Typology of Parent-to-Child Emotions: A Study of Japanese Parents of a Foetus up to a 12-Year-Old Child.

Background: Emotions are the fundamental origin of parent-child bonding, which is measurable by the Scale for Parent-to-Child Emotions (SPCE) based on the theories of basic and self-conscious emotions. Methods: This study is based on the data from a cross-sectional study that we previously reported. The data consist of fathers and mothers who had a child/children, whose eldest child's age was at the foetal stage up to 12 years old, and were recruited via the Internet (N = 4600). A series of cluster analyses using factor scores (theta[Ó¨]s) of all domains of the SPCE were conducted. After the clusters emerged, the fathers and mothers allocated to each cluster were compared by the child's age stage. The validation of the classifications was also conducted using ANOVAs and chi-squared tests. A discriminant function analysis was conducted. Results: The participant mothers and fathers were classified into Cluster 1 (Lack of Bonding Emotions, n = 509), Cluster 2 (Bonding Disorder, n = 1471), Cluster 3 (Ambivalent Bonding Emotions, n = 1211), and Cluster 4 (Positive Bonding, n = 1409). Across the four clusters, there were no differences in the age of the parents or the gender of the child. During the second trimester, mothers made up the majority of Cluster 4 (Positive Bonding), totalling 81 cases (37.5%), whereas fathers made up the majority of Cluster 2 (Bonding Disorder), totalling 126 cases (60.0%). The three linear discriminants (LDs) well predicted the four clusters, and their functions showed cross validation. Conclusions: The typology of the SPCE is helpful to understand individual differences in terms of parental emotional bonding.

A scale of parent-to-child emotions: Adaptation, factor structure, and measurement invariance.

Emotions that parents feel when they think about their own child are extremely important in determining parenting approaches toward a child. Parental emotions should be defined under the rubric of human emotions that include both basic and self-conscious emotions. The Scale for Parent-to-Baby Emotions (SPBE) was developed underlying this concept, whereas an applicable scale for parent-to-child emotions for a wider age range for both mothers and fathers is needed. This study is aimed at examining the measurement invariance of this adapted scale among Japanese families. In a cross-sectional internet survey, men and women who had a child/children (including a fetus), whose eldest was aged up to 12 years old (N = 4600), were recruited. The questionnaire, which included the Scale for Parent-to-Child-Emotions-62 (SPCE-62) created from the SPBE via a process of rigorous translation, focused only on the eldest child. The feasibility of the SPCE-62 was assessed by a panel of three researchers. Each domain of both basic and self-conscious emotions was examined both in terms of robust factor structure and stable measurement invariance by multi-group confirmatory factor analysis. Responses to individual items were examined via item response theory, including differential item functioning. This resulted in a 43-item SPCE consisting of 9 domains: Happiness (four items), Anger (six items), Fear (four items), Sadness (five items), Disgust (five items), Shame (five items), Guilt (seven items), Alpha Pride (three items), and Beta Pride (four items). An empirical construct of parental emotion toward a child was derived. The SPCE makes it possible to measure parent-to-child emotions across parents' gender and the three age ranges of the child.

Is Your Pregnancy Unwanted or Unhappy? Psychological Correlates of a Cluster of Pregnant Women Who Need Professional Care.

BACKGROUND: A negative response towards a current pregnancy consists of two elements: unwantedness of and unhappiness about the current pregnancy. Little is clear about whether pregnant women can be categorized in terms of unwantedness and unhappiness as well as what the correlates are of these categories. METHODS: An internet survey of 696 women in their first trimester of pregnancy examined the participants' intention of and emotional reaction towards pregnancy, borderline personality traits, adult attachment style, depression, fear of childbirth, obsessive-compulsive symptoms, fetal bonding disorder, avoidance of taking part in child care, and consideration about termination of pregnancy (TOP). About one third of the participants were followed up with in their second trimester. RESULTS: Two-step cluster analysis using the participants' intention of and emotional reaction towards pregnancy revealed three groups of pregnant women: those who wanted and were happy about the pregnancy (Cluster 1), those who were unhappy about the pregnancy (Cluster 2), and those who did not intend to be pregnant but were happy about pregnancy (Cluster 3). Cluster 2 women, but not Cluster 3 women, were likely to be single, with borderline personality traits as well as unstable adult attachment styles, accompanied by depression, fear of childbirth, obsessive-compulsive symptoms, and fetal bonding disorder. They were more likely to avoid caring for the baby after childbirth and consider TOP. CONCLUSION: Expectant women who were unhappy about their pregnancy were at risk of psychological adjustment and need specific perinatal mental health assessment and care.

