff. Finally, a range of practical considerations regarding wider use of EIS were identified, with valuable complementary detail regarding acceptability for use in antenatal care.

CONCLUSIONS

Cervical EIS is well tolerated and acceptable to both low and high-risk women when performed as part of a multi-modal screening package. These results provide useful insights to inform the design of future study and screening protocols.

Anxiety levels in parents of asymptomatic neonates and young infants referred for echocardiography

INTRODUCTION

Previous studies in children with innocent murmurs have shown that parental concern is common.

METHODS

We assessed the anxiety levels among parents of asymptomatic neonates or infants up-to 6 weeks referred for cardiologic consultation because of a heart murmur. A six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) was completed by the parents before and after consultation.

RESULTS

The average STAI score decreased from 14.42 ± 4.54 on arrival to 9.69 ± 4.26 after the consultation (p < 0.001). Overall, the parents felt more calm, less tense, less upset, more relaxed, more content and less worried after the consultation (p < 0.001). Multivariable linear regression analysis showed that the STAI score prior to consultation was related to infants age (coefficient β = - 0.172; P = 0.046) and STAI score post consultation was related to the final diagnosis (β = 0.312; P < 0.001).

CONCLUSION

In conclusion, parents of asymptomatic neonates and young infants with a murmur exhibit moderate levels of anxiety which can be ameliorated after consultation. Parental education in the field is of paramount importance and the role of both paediatric cardiologists as well as primary care physicians is crucial and decisive.

Assessment tools to measure postnatal mental illness: A 10-year scoping review

INTRODUCTION

The use of assessment tools to measure postnatal mental illness is essential in healthcare settings. However, variations in the types of tools and their reliability in a particular population lead to under-recognition of mental health status in postnatal mothers. The aim of this review is to evaluate the most recent 10 year of research on the validity and reliability of postnatal mental illness assessment tools.

METHODS

A literature search of studies from online databases PubMed, Scopus, and Science Direct was conducted.

RESULTS

A total of 59 studies were selected for this review. Several studies utilised multiple assessment tools, and a total of 96 assessment tools were identified and classified into six domains: postnatal blues, postnatal stress, postnatal anxiety, postnatal depression, postnatal psychosis, and postnatal psychological disorder. In this review, EPDS was the most common tool used to identify postnatal depression and anxiety while DASS 21 was the most common tool used to identify postnatal psychological disorder. There is a wide range in preponderance of evidence for the reliability of each assessment tool and there were inconsistencies in assessing the validity of the assessment tools.

CONCLUSION

This review provides information regarding some of the main assessment tools currently available to measure postnatal mental illnesses. There were no standardised tools that were used in a particular setting. The results may differ in different population because there are differences in not only languages and dialects, but also cultural and racial backgrounds, which greatly influences their perception and interpretation of postnatal mental illness.

Acute Stress in Health Workers during Two Consecutive Epidemic Waves of COVID-19

The COVID-19 pandemic has provoked generalized uncertainty around the world, with health workers experiencing anxiety, depression, burnout, insomnia, and stress. Although the effects of the pandemic on mental health may change as it evolves, the majority of reports have been web-based, cross-sectional studies. We performed a study assessing acute stress in frontline health workers during two consecutive epidemic waves. After screening for trait anxiety/depression and dissociative experiences, we evaluated changes in acute stress, considering resilience, state anxiety, burnout, depersonalization/derealization symptoms, and quality of sleep as cofactors. During the first epidemic wave (April 2020), health workers reported acute stress related to COVID-19, which was related to state anxiety. After the first epidemic wave, acute stress decreased, with no increase during the second epidemic wave (December 2020), and further decreased when vaccination started. During the follow-up (April 2020 to February 2021), the acute stress score was related to bad quality of sleep. However, acute stress, state anxiety, and burnout were all related to trait anxiety/depression, while the resilience score was invariant through time. Overall, the results emphasize the relevance of mental health screening before, during, and after an epidemic wave of infections, in order to enable coping during successive sanitary crises.

