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Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder

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Clinical Psychology & Psychotherapy
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Corrie Goldfinger
Corrie Goldfinger
Corrie Goldfinger
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Sheryl M Green at McMaster University
Sheryl M Green
Melissa Furtado at McMaster University
Melissa Furtado
Randi E McCabe at McMaster University
Randi E McCabe
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Abstract and Figures

Prevalence of perinatal anxiety disorders continues to grow, with estimates greater than those of postpartum depression. Generalized anxiety disorder (GAD) is the most commonly reported perinatal anxiety disorder, yet very little is known about the worry content experienced during the perinatal period in those with GAD. This study investigated worry content and frequency in a sample of perinatal women (n = 20) and age‐matched nonperinatal women (n = 20) diagnosed with GAD. Participants completed the Penn State Worry Questionnaire (PSWQ) to assess worry severity, in addition to providing their current top worries. Mean scores on the PSWQ in both samples exceeded a clinical cut‐off score of 65, and thematic analyses revealed that perinatal women experienced significantly greater parental‐themed worries compared with the nonperinatal GAD sample (p < .05). Capturing the unique content of worry for perinatal woman will assist clinicians in identifying treatment targets and may enhance treatment outcome.
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RESEARCH ARTICLE
Characterizing the nature of worry in a sample of perinatal
women with generalized anxiety disorder
Corrie Goldfinger
1
|Sheryl M. Green
1,2
|Melissa Furtado
1
|Randi E. McCabe
2,3
1
Women's Health Concerns Clinic, St. Joseph's
Healthcare, Hamilton, Ontario, Canada
2
Department of Psychiatry and Behavioural
Neurosciences, McMaster University,
Hamilton, Ontario, Canada
3
Anxiety Treatment and Research Clinic, St.
Joseph's Healthcare, Hamilton, Ontario,
Canada
Correspondence
Sheryl M. Green, Women's Health Concerns
Clinic, St. Joseph's Healthcare, 100 West 5th
Street, Hamilton, ON L8N 3K7, Canada.
Email: sgreen@stjosham.on.ca
Abstract
Prevalence of perinatal anxiety disorders continues to grow, with estimates greater
than those of postpartum depression. Generalized anxiety disorder (GAD) is the most
commonly reported perinatal anxiety disorder, yet very little is known about the
worry content experienced during the perinatal period in those with GAD. This study
investigated worry content and frequency in a sample of perinatal women (n= 20)
and age‐matched nonperinatal women (n= 20) diagnosed with GAD. Participants
completed the Penn State Worry Questionnaire (PSWQ) to assess worry severity,
in addition to providing their current top worries. Mean scores on the PSWQ in both
samples exceeded a clinical cut‐off score of 65, and thematic analyses revealed that
perinatal women experienced significantly greater parental‐themed worries com-
pared with the nonperinatal GAD sample (p< .05). Capturing the unique content of
worry for perinatal woman will assist clinicians in identifying treatment targets and
may enhance treatment outcome.
KEYWORDS
anxiety, generalized anxiety disorder, pregnancy, postpartum, worry
1|INTRODUCTION
Although depression continues to be the psychiatric disorder predomi-
nantly investigated during pregnancy and the postpartum, also known
as the perinatal period, increasing attention has been paid to clinically
significant anxiety during this time. On average, prevalence rates of
perinatal anxiety disorders range between 13% and 22%, whereas prev-
alence rates of postpartum depression range between 10% and 18%
(Beck, 2001; Borri et al., 2008; Fairbrother, Janssen, Antony, Tucker, &
Young, 2016; Giardinelli et al., 2012; Goodman, Watson, & Stubbs,
2016; Grant, McMahon, & Austin, 2008; Horowitz & Goodman, 2005;
Uguz, Gezginc, Kayhan, Sari, & Büyüköz, 2010). Heightened anxiety
and worry during the perinatal period is understandable, and often seen
as normal, given the physical changes, changing roles, and demands that
a woman faces, as well as the reduced sense of control and predictability
(Parfitt & Ayers, 2014). Anxiety and worry are considered problematic,
however, if it results in significant distress and interference with func-
tioning in important areas of life (e.g., work, social, and relationships).