What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester.

Background: Depression is frequently seen among pregnant women. This is called antenatal depression (AND). Aim: Our aim was to identify clusters of AND and its core symptoms. Methods: The Patient Health Questionnaire-9 (PHQ-9), Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24), and Nausea and Vomiting of Pregnancy Quality of Life Questionnaire (NVP-QOL) were distributed to 382 pregnant women with a gestational age of 10 to 13 weeks who were attending antenatal clinics. The two PHQ-9 subscale scores were entered into a 2-step cluster analysis. The PHQ-9 items' capacity to identify AND were examined in terms of the area under curve (AUC) of a receiver operating characteristic (ROC) analysis. The selected symptom items were examined for their diagnostic capability in terms of the graded response model (GRM) in the item response theory (IRT) analysis. Results: Three clusters emerged. Cluster 3 scored highly in the scores of the two PHQ-9 subscales and the two emesis scales. In the ROC, five items showed an AUC > 0.80. The GRM identified four items with high information: 'loss of interest', 'depressed mood', 'self-esteem', and 'poor concentration'. Conclusions: The core symptoms of antenatal depression were four non-somatic symptoms; particularly, 'depressed mood' and 'loss of interest'. AND did not exist alone, but was accompanied by nausea and vomiting. Hence, we propose a new category: emesis-depression complex among pregnant women.

The Insomnia Severity Index: Factor Structure and Measurement and Structural Invariance across Perinatal Time Points.

Insomnia is associated with adverse outcomes in women in the perinatal period; thus, the assessment of insomnia is important for pregnant women. The Insomnia Severity Index (ISI) is an instrument used globally to assess the severity of insomnia. However, its factor structure and structural invariance for pregnant women have not been studied. Therefore, we aimed to conduct factor analyses to search for the best model to fit its structural invariance. A cross-sectional study with the ISI was conducted at one hospital and five clinics in Japan from January 2017 to May 2019. A set of questionnaires was administered on two occasions with a one-week interval. The study included 382 pregnant women ranging in gestational age from 10 to 13 weeks. One week later, 129 participants answered the retest. After exploratory and confirmatory factor analyses, the measurement and structural invariance between parity and two time points was tested. The two-factor structure model showed an acceptable fit for the ISI in pregnant women (χ2 (12) = 28.516, CFI = 0.971, RMSEA = 0.089). The model also showed satisfactory measurement and structure invariance between parity and time points. The findings indicate that the ISI's use would be appropriate for pregnant women as a two-factor subscale of "severity" and "impact", regardless of the parity or time point. The ISI's factor structure may vary by subject; hence, it is necessary to confirm the measurement and structural invariance of the subject for whom the ISI will be used. Furthermore, interventions that focus not only on total scores and cutoff points but also on the phenomenon of subscales should be considered.

A Scale of Parent-to-Child Emotions (SPCE): Development and validation of a short form.

Aim: Parents' emotions towards a child are extremely important. The Scale of Parent-to-Child Emotions (SPCE) consists of five basic and four self-conscious emotion domains for assessment of parental emotional states. Abridgement of the SPCE is needed for research and clinical settings. Methods: Our previous investigational data for SPCE development were used in this study. The sample of 2336 fathers and 2264 mothers, whose eldest child's age was up to 12 years old, was analyzed. Total information for each pair (form) of items corresponding to a latent trait (θ) was calculated. The form with the greatest amount of total information was selected as the best for each domain. In addition, relative efficiency for each form and correlations of raw sum scores in classical test theory (CTT) for short forms with factor scores in item response theory (IRT) were calculated. Results: The SPCE was shortened to 18 items by selecting two items each for nine domains. Correlations of raw sum scores in CTT for short forms with factor scores in IRT were correlated strongly and significantly. Conclusion: This abridged form of the scale, the SPCE-18, may be applicable in a busy clinical setting or research works to investigate the trajectory of parent-to-child emotions across a long span of time.

