Overall, 283 women were recruited for this study. Twenty of them were consented for the initial piloting phase, 30 of them for the test re-test reliability, 16 withdrew before completing the survey and were not included in the final sample size; the remaining sample of 217 women were included in the final sample size for this study.
The mean age of participants was 28.89 years (range between 19 and 44) with a standard deviation of 7.07 years. Most of the sample (70.51%) reported having a college degree. The majority (58.06%) did not work and 56.28% reported that their income was adequate for their lifestyle; an income of less than 10,000 Saudi Riyals (SAR) was reported by approximately half (47.69%) of the sample. Using the suggested cut-off values for the English version of the PASS scale  of 0-20 (risk of minimal anxiety), 21-41 (risk of moderate anxiety), and above 41 (risk of severe anxiety), 34.10% of the participating women reported a risk of moderate anxiety and 47.0% reported a risk of severe anxiety. Participants’ characteristics are presented in table1.
Frequency of responses to each of the questions of the Arabic version of the PASS scale are displayed in table 2. The mean average score for the Arabic version of the PASS scale was 41.01(SD=20.55) (range: 0 to 93). The mean EPDS-10 score was 17.57 (SD = 4.32) (range: from 0 to 30) with 82.40% of the surveyed women scoring above 13 for depression symptoms (indicative of risk of depression) . Additionally, the mean score for GHQ-12 was 10.81(SD=7.30) (range: 0 to 36) and 36.87% of participants exhibited an above 12 score (indicative of risk mental disorder and risk of psychological distress) . The mean scores for the three components of the DASS-21 were 11.04 (SD=9.70) for depression, 11.73 (SD=9.46) for anxiety, and 17.10 (SD=10.26) for stress symptoms. Almost 37% of the participants reported a risk of severe and extremely severe anxiety according to the DASS-21. Mean scores for the four scales and the composite score for adverse life events are presented in table 3.
Reliability of the instrument
Internal consistency using Cronbach’s alpha coefficient as a measure of reliability of the Arabic version of the PASS questionnaire was found to be 0.94 for the whole sample indicating very satisfactory results. It was 0.83, 0.80, 0.86, and 0.90 for the four sections of the scale. The results of the test-retest reliability of the Arabic version of the PASS tool showed to be acceptable with a correlation coefficient of 0.78.
Validity of the instrument
Validity of the instrument was assessed using convergent validity. The correlations between the Arabic version of PASS, the Arabic version of the EPDS-10, the Arabic version of the GHQ-12, the three components of the DASS-21 (Depression, Anxiety, and Stress), and the score of the stressful life events within the last 12 months were significantly positive (Spearman’s rho=0.46; p<0.001, Spearman’s rho=0.58; p<0.001, Spearman’s rho=0.47; p<0.00’ Spearman’s rho=0.50;p <0001, spearman’s rh=0.43; p<0.001, and Spearman’s rho= 0.28; p=0.003; respectively), indicating that those who had perinatal anxiety showed higher levels of depression and higher levels of psychological disorders. Particularly those who reported experiencing problems at work, illness in the family, money problems, and personal problems significantly correlated with the PASS scores (table3).
Results of the content validity results from the expert panel displayed a mean Content Validity Ratio (CVR) of 0.79 and a mean Content Validity Index (CVI) of 0.88.
In order to confirm the structure of the Arabic version of the instrument and demonstrate its construct validity and similarity to the English version, the Principal Component Method for factor analysis with varimax rotation was applied using the original four factor structure of the instrument. The four factors jointly accounted for 54.53% of the total detected variance. Factor 1 (acute anxiety, social anxiety, and dissociation) accounts for 37.12% of the total variance, Factor 2 (specific fears and trauma) 7.51%, Factor 3 (general anxiety and adjustment) 5.20%, and factor 4 (perfectionism and control) 4.11%.