Methods of Assessing Perinatal Anxiety (MAP) v1.0
Research type
Research Study
Full title
Methods of Assessing Perinatal Anxiety (MAP): The Effectiveness of Different Approaches
IRAS ID
274901
Contact name
Susan Ayers
Contact email
Sponsor organisation
City, University of London
Duration of Study in the UK
1 years, 6 months, 30 days
Research summary
Research Summary
Mental illness affects one in five women during pregnancy and the first year after birth. Depression and anxiety are most common but there is very little research on anxiety. Perinatal anxiety affects around 15% of women and leads to greater risk of premature birth, postnatal depression and long-term mental health and behaviour problems in their children. It is currently recommended that women are asked two questions about anxiety by their midwife. However, it is not known if these are the best questions to identify women who need treatment. To be useful the anxiety questionnaire must be: (1) acceptable to women; (2) effective at identifying women who require treatment and those who do not; (3) practical and easy to use in the NHS and other UK health services.
This application is part of a larger study (MAP - Methods of Assessing Perinatal Anxiety: The Acceptability, Effectiveness and Feasibility of Different Approaches). The MAP study aims to identify the most effective, acceptable and feasible method for assessing anxiety in women during pregnancy and after birth. We will address each of these important points through three connected Work Packages (WPs). We will compare four different anxiety questionnaires in NHS services in England and Scotland. We selected the questionnaires by looking at reviews of all the available evidence.
The current application is focused on Work Package 2 (WP2) of the MAP study. WP2 will identify the most effective questionnaire to identify women who need treatment. It will also establish the best time in pregnancy to ask women about anxiety in order to prevent long term problems. Women will complete the questionnaires three times in pregnancy and once after birth together with other questions about their health. Interviews will be carried out on a sub-sample (25%) to compare interview responses with questionnaire scores for accuracy.
Summary of Results
Mental illness affects one in five women during pregnancy and the first year after birth. Depression and anxiety are most common but there is very little research on anxiety. Perinatal anxiety affects around 15% of women and leads to greater risk of premature birth, postnatal depression and long-term mental health and behaviour problems in their children.
The MAP (Methods of Assessing Perinatal Anxiety) study aimed to find the best screening questionnaire to identify women with anxiety in pregnancy or after birth (perinatal). This summary is for Work Package 2 (WP2) of the MAP study, which identified the most effective questionnaires to identify women with perinatal anxiety who need treatment. The research was funded by the National Institute for Health and Care Research (NIHR), and conducted in collaboration by researchers at City, University of London (study sponsor) and the University of Stirling.
WP2 of the MAP study took place in England and Scotland between October 2020 and August of 2022. A total of 2,243 women took part in the study (89% from England, 11% from Scotland). The primary research objective for this work package was to determine the diagnostic accuracy of four different questionnaires (i.e. how effective they were at identifying women meeting the diagnostic criteria for an anxiety disorder). We selected the questionnaires by looking at reviews of all the available evidence, and conducting our own research. The questionnaires were the GAD-2/7, Whooley questions, CORE-10 and SAAS.Study participants completed the questionnaires and additional questions on their pregnancy and general health at 4 time points (3 during pregnancy and 1 in the early postnatal period). To address the primary research objective, we also conducted 408 diagnostic interviews with a sub-sample of participants. We subsequently compared the results from the four questionnaires to expert assessment using the diagnostic interview at all four time points.
Our findings indicated that two of the questionnaires we tested were the most accurate for identifying women with anxiety disorders. Specifically, these were the Stirling Antenatal Anxiety Scale (SAAS) and the Clinical Outcomes in Routine Evaluation (CORE-10). At the optimal cut-off scores identified, the SAAS had the highest sensitivity (probability of a questionnaire score indicating anxiety in someone who does have anxiety) and the CORE-10 had the highest specificity (probability of a questionnaire score indicating no anxiety in someone who does not have anxiety).We also examined the effectiveness of the four questionnaires in identifying women experiencing depression, and the CORE-10, SAAS, GAD-7 and Whooley all had acceptable diagnostic accuracy. We found that across all four time points the combined prevalence of anxiety disorders was 19.9%, corresponding approximately to one woman in five experiencing an anxiety disorder at some point during pregnancy or in the early postnatal period.
This study identified robust and effective methods of assessing perinatal anxiety and depression.Recommendations are that the CORE-10 or SAAS are used for assessment and identification of perinatal anxiety; and the CORE-10 or Whooley are used for assessment and identification of perinatal depression. The GAD-7 and GAD-2 did not perform well and optimal cut-offs were lower than currently used in clinical practice, so they are not recommended for use. This research can be used to inform clinical guidelines on assessment of perinatal anxiety and depression.
Patient and Public involvement (PPI) through our PPI co-applicants and colleagues has played a pivotal role in MAP and provided the research team with valuable support and feedback throughout the study. These advisors were Clare Thompson (Maternal Mental Health Change Agents, Scotland), Agnes Hann, Jennifer Holly and Rachael Leonard (NCT, England). They attended our regular core research team meetings and contributed to project planning, production of participant documents, responses to the impact of COVID-19, risk management, and routes for dissemination and publications.
Updates and further details about the MAP study, and the complementary MAP Alliance study, are available on the following website: https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbSsDQE0TCeWoYSDds9hGl6KkvDheJxeuOahI6ZLdir77pcNW_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YK-2FG1lglvKV6rlCtPQpQ9yPAzB3VWWrFDL-2FusALH6FHXOeCGnNLaKtld-2FnYQvsD2Li8lqyNr9TcJvxDIqbQb5tUoJ5ZXM9sHhw0vTADEhcm2gsjKPF3-2F0j5P0EIrK4RJry4vfHw0jRUxBgfCcnlVbaRE-2FMZmOLktxZHfFikAqDFBA-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7C86e84ba51ed94186deb108dba8a09862%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638289179939876242%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=10%2FPZQR3ELcLYt%2FL7RvI3SxVtKRFFeoCTD3A%2BNsYsKI%3D&reserved=0
REC name
West of Scotland REC 3
REC reference
20/WS/0065
Date of REC Opinion
30 Apr 2020
REC opinion
Favourable Opinion