Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature.

Childhood abuse can have long-term adverse outcomes in adulthood. These outcomes may pose a particular threat to the health and well-being of perinatal women; however, to date, this body of knowledge has not been systematically collated and synthesized. This systematic review examined the child abuse literature and a broad range of perinatal outcomes using a comprehensive search strategy. The aim of this review was to provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Following PRISMA guidelines, EBSCO, PsychInfo, Scopus, Medline, CINAHL, PubMed, and Google Scholar databases and gray literature including preprints, dissertations and theses were searched for literature where childhood abuse was associated with any adverse perinatal outcome between 1969 and 2022. Exclusion criteria included adolescent samples, abuse examined as a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Using an assessment tool, two reviewers extracted and assessed the methodological quality and risk of bias of each study. From an initial 12,384 articles, 95 studies were selected, and the outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. The prevalence of childhood abuse ranged from 5-25% with wide variability (physical 2-78%, sexual 2-47%, and emotional/psychological 2-69%). Despite some consistent findings relating to psychological outcomes (i.e., depression and PTSD), most evidence was inconclusive, effect sizes were small, or the findings based on a limited number of studies. Inconsistencies in findings stem from small sample sizes and differing methodologies, and their diversity meant studies were not suitable for a meta-analysis. Research implication include the need for more rigorous methodology and research in countries where the prevalence of abuse may be high. Policy implications include the need for trauma-informed care with the Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model a useful framework. This review highlights the possible impacts of childhood abuse on perinatal women and their offspring and areas of further investigation. This review was registered with PROSPERO in 2021 and funded by an internal grant from Charles Sturt University.

Intimate Partner Violence Risk Factors: A Vulnerability-Adaptation Stress Model Approach.

Intimate partner violence (IPV) disproportionally affects women. Using the vulnerability-adaptation stress model, we examined adverse childhood experiences (ACEs), self-esteem, and hope as vulnerability indicators and relationship status and length, positive and negative affect, and socioeconomic status (SES) as stressors to ascertain the risk for IPV. Women (N = 491, M = 37.15, standard deviation = 12.51) completed an online survey comprised of the Positive and Negative Affect Scale, Rosenberg's Self-esteem Scale, Snyder's Hope Scale, ACE questionnaire, Composite Abuse Scale Revised-Short Form, and demographic questions. Factor analysis identified four ACE factors of sexual abuse, physical or psychological abuse, witnessing domestic violence, and household dysfunction. A five-step hierarchical multiple regression identified that greater exposure to physical or psychological child abuse was associated with an increased risk of IPV (Step 2), B = 0.73 [0.16, 1.34]. Lower self-esteem, B = -0.30 [-0.47, -0.14] predicted IPV (Step 3). Age B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length, B = -1.24 [-2.16, 0.41] were associated with a higher risk of IPV (Step 4). In Step 5, previous variables attenuated to non-significance while age, B = 0.07 [0.01, 0.13], negative affect, B = 0.39 [0.19, 0.59], and relationship length B = -1.25 [-2.16, 0.41] remained significant. While the key findings of this study were inconsistent with some commonly reported findings (e.g., ACEs, self-esteem, hope, relationship status, SES, age), these inconsistencies are important to highlight given the factorial approach to examining ACEs, the comprehensive analyses conducted, and our examination of these variables' direct relationship to IPV. The study was limited by its cross-sectional nature, higher prevalence of IPV victims, and not examining IPV sub-types. Similar studies need to be conducted for other relationship types and victimized individuals (e.g., same-sex relationships and male victims) to provide a complete picture of risk factors for IPV.

Examining the relationship between maternal childhood abuse history and mother-infant bonding: The mediating roles of postpartum depression and maternal self-efficacy.

