Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS) Susanne Somerville a,n , Shannon L. Byrne a,c , Kellie Dedman a , Rosemary Hagan a,b , Soledad Coo a , Elizabeth Oxnam a , Dorota Doherty b , Nadia Cunningham c , Andrew C. Page c a Department of Psychological Medicine, King Edward Memorial Hospital, Australia b School of Women’s and Infants’ Health, The University of Western Australia, King Edward Memorial Hospital, Australia c School of Psychology, The University of Western Australia, Australia article info Article history: Received 20 February 2015 Received in revised form 29 May 2015 Accepted 8 July 2015 Available online 11 July 2015 Keywords: Perinatal Pregnancy Postnatal Screening Anxiety disorders abstract Background: The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety. Methods: Antenatal and postnatal women (n ¼410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine – King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild–moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety di- agnoses. Results: Two cut-off points for the normative groups were calculated using the Jacobson–Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: ‘minimal anxiety’; ‘mild–moderate anxi- ety’; and ‘severe anxiety’. Limitations: The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the gen- eralisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia. Conclusions: Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments, prioritisation of access to resources and tracking of clinically significant deterioration, improvement or stability in anxiety over time. Crown Copyright & 2015 Published by Elsevier B.V. All rights reserved. 1. Introduction Elevated untreated perinatal anxiety may negatively impact on maternal health (Johnson and Slade, 2003; Matthey et al., 2003; Milgrom et al., 2008), the child's cognitive (Bergman et al., 2010), emotional and behavioural development (O'Connor et al., 2002) and the mother–infant relationship (Stevenson-Hinde et al., 2011). Given this, the detection of problematic anxiety via the use of an effective screening tool may be important in screening for risk of problematic anxiety, prevention, early intervention and treatment in the field of perinatal mental health. Current screening guide- lines recommend classifying women as “at risk” of problematic anxiety if they score over an established cut-off score on self ad- ministered questionnaires (e.g., Austin and Highet, 2011), such as the Edinburgh Postnatal Depression Scale (Cox et al., 1987). However, as described below there is the potential to improve the detection and management of perinatal anxiety by using a vali- dated measure that enables the classification of the severity of anxiety along a continuum of severity ranges. Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2015.07.012 0165-0327/Crown Copyright & 2015 Published by Elsevier B.V. All rights reserved. n Correspondence to: Department of Psychological Medicine, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia. Fax: þ61 8 9340 1111. E-mail address: susanne.somerville@health.wa.gov.au (S. Somerville). Journal of Affective Disorders 186 (2015) 18–25