Objective: Despite the prevalence of perinatal anxiety and the maternal health crisis, underdiagnosis is an ongoing issue as women are not being properly screened for anxiety at their perinatal health visits. Asian immigrant mothers may be at higher risk for untreated perinatal mental health issues, including perinatal anxiety, due to the lack of perinatal screening tools developed specifically for this population. The Perinatal Anxiety Screening Scale (PASS) has been shown to be an acceptable measure for detecting anxiety disorder symptoms. While the PASS had been translated into Simplified Chinese and validated against a group of perinatal mothers in China, it had not been tested for validity and reliability for perinatal Chinese immigrant mothers in the U.S. The current study examined the validity and reliability of the adapted Chinese version of the PASS (i.e., PASS-C) when used among Chinese-speaking perinatal mothers aged 18-45.

Methods: This study used a combination of cross-sectional and longitudinal designs. Data was collected twice, two weeks apart (Time 1 and Time 2), through participant self-reporting via an online survey through Qualtrics. A sample of N = 255 completed Time 1 survey and n = 85 completed Time 2 survey. All participants were U.S.-based first-generation and 1.5-generation ethnic Chinese immigrant women between 18 to 45 years of age, able to read either Simplified or Traditional Chinese, and between 20 completed weeks of gestation and up to 1 year after childbirth. The Time 1 survey included the adapted PASS-C, a set of sociodemographic questions, and additional measures, including translated Chinese versions of the Depression, Anxiety and Stress Scale (DASS-21) for convergent validity and the Hypomania Checklist 32 (HCL-32) for discriminant validity. The Time 2 survey included only the PASS-C and was used to assess the scale's test-retest reliability.

Results: Findings showed the PASS-C to be an acceptable measure in identifying perinatal anxiety symptoms among Chinese-speaking perinatal mothers. The PASS-C demonstrated very good test-retest reliability in both antenatal and postnatal mothers and across both Traditional and Simplified Chinese language versions. Results demonstrated good internal reliability of the PASS-C in both Traditional Chinese (Cronbach’s alpha = 0.95) and Simplified Chinese (Cronbach’s alpha = 0.97) language versions. Further, the PASS-C and its Acute Anxiety and Adjustment subscale demonstrated very good convergent validity with the overall DASS-21 and DASS Anxiety scores. Results demonstrated acceptable convergent validity with the remaining PASS-C subscales: Excessive Worry and Specific Fears; Perfectionism, Control and Trauma; and Social Anxiety. The PASS-C also demonstrated good discriminant validity with the HCL-32 across all its subscales.

Conclusion: The development and validation of culturally and linguistically responsive mental health screening tools are necessary to address mental health disparities and increase access to care for Asian immigrant mothers and their families. The validation of the PASS-C is a step toward increasing health equity and resources for Chinese immigrant mothers who may be at risk of underdiagnosis and untreated perinatal anxiety.