Mediating mechanisms for maternal mental health from pre- to during the COVID-19 pandemic: Mediators of maternal mental illness during COVID-19

Background

Mothers have experienced a near doubling of depression and anxiety symptoms pre- to during the COVID-19 pandemic. The identification of mechanisms that account for this increase can help inform specific targets for mental health recovery efforts. The current study examined whether women with higher levels of depression and anxiety symptoms pre-pandemic, reported higher levels of depression and anxiety symptoms during the pandemic, and whether these increases were mediated by perceived stress, strained relationships, coping attitudes, participation in activities, alcohol use, and financial impact.

Methods

Mothers (n = 1,333) from an ongoing longitudinal cohort (All Our Families; AOF) from Calgary, Alberta, Canada, completed online questionnaires prior to (2017–2019) and during the COVID-19 pandemic (May-July 2020). Mothers reported on depressive and anxiety symptoms pre- and during the pandemic, as well as perceived stress, engagement in physical and leisure activities, coping, alcohol use, and financial impact of the pandemic.

Results

In unadjusted analyses, maternal depression and anxiety symptoms pre-pandemic were strongly associated with COVID-19 depressive (r = 0.57, p<.01) and anxiety symptoms (r = 0.49, p<.01). Significant indirect effects between maternal depressive symptoms pre- and during COVID-19 were found for coping behavior (ab_cs=0.014, 95%CI=0.005, 0.022, p=.001), perceived stress (ab_cs=0.22, 95%CI=0.179, 0.258, p<.001), and strained relationships (ab_cs=0.013, 95%CI= 0.005, 0.022, p=.003). For maternal anxiety symptoms pre- and during COVID-19, significant indirect effects were observed for perceived stress (ab_cs=0.012, 95%CI=0.077, 0.154, p=.003) and strained relationships (ab_cs=0.010, 95%CI=0.001, 0.018, p=.03).

Conclusions

Perceived stress, coping attitudes, and interpersonal relationships are three potential intervention targets for mitigating COVID-19 related mental distress in mothers.

The development and validation of the Misophonia response scale

OBJECTIVE

Most current Misophonia scales are not validated, do not include both emotional and physiological responses to triggers, and/or focus only on auditory triggers. This research aimed to develop and validate a measure of the magnitude of the Misophonic response that addressed these omissions.

METHOD

Three studies were carried out with individuals with self-diagnosed Misophonia. In study 1, expert opinion and participants commented on initial items to determine both face and content validity. In study 2, scale structure, reliability, and convergent and discriminant validity were determined using correlations, principal component analysis (PCA), and reliability analysis. In study 3, factor structure was confirmed in another sample of participants using confirmatory factor analysis (CFA).

RESULTS

The final 22-item scale assesses the magnitude of responses to triggers across any sensory modality. There are three subscales (emotional, physiological, and participation in life), with three additional items measuring frequency of triggers, avoidance of triggers, and time taken to recover from the triggers. The final scale showed suitable discriminant and convergent validity, with good internal consistency (Cronbach's alphas range 0.77 to 0.89). The three-component solution extracted using PCA explained 53.97% of variance, with all items loading between 0.45 and 0.84. The structure was confirmed with CFA (χ² = 269.01, p < .001; CFI = 0.96; TLI = 0.96 and RMSEA = 0.045 (CI 0.037-0.053).

CONCLUSION

The Misophonia Response Scale, which is valid and reliable, will facilitate understanding of Misophonia as it is short and easy to use for self-report in research.

Parental anxiety and misperceptions in children with innocent murmurs

BACKGROUND

Previous studies in children with innocent murmurs have shown that parental concern is common. Our aim was to assess the level of anxiety among parents of children referred for cardiology evaluation because of an innocent heart murmur and investigate their perceptions about innocent murmurs.

METHODS

A questionnaire was completed by parents before and after consultation. The questionnaire included a six-item short form of the state scale of the Spielberger State-Trait Anxiety Inventory. After the echocardiogram, a detailed consultation was offered including a thorough explanation that the results were normal, as well as a written report.

