Turkish Validity and Reliability Study of the Maternal Disintegrative Responses Scale

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Methods: This methodological research was carried out with 150 puerperants women with a 0-12 month old child who applied to Kars Harakani State Hospital- Obstetrics and Gynecology Service and Obstetrics Hall. Language validity and pilot application studies of the MDRS, which can be used in women with postpartum children aged 0-12 months, were conducted. Cronbach Aplha, discriminant validity and CR values regarding the reliability and validity of the scale were calculated.Confirmatory factor analysis was performed to determine whether the scale was validated in Turkish culture and fit values were calculated. Correlation values between factor loadings and sub-dimensions of the scale were calculated. Results: The Turkish version of the MDRS a 8-item scale with two sub-dimensions was obtained. These two sub-dimensions found as a result of confirmatory factor analysis support the structure of the scale. Conclusion: Cronbach α reliability coefficient was found to be sufficient for the total (0.91) and sub-dimensions of the scale. Maternal Intrusive thoughts dissociative experiences validity reliability Figures Figure 1 Introduction The postpartum period refers to a period of adaptation and crisis requiring new roles during which mothers face many biological, psychological, physical, and social changes [ 1 , 2 ]. A mother who has to devote herself to her infant dependent on her in numerous aspects during this process may experience intense stress and some negative emotions characterized by helplessness and fear in the face of significant responsibilities along with this unique experience. Negative emotions and false beliefs about motherhood are important causes of postpartum psychological disorders [ 3 ]. Thoughts, ideas, and urges that an individual cannot prevent from entering their mind or keeping away from their mind may be obsessive-compulsive disorder symptoms [ 4 ]. Recurring and persistent thoughts, urges, or images that are experienced as intrusive and lead to intense anxiety are the four most essential characteristics of obsessions [ 5 ]. Whereas recurring thoughts that characterize obsessive-compulsive disorder (OCD) occupy individuals’ minds and make life unbearable with the distress they cause, normal recurring thoughts are unpleasant but tolerable experiences [ 6 , 7 ]. Although these obsessions and compulsions are observed in individuals diagnosed with OCD, it is a fact that individuals without any psychiatric diagnosis also have obsessional experiences [ 8 ]. Unwanted intrusive thoughts of intentional harm to the infant that are common among parents after birth are distressing. During this period, 70–100% of new mothers report unwanted intrusive thoughts concerning their infants, and nearly half of all new mothers state unwanted intrusive thoughts, such as intentionally harming their infants [ 9 , 10 , 11 ]. The content of unwanted intrusive thoughts is associated with an individual's ongoing concerns triggered by external stimuli. High levels of stress, low levels of social support, and prolonged crying of the infant are the factors associated with the emergence of postpartum intrusive thoughts [ 12 ]. Postpartum intrusive thoughts do not cause any pathological discomfort or clinical warning signs in the mother, especially during and after the first birth. However, the frequency, duration, and intensity of the said thoughts and the resulting increase in distress and behaviors can lead to OCD development [ 13 , 14 ]. Lexically, dissociation has meanings such as separation, division, breakage, and dissolution. In dissociative disorders, an individual's memory, identity, consciousness, or perception integrity are impaired, although there is no medical disorder. Dissociation is considered a widely implemented psychological defense mechanism. Dissociative experiences, which can be observed as a person's detachment from painful emotions in the face of stressful and overwhelming situations, such as traumatic events, may occur in a wide range of behaviors from adaptive to pathological [ 15 ]. The psychiatric classification system DSM-5 examines dissociative disorders under five headings: dissociative identity disorder, dissociative amnesia, depersonalization (self-alienation) and derealization (unreality), other specified dissociative disorder, and unspecified dissociative disorder [ 16 , 17 ]. Dissociative experiences in the mother during the postpartum period may be triggered by various reasons, which include a trauma related to the birth experience, and especially the mother's feeling of helplessness concerning infant care and her maternal role [ 18 , 19 ]. Main and Hesse 20 reported a possible connection between parents' unresolved traumatic experiences and their relationship