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Published in: Archives of Women's Mental Health 6/2015

01-12-2015 | Original Article

Postnatal demoralisation among women admitted to a hospital mother-baby unit: validation of a psychometric measure

Authors: I. Bobevski, H. Rowe, D. M. Clarke, D. P. McKenzie, J. Fisher

Published in: Archives of Women's Mental Health | Issue 6/2015

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Abstract

Demoralisation is a psychological state characterised by experiences of distress and sadness, helplessness, subjective incompetence and hopelessness, in the context of a stressful situation. Experiences of demoralisation may be particularly relevant to women who have recently given birth, who can feel incompetent, isolated and helpless. The psychometric properties of the Demoralisation Scale among women in the postnatal period participating in a clinical program were examined. Women admitted with their infants to a hospital mother-baby unit in Australia for five nights were recruited consecutively (N = 209) and assessed at admission and discharge. The Demoralisation Scale was perceived as relevant and exhibited high reliability, acceptable construct validity and good sensitivity to change. The mean demoralisation score was high (M = 30.9, SD = 15.5) and associated with negative experiences of motherhood and functional impairment, independent of depression and anxiety symptoms. Mean demoralisation decreased significantly after program completion (M = 18.4, SD = 12.4). More participants showed a significant improvement in demoralisation (57.5 %) than in depression (34.8 %) and anxiety (9.8 %) symptoms. Demoralisation can provide a useful framework for understanding and measuring the experiences of women participating in postnatal clinical programs and in directing treatment towards helping women to acquire the necessary caregiving skills and increasing parental efficacy. The Demoralisation Scale is a useful clinical tool for assessing intervention effects.
Literature
go back to reference American Psychiatric Association (2013) The Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Publishing, WashingtonCrossRef American Psychiatric Association (2013) The Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Publishing, WashingtonCrossRef
go back to reference Australian Bureau of Statistics (2009) National Survey of Mental Health and Wellbeing: users guide. Australian Bureau of Statistics, Canberra Australian Bureau of Statistics (2009) National Survey of Mental Health and Wellbeing: users guide. Australian Bureau of Statistics, Canberra
go back to reference Brown S, Small R, Lumley J (1994) Missing voices: the experience of motherhood. Oxford University Press, Melbourne Brown S, Small R, Lumley J (1994) Missing voices: the experience of motherhood. Oxford University Press, Melbourne
go back to reference Catanese AA, John MS, Di Battista J, Clarke DM (2009) Acute cognitive therapy in reducing suicide risk following a presentation to an emergency department. Behav Chang 26:16–26CrossRef Catanese AA, John MS, Di Battista J, Clarke DM (2009) Acute cognitive therapy in reducing suicide risk following a presentation to an emergency department. Behav Chang 26:16–26CrossRef
go back to reference Child D (2006) The essentials of factor analysis. Bloomsbury Publishing Child D (2006) The essentials of factor analysis. Bloomsbury Publishing
go back to reference Clarke DM (2011) Depression, demoralization, and psychotherapy in people who are medically ill. In: Alarcon RD, Frank JB (eds) The psychotherapy of hope: the legacy of persuasion and healing. The John Hopkins University Press, Baltimore, p 125 Clarke DM (2011) Depression, demoralization, and psychotherapy in people who are medically ill. In: Alarcon RD, Frank JB (eds) The psychotherapy of hope: the legacy of persuasion and healing. The John Hopkins University Press, Baltimore, p 125
go back to reference Clarke DM, Mackinnon AJ, Smith GC, McKenzie DP, Herrman HE (2000) Dimensions of psychopathology in the medically ill. Psychosomatics 41:418–425CrossRefPubMed Clarke DM, Mackinnon AJ, Smith GC, McKenzie DP, Herrman HE (2000) Dimensions of psychopathology in the medically ill. Psychosomatics 41:418–425CrossRefPubMed
