the development and initial validation of a screening ... mental health problems – the development...
TRANSCRIPT
Perinatal mental health problems – The development of a screening scale for antenatal anxiety
Andrea Sinesi
NMAHP-RU – University of Stirling
Project funded by a CSO Scotland Doctoral Training Fellowship
Overview
o Perinatal mental health problems: beyond postnatal depression
o The importance of early identification and support
o The costs of perinatal mental health problems
o Anxiety in pregnancy
o A new screening tool for antenatal anxiety: development and
validation
PERINATAL MENTAL HEALTH PROBLEMS – BEYOND POSTNATAL DEPRESSION
Perinatal mental health problems: a range of mental health difficulties that women can experience in the perinatal period, from mild and moderate depression or anxiety to postpartum psychosis.
Perinatal mental health problems are common, affecting between 10% and 20% of women (Gavin et al., 2005; Ross et al., 2006)
Anxiety disorders are at least as common as depression, both in pregnancy and in the postnatal period (Matthey et al., 2003, Stein et al, 2014).
Shift from the focus on Postnatal Depression to the idea of “perinatal stress”
(Austin et al., 2004)
Prevalence rates of perinatal mental health problems
Depression – 12% across pregnancy, approximately 13% in the postpartum period (Gavin et al., 2005)
Anxiety – 14.8% during pregnancy in the largest UK study (over 8000 women),
varying prevalence rates between 11% and 18% postnatally (Heron et al., 2004)
Postpartum psychosis – 1 to 2 women per 1000 births (Rothschild et al., 2006)
But…
• Growing recognition that perinatal mental health problems, particularly anxiety disorders, often go undetected and untreated (NICE, 2014)
• Only half of all cases of perinatal depression and anxiety are identified (Centre for Mental
Health, 2015; Bauer et al., 2014), even less receive evidence-based forms of treatment
Reasons for the importance of early identification and support
Relative stability of mood and anxiety disorders over the perinatal period (Heron et al., 2004)
Increasing evidence that perinatal mental health problems affect not only women’s wellbeing but also child development, both short- and long-term (Sutter-Dallay et al., 2011).
Adverse outcomes in children can include (Stein et al., 2014):
Poorer emotional regulation, ADHD, behavioural problems
Language delay
Poorer self-reported mental health in adolescence
ANXIETY IN PREGNANCY
Why is it particularly important to identify and support women experiencing elevated (clinical) levels of anxiety in pregnancy?
The estimated prevalence of antenatal anxiety is approximately 15% (Heron et al. 2004)
Antenatal anxiety is associated with:
An increased risk of developing postnatal depression (Milgrom et al., 2008)
A number of adverse obstetric outcomes including increased risk of preterm birth and low birth weight (Kramer et al., 2009; Dunkel et al., 2011)
Long-term, detrimental effects on neurodevelopmental, cognitive and emotional outcomes (Van Der Berg et al., 2005; Talge et al., 2007)
THE DEVELOPMENT OF A SCREENING SCALE FOR ANTENATAL ANXIETY
STAGE 1 – SCALE DEVELOPMENT 1. Questions were formulated based on evidence from multiple sources:
• Research literature: Systematic review of anxiety measures
• Target population: Qualitative interviews with women with experience of AA • Expert opinion: Delphi study with health professionals working in perinatal mental health
to determine questions to be included in the scale 2. Preliminary version of the scale piloted on 62 women
STAGE 2 – SCALE VALIDATION
3. Final scale testing (Dec ‘17 – May ‘18) – A psychometric validation study with 200 women to determine the screening accuracy of the scale.
Given that:
• Mental health problems affect 1 woman in 6 in the perinatal period
• There is evidence of the potential adverse effects on both mother and child
• The antenatal period is a time of almost universal access to healthcare service
• Successful management of symptoms during pregnancy is likely to aid in the
reduction of postnatal mood and anxiety disorders
The perinatal period, in particular
pregnancy, provides an important
opportunity for screening and
early identification of problems
as they arise
An ideal time for preventive
interventions that can improve
women’s emotional wellbeing
and promote healthy child
development
A valuable opportunity for prevention
REFERENCES
Bauer, A., Parsonage, M., Knapp, M., et al. (2014). Costs of perinatal mental health problems. London: London School of Economics and Political Science
Diego MA, Jones NA, Field T, Hernandez-Reif M, Schanberg S, et al. 2006. Maternal psychological distress, prenatal cortisol, and fetal weight. Psychosom. Med. 68:747–53
Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: a systematic review of prevalence and incidence. Obstetrics & Gynecology, 106(5), 1071-1083.
Glynn LM, Dunkel Schetter C, Hobel C, Sandman CA. Pattern of perceived stress and anxiety in pregnancy predict preterm birth. Health Psychology. 2008;27(1):42–51
Heron, J., O’Connor, T.G., Evans, J., et al. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73
Dunkel-Schetter, C., & Lobel, M. (2011). Pregnancy and birth: a multilevel analysis of stress and birth weight. In: Revenson, T., Baum, A., Singer, J. editors. Handbook of health psychology 2. Mahwah, NJ: Lawrence Erlbaum, 427-453.
Talge, N. M., Neal, C., Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry 48(3/4), 245-261.
REFERENCES
Kramer, M. S., Lydon, J., & Seguin, L. (2009). Stress pathways to spontaneous preterm birth: the role of stressors, psychological distress and stress hormones. American Journal of Epidemiology, 169, 367-371.
Matthey S, Barnett B, Howie P, Kavanagh DJ (2003) Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74:139–147
Milgrom, J., Gemmil, A, Bilszta, J. L. et al. (2008). Antenatal risk factors for postnatal depression: a large prospective study. Journal of Affective Disorders, 108(1-2), 147-157.
NICE National Institute for Health and Care Excellence (2014). Antenatal and postnatal mental health: clinical management and service guidance. NICE clinical guideline 192, Issued: December 2014
Stein, A., Pearson, R. M., Goodman, S. H, et al (2014). Effects of perinatal mental disorders on the fetus and child. Lancet, 384, 1800-1819.