Problematic behaviours associated with generalized anxiety disorder during pregnancy and the postpartum period: A thematic analysis

Abstract

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in pregnancy and the postpartum (perinatal) period. Perinatal women with GAD engage in problematic behaviours, yet the focus and function of these behaviours remain unknown. Objective: Given that worry during the perinatal period is largely maternally focused, the objective of this study was to explore the accompanying behavioural features of GAD during pregnancy and the postpartum period. Design: A qualitative study was conducted.Methods: Twenty-five pregnant (n = 10) and postpartum (n = 15) women were recruited through clinical referrals and the Hamilton community. Following the completion of a semistructured diagnostic interview and symptom measures, participants participated in one of seven focus groups to learn about behaviours utilized in response to their worries. A thematic analysis was conducted to identify behaviour themes and subthemes in pregnant and postpartum women. Results: Five behaviour themes and 12 subthemes were identified. Specifically, participants endorsed engaging in excessive reassurance seeking, checking and repeating, overcontrol, overpreparation and avoidance behaviours. Conclusions: Our results confirm that perinatal women with GAD engage in comparable problematic behaviours to

The Worry Behaviors Inventory–Perinatal Revised: Adaptation and Initial Validation for Use in Perinatal Samples

“…Perinatal women with GAD engage in comparable problematic behaviors to those with GAD in the general population ( Inness et al, 2022 ). However, the extent of these behaviors may not be adequately captured by existing GAD behavior measures.…”

“…Some of the omitted items, such as item 3 (“ I reassure myself ”), 4 (“ I distract myself ”), and 13 (“ I do nothing” ), may reflect more useful attempts to cope with worry, as those with GAD have been found to use less distraction and reappraisal strategies than nonanxious controls ( Coles & Heimberg, 2005 ). Furthermore, behaviors such as distraction, self-reassurance, and doing nothing in response to worries have not been cited in perinatal women with GAD ( Inness et al, 2022 ). Conversely, items that reflect situational avoidance (item 9: “ I avoid situations or people that worry me ”) and excessive reassurance and information seeking (item 1: “ I seek reassurance from other people” ; item 11: “ I seek reassurance from sources of information ”) have been documented in perinatal women with GAD ( Inness et al, 2022 ) but were, nonetheless, omitted from the WBI-PR.…”

“…While recent efforts have been made to characterize the nature of worry during the perinatal period ( Goldfinger et al, 2020 ), the corresponding behavioral features of GAD have been largely overlooked. In response, Inness and colleagues (2022) conducted a qualitative study to gain insight into the behaviors reported by perinatal women with GAD. They found that perinatal women, like individuals with GAD in the general population, engage in various reassurance seeking, checking, controlling, overpreparation, and avoidance behaviors.…”

“…For example, items that reflect reassurance-seeking [i.e., item 1: “ I seek reassurance from other people (e.g., family, friends, doctors, experts, authorities ”)], controlling [i.e., item 15: “ I take control of every aspect of a situation (e.g., try to do everything myself, avoid delegating tasks, control money/finances, keep a close eye on what is happening ”)], and inflexible behaviors [i.e., item 14: “ I act very carefully (e.g., arrive early, avoid rushing, leave more time than is needed, really think before I act ”)] were omitted from the WBI ( Mahoney et al, 2016 ). While these items were not representative of GAD behaviors in the general population ( Mahoney et al, 2016 ), reassurance seeking (e.g., confirming baby-related decisions with partner, family, and medical professionals), controlling (e.g., reluctance to delegate baby care tasks), and inflexible behaviors (e.g., rigid parenting practices and routines) are prevalent and may be more relevant during the perinatal period ( Inness et al, 2022 ).…”

“…As such, the primary objective of this study was to evaluate the initial 20-item pool proposed by Mahoney and colleagues (2016) to determine whether a divergent factor structure would emerge within a perinatal sample. We hypothesized that the factor structure and items retained within each factor would differ, given previous research to suggest that certain GAD behaviors (i.e., reassurance seeking, controlling, and inflexible behaviors) may be more relevant during the perinatal period ( Inness et al, 2022 ). Given our prediction that the factor structure would differ, our secondary objective was to assess the internal consistency and construct validity of the Perinatal Revised WBI (i.e., WBI-PR), hypothesizing that the WBI-PR would demonstrate good internal consistency, converge with measures assessing similar constructs, and successfully discriminate between those with and without a GAD diagnosis.…”