The most commonly diagnosed anxiety disorder in nonperinatal
populations is generalized anxiety disorder (GAD). Lifetime prevalence
rates of GAD range between 5.1–11.9% (Kessler & Wang, 2008; Wat-
terson, Williams, Lavorato, & Patten, 2017; Weisberg, 2009), with
women observed to be more affected than men (Wittchen, 2002).
These findings extend into the perinatal period, as GAD is reported
to be the most commonly occurring anxiety disorder during this time,
with prevalence rates ranging from 4.4% to 10.8% (Phillips et al., 2007;
Ross & McLean, 2006; Sutter‐Dallay, Giaconne‐Marcesche, Glatigny‐
Dallay, & Verdoux, 2004; Wenzel, Haugen, Jackson, & Robinson,
2003, Wenzel, Haugen, Jackson, & Brendle, 2005).
The increase in prevalence of anxiety disorders during the perinatal
period, particularly GAD (Grigoriadis et al., 2011; Ross & McLean,
2006; Sutter‐Dallay et al., 2004; Wenzel et al., 2003; Wenzel et al.,
2005), is associated with numerous negative outcomes for both
mothers and their infants. Women are more likely to experience
obstetric complications, a more difficult labour and delivery, and give
birth preterm (Anniverno, Bramante, Mencacci, & Durbano, 2013;
Received: 28 July 2019 Revised: 11 October 2019 Accepted: 4 November 2019
DOI: 10.1002/cpp.2413
136 © 2019 John Wiley & Sons, Ltd. Clin Psychol Psychother. 2020;27:136–145.wileyonlinelibrary.com/journal/cpp
... Generalized anxiety disorder (GAD) is the most common perinatal anxiety disorder and is defined by excessive anxiety and worry for the majority of days, to the point of causing significant functional impairment to the person for at least 6 months [64]. Women with GAD appear to experience a more restricted range of worry content during pregnancy and the postpartum period. ...
... Additionally, the immune system may be implicated, as alterations in immune cell populations and cytokine expression during pregnancy and postpartum are linked to anxiety symptoms [69]. Lastly, pregnancy-related and psychological factors can also play a role, such as pregnancy and traumatic delivery, limited social support, prior history of mental illness as well as parental-themed worries [64]. ...
Mental Health Challenges in the Postpartum Period
Chapter
Full-text available
  • Mar 2025
The postpartum period presents significant mental health challenges, with many women experiencing mood and anxiety disorders that can greatly impact both maternal and infant well-being. Early and accurate screening for mental health conditions is crucial for ensuring timely diagnosis and intervention. Postpartum depression (PPD) is the most common, affecting up to 15% of new mothers, characterized by persistent sadness, fatigue, and feelings of inadequacy. Anxiety disorders, often underdiagnosed, manifest as excessive worry, intrusive thoughts, and panic. Left untreated, both can impair a mother’s ability to bond with her infant. A psychiatric emergency in the postpartum period is postpartum psychosis, a rare but severe condition that may involve delusions, hallucinations, and risk to both mother and baby, requiring immediate medical attention. Additionally, post-traumatic stress disorder (PTSD) can develop after a traumatic birth or the loss of an infant, further complicating recovery and maternal mental health. Prompt identification and treatment of these conditions through universal screening and targeted care can mitigate long-term consequences and improve outcomes for both mothers and their families. This manuscript highlights the critical importance of mental health care in the postpartum period and calls for greater awareness and resources to support new mothers during this vulnerable time.