go back to reference Clarke DM, Smith GC, Dowe DL, McKenzie DP (2003) An empirically derived taxonomy of common distress syndromes in the medically ill. J Psychosom Res 54:323–330CrossRefPubMed Clarke DM, Smith GC, Dowe DL, McKenzie DP (2003) An empirically derived taxonomy of common distress syndromes in the medically ill. J Psychosom Res 54:323–330CrossRefPubMed
go back to reference Clarke DM, Kissane DW, Trauer T, Smith GC (2005) Demoralization, anhedonia and grief in patients with severe physical illness. World Psychiatry 4:96PubMedCentralPubMed Clarke DM, Kissane DW, Trauer T, Smith GC (2005) Demoralization, anhedonia and grief in patients with severe physical illness. World Psychiatry 4:96PubMedCentralPubMed
go back to reference Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46CrossRef Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46CrossRef
go back to reference Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786CrossRefPubMed Cox J, Holden J, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786CrossRefPubMed
go back to reference Cutrona CE, Troutman BR (1986) Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression. Child Dev: 1507–1518 Cutrona CE, Troutman BR (1986) Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression. Child Dev: 1507–1518
go back to reference de Figueiredo JM (1983) Some issues in research on the epidemiology of demoralization. Compr Psychiatry 24:154–157CrossRefPubMed de Figueiredo JM (1983) Some issues in research on the epidemiology of demoralization. Compr Psychiatry 24:154–157CrossRefPubMed
go back to reference de Figueiredo JM (2012) Deconstructing demoralization: subjective incompetence and distress in adversity. In: Alarcon RD, Frank JB (eds) The Psychotherapy of Hope: The Legacy of Persuasion and Healing. The John Hopkins University Press, Baltimore, p 107 de Figueiredo JM (2012) Deconstructing demoralization: subjective incompetence and distress in adversity. In: Alarcon RD, Frank JB (eds) The Psychotherapy of Hope: The Legacy of Persuasion and Healing. The John Hopkins University Press, Baltimore, p 107
go back to reference Fisher J, Rowe H (2004) Building an evidence base for practice in early parenting centres. A systematic review of the literature and a report of an outcome study. Key Centre for Women’s Health in Society, Melbourne School of Population Health, University of Melbourne, Melbourne Fisher J, Rowe H (2004) Building an evidence base for practice in early parenting centres. A systematic review of the literature and a report of an outcome study. Key Centre for Women’s Health in Society, Melbourne School of Population Health, University of Melbourne, Melbourne
go back to reference Fisher J, Feekery CJ, Amir L, Sneddon M (2002a) Health and social circumstances of women admitted to a private mother baby unit. Aust Fam Physician 31:966–973PubMed Fisher J, Feekery CJ, Amir L, Sneddon M (2002a) Health and social circumstances of women admitted to a private mother baby unit. Aust Fam Physician 31:966–973PubMed
go back to reference Fisher JRW, Feekery C, Rowe‐Murray H (2002b) Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit. J Paediatr Child Health 38:140–145CrossRefPubMed Fisher JRW, Feekery C, Rowe‐Murray H (2002b) Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit. J Paediatr Child Health 38:140–145CrossRefPubMed
go back to reference Fisher JR, Rowe HJ, Hammarberg K (2011) Admission of women, with their infants, for psychological and psychiatric causes in Victoria, Australia. Aust N Z J Public Health 35:146–150CrossRefPubMed Fisher JR, Rowe HJ, Hammarberg K (2011) Admission of women, with their infants, for psychological and psychiatric causes in Victoria, Australia. Aust N Z J Public Health 35:146–150CrossRefPubMed
go back to reference Frank JD (1974) Psychotherapy: the restoration of morale. Am J Psychiatry Frank JD (1974) Psychotherapy: the restoration of morale. Am J Psychiatry