with their infants. They described three behavioral patterns that may characterize mothers during their interactions with their infants: frightening behavior (expressed by sudden and frightening reactions toward the child), frightened behavior (manifested by the mother's sudden expressions of fear), and dissociative behavior (physical or emotional stagnation and freeze reactions of the mother in the course of interaction) [ 20 ]. Considering the lack of instruments related to the mother's disintegrative or dissociative reactions, particularly in early motherhood, the Maternal Disintegrative Responses Scale (MDRS), which was developed by examining a wide range of mothers' intrusive thoughts and dissociative experiences in infant care during the postpartum period, is a valid and reliable assessment instrument [ 21 ]. The scale’s original version is a 5-point Likert scale (0-never, 4-very often). The literature showed that none of the diagnostic scales used to evaluate the mother's mental health in the postpartum period in Türkiye directly assess the intrusive thoughts and dissociative experiences of the mother. The current work aimed to evaluate the suitability, validity, and reliability of the MDRS [ 21 ], developed by Chasson et al. in 2021, for Turkish society. Materials and methods Research Type: The current work is a methodological study. Research Questions: Is the MDRS valid and reliable for Turkish society? Is the MDRS reliable for Turkish society? Place of Research and Its Characteristics : The research was conducted in Kars Harakani State Hospital-Gynecology and Obstetrics Clinics between 01.05.2023 and 30.05.2024. Population and Sample: The study’s population consisted of postpartum women who presented to Kars Harakani State Hospital Gynecology and Obstetrics clinics between 01.05.2023 and 01.05.2024. While adapting a scale to another culture, it is necessary to reach a group that is at least 5-10 times larger than the number of scale items [22] Since the number of items on the scale was 8 in the present research, the sample size must be at least 40-80. However, we determined the sample size as 150 women to reach more reliable results. Inclusion criteria: Postpartum women who could speak and understand Turkish, volunteered to take part in the research, and had children aged 0-1. Translation and Language Validity The 5-stage method developed by Brislin et al. (1973) was employed when translating the MDRS into Turkish [23]. The aforesaid stages involve the initial translation, evaluation of the initial translation, back-translation, evaluation of back-translation, and expert opinions. In this regard, the MDRS developed by Chasson et al. in 2021 was initially translated into Turkish independently by two faculty members with a good command of English [21]. Ten field experts examined and compared the translations, and the statements that were considered to best represent each item were evaluated for intelligibility and cultural appropriateness. The Turkish scale obtained as a result of the evaluation was re-evaluated by three academicians, experts in the field of Turkish language. Then, this scale was compared to the original scale and finally presented to two experts’ opinions. Following the expert reviews, the Turkish form of the scale was finalized. In this way, the scale’s Turkish translation was completed. Afterward, it was presented to expert opinion for content validity. Content Validity The scale’s Turkish and English versions were sent to 10 academicians, experts in their fields, via e-mail to evaluate its content validity in line with the basic information. The experts were requested to assess each item on the scale between 1 and 4 points, 4: “Completely appropriate,” 3: “Appropriate,” 2: “Somewhat appropriate,” 1: “Inappropriate.” The experts’ opinions were determined by employing the Davis method. As a result of the evaluation, the statements that the experts indicated as quite appropriate were accepted definitively. The statements that they wanted to change or were inappropriate were reviewed and corrected. Pilot Study Following the content validity analysis, the scale form was applied to a group of 20 postpartum women. The statements on the scale were determined to be intelligible in the group where the pilot study was conducted. As a result of the experts' recommendations and the preliminary application, the Turkish version of the MDRS was drafted. Construct validity Factor analysis was used to determine the construct validity of the MDRS. Principal components analysis was employed to examine the factor structure of the MDRS. The view that the items’ factor loading values should be at least 0.30 and that it would be more appropriate to remove an item below this value was adopted [19] Reliability (internal consistency) Cronbach's α internal consistency coefficient technique is recommended to