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... Agreement in the current sample was higher than is typically observed in those with GAD, as kappa values typically range from κ = 0.63 to 0.81 (Brown et al., 2001;Rutter & Brown, 2015;Zanarini et al., 2000). It is possible that the clinical presentation of worry during the perinatal period is more homogenous than in the general population (Goldfinger et al., 2019), making GAD easier to identify in 14 1 0.14 Note R 2 N = Nagelkerke R Square; One participant did not complete the GAD-Q-IV and was not included in regression analyses components of GAD (Donegan et al., 2012;Green et al., 2021;Mahoney et al., 2018a), suggesting that this is perhaps unnecessary. Future research should evaluate if greater reductions in checking behaviors throughout treatment for GAD leads to better end-state functioning, to determine the therapeutic relevance of checking behaviors. ...
The Role of Hypervigilance, Checking, and Avoidance Behaviours in the Diagnosis of Generalized Anxiety Disorder During the Perinatal Period
Article
Full-text available
  • Apr 2025
  • J PSYCHOPATHOL BEHAV
Generalized anxiety disorder (GAD) is common during the perinatal period. Since its inception, substantial efforts have been put forth to improve the specificity and interrater reliability of GAD. More recently, increased attention has been given to the behavioral features of GAD, with evidence to suggest that hypervigilance, checking, and avoidance may be particularly relevant. It is unknown however if these behaviors lead to improved classification and understanding of GAD. The present study examines: (1) the proportion of perinatal individuals with and without GAD who endorse hypervigilance, checking and avoidance; (2) interrater reliability of GAD during the perinatal period; (3) whether inclusion of hypervigilance, checking, and avoidance in GAD diagnostic criteria leads to improved interrater reliability; and (4) if hypervigilance, checking and avoidance significantly predict GAD diagnostic status beyond current features of the disorder. Thirty-eight perinatal women, who were predominantly white and highly educated were randomized to one of two assessors to complete a semi-structured diagnostic assessment. Interviewers queried about the presence of current mental health disorders and engagement in behaviors of interest. Each assessment was independently rated by three assessors. More participants with GAD reported engaging in hypervigilance, checking, and avoidance than those without GAD. Interrater agreement of GAD diagnoses was excellent (κ = 0.91). Inter-rater agreement of GAD diagnoses was comparable (κ = 0.92) when checking was included in the diagnostic criteria of GAD. Checking also significantly predicted GAD diagnostic status beyond existing features of the disorder. These results support continued evaluation of the role of checking in GAD.
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... Some women have a spiritual sense about being pregnant and consider being treated special by others as an uplifting experience (Sanaeinasab et al. 2021). On the other hand, women are concerned for various reasons, such as parenting ability, the child's well-being, returning to work and social or interpersonal matters (Goldfinger et al. 2020). Physical conditions such as common pregnancy symptoms and pregnancy hassles may influence their mental health and vice versa (Gooley, Mohapatra, and Twan 2018;Harmel and Höfelmann 2022). ...
Can Pregnancy Experience Predict Birth Experience, Postpartum Depression and Anxiety? A Prospective Descriptive Study
Article
Full-text available
  • Dec 2024
Aim A positive pregnancy experience can be a good start for healthy motherhood. This study aimed to investigate Iranian women's pregnancy experience and how self‐reported hassles and uplifts influence birth experience, postpartum depression and anxiety, and the association between childbirth experience and postpartum mental health. Design A prospective descriptive study. Methods A prospective descriptive study was conducted among 228 pregnant women from health centres in Tabriz, Iran. From the 28th to 36th weeks of pregnancy, participants completed the Pregnancy Experience Scale. Then, the mothers were followed up until 4–6 weeks postpartum, and Childbirth Experience Questionnaires version 2.0, Edinburgh Postnatal Depression and the short form of Specific Postpartum Anxiety Scales were completed. The data were analysed using the general linear model. Results After adjusting for possible confounding variables, there was no statistically significant association between women's pregnancy and childbirth experiences. However, the mean scores of postpartum depression and anxiety were significantly higher in women who felt unhappy about the discomforts that they experienced during pregnancy (β [95% CI] = 0.01 [0.01–0.02]; p < 0.001, 0.22 [0.09–0.35]; p = 0.001, respectively). Conclusion There was a significant statistical reverse association between childbirth experience and postpartum anxiety and depression. The study demonstrated a significant association between women's pregnancy, birth experiences and postpartum psychological outcomes. Implementing interventions that create a positive pregnancy experience will likely have an impact on reducing the prevalence of postpartum depression and anxiety. Patient or Public Contribution Pregnant women participated solely in the data collection by responding to the questionnaires. No participant contributions were required for the study's design, outcome measurement or implementation.
