Psychometric Evaluation of the Ford Insomnia Response to Stress Test (FIRST) in Early Pregnancy

Abstract

Study Objectives: To evaluate the construct validity and factor structure of the Spanish-language version of the Ford Insomnia Response to Stress Test questionnaire (FIRST-S) when used in early pregnancy. Methods: A cohort of 647 women were interviewed at ≤ 16 weeks of gestation to collect information regarding lifestyle, demographic, and sleep characteristics. The factorial structure of the FIRST-S was tested through exploratory and confirmatory factor analyses (EFA and CFA). Internal consistency and construct validity were also assessed by evaluating the association between the FIRST-S with symptoms of depression, anxiety, and sleep quality. Item response theory (IRT) analyses were conducted to complement classical test theory (CTT) analytic approaches. Results: The mean score of the FIRST-S was 13.8 (range: 9-33). The results of the EFA showed that the FIRST-S contained a one-factor solution that accounted for 69.8% of the variance. The FIRST-S items showed good internal consistency (Cronbach α = 0.81). CFA results corroborated the one-factor structure finding from the EFA; and yielded measures indicating goodness of fit (comparative fit index of 0.902) and accuracy (root mean square error of approximation of 0.057). The FIRST-S had good construct validity as demonstrated by statistically significant associations of FIRST-S scores with sleep quality, antepartum depression and anxiety symptoms. Finally, results from IRT analyses suggested excellent item infit and outfit measures. Conclusions: The FIRST-S was found to have good construct validity and internal consistency for assessing vulnerability to insomnia during early pregnancy.

The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders

“…Exploratory factor analysis identified a single‐factor structure for the FIRST, comprised of nine items accounting for 25.7% of the variance among all 27 items. This single‐factor nine‐item structure has also been validated for use in early pregnancy (Gelaye et al., ) and translated into Spanish (Gelaye et al., ), Japanese (Nakajima et al., ), European Portuguese (Marques, Allen Gomes, Drake, Roth, & De Azevedo, ), French (Chen et al., ), German (Dieck, Helbig, Drake, & Backhaus, ) and Italian (Palagini et al., ).…”

Insomnia evaluation and treatment during peripartum: a joint position paper from the European Insomnia Network task force “Sleep and Women,” the Italian Marcè Society and international experts task force for perinatal mental health

“…Other questionnaires which have been used to evaluated insomnia during peripartum were the Bergen Insomnia Scale (Pallesen et al 2008) but it was used in studies from Norway only, the Insomnia Symptom Questionnaire (ISQ) which is an insomnia questionnaire validated among pregnant women (Okun et al 2015) but it has been used in two studies only . Additional evaluations during pregnancy have included the measure of stress related sleep reactivity with the Ford Insomnia Response to Stress Test (FIRST) (Drake et al 2004) to measure the vulnerability to insomnia and psychopathology during pregnancy (Gelaye et al 2016;Palagini et al 2019;Gelaye et al 2016;Sanchez et al 2020). Particularly for the evaluation of perpetuating negative behaviors and cognitive processes, the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) (Morin 1993) that is suggested for insomnia has been used in one study during pregnancy (Wang et al 2020) and the pre-sleep arousal which may perpetuate insomnia with Pre-sleep Arousal Scale (Nicassio et al 1985) in 4 studies (Table 1).…”

Hyperarousal and sleep reactivity in insomnia: current insights

“…A validated assay for a priori measurement of sleep reactivity in large epidemiological samples is the Ford Insomnia Response to Stress Test (FIRST), a self-report instrument that was originally validated in a large adult sample in the USA (see Drake et al 2004 38 for the full instrument). The FIRST has also been validated for use in early pregnancy 44 and translated into Spanish, 44 Japanese, 45 European Portuguese, 46 French, 47 German, 48 and Italian languages. 49 Many studies comparing high vs low sleep reactivity in individuals have relied on using median splits to distinguish the two groups with good results.…”