This edition of Spotlight focuses on Dr Vicky Fallon, a Chartered Psychologist and Lecturer in Health Psychology in the Department of Psychology. Her research into perinatal mental health has led to the development of a tool to measure postpartum anxiety that is now used globally.
Estimates suggest up to 40% of women experience anxiety in the year following childbirth, yet current measurement practices mean the condition is poorly detected. Since its creation, The Postpartum Specific Anxiety Scale (PSAS) has received global interest and is now being used and/or translated in over 30 countries worldwide.
Our research
In 2014, I was conducting my PhD focused on examining the relationship between maternal anxiety and infant feeding from pregnancy to parenthood, and wanted to explore this relationship quantitatively. It was of surprise to me that all the scales that researchers had previously used to measure postpartum anxiety were only validated with general adult populations and had been extrapolated for use with mothers as there was no suitable alternative. For example, a commonly used anxiety measurement tool includes “I feel rested”, of which a low score (i.e., not feeling rested) may indicate anxiety. However, as we all know, feeling rested tends to be the opposite of what new mothers usually feel. Using this as a measure therefore can lead to inaccurate results.
Developing the Postpartum Specific Anxiety Scale (PSAS)
The 51-item version of the PSAS was developed and validated in 2016. It measures maternal- and infant-focused anxieties that have occurred during the previous 7 days. The measure assesses four components of anxiety that, unlike other measures, are specific to the postpartum-period:
- Worries relating to maternal self-efficacy and mother-infant bonding (Maternal Competence and Attachment Anxieties)
- Fears relating to infant health and accidental harm (Infant Safety and Welfare Anxieties)
- Fears relating to sleep and infant routine (Practical Infant Care Anxieties)
- Concerns over adjustment to parenthood such as relationship changes, work, and finances (Psychosocial Adjustment to Motherhood)
Further development
In 2021, a 16-item short form was developed and validated in mothers of infants up to 12-months (PSAS-RSF). The brief tool retains the original four-factor structure, whilst reducing the time needed for completion. During the pandemic we also developed a 12-item version, PSAS Research Short-Form Crises (PSAS-RSF-C), for use in global crises.
Both the original PSAS and its derivatives have received international interest, including from low and middle income countries. The long-form PSAS has now been translated and validated in over 29 countries, with published versions available in French, Iranian, Chinese, and Spanish, and many more underway. Globally, the four-factor structure of the PSAS remains, suggesting that experiences of anxiety after birth seem to be universal.
Global collaboration
We recently received an IPH Research and Knowledge Exchange grant to bring together the international teams for the first PSAS Global Collaborative meeting earlier this month at the University of Liverpool. Delegates from Italy, Brazil, France, Spain, and The Netherlands joined us for an update on the current use of the PSAS in different cultures. We also developed a strategic cross-cultural proposal for future work as well as launching our brand new website.
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Future plans
Our next step is to modify the PSAS for use in a clinical setting in the UK to identify clinically relevant anxiety. We received some funding last year from the IPH Policy Support Fund to gain consensus from key stakeholders about how to achieve this. We now want to work with mothers with a clinical diagnosis of anxiety to find out how best to measure their symptoms with the PSAS. The Global Collaborative meeting was a real success so we are now also planning another one for next year in London.
With increasing globalisation of the PSAS, we need to evaluate it cross-culturally, so that cross cultural comparisons in postpartum anxiety can be made. This has not been done previously with a measure of postpartum anxiety and would further our global understanding of anxiety after birth. We have expressions of interest in a cross-cultural evaluation of the PSAS from France, Italy, Spain, The Netherlands, Iran, United Arab Emirates, Brazil, and China and have begun the process of setting up data sharing agreements. Inclusion of a wide range of countries and continents will provide essential insights into the universality of postpartum anxiety and any cross-cultural differences to enable meaningful comparisons in women’s experiences of anxiety after birth.