Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies

BACKGROUND

Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy.

METHODS

An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies.

RESULTS

A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers.

LIMITATIONS

Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships.

CONCLUSIONS

Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

The pregnancy-related anxiety scale: A validity examination using Rasch analysis

BACKGROUND

Pregnancy-related anxiety is increasingly recognised as a common condition that is associated with many deleterious outcomes for both the mother and infant (e.g., preterm birth, postnatal depression). Limitations in the psychometric properties and/or breadth of existing scales for pregnancy-related anxiety highlight the need for a psychometrically sound measure to facilitate effective screening and possible early interventions. The recently developed Pregnancy-related Anxiety Scale (PrAS) was evaluated using Rasch analysis to explore how the scale's psychometric properties could be fine-tuned.

METHOD

A sample of 497 pregnant women completed the PrAS. Data were subjected to Rasch analysis, and the resulting scale structure examined using Confirmatory Factor Analysis.

RESULTS

After minor modifications, the Rasch model with 33-items and 8-factors demonstrated good fit, unidimensionality and excellent targeting and internal consistency. Confirmatory Factor Analysis confirmed the final structure, and Cronbach's alpha demonstrated excellent reliability.

LIMITATIONS

The use of the same sample for all analyses was a potential limitation due to the possibility of sample-specific influences.

CONCLUSIONS

The Rasch analysis further supports the internal construct validity of the PrAS. Ordinal to interval score conversions provide added precision to the analysis of the PrAS scores. The Rasch results, together with previous validation evidence, point to the PrAS as a comprehensive and psychometrically sound screening scale for pregnancy-related anxiety. The PrAS offers clinicians the ability to screen for pregnancy-related anxiety. The subscales provide additional insights into a woman's pregnancy-related anxiety and her specific areas of concern, enabling more targeted interventions.

Pregnancy anxiety: A systematic review of current scales

BACKGROUND

Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap.

METHODS

Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified.

RESULTS

Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale's strengths and limitations were discussed.

LIMITATIONS

Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties.

CONCLUSIONS

Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.