Separation Anxiety in Pregnancy: A Mixed Methods Study

Abstract

Maternal separation anxiety is emerging as an important risk factor for maternal psychopathology, impaired mother-infant relationship and child separation anxiety. However, there is ongoing debate about the criteria that define adult separation anxiety disorder (ASAD), making accurate diagnosis more difficult. This thesis evaluates the theory, instruments and diagnosis of ASAD in pregnancy. METHOD: Mixed-methods explanatory design. Expectant mothers (n=331) were screened using the ASA-27 and EDS and diagnosed using the MINI ASAD module based on the criteria for diagnosing separation anxiety disorder in childhood. The relationship of ASAD with comorbid disorders was assessed in logistic regression, and with patterns of attachment in MANOVA. Those diagnosed with ASAD took part in a clinical interview. RESULTS: 24% of subjects screened positive and 15.6% were diagnosed with ASAD. ASAD was significantly more likely in first time mothers (OR=2.16) and in those with a history of anxiety or depression (p=0.005). ASA-27 had a sensitivity of 74% and specificity of 66%, and the EDS-3A (cut off=4) had a sensitivity of 81% and specificity of 68%. ASAD was significantly associated with: generalised anxiety disorder (p=0.013) and agoraphobia (p<0.001); anxious attachment; and measures of parental confidence, bonding and anxiety. Separation anxiety was evident in the subjects' significant relationships with their parents, partners, siblings and children, focusing on their health and safety. It was associated with distress, but rarely impairment, and included depressive symptoms. ASAD could be classified into high stress, low support, overanxious and high comorbidity groups. These data support the validity of the MINI ASAD module, but it requires further validation for diagnosing ASAD. CONCLUSION: Mixed-methods is a useful technique for investigating ASAD, which is a common and potentially significant problem in pregnancy. Depressive symptoms occur in the context of separation and should be included in the diagnostic criteria for ASAD. ASA-27 and EDS-3A may be used as screening instruments but prognostic studies would help to further evaluate the validity of the MINI ASAD module as a diagnostic tool. Patterns of separation anxiety in the perinatal period point to potential interventions.