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... Generalized anxiety disorder (GAD) is a globally prevalent condition, affecting millions worldwide (1). Amidst the diverse array of individuals grappling with anxiety, women stand out as a distinct demographic group facing unique challenges (2). ...
The Effectiveness of Metacognitive Therapy on Rumination, Self-concept, and Perceived Social Support in Women with Generalized Anxiety Disorder
Article
Full-text available
  • Sep 2024
Background: Metacognitive therapy (MCT) is an evolving therapeutic approach that has shown promise in the treatment of generalized anxiety disorder (GAD). Accordingly, this study aimed to assess the impact of MCT on rumination, self-concept, and perceived social support (PSS) in women diagnosed with GAD. Methods: The current quasi-experimental study was conducted using a pre-test-post-test design with a control group. The statistical population consisted of women diagnosed with GAD in Tehran in 2022. The research sample comprised 36 women with GAD, selected through purposive sampling and allocated into an experimental group (n = 18) and a control group (n = 18). The experimental group underwent ten 90-minute sessions of MCT, while the control group received no intervention. Data were collected through questionnaires to assess GAD symptoms, rumination, self-concept, and PSS. The collected data were analyzed using multivariate analysis of covariance (MANCOVA) via SPSS version 24. Results: The findings indicated that MCT led to a significant decrease in rumination from 53.61 ± 3.25 to 48.94 ± 3.45 (P < 0.001) and an increase in self-concept from 70.55 ± 2.87 to 74.16 ± 2.74 (P < 0.001) among women diagnosed with GAD. Additionally, the dimensions of PSS were significantly enhanced: support from significant others increased from 15.72 ± 1.34 to 18.50 ± 1.20 (P < 0.001), family support increased from 17.78 ± 1.22 to 20.50 ± 1.91 (P < 0.001), and support from friends increased from 16.22 ± 1.74 to 19.01 ± 1.30 (P < 0.001). Conclusion: The findings from this study underscore the potential of MCT as a tailored intervention for enhancing well-being and reducing anxiety in individuals diagnosed with GAD, highlighting its relevance for clinical practice and future research endeavors.
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... In a research collaboration across the ATRC and the Women's Health Concerns Clinic at SJHH, Dr. Sheryl Green and I have examined how anxiety symptoms such as worry may vary in certain groups, such as women who are pregnant or postpartum, a period termed the perinatal phase. We found that pregnant and postpartum women with generalized anxiety disorder (GAD) have increased worry characterised by parental themes compared to a nonperinatal sample with GAD (Goldfinger et al., 2020). This finding highlights the importance for clinicians working with perinatal women to capture these themes that would not be identified on a standard measure of worry such as the Penn State Worry Questionnaire, as they are an important treatment target. ...
Actualising the Psychologist Role in an Academic Health Sciences Centre: Reflections on the Journey
Article
Full-text available
  • May 2024
En tant que lauréate du Prix de la Société canadienne de psychologie pour contributions remarquables à la psychologie en tant que profession, j’ai le plaisir de partager le fruit de mes travaux dans cet article. À travers le regard unificateur d’une psychologue travaillant dans un centre universitaire de sciences de la santé, je présente mon travail dans chacune des dimensions qui rendent une carrière dans ce milieu gratifiante et, en fin de compte, mon parcours d’accomplissement personnel. Ces dimensions comprennent le travail en équipe, l’intégration des services cliniques, la recherche et la formation, le fait d’être à la frontière de la pratique fondée sur des données probantes, le travail au sein du système de santé, la voie académique vers la promotion, l’obtention de bourses dans un contexte académique de sciences de la santé, la possibilité de faire preuve de curiosité et de trouver un sens au travail ainsi que l’implication dans le domaine. Tout au long de l’article, je partage les leçons apprises en tant que scientifique-praticienne au sein d’un centre universitaire de sciences de la santé, ainsi que des exemples illustrant la génération de questions de recherche critiques à partir de défis cliniques de première ligne et la mise en pratique de la recherche, facilitée par ce contexte. Le thème de l’adaptabilité est omniprésent, car il s’agit d’un attribut essentiel pour réussir dans ce cadre dynamique qui est continuellement mis à l’épreuve sur de multiples fronts. Enfin, je souligne l’occasion qu’offre ce contexte de générer une signification personnelle, un sentiment de détermination et des sentiments de faire la différence qui peut être localisée au niveau du patient ou avoir un impact sur le système de santé dans son ensemble.