go back to reference IBM Corp. (2011) IBM SPSS Statistics for Windows, version 20.0. IBM Corp., Armonk, NY IBM Corp. (2011) IBM SPSS Statistics for Windows, version 20.0. IBM Corp., Armonk, NY
go back to reference Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12CrossRefPubMed Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12CrossRefPubMed
go back to reference Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB (1999) Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol 67:300CrossRefPubMed Jacobson NS, Roberts LJ, Berns SB, McGlinchey JB (1999) Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J Consult Clin Psychol 67:300CrossRefPubMed
go back to reference Jones TL, Prinz RJ (2005) Potential roles of parental self-efficacy in parent and child adjustment: a review. Clin Psychol Rev 25:341–363CrossRefPubMed Jones TL, Prinz RJ (2005) Potential roles of parental self-efficacy in parent and child adjustment: a review. Clin Psychol Rev 25:341–363CrossRefPubMed
go back to reference Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The demoralization scale: a report of its development and preliminary validation. J Palliat Care 20:269PubMed Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The demoralization scale: a report of its development and preliminary validation. J Palliat Care 20:269PubMed
go back to reference Knudson‐Martin C, Silverstein R (2009) Suffering in silence: a qualitative meta‐data‐analysis of postpartum depression. J Marital Fam Ther 35:145–158CrossRefPubMed Knudson‐Martin C, Silverstein R (2009) Suffering in silence: a qualitative meta‐data‐analysis of postpartum depression. J Marital Fam Ther 35:145–158CrossRefPubMed
go back to reference Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics:159–174 Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics:159–174
go back to reference Long JS, Freese J (2006) Regression models for categorical dependent variables using Stata. Stata Press, College Station Long JS, Freese J (2006) Regression models for categorical dependent variables using Stata. Stata Press, College Station
go back to reference Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 33:335–343CrossRefPubMed Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 33:335–343CrossRefPubMed
go back to reference Lovibond S, Lovibond PF (1996) Manual for the depression anxiety stress scales. Psychology Foundation of Australia Lovibond S, Lovibond PF (1996) Manual for the depression anxiety stress scales. Psychology Foundation of Australia
go back to reference Matthey S (2004) Calculating clinically significant change in postnatal depression studies using the Edinburgh postnatal depression scale. J Affect Disord 78:269–272CrossRefPubMed Matthey S (2004) Calculating clinically significant change in postnatal depression studies using the Edinburgh postnatal depression scale. J Affect Disord 78:269–272CrossRefPubMed
go back to reference Matthey S, Speyer J (2008) Changes in unsettled infant sleep and maternal mood following admission to a parentcraft residential unit. Early Hum Dev 84:623–629CrossRefPubMed Matthey S, Speyer J (2008) Changes in unsettled infant sleep and maternal mood following admission to a parentcraft residential unit. Early Hum Dev 84:623–629CrossRefPubMed
go back to reference Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh postnatal depression scale: implications for clinical and research practice. Arch Wom Ment Health 9:309–315CrossRef Matthey S, Henshaw C, Elliott S, Barnett B (2006) Variability in use of cut-off scores and formats on the Edinburgh postnatal depression scale: implications for clinical and research practice. Arch Wom Ment Health 9:309–315CrossRef
go back to reference McKenzie M, Clarke DM, McKenzie DP, Smith GC (2010) Which factors predict the persistence of DSM-IV depression, anxiety, and somatoform disorders in the medically ill three months post hospital discharge? J Psychosom Res 68:21–28CrossRefPubMed McKenzie M, Clarke DM, McKenzie DP, Smith GC (2010) Which factors predict the persistence of DSM-IV depression, anxiety, and somatoform disorders in the medically ill three months post hospital discharge? J Psychosom Res 68:21–28CrossRefPubMed