BACKGROUND: The detrimental effects of childhood abuse on long-term outcomes are well-known, however few studies have examined these effects in the context of postpartum psychopathology, maternal self-efficacy, and mother-infant bonding quality. OBJECTIVE: This study aimed to examine the relationship between a maternal childhood abuse experience (i.e., physical, psychological, and sexual) and mother-infant bonding disturbances, and whether this relationship was mediated by postnatal depression symptomatology and maternal self-efficacy. METHOD: A sample of 191 postpartum women (Mage = 32.88, SD = 4.20) recruited online from the general population completed self-report measures of the constructs of interest. RESULTS: Postnatal depression symptomatology and maternal self-efficacy were found to fully mediate the relationship between psychological child abuse experience and mother-infant bonding disturbances (ß = 0.06, SE = 0.03, 95% CI: 0.01, 0.12). Postnatal depression symptomatology (but not maternal self-efficacy) was an independent mediator between psychological child abuse experience and mother-infant bonding (ß = 0.07, SE = 0.03, 95 % CI: 0.01, 0.13). After inclusion of other abuse types as covariates in the analyses, the findings for maternal child physical abuse attenuated to non-significance. Child sexual abuse was not associated with the mediating or outcome variables, highlighting the issue of disclosure despite the anonymous online environment. CONCLUSION: This study highlights the negative impact of psychological childhood abuse experience on the quality of the mother-infant bond during the postpartum period and potential pathways that underlie this relationship. This study also draws attention to the need to recognize comorbidity of abuse types in research.

Validation of the German version of the pregnancy-related anxiety scale (PrAS): psychometric properties across all trimesters of pregnancy.

BACKGROUND: Pregnancy-related anxiety has received greater research attention recently given its association with adverse outcomes (e.g., negative birth experiences). The Pregnancy-related Anxiety Scale (PrAS) offers the possibility to assess pregnancy-related anxiety, but no German version is available. Therefore, the aim of this study was to validate a German version of the PrAS, a comprehensive measure with eight dimensions. METHODS: Pregnant women of any parity or gestation completed an online survey consisting of the PrAS, PRAQ-R2, and measures of anxiety, depression, and resilience. The PrAS was translated into German (PrAS-G) using the back-translation method. Data were subjected to confirmatory factor analysis and inferential statistics. RESULTS: Complete data were provided by 443 women. Participants were predominantly German nationals, partnered, and well-educated with a planned pregnancy. Approximately half were nulliparous. The eight-factor model was well fitting and consistent with the development of the original PrAS. Criterion-related validity was demonstrated by strong correlations with similar measures (PRAQ-R2, anxiety, and depression) and lower correlations with resilience scores. Predictive validity was shown by group comparisons for: planned versus unplanned pregnancy, trimester, and parity. CONCLUSIONS: The PrAS-G provides a broader assessment of pregnancy-related anxiety than existing measures. Initial evaluation has demonstrated convergent, divergent, and predictive validity, excellent internal consistency, and good model fit indicating promising psychometric properties. The PrAS-G offers a comprehensive assessment of pregnancy-related anxiety which will enable tailored interventions aiming to improve birth experience and well-being of expectant mothers.

Development and Psychometric Evaluation of the IPV Internalized Stigma Scale.

Self-stigma is the internalization of widespread and negative attitudes around a devalued attribute. Being a victim of intimate partner violence (IPV) is a stigmatized identity, with IPV self-stigma is a potential barrier to help seeking. The lack of an IPV self-stigma scale limits current measurement of this latent trait; this study sought to fill this gap. We developed the IPV Internalized Self-stigma Scale (IPVIS) by revising existing self-stigma and devaluation/discrimination measures and adding new items to fill perceived gaps. Using an online survey, a diverse sample (N = 455, M = 39.51, SD = 12.03) with various relationship types (e.g., heterosexual, same-sex), IPV circumstances (e.g., male or female perpetrators/victims) and different gender and sexual identities was recruited. Participants first completed the item pool (44-items), followed by measures of IPV, anxiety, depression, social health, and self-efficacy with data analyzed using a multi-model approach (e.g., factor analysis, item response theory [IRT]). Factor analyses revealed one dominant factor; IRT analyses further refined the unidimensional item set. The final 11 items had high internal consistency, ω = .90, 95% CI [0.89, 0.91], and were highly informative with moderate to high discrimination levels. The IPVIS demonstrated measurement invariance by demographics, showing no differential item functioning by age groups, sex, residence (urban/suburban/rural), ethnicity (European/Caucasian vs. others), or relationship status (partnered/unpartnered). Initial validity examination revealed significant correlations between the IPVIS and related measures (e.g., depression, anxiety, social health). The IPVIS is suitable for research and has widespread clinical applicability. To the best of our knowledge, the IPVIS is the first scale developed that assesses IPV self-stigma inclusive of a diverse range of clients/participants, relationship types, and IPV circumstances.