RESULTS

A total of 417 questionnaires were completed by parents of 340 children. Almost half of the parents believed that a heart murmur signifies heart disease or may interfere with child's ability to exercise; 21% of them stated that the siblings should also be investigated irrespective of the presence of a murmur. The mean Spielberger State-Trait Anxiety Inventory questionnaire score before pediatric cardiology consultation was 17.1 ± 4.3 and increased to 22.6 ± 2.8 after the consultation (Wilcoxon P < 0.001).

CONCLUSIONS

Parents of infants and children with innocent murmurs exhibit moderate levels of anxiety and this condition can be ameliorated significantly after pediatric cardiology consultation. Focused parental education is of paramount importance and the role of pediatric cardiologists is crucial and decisive.

Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: a longitudinal analysis

BACKGROUND

Parents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes in the prevalence of maternal depression and anxiety symptoms as a result of the COVID-19 pandemic over time and at the individual level.

METHODS

In this longitudinal observational study, women who took part in the All Our Families pregnancy cohort in Canada were invited to complete a COVID-19 impact survey between May 20 and July 15, 2020. Women who had not agreed to additional research, had discontinued, were lost to follow-up, or who were not contactable via email were excluded. Maternal depression and anxiety symptoms during the COVID-19 pandemic were compared with three previous estimates collected at 3, 5, and 8-year timepoints (between April, 2012, and October, 2019). Depression symptoms were assessed using the 10-item Center for Epidemiological Studies Depression scale and anxiety symptoms were assessed using the short form of the Spielberger State-Trait Anxiety Inventory. Repeated cross-sectional analyses were done to assess temporal trends and fixed-effects regression models were fitted to assess within-person change over time.

FINDINGS

Of the 3387 women included in the All Our Families study, 2445 women were eligible and were invited to participate in the COVID-19 impact study, of whom 1333 consented to participate, and 1301 were included in the longitudinal analysis. At the COVID-19 impact survey timepoint, a higher proportion of mothers had clinically significant depression (35·21%, 95% CI 32·48-38·04) and anxiety symptoms (31·39%, 28·76-34·15) than at all previous data collection timepoints. The mean depression score (8·31, 95% CI 7·97-8·65) and anxiety score (11·90, 11·66-12·13) at the COVID-19 pandemic timepoint were higher than previous data collection waves at the 3-year timepoint (mean depression score 5·05, 4·85-5·25; mean anxiety score 9·51, 9·35-9·66), 5-year timepoint (mean depression score 5·43, 5·20-5·66; mean anxiety score 9·49, 9·33-9·65), and 8-year timepoint (mean depression score 5·79, 5·55-6·02; mean anxiety score 10·26, 10·10-10·42). For the within-person comparisons, depression scores were a mean of 2·30 points (95% CI 1·95-2·65) higher and anxiety scores were a mean of 1·04 points (0·65-1·43) higher at the COVID-19 pandemic timepoint, after controlling for time trends. Larger increases in depression and anxiety symptoms were observed for women who had income disruptions, difficulty balancing home schooling with work responsibilities, and those with difficulty obtaining childcare. White mothers had greater increases in anxiety scores than non-white mothers and health-care workers had smaller increases in depressive symptoms than non-health-care workers.

INTERPRETATION

Compared with previous estimates, the prevalence of maternal depression and anxiety among mothers in a Canadian cohort increased during the COVID-19 pandemic. Financial support, childcare provision, and avoiding the closure of schools, might be key priorities for preventing future increases in maternal psychological distress.

FUNDING

Alberta Innovates Health Solutions Interdisciplinary Team, Canadian Institutes of Health Research, Alberta Innovates, and Alberta Children's Hospital Foundation.

Effects of Hand Holding on Anxiety and Pain During Prostate Biopsies: A Pilot Randomized Controlled Trial

BACKGROUND

Effective pain management is limited for patients during prostate biopsy (PBx). Touch support, such as hand holding, has stress-buffering benefits and effective analgesic effects. We conducted a prospective, single-center randomized clinical trial to assess whether hand holding can reduce patient anxiety, pain, and dissatisfaction during PBx.

