Assessment of perinatal anxiety: diagnostic accuracy of five measures.

BACKGROUND: Anxiety in pregnancy and after giving birth (the perinatal period) is highly prevalent but under-recognised. Robust methods of assessing perinatal anxiety are essential for services to identify and treat women appropriately. AIMS: To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective). METHOD: We conducted a prospective longitudinal cohort study of 2243 women who completed five measures of anxiety and depression (Generalized Anxiety Disorder scale (GAD) two- and seven-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS)) during pregnancy (15 weeks, 22 weeks and 31 weeks) and after birth (6 weeks). To assess diagnostic accuracy a sample of 403 participants completed modules of the Mini-International Neuropsychiatric Interview (MINI). RESULTS: The best diagnostic accuracy for anxiety was shown by the CORE-10 and SAAS. The best diagnostic accuracy for depression was shown by the CORE-10, SAAS and Whooley questions, although the SAAS had lower specificity. The same cut-off scores for each measure were optimal for identifying anxiety or depression (SAAS ≥9; CORE-10 ≥9; Whooley ≥1). All measures were psychometrically robust, with good internal consistency, convergent validity and unidimensional factor structure. CONCLUSIONS: This study identified robust and effective methods of assessing perinatal anxiety and depression. We recommend using the CORE-10 or SAAS to assess perinatal anxiety and the CORE-10 or Whooley questions to assess depression. The GAD-2 and GAD-7 did not perform as well as other measures and optimal cut-offs were lower than currently recommended.

Working memory period: the endurance of mental representations.

Working memory span assesses the maximum number of items that can be remembered in the face of concurrent processing. Models of working memory differ on several dimensions, yet many rely exclusively on this span procedure for their evidence. Three experiments consider an alternative paradigm that attempts to capture the endurance limits for remembering a fixed number of items during concurrent processing. Eight-year-old children performed two versions of this working memory period measure--operation period and reading period. Period scores show healthy test-retest reliability and external validity for scholastic attainment, comparing well with span scores in these respects. In addition, period is highly correlated with span and shows similar effects of varying the order in which stimuli are presented. We conclude that the durability of representations is an important factor in both span and period.

On the nature of the relationship between processing activity and item retention in children.

The concept of working memory emphasizes the interrelationship between the transient retention of information and concurrent processing activity. Three experiments address this relationship in children between 8 and 17 years of age by examining forgetting when a processing task is interpolated between presentation and recall of the memory items. Unlike previous studies, delivery of interpolated stimuli was under computer control and responses to these stimuli were timed. There were consistent effects of the duration of the interpolated task, but no effects of either its difficulty or similarity to memory material and no qualitative developmental differences in task performance. The absence of an effect of difficulty provides no support for models of working memory in which limited capacity is shared between the dual functions of processing and storage, but is compatible with an alternative "task switching" account. However, task switching did not explain developmental differences in recall. Other aspects of the results suggest that there can be interactions between processing and storage but it is argued that these cannot be straightforwardly explained in terms of either task switching or resource sharing.

Short-term memory and working memory as indices of children's cognitive skills.

In the current literature, empirical and conceptual distinctions have been drawn between a more or less passive short-term memory (STM) system and a more dynamic working memory (WM) system. Distinct tasks have been developed to measure their capacity and research has generally shown that, for adults, WM, and not STM, is a reliable predictor of general cognitive ability. However, the locus of the differences between the tasks has received little attention. We present data from children concerning measures of matrices reasoning ability, reading, and numerical skill along with forward and backward order serial recall of WM, STM, and STM with articulatory suppression tasks. As indices of children's cognitive skills, STM and WM are shown to be rather similar in terms of memory per se. Neither the opportunity for rehearsal nor task complexity provides satisfactory explanations for differences between memory tests.