Stressful events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study.

OBJECTIVE: to identify problems and events perceived as stressful by primiparous mothers during the postpartum period, and to explore the social support and coping strategies they used to face these situations. DESIGN: a qualitative study. Data were collected via semi-structured interviews and analysed using a content-analysis method. SETTING: Geneva University Hospitals, Geneva, Switzerland from October 2006 to March 2007. PARTICIPANTS: 60 women interviewed six weeks after the birth at term of their first child. FINDINGS: during the early postpartum period, interaction with caregivers was an important source of perceived stress. Upon returning home, the partner was considered as the primary source of social support, but the first need expressed was for material support. Breast feeding was perceived negatively by the new mothers, and this may be due to the difference between the actual problems encountered and the idealised expectations conveyed by prenatal information. Educational information dispensed by medical staff during the prenatal period was not put into practice during the postpartum period. Mothers expressed the need to be accompanied and counselled when problems arose and regretted the lack of long-term postpartum support. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: both the prenatal education and postpartum social support seem to mismatch women's needs and expectations. Concerted efforts are required by health professionals at the maternity unit and in the community to provide mothers with more adequate postpartum assistance.

[The French adaptation of the STAXI-2, C.D. Spielberger's State-trait anger expression inventory]. / Une adaptation française du STAXI-2, inventaire de colère-trait et de colère-état de C.D. Spielberger.

The assessment of anger has received increasing attention because of growing evidence that anger and hostility are related to heart disease. Research on anger assessment has also been stimulated by the development of psychometric measures for evaluating different aspects of anger. First, we review the major self-report scales used to assess anger and hostility. The scales appeared to have been constructed without explicit definition of anger and there is little differentiation between the experience and expression of anger. The factor-derived STAXI-2 is a 57-item measure of the expression of anger, and is comprised of the state-trait anger scale [Spielberger CD, Jacobs G, Russell JS, Crane RS. Assessment of anger: the state-trait anger scale. In: Butcher JN, Spielberger CD, editors. Advances in personality assessment, 2. Hillside, NJ: Erlbaum; 1983] and the anger expression scale (AX; Spielberger et al., 1985). The state anger scale (SAS) includes three subscales: feeling angry, feeling like expressing anger verbally, and feeling like expressing anger physically. The trait anger scale (TAS) consists of two subscales: angry temperament and angry reaction. The AX deals with the direction of both anger expression and anger control, resulting in four revised AX subscales: anger expression/out (verbal and physical, aggressive behavior directed toward other persons or objects), and anger expression/in (anger suppression), anger control/out (attempts to monitor and prevent the outward expression of anger) and anger control/in (active attempts to calm down and reduce angry feelings). The aim of this work was to examine the factor structure and the psychometric properties of the French adaptation of STAXI-2. A sample of 1085 French subjects, 546 female and 539 male, between 18 and 70 years old participated in the study. The 57 items of the three original subscales (SAS, TAS, and AX scale) were analyzed separately by sex and by subscale, using exploratory factor analyses (principal axis analysis, followed by promax rotations). For the first part of the questionnaire (SAS), factor analysis suggested the presence of three factors with eigenvalues >1.0; but the factor structure obtained for males and females differed and was difficult to interpret. Moreover, the explained variance of Factors 2 and 3 was low. Velicer's MAP criteria and screen test established that one solution factor was more relevant. Confirmatory factor analysis suggested that the three factor solution was acceptable, but the unifactorial solution adjusted better to the data. For the second part of the questionnaire (TAS) factor analysis was conducted following the same procedure, and two factors were extracted. The explained variance of Factor 2 was very low. Velicer's MAP criteria and screen test suggested that the solution factor was more relevant. Moreover, the adjustment parameters of the original two-factor structure were not satisfactory. Finally, the analyses of the 32 items of anger expression and control yielded four factors with eigenvalues >1.0. All items loaded higher than 0.38 on the corresponding factor and lower than 0.30 in other factor. The factor structure of the AX scale was fairly robust, both for males and females. Internal consistency and test-retest reliability of the subscales were acceptable except for the SAS. The correlations of the six subscales with four criterion variables (Buss Durkee hostility inventory, Cook and Medley Ho scale, NEO PI-R Ho scale and Courtauld emotions control scale) were in the expected direction, establishing their convergent validity. In summary, the analysis reported in this study checked the factor structure of the STAXI-2 translated into French. The state anger dimension was also essentially confirmed, but no distinction was found between the three components: feeling angry, feeling like expressing anger verbally, and feeling like expressing anger physically. Moreover, the distinction between angry temperament and angry reaction was not confirmed because of gender differences, but we established a robust and valid trait anger factor. Finally, we confirmed the factor structure of the original anger expression scale without gender differences. Some practical and theoretical perspectives for the use of the French adaptation of the STAXI-2 are suggested.

