Research paper
Development and properties of a brief scale to assess intimate partner relationship in the postnatal period

https://doi.org/10.1016/j.jad.2017.03.001Get rights and content

Highlights

  • A brief Partner Interactions after Baby Scale (PIBS) was developed.

  • The PIBS assesses specific, potentially modifiable partner behaviours.

  • Reliability and criterion validity of the PIBS were confirmed.

  • This may be a useful tool to assess partner relationship in targeted interventions.

Abstract

Background

Poor quality intimate partner relationship is associated with postnatal depression and anxiety among women. Existing scales assessing the quality of this relationship are long and measure stable aspects of the relationship rather than specific behaviours which may respond to targeted interventions. The aim was to develop and investigate the properties of a brief, life stage-specific scale to assess potentially modifiable partner behaviours in the postpartum period.

Methods

Participants were primiparous women from diverse geographical and socio-economic backgrounds in Victoria, Australia. Seven study-specific items were developed to assess potentially modifiable aspects of the intimate partner relationship at 6 months postpartum. Women's mental health was assessed using the Composite International Diagnostic Interview and the Patient Health Questionnaire depression and generalised anxiety modules. Factor analysis was conducted on the 7 items, and associations calculated between factor scores. Factor scores were compared for women with and without mental health problems. Mean inter-item correlations were computed to assess internal consistency.

Results

Factor analysis on data from 355 women revealed two factors with good internal consistency: Caring Partner Behaviours and Emotionally Abusive Partner Behaviours. Having mental health problems was associated with lower Caring Partner Behaviours and higher Emotionally Abusive Partner Behaviours scores.

Limitations

Interaction between partners was not observed; thus external criterion validity was not assessed.

Conclusion

This brief scale is a promising means of assessing potentially modifiable aspects of the intimate partner relationship in the postnatal period.

Introduction

Poor quality intimate partner relationship is associated with worse mental health (Braithwaite and Holt-Lunstad, 2017, Overbeek et al., 2006, Proulx et al., 2007, Whisman, 2001). This association may be particularly relevant among women in the postnatal period (Fisher et al., 2012; Martini et al., 2015; National Institute for Clinical Excellence (NICE), 2004): after the birth of a baby, women often have reduced interactions with workplaces and communities and increased dependence on their intimate partners (Rowe and Fisher, 2010). Following the birth of a baby, depression and grief can arise among women as a result of disenfranchised or unrecognised losses (Doka, 2002), for example loss of occupational identity, capacity to generate an income, social and leisure activities and autonomy (Fisher et al., 2010). In comparison, men's losses may not be as significant at this life stage, and the gender difference in disenfranchised losses can cause conflict, unless the workload of caring for a new infant can be negotiated fairly. According to Brown and Harris's (1978) social theory, depression in women arises from experiences of entrapment and humiliation. These experiences can be more common in the postnatal period than at other life stages. After the birth of a baby, a woman may be more dependent on her intimate partner for recognition and affirmation, and more vulnerable to criticism, which can be experienced as humiliating. Therefore, during this life stage, day-to-day interpersonal interactions between intimate partners are of fundamental importance to women's mental health (Fisher et al., 2016).

“Quality” of intimate partner relationship has been conceptualised and operationalised in diverse, often non-specific ways, including as: “satisfaction”, “adjustment”, and “happiness” (Bower et al., 2013, Funk and Rogge, 2007, Locke and Wallace, 1959, Spanier, 1976, Whisman et al., 2011). In perinatal samples, relationship “quality” is often assessed using the Intimate Bonds Measure (IBM) (Wilhelm and Parker, 1988), the Dyadic Adjustment Scale (DAS) (Spanier, 1976), the Couple Satisfaction Index (CSI) (Funk and Rogge, 2007) or the Marital Adjustment Test (MAT) (Locke and Wallace, 1959). These instruments are all theoretically grounded and have adequate psychometric properties, but they are relatively time-consuming to complete (each at least 15 items) and are not specific to the postnatal period in which, as mentioned, women may experience particular changes in their interpersonal interactions with their intimate partners.

Fincham and Rogge (2010) distinguish between scales and items that assess more stable, subjective evaluations of the intimate partner relationship and those which assess day-to-day partner behaviours and interactions which are more specific and potentially sensitive to change. Some instruments, such as the CSI, focus on more stable relationship satisfaction, while others such as the DAS and the IBM are sometimes criticized (Fincham and Rogge, 2010) for including both the stable aspects of the quality of the intimate partner relationship and the specific behaviours and interactions between partners. There is therefore a need for a scale which focuses exclusively on specific, potentially modifiable behaviours and interactions in the intimate partner relationship. Such an instrument would provide an opportunity for assessing the efficacy of intervention studies which target the couple relationship in order to improve mental health among women.