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... [2][3][4][5] These worries often include parenting abilities, fetal well-being, and partner's health. 2,6 GAD is the most prevalent anxiety disorder during this period, affecting 4% of pregnant individuals and 4.2-5.7% of postpartum individuals, 7 compared to 1.8% in non-perinatal populations. 8 Left untreated, GAD in the perinatal period (GAD-p) leads to distress, impaired functioning, obstetric complications, and adverse neonatal outcomes, emphasizing the need for effective treatments. ...
Variability Exists Across Outcomes Measured and Reported in Studies Assessing Interventions for Generalized Anxiety Disorder During the Perinatal Period: A Scoping Review
Preprint
  • Sep 2023
Objective: This review aimed to identify if heterogeneity exists across outcomes measured and reported in treatment studies targeting perinatal individuals with Generalized Anxiety Disorder (GAD). Design: Scoping review. Setting: Existing literature that evaluates the effectiveness of interventions for GAD during the perinatal period (i.e., pregnant and postpartum). Methods: Studies were eligible if: 1) they were English from the years 2011 to 2021; 2) participants were in the perinatal period with a GAD diagnosis; and 3) the aim of the intervention was to treat GAD during the perinatal period. Three bibliographic databases were searched. Two reviewers independently screened studies for eligibility. Study characteristics and data (e.g., outcomes, OMIs used) were extracted. Main outcome measures: Outcome measures are not required for this type of study design. Results: Of the 4424 records identified, 4 studies were included. The outcomes from the four studies were mapped to one of five core areas in Dodd et al.’s (2018) research outcome framework. A total of 10 distinct outcomes were captured across the 4 studies. Anxiety symptoms, the most common outcome, employed three different OMIs. Notably, the majority of outcomes fell within the physiological/clinical core area, indicating a dearth of patient-centered outcomes in the literature. Conclusions: This review highlights outcome and OMI variations in perinatal GAD studies. To improve synthesis, reproducibility, and comparability among treatment studies, future research in perinatal GAD treatment should adopt standardized outcomes and OMIs. This standardization is essential for informing clinical practice guidelines and policies.
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Cognitive behavioural therapy for intolerance of uncertainty: A study protocol for the prevention of postpartum anxiety
Article
  • Apr 2025
  • J REPROD INFANT PSYC
Background: Mental health disorders are the most prevalent health complication experienced during pregnancy and the postpartum, with anxiety disorders being most common. Intolerance of uncertainty (IU) is a well-known feature of anxiety disorders and has recently been identified as a risk factor for the worsening of anxiety during the postpartum period. Cognitive Behavioural Therapy (CBT) is a first-line treatment for perinatal anxiety, and CBT specifically targeting IU in non-perinatal populations has demonstrated positive findings for reducing anxiety. As such, the objective of our study is to examine whether CBT targeting IU in pregnancy can reduce the risk of postpartum anxiety. Methods: This protocol paper outlines a proof-of-concept randomised clinical trial assessing the effectiveness of a newly developed CBT for IU (CBT-IU) protocol to reduce the risk of postpartum anxiety. Pregnant individuals identified at increased risk for postpartum anxiety (defined as a baseline score of 64 or greater on the Intolerance of Uncertainty Scale) will be randomised to receive CBT-IU or care as usual (CAU) during pregnancy and will be followed through the postpartum period (6-12 weeks). The CBT-IU protocol is a weekly, six session treatment, which includes psychoeducation, behavioural experiments, imaginal exposure, and problem-solving to target IU. Discussion: To our knowledge, this will be the first study to investigate the efficacy of a CBT protocol aimed at reducing the risk of developing postpartum anxiety. Establishing this protocol as a potentially preventative strategy will offer a new option to improve the mental health and well-being of mothers and their infants. Clinical trial registration: Trial Number is NCT05691140 and accessible at https://clinicaltrials.gov/study/NCT05691140.
