Mixed-Methods Assessment of Maternal Anxiety During the First 8 Weeks After Birth.

OBJECTIVE: To describe and compare the experiences of postpartum anxiety among women with generalized anxiety and postpartum-specific anxiety. DESIGN: Prospective, longitudinal, mixed methods. SETTING: Academic tertiary center in the mid-Atlantic United States. Study activities were remote. PARTICIPANTS: Women at 1 to 8 weeks after birth (N = 34). METHODS: We used mobile surveys to measure daily anxiety ratings and responses to open-ended, theory-driven questions about anxiety. We used the cutoff scores on the State-Trait Anxiety Inventory and Postpartum Specific Anxiety Scale administered 8 weeks after birth to determine the presence of generalized and postpartum-specific anxiety. Participants' responses were analyzed with qualitative description and sorted by anxiety questionnaire scores at 8 weeks after birth. We compared qualitative findings between participants with generalized anxiety and postpartum-specific anxiety. RESULTS: Participants with generalized anxiety had high levels of overwhelm and felt ill-equipped to handle daily stressors, whereas those with postpartum-specific anxiety felt adept at coping. Participants with generalized anxiety lacked emotional and physical support, and those with postpartum-specific anxiety reported more physical but variable emotional support. Sources of daily anxiety in participants with postpartum-specific anxiety were infant-centric (e.g., infant health, end of maternity leave, breastfeeding), whereas anxiety sources for participants with generalized anxiety were varied (e.g., self-health, partner concerns). Participants with generalized anxiety versus postpartum-specific anxiety were more likely to be multiparous and have comorbid depression symptoms. CONCLUSION: Symptoms, levels of perceived support, and sources of anxiety differed between participants with generalized versus postpartum-specific anxiety. Our findings can inform postpartum anxiety screening strategies and support interventions.

Descriptive Exploratory Study to Understand Postpartum Anxiety Using Multiple Measures.

OBJECTIVE: To compare a general anxiety instrument plus a depression instrument with a specific postpartum anxiety instrument plus a depression instrument to detect postpartum anxiety and to explore trends in daily postpartum anxiety. DESIGN: Prospective, longitudinal cohort study. SETTING: Academic tertiary center in the mid-Atlantic United States. Study activities were remote. PARTICIPANTS: Pregnant women (N = 73) in the third trimester of pregnancy. METHODS: We administered the State-Trait Anxiety Inventory (STAI), Postpartum Specific Anxiety Scale (PSAS), and Edinburgh Postnatal Depression Scale (EPDS) at 1 and 8 weeks after birth. We used mobile ecological momentary assessment prompts to measure daily anxiety levels (0-10) from 1 to 8 weeks after birth. We defined the presence of anxiety and depression by using the established instrument cutoff scores. We used repeated-measures analysis of variance and dependent-samples t tests to determine the stability of the determined anxiety instruments during the study time frame. We used linear mixed modeling to explore mobile ecological momentary assessment anxiety trends. RESULTS: The PSAS and EPDS detected more participants with anxiety and/or depression (26.8%, 19/71) than the STAI and EPDS (23.9%, 17/71) at 8 weeks after birth. PSAS scores increased from 1 to 8 weeks after birth (p = .003); STAI scores decreased (p = .01). Daily anxiety ratings changed nonlinearly during the study period, were greatest at 2 weeks, declined and stabilized, and then trended upward toward Week 8. CONCLUSION: Detection of postpartum anxiety in clinical settings can be improved through addition of the PSAS in routine screening. Timing of anxiety assessment should be considered between 6 to 8 weeks after birth.