Development and psychometric properties of the maternal ambivalence scale in spanish women

Abstract

Background maternal ambivalence, which refers to experiencing mixed emotions about motherhood, like happiness and sadness, is frequent during the perinatal period. Aim Due to the relevance of this topic and the lack of psychometrically-sound instruments to measure it, this study aims to develop and test a measure of maternal ambivalence called the Maternal Ambivalence Scale (MAS). Methods in this cross-sectional, observational study, participants were 1424 Spanish women recruited online who were either pregnant (33%) or recent mothers of children under 2 years (67%). They responded to the MAS and measures of anxiety and depressive symptoms and life satisfaction. Analyses included exploratory and confirmatory factor solutions for the MAS, internal consistency estimates (Cronbach’s α) for all scales, as well as bivariate correlations to investigate sources of validity evidence. Comparisons between pregnant and postpartum women were also examined. Results The assumptions for factor analysis about the relationship between items were met (Kaiser-Meyer-Olkin’s [KMO] test = 0.90; Barlett’s Chi-square sphericity test = 5853.89, p < .001). A three-factor solution (Doubts, Rejection, and Suppression) for the MAS showed a good model fit both in exploratory (Chi-square = 274.6, p < .001, Root Mean Square Error of Approximation [RMSEA] = 0.059, RMSEA 90% Confidence Interval [CI]=[0.052, 0.066], Comparative Fit Index [CFI] = 0.985, Tucker Lewis Index [TLI] = 0.974) and confirmatory analyses (Chi-square = 428.0, p < .001, RMSEA = 0.062, RMSEA 90% CI=[0.056, 0.068], CFI = 0.977, TLI = 0.971). Doubts (α = 0.83), Rejection (α = 0.70), and Suppression (α = 80) were associated with higher anxiety and depressive symptoms, as well as lower life satisfaction (all p < .001). Pregnant women presented greater Rejection (mean difference = 0.30, p = .037, 95% CI=[0.02, 0.58]) and less Suppression (mean difference=-0.47, p = .002, 95% CI=[-0.77,-0.17]) than mothers. Conclusion with this study, we provide clinicians and researchers with a novel tool that successfully captures the complex nature of maternal ambivalence. Given the associations of maternal ambivalence with important outcomes in perinatal women, this tool could be important for the prevention of distress associated with chronic ambivalence and to evaluate the effectiveness of interventions addressing ambivalence.

Perinatal Depression in the Spanish Context: Consensus Report from the General Council of Psychology of Spain

“…Other biopsychosocial variables associated with increased likelihood of experiencing perinatal depression are health problems in the baby, a non-vaginal or instrumented delivery (Dekel et al, 2019), lack of social support (Racine et al, 2020), marital dissatisfaction (Whisman et al, 2011, low socioeconomic and educational status, ethnic minority background, high psychological, and biological stress (Glover et al, 2010;Lobel et al, 2022), high neuroticism (Martín- Santos et al, 2012), tendency to excessive rumination and worry (Osborne et al, 2021;Petrošanec et al, 2022), high perfectionism (Maia et al, 2012), anxious/insecure attachment styles and passive coping (Gutiérrez-Zotes et al, 2015;Warfa et al, 2014), such as a tendency to self-blame and distractibility and difficulty reframing problems in a positive way (Gutiérrez-Zotes et al, 2016), low self-and partner motivation to have a baby (Reut & Kanat-Maymon, 2018), the existence of a substance abuse disorder (Chapman & Wu, 2013), family history of depressive or anxiety disorders, or the experience of multiple, unwanted, particularly difficult or adolescent childbirth (Hutchens & Kearney, 2020;Meuti et al, 2015;Puyané et al, 2022;Soto-Balbuena et al, 2018;Van Niel & Payne, 2020). In the case of adolescent females, in addition, family criticism, self-esteem, and perceived self-efficacy seem to become particularly important (Recto & Champion, 2017).…”

“…Another variable is ambivalence towards motherhood, understood as the coexistence of positive and negative feelings associated with being a mother (Martín-Sánchez et al, 2022), which has been traditionally silenced in this field and has been shown to play an important role in predicting a worsening of symptoms throughout the perinatal stage (Santos et al, 2017).…”

Maternal Ambivalence Questionnaire (MAQ): Development and preliminary validation.

“…Currently, there are no empirically validated instruments for assessing manageable–unmanageable maternal ambivalence. In previous research, maternal ambivalence has been primarily evaluated using qualitative interviews (Chapman & Gubi, 2019; Raneberg & MacCallum, 2023; Tuval-Mashiach & Shaiovitz-Gourman, 2014), with the exception of one study that used a quantitative measure, the Maternal Ambivalence Scale (MAS; Martín-Sánchez et al, 2022). However, the authors of the MAS conceptualized maternal ambivalence as doubts and convictions about wanting to be a mother and the coping strategies used to deal with ambivalence (i.e., expression/suppression).…”