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Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals
Article
Full-text available
  • Feb 2025
  • CAN J PSYCHIAT
Background The Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders. Methods CANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive–compulsive and post-traumatic stress disorders (January 2013–October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations. Results The guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided. Conclusions This guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.
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Yeni Doğum Yapmış Annelerin Doğum Endişelerinin BelirlenmesiDetermination of Birth Worries of Postpartum Mothers
Article
  • Jun 2023
Amaç: Bu araştırma, yeni doğum yapmış annelerin doğum endişelerini belirlemek amacıyla yapıldı. Yöntem: Tanımlayıcı tipteki araştırma, 22 Ocak-22 Şubat 2018 tarihleri arasında Gaziantep’te bir eğitim ve araştırma hastanesi ile kadın doğum ve çocuk hastanesinde uygulandı. Araştırmanın örneklemini, belirtilen hastanelerin kadın doğum servisinde yeni doğum yapmış ve araştırmaya katılmayı kabul eden 482 anne oluşturdu. Veriler, annelerin sosyo-demografik ve obstetrik öykülerini içeren “Anket Formu” ve “Oxford Doğum Endişesi Ölçeği (ODEÖ)” kullanılarak toplandı. Verilerin analizinde sayı-yüzde dağılımı, t testi ve varyans analizi, Kruskal Wallis H ve Mann Whitney U testi kullanıldı. Bulgular: Annelerin en yüksek puan ortalamasını Ağrı ve sıkıntı alt boyutundan, en düşük puan ortalamasını Müdahaleler alt boyutundan aldıkları ve ölçek puan ortalamasının 26.30±8.39 olduğu saptandı. Yaşı genç, eğitim seviyesi düşük, ev halkı hane sayısı, yaşayan çocuk sayısı ve gebelik sayısı az, son gebeliği planlı ve normal doğum yapan annelerin doğum endişelerinin daha fazla olduğu ve ODEÖ’nden aldıkları puan ortalamalarının daha düşük ve istatistiksel olarak anlamlı olduğu saptandı (p
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Associations of maternal and paternal antenatal mood with offspring anxiety disorder at age 18 years
Article
Full-text available
  • Aug 2015
Maternal antenatal depression and anxiety are associated with increased risk of childhood behavioural and emotional problems in offspring; it remains unclear to what extent this is due to a maternal biological impact on foetal development. Here, we compare associations between maternal and paternal antenatal depression and anxiety with offspring anxiety disorders, thus controlling for some genetic and shared environmental factors. We used data from the ALSPAC population cohort including measures of antenatal parental depression and anxiety. At 18 years, offspring completed the CIS-R interview, yielding diagnoses for anxiety disorders. Results were adjusted for confounding variables including parental postnatal depression and anxiety. Children of women with antenatal depression (18 weeks gestation), had an increased risk of anxiety disorders at 18 years of age (11.1% vs. 6.2%; adj. OR 1.75 (1.19, 2.58); p=0.01). Children of women with antenatal anxiety had increased risk of co-morbid anxiety and depression (adj. OR 1.39 (1.06, 1.82); p=0.02). No such associations were found with paternal antenatal depression or anxiety. There was a high attrition rate from the original cohort to the CIS-R completion at 18 years postpartum. Parental mood was only assessed together at one time point during the antenatal period. The differences in the association between maternal and paternal mood during pregnancy and child outcomes supports the hypothesis that foetal programming may account, at least in part, for this association. We highlight the potential opportunity for preventative intervention by optimising antenatal mental health. Copyright © 2015. Published by Elsevier B.V.
