Elsevier

Journal of Affective Disorders

Volume 150, Issue 3, 25 September 2013, Pages 1217-1220
Journal of Affective Disorders

Brief report
Can we identify mothers at-risk for postpartum anxiety in the immediate postpartum period using the State-Trait Anxiety Inventory?

https://doi.org/10.1016/j.jad.2013.05.049Get rights and content

Abstract

Background

This study assessed the stability of maternal anxiety and concordance between State-Trait Anxiety Inventory (STAI) scores in the immediate postpartum period to 8 weeks postpartum.

Methods

A population-based sample of 522 mothers completed the STAI at 1, 4, and 8 weeks postpartum. Sensitivity, specificity, and predictive power of the 1-week STAI in relation to identifying mothers with elevated STAI scores at 4 and 8 weeks was determined. Predictive power of the STAI was further assessed using odds ratios and receiver operator characteristic (ROC) curves.

Results

At 1 week postpartum, 22.6% of mothers scored >40 on the STAI, decreasing to 17.2% at 4 weeks and 14.8% at 8 weeks. Using the cut-off score of >40, the 1-week STAI accurately classified 84.0% mothers at 4 weeks and 83.6% at 8 weeks with or without anxiety symptomatology. The 1-week STAI was significantly correlated to the 4-week (r=0.68, p<0.001) and 8-week (r=0.64, p<0.001) STAI. Mothers with a 1-week STAI score >40 were 15.2 times more likely at 4 weeks (95% CI=8.9−26.1) and 14.0 times more likely at 8 weeks (95% CI=7.9–24.8) to exhibit postpartum anxiety symptomatology.

Limitations

Psychiatric interviews were not completed in collaboration with the STAI and specific types of anxiety disorders were not identified.

Conclusions

A cut-off score of >40 on the STAI administered early in the postpartum period is recommended in a 2-phase identification program in order to not miss mothers with postpartum anxiety.

Introduction

Anxiety affects almost 30% of individuals over their lifetime (Kessler et al., 2005). The postpartum period is particularly a high-risk time for both new onset anxiety and exacerbation of existing anxiety disorders (Ross and McLean, 2006). This is a particularly critical time period due to substantial impact of maternal anxiety disorders on attachment with their infants and on child development (Arteche et al., 2011, Keim et al., 2011). Unfortunately, treatment rates for psychiatric illness in the postpartum period are low, suggesting that more work is required to identify women in need of treatment and engage them in the treatment process (Smith et al., 2009). It is ideal to identify women at high risk for anxiety in the immediate postpartum because they are engaged in other non-psychiatric perinatal health care. However, an effective assessment must be able to distinguish women with clinically significant anxiety who will require treatment from women with transient, spontaneously remitting anxiety symptoms. To our knowledge, no study has specifically assessed the stability of maternal anxiety or the concordance between STAI scores in the immediate postpartum period to 8 weeks postpartum. The purpose of this population-based study was to determine the prevalence and stability of high maternal anxiety at 1 week postpartum and to evaluate the sensitivity, specificity, and predictive power of the STAI when administered at 1 week postpartum on anxiety symptomatology at 4 and 8 weeks postpartum.

Section snippets

Subjects

Participants completed questionnaires as part of a longitudinal study conducted in a health region near Vancouver, British Columbia from April 2001 to January 2002. Eligible women, who were at least 18 years and able to understand English, were recruited after the study received approval from the university ethics committee and authorization from the participating health region. Study packages were provided antenatally (through participating family physician, obstetrician, and midwifery

Sample characteristics

One hundred and sixty-six participants were recruited antenatally with 115 (69%) returning the 1-week postpartum questionnaire. Of the 857 eligible women identified postnatally, 667 (78%) agreed to participate in the study with 479 returning the 1-week postpartum questionnaire (response rate 72%). In total, 594 participants returned the 1-week postpartum questionnaire with 535 (90%) of these mothers returning the 4-week and 498 (84%) returning the 8-week questionnaire. All women returning the

Discussion

This study demonstrates that the 1-week STAI, using various thresholds, can discriminate between mothers at-risk for elevated STAI scores and postpartum anxiety symptomatology at 8 weeks postpartum (AUC 0.86, 95% CI 0.81–0.90). A cut-off point of >40 on the STAI misses 25.4% and 25.0% of mothers with major postpartum anxiety at 4 and 8 weeks respectively, while 14.8% of non-anxious mothers at 4 weeks and 16.1% of non-anxious mothers at 8 weeks would receive a false positive report. Raising the

Role of funding source

Financial support was provided by the Canadian Institutes for Health Research through the provision of a postdoctoral research fellowship for Dr. Dennis and research grants from the Hamber Foundation and the BC Fraser Valley Health Region. None of these agencies had any further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

None of the authors have any conflicts of interest to declare.

Acknowledgment

Financial support was provided by the Canadian Institutes of Health Research through the provision of a postdoctoral research fellowship for Dr. Dennis and research grants from the Hamber Foundation and the BC Fraser Valley Health Region, Prevention and Early Intervention Program.

References (11)

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    Depression and anxiety are the most common psychiatric disorders reported during pregnancy and the postpartum period (Alipour et al., 2012). Approximately 15–22% of women experience depression (Gavin et al., 2005; Howard et al., 2018; Woolhouse et al., 2015; Yelland et al., 2010), and 15–33% anxiety during pregnancy and the postpartum period (Dennis et al., 2013; Farr et al., 2014; Grant et al., 2008). Emerging evidence has demonstrated that maternal depression and/or anxiety are associated with numerous adverse pregnancy outcomes, including miscarriage, preterm birth, lower Apgar scores, and lower birthweight (Accortt et al., 2015; Ghimire et al., 2021; Hasanjanzadeh and Faramarzi, 2017; Stein et al., 2014).

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