Development and Validation of a Scale to Measure Anxiety Specific to Pregnancy During the COVID-19 Pandemic: The Antenatal COVID-19 Anxiety Scale

Prabha S. Chandra, MD^e; Sai Krishna Tikka, MD^a; Sonia Parial, MD^b; Deyashini Lahiri, PhD^c; Chandni Prakash, MD^d; CAn Study Group Collaborators^f

Prim Care Companion CNS Disord 2021;23(6):21m03038

ABSTRACT

Objective: In the context of the coronavirus disease 2019 (COVID-19) pandemic, anxiety during pregnancy should be assessed from a composite context of anxiety/fear of COVID-19 infection and pregnancy-specific anxiety. The objective of this study was to develop and validate a scale that measures anxiety related to situations specific to pregnancy during the COVID-19 pandemic—the Antenatal COVID-19 Anxiety (AnCAn) Scale.

Methods: Items were generated based on a literature review and focused group discussions. Face and content validation was completed. Data were collected from 557 pregnant women attending antenatal clinics of 5 tertiary care general hospitals in India. An exploratory factor analysis was conducted to measure structural validity and to identify latent factors. Screening accuracy was assessed using scores on the 7-item Generalized Anxiety Disorder scale. Data were collected between July and October 2020.

Results: The principal component analysis showed that the 12 items of the scale significantly loaded onto 2 latent factors, with Eigen values of 6.575 and 1.213, respectively. Factor solution showed that 6 items correlated with each of the 2 factors. Both sensitivity and specificity of AnCAn total and subscores were > 70%.

Conclusions: We conclude that the AnCAn Scale holds good psychometric properties, and it identifies and distinguishes 2 latent factors: (1) anxiety related to acquiring infection and (2) anxiety related to spreading infection and social role obligations, which are compositely related to anxiety specific to COVID-19 and pregnancy.

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References (23)

Pregnant and Recently Pregnant People: At Increased Risk for Severe Illness from COVID-19. Centers for Disease Control and Prevention. Accessed May 11, 2021. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html
Joma M, Fovet CM, Seddiki N, et al. COVID-19 and pregnancy: vertical transmission and inflammation impact on newborns. Vaccines (Basel). 2021;9(4):391. PubMed CrossRef
Breastfeeding and Caring for Newborns if You Have COVID-19. Centers for Disease Control and Prevention. Accessed November 9, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html
Shiina A, Niitsu T, Kobori O, et al. Relationship between perception and anxiety about COVID-19 infection and risk behaviors for spreading infection: a national survey in Japan. Brain Behav Immun Health. 2020;6:100101. PubMed CrossRef
Salehi L, Rahimzadeh M, Molaei E, et al. The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: a structural equation model. Brain Behav. 2020;10(11):e01835. PubMed CrossRef
Arora A, Jha AK, Alat P, et al. Understanding coronaphobia. Asian J Psychiatr. 2020;54:102384. PubMed CrossRef
Chandra PS, Nanjundaswamy MH. Pregnancy specific anxiety: an under-recognized problem. World Psychiatry. 2020;19(3):336–337. PubMed CrossRef
Moyer CA, Compton SD, Kaselitz E, et al. Pregnancy-related anxiety during COVID-19: a nationwide survey of 2740 pregnant women. Arch Women Ment Health. 2020;23(6):757–765. PubMed CrossRef
Nanjundaswamy MH, Shiva L, Desai G, et al. COVID-19-related anxiety and concerns expressed by pregnant and postpartum women-a survey among obstetricians. Arch Women Ment Health. 2020;23(6):787–790. PubMed CrossRef
Corbett GA, Milne SJ, Hehir MP, et al. Health anxiety and behavioral changes of pregnant women during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;249:96–97. PubMed CrossRef
Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. PubMed CrossRef
Zhang J, Yu H, Gao Y, et al. Prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic: a systematic review and meta-analysis. Researchsquare. Preprint posted October 6, 2020. Accessed May 11, 2021. https://www.researchsquare.com/article/rs-87129/v1
Brunton RJ, Dryer R, Krägeloh C, et al. The Pregnancy-Related Anxiety Scale: a validity examination using Rasch analysis. J Affect Disord. 2018;236:127–135. PubMed CrossRef
Somerville S, Dedman K, Hagan R, et al. The Perinatal Anxiety Screening Scale: development and preliminary validation. Arch Women Ment Health. 2014;17(5):443–454. PubMed CrossRef
Lee SA. Coronavirus Anxiety Scale: a brief mental health screener for COVID-19 related anxiety. Death Stud. 2020;44(7):393–401. PubMed CrossRef
Ganjekar S, Chandra PS. Addressing Mental Health Issues among Pregnant and Postpartum Women During COVID-19. Mental Health in the Times of COVID-19 Pandemic-Guidance for General Medical and Specialized Mental Health Care Settings. Bengaluru, India: NIMHANS; 2020:41–45.
Adhikari EH, Moreno W, Zofkie AC, et al. Pregnancy outcomes among women with and without severe acute respiratory syndrome coronavirus 2 infection. JAMA Netw Open. 2020;3(11):e2029256. PubMed CrossRef
Di Mascio D, Khalil A, Saccone G, et al. Outcome of coronavirus spectrum infections (SARS, MERS, COVID-19) during pregnancy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(2):100107. PubMed CrossRef
Lackey KA, Pace RM, Williams JE, et al. SARS-CoV-2 and human milk: what is the evidence? Matern Child Nutr. 2020;16(4):e13032. PubMed CrossRef
Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5):315–323. PubMed CrossRef
Nath A, Venkatesh S, Balan S, et al. The prevalence and determinants of pregnancy-related anxiety amongst pregnant women at less than 24 weeks of pregnancy in Bangalore, Southern India. Int J Womens Health. 2019;11:241–248. PubMed CrossRef
Priya A, Chaturvedi S, Bhasin SK, et al. Depression, anxiety and stress among pregnant women: a community-based study. Indian J Psychiatry. 2018;60(1):151–152. PubMed CrossRef
Supraja TA, Varghese M, Desai G, et al. The relationship of gender preference to anxiety, stress and family violence among pregnant women in urban India. Int J Cult Ment Health. 2016;9(4):356–363. CrossRef