Pregnancy-Specific Mood and Anxiety Self-Report Measures for Between-Visit Tracking
For tracking pregnancy-specific mood and anxiety symptoms between visits, use the Edinburgh Postnatal Depression Scale (EPDS), which is freely available, takes 10 questions covering the past 7 days, and can be scored for both depression and anxiety symptoms with a cutoff of ≥10 suggesting possible depression. 1
Primary Recommended Measure
The Edinburgh Postnatal Depression Scale (EPDS) is the optimal choice for several reasons:
- Freely available and widely validated for use during pregnancy and postpartum 1
- Brief administration with only 10 questions assessing the past 7 days, making it practical for frequent between-visit monitoring 1
- Dual assessment capability: The full scale screens for depression (cutoff ≥10), while the 3-item anxiety subscale (questions 3,4, and 5) specifically captures anxiety symptoms 2
- Strong psychometric properties with demonstrated validity in pregnant populations, though it shows moderate accuracy for anxiety detection (area under ROC curve 0.62-0.73) 1
- Pregnancy-specific relevance: While not exclusively pregnancy-focused, it addresses affective, behavioral, and interference domains relevant to perinatal mental health 1
Alternative Measures to Consider
For General Anxiety Tracking
The Patient Health Questionnaire-9 (PHQ-9) offers another freely available option:
- 9 questions covering the past 2 weeks 1
- Provides severity stratification: minimal (1-4), mild (5-9), moderate (10-14), moderately severe (15-19), severe (20-27) 1
- Allows precise tracking of symptom changes over time 3
The Hospital Anxiety and Depression Scale (HADS) provides separate anxiety and depression scoring:
- 14 questions assessing the past week 1
- Freely available with independent scoring for anxiety and depression domains 1
- Demonstrates moderate to high accuracy in pregnant populations 1
For Pregnancy-Specific Anxiety
Pregnancy-specific anxiety measures are particularly important because pregnancy-related anxiety is more strongly associated with adverse maternal and fetal outcomes (including preterm birth) than general anxiety measures 1, 4, 5
Research-validated pregnancy-specific tools include:
- Pregnancy-Related Anxiety Questionnaire (multiple versions by Huizink and Rini) assessing concerns about fetal health, childbirth, and parenting 2, 4
- Pregnancy Anxiety and Stress Rating Scale (PASRS): 15 questions covering baby health, maternal health, body changes, finances, and social support 6
- These tools capture distinct dimensions not assessed by general anxiety measures and may better predict birth outcomes 4, 5
Practical Implementation Strategy
For routine between-visit monitoring:
Start with the EPDS as your primary tool due to its brevity, free availability, and dual depression/anxiety assessment 1, 2
Score both the full scale and the 3-item anxiety subscale to capture both mood and anxiety symptoms 2
Establish baseline severity at the initial visit using cutoff scores to guide interpretation of subsequent assessments 1
Repeat at consistent intervals (weekly to biweekly) to track symptom trajectory and treatment response 3
Critical Considerations
Common pitfalls to avoid:
Don't rely solely on general anxiety measures when pregnancy-specific concerns are present, as pregnancy-related anxiety shows distinct clinical significance and stronger associations with adverse outcomes 4, 5
Recognize that avoidant coping strategies identified through these measures are associated with poor outcomes including prenatal distress, postpartum depression, and preterm delivery 1, 3
Untreated severe anxiety carries significant risks including preterm birth and low birth weight, which must be weighed against any treatment concerns 3, 7
The EPDS anxiety subscale detected 54% of women with anxiety disorders in validation studies, making it useful for screening but not definitive for diagnosis 2. Positive screens warrant clinical follow-up with more comprehensive assessment 1, 3.