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A psychometric systematic review of self-report instruments to identify anxiety in pregnancy

Evans, Kerry; Spiby, Helen; Morrell, C. Jane


C. Jane Morrell


Aims: To report a systematic review of the psychometric properties of self‐report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument.
Background: Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed.
Design: Psychometric systematic review.
Data sources: A systematic literature search of the multiple databases (1990–September 2014).
Review methods: Identification of self‐report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability.
Results: Thirty‐two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category.
Conclusion: Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy.


Evans, K., Spiby, H., & Morrell, C. J. (2015). A psychometric systematic review of self-report instruments to identify anxiety in pregnancy. Journal of Advanced Nursing, 71(9), 1986-2001. doi:10.1111/jan.12649

Journal Article Type Article
Acceptance Date Feb 8, 2015
Online Publication Date Mar 26, 2015
Publication Date Sep 30, 2015
Deposit Date Jun 11, 2018
Print ISSN 0309-2402
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 71
Issue 9
Pages 1986-2001
Public URL
Publisher URL