examine the reliability of Likert scales. It is desired that the reliability coefficient to be considered adequate in an assessment instrument is close to one [21] To this end, Cronbach's α coefficient was assessed for the MDRS. The item-total correlation coefficients were checked to investigate the correlation between the scores obtained from the MDRS test items and the test’s total score. The items were selected based on the recommendation that the acceptable coefficient should be higher than 0.20 [22]. Furthermore, AVE values and composite reliability (CR) coefficients were computed for the scale’s discriminant validity. Data analysis The research data were statistically analyzed using the Social Sciences Statistical Package (SPSS) for Windows (SPSS Inc, Chicago, IL) 25.0 and AMOS 24.0. Descriptive statistics were used to perform statistical analysis. Confirmatory factor analyses were conducted for the scale’s construct validity. Internal consistency and item-total correlation were investigated. Concerning internal consistency, Cronbach's α was computed as a recommended reliability coefficient. Item-total correlation was estimated using Pearson’s correlation coefficient. Ethical considerations When adapting the MDRS to Turkish culture, Condon who developed the scale was first contacted via e-mail, and the permissions required to use the scale were obtained. Ethics approval from Atatürk University Health Sciences Scientific Research and Publication Ethics Board (Decision No: 2018/15-24) and institutional permission from Kars Provincial Health Directorate (E-74033640-799-219986888) were received to conduct the research. Furthermore, participants were informed about the study and the confidentiality of their personal data. Finally, participants who volunteered for the research were registered. Results Table 1. Distribution of the sample by variables Variables f % Educational Status Primary School Graduate 44 29.3 High School Graduate 67 44.7 University Graduate 39 26.0 Employment Status Employed 38 25.3 Unemployed 112 74.7 Income Status Income more than expenses 14 9.4 Income equals expenses 95 63.3 Income less than expenses 41 27.3 Number of Births 1 86 57.3 2 34 22.7 3 and↑ 30 20.0 Week of Birth 36 11 7.3 37 22 14.7 38 32 21.3 39 40 26.7 40 31 20.7 41 14 9.3 Delivery Method Vaginal 61 40.7 Cesarean section 89 59.3 Upon examining the distribution of the study participants by demographic variables in Table 1, it is seen that while 4 out of 150 individuals were illiterate (2.7%), nine were literate (6.0%), 31 were primary school graduates (20.7%), 67 were high school graduates (44.7%), and 39 were university graduates (26.0%). Of the 150 women, 38 (25.3%) and 112 (74.7%) were employed and unemployed, respectively. Concerning the distribution of the 150 women by their income status, 14 (9.3%) had income more than their expenses, 95 (63.3%) had income equal to their expenses, and 41 (27.3%) had income less than their expenses. According to the number of births, whereas 86 of the 150 women (57.3%) had one birth, 34 (22.7%) had two births, 23 (15.3%) had three births, and 7 (4.7%) had four births. Considering the distribution by the birth week, women gave birth at 34 and 42 weeks. Upon examining the distribution of the 150 women by the delivery method, 61 (40.7%) and 89 (59.3%) gave birth by vaginal delivery and cesarean section, respectively. The mean age of the participating women was 28, the mean age of the youngest child was 2.4, and the mean week of birth was 38.6. Table 2. Factor Loading Values of the Maternal Disintegrative Responses Scale Item Number Item Dissociative experiences Intrusive thoughts 3 When I'm with the baby or caring for him/her, I feel as if I'm not really there but only watching from a distance. .905 5 When I hold the baby, I feel as if it's not really me doing it. .813 1 When I'm with the baby, I feel that what's happening isn't real, as if it's a dream or a movie. .782 8 There are moments when I feel like a stranger to my own baby. .692 2 I think about things that could happen to my baby that aren't really logical. .865 4 I have unwanted thoughts about bad things that could happen to my baby. .833 7 When I'm holding the baby, the uncontrollable thought that I'm going to drop him/her flits through my mind. .690 6 When I'm caring for the baby, disturbing thoughts suddenly pop into my head. .600 Table 2 demonstrates that the factor loading values of the items in the “Dissociative experiences” sub-scale in the Turkish version of the MDRS vary between .905 and .692, and the factor loading values of the items in the "Intrusive thoughts" sub-scale vary between .865 and .600. Figure 1 displays the path diagram of the confirmatory factor analysis conducted to reveal whether the structure of the adapted MDRS was validated in Turkish culture, and Table 3 contains the values of the analysis results. Table 