This is the first study conducted to evaluate the validity and reliability of the Arabic Perinatal Anxiety Scale. This study showed that the Arabic version of the PASS is valid and reliable for use in the Arabic speaking populations and have good psychometric properties. Women who participated in this validation study were in the antenatal and postnatal phase, reflecting the suitability of the scale for both phases. Also, participants were from different age groups and different socioeconomic status.
The reliability coefficient was assessed and the Arabic version of PASS, similarly to the original English version of the scale (0.95) [14]and the Turkish version of the scale (0.96) [19], demonstrated high reliability (0.94). The test retest reliability of 0.78 was acceptable and comparable to the test retest reliability of the original scale of 0.74 [14].
The factor analysis was conducted with retaining the four components structure of the original version of the scale. Similarly, to the original English version [14] and the Turkish version[19] of the PASS, the questions loaded on the four factors; however, the actual distribution of the questions for the Arabic version of the PASS varied across the four components. The original scale factor structure were “acute anxiety and adjustment” for factor 1 (constructs related to panic disorder, dissociative disorder, and adjustment difficulties), “general worry and specific fear” for factor 2 (constructs related general anxiety disorder and phobia), “perfectionism, control and trauma” for factor 3 (constructs related to obsessive compulsive disorder and posttraumatic stress disorder), and “social anxiety” for factor 4 (constructs related to social anxiety) [14]. For the Arabic PASS, factor 1 included acute anxiety, social anxiety, and dissociation; factor 2 included specific fears and trauma; factor 3 included general anxiety and adjustments; and factor 4 included perfectionism and control. Actually, these results of factor analysis are similar to those obtained for the Turkish version of the scale on factor 4 (perfectionism and control) and partially for the other three factors [19]. These changes in the structure of components distribution for the scale may reflect the cultural and linguistic adaptation of the scale to the Arabic speaking population.
As hypothesized, the Arabic PASS had positive significant associations with previously validated Arabic versions of the EPDS-10 and GHQ-12. It is not surprising that the PASS correlated positively with the EPDS since anxiety and depression are known to occur concurrently in more than 50% of the time [20]. The results showed that more than 82.40% had depression illness among this group and 34.10% have severe anxiety. Results are indicative that some of the women in this group may suffer from anxiety with or without depression. The PASS can identify anxiety status regardless of the depression status among women in the antenatal and postnatal stage. Further studies are recommended for assessing the ability of the PASS to distinguish between those who have anxiety only or in combination with other psychological disorders among pregnant and postpartum women. There was also a positive, significant, but weaker, association between the PASS and the adverse life events. This existing low magnitude association may be due to the way people cope with adverse life events. For example, persons with good coping strategies may score low on the Arabic PASS even though their score for adverse life events is high. It is highly recommended to conduct further investigation regarding experienced life events and anxiety and the impact of coping strategies.
This study has some limitations. Participants were recruited from clinics in the Eastern part of Riyadh and the sample cannot be considered representative of the entire population of Riyadh or the Saudi population. However, formal Arabic was used to translate and validate the tool, making it comprehended and useful for all Arabic speaking nations.