Development and Validation of a Scale to Measure Anxiety Specific to Pregnancy During the COVID-19 Pandemic: The Antenatal COVID-19 Anxiety Scale.

Objective: In the context of the coronavirus disease 2019 (COVID-19) pandemic, anxiety during pregnancy should be assessed from a composite context of anxiety/fear of COVID-19 infection and pregnancy-specific anxiety. The objective of this study was to develop and validate a scale that measures anxiety related to situations specific to pregnancy during the COVID-19 pandemic-the Antenatal COVID-19 Anxiety (AnCAn) Scale.Methods: Items were generated based on a literature review and focused group discussions. Face and content validation was completed. Data were collected from 557 pregnant women attending antenatal clinics of 5 tertiary care general hospitals in India. An exploratory factor analysis was conducted to measure structural validity and to identify latent factors. Screening accuracy was assessed using scores on the 7-item Generalized Anxiety Disorder scale. Data were collected between July and October 2020.Results: The principal component analysis showed that the 12 items of the scale significantly loaded onto 2 latent factors, with Eigen values of 6.575 and 1.213, respectively. Factor solution showed that 6 items correlated with each of the 2 factors. Both sensitivity and specificity of AnCAn total and subscores were > 70%.Conclusions: We conclude that the AnCAn Scale holds good psychometric properties, and it identifies and distinguishes 2 latent factors: (1) anxiety related to acquiring infection and (2) anxiety related to spreading infection and social role obligations, which are compositely related to anxiety specific to COVID-19 and pregnancy.

Anxiety among pregnant women during the COVID-19 pandemic in India - A multicentric study.

While higher anxiety during antenatal period cause several maternal and foetal health related complications, lower anxiety levels are found to be associated with lesser "precautionary behaviours" and consequently greater risk of infection, during the COVID-19 pandemic. In this study, we aimed to assess rates and determinants of generalized anxiety at the time of the pandemic as well as anxiety that was specific to the context of being pregnant during the COVID-19 pandemic. (COVID-19-antenatal anxiety) in Indian women. This hospital-based, cross-sectional study using face-to-face interviews was conducted at antenatal clinics of five medical college hospitals in India. The Generalized Anxiety Disorder-7 scale (GAD -7) and a customized scale to assess antenatal COVID-19 anxiety along with other tools that assessed social support and COVID-19-risk perception were administered to 620 pregnant women. We found that the percentage of women with moderate or severe anxiety based on GAD -7 was 11.1%. Multivariate analysis showed that higher COVID-19-risk perception, greater antenatal COVID-19 anxiety and lower perceived support significantly predicted moderate and severe generalized anxiety. Greater number of weeks of gestation, lower education, semiurban habitat and lower perceived social support were significant predictors of antenatal COVID-19 anxiety. We conclude that the rates of anxiety in pregnant women though not very high, still warrant attention and specific interventions.

Bipolar disorder in women.

Bipolar affective disorder in women is a challenging disorder to treat. It is unique in its presentation in women and characterized by later age of onset, seasonality, atypical presentation, and a higher degree of mixed episodes. Medical and psychiatric co-morbidity adversely affects recovery from the bipolar disorder (BD) more often in women. Co-morbidity, particularly thyroid disease, migraine, obesity, and anxiety disorders occur more frequently in women while substance use disorders are more common in men. Treatment of women during pregnancy and lactation is challenging. Pregnancy neither protects nor exacerbates BD, and many women require continuation of medication during the pregnancy. The postpartum period is a time of high risk for onset and recurrence of BD in women. Prophylaxis with mood stabilizers might be needed. Individualized risk/benefits assessments of pregnant and postpartum women with BD are required to promote the health of the women and to avoid or limit exposure of the fetus or infant to potential adverse effects of medication.

Violence against women.

Violence against women (VAW) is a major public health problem in the country. The problem is grossly under-reported. A number of factors have been blamed for crimes against women. An inefficient law enforcing machinery has often been targeted for the increasing number of cases being reported. There is little recognition that psychiatric morbidity can perpetuate such crimes. Of late, there appears to a continuous increase in the number of crimes committed against women; especially the very serious ones like gang rapes. The latter have shaken the very conscience of people. Even harsher legislation does not seem to have made any effect. One wonders how this could be possible in a society heading toward high education, economic and technological development. Media has played a pivotal role by highlighting the problem to the masses. The need for the hour is for mental health professionals to take the challenge and present a comprehensive proposal for definite action to prevent all forms of VAW.