METHODS

Between April 2020 and October 2020, 120 male patients were randomized into three groups: a hand holding with relatives (HR) group, a hand holding with strangers (HS) group and a control group. A visual analog scale (VAS) was used for self-assessments of pain and satisfaction. Anxiety levels were quantified according to the State-Trait Anxiety Inventory (STAI). Hemodynamic changes were also measured.

RESULTS

The degree of pain and anxiety in the hand-holding groups was significantly better than that in the control group (P<0.001), and the patients were more willing to undergo repeat PBx (P=0.017). The anxiety levels in the HR group were significantly lower than those in the HS group (P=0.019). During PBx, the changes in systolic blood pressure and heart rate in the hand-holding groups were more stable than those in the control group (P<0.01), and the fluctuations in heart rate in the HR group were smaller than those in the HS group (P<0.01).

CONCLUSION

Hand holding, especially with relatives, can promote incremental reductions in anxiety, pain and dissatisfaction in patients during PBx. Hence, we recommend hand holding with relatives as an effective adjunct during PBx.

Turkish version of the Pregnancy-related Anxiety Scale: A psychometric study

PURPOSE

To adapt the Pregnancy-related Anxiety Scale (PrAS) into Turkish and evaluate its psychometric properties.

DESIGN AND METHODS

This cross-sectional study comprised of 400 pregnant women. The PrAS was translated using the methods of translation, back-translation, consensus meetings, and a trial of potential users. Then, its psychometric properties were evaluated by exploratory factor analysis and confirmatory factor analysis.

FINDINGS

The PrAS consists of 33 items. Following the exploratory factor analysis, the two items in the scale were discarded because factor loads were less than 0.50, therefore, the number of items decreased from 33 to 31. In the confirmatory factor analysis, the goodness-of-fit indices of the scale were found to be suitable. The internal consistency coefficient calculated for the reliability of the scale was .89. After correlating it with another scale for measuring pregnancy distress, the Turkish version of the PrAS shows discriminant validity.

PRACTICE IMPLICATIONS

The Turkish version of the PrAS is a valid and reliable instrument that can be used to evaluate pregnancy-related-anxiety. The use of the PrAS in prenatal healthcare services will contribute to the early diagnosis, treatment, and management of pregnancy-related anxiety.

Trajectories and predictors of anxiety symptoms during pregnancy in an Australian sample

BACKGROUND

There is a growing realisation that anxiety symptoms and disorders during pregnancy are associated with various negative outcomes. The aims of this study were to identify latent classes of anxiety symptom trajectories during pregnancy, compare anxiety levels between pregnancy trimesters and ascertain the predictors of anxiety symptom trajectories.

METHODS

Two hundred pregnant women in their first trimester who attended obstetric clinics at the local hospital were recruited. Three self-report questionnaires assessing anxiety levels were administered at three time points during pregnancy. Latent class growth analysis was used to identify anxiety symptom trajectories, and logistic regression analysis was performed to ascertain the predictors of latent class membership.

RESULTS

Data for analyses were available for 188 women. Two anxiety symptom trajectories were identified: a 'high-anxiety' trajectory (13.3% of participating women) and 'low-anxiety' trajectory (86.7%). This finding was consistent across all the anxiety measures used in the study. Overall, anxiety levels gradually decreased during pregnancy, with a significant decrease between the first and second trimesters on some measures. Past mental disorders and significant stressors in the preceding 6 months predicted membership in the 'high-anxiety' trajectory group.

CONCLUSIONS

These findings support an early assessment of anxiety in pregnant women. If untreated, a high level of anxiety in the first trimester is likely to persist throughout pregnancy, although it may decrease somewhat. An early recognition of pathological anxiety during pregnancy allows its timely treatment and prevention of unfavourable outcomes.

Relative contribution of maternal adverse childhood experiences to understanding children's externalizing and internalizing behaviours at age 5: findings from the All Our Families cohort

BACKGROUND

The negative effect of adverse childhood experiences (ACEs) on physical and mental health has led to calls for routine screening for ACEs in primary care settings. We aimed to examine the association between maternal ACEs and children's behaviour problems (externalizing and internalizing) at age 5 in the context of other known predictors.