Child abuse and wellbeing: Examining the roles of self-compassion and fear of self.

INTRODUCTION: Childhood abuse is linked to poorer well-being, yet some survivors show no prolonged effect, suggesting multifinality. Men and women also differ in the experience and sequelae of abuse supporting gender-specific analyses. To assist in circumventing poor outcomes associated with child abuse, this study examined fear of self (FoS) and self-compassion (SC) as risk and protective factors between child abuse and well-being. METHOD: Australian women (N = 1302, Mage = 47.28 [13.63]) completed an online assessment of childhood abuse, psychological distress, perceived quality of life, SC, FoS. Moderated-moderation examined the different abuses as predictors of psychological distress and quality of life (QoL) and FoS and SC as primary and secondary moderators, respectively. RESULTS: Physical abuse did not predict psychological distress or QoL. FoS and SC were independent predictors of distress and QoL. Similarly, childhood sexual abuse was not found to predict distress or QoL. FoS and SC were independent predictors of distress and QoL. There was also an interaction between childhood sexual abuse and SC in predicting QoL. A moderated-moderation was found for the relationship between child sexual abuse and distress. Psychological abuse predicted distress and QoL, and FoS and SC both moderated this relationship. Moreover, a moderated-moderation was observed for the relationship between psychological abuse and QoL. CONCLUSIONS: Greater FoS is associated with poorer outcomes for child abuse survivors; SC may mitigate this impact. Psychological abuse was the strongest predictor of well-being. Interventions that increase SC and raise awareness of psychological abuse and its impacts are needed.

Screening for Pregnancy-Related Anxiety: Evaluation of the Pregnancy-Related Anxiety Scale-Screener Using Rasch Methodology.

Pregnancy-related anxiety has been linked to many maternal and child-related negative outcomes. However, there is an absence of free, well-validated screeners for this condition. The Pregnancy-related Anxiety Scale-Screener (PrAS-Screener) was evaluated using robust Rasch methodology. This study also aimed to develop a shorter version to meet the need of settings governed by professional guidelines stipulating the use of brief instruments. Data from 400 pregnant women (Mage = 27.82, SD = 5.38) were subjected to Rasch analyses and the resulting Rasch models confirmed in a second sample (N = 400, Mage = 26.29, SD = 4.95). After minor modifications, the original 15-item PrAS-Screener demonstrated good fit, unidimensionality, excellent targeting, invariance, and internal consistency. After removal of items with content overlap, an 11-item version was developed, with this version showing good fit, unidimensionality, reasonable targeting, and sound internal consistency. The PrAS-Screeners show promise as psychometrically sound clinical scales for screening pregnancy-related anxiety.

Paternal pregnancy-related anxiety: Systematic review of men's concerns and experiences during their partners' pregnancies.

BACKGROUND: Up to 25 % of expectant parents experience anxiety symptoms. Pregnancy-related anxiety is characterised by concerns and worries specific to pregnancy, childbirth, and the transition to parenthood. While pregnancy-related anxiety is well-researched in women, the exact nature of this construct in men is unclear. The purpose of the current review was to examine men's concerns, worries, and fears during pregnancy and gain an understanding of their experiences during pregnancy. METHODS: An integrative review design was adopted, using thematic content analysis to synthesise findings from quantitative and qualitative studies. Quality appraisal of the quantitative studies used the AXIS appraisal tool. The Critical Appraisal Skills Program (CASP) checklist was used for the qualitative studies. RESULTS: A comprehensive search of nine databases led to inclusion of 14 quantitative and 41 qualitative studies. Ten dimensions of paternal pregnancy-related anxiety were identified: childbirth concerns, attitudes towards childbirth, baby concerns, acceptance of pregnancy, partner concerns, relationship concerns, worry about self, transition to parenthood, attitudes towards health care professionals, and practical and financial concerns. The pregnancy transition was characterised by mixed emotions and conflicted experiences for fathers. LIMITATIONS: Generalizability of review findings was limited by poor reporting of demographic information by many included studies, exclusion of studies not published in English, and focus on heterosexual relationships. CONCLUSIONS: Expectant fathers may experience anxiety symptoms characterised by excessive worry across multiple domains of pregnancy-related concerns. Clinicians play an important role in identifying and supporting fathers with pregnancy-related anxiety and addressing the sense of exclusion often experienced by them.

