Background
Methods
Ethical approval
Study design
Setting and sample
Procedure
Measures
Factor (% of total variance explained) | Item mean (SD) | Corrected item-total correlation | Factor loadings | |||
---|---|---|---|---|---|---|
F1 | F2 | F3 | F4 | |||
F1: Helplessness (35.4 %) (α = .83) | ||||||
9. I feel hopeless. | 0.4 (0.7) | .64 | .73 | |||
7. No one can help me. | 0.4 (0.8) | .52 | .72 | |||
8. I feel that I cannot help myself. | 0.4 (0.7) | .62 | .70 | |||
22. I feel discouraged about life. | 0.3 (0.6) | .68 | .64 | |||
10. I feel guilty. | 0.7 (1.0) | .54 | .58 | |||
21. I feel sad and miserable. | 0.7 (0.8) | .67 | .51 | .47 | ||
F2: Disheartenment (7.2 %) (α = .79) | ||||||
4. My role in life has been lost. | 0.4 (0.7) | .42 | .76 | |||
24. I feel trapped by what is happening to me. | 0.4 (0.8) | .65 | .68 | |||
23. I feel quite isolated or alone. | 0.8 (1.0) | .59 | .58 | |||
5. I no longer feel emotionally in control. | 0.7 (0.9) | .54 | .54 | |||
18. I feel distressed about what is happening to me. | 0.5 (0.8) | .65 | .45 | .51 | ||
6. I am in good spirits. | 0.9 (0.7) | .46 | .43 | .48 | ||
F3: Sense of Failure (6.5 %) (α = .63) | ||||||
19. I am a worthwhile person. | 0.7 (0.8) | .36 | .73 | |||
17. I am proud of my accomplishments. | 0.8 (0.7) | .47 | .67 | |||
1. There is a lot of value in what I can offer others. | 1.5 (0.8) | .27 | .65 | |||
12. I cope fairly well with life. | 0.8 (0.7) | .49 | .49 | |||
F4: Dysphoria (5.0 %) (α = .71) | ||||||
15. I tend to feel hurt easily. | 1.1 (0.9) | .39 | .81 | |||
16. I am angry about a lot of things. | 0.6 (0.8) | .55 | .68 | |||
11. I feel irritable. | 1.3 (0.9) | .48 | .59 | |||
13. I have a lot of regret about my life. | 0.5 (0.8) | .51 | .53 | |||
Items excluded from factor analysis due to extreme kurtoses | ||||||
2. My life seems to be pointless. | 0.2 (0.6) | .53 | ||||
3. There is no purpose to the activities in my life. | 0.2 (0.6) | .40 | ||||
14. Life in no longer worth living. | 0.1 (0.3) | .40 | ||||
20. I would rather not be alive. | 0.1 (0.3) | .41 |
Analysis
Results
Participants
Demographics
Postnatal demoralisation in the community
Reliability of the Demoralisation Scale
Factor analysis of the Demoralisation Scale
F1 | F2 | F3 | F4 | Demoralisation Scale | PHQ-9 | GAD-7 | VPS Personality vulnerability | |
---|---|---|---|---|---|---|---|---|
F1: Helplessnessa (mean of items = 0.5; SD = 0.5) | - | |||||||
F2: Disheartenmenta (mean of items = 0.6; SD = 0.2) | .68* | - | ||||||
F3: Sense of Failurea (mean of items = 1.0; SD = 0.3) | .33* | .45* | - | |||||
F4: Dysphoriaa (mean of items = 0.9; SD = 0.4) | .58* | .53* | .33* | - | ||||
Total demoralisation scorea | .78* | .84* | .68* | .76* | - | |||
PHQ-9a (α = .73) | .40* | .52* | .36* | .45* | .54* | - | ||
GAD-7a (α = .85) | .48* | .55* | .31* | .48* | .56* | .68* | - | |
VPS personality vulnerability (α = .70) | .40* | .35* | .31* | .45* | .47* | .47* | .47* | - |
Discriminant validity
Correlations between demoralisation and other measures of distress
Comparison of categorical scores of the Demoralisation Scale with the PHQ-9 and GAD-7
Comparison Scale | Demoralisation Scale cutoff score | Sensitivity | Positive Predictive Value (PPV) | Cohen's kappa |
---|---|---|---|---|
PHQ-9 (cutoff score ≥ 10) | ≥30 | 40.0 % (10/25) | 32.0 % (10/31) | 0.25 |
GAD-7 (cutoff score ≥ 10) | ≥30 | 52.2 % (12/23) | 38.7 % (12/31) | 0.41 |
Postnatal factors associated with demoralisation
Geometric mean (SD) of the Demoralisation Scale | Median (IQR) of the Demoralisation Scale | Unstandardised regression coefficient (unadjusted) |
