A Comparison of Three Measures to Identify Postnatal Anxiety: Analysis of the 2020 National Maternity Survey in England

Perinatal anxiety affects an estimated 15% of women globally and is associated with poor maternal and infant outcomes. Identifying women with anxiety is essential to prevent these adverse associations, but there are a number of challenges around measurement. We used data from England's 2020 National Maternity Survey to compare the prevalence of anxiety symptoms at six months postpartum using three different measures: the two-item Generalised Anxiety Disorders Scale (GAD-2), the anxiety subscales of the Edinburgh Postnatal Depression Scale (EPDS-3A) and a direct question. The concordance between each pair of measures was calculated using two-by-two tables. Survey weights were applied to increase the representativeness of the sample and reduce the risk of non-response bias. The prevalence of postnatal anxiety among a total of 4611 women was 15.0% on the GAD-2, 28.8% on the EPDS-3A and 17.1% on the direct question. Concordance between measures ranged between 78.6% (95% CI 77.4-79.8; Kappa 0.40) and 85.2% (95% CI 84.1-86.2; Kappa 0.44). Antenatal anxiety was the strongest predictor of postnatal anxiety across all three measures. Women of Black, Asian or other minority ethnicity were less likely to report self-identified anxiety compared with women of White ethnicity (adjusted odds ratio 0.44; 95% CI 0.30-0.64). Despite some overlap, different anxiety measures identify different groups of women. Certain population characteristics such as women's ethnicity may determine which type of measure is most likely to identify women experiencing anxiety.