Disability during Early Pregnancy: Using the Sheehan Disability Scale during the First Trimester in Japan.

Background: Many pregnant women experience impairments in social, occupational, or other important functioning. Aim: This study aimed to confirm measurement and structural invariance of the Sheehan Disability Scale (SDS) and its validity during early pregnancy. Design: Longitudinal study with two observations. Methods: Questionnaires were distributed to pregnant women attending antenatal clinics at gestational weeks 10-13. Of 382 respondents, 129 responded to the SDS again 1 week later. Results: Confirmatory factor analysis shows good fit with the data: χ2/df = 0, comparative fit index (CFI) = 1.000, standardized root mean square residual (SRMR) = 0, and root mean square error of approximation (RMSEA) = 0.718. There is acceptable configural, measurement, and structural invariance of the factor structure between primiparas and multiparas as well as between two observation occasions. The Pregnancy-Unique Quantification of Emesis and Nausea, Patient Health Questionnaire-9, and Insomnia Severity Index subscales explain 47% of the variance in SDS scores. Conclusion: Perinatal health care professionals should pay more attention to the difficulties and disabilities that pregnant women face.

Development of a Scale for COVID-19 Stigma and Its Psychometric Properties: A Study among Pregnant Japanese Women.

Background: Stigma towards COVID-19 may negatively impact people who suffer from it and those supporting and treating them. Objective: To develop and validate a scale to assess 11-item COVID-19−related stigma. Methods: A total of 696 pregnant women at a gestational age of 12 to 15 weeks were surveyed using an online survey with a newly developed scale for COVID-19 stigma and other variables. The internal consistency of the scale was calculated using omega indices. We also examined the measurement invariance of the scale. Results: Exploratory factor analyses (EFAs) of the scale items were conducted using a halved sample (n = 350). Confirmatory factor analyses (CFAs) among the other halved sample (n = 346) compared the single-, two-, three-, and four-factor structure models derived from the EFAs. The best model included the following three-factor structure (χ2/df = 2.718, CFI = 0.960, RMSEA = 0.071): Omnidirectional Avoidance, Attributional Avoidance, and Hostility. Its internal consistency was excellent (all omega indices > 0.70). The three-factor structure model showed configuration, measurement, and structural invariances between primiparas and multiparas, and between younger (less than 32 years) and older women (32 years or older). Fear of childbirth, mother−fetal bonding, obsessive compulsive symptoms, depression, adult attachment self-model, and borderline personality traits were not significantly correlated with the Omnidirectional Avoidance subscale but correlated with the Attributional Avoidance and Hostility subscales (p < 0.001). Conclusion: The findings suggested that our scale for COVID-19 stigma was robust in its factor structure, as well as in construct validity.

Effects of 1-day e-learning education on perinatal psychological support skills among midwives and perinatal healthcare workers in Japan: a randomised controlled study.

BACKGROUND: Although midwives are expected to play a key role for psychological support throughout perinatal periods, their educational chances are limited. Versatile teaching strategies such as e-learning may be promising in expanding education. The objective of our study was to clarify the effects of an e-learning educational programme on midwives' empathic communication skills. METHODS: From April 2019 to September 2019, a randomised controlled trial of a 1-day e-learning educational programme on perinatal psychological issues (both perinatal mental health assessment and empathic communication) was conducted to improve empathic communication skills of midwives and perinatal healthcare workers. Two types of measurements (paper-and-pencil multiple-choice test and video-viewing tests of simulated patient) were used to measure the competency of empathic communication skills. RESULTS: Participants (N = 115) were randomly allocated to two groups (Intervention: n = 58, Control: n = 57). The intervention group was at a significantly higher level for both post-tests of empathic communication skills compared with the control group. Both intervention and control groups showed improvements in acquiring knowledge about perinatal mental health assessments. CONCLUSIONS: The results of our study show that a 1-day e-learning programme helped improve the midwives' empathic communications skills. Therefore, an effective 1-day e-learning educational programme of perinatal mental health will expand opportunity to learn about empathic communication skills for midwives and perinatal healthcare workers. TRIAL REGISTRATIONS: UMIN000036052.

