Sinhala translation of Perinatal Anxiety Screening Scale: A valid and reliable tool to detect anxiety among pregnant women

Background: Anxiety disorders during pregnancy are not routinely assessed in Sri Lanka despite being common and leading to adverse pregnancy outcomes. A screening tool will help early detection and management of anxiety to improve pregnancy outcomes. Our aim was to determine the validity of Sinhala translation of Perinatal Anxiety Screening Scale (PASS) to detect anxiety among Sri Lankan pregnant women.Methods A cross-sectional study was conducted in antenatal clinics of ateaching hospital in Colombo. PASS was translated to Sinhala language using the standard translation/back-translation method. Pregnant women (n=221) were sequentially recruited and assessed by a psychiatrist until 81 women with anxiety disorder were diagnosed usingInternational Classification of Diseases-10 criteria(gold standard). Sinhala translation of PASS (PASS-S) was administered to all recruited women, including to 139women without anxiety. Receiver-Operator-Characteristics(ROC) analysis was performed, the optimal cut-off score for PASS-S was determined, and its validity was assessed using sensitivity, specificity, predictive values and positive and negative likelihood ratios.Internal consistency was assessed using Cronbach’salpha.Test-retest and inter-rater reliabilityfor PASS-S score and anxiety classification were assessed using intraclass correlation coefficient (ICC) and Cohen’s kappa (k), respectively.Results Mean age( + SD) of women was 30( + 5.8) years. Of them,53.7% were multiparous. Psychiatrist diagnosed anxiety disorder in 37.0% of women while PASS-S at its optimal cut-off of 20 classified 37.5% of women as having anxiety. Area under the ROC curve for PASS-S was 0.96 (95% CI0.94-0.99).Sensitivity, specificity and positive and negative predictive values of PASS-S were 0.93(95%CI 0.84-0.97), 0.90(95%CI0.83-0.94), 0.85(95%CI0.75-0.90)and 0.95(95% CI0.89-0.98),respectively. Positive and negative likelihood ratios were 8.8(95%CI 5.3-14.5) and 0.08(95% CI0.04-0.18), respectively. Internal consistency was high (Cronbach’s alpha 0.95).Four factor structures obtained by exploratory factor analysis were“Generalized anxiety, acute anxiety and adjustment difficulties”,“Social anxiety, excessive worry and specific fears”,”Perfectionism, control andtrauma” and “Generalized anxiety”.Test-retest reliability was high for the PASS-S score (ICC 0.85 [95%CI 0.65-0.96]) and anxiety classification (k0.77 [95%CI 0.34-1.2]).Inter-interviewer reliability was also high(ICC 0.92 [95%CI0.81-0.97] for the PASS-S score and (k0.86 [95%CI0.59-1.1] for anxiety classification).Conclusion Sinhala translation of PASS is a valid and reliable instrument to screen for anxiety disorders among antenatal women in Sri Lanka.