Mental disorders during the perinatal period have serious consequences for women and their offspring. The majority of research on perinatal mental health has focused on the postnatal period and particularly on postnatal depression. Depression and anxiety during pregnancy have been largely neglected despite evidence suggesting symptoms of these disorders are higher during pregnancy than the postnatal period (Evans et al., 2001; Heron et al., 2004; Lee et al., 2007; Ross, Evans, Sellers, & Romach, 2003). Furthermore, research in this area indicates that antenatal depression and anxiety increase the likelihood of postnatal mental health problems (Heron et al., 2004), and are associated with negative offspring outcomes in childhood (Deave, Heron, Evans, & Edmond, 2008; O'Connor, Heron, Glover, & the ALSPAC Study Team, 2002; O'Connor, Heron, Golding, Beveridge, & Glover, 2002; O'Connor, Heron, Golding, Gover, & the ALPAC Study Team, 2003). While existing research highlights the need for increased attention to anxiety and depression experienced during pregnancy, important questions remain. The current proposal seeks to use data from a longitudinal, community-based study, the Avon Longitudinal Study of Parents and Children (ALSPAC; Golding, Pembrey, Jones, & the ALSPAC Study Team, 2001), to investigate the following aims:

Aim 1. To examine the presentation of anxiety during the perinatal period.Analyses will be conducted to examine perinatal anxiety symptoms as measured by a commonly used perinatal depression rating scale, the Edinburgh Postnatal Depression Sale (EPDS), in comparison to the Crown Crisp Experiential Index (CCEI). The proportion of women with clinically significant anxiety symptoms at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally, the contribution of the anxiety subscale to the total EPDS score, and the extent to which antenatal anxiety and depression are comorbid will be investigated. It is hypothesized that the EPDS will reveal patterns of perinatal anxiety that are similar to those previously seen with the CCEI and will be a valid measure of perinatal anxiety.

Aim 2. To assess the impact of antenatal anxiety, antenatal depression, and comorbid antenatal anxiety and depression on alcohol use during pregnancy and postpartum.Analyses drawing upon ALSPAC gestation data will be conducted to determine if women with antenatal anxiety, women with antenatal depression, and women with comorbid antenatal anxiety and depression have increased alcohol use during pregnancy and the postnatal period compared to women with no antenatal anxiety or depression. Antenatal mental health problems are hypothesized to predict increased use of alcohol both during and after pregnancy.

Aim 3. To examine the effects of antenatal anxiety, antenatal depression, and comorbid antenatal anxiety and depression on age 10 child behavioral and emotional problems. Reports from multiple informants (i.e., mothers and teachers) on the Development and Well-Being Assessment (DAWBA) and the Strengths and Difficulties Questionnaire (SDQ) will be included in analyses examining the association between antenatal anxiety, antenatal depression, and comorbid antenatal anxiety and depression and child behavioral and emotional problems at age 10. Antenatal mental health problems are hypothesized to increase risk for behavioral and emotional problems in offspring.

Deave, T., Heron, J., Evans, J., Edmond, A. (2008). The impact of maternal depression in

pregnancy on early child development. British Journal of Obstetrics and Gynaecology, 115, 1043-1051.

Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed

mood during pregnancy and after childbirth. British Medical Journal, 323, 257-260.

Golding, J., Pembrey, M., Jones, R., & the ALSPAC Study Team. (2001). ALSPAC - The Avon

Longitudinal Study of Parents and Children I. Study methodology. Paediatric and Perinatal Epidemiology, 15, 74-87.

Heron, J., O'Connor, T. G., Evans, J., Golding, J., Glover, V., & the ALSPAC Study Team.

(2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65-73.

Lee, A. M., Lam, S. K., Sze Mun Lau, S. M., Chong, C. S., Chui, H. W., & Fong, D. Y. (2007).

Prevalence, course, and risk factors for antenatal anxiety and depression. Obstetrics & Gynecology, 110, 1102-1112.

O'Connor, T. G., Heron, J., Glover, V., & the ALSPAC Study Team. (2002). Antenatal anxiety

predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1470-1477.

O'Connor, T. G., Heron, J., Golding, J., Glover, V., & the ALSPAC Study Team. (2003).

Maternal antenatal anxiety and behavioural/emotional problems in children: A test of a programming hypothesis. Journal of Child Psychology and Psychiatry, 44, 1025-1036.

O'Connor, T. G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2002). Maternal antenatal

anxiety and children's behavioural/emotional problems at 4 years. British Journal of Psychiatry, 180, 502-508.

Ross, L. E., Gilbert Evans, S. E., Sellers, E. M., & Romach, M. K. (2003). Measurement issues

in postpartum depression part 1: Anxiety as a feature of postpartum depression. Archives of Women's Mental Health, 6, 51-57.