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      Repetitive Negative Thinking and Interpretation Bias in Pregnancy


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          Repetitive negative thinking (RNT; e.g., worry about the future, rumination about the past) and the tendency to interpret ambiguous information in negative ways (interpretation bias) are cognitive processes that play a maintaining role in anxiety and depression, and recent evidence has demonstrated that interpretation bias maintains RNT. In the context of perinatal mental health, RNT has received minimal research attention (despite the fact that it predicts later anxiety and depression), and interpretation bias remains unstudied (despite evidence that it maintains depression and anxiety which are common in this period).


          We investigated the relationship between RNT, interpretation bias and psychopathology (depression, anxiety) in a pregnant sample (n = 133). We also recruited an age-matched sample of non-pregnant women (n = 104), to examine whether interpretation bias associated with RNT emerges for ambiguous stimuli regardless of its current personal relevance (i.e., pregnancy or non-pregnancy-related).


          As predicted, for pregnant women, negative interpretation bias, RNT, depression and anxiety were all positively associated. Interpretation bias was evident to the same degree for material that was salient (pregnancy-related) and non-salient (general), and pregnant and non-pregnant women did not differ. RNT was associated with interpretation bias for all stimuli and across the full sample.


          Our findings highlight the need to further investigate the impact of interpretation bias in pregnant women, and test the effectiveness of interventions which promote positive interpretations in reducing RNT in the perinatal period.


          • A tendency to make negative interpretations was investigated in pregnant women for the first time.

          • Negative interpretation bias was associated with repetitive negative thinking.

          • Interpretation bias extended to pregnancy related information for pregnant and non-pregnant women.

          • Reducing negative interpretation bias in pregnant women could be useful.

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          Most cited references42

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

              The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

                Author and article information

                Clin Psychol Eur
                Clin Psychol Eur
                Clinical Psychology in Europe
                December 2020
                23 December 2020
                : 2
                : 4
                : e3615
                [a ]Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, United Kingdom
                [b ]School of Psychology, University of Sussex , Sussex, United Kingdom
                [c ]School of Psychology, University of New South Wales , Sydney, Australia
                [d ]Black Dog Institute, Hospital Road Randwick, New South Wales, Sydney, Australia
                [e ]Warwick Clinical Trials Unit, University of Warwick , Coventry, United Kingdom
                [6]Philipps-University of Marburg, Marburg, Germany
                Author notes
                Colette R. Hirsch, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK. Phone: +44 207 848 0697. colette.hirsch@ 123456kcl.ac.uk
                Author information

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY) 4.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 26 April 2020
                : 01 November 2020
                Funded by: National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London;
                CH receives salary support from the National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.
                Research Articles

                perinatal mental health,repetitive thinking,worry,interpretation bias,pregnancy


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