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Descriptive Epidemiology of Generalized Anxiety Disorder in Canada
Article
  • Apr 2016
Objective: The first national survey to assess the prevalence of generalized anxiety disorder (GAD) in Canada was the 2012 Canadian Community Health Survey: Mental Health and Well-Being (CCHS-MH). The World Mental Health Composite International Diagnostic Interview (WMH-CIDI), used within the representative sample of the CCHS-MH, provides the best available description of the epidemiology of this condition in Canada. This study uses the CCHS-MH data to describe the epidemiology of GAD. Method: The analysis estimated proportions and odds ratios and used logistic regression modelling. All results entailed appropriate sampling weights and bootstrap variance estimation procedures. Results: The lifetime prevalence of GAD is 8.7% (95% CI, 8.2% to 9.3%), and the 12-month prevalence is 2.6% (95% CI, 2.3% to 2.8%). GAD is significantly associated with being female (OR 1.6; 95% CI, 1.3 to 2.1); being middle-aged (age 35-54 years) (OR 1.6; 95% CI, 1.0 to 2.7); being single, widowed, or divorced (OR 1.9; 95% CI, 1.4 to 2.6); being unemployed (OR 1.9; 95% CI, 1.5 to 2.5); having a low household income (<$30 000) (OR 3.2; 95% CI, 2.3 to 4.5); and being born in Canada (OR 2.0; 95% CI, 1.4 to 2.8). Conclusions: The prevalence of GAD was slightly higher than international estimates, with similar associated demographic variables. As expected, GAD was highly comorbid with other psychiatric conditions but also with indicators of pain, stress, stigma, and health care utilization. Independent of comorbid conditions, GAD showed a significant degree of impact on both the individual and society. Our results show that GAD is a common mental disorder within Canada, and it deserves significant attention in health care planning and programs.
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Anxiety disorders during pregnancy and the postpartum period: A systematic review
Conference Paper
  • Aug 2006
Objective: The postpartum period is recognized as a time of vulnerability to affective disorders, particularly postpartum depression. In contrast, the prevalence and clinical presentation of anxiety disorders during pregnancy and the postpartum period have received little research attention. In this article, we review the medical literature as it relates to the prevalence and clinical presentation of panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder during pregnancy and the postpartum period. Data Sources: MEDLINE (1966 to July 2005 week 1) and PsycInfo (1840 to July 2005 week 1) were searched using combinations of the following search terms: pregnancy, childbirth, postpartum, panic disorder, phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and generalized anxiety disorder. Study Selection: All relevant papers published in English and reporting original data related to perinatal anxiety disorders were included. Data Extraction: Studies were examined for data related to the prevalence, presentation, predictors/risk factors, new onset, course, and treatment of anxiety disorders during pregnancy and the postpartum period. Data Synthesis: Anxiety disorders are common during the perinatal period, with reported rates of obsessive-compulsive disorder and generalized anxiety disorder being higher in postpartum women than in the general population. The perinatal context of anxiety disorders presents unique issues for detection and management. Conclusions: Future research is needed to estimate the prevalence of perinatal anxiety disorders more precisely, to identify potential implications of maternal anxiety disorders for maternal quality of life and child development, and to determine safe and effective treatment methods.