go back to reference Mehnert A, Vehling S, Hocker A, Lehmann C, Koch U (2011) Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale. J Pain Symptom Manag 42:768–776CrossRef Mehnert A, Vehling S, Hocker A, Lehmann C, Koch U (2011) Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale. J Pain Symptom Manag 42:768–776CrossRef
go back to reference Mullane M, Dooley B, Tiernan E, Bates U (2009) Validation of the demoralization scale in an Irish advanced cancer sample. Palliat Support Care 7:323–330CrossRefPubMed Mullane M, Dooley B, Tiernan E, Bates U (2009) Validation of the demoralization scale in an Irish advanced cancer sample. Palliat Support Care 7:323–330CrossRefPubMed
go back to reference Oakley A, Chamberlain G (1981) Medical and social factors in postpartum depression. J Obstet Gynecol 1:182–187CrossRef Oakley A, Chamberlain G (1981) Medical and social factors in postpartum depression. J Obstet Gynecol 1:182–187CrossRef
go back to reference Phillips J, Sharpe L, Nemeth D (2010) Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatry 44:280–289CrossRefPubMed Phillips J, Sharpe L, Nemeth D (2010) Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatry 44:280–289CrossRefPubMed
go back to reference Rafanelli C, Roncuzzi R, Milaneschi Y, Tomba E, Colistro MC, Pancaldi LG, Di Pasquale G (2005) Stressful life events, depression and demoralization as risk factors for acute coronary heart disease. Psychother Psychosom 74:179–184. doi:10.1159/000084003 CrossRefPubMed Rafanelli C, Roncuzzi R, Milaneschi Y, Tomba E, Colistro MC, Pancaldi LG, Di Pasquale G (2005) Stressful life events, depression and demoralization as risk factors for acute coronary heart disease. Psychother Psychosom 74:179–184. doi:10.​1159/​000084003 CrossRefPubMed
go back to reference Rowe H, Fisher J (2010a) The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study. Int J Ment Heal Syst 4:6CrossRef Rowe H, Fisher J (2010a) The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study. Int J Ment Heal Syst 4:6CrossRef
go back to reference Rowe H, Fisher J (2010b) Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach. BMC Public Health 10:499PubMedCentralCrossRefPubMed Rowe H, Fisher J (2010b) Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach. BMC Public Health 10:499PubMedCentralCrossRefPubMed
go back to reference Small R, Brown S, Lumley J, Astbury J (1994) Missing voices: what women say and do about depression after childbirth. J Reprod Infant Psychol 12:89–103CrossRef Small R, Brown S, Lumley J, Astbury J (1994) Missing voices: what women say and do about depression after childbirth. J Reprod Infant Psychol 12:89–103CrossRef
go back to reference StataCorp (2011) Stata Statistical Software: Release 12. College Station, TX: StataCorp LP StataCorp (2011) Stata Statistical Software: Release 12. College Station, TX: StataCorp LP
go back to reference Tabachnick B, Fidell L (2011) Using multivariate statistics, 6th edn. Pearson, Boston Tabachnick B, Fidell L (2011) Using multivariate statistics, 6th edn. Pearson, Boston
go back to reference Weber S (2000) Factor structure of the Reynolds adolescent depression scale in a sample of school-based adolescents. J Nurs Meas 8:23–40PubMed Weber S (2000) Factor structure of the Reynolds adolescent depression scale in a sample of school-based adolescents. J Nurs Meas 8:23–40PubMed
go back to reference Zientek LR, Thompson B (2006) Commonality analysis: partitioning variance to facilitate better understanding of data. J Early Interv 28:299–307CrossRef Zientek LR, Thompson B (2006) Commonality analysis: partitioning variance to facilitate better understanding of data. J Early Interv 28:299–307CrossRef
Metadata
Title
Postnatal demoralisation among women admitted to a hospital mother-baby unit: validation of a psychometric measure
Authors
I. Bobevski
H. Rowe
D. M. Clarke
D. P. McKenzie
J. Fisher
Publication date
01-12-2015
Publisher
Springer Vienna
Published in
Archives of Women's Mental Health / Issue 6/2015
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI
https://doi.org/10.1007/s00737-014-0486-8

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