The NVP QOL Questionnaire: Psychometric properties of the self-report measure of health-related quality of life for nausea and vomiting during pregnancy.

Aim: The Nausea and Vomiting of Pregnancy Quality of Life (NVP QOL) Questionnaire is a self-report measure of health-related QOL for nausea and vomiting during pregnancy. This study determines the best fitting factor structure for the NVP QOL Questionnaire and explores its measurement invariance in terms of observation time and parity. Methods: A test-retest study of pregnant women was conducted at Gestational Weeks (GWs) 10-13 (T1: N = 381) and 1 week later (T2: n = 128) at one hospital and five clinics with the NVP QOL and the Pregnancy-Unique Quantification of Emesis and Nausea (PUQE). Exploratory and confirmatory factor analyses were performed to compare different factor structure models and evaluate measurement invariance of the best fitting model between two time points and between primiparas and multiparas. Concurrent validity of the NVP QOL was clarified by correlations with the PUQE, Sheehan Disability Scale, and other scales. Results: The one-factor model had the best fit. This factor structure model was acceptable up to the factor invariance level for two time points and up to the factor mean level for primiparas versus multiparas. Correlations between NVP QOL, PUQE, and Sheehan Disability Scale scores were strong. Women with higher NVP QOL scores were more likely to lose weight, have lower daily fluid intake, have reduced fluid and food intake since pregnancy began, and receive outpatient or inpatient treatment. Conclusion: The one-factor structure and measurement invariance of the NVP QOL at different times and parities were demonstrated, suggesting that the NVP QOL can be used to evaluate primiparas and multiparas in a longitudinal study.

Development of a scale for parent-to-baby emotions: Concepts, design, and factor structure.

Aim: Although infant crying is a prerequisite for a baby's survival, it often leads to negative consequences for the caregivers. We hypothesized that this would be mediated by a primary emotion that we feel directly in response to an internal or external event. Hence, this study aimed to develop a new scale to measure basic and self-conscious emotions as primary emotions towards an infant's cry. Methods: We conducted a cross-sectional web survey including the scale for parent-to-baby emotions (SPBE)-with 73 items elicited from a literature review-targeted at mothers at 1 month after childbirth (N = 879). A series of explanatory and confirmatory factor analyses were conducted using item parcels. Internal consistency of the scale was calculated by omega indices. We also examined measurement invariance of the scale. Results: The theory-driven six basic emotions bifactor model (comparative fit index [CFI] = 0.968, root mean square of error approximation [RMSEA] = 0.070) and four self-conscious emotions factor model (CFI = 0.973, RMSEA = 0.079) were judged as the best models. They were stable in terms of configural, measurement, and structural invariances across parity. Conclusion: The SPBE we created is a psychometrically robust measure to assess the primary emotions under the rubric of parent-to-baby emotions. It is a promising tool for measuring parent-to-baby emotions in clinical and research settings.

The Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24): Configural, Measurement, and Structural Invariance between Nulliparas and Multiparas and across Two Measurement Time Points.

BACKGROUND: The severity of nausea and vomiting of pregnancy (NVP) correlates with pregnancy complications. This study aimed to confirm the measurement and structural invariance of the 24 h Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) regarding parity and observation time among pregnant women during the first trimester. METHODS: Questionnaires including the PUQE-24 and the Health-Related Quality of Life for Nausea and Vomiting during Pregnancy (NVP-QOL) questionnaire were distributed to pregnant women from 10 to 13 weeks of gestation who were attending antenatal clinics. There were 382 respondents, and of these, 129 responded to the PUQE-24 again one week later. RESULTS: Confirmatory factor analysis of this single factor model showed a good fit with the data: CFI = 1.000. The PUQE-24 factor and NVP-QOL factor were strongly correlated (r = 82). Configural, measurement, and structural invariance of the factor structure of the PUQE items were confirmed between primiparas and multiparas as well as at the test and retest observation occasions. CONCLUSION: The findings suggested that using the PUQE-24 among pregnant women in the first trimester was robust in its factor structure. The PUQE-24 may be a promising tool as an easy and robust measure of the severity of nausea and vomiting among pregnant women.