Checking for Positive Mental Health in Pregnancy

Checking for Positive Mental Health in Pregnancy January 25, 2018Leave a comment

Many pregnant women don’t feel emotionally healthy.

Janine, the consummate detail person, was able to get through her first prenatal visit in record time. She quickly divulged information about her health history and her experience with getting pregnant. That is until her doctor asked her to respond to the question “In the past 7 days have you been able to laugh and see the funny side of things”…followed by “In the past 7 days have you looked forward with enjoyment to things?” The doctor had explained that these questions were part of a depression screening questionnaire that he used for all pregnant women. Janine was pretty sure that she wasn’t depressed. But on the other hand, she couldn’t say she was feeling “happy” or “content” with her life. She seemed to be in this in-between twilight zone.

Many pregnant women don’t feel emotionally healthy

In fact, while up to 25% of women experience symptoms of anxiety and/or depression during pregnancy, there is a lot of difference in the level of mental health “healthiness” among the remaining 75%.

You may be surprised that our research shows that as many as 30% to 40% of pregnant women have “sub-clinical” symptoms of anxiety and depression. In other words, their symptoms aren’t quite high enough to qualify as having anxiety or depression, but they have low-level symptoms that ride just under the surface – but enough to affect their lives. You may recognize these “symptoms” in yourself. You feel like you don’t have much joy. You are tired and feel low-energy.  You don’t have a lot of motivation anymore. You feel under stress – more than usual. You don’t feel like you’re getting what you need out of your relationships. You struggle to feel like what you’re doing in your life has meaning and purpose. And – it’s all affecting your relationships.

So….while you don’t have symptoms of anxiety or depression per se, you don’t have positive mental health either.

Introducing the idea of positive mental health: Key ideas

Janine’s experience exemplifies the findings of a 2017 study (Phua et al., 2017) that explored this very topic.

The study highlights 3 key points about positive mental health during pregnancy:

  1. It is more than the absence of symptoms of anxiety or depression
  2. It includes our beliefs, attitudes, and actions that are resources that we pull on when we face challenging times, such as being able to have a sense of humour and generally feeling like you are in control of your life and situations.
  3. It has a clear effect on your child’s development. When women had positive mental health in pregnancy, their children had significantly better cognitive and language development (based on objective laboratory testing) and better social skills.


Checking Yourself for Positive Mental Health

This study pulled together indicators of positive mental health from questionnaires designed and tested to screen for depression and anxiety in clinical settings. There are three parts (Part A, B and C) with a total of 21 questions. These questions can help you to understand how high your positive mental health is, which can help you to understand more about yourself and how you respond to challenges.

Part A Instructions: For each of the 2 questions below, select one response.*

In the past 7 days, I have been able to laugh and see the funny side of things* 0=not at all 1=definitely not so much now 2=not quite so much now 3=as much as I always could
In the past 7 days, I have looked forward with enjoyment to things* 0=hardly at all 1= definitely less than I used to 2=rather less than I used to 3=as much as I ever did

Part B Instructions:

For each of the 10 questions below, score 1=not at all; 2=somewhat; 3=moderately so; 4=very much so**

  1. At this moment, I feel calm
  2. At this moment, I feel secure
  3. At this moment, I feel at ease
  4. At this moment, I feel satisfied
  5. At this moment, I feel comfortable
  6. At this moment, I feel self-confident
  7. At this moment, I feel content
  8. At this moment, I am relaxed
  9. At this moment, I feel steady
  10. At this moment, I feel steady

Part C Instructions:

For each of the 9 questions below, score 1=almost never; 2=sometimes; 3=often; 4=almost always**

  1. Generally, I feel pleasant
  2. Generally, I feel satisfied with myself
  3. Generally, I feel rested
  4. Generally, I am calm, cool and collected
  5. Generally, I am happy
  6. Generally, I feel secure
  7. Generally, I make decisions easily
  8. Generally, I am content
  9. Generally, I am a steady person

*From the Edinburgh Postnatal Depression Scale (validated for use in pregnancy)

**From the State-Trait Inventory (validated for use in pregnancy)

How Did You Do?

Add up the total number of points for each question (e.g., 1=definitely not so much now would equal 1 point; 2=not quite so much now would equal 2 points). This score should include all 21 questions from Part A, B and C. The higher the score, the better the level of positive mental health. There are no cut-off points as of yet indicating “high” versus “low” positive mental health. The lowest score is 19 and the highest score possible is 83

But, for the purpose of having a broad sense of your positive mental health, we suggest:

  • a score of 56 and above is high positive mental health
  • a score of 28-55 is moderate, and
  • a score of 27 or below is on the low side.

A high score (18 or above) tells you that you have a lot of positive psychological resources that can support you when you face stressful or challenging situations. A moderate score (10-17) indicates that you still have a good degree of positive psychological resources, but that under high stress you might need some additional support. A score on the low side (9 or below) suggests that under moderate or high stress you might benefit from some additional support to help you get through a trying time. For example, having a trusted confidant to talk to may help you not only to feel that you are not alone and to gain another helpful perspective but also to “beef up” your own personal psychological resources.

Read More: How to Keep Calm and Survive Your Pregnancy Brain


Bottom line: It’s possible not to have depression or anxiety, and yet still not have positive mental health. Knowing what positive mental health is and identifying your personal level of positive mental health can help you to understand how you respond to challenging situations and what areas you might like to shift in your life.

I’d love to hear your thoughts on “positive mental health” and whether you found these questions useful to you. Please feel free to share your comments below!

Feeling stressed about COVID during pregnancy? Check out our COVID-19 Mental Health Resources


Phua, D. Y., Kee, Mkzl, Koh, D. X. P., Rifkin-Graboi, A., Daniels, M., Chen, H., . . . Growing Up In Singapore Towards Healthy Outcomes Study, Group. (2017). Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study. Dev Psychopathol, 29(5), 1573-1587. doi:10.1017/S0954579417001249

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