What is Perinatal Anxiety?
Perinatal anxiety is a relatively new concept. While decades of research exists into the identification and treatment of depression in the perinatal period (i.e. from pregnancy, throughout the first year post-birth), perinatal anxiety has received comparatively little attention. This is despite evidence that anxiety may occur at a higher rate and independently of depression in the perinatal period (Glasheen et al. 2010; Leach et al, 2017; Paul et al. 2013). Recent reviews of the literature put perinatal prevalence estimates at an average of about 20% (Leach et al, 2017), with slightly higher rates in pregnancy compared to postnatally (Dennis et al, 207). NHS statistics suggesting that between 10-15% of women report mild-to-moderate symptoms of depression and anxiety in the perinatal period.
Despite being treatable once recognised, less than 50% of women experiencing perinatal anxiety PNA will seek help or be identified as needing treatment (Accortt & Wong, 2017). This may be due to the relatively poor awareness of perinatal (Higgins et al, 2018), combined with the perceived stigma attached to mental health issues in this period (Moore et al, 2017). This lack of support is problematic, as research suggests untreated perinatal may be associated with a variety of negative outcomes in both the mother and infant, including preterm delivery, low birth weight, PND, excessive infant crying, difficulties in attachment, problematic feeding behaviours, and mental health problems in children (Lonstein 2007; Martini et al, 2015, Glasheen et al. 2010). Furthermore, elevated levels of maternal anxiety postpartum are associated with negative effects on child development and attachment (Murray et al, 1999) due in part to resultant impaired sensitivity to infant signals (Stevenson-Hinde et al, 2016), and difficulties in attuning to infants’ mental states (Meins et al, 2001). However, evidence suggests that this association can be moderated by support (Lefkovics et al, 2018). As such, it’s important to recognise perinatal anxiety as and when it occurs.
How can I recognise it?
While some anxiety and worry is normal in pregnancy and the post-natal period, women can often find that their anxiety symptoms can cause them significant distress. If this is the case, they may benefit from extra support. While it is important not to over-pathologise anxiety experienced in this period, as evidence suggests even sub-syndromal anxiety symptoms may have a negative impact on maternal and infant outcomes (Ayers et al, 2015), support for women who experience distressing sub-threshold symptoms is also be important.
There is some evidence that there are higher rates of some anxiety disorders in the perinatal period, for example, generalised anxiety disorder and obsessive-compulsive disorder (Matthey and Ross-Hamid, 2011). However, a significant proportion of women who experience anxiety in the perinatal period do not meet the criteria for standard DSM-V diagnosis, instead presenting with distressing levels of “maternally focused worry” (Huizink et al, 2004; Phillips et al, 2009). Therefore, to recognise perinatal anxiety, it is necessary to use screening tools that are specific to the perinatal period, rather than relying on generic anxiety scales.
Unfortunately, research consistently suggests that the most common screening tool currently used in perinatal primary care (the Edinburgh Postnatal Depression Scale) may not be appropriate for perinatal anxiety screening (e.g. Fairbrother, et al., 2019). Instead, we recommend using one of the following tools:
• The Perinatal Anxiety Screening Scale (Somerville et al., 2014)
• The Pregnancy-related Anxiety Scale (Brunton et al, 2018)
• The Postpartum Specific Anxiety Scale (Fallon et al, 2016)
All of these screening scales can be found on the Assessment and Screening Tools page.