METHODS

We analyzed data from mother-and-child dyads participating in the All Our Families cohort in Calgary, Canada, between 2011 and 2017. Data were collected for factors related to the individual child (sex, age, temperament and behaviour), the mother (adverse childhood experiences, mental health, personality and parenting) and sociodemographic characteristics (family income, ethnicity and family structure) when the children were 3 and 5 years of age. We used logistic regression models to estimate crude and adjusted associations between maternal ACEs and children's externalizing (hyperactivity and aggression) and internalizing (anxiety, depression and somatization) behaviours.

RESULTS

Data were available for 1688 mother-and-child dyads. In the crude models, the presence of 4 or more maternal ACEs was associated with children's externalizing and internalizing behaviours at age 5. However, these associations were attenuated with adjustment. Persistent maternal mental health symptoms were associated with both externalizing and internalizing behaviours at age 5 (adjusted odds ratio [OR] 4.20, 95% confidence interval [CI] 2.50-7.05, and adjusted OR 2.52, 95% CI 1.66-3.81, respectively). High levels of ineffective parenting behaviours were also associated with both externalizing and internalizing behaviours at age 5 (adjusted OR 6.27, 95% CI 4.30-9.14, and adjusted OR 1.43, 95% CI 1.03-1.99, respectively).

INTERPRETATION

The association between maternal ACEs and children's behaviour at age 5 was weakened in the presence of other maternal and family-level factors. Assessments of maternal mental health and parenting behaviours may be better targets for identifying children at risk of behavioural problems.

Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity

Poor maternal mental health has been associated with a myriad of pregnancy and child health complications. Obesity in pregnancy is known to increase one’s risk of experiencing poor maternal mental health and associated physical and mental health complications. Probiotics may represent a novel approach to intervene in poor mental health and obesity. We conducted this pre-specified secondary analysis of the Healthy Mums and Babies (HUMBA) randomised controlled trial to investigate whether probiotics would improve maternal mental health outcomes up to 36 weeks of pregnancy. Two-hundred-and-thirty pregnant women with obesity (BMI ≥ 30.0 kg/m²) were recruited and randomised to receive probiotic (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 10⁹ CFU) or placebo capsules. Depression, anxiety, and functional health and well-being were assessed at baseline (12⁰−17⁶ weeks’ gestation) and 36 weeks of pregnancy. Depression scores remained stable and did not differ between the probiotic (M = 7.18, SD = 3.80) and placebo groups (M = 6.76, SD = 4.65) at 36 weeks (p-values > 0.05). Anxiety and physical well-being scores worsened over time irrespective of group allocation, and mental well-being scores did not differ between the two groups at 36 weeks. Probiotics did not improve mental health outcomes in this multi-ethnic cohort of pregnant women with obesity.

Anxiety scales used in pregnancy: systematic review

BACKGROUND

Anxiety disorders and self-reported symptoms are highly prevalent in pregnancy. Despite their negative impact on maternal and child outcomes, uncertainty remains regarding which symptoms can be considered accurate indicators of antenatal anxiety.AimsTo examine and synthesise the evidence in relation to the psychometric properties and content of self-report scales used to detect anxiety symptoms in pregnant women.

METHOD

A systematic search was carried out and the methodological quality of all included studies was assessed. Only those achieving a rating of good or excellent were considered in a synthesis of the best available evidence.

RESULTS

Several anxiety symptoms and domains were identified as promising for screening for general antenatal anxiety and pregnancy-related anxiety, including elevated levels of worry, symptoms of panic, fear of childbirth and excessive worries about the baby's health.

CONCLUSIONS

This review contributes to the existing knowledge by identifying a number of anxiety symptoms that can be considered psychometrically robust indicators of antenatal anxiety.Declaration of interestNone.

