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

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Nath, Selina, Ryan, Elizabeth G., Trevillion, Kylee, Bick, Debra, Demilew, Jill, Milgrom, Jeannette, Pickles, Andrew and Howard, Louise M. (2018) Prevalence and identification of anxiety disorders in pregnancy : the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2). BMJ Open, 8 (9). e023766. doi:10.1136/bmjopen-2018-023766

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Official URL: https://doi.org/10.1136/bmjopen-2018-023766

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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.

Item Type: Journal Article
Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit
Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Pregnant women -- Mental health, Anxiety disorders -- Statistics, Anxiety in women, Mental illness in pregnancy
Journal or Publication Title: BMJ Open
Publisher: BMJ Publishing Group
ISSN: 2044-6055
Official Date: 4 September 2018
Dates:
DateEvent
4 September 2018Published
20 July 2018Accepted
Date of first compliant deposit: 18 September 2018
Volume: 8
Number: 9
Article Number: e023766
DOI: 10.1136/bmjopen-2018-023766
Status: Peer Reviewed
Publication Status: Published
Publisher Statement: ** From BMJ via Jisc Publications Router. ** History: received 26-04-2018; rev-recd 10-07-2018; accepted 20-07-2018; ppub 09-2018; epub 04-09-2018. ** Licence for this article: https://creativecommons.org/licenses/by/4.0/
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
RP-PG-1210-12002[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100010269
UNSPECIFIEDSouth London and Maudsley NHS Foundation Trusthttp://dx.doi.org/10.13039/100009362
UNSPECIFIEDKing's College Hospital NHS Foundation Trusthttp://dx.doi.org/10.13039/100010872
NIHR-RP-R3-12-011[NIHR] National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
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