Measuring Perinatal Anxiety

The effective assessment of perinatal anxiety (PNA) remains challenging in clinical practice despite its high prevalence (affecting at least 20% of women and birthing people) and its established association with adverse maternal and child outcomes^1,2,.

Generalised anxiety scales are often unreliable in this population. Many general measures rely on somatic symptoms (e.g., difficulty sleeping, fatigue, changes in appetite), which mirror the normal physiological changes that occur during pregnancy and the postpartum period. Relying on these instruments can result in inflated scores and subsequent misclassification of women experiencing normative worries as having a disorder. Conversely, generalised scales frequently fail to capture the unique fears specific to the perinatal context (e.g., infant safety, childbirth, or parenting competency), risking missed identification of women with true, clinically relevant anxiety².

The Edinburgh Postnatal Depression Scale (EPDS³) is widely used in perinatal screening, yet it is not ideal for measuring anxiety⁴. It was designed as a depression screening tool, and its authors caution against its use as a dedicated anxiety measure. Its anxiety subscale typically lacks sufficient item breadth to fully capture the complex dimensions of clinical anxiety. Furthermore, the anxiety items often contain qualifiers, such as assessing worry “for no good reason,” potentially excluding people who are genuinely distressed by rational, pregnancy- and parenting-related fears (e.g., anxiety about the birth outcome).

To address these limitations, several context-specific screening tools have been developed. The Perinatal Anxiety Screening Scale (PASS⁵) is a validated 31-item self-report tool developed specifically to detect problematic anxiety across the entire perinatal period. It improves screening accuracy by encompassing symptoms of acute anxiety, general worry, perfectionism, control issues, trauma, and social anxiety, while notably excluding potentially confounding somatic items. The PASS also allows for the classification of anxiety along a severity continuum (minimal, mild-moderate, severe), which is crucial for determining appropriate referral and treatment urgency⁶. An online version of the PASS is available to use on this website via the link below. Other tools are also available, such as the Postpartum Specific Anxiety Scale (PSAS⁷); however, this is limited to use in the year following childbirth only.

Where concerning levels of PNA are detected, specialist mental health care services (e.g., perinatal mental health and/or maternal mental health teams) are best placed to assess the individual’s unique symptom profile, and other mental health conditions might also be considered. You can read more about these in our family-focused information. 

Use the links below to find out more about different types of perinatal anxiety and try to the PASS.