p
| ||
---|---|---|---|---|---|
Language | English (n = 333) | 11.7 (2.1) | 11.0 (7–18) | Reference | |
Other (n = 67) | 16.0 (1.9) | 16.0 (10–26) | 0.32 | .001 | |
Education | Up to secondary (n = 74) | 10.3 (2.1) | 10.0 (7.0-19.0) | Reference | |
Diploma/Certificate (n = 77) | 13.4 (2.0) | 12.0 (8.0-19.5) | 0.25 | .008 | |
Tertiary (n = 249) | 12.7 (2.0) | 12.0 (5.8-16.0) | 0.27 | .019 | |
Age | 18-25 (n = 54) | 11.0 (2.2) | 10.0 (5.8-15.3) | −0.20 | .055 |
26-39 (n = 328) | 12.6 (2.0) | 12.0 (7.0-19.0) | Reference | ||
40+ (n = 18) | 12.0 (1.6) | 12.0 (6.2-15.0) | −0.08 | .632 | |
Mode of birth | Vaginal spontaneous (n = 175) | 12.0 (2.1) | 12.0 (7.0-18.0) | Reference | |
Vaginal assisted (n = 87) | 12.4 (1.9) | 12.0 (5.0-18.0) | 0.07 | .481 | |
Caesarian without labour (n = 59) | 13.6 (1.9) | 13.0 (5.0-18.0) | 0.15 | .153 | |
Caesarian after a period of labour (n = 79) | 12.3 (2.1) | 13.0 (4.0-21.0) | 0.05 | .580 | |
Unexpected pregnancy | No (n = 305) | 12.0 (2.0) | 12.0 (7.0-18.0) | Reference | |
Yes (n = 95) | 13.6 (2.0) | 13.0 (8.0-13.0) | 0.12 | .135 | |
Self-rating of health | Fair to good (n = 64) | 18.1 (2.0) | 17.5 (10.3-27.8) | Reference | |
Very good to extremely good (n = 335) | 11.5 (2.0) | 11.0 (7.0-17.0)_ | −0.45 | .000 | |
Missing (n = 1) | |||||
Feeding method | Breast milk only (n = 267) | 11.8 (2.0) | 11.0 (7.0-18.0) | Reference | |
Formula only or with breast milk (n = 118) | 13.8 (2.2) | 14.0 (8.8-23) | 0.16 | .042 | |
Missing (n = 15) | |||||
Baby crying/fussing | <3 h (n = 293) | 11.4 (2.1) | 11.0 (6.0-17.0) | Reference | |
≥3 h (n = 107) | 15.3 (1.8) | 14.0 9.0 (14.0-21.0) | .027 | .001 | |
Psychiatric history | No (n = 302) | 11.4 (2.0) | 11.0 (7.0-17.0) | 0.29 | .000 |
Yes (n = 98) | 16.1 (2.0) | 15.0 (9.0-23.3) | |||
Correlation with the Demoralisation Scale: r (p) | |||||
Confidence in going home from hospital | -.39 (p = .000) | −0.25 | .000 | ||
IBM care subscalea | .22 (p = .000) | .018 | .000 | ||
IBM control subscaleb | .24 (p = .000) | .021 | .000 |
Hierarchical linear regression | |||||
---|---|---|---|---|---|
Independent Variables | Unstandardised regression coefficient (adjusted) | p | Model R2 | p for change in R2 | |
Model 1 | .44 | - | |||
Language spoken at home: English | Reference | ||||
Other | 0.21 | .007 | |||
Education: Up to secondary | Reference | ||||
Certificate/Diploma | 0.12 | .119 | |||
Tertiary | 0.17 | .058 | |||
Age: 18-25 | −0.15 | .093 | |||
26-39 | Reference | ||||
40+ | 0.04 | .790 | |||
Psychiatric history | 0.09 | .183 | |||
PHQ-9a | 0.27 | .000 | |||
GAD-7a | 0.21 | .000 | |||
Vulnerable personality characteristicsa | 0.05 | .000 | |||
Model 2 | .51 | .000 | |||
Language spoken at home: English | Reference | ||||
Other | 0.13 | .097 | |||
Education: Up to secondary | Reference | ||||
Certificate/Diploma | 0.08 | .320 | |||
Tertiary | 0.14 | .115 | |||
Age: 18-25 | −0.15 | .078 | |||
26-39 | Reference | ||||
40+ | −0.00 | .990 | |||
Psychiatric history | 0.08 | .221 | |||
PHQ-9a | 0.21 | .000 | |||
GAD-7a | 0.19 | .000 | |||
Vulnerable personality characteristics | 0.04 | .000 | |||
Self-rated health: Fair to good | Reference | ||||
Very or extremely good | −0.18 | .018 | |||
Feeding method: Only breast milk | Reference | ||||
Formula and/or breast milk | −0.05 | .377 | |||
Baby crying or fussing: <3 h | Reference | ||||
≥3 h | 0.12 | .046 | |||
Confidence in going home from hospital | −0.13 | .000 | |||
IBM care subscaleb | 0.04 | .236 | |||
IBM control subscalea | 0.10 | .006 |