The role of body dissatisfaction and self-compassion in pregnancy-related anxiety.

BACKGROUND: Women undergo significant physical, physiological, and psychological changes during pregnancy. They are also exposed to sociocultural pressure to meet appearance-related ideals. These pregnancy-related changes and sociocultural appearance-related pressures may place pregnant women at greater vulnerability to developing body dissatisfaction and psychological distress. To date, however, little is known about how sociocultural pressure may influence pregnancy-related anxiety, or factors that may protect against such distress during pregnancy. This study examined whether body dissatisfaction mediated the relationship between appearance-related sociocultural pressure and pregnancy-related anxiety, and whether this relationship was moderated by self-compassion and/or self-criticism. METHOD: A cross-sectional sample of 253 pregnant women (Mage = 26.28, SDage = 4.43) completed an online questionnaire measuring sociocultural pressure, body dissatisfaction, pregnancy-related anxiety, and self-compassion. RESULTS: Moderated mediation analyses revealed body dissatisfaction fully mediated the relationship between sociocultural pressure and pregnancy-related anxiety. Analyses confirmed the moderating role of self-compassion and self-criticism on the relationship between sociocultural pressure and body dissatisfaction, but not on the relationship between body dissatisfaction and pregnancy-related anxiety. LIMITATIONS: The cross-sectional nature of this study limits confirmation of the direction of relationships between sociocultural pressure, body dissatisfaction and pregnancy-related anxiety. CONCLUSIONS: While the findings of this study need to be replicated in prospective and longitudinal studies, they suggest that sociocultural pressure to meet appearance-related standards contribute to body dissatisfaction, which in turn may facilitate pregnancy-related anxiety. Self-compassion may protect the body image of pregnant women against negative effects of appearance-related sociocultural pressure.

Psychometric properties of the Pregnancy-Related Anxiety Scale-Screener.

Pregnancy-related anxiety, a distinct anxiety characterized by pregnancy-specific concerns, has consistently been associated with adverse birth outcomes and obstetric and pediatric risk factors. Despite this, widespread screening for pregnancy-related anxiety has not been integrated into routine antenatal care likely due to the absence of a psychometrically sound screener. This study reports on the initial development of a brief screener derived from the 32-item pregnancy-related anxiety scale (PrAS). Three datasets (comprising pregnant women recruited online) were utilized in the development and evaluation of the PrAS screener (PrAS-Screener). Dataset one (N = 1,084) was used to derive two potential screeners from the PrAS using principal axis factoring (PAF). The factor structure of the models was evaluated using PAF and model fit assessed with confirmatory factor analysis (CFA) using datasets two (N = 638) and three (N = 581). The model comprised 15 items and five subscales was selected as the superior model. The selected model (i.e., PrAS-Screener) was evaluated for convergent and discriminant validity demonstrating higher correlations with similar measures and lower correlations with dissimilar measures and high internal consistency reliability (α = .93). The PrAS-Screener assesses the three core areas of pregnancy-related anxiety (childbirth, body image, baby concerns) but has the advantage of also assessing anxiety symptoms and medical staff concerns, an area integral to providing optimal antenatal care through trusted relationships with clinicians. Initial evidence indicates that the PrAS-Screener is promising as a brief and easy-to-administer screener suitable for use in routine antenatal care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Childhood abuse, pregnancy-related anxiety and the mediating role of resilience and social support.

Physical, sexual and psychological abuse were examined as risk factors for pregnancy-related anxiety with resilience and social support as mediators. Pregnant women (n = 638) completed measures of pregnancy-related anxiety, resilience, perceived social support and childhood abuse. Women with an abuse history had higher pregnancy-related anxiety scores (m = 64.40) than other women (m = 55.36). All abuse types independently predicted pregnancy-related anxiety; resilience and social support were mediators. Results highlight the value of antenatal screening for pregnancy-related anxiety including specific risk factors such as child abuse. Programs such as the Midwife Continuity of Care are useful in encouraging disclosure.

