The Italian language postpartum specific anxiety scale [PSAS-IT]: translation, psychometric evaluation, and validation

Abstract

IntroductionWhile often positive, the lifecourse transition to motherhood is susceptible to the risk for developing mood disorders. Postpartum anxiety has often been overshadowed by other perinatal-specific mental health disorders, such as postpartum depression, and therefore has not been at the forefront or center of as much empirical study. This has meant there is a lack of effective and reliable tools with which to measure it, despite growing evidence suggesting its detrimental impact on mothers, their babies, wider family and social contacts, and on healthcare systems. This current study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] into the Italian language, and to validate the tool for its use in detecting anxiety specific to motherhood.MethodsThe study (N = 457) comprised 4 stages: English-Italian translation and back-translation to obtain the Italian version [PSAS-IT]; a preliminary pilot study to adapt the PSAS to the characteristics of the Italian population; measurement invariance; and internal reliability of subscales.ResultsThe PSAS-IT demonstrates similar psychometric properties as the original English-language PSAS, with acceptable acceptability, construct and convergent validity, and internal consistency. Confirmatory factor analysis for multiple groups (Italy and United Kingdom) showed that the factor structure of the PSAS was valid for both groups [χ2 (2436) = 4679.481, p < 0.001, TLI = 0.969, CFI =0.972, RMSEA = 0.045, SRMR =0.064].DiscussionThe resulting findings offer a reliable measure of postpartum anxiety in Italian language up to six months after birth.

Postpartum-Specific Anxiety and Maternal–Infant Bonding: A Predictive Validity Study amongst Italian Women

“…The PSAS-IT [ 14 ] is a self-report instrument comprising 51 items designed to assess the frequency of specific anxiety symptoms during the postpartum period. Respondents are asked to rate their experiences over the past week on a 4-point Likert scale, ranging from 1 (never) to 4 (almost always).…”

“…The PSAS was originally developed as an English-language tool [ 20 ] and contains these four factors: maternal competence and bonding anxieties (15 items), infant safety and welfare anxieties (11 items), practical infant care anxieties (7 items), and psychosocial adjustment to motherhood (18 items). To date, there have been two derivative short-form research studies [ 38 , 39 ], and the tool has been translated and validated in French [ 40 ], Spanish [ 41 ], Chinese [ 42 ], Persian [ 43 ], and Italian [ 14 ], the latter of which has been used in this study. The scale showed good internal consistency (Cronbach’s α = 0.94).…”

“…However, little is known about maternal bonding in women with postpartum anxiety disorders, despite the high incidence of anxiety disorders in the postpartum period, particularly in Italy [ 13 ]. Indeed, in August 2020, the Italian National Institute of Health conducted a multi-center study which found the prevalence of postpartum anxiety in Italy is more than double the overall prevalence of 15% (1 to 24 weeks postpartum) and 14.8% (>24 weeks) found in meta-analytical studies [ 13 , 14 ]. Despite increasing scientific evidence in favor of early detection and immediate treatment of maternal anxiety, in pregnant women in Italy, anxiety is still largely undiagnosed and untreated [ 13 , 14 ].…”

“…Indeed, in August 2020, the Italian National Institute of Health conducted a multi-center study which found the prevalence of postpartum anxiety in Italy is more than double the overall prevalence of 15% (1 to 24 weeks postpartum) and 14.8% (>24 weeks) found in meta-analytical studies [ 13 , 14 ]. Despite increasing scientific evidence in favor of early detection and immediate treatment of maternal anxiety, in pregnant women in Italy, anxiety is still largely undiagnosed and untreated [ 13 , 14 ]. As a result, there is little research, particularly in Italy, on the prevalence and risk factors of anxiety in the postpartum period [ 15 ], and generic measures of anxiety are often used, which may have psychometric shortcomings and are not able to accurately capture unique presentations, as they can lead to false-positives and exaggerated anxiety scores [ 15 ].…”

“…This study aims to examine the predictive validity of the only assessment tool for postpartum-specific anxiety, the Italian-language version of the postpartum-specific anxiety scale (PSAS-IT) [ 14 ], to test whether postnatal maternal anxiety is a more effective predictor of maternal bonding and caregiving behavior than general measures of anxiety [ 32 , 33 ].…”