Abstract

Background

Differential experiences of psychosocial stress during pregnancy may contribute to racial inequities in adverse pregnancy outcomes in the US. Valid and unbiased measurement scales are needed to assess the effect of psychosocial stress on pregnancy outcomes, however, the numerous modified scales implemented to measure stress are not always validated.

Methods

The construct validity and measurement invariance of maternal stress among Medicaid-covered pregnant women (N = 1,632) were examined. Model fit estimates of three confirmatory factor analysis (CFA) models were compared to determine the appropriate measurement structure. Multiple-group CFA assessed measurement invariance across Black or African American women (51.7%) and women of all other races.

Results

Robust estimates of model fit supported a hierarchical CFA model composed of four latent domains of stress. Standardized factor loadings of three of these latent domains—external stress, perceived stress, and enhancers of stress- indicated positive correlations with a second-order latent factor for overall maternal stress, whereas the fourth domain, buffers of stress, had a negative association. Multiple-group CFA demonstrated strong measurement invariance.

Conclusions

Among Medicaid-covered pregnant women, measures for psychosocial stress were unbiased across two subgroups of maternal race/ethnicity. These findings support the construct validity of overall maternal stress underlying the common variability among four latent domains of stress.

中文翻译：

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测量怀孕期间的心理社会压力：美国医疗补助覆盖的孕妇跨种族/民族的多组确认性因素分析

摘要

背景

怀孕期间心理社会压力的不同经历可能导致美国不良妊娠结局的种族不平等。需要有效且无偏见的测量量表来评估心理社会压力对妊娠结局的影响，然而，用于测量压力的众多修改量表并不总是得到验证。

方法

对医疗补助覆盖的孕妇 ( N  = 1,632) 中母亲压力的结构效度和测量不变性进行了检查。比较三个验证性因子分析 (CFA) 模型的模型拟合估计，以确定适当的测量结构。多组 CFA 评估了黑人或非裔美国女性 (51.7%) 和所有其他种族女性的测量不变性。

结果

模型拟合的稳健估计支持由四个潜在应力域组成的分层 CFA 模型。其中三个潜在领域的标准化因子负荷——外部压力、感知压力和压力增强剂——表明与整体母体压力的二级潜在因素呈正相关，而第四个领域，压力缓冲，则呈负相关。多组 CFA 表现出很强的测量不变性。

结论

在医疗补助覆盖的孕妇中，心理社会压力的测量在孕产妇种族/民族的两个亚组中没有偏见。这些发现支持了四个潜在压力域之间常见变异性的总体母体压力的结构有效性。