Sexual violence and Australian women: A longitudinal analysis of psychosocial and behavioral outcomes.

RATIONALE: Sexual violence (SV) is associated with adverse psychosocial and behavioural outcomes with revictimization likely. However, there are significant gaps in the current literature in regard to (a) whether over time women's levels of distress/behaviour change, and (b) whether social support mediates the relationship between SV and adverse outcomes. METHODS AND RESULTS: This study aimed to address these two issues by analysing data from the Australian Longitudinal Women's Health Survey, surveys 4 (2006) to 8 (2018). Using repeated-measures data analytic procedures we found that women who had suffered SV, in comparison to women with no SV history, had greater anxiety, depression, stress, a lower mental health-related quality of life and less life satisfaction. Moreover, their level of distress remained higher at all time points, in comparison to the other group. Women with a SV history were also more likely to suffer re-victimization, consume more cigarettes and illicit drugs than other women. Moreover, SV predicted all psychosocial outcomes (except life satisfaction) 12 years later, with social support mediating these relationships. SV predicted drug status; however social support did not mediate this relationship. CONCLUSIONS: These findings suggest that for women who have experienced SV their distress levels remain elevated. The findings also provide additional insights into the long-term impact of SV in Australian women with social support being identified as a resource that may assist in reducing some of the negative psychological outcomes associated with SV.

Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature.

BACKGROUND: Child sexual abuse is related to many negative outcomes but less known is the effect on pregnancy and childbirth. OBJECTIVE: This review critically examined the literature on the occurrence of child sexual abuse and outcomes associated with this abuse during pregnancy and childbirth. METHODS: Five databases were searched over 50 years using an iterative approach and the terms pregnancy, sexual abuse/assault, childbirth/labour, identifying 49 studies. RESULTS: The prevalence of child sexual abuse in pregnant women ranged from 2.63% to 37.25 with certain characteristics more common with a higher (e.g., specific questions, low income) or lower (broad questions, higher education) prevalence. Compared to women with no history of abuse, child sexual abuse survivors may have more concerns with their care, greater health complaints, fear childbirth and have difficulties with delivery. They also had a higher likelihood of PTSD symptomology and anxiety, consumed more harmful substances (e.g., alcohol, cigarettes, and drugs) and had greater concerns with their appearance, poorer health, sleep and may also have a higher risk of re-victimisation. CONCLUSIONS: The balance of evidence suggests that compared to non-abused women, women with a child abuse history have more adverse experiences with pregnancy, childbirth, and care, with their abuse history, likely contributes to harmful behaviours and psychopathology. However, variability in operationalisation and measurement of abuse may contribute to these findings so tentative conclusions are drawn. Future research should examine the generalisability of the findings (relating to scale limitations) and recommendations for screening (e.g., sensitive items, scoring). Clinical implications of the findings point to the need for early identification of women with a child abuse history as such women require trauma-sensitive care and consideration. A useful tool is the Pregnancy-related Anxiety Scale which provides insights into specific areas of concern.

Psychometric evaluation of the pregnancy-related anxiety scale: Acceptance of pregnancy, avoidance, and worry about self subscales.

BACKGROUND: Increasingly pregnancy-related anxiety is acknowledged as a distinct anxiety type, characterised by specific fears/worries. The Pregnancy-related Anxiety Scale (PrAS) screens for this distinct anxiety and refinements to the scale have prompted further validity examination. This study aims to: replicate findings that distinguished pregnancy-related anxiety from general anxiety/depression using the PrAS; confirm the PrAS's factor structure, and examine the validity of the PrAS subscales: Acceptance of Pregnancy, Avoidance and Worry About Self. METHODS: Pregnant women (N = 608) were recruited online and completed the PrAS, Pregnancy Acceptance Questionnaire, Ways of Coping Questionnaire, Cambridge Worry Scale, Parenting Sense of Competence Scale, State Trait Anxiety Inventory and the Edinburgh Depression Scale. RESULTS: Multiple regression analysis confirmed general anxiety/depression contributed little to the PrAS's variance, supporting the scale's validity and distinctiveness of pregnancy-related anxiety. Structural equation modelling confirmed the PrAS's factor structure, and the three PrAS subscales generally correlated more highly with convergent measures than the discriminant measures. LIMITATIONS: Limitations included the cross-sectional design of the study and the use of some convergent/discriminant measures that lacked validity evidence for prenatal use. CONCLUSIONS: This study provides evidence of the distinctiveness of pregnancy-related anxiety from state/trait anxiety and depression and also adds to the psychometric properties of the PrAS. The PrAS is a useful screening scale that can be used for antenatal screening potentially reducing the risk of adverse outcomes associated with pregnancy-related anxiety. The PrAS is also a useful research tool providing a more comprehensive assessment of pregnancy-related anxiety.