INTER-ACT: prevention of pregnancy complications through an e-health driven interpregnancy lifestyle intervention - study protocol of a multicentre randomised controlled trial

Background

Excessive maternal pre-pregnancy and gestational weight gain are related to pregnancy- and birth outcomes. The interpregnancy time window offers a unique opportunity to intervene in order to acquire a healthy lifestyle before the start of a new pregnancy.

Methods

INTER-ACT is an e-health driven multicentre randomised controlled intervention trial targeting women at high risk of pregnancy- and birth related complications. Eligible women are recruited for the study at day 2 or 3 postpartum. At week 6 postpartum, participants are randomised into the intervention or control arm of the study. The intervention focuses on weight, diet, physical activity and mental well-being, and comprises face-to-face coaching, in which behavioural change techniques are central, and use of a mobile application, which is Bluetooth-connected to a weighing scale and activity tracker. The intervention is rolled out postpartum (4 coaching sessions between week 6 and month 6) and in a new pregnancy (3 coaching sessions, one in each trimester of pregnancy); the mobile app is used throughout the two intervention phases. Data collection includes data from the medical record of the participants (pregnancy outcomes and medical history), anthropometric data (height, weight, waist- and hip circumferences, skinfold thickness and body composition by bio-electrical impedance analysis), data from the mobile app (physical activity and weight; intervention group only) and questionnaires (socio-demographics, breastfeeding, food intake, physical activity, lifestyle, psychosocial factors and process evaluation). Medical record data are collected at inclusion and at delivery of the subsequent pregnancy. All other data are collected at week 6 and month 6 postpartum and every subsequent 6 months until a new pregnancy, and in every trimester in the new pregnancy. Primary outcome is the composite endpoint score of pregnancy-induced hypertension, gestational diabetes mellitus, caesarean section, and large-for-gestational-age infant in the subsequent pregnancy.

Discussion

INTER-ACT is a unique randomised controlled lifestyle intervention trial in its implementation between pregnancies and during the subsequent pregnancy, with an e-health driven approach.

Trial registration

ClinicalTrials.gov Identifier: NCT02989142. Registered August 2016.

Cortisol awakening response is blunted and pain perception is increased during menses in cyclic women

BACKGROUND AND AIMS

The incidence of menstrual symptoms is reported to be as high as 90% in cyclic women. These symptoms, including anxiety and pain, might be associated with cortisol, as its receptors are widely distributed in the brain areas associated with behavior. Therefore, the current study aimed to assess the cortisol awakening response (CAR) throughout the menstrual cycle and correlate it with pain perception and trait anxiety.

MATERIALS AND METHODS

CAR was assessed by measuring salivary cortisol at 0, 15, 30, and 60min following awakening in the same women (n=59, age 22.2±0.37years) at various stages of the menstrual cycle (menses, midcycle, luteal and premenstrual phases). Progesterone and estradiol concentrations were also determined in saliva samples to assess cyclic changes. Self-reported pain, trait anxiety, and menstrual symptoms were assessed by visual analog scale (VAS), state-trait anxiety inventory (STAI-T), and the Daily Record of Severity of Problems (DRSP), respectively.

RESULTS

Estradiol was significantly elevated during the midcycle period and remained high during the early luteal phase (p<0.05). Progesterone was increased during the luteal phase (p<0.05). Post-awakening cortisol values increased during midcycle, luteal phase, and premenstrual phase (p<0.05, classical CAR), but not during the menses (p>0.05, blunted or flat CAR). Positive and significant correlations were found between cortisol and estradiol (R²=0.322; p=0.000), cortisol and progesterone (R²=0.156; p=0.000), and estradiol and progesterone (R²=0.349; p=0.001). Premenstrual symptom scores were higher in the menses and premenstrual phases than in the midcycle and luteal phases (p<0.001). Pain perception was the highest during the menses followed by the premenstrual phase (p<0.01).

CONCLUSIONS

CAR was blunted during the menses, suggesting that cortisol might play a phase-specific role in the regulation of the cycle. Additionally, premenstrual symptoms, including pain, were more severe when ovarian steroid levels reduced (i.e., menses and the premenstrual phase).