Perinatal anxiety has been receiving growing attention in the literature in recent years. A systematic review and meta-analysis of 102 studies with 221,974 women from 34 countries estimated that the prevalence for self-reported anxiety symptoms was 18.2% in the first trimester, 19.1% in the second trimester, 24.6% in the third trimester, and 15% at 1–24 weeks postpartum (Dennis et al., 2017). A recent meta-analysis by Fawcett et al. (2019) suggests that 1 in 5 women in the perinatal period meet the diagnostic criteria for at least one anxiety disorder, constituting anxiety disorders with perinatal onset much more prevalent than previously thought. While significant differences in study methodology result in a wide variation in the estimates of anxiety-related disorders or symptoms (Viswasam et al., 2019; Leach et al., 2017), it is now well-established that the prevalence of anxiety warrants clinical attention (Dennis et al., 2017; Fawcett et al. 2019; Kendig et al. 2017). In addition, the association of perinatal anxiety with adverse consequences on birth and neonatal outcomes (Ding et al., 2014; Field, 2017; Grigoriadis et al., 2018), mother-infant relationship (Farré-Sender et al., 2018; Field, 2018), as well as the association with postpartum depression (Robertson et al., 2004; Grigoriadis et al., 2019) constitute screening imperative.
The National Institute for Health and Care Excellence (NICE Guideline CG192, 2014) states that the range and prevalence of anxiety disorders are under-recognised both during pregnancy and the postpartum period. The American College of Obstetricians and Gynecologists (2015) recommends that women in the perinatal period are screened at least once for depression and anxiety symptoms through standardized, validated tools. More than ever, routine screening for anxiety, depression, and other mental health issues becomes of utmost importance under the current circumstances of COVID-19 pandemic (Tomfohr-Madsen et al., 2021; Suwalska, 2021). Proactive measures could result in prevention, early detection, and prompt referral and treatment (Almeida et al., 2020).
The Generalized Anxiety Disorder-7 (GAD-7), developed by Spitzer et al. (2006), is one of the recommended screening measures for perinatal anxiety by NICE (Guideline CG192, 2014), although it is recommended for further assessment in case a woman scores 3 or more on the GAD-2, a distinct subscale comprising of the first two GAD-7 items, whose usefulness in maternity services has been debated (Nath et al., 2018). A recent study by Fairbrother et al. (2019) showed that GAD-7 outperformed the GAD-2 in their sample of 310 Canadian at 3-months postpartum. The GAD-7 has been found to have good psychometric properties among other populations in the perinatal period such as English-speaking perinatal women in Canada (Simpson et al., 2014), Spanish-speaking pregnant Peruvian women (Zhong et al., 2015), Spanish-speaking pregnant women in urban Spain (Soto-Balbuena et al., 2021), and pregnant Chinese women in mainland China (Gong et al., 2021).
The aim of the present article is to examine the psychometric properties and the factor structure of the GAD-7 in a sample of Cypriot pregnant and postpartum women. So far, there are no published studies of the properties of the GAD-7 in Cypriot women in the perinatal period.