Screening for perinatal anxiety.

Abstract

OBJECTIVE\nPerinatal Mood and Anxiety Disorders (PMADs) are one of the most common complications of the perinatal period.1 ACOG recommends screening for both depressive and anxiety symptoms at least once during the perinatal period using a standardized, validated tool.2 The Edinburgh Postnatal Depression Screen (EPDS) is the most commonly used tool to screen for depression, and while it contains anxiety-related questions, it has not been validated to screen for anxiety. In fact, the ideal tool to screen for perinatal anxiety remains a matter of debate.3-5 The aim of our study was to evaluate the ability of the EPDS to also screen for anxiety related symptoms as compared to the gold-standard of the Generalized Anxiety Disorder-7 (GAD-7).\n\n\nSTUDY DESIGN\nWomen receiving obstetric care at three of the University of Alabama at Birmingham obstetric clinics were screened simultaneously using the EPDS and GAD-7 from 10/1/17 to 5/31/18. The screened population included English and Spanish-speaking women from public and private offices at varied gestational ages and postpartum. Only the first screen was included if a woman was screened more than once. The total score on both the EDPS and GAD-7, as well as the score on three anxiety-specific EPDS questions (#4, 5 and 6) were collected. Demographic data were collected from the electronic medical record. A positive score was set at 10 for both the GAD-7 and EPDS. The data were then analyzed using standard statistical modeling including logistic regression and Pearson correlation coefficients.\n\n\nRESULTS\n407 women were screened and included in the study: 102 (25%) were postpartum, otherwise average gestational age was 22.4 weeks; 178 (44%) self-identified as African American and 24 (6%) as Hispanic; 203 (49%) received care in the public office (predominantly Medicaid-insured). Only 13 (3%) of screens were completed in Spanish. The prevalence of a positive GAD-7 was 17% and a positive EPDS was 11%. The correlation between a positive EPDS and GAD-7 screen was 0.83 (p<0.001), while the correlation between the anxiety specific EPDS questions and GAD-7 was 0.75 (p<0.001). A score of 5 or greater on the anxiety specific EPDS questions had a sensitivity of 75% and a specificity of 90% for a positive GAD-7 score. Demographic data were analyzed and none were found to be significantly associated with a positive screen for either anxiety or depression.\n\n\nCONCLUSION\nPMADs are common in our obstetric population. A positive EPDS alone was correlated with a positive GAD-7. In the presence of a negative EPDS screen, using a score of 5 or greater on the three anxiety-specific EPDS questions may be helpful in identifying women who could benefit from further anxiety screening and treatment.