Pregnancy-Related Anxiety, Perceived Parental Self-Efficacy and the Influence of Parity and Age.

Pregnancy-related anxiety is contextualised by pregnancy and is a health concern for the mother and child. Perceived parental self-efficacy is associated with this anxiety and age and parity are identified as influential factors. This research, therefore, predicted that negative perceptions of parental self-efficacy would predict greater pregnancy-related anxiety, moderated by parity and age. Participants (N = 771) were recruited online and assessed for perceived parental self-efficacy, pregnancy-related anxiety, and demographics. Moderation models showed that the psychosocial and sociodemographic factors combined predicted up to 49% of the variance. Parental self-efficacy predicted anxiety in the areas of body image, worry about themselves, baby concerns, pregnancy acceptance, attitudes towards medical staff and childbirth, and avoidance. Parity predicted pregnancy-related anxiety both overall and in childbirth concerns, worry about self, baby concerns and attitudes towards childbirth. Age predicted baby concerns. There was a significant moderation effect for pregnancy acceptance indicating that primiparous women with low perceptions of parental self-efficacy are less accepting of their pregnancy. Results suggest that parity and parental self-efficacy may be risk factors for first-time mothers for pregnancy-related anxiety.

Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress.

BACKGROUND: During pregnancy, women are vulnerable to mood and anxiety disorders due to the significant physical and emotional changes that occur during this period. For some women, pregnancy can also present as a period of immense body dissatisfaction due to the substantial changes in body shape and size. OBJECTIVES: This study examined the mediating role of Fat Talk (i.e., engaging in disparaging comments about one's body shape and size with others) in the relationship between (a) body dissatisfaction and distress in pregnant women (i.e., pregnancy-related anxiety, depression and eating disorder symptomatology), and (b) sociocultural pressure to meet the thin ideal and distress. METHOD: A nonclinical sample of 408 pregnant women (Mage = 28.24 years, SDage = 5.04, range 18-44 years) completed measures of body dissatisfaction, sociocultural pressure, pregnancy-related anxiety, depression and eating disorder symptomatology. FINDINGS: Analyses confirmed the partial mediating role of Fat Talk between body dissatisfaction and all three measures of distress, when examined individually. Fat Talk also mediated the relationship between sociocultural pressure (i.e., peers/family and media) and the three measures of distress. Age also partially mediated the relationship between body dissatisfaction and a composite measure of pregnancy distress. CONCLUSIONS: The results suggest that women face sociocultural pressures for thinness and body dissatisfaction even when pregnant, and that engaging in Fat Talk contribute to greater levels of pregnancy-related anxiety, depression and eating disorder symptomatology. The role of Fat Talk in regard to pregnancy distress may be more pertinent to younger women.

Re-examining pregnancy-related anxiety: A replication study.

BACKGROUND: Recognition of pregnancy-related anxiety as a distinct anxiety is supported by evidence differentiating it from general anxiety and depression. Adverse associations with pregnancy-related anxiety further support this distinction. An influential study by Huizink et al. (2004), demonstrated that anxiety and depression contribute little to the variance of pregnancy-related anxiety, yet this study has not been replicated. Further, addressing limitations of the original study will provide further clarity to the findings. METHODS: Participants (N=1209), were recruited online and completed three scales: pregnancy-related anxiety, general anxiety and depression. Multiple regression assessed the unique contribution of general anxiety and depression (predictors) to pregnancy-related anxiety scores (criterion) for each trimester. RESULTS: Across pregnancy, general anxiety and depression explained only 2-23% of the variance in the pregnancy-related anxiety scores. Anxiety and depression showed small unique contributions for some trimesters and specific areas of concern, ranging from 2 to 11%. Comparisons to the original Huizink study showed most results were comparable. CONCLUSIONS: The methodology and more detailed analyses employed addressed noted limitations of the Huizink study. Findings that the contribution of general anxiety and depression to the variance in pregnancy-related anxiety scores was low, supports previous conclusions that pregnancy-related anxiety is a discrete anxiety type. Recognition of this unique anxiety (associated with many deleterious outcomes) may provide opportunity for prenatal screening/early intervention, potentially resulting in improved pregnancy outcomes. Limitations include no exclusion of women deemed as high-risk pregnancy and the pregnancy-related anxiety scale limited in its ability to fully assess this anxiety type.

