The aim of the current study was to develop a pregnancy specific psychological functioning scale. Based on the outcome of group interviews with pregnant women, new mothers and clinicians, a 16-item self-rating scale was developed (i.e., the TPDS; for full scale see appendix). Subsequent analyses confirmed that the TPDS has a two factor structure: 'negative affect' and 'partner involvement'. Negative affect, in turn, appeared to have three sub components: negative affect with regard to confinement, postpartum period and general health. Both AMOS and Lisrel showed appropriate structure of the final scale using CFA.
Although the overall TPDS and its NA sub-scale were only moderately correlated with well-recognized measures of depression (EPDS) and anxiety (GAD-7), indicating that the TPDS and its subscale 'NA' also assessed dimensions other than depression and anxiety, encouraging construct validity features may be derived from our finding that women with a previous diagnosis of depression/anxiety were at high risk for developing depressive and/or anxiety symptoms during pregnancy.
Interestingly, the current TPDS analyses indicated that perceived partner involvement (TPDS-PI sub-scale) constitutes a critically important variable for women during and after pregnancy (items 2, 4, 8, 16). The TPDS-PI sub-scale was only marginally correlated (r = .15) with the TPDS-NA sub-scale. Moreover, high scores on the TPDS-PI sub-scale were not related to a previous episode of depression/anxiety. Future research should concentrate on the impact of the woman's perception of little partner involvement during pregnancy. However, since partner involvement spontaneously emerged during the interviews these findings suggests that the TPDS-PI sub-scale constitutes a distinct dimension relevant to pregnant women.
To our knowledge the current paper is among the first to report on a pregnancy specific psychological functioning scale which was developed in close interaction with pregnant women, recently delivering mothers and health professionals for obstetric care. While over the last years there have been several attempts to develop pregnancy specific distress scales, most of these scales were adaptations from existing general depression and anxiety questionnaires [9
]. Moreover, none of these scales were developed after in-depth interviews with pregnant women and clinicians [9
]. The NA subscale of the TPDS has several items which are similar to the Cambridge Worry Questionnaire [11
]. The correlations in the current study between the NA-subscale and the EPDS and the GAD-7 scales were also found in the validation study of the Cambridge Worry Scale [11
]. The latter however, does not contain a sub-scale which specifically refers to the woman's perception of partner involvement.
Several recent studies have reported a relationship between high maternal distress levels during gestation and poor developmental outcomes in offspring [4
]. Evidently, low perceived partner involvement adds to the pregnancy stress experienced by women and, as such, constitutes an important topic for future research. Likewise, poor parental relationships should be included in future studies as marital distress also constitutes a major threat to developmental outcome [21
]. In view of this, one may also speculate whether those women who perceive poor partner involvement during gestation, are also at risk for continued poor partner interaction in the postpartum period.
The current study's key strength relates to the fact that the TPDS' first version originated from direct consultation with pregnant women, new mothers and clinicians. Other strengths include its large sample size, as well as the fact that the validity of the newly developed scale was examined in a separate cohort of women.
Limitations of the study include the fact that the participating women were all Caucasian, and that the term of gestation at which the women were assessed varied between 12 and 40 weeks. One may argue that the scores on the TPDS are trimester specific which would in turn call for future research to validate the TPDS per trimester.
However, as far as the NA-subscale is concerned, the Cambridge Worry Scale scores at different trimesters showed to be highly inter-correlated with appropriate validity at each trimester [11
Not having a psychiatric interview to diagnose pregnancy specific distress is another limitation of the study. However such an interview doesn't exist yet, indicating the need for further research on this topic.
The clinical relevance of a pregnancy specific distress scale is that it allows for quick screening and, if needed, quick subsequent intervention with active partner participation when necessary.