Behavioral Health

Postpartum anxiety: More common than you think

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References

SCREENING FOR POSTPARTUM ANXIETY

Screening for perinatal depression has become standard of care, and the Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument.1 The EPDS, a 10-question self-report scale, was created and validated to screen for perinatal depression, with a cutoff of > 10/30 usually considered a positive result.

Researchers have investigated the utility of the EPDS as a screening tool for perinatal anxiety as well.21-23 These studies show some promise, but there are questions as to whether a total score or a subscale score of the EPDS is most accurate in detecting anxiety. Women with perinatal anxiety may score low on the total EPDS, yet score higher on 3 anxiety-specific questions (TABLE 123). For this reason, several studies propose an EPDS anxiety subscore or subscale (referred to as EPDS-3A).

EPDS-3A subscale: Questions 3-5 from the Edinburgh Postnatal Depression Scale

Of note, there are some women who will score high on the subscale who do not ultimately meet the criteria for an anxiety disorder diagnosis. Clinicians should not over-interpret these scores and should always use sound clinical judgment when making a diagnosis.

Research has also focused on using the GAD 7-item (GAD-7) scale (TABLE 224),25 and on the development of new tools and screening tools designed specifically for perinatal anxiety, including the Postpartum Worry Scale26 and the Postpartum Specific Anxiety Scale (PSAS).27

Generalized Anxiety Disorder 7-item (GAD-7) scale

Family physicians may consider using the EPDS subscale if they are already using the EPDS, or adding the GAD-7 as a separate screening instrument during a postpartum visit. To date there is no one standard recommendation or screening tool.

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