“The minute I said the words to someone, help was there for me. When the doctor told me what I was feeling…it was so liberating. I felt such a sense of relief that I wasn’t going mad.”

Recently, the BBC reported on a UK-based study that found 25% of pregnant women suffered from mental health problems, including anxiety, depression, eating disorders, and bipolar disorder.

Our research shows that anxiety is the most common of all of these. In fact, we’ve found that 22% of pregnant women struggle with anxiety.

One psychologist I spoke with recently said that when she became a clinical psychologist, she thought she’d see mainly postpartum depression. Instead, she sees mostly prenatal anxiety.

Prenatal anxiety is one of the least understood – and most missed – diagnoses in pregnancy. Here are some facts:

  • Prenatal anxiety can precede depression, but commonly occurs alone as well
  • In up to 60% of women, prenatal anxiety is comorbid with depression
  • Our research shows that high prenatal anxiety is always paired with high stress
  • Not understanding that there is such a thing as “prenatal anxiety” keeps 75% of pregnant women from mentioning their concerns to their doctors, midwives and nurses
  • The symptoms of prenatal anxiety tend to include irritability, constant and unrelenting worry, over-reaction, feeling a lack of control, and feeling overwhelmed.
  • Studies show that women with prenatal depression are over 3 times more likely to experience postpartum depression, and those with prenatal depression and anxiety are almost 10 times more likely

Screening pregnant women for anxiety (and depression) is a key recommendation of several international guidelines, including the newly released Australian Perinatal Mental Health Clinical Guideline.

Two anxiety screening tools that are useful in busy clinical settings are the 2-question Generalized Anxiety Disorder (GAD-2) and the anxiety questions of the Depression, Anxiety, Stress Scale (DASS-21). Both of these screening tools have been validated in pregnant women and demonstrate the ability to detect anxiety well.

GAD-2:

  1. Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious, or on edge? (score 0=not at all; 1=several days; 2=more than half the days; 3=nearly every day)
  2. Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying? (score 0=not at all; 1=several days; 2=more than half the days; 3=nearly every day)

To score, add the scores for question 1 and 2. A total score of 3 or more indicates the presence of anxiety symptoms, and warrants a more in-depth follow-up assessment.

DASS-21 (Anxiety questions)

Responses (and scoring) are: 0=did not apply to me at all; 1=applied to me to some degree or some of the time; 2=applied to me to a considerable degree or a good part of time; and 3=applied to me very much or most of the time.

Over the past week…

  1. I was aware of dryness of my mouth.
  2. I experienced breathing difficulty (e.g., excessively rapid breathing, breathlessness in the absence of physical exertion).
  3. I experienced trembling (e.g., in the hands).
  4. I was worried about situations in which I might panic and make a fool of myself.
  5. I felt I was close to panic.
  6. I was aware of the action of my heart in the absence of physical exertion (e.g., sense of heart rate increase, heart missing a beat).
  7. I felt scared without any good reason.

To score the DASS-21 anxiety questions, add up the score of each question and multiply the total score by 2. A total score of 0-7 indicates no anxiety; 8-9 indicates mild anxiety; 10-14 indicates moderate anxiety; 15-19 indicates severe anxiety; and 20+ indicates extremely severe anxiety.

What do women think about screening? Many clinicians feel uncomfortable asking these kinds of screening questions. Women feel quite differently. They express relief – and a feeling of being validated. Many suspect that something is different, but they don’t know how to get answers. In the end, they feel that it gives them a place to move forward from. A fresh start.

Bottom line: Anxiety is one of the most common complications in pregnancy. Screening pregnant women for anxiety is the first step to supporting women to have better emotional health. The GAD-2 and DASS-21 are practical, validated screening tools.

 

 

References:
EveryonesBusiness.org
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819543/
https://www.ncbi.nlm.nih.gov/pubmed/26281038
https://www.ncbi.nlm.nih.gov/pubmed/18067974
http://cope.org.au/about/review-of-new-perinatal-mental-health-guidelines/
https://www.ncbi.nlm.nih.gov/pubmed/26719105
Lovibond, S.H., & Lovibond, P.F. . (1995). Manual for the Depression, Anxiety and Stress Scales (2nd ed.). Sydney: Psychology Foundation.

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