3. Goodness-of-Fit Values Obtained from Confirmatory Factor Analysis Reference Value Measurement Result Indices Good Fit Acceptable Fit CMIN/DF 0< χ2/sd ≤ 3 3< χ2/sd ≤ 5 1.497 Good fit TLI .95< TLI≤ 1 .90 < TLI≤ .94 .981 Good fit RMSEA 0 ≤ RMSEA ≤ .05 .05 ≤ RMSEA ≤ .08 .058 Acceptable fit SRMR 0≤SRMR≤.05 0.05≤SRMR≤.10 .0281 Good fit AGFI .90< AGFI≤ 1 .80 < AGFI≤ .90 .915 Good fit GFI .90< GFI≤ 1 .85 < GFI≤ .90 .955 Good fit IFI .95< IFI≤ 1 .90 < IFI≤ .95 .988 Good fit CFI .95< CFI≤ 1 .90 < CFI≤ .94 .987 Good fit Sd 19 The original structure of the MDRS comprises 4 items in the “Dissociative experiences” sub-scale and 4 items in the “Intrusive thoughts” sub-scale. A confirmatory factor analysis was carried out to identify whether this structure was also provided in Turkish culture. Upon examining the model fit criteria obtained from the confirmatory factor analysis, the values obtained were as follows: CMIN=28.439, DF=19, p<.001, RMSEA=0.058, TLI=0.981, SRMR= 0.0281, AGFI=0.915, GFI=0.955, IFI=0.988, and CFI=0.987. Based on the values obtained, the confirmatory factor analysis conducted for the Turkish adaptation of the scale showed a good fit according to the reference values. Table 4. Correlation values between the sub-scales of the MDRS Dissociative experiences Intrusive thoughts Dissociative experiences 1 .835** Intrusive thoughts .835** 1 Total Table 4 shows that the correlation coefficients between the sub-scales were positive and high. Table 5 contains Cronbach’s alpha, AVE, and CR values computed for the scale’s reliability. Table 5. Cronbach’s alpha, AVE, and CR values computed for the MDRS reliability and validity Cronbach’s Alpha AVE CR Dissociative experiences .875 .643 0.877 Intrusive thoughts .827 .569 0.838 Total .918 Table 5 presents the coefficients calculated for the reliability and validity of the Maternal Disintegrative Responses Scale. The AVE values computed for the scale’s discriminant validity vary between .643 and .569. These values being higher than .50 indicate the presence of discriminant validity. Additionally, the scale’s internal reliability coefficient and the composite reliability (CR) coefficients were also calculated. The CR values computed within the scope of composite reliability vary between .877 and .838. These values being greater than .60 indicate the presence of composite reliability. DISCUSSION Physiological, psychological, and social changes that occur in mothers during the postpartum period may also bring about numerous mental health problems. One out of every five women in the world experiences a psychiatric problem during this period, and 7 out of every 10 women cannot access the necessary treatment [ 2 ]. Intrusive thoughts determined in the early postpartum period are essential for preventing further psychological problems. However, none of the diagnostic scales used to evaluate the mother's mental health in the postpartum period in Türkiye directly assess the intrusive thoughts and dissociative experiences of the mother. Therefore, the suitability, validity, and reliability of the MDRS developed by Chasson et al. in 2021 were evaluated for Turkish society, and the results were discussed with the relevant literature [ 21 ]. The Davis technique, which is based on expert consensus, was employed to evaluate content validity. In content validity studies using the Davis method, the CVI score must be 0.80 and above. In the current study, the content validity index score of all scale statements was 1.00, which indicates that the scale is quite adequate concerning content validity. Confirmatory factor analysis (CFA) is a frequently used analysis method that provides significant convenience in developing measurement models. This method aims to create a latent variable (factor) based on observed variables through a previously created model. It is usually employed in scale development and validity analyses or aims to verify a predetermined structure [ 24 ]. The original structure of the Maternal Disintegrative Responses Scale comprises 4 items in the “Dissociative experiences” sub-scale and 4 items in the “Intrusive thoughts” sub-scale. A confirmatory factor analysis was carried out with the objective of determining whether this structure was also provided in Turkish culture. Upon examining the model fit criteria obtained from the confirmatory factor analysis, the values obtained were as follows: CMIN = 28.439, DF = 19, p < .001, RMSEA = 0.058, TLI = 0.981, SRMR = 0.0281, AGFI = 0.915, GFI = 0.955, IFI = 0.988, and CFI = 0.987. Based on the values obtained, the confirmatory factor analysis carried out for the Turkish adaptation of the scale showed a good fit according to the reference values. Fornell and Larcker (1981) recommend that CR be above 0.8 and an AVE value be above 0.5 for a good convergent validity [ 25 ]. In our study, the AVE values calculated for the scale’s discriminant