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Pregnancy-Related Anxiety: Evidence of Distinct Clinical Significance from a Prospective Longitudinal Study
Article
  • Mar 2016
Background: Pregnancy-related anxiety (PrA) has attracted considerable research attention, but questions remain about its distinctiveness from conventional constructs and measures. In a high psychosocial risk, ethnically diverse sample, we examine the degree to which PrA is distinct from continuous and diagnostic measures of anxiety and worry in terms of longitudinal course, associations with psychosocial and perinatal risk, and prediction of postnatal mood disturbance. Methods: 345 women oversampled for prenatal anxiety and depression were selected from an urban obstetrics clinic serving a predominantly low-income, ethnically diverse population. PrA was assessed at 20 and 32 weeks gestation; anxiety and depression symptoms were assessed from questionnaire and from clinical interview at 20 and 32 weeks gestation and again at 2 and 6 months postnatally. Data relevant to psychosocial and obstetric risks were ascertained from interview, medical exam, and chart review. Results: Two distinct factors of PrA were identified, indexing specific concerns about the child's health and about the birth; these two PrA factors showed distinct longitudinal patterns in the prenatal period, and modest associations with general measures of anxiety and depression from questionnaire and clinical interview. PrA was also distinguished from conventional symptom measures in its associated features and prediction of birth weight and postnatal mood. Limitations: The sample was at high psychosocial risk and ethnically diverse; findings may not generalize to other samples. Conclusions: PrA can be distinguished from general measures of anxiety in pregnancy in terms of longitudinal course, associated features, and prediction to postnatal mood disturbance, and may warrant specific clinical attention.
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Maternal Stress and Preterm Birth
Article
  • Jun 2003
Although there are biological pathways that conceivably might link stress with preterm birth, studies attempting to demonstrate such a relationship have given conflicting results. For the most part, social support has notbeen found to reduce preterm births. The present study is a prospective examination of how such factors as life events, social support, depression, and anxiety related to pregnancy may be associated with birth before 37 weeks' gestation. The study cohort included 1962 women who gave birth in central North Carolina in the years 1996-2000. Participants, aged 16 years and older, were entered into the study at 24-29 weeks' gestation. Many subjects were African-American women, and about half were nulliparous. More than half were not married when entering the study. Low-income households were liberally represented in the study group. The incidence of preterm birth was 12%. Life events, social support, and depression were not associated with preterm birth in this study, but women having medium and high scores for self-rated pregnancy-related anxiety were at increased risk; risk ratios were 1.5 and 2.1, respectively. High scores on a scale of perceived racial discrimination also correlated with an increased risk of preterm birth (risk ratio, 1.4). Similar findings were obtained when alcohol or tobacco use was taken into account. Women with greater self-rated anxiety were more at risk of spontaneous than of medically indicated preterm birth. A risk ratio of 1.8 was associated with life events perceived as having had a negative impact. Among women with negative life events, pregnancy-related anxiety was associated with preterm birth triggered by either labor or ruptured membranes. The association between high levels of pregnancy-related anxiety and preterm birth was less marked when limited to women lacking comorbid medical conditions, but it persisted. These findings suggest that some psychosocial measures are in fact associated with preterm birth.
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Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour
Article
  • Apr 2014
  • ARCH WOMEN MENT HLTH
Hardly any research has examined the link between postpartum anxiety disorder and maternal bonding. This study examined if postpartum anxiety disorder and maternal bonding are related in the postpartum period. Thereby, subclinical depressive symptoms and specific aspects of an anxious symptomatology were also taken into consideration. The German sample of N = 78 mother-infant dyads is composed of n = 30 mothers with postpartum anxiety disorders but without major or minor depression according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and n = 48 healthy mothers. Subjects were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months. Moreover, mothers filled out the Postpartum Bonding Questionnaire-16. The Anxiety Cognitions Questionnaire, the Body Sensations Questionnaire and the Mobility Inventory were chosen to assess different aspects of anxious symptomatology. To control for concurrent subclinical depressive symptoms, we used the German Edinburgh-Postnatal-Depression Scale. Mothers with postpartum anxiety disorder reported significantly lower bonding than healthy mothers. However, in a linear regression analysis, concurrent subclinical depressive symptoms and avoidance of anxiety-related situations in company explained 27 % of the overall variance in maternal bonding. The perceived lower bonding of mothers with anxiety disorder could be due to aspects of a concurrent subclinical depressive symptomatology. This notion emphasizes the need to target even mild depressive symptoms in the treatment of postpartum anxiety disorders. The outcomes also underline that the severity of anxious symptomatology, reflected by avoidance behaviour in company, puts the mother-infant bond at risk.
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