Using the study-specific Postpartum Partner Support Scale (PPSS), Dennis and Ross (2006) identified that perceptions of partner support (emotional, informational and instrumental) were significantly associated with fewer symptoms of postnatal depression, while relationship conflict was significantly associated with more depressive symptoms among women at 8 weeks postpartum. While the PPSS is theoretically grounded and specific to the postnatal period, it is relatively long (24 items).

The aim of this study was to investigate the properties of a new, brief, gender-informed scale which assesses specific, day-to-day partner behaviours and interactions in the postnatal period, the Partner Interactions after Baby Scale (PIBS).

Section snippets

Methods

The data reported here were collected in a cluster randomised controlled trial of What Were We Thinking (WWWT), a gender-informed, structured, psycho-educational program for couples and babies which aims to prevent depression and anxiety in primiparous women at six months postpartum. Details of the intervention (Rowe and Fisher, 2010) and cluster randomised controlled trial (Fisher et al., 2016) are described in full elsewhere. WWWT specifically targets the partner relationship following the

Results

Overall, 400 participants were recruited. 355 provided complete endline data on the items of the PIBS, of whom 346 indicated that they were partnered and 9 indicated that they were not currently partnered with, but were still in contact with the baby's father.

The item correlation matrix (Table 2) included several coefficients of 0.3 and above.

The KMO was 0.755 and Bartlett's Test of Sphericity was significant (p<0.005). Data were therefore considered suitable for factor analysis.

Two components

Discussion

In this study, a brief, life-stage specific scale, the Partner Interactions after Baby Scale (PIBS), was developed to assess women's perceptions of specific partner behaviours and interactions. Properties of the scale were investigated at 6 months postpartum.

The PIBS, which has two factors, the Considerate Partner Behaviours scale and the Emotionally Abusive Partner Behaviours scale, is unique in several ways. Unlike existing standardized instruments commonly used to assess quality of intimate

Contributors

JF, HR and KW conceptualised and developed the original study, obtained funding and conducted the research. KW and TT were involved with the management of study data and undertook the analysis. All authors were involved in interpretation of the data. KW drafted the manuscript with critical revision from TT, HR and JF. All authors have read and approved the final manuscript.

Funding

This study was funded by competitively awarded grants from the National Health and Medical Research Council (APP1026550), the Australian Government Department of Social Services (formerly Families, Housing, Community Services and Indigenous Affairs) and the Victorian Department of Education and Training (formerly Department of Education and Early Childhood Development). JF is supported by a Monash Professorial Fellowship and the Jean Hailes Professorial Fellowship, which is supported by a grant

Acknowledgements

The authors are very grateful to Cardinia Shire Council, Frankston City Council, Hobson’s Bay City Council, Monash City Council, Moreland City Council and Mornington Peninsula Shire Council for their collaboration in implementing this study; project manager Ms Joanna Burns, project officer Ms Hau Nguyen and telephone interviewers Ms Harriet Dwyer, Ms Blathnaid Greene, Ms Cynthia Murray, Ms Debbie Sandler and Ms Carmin Smith.

References (38)

  • C.-L. Dennis et al.

    Women's perceptions of partner support and conflict in the development of postpartum depressive symptoms

    J. Adv. Nurs.

    (2006)
  • K. Doka

    Disenfranchised Grief

    (2002)
  • S.A. Elliott et al.

    Promoting mental health after childbirth: a controlled trial of primary prevention of postnatal depression

    Br. J. Clin. Psychol.

    (2000)
  • M.E. Feinberg et al.

    Establishing family foundations: intervention effects on coparenting, parent/infant well-being, and parent-child relations

    J. Fam. Psychol.

    (2008)
  • F.D. Fincham et al.

    Understanding relationship quality: theoretical challenges and new tools for assessment

    J. Fam. Theory Rev.

    (2010)
  • J. Fisher

    The Unpaid Workload: Gender Discrimination in Conceptualisation and its Impact on Maternal Wellbeing. Contemporary Topics in Women's Mental Health

    (2009)
  • J. Fisher et al.

    Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review

    Bull. World Health Organ.

    (2012)
  • J. Fisher et al.

    Gender-informed, psychoeducational programme for couples to prevent postnatal common mental disorders among primiparous women: cluster randomised controlled trial

    BMJ Open

    (2016)
  • J.R.W. Fisher et al.

    Innovative psycho-educational program to prevent common postpartum mental disorders in primiparous women: a before and after controlled study

    BMC Public Health

    (2010)
  • View full text