[Pain coping strategies: French adaptation of the coping strategies questionnaire (CSQ-F)]. / Stratégies de coping des patients douloureux: adaptation française du coping strategies questionnaire (CSQ-F).

BACKGROUND: Many studies have shown that the strategies used to cope with chronic pain play a very important role in the adjustment to the pathology and to its effects (emotional distress, physical and psychosocial impairment, and quality of life). Among the methods assessing coping with pain, the most widely used instrument at present is the coping strategies questionnaire (CSQ) developed by Rosenstiel and Keefe, [Pain 17 (1983) 33-44]. This questionnaire is composed of 48 items distributed in eight subscales each including six items: diverting attention, reinterpreting pain sensations, coping self-statements, ignoring pain sensations, praying and hoping, catastrophizing, increasing activity level, and increasing pain behaviour. Most studies examining the factor structure of the CSQ have used the scores of its eight prior theoretically derived scales rather than the 48 items. Three studies, Tuttle et al. [Rehab Psychol 36 (1991) 179-187], Swartzmann et al. [Pain 54 (1994) 311-316; Robinson et al. [Clin J Pain 13 (1997) 43-49] have examined the factor structure of the CSQ from the 48 original items on the questionnaire and have yielded five or six factors. A structural confirmatory analysis showed the superiority of the six-factor model [Clin J Pain 13 (1997) 156-162]: distraction, catastrophizing, ignoring pain sensations, distancing from pain, coping self-statements and praying. The present study aimed at measuring the internal consistency and the construct validity of the French version of the CSQ. METHOD: The CSQ was translated into French with the forward and backward translation procedure. To evaluate internal consistency, Cronbach's alphas were computed. Construct validity of the questionnaire was estimated through confirmatory factor analysis (CFA) in a sample of 330 chronic pain patients (71% of women): 40.3% suffered from low back pain, 33.6% from headaches and 26.1% from neuropathic pain. The three factor structures previously proposed in the literature were tested using the LISREL 8.3 structural equation-modelling program developed by Jöreskog and Sörbom, [Lisrel 8: user's reference guide, Chicago: Scientific Software International, 1993]. RESULTS: The CFA performed on the three models of factor structures of the CSQ previously reported confirms the best fit of the six-factor model by Robinson et al. [Clin J Pain 13 (1997) 43-49] in our sample. However, the coping self-statements factor, whose internal consistency was too weak in our analysis (Cronbach's alpha=0.57), was eliminated. We therefore retained only five factors in our sample. The French version of the CSQ (CSQ-F) is composed of 21 items belonging to five factors: distraction, catastrophizing, ignoring pain sensations, reinterpreting pain sensations, and praying. CONCLUSIONS: The present study indicates that the internal consistency and the construct validity of the French version of the CSQ were adequate, and contributes to demonstrate the stability of the factor structure of the CSQ across samples. The 21-item French adaptation of the CSQ (CSQ-F) appears to be a very interesting tool because it facilitates the use of this questionnaire, not only for research but also in the clinical assessment of the patients suffering from chronic pain.

Dimensions of cancer locus of control scale as predictors of psychological adjustment and survival in breast cancer patients.