The initial development of the Pregnancy-related Anxiety Scale.

PROBLEM/BACKGROUND: Pregnancy-related anxiety is a distinct anxiety characterised by pregnancy-specific concerns. This anxiety is consistently associated with adverse birth outcomes, and obstetric and paediatric risk factors, associations generally not seen with other anxieties. The need exists for a psychometrically sound scale for this anxiety type. This study, therefore, reports on the initial development of the Pregnancy-related Anxiety Scale. METHODS: The item pool was developed following a literature review and the formulation of a definition for pregnancy-related anxiety. An Expert Review Panel reviewed the definition, item pool and test specifications. Pregnant women were recruited online (N=671). RESULTS: Using a subsample (N=262, M=27.94, SD=4.99), fourteen factors were extracted using Principal Components Analysis accounting for 63.18% of the variance. Further refinement resulted in 11 distinct factors. Confirmatory Factor Analysis further tested the model with a second subsample (N=369, M=26.59, SD=4.76). After additional refinement, the resulting model was a good fit with nine factors (childbirth, appearance, attitudes towards childbirth, motherhood, acceptance, anxiety, medical, avoidance, and baby concerns). Internal consistency reliability was good with the majority of subscales exceeding α=.80. CONCLUSIONS: The Pregnancy-related Anxiety Scale is easy to administer with higher scores indicative of greater pregnancy-related anxiety. The inclusion of reverse-scored items is a potential limitation with poorer reliability evident for these factors. Although still in its development stage, the Pregnancy-related Anxiety Scale will eventually be useful both clinically (affording early intervention) and in research settings.

The pregnancy-related anxiety scale: A validity examination using Rasch analysis.

BACKGROUND: Pregnancy-related anxiety is increasingly recognised as a common condition that is associated with many deleterious outcomes for both the mother and infant (e.g., preterm birth, postnatal depression). Limitations in the psychometric properties and/or breadth of existing scales for pregnancy-related anxiety highlight the need for a psychometrically sound measure to facilitate effective screening and possible early interventions. The recently developed Pregnancy-related Anxiety Scale (PrAS) was evaluated using Rasch analysis to explore how the scale's psychometric properties could be fine-tuned. METHOD: A sample of 497 pregnant women completed the PrAS. Data were subjected to Rasch analysis, and the resulting scale structure examined using Confirmatory Factor Analysis. RESULTS: After minor modifications, the Rasch model with 33-items and 8-factors demonstrated good fit, unidimensionality and excellent targeting and internal consistency. Confirmatory Factor Analysis confirmed the final structure, and Cronbach's alpha demonstrated excellent reliability. LIMITATIONS: The use of the same sample for all analyses was a potential limitation due to the possibility of sample-specific influences. CONCLUSIONS: The Rasch analysis further supports the internal construct validity of the PrAS. Ordinal to interval score conversions provide added precision to the analysis of the PrAS scores. The Rasch results, together with previous validation evidence, point to the PrAS as a comprehensive and psychometrically sound screening scale for pregnancy-related anxiety. The PrAS offers clinicians the ability to screen for pregnancy-related anxiety. The subscales provide additional insights into a woman's pregnancy-related anxiety and her specific areas of concern, enabling more targeted interventions.

Pregnancy anxiety: A systematic review of current scales.

BACKGROUND: Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap. METHODS: Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified. RESULTS: Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale's strengths and limitations were discussed. LIMITATIONS: Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties. CONCLUSIONS: Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.