Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 5;8(9):e023766.
doi: 10.1136/bmjopen-2018-023766.

Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)

Selina Nath  1 , Elizabeth G Ryan  2   3 , Kylee Trevillion  1 , Debra Bick  4 , Jill Demilew  5 , Jeannette Milgrom  6 , Andrew Pickles  2 , Louise M Howard  1   4   7
Affiliations

Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)

Selina Nath et al. BMJ Open. .

Abstract

Objective: To estimate the population prevalence of anxiety disorders during pregnancy and investigate the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2) for a) GAD and b) any anxiety disorder.

Design: Cross-sectional survey using a stratified sampling design. Sampling weights were used in the analysis to adjust for the bias introduced by the stratified sampling.

Setting: Inner-city maternity service, South London.

Participants: 545 pregnant women were interviewed after their first antenatal appointment; 528 provided answers on the GAD-2 questions.

Main outcome measures: Diagnosis generated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID).

Results: Population prevalence of anxiety disorders was 17% (95% CI 12% to 21%): 5% (95% CI 3% to 6%) for GAD, 4% (95% CI 2% to 6%) for social phobia, 8% (95% CI 5% to 11%) for specific phobia and 2% (95% CI 1% to 4%) for obsessive-compulsive disorder. Post-traumatic stress disorder (PTSD) prevalence was unclear due to higher levels of reluctance to respond to PTSD interview questions but sensitivity analyses suggest population prevalence maybe up to 4% (95% CI 2% to 6%). Weighted sensitivity of GAD-2 for GAD (cut-off ≥3) was 69%, specificity 91%, positive predictive value 26%, negative predictive value 98% and likelihood ratio 7.35. For any anxiety disorder the weighted sensitivity was 26%, specificity 91%, positive predictive value 36%, negative predictive value 87% and likelihood ratio 2.92.

Conclusions: Anxiety disorders are common but GAD-2 generates many false positives and may therefore be unhelpful in maternity services.

Keywords: anxiety disorders; diagnostic accuracy; gad; gad-2; maternal.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Louise M Howard (senior author and chief investigator), chaired the National Institute for Health and Care Excellence CG192 guidelines development group on antenatal and postnatal mental health in 2012-14. No other conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of women through the WEll-being in pregNancy stuDY (WENDY) study during the study period (total recruited n=545) and women with available data on the two-item Generalised Anxiety Disorder scale (GAD-2) (n=528).
See this image and copyright information in PMC

References

    1. Kessler RC, Petukhova M, Sampson NA, et al. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 2012;21:169–84. 10.1002/mpr.1359 - DOI - PMC - PubMed
    1. Li SH, Graham BM. Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. Lancet Psychiatry 2017;4:73–82. 10.1016/S2215-0366(16)30358-3 - DOI - PubMed
    1. Goodman JH, Chenausky KL, Freeman MP. Anxiety disorders during pregnancy: a systematic review. The Journal of clinical psychiatry 2014;75:1153–84. - PubMed
    1. Martini J, Petzoldt J, Einsle F, et al. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord 2015;175:385–95. 10.1016/j.jad.2015.01.012 - DOI - PubMed
    1. Stein A, Pearson RM, Goodman SH, et al. Effects of perinatal mental disorders on the fetus and child. The Lancet 2014;384:1800–19. 10.1016/S0140-6736(14)61277-0 - DOI - PubMed

Publication types

MeSH terms