COSMIN database

Anxiety measures validated in perinatal populations: a systematic review

Meades, R. and Ayers, S.
BACKGROUND: Research and screening of anxiety in the perinatal period is hampered by a lack of psychometric data on self-report anxiety measures used in perinatal populations. This paper aimed to review self-report measures that have been validated with perinatal women.

METHODS: A systematic search was carried out of four electronic databases. Additional papers were obtained through searching identified articles. Thirty studies were identified that reported validation of an anxiety measure with perinatal women.

RESULTS: Most commonly validated self-report measures were the General Health Questionnaire (GHQ), State-Trait Anxiety Inventory (STAI), and Hospital Anxiety and Depression Scales (HADS). Of the 30 studies included, 11 used a clinical interview to provide criterion validity. Remaining studies reported one or more other forms of validity (factorial, discriminant, concurrent and predictive) or reliability. The STAI shows criterion, discriminant and predictive validity and may be most useful for research purposes as a specific measure of anxiety. The Kessler 10 (K-10) may be the best short screening measure due to its ability to differentiate anxiety disorders. The Depression Anxiety Stress Scales 21 (DASS-21) measures multiple types of distress, shows appropriate content, and remains to be validated against clinical interview in perinatal populations.

LIMITATIONS: Nineteen studies did not report sensitivity or specificity data. The early stages of research into perinatal anxiety, the multitude of measures in use, and methodological differences restrict comparison of measures across studies.

CONCLUSION: There is a need for further validation of self-report measures of anxiety in the perinatal period to enable accurate screening and detection of anxiety symptoms and disorders.
J Affect Disord
1573-2517 (Electronic)
Publication year:
Symptom status:
Cognitive/mental state
Functional status:
Cognitive/mental functioning
Adults (18-65)
Certain conditions originating in the perinatal period and related symptoms
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
BAI - Beck Anxiety Inventory (versions: BAI-Youth)
BDI - Beck Depression Inventory (versions: mBDI)   
CC-D&A - Trait anxiety and depression scales
DASS - Depression, Anxiety and Stress Scale (Versions: DASS-42 and DASS-21)
DSSI/sAD - State of Anxiety and Depression
ENES - Eysenk Neuroticism & Extroversion Scale
EPDS - Edinburgh Postnatal Depression Scale   
GHQ - General Health Questionnaire (versions: original = GHQ-60; GHQ-12; GHQ-20; GHQ-28; GHQW-30; GHQ-36)
HADS-A - Hospital Anxiety and Depression Scale–Anxiety subscale
HSCL - Hopkins Symptom Checklist (versions: HSCL-25; HSCL-37-A; Afgan SCL)
HSPA - Hereford Scale of Parental Attitudes
IDAS - Inventory of Depression and Anxiety Symptoms
ISSI - Interview Schedule for Social Interaction
Kessler Psychological Distress Scale (versions: K-10; K-5; K-6)
LES - Life Experience Survey
PAS - Pregnancy Anxiety Scale
PSAI - Perinatal Self-Administered Inventory
SCL-90-R - Symptom Checklist 90-Revised
SDS - Zung Self-rating Depression Scale
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
STAI - State-Trait Anxiety Inventory