Construct elaboration and validity of the Pregnancy Depression Risk Scale

methodological research, in six steps: theoretical model empirical definition; elaboration of scale items with literature review; consultation with five professional health experts and 15 pregnant women; content validity with six experts; pre-test-semantic validity with 24 pregnant women; scale factor structure definition with 350 pregnant women; pilot study with 100 pregnant women, totaling 489 pregnant women and 11 experts. Data were analyzed by content analysis, exploratory factor analysis, multitrait-multimethod analysis and internal consistency.

Results:

sixty-eight risk factors were identified for item formulation. The final version of the scale consisted of 24 items in five domains. The scale demonstrated satisfactory construct content, semantic, validity and reliability.

Conclusions:

the scale proved to be valid in terms of content and semantics, with a factor structure defined according to the adopted theoretical model and satisfactory psychometric properties.

Descriptors:
Nursing; Depression; Pregnancy; Psychometrics; Validation Study.

Scale items		Dimension or factor
Scale items		1	2	3	4	5
1^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	How old are you?	-0.07	-0.06	-0.21	-0.11	0.11
2^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	What is your education level?	-0.08	0.02	0.00	0.24	0.19
3	What is your current marital status?	-0.06	0.55^†	-0.13	0.20	-0.13
4	How do you define your current family income?	0.14	0.01	0.10	0.69^†	0.03
5	Considering the people who live with you, what is the head of the family’s labor situation?	0.02	0.10	-0.09	0.50†	0.04
6	How do you consider your social situation?	0.10	0.07	0.03	0.44^†	0.04
7	In this pregnancy, do you use illegal drugs?	0.04	-0.03	-0.06	-0.00	0.40^†
8	In this pregnancy, do you drink alcohol?	0.01	0.03	-0.00	0.07	0.52^†
9	In this pregnancy, do you smoke cigarettes?	0.03	0.00	-0.01	0.04	0.51^†
10^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	In the last 12 months, have you experienced a remarkable negative event in your life?	0.29	0.16	0.20	0.01	0.01
11	Did you suffer any kind of violence before this pregnancy?	0.27	0.35^†	0.19	0.02	0.18
12	Did you suffer any kind of violence in this pregnancy?	0.10	0.47^†	0.11	0.00	0.27
13^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	Do you face arguments with your partner in this pregnancy?	0.12	0.27	0.08	0.21	0.24
14	How do you define your relationships with people?	0.08	0.46^†	0.02	0.02	0.08
15^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	Do you have any support in difficult times?	0.11	0.25	0.02	-0.01	-0.01
16^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	Do you have a religion?	-0.01	0.05	-0.10	0.03	0.22
17	Do you have the support of your child’s father in this pregnancy?	0.01	0.66^†	-0.04	0.25	-0.10
18^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	Do you have a religion?	0.22	0.21	0.05	0.12	0.20
19	In this pregnancy, how do you define your mood most of the time?	0.35	0.39^†	0.15	0.18	0.22
20	In this pregnancy, have you been worried, more than usual, to the point of harming you?	0.58^†	0.07	0.30	0.16	-0.03
21	In this pregnancy, do you experience stressful situations that you consider to be harming you?	0.47^†	0.25	0.14	0.09	0.11
22	Do you have pregnancy-related fears?	0.49^†	-0.04	0.21	0.10	0.12
23	Do you want this pregnancy?	0.06	0.46^†	0.12	0.04	0.01
24	Have you had depression at any point in your life?	0.38^†	0.28	0.03	0.05	-0.01
25	Do you have cases of depression in your family?	0.33^†	0.12	-0.02	-0.10	-0.05
26	In this pregnancy, do you feel anxious, more than usual, to the point of interfering with your daily life?	0.58^†	-0.10	0.00	0.13	0.09
27	Do you have any health problem?	0.16	0.08	0.59^†	-0.00	-0.02
28	How do you define your ability to adapt to new life situations?	0.40^†	0.10	0.09	0.16	-0.04
29^* * Item eliminated from the scale according to factor loading criterion ≤ 0.30; †Highest factor load presented by the item. This scale was freely translated.	Was this pregnancy planned?	0.09	0.12	0.02	0.20	0.02
30	Is your pregnancy at risk?	0.12	-0.02	0.78^†	0.00	-0.07
31	In any previous pregnancies did you face complications?	0.34^†	-0.01	0.20	-0.01	-0.04
32	In this pregnancy, do you face complications?	0.24	0.11	0.60^†	-0.01	-0.06

