Perinatal Anxiety Screening Scale, PASS-R Test - the question form
Questions: 31 · 6 minutes
1. Worried about your baby/pregnancy.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
2. Fear that your baby will be harmed.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
3. Feeling afraid that something bad will happen.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
4. Worrying about many things.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
5. Worry about the future.
1 - Not at all
2 - Sometimes
3 - Often
4 - Almost always
6. Feeling downhearted.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
7. Very strong fear of needles, blood, childbirth, pain, etc.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
8. Sudden episodes of intense fear or discomfort.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
9. Repetitive thoughts that are difficult to stop or control.
Not at all
Sometimes
Often
Almost always
10. Difficulty sleeping, even when I have the opportunity to sleep.
1 - Not at all
2 - Sometimes
3 - Often
4 - Almost always
11. Needing to do things in a certain way or in a particular order.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
12. Wanting everything to be perfect.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
13. Needing to be in control of things.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
14. Difficulty stopping yourself from checking or redoing things over and over again.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
15. Felt nervous or easily startled.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
16. Worry about repetitive thoughts.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
17. Being on guard all the time or feeling you have to keep an eye on certain things.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
18. Feeling distressed by recurring memories, dreams, or nightmares.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
19. I worry that I will embarrass myself in front of others.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
20. Fear that others will judge me negatively.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
21. I feel very uncomfortable in crowds.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
22. I avoid social activities because I might start to feel nervous.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
23. I avoid things that make me anxious.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
24. Feeling detached, as if you are watching yourself in a movie.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
25. Lose track of time and cannot remember what happened.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
26. Difficulty adapting to new changes.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
27. Anxiety prevents me from getting things done.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
28. Racing thoughts make it difficult for me to concentrate.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
29. Fear of losing control.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
30. Feeling panicky.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always
31. Feeling keyed up.
1 – Not at all
2 – Sometimes
3 – Often
4 – Almost always