Mixed-Methods Assessment of Maternal Anxiety During the First 8 Weeks After Birth

Abstract

Objective: To describe and compare the experiences of postpartum anxiety among women with generalized anxiety and postpartum-specific anxiety.

Design: Prospective, longitudinal, mixed methods.

Setting: Academic tertiary center in the mid-Atlantic United States. Study activities were remote.

Participants: Women at 1 to 8 weeks after birth (N = 34).

Methods: We used mobile surveys to measure daily anxiety ratings and responses to open-ended, theory-driven questions about anxiety. We used the cutoff scores on the State-Trait Anxiety Inventory and Postpartum Specific Anxiety Scale administered 8 weeks after birth to determine the presence of generalized and postpartum-specific anxiety. Participants' responses were analyzed with qualitative description and sorted by anxiety questionnaire scores at 8 weeks after birth. We compared qualitative findings between participants with generalized anxiety and postpartum-specific anxiety.

Results: Participants with generalized anxiety had high levels of overwhelm and felt ill-equipped to handle daily stressors, whereas those with postpartum-specific anxiety felt adept at coping. Participants with generalized anxiety lacked emotional and physical support, and those with postpartum-specific anxiety reported more physical but variable emotional support. Sources of daily anxiety in participants with postpartum-specific anxiety were infant-centric (e.g., infant health, end of maternity leave, breastfeeding), whereas anxiety sources for participants with generalized anxiety were varied (e.g., self-health, partner concerns). Participants with generalized anxiety versus postpartum-specific anxiety were more likely to be multiparous and have comorbid depression symptoms.

Conclusion: Symptoms, levels of perceived support, and sources of anxiety differed between participants with generalized versus postpartum-specific anxiety. Our findings can inform postpartum anxiety screening strategies and support interventions.

Keywords: anxiety; postpartum anxiety; postpartum period.

Figure 1. Study Design, Data Collection and Sampling Plan

^aMobile Ecological Momentary Assessment; ^bMode determined by each participant’s most common daily anxiety rating (e.g., mode = 0, “none” and mode = ≥1, “some”); ^cVariation determined the day to day variability in anxiety ratings (e.g., individual mean variance < sample median variance = “minimal” and individual mean variance > sample median variance = “moderate to marked”); ^dState Trait Anxiety Inventory, State Scale, cut-off >40 (Spielberger, 1983, Dennis et al., 2013); ^ePostpartum Specific Anxiety Scale, cut-off > 112 (Fallon et al., 2016); Category 1: “No Anxiety”; Category 2: “Generalized Anxiety”; Category 3: “Postpartum-Specific Anxiety”; Category 4: “Generalized and Postpartum-Specific Anxiety”

Figure 2. Sources of Daily Anxiety by Anxiety Type at 8 weeks Postpartum (N = 34)

Note. Category 1:< Cut-off for anxiety on State Trait Anxiety Inventory (STAI) & Postpartum Specific Anxiety Scale (PSAS); Category 2: > Cut-off for anxiety on STAI, (e.g., score >40) (Spielberger, 1983); Category 3: > Cut-off on PSAS, (e.g., score >112) (Fallon et al., 2016); > cut-off on both STAI and PSAS