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Assessment of perinatal anxiety: diagnostic accuracy of five measures

Ayers, S. ORCID: 0000-0002-6153-2460, Coates, R., Sinesi, A. , Cheyne, H., Maxwell, M., Best, C., McNicol, S., Williams, L. R., Uddin, N., Hutton, U., Howard, G., Shakespeare, J., Walker, J. J., Alderdice, F. & Jomeen, J. (2024). Assessment of perinatal anxiety: diagnostic accuracy of five measures. The British Journal of Psychiatry, 224(4), pp. 132-138. doi: 10.1192/bjp.2023.174


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.

To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective).

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).

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.

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.

Publication Type: Article
Additional Information: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited. Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists
Publisher Keywords: Anxiety or fear-related disorders, depressive disorders, diagnostic accuracy, perinatal psychiatry, rating scales
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RG Gynecology and obstetrics
Departments: School of Health & Psychological Sciences
School of Health & Psychological Sciences > Midwifery & Radiography
SWORD Depositor:
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