validity vary between .643 and .569. The CR values calculated within the scope of composite reliability vary between .877 and .838. This is a supported and positive result. In scale adaptation studies, it is also essential to test the reliability of the scale adapted to the target language. Cronbach's α coefficient, which is used to measure the internal consistency of Likert scales, takes a value between 0.00 and 1.00, and reliability increases as the value approaches 1.00. Cronbach's alpha was 0.918 in the adaptation study of the Maternal Disintegrative Responses Scale, which indicates a high reliability of the scale. In conclusion, the Turkish version of the MDRS appears to be valid and reliable. Conclusion and Recommendations When the MDRS used to evaluate maternal mental health in the postpartum period was adapted into Turkish, it showed good fit values with the original scale. Hence it can be safely used to evaluate early dissociative experiences and intrusive thoughts of Turkish women in the postpartum period. Due to inadequate assessment instruments evaluating dissociative experiences and intrusive thoughts in Turkish literature, it will contribute to early detecting psychiatric problems in the postpartum period and taking necessary precautions. Abbreviations CFA: Confirmatory factor analysis CR: composite reliability MDRS 'Maternal Disintegrative Responses Scale Declarations Ethics approval and consent to participate: Ethical approval was obtained from the Institutional Review Board of Atatürk University Health Sciences Scientific Research and Publication Ethics Board (Decision No: 2018/15-24). This study has been performed in accordance with the Declaration of Helsinki. All women included in the study were informed and provided oral consent . Consent for publication: Not applicable. Data availability statement: The data of this study can be used by anyone. Competing interests: The authors declare that there is no conflict of interest. The authors alone are responsible for the content and writing of the paper. Funding: No funding. Authors' contributions: Study design: SEA, ML, SET; Data collection: ML;SET; Data analysis: SEA, Draft preparation: SEA, ML, SET; Critical review for content: SEA, Final approval of the version to be published: SEA, ML, SET. Acknowledgments : The authors thank the women who participated in the study. Clinical trial number: Not applicable References D. Agrati and J. S. Lonstein. Affective changes during the postpartum period: Influences of genetic and experiential factors. Hormones and Behavior, (2016): 77, 141–152. https://doi.org/10.1016/j.yhbeh.2015.07.016. C. Stramrood and P. A. Slade. Woman Afraid of Becoming Pregnant Again: Posttraumatic Stress Disorder Following Childbirth. K.M. Paarlberg, H.B.M. Van de Wiel, (Ed.), Bio-Psycho-Social Obstetrics and Gynecology. Switzerland: Springer, (2017): 33-47. A. Fonseca, F. Monteiro and M. C. Canavarro. Dysfunctional beliefs towards motherhood and postpartum depressive and anxiety symptoms: Uncovering the role of experiential avoidance. 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Şti.( 2014): pp. 193-232. R. W. Brislin, W. J. Lonner and R. M. Thorndike. Cross-Cultural Research Methods, New York, (1973): John Wiley – SonsPub. N. Bayram. Yapısal Eşitlik Modellemesine Giriş [Introduction to Structural Equation Modeling], (2010): Ekin Kitabevi, Bursa. C. Fornell, and D. F. Larcker. Structural Equation Models with Unobservable Variables and Measurement Error: Algebra and Statistics. Journal of Marketing Research, (1981): 18, 382-388. http://dx.doi.org/10.2307/315098. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6810254","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485037253,"identity":"e433df72-4cc2-4757-b362-f407418f42cb","order_by":0,"name":"Merve LAZOGLU","email":"","orcid":"","institution":"Kafkas University","correspondingAuthor":false,"prefix":"","firstName":"Merve","middleName":"","lastName":"LAZOGLU","suffix":""},{"id":485037254,"identity":"b21f13ed-8b3d-4c93-9782-a558560834e2","order_by":1,"name":"Sibel TEKGUNDUZ","email":"","orcid":"","institution":"Health University","correspondingAuthor":false,"prefix":"","firstName":"Sibel","middleName":"","lastName":"TEKGUNDUZ","suffix":""},{"id":485037255,"identity":"47abe51d-ca1c-437c-9616-44438232b9dd","order_by":2,"name":"Serap EJDER APAY","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYHCCBAkGBpsECLOAeC1pCQxsIKYBkdYAtRyGaGEgRot8e8PDGx/3nM/jl+9O/PDAgEGeX+wAfi0GZw4kW854drtYso13swTQYYYzZycQ0CKRkCbNc+B24oZjvBtAWhIMbhPQIj//QZr0nwPnQFo2/yBKC8MNhjRphgMHQFq2EWeLwZmEZMueA8mJM9tyt1kkGEgQ9ot8+5nEGz8O2CX2M5/dfPNHhY08vzQhhzHwoKiQIKQcBNgPEKNqFIyCUTAKRjIAABSQRs1Lz3NJAAAAAElFTkSuQmCC","orcid":"","institution":"Atatürk University","correspondingAuthor":true,"prefix":"","firstName":"Serap","middleName":"EJDER","lastName":"APAY","suffix":""}],"badges":[],"createdAt":"2025-06-03 10:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6810254/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6810254/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86829431,"identity":"a1059aaf-fefe-4995-9b16-dcc1b1326e31","added_by":"auto","created_at":"2025-07-16 05:45:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45447,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePath diagram for confirmatory factor analysis\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6810254/v1/e72ada40fc84901c57cebcaa.png"},{"id":88070960,"identity":"988bf2c9-dee5-443c-a580-4200bdf75fc9","added_by":"auto","created_at":"2025-08-01 05:38:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":850061,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6810254/v1/d28bc545-cc1e-435e-9de0-69f8db4364b2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Turkish Validity and Reliability Study of the Maternal Disintegrative Responses Scale","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe postpartum period refers to a period of adaptation and crisis requiring new roles during which mothers face many biological, psychological, physical, and social changes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A mother who has to devote herself to her infant dependent on her in numerous aspects during this process may experience intense stress and some negative emotions characterized by helplessness and fear in the face of significant responsibilities along with this unique experience. Negative emotions and false beliefs about motherhood are important causes of postpartum psychological disorders [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thoughts, ideas, and urges that an individual cannot prevent from entering their mind or keeping away from their mind may be obsessive-compulsive disorder symptoms [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Recurring and persistent thoughts, urges, or images that are experienced as intrusive and lead to intense anxiety are the four most essential characteristics of obsessions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Whereas recurring thoughts that characterize obsessive-compulsive disorder (OCD) occupy individuals\u0026rsquo; minds and make life unbearable with the distress they cause, normal recurring thoughts are unpleasant but tolerable experiences [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Although these obsessions and compulsions are observed in individuals diagnosed with OCD, it is a fact that individuals without any psychiatric diagnosis also have obsessional experiences [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUnwanted intrusive thoughts of intentional harm to the infant that are common among parents after birth are distressing. During this period, 70\u0026ndash;100% of new mothers report unwanted intrusive thoughts concerning their infants, and nearly half of all new mothers state unwanted intrusive thoughts, such as intentionally harming their infants [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The content of unwanted intrusive thoughts is associated with an individual's ongoing concerns triggered by external stimuli. High levels of stress, low levels of social support, and prolonged crying of the infant are the factors associated with the emergence of postpartum intrusive thoughts [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Postpartum intrusive thoughts do not cause any pathological discomfort or clinical warning signs in the mother, especially during and after the first birth. However, the frequency, duration, and intensity of the said thoughts and the resulting increase in distress and behaviors can lead to OCD development [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLexically, dissociation has meanings such as separation, division, breakage, and dissolution. In dissociative disorders, an individual's memory, identity, consciousness, or perception integrity are impaired, although there is no medical disorder. Dissociation is considered a widely implemented psychological defense mechanism. Dissociative experiences, which can be observed as a person's detachment from painful emotions in the face of stressful and overwhelming situations, such as traumatic events, may occur in a wide range of behaviors from adaptive to pathological [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The psychiatric classification system DSM-5 examines dissociative disorders under five headings: dissociative identity disorder, dissociative amnesia, depersonalization (self-alienation) and derealization (unreality), other specified dissociative disorder, and unspecified dissociative disorder [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Dissociative experiences in the mother during the postpartum period may be triggered by various reasons, which include a trauma related to the birth experