Abstract
Abstract. Pregnancy-related anxiety is an important risk factor for adverse pregnancy outcomes and postnatal parental well-being, to a greater extent than general anxiety, calling for a reliable and validated measure for its assessment. The current paper aimed to validate the Pregnancy Anxiety Questionnaire – Revised-2 (PRAQ-R2; Huizink et al., 2016) in a sample of Italian women, by testing its psychometric properties, and checking for Italian–Finnish measurement invariance. Additionally, the association with general anxiety and depression was examined. Participants included 348 Italian pregnant women and 348 Finnish pregnant women. Results showed that the Italian version of PRAQ-R2 presents satisfying psychometric proprieties. Data supported a three-factor solution including fear of giving birth, worries about bearing a handicapped child, and concern about own appearance. Invariance across countries was confirmed. The primiparous condition was associated with a higher level of pregnancy anxiety only for fear of giving birth. A moderate correlation was found between pregnancy anxiety and general anxiety and depression, providing evidence for concurrent validity, as well as for the existence of a specific pregnancy anxiety dimension.
References
2014). Maternal-fetal attachment and its correlates in a sample of Italian women: A study using the Prenatal Attachment Inventory. Journal of Reproductive and Infant Psychology, 32, 230–239.
(2016). Pregnancy-related anxiety: A concept analysis. International Journal of Nursing Studies, 55, 115–130. https://doi.org/10.1016/j.ijnurstu.2015.10.023
(2012). The structure of cognitive abilities in youths with manic symptoms: A factorial invariance study. Assessment, 19, 462–471.
(1989). EQS 6 structural equations program manual. Los Angeles, CA: BMDP Statistic Software.
(1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238–246.
(1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88, 588–606.
(1999). The Edinburgh Postnatal Depression Scale: Validation for an Italian sample. Journal of Affective Disorders, 53, 137–141. https://doi.org/10.1016/S0165-0327(98)00102-5
(2016). Identifying the women at risk of antenatal anxiety and depression: A systematic review. Journal of Affective Disorders, 191, 62–77. https://doi.org/10.1016/j.jad.2015.11.014
(2016). Pregnancy-related anxiety: Evidence of distinct clinical significance from a prospective longitudinal study. Journal of Affective Disorders, 197, 251–258. https://doi.org/10.1016/j.jad.2016.03.008
(1989). Structural equations with latent variables. New York, NY: Wiley.
(1993).
(Alternative ways of assessing model fit . In K. A. BollenJ. S. LongEds., Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.2015). Pregnancy anxiety: A systematic review of current scales. Journal of Affective Disorders, 176, 24–34. https://doi.org/10.1016/j.jad.2015.01.039
(1998). Structural equation modeling with LISREL, PRELIS, and SIMPLIS: Basic concepts, applications, and programming. Mahwah, NJ: Erlbaum.
(2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233–255. https://doi.org/10.1207/S15328007SEM0902_5
(2011). Anxiety: Splitting the phenomenological atom. Personality and Individual Differences, 50, 889–897. https://doi.org/10.1016/j.paid.2010.09.013
(1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150, 782–786. https://doi.org/10.1192/bjp.150.6.782
(1983). Cross-validation of covariance structures. Multivariate Behavioral Research, 18, 147–167.
(2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. The British Journal of Psychiatry, 210, 315–323. https://doi.org/10.1192/bjp.bp.116.187179
(2012). Anxiety, depression and stress in pregnancy. Current Opinion in Psychiatry, 25, 141–148. https://doi.org/10.1097/YCO.0b013e3283503680
(2017). semplot: Path diagrams and visual analysis of various sem packages’ output (R package version 1.1) [Computer software manual]. Retrieved from https://CRAN.R-project.org/package=semPlot
. (2015). A psychometric systematic review of self-report instruments to identify anxiety in pregnancy. Journal of Advanced Nursing, 71, 1986–2001. https://doi.org/10.1111/jan.12649
(2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491. https://doi.org/10.1037/1082-989X.9.4.466
(2016). polycor: Polychoric and polyserial correlations (R package version 0.7-9) [Computer software manual]. Retrieved from http://CRAN.R-project.org/package=polycor
(2009). A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatrica Scandinavica, 119, 350–364. https://doi.org/10.1111/j.1600-0447.2009.01363.x
(2017). Prenatal maternal mood patterns predict child temperament and adolescent mental health. Journal of Affective Disorders, 228, 83–90. https://doi.org/10.1016/j.jad.2017.11.065
(2014). Understanding pregnancy anxiety: Concepts, correlates and consequences. Zero to Three, 3, 12–21.
(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. https://doi.org/10.1080/10705519909540118
(2016). Adaption of Pregnancy Anxiety Questionnaire – Revised for all pregnant women regardless of parity: PRAQ-R2. Archives of Women’s Mental Health, 19, 125–132. https://doi.org/10.1007/s00737-015-0531-2
(2017). From prenatal anxiety to parenting stress: A longitudinal study. Archives of Women’s Mental Health, 20, 663–672. https://doi.org/10.1007/s00737-017-0746-5
(2014). The interrelationship between pregnancy-specific anxiety and general anxiety across pregnancy: A longitudinal study. Journal of Psychosomatic Obstetrics Gynaecology, 35, 92–100. https://doi.org/10.3109/0167482X.2014.944498
(2004). Is pregnancy anxiety a distinctive syndrome? Early Human Development, 79, 81–91. https://doi.org/10.1016/j.earlhumdev.2004.04.014
(1996). LISREL 8: User’s reference guide. Lincolnwood, IL: Scientific Software International.
(2018). Cohort profile: The FinnBrain birth cohort study (FinnBrain). International Journal of Epidemiology, 47, 15–16j. https://doi.org/10.1093/ije/dyx173
(2017). Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: A prospective cohort study. BMJ Open, 7, e013413. https://doi.org/10.1136/bmjopen-2016-013413
(2016). Evidence of factorial validity of parental knowledge, control and solicitation, and adolescent disclosure scales: When the ordered nature of Likert scales matters. Frontiers in Psychology, 7, 941.
(2008). Power and sensitivity of alternative fit indices in tests of measurement invariance. The Journal of Applied Psychology, 93, 568–592. https://doi.org/10.1037/0021-9010.93.3.568
(2014). The persisting effect of maternal mood in pregnancy on childhood psychopathology. Development and Psychopathology, 26, 393–403. https://doi.org/10.1017/S0954579414000029
(1996). STAI: State-Trait Anxiety Inventory – Forma Y
([State Trait Anxiety Inventory - Form Y] . Firenze, Italy: Organizzazioni Speciali.2017). R: A Language and environment for statistical computing [Computer software manual]. Retrieved from http://www.R-project.org/
. (2013). The influence of general anxiety and childbirth-specific anxiety on birth outcome. Archives of Women’s Mental Health, 16, 363–369. https://doi.org/10.1007/s00737-013-0344-0
(2012). lavaan: An R Package for Structural Equation Modeling. Journal of Statistical Software, 48, 1–36. Retrieved from http://www.jstatsoft.org/v48/i02/
(2015). A review of the effects of anxiety during pregnancy on children’s health. Materia Socio-Medica, 27, 200–202. https://doi.org/10.5455/msm.2015.27.200-202
(1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
(1989). EzPATH: Causal Modeling: A supplementary module for SYSTAT and SYGRAPH. Evanston, IL: SYSTAT.
(1980, May). Statistically based tests for the number of common factors. Paper Presented at the Annual Meeting of the Psychometric Society, Iowa City, IA.
(1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1–10.
(1990). The influence of maternal emotion during pregnancy on fetal and neonatal behavior. Journal of Prenatal & Perinatal Psychology & Health, 5, 119–130.
(2017). Pregnancy-specific anxiety and its association with background characteristics and health-related behaviors in a low-risk population. Comprehensive Psychiatry, 75, 6–13. https://doi.org/10.1016/j.comppsych.2017.02.002
(2009). ggplot2 [Computer software manual]. New York, NY: Springer. Retrieved from https://cran.r-project.org/web/packages/ggplot2/ggplot2.pdf
(1997).
(Exploring the measurement invariance of psychological instruments: Applications in the substance use domain . In K. J. BryantM. WindleS. G. WestEds., The science of prevention: Methodological advances from alcohol and substance abuse research (pp. 281–324). Washington, DC: American Psychological Association.2010). Confirmatory factor analysis of ordinal variables with misspecified models. Structural Equation Modeling, 17, 392–423. https://doi.org/10.1080/10705511.2010.489003
(