The Cancer Locus of Control Scale, to investigate specific beliefs of control in cancer patients, was validated previously with an English-speaking population. This study tested the construct and concurrent validity of a 17-item French version of the scale and explored its relations with psychological adjustment and with adaptation assessed two years later. In a sample of 157 women diagnosed with a first breast cancer, the French version was administered along with the Body Image Questionnaire, the State-Trait Anxiety Inventory, the Perceived Stress Scale, the Social Support Questionnaire, and the Ways of Coping Checklist. A factor analysis performed on scores identified the three original factors: internal causal attribution, control over the course of the illness, and religious control. Internal causal attribution was associated with high scores for state and trait anxiety, negative body image, emotion-focused coping, and problem-focused coping. Control over the course of the cancer was positively associated with scores on both problem- and emotion-focused coping. Religious control was negatively associated with perceived stress. Emotional adjustment and quality of life were assessed in 59 of the 157 breast cancer patients two years after diagnosis and original testing. Hierarchical regression analyses indicated that internal causal attribution significantly predicted 38.1% of the variance in rated state anxiety. None of the dimensions of the Cancer Locus of Control Scale predicted the duration of survival measured two years later in 75 of the 157 patients.

Development and validation of a multidimensional smoking behaviour questionnaire.

We administered a 42-item smoking behaviour questionnaire to 150 adult smokers (75 men and 75 women), 18 to 70 years old (M = 37.1 yr., SD = 12.2). A principal component analysis of their responses followed by varimax rotation yielded four factors accounting for about 52% of the total variance: dependence, social integration, regulation of negative affect, and hedonism. Some sociodemographic and dispositional characteristics of the smokers predict these four dimensions. The predictors of each smoking dimension are quite different for male and female smokers.

French adaptation of the Ways of Coping Checklist.

A short form (42 items) of the Ways of Coping Checklist was administered to 468 French men and women. A factor analysis of the responses yielded three factors, accounting for about 35% of the total variance, and named Problem-focused Coping, Emotion-focused Coping, and Social Support seeking. The first two dimensions are close to those generally described in the literature. Some interesting relationships of scores appeared between personality and coping, notably, between anxiety and emotion-focused coping.

Psychological adjustment to hospitalization: factorial structure, antecedents, and outcome.

Using various methods of observation, the psychological status of 211 patients of both sexes was assessed after the surgery or treatment justifying their hospitalization. Intercorrelations of scores on 40 variables obtained to describe the state of the patients were submitted to a principal components analysis. The latter yielded a factor of maladjustment to hospitalization associated with various psychosociological antecedents of the patients and a short-term unfavorable development of their physical health. This dimension seems to correspond not just with personal characteristics but to involve the interaction of medical staff members and patients in a manner detrimental to patients' recovery.

[Various components of smoking behavior: construction and validation of a questionnaire]. / Différentes composantes du comportement tabagique: construction et validation d'un questionnaire (QCT).

The general objective of this work was to identify within the smoking population different types of smoking behavior and to determine the multiple pharmacological and psychosocial factors (and their interaction) which could determine these categories of behavior. Our first step was to construct a valid instrument consisting of a questionnaire (self-administered) with the goal to measure the different types of smoking behavior. The second step relevant to the multifactorial approach is actually in progress. Its objective is to determine the relation between the pharmacological and psychosocial factors that could explain the inter-individual differences for smoking behavior. In this paper we present the data obtained from the first step of our research. Our population is composed of 113 smokers of the age of 21 to 40 years to whom we presented a questionnaire "Types of Smoking Behavior" constructed during a preceding step. The data were submitted to different factorial analysis. Thus, a Principal Component Analysis gave us a general factor of smoking behavior or bipolar axis of high/low tobacco use (21.4% VT). The factorial analysis with varimax rotation confirmed the existence of 5 types of smoking behavior. These are "dependence" factor (29.1% VT), "regulation of negative affectivity "factor (11.2% VT), "increase of positive affect" factor (9.3% VT), "stimulation" factor (7.6% VT) and "social integration" factor (6.7% VT). These results allowed us to construct a valid questionnaire of 20 items measuring 5 types of smoking behavior.

Dimensionality of body perception and personality.

Fisher's Body Focus Questionnaire (1970) permits an estimation of the relative perceptive importance of eight zones of the body. The scores obtained by 377 French students of both sexes on the French version of this questionnaire show that the various body perceptions are structured by two main perceptual patterns, one of which is probably linked to orality and the other to anality. The relations which appeared between the scores and various personality traits are discussed.