title: Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS).
abstract: BACKGROUND
  The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety.
  
  
  METHODS
  Antenatal and postnatal women (n=410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine - King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild-moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety diagnoses.
  
  
  RESULTS
  Two cut-off points for the normative groups were calculated using the Jacobson-Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: 'minimal anxiety'; 'mild-moderate anxiety'; and 'severe anxiety'.
  
  
  CONCLUSIONS
  The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the generalisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia.
  
  
  CONCLUSIONS
  Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments, prioritisation of access to resources and tracking of clinically significant deterioration, improvement or stability in anxiety over time.
authors.affiliation: Department of Psychological Medicine, King Edward Memorial Hospital, Australia. Electronic address: susanne.somerville@health.wa.gov.au.
authors.forename: Susanne
authors.initials: S
authors.lastname: Somerville
authors.affiliation: Department of Psychological Medicine, King Edward Memorial Hospital, Australia; School of Psychology, The University of Western Australia, Australia.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Byrne
authors.affiliation: Department of Psychological Medicine, King Edward Memorial Hospital, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Dedman
authors.affiliation: Department of Psychological Medicine, King Edward Memorial Hospital, Australia; School of Women's and Infants' Health, The University of Western Australia, King Edward Memorial Hospital, Australia.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Hagan
authors.affiliation: Department of Psychological Medicine, King Edward Memorial Hospital, Australia.
authors.forename: Soledad
authors.initials: S
authors.lastname: Coo
authors.affiliation: Department of Psychological Medicine, King Edward Memorial Hospital, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oxnam
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, King Edward Memorial Hospital, Australia.
authors.forename: Dorota
authors.initials: D
authors.lastname: Doherty
authors.affiliation: School of Psychology, The University of Western Australia, Australia.
authors.forename: Nadia
authors.initials: N
authors.lastname: Cunningham
authors.affiliation: School of Psychology, The University of Western Australia, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Page
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003863:Depression; D005260:Female; D006801:Humans; D010555:Personality Inventory; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000523:psychology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012016:Reference Values; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Anxiety disorders; Perinatal; Postnatal; Pregnancy; Screening