Dimension or factor		Initial eigenvalues
Dimension or factor	Total	% variance	% accumulated	Total	% variance
1	4.192	17.465	17.465	4.192	17.465
2	2.246	9.360	26.824	2.246	9.360
3	1.718	7.159	33.984	1.718	7.159
4	1.576	6.568	40.552	1.576	6.568
5	1.356	5.649	46.202	1.356	5.649
6	1.104	4.602	50.803
7	1.050	4.376	55.179
8	.962	4.010	59.189
9	.929	3.869	63.058
10	.848	3.532	66.590
11	.826	3.441	70.031
12	.796	3.315	73.347
13	.734	3.057	76.404
14	.690	2.876	79.280
15	.676	2.815	82.095
16	.597	2.488	84.583
17	.581	2.421	87.004
18	.556	2.318	89.322
19	.536	2.232	91.555
20	.476	1.983	93.538
21	.435	1.811	95.349
22	.415	1.730	97.079
23	.379	1.578	98.657
24	.322	1.343	100.000

Item	Dimension
Item	Socioeconomic	Psychoactive substances	Psychosocial	Psychic	Maternal health	Total
1	0.32^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.05	0.21	0.22	0.17	0.31
2	0.26^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.08	0.11	0.11	0.08	0.18
3	0.38^* * Pearson’s correlation coefficient of an item with its respective dimension.	-0.10	0.06	0.14	-0.06	0.13
4	0.05	0.34^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.02	0.15	0.08	0.17
5	-0.02	0.28^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.07	-0.03	-0.22	-0.05
6	0.04	0.43^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.07	0.12	0.01	0.14
7	0.13	0.04	0.53^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.28	0.16	0.39
8	0.14	0.18	0.39^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.32	0.20	0.42
9	-0.01	-0.05	0.49^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.19	0.17	0.29
10	0.18	-0.07	0.63^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.13	0.20	0.33
11	0.11	0.07	0.61^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.25	0.08	0.35
12	0.17	0.25	0.32^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.12	0.11	0.27
13	0.12	-0.02	0.41^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.18	0.15	0.29
14	0.19	0.13	0.23	0.54^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.19	0.49
15	0.38	0.06	0.33	0.53^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.20	0.56
16	0.06	0.01	0.19	0.38^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.23	0.36
17	0.06	0.09	0.31	0.41^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.32	0.47
18	0.00	-0.13	0.18	0.30^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.04	0.21
19	0.18	0.03	0.06	0.40^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.11	0.31
20	0.08	0.28	0.05	0.28^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.06	0.25
21	0.09	0.05	0.24	0.27^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.25	0.34
22	-0.01	-0.12	0.10	0.24	0.52^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.31
23	0.15	-0.02	0.24	0.27	0.81^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.48
24	-0.04	0.28	0.31	0.88	0.53^* * Pearson’s correlation coefficient of an item with its respective dimension.	0.53

	Dimension
	Socio economic	Psychoactive substances	Psychosocial	Psychic	Maternal health	Total
	Nº items (%)	Nº items (%)	Nº items (%)	Nº items (%)	Nº items (%)	Nº items (%)
-2	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
-1	0 (0)	0 (0)	0 (0)	1 (3.1)	0 (0)	1 (1)
1	7 (58.3)	2 (16.7)	5 (17.9)	23 (82.1)	28 (100)	25 (26)
2	5 (41.7)	10 (83.)	23 (82.1)	20 (62.5)	12 (100)	70 (72.9)
1+2	12 (100)	12 (100)	28 (100)	31 (96.9)	12 (100)	95 (99)
Adjustment	100%

Dimension	Nº items	Kr-20
Socioeconomic	3	0.49
Psychoactive substances	3	0.54
Psychosocial	7	0.76
Psychic	8	0.70
Maternal health	3	0.86
Total ERDEG	24	0.77

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[1] Corresponding author: Mônica Maria de Jesus Silva, E-mail: monicamjs@usp.br