COSMIN database

A psychometric systematic review of self-report instruments to identify anxiety in pregnancy

Evans, K., Spiby, H., and Morrell, C. J.
AIMS: To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument.

BACKGROUND: Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed.

DESIGN: Psychometric systematic review.

DATA SOURCES: A systematic literature search of the multiple databases (1990-September 2014).

REVIEW METHODS: Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability.

RESULTS: Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category.

CONCLUSION: Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy.
J Adv Nurs
1365-2648 (Electronic)
Publication year:
Functional status:
Cognitive/mental functioning
Adults (18-65)
Pregnancy, childbirth and puerperium and related symptom
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
BAI - Beck Anxiety Inventory
CWS - Cambridge Worry Scale
DASS - Depression, Anxiety and Stress Scale (Versions: DASS-42 and DASS-21)
EPDS - Edinburgh Postnatal Depression Scale   
GAD-7 - Generalised Anxiety Disorder – 7
HADS - Hospital Anxiety and Depression Scale   
MGMQ - Matthey Generic Mood Question
PDQ - Prenatal Distress Questionnaire
PRAQ - Pregnancy-Related Anxiety Questionnaire
PRAQ-R - Pregnancy-Related Anxiety Questionnaire Revised
PRT - Pregnancy Related Thoughts
RPES - Rural Pregnancy Experience Scale
SCL-90-R - Symptom Checklist 90-Revised
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
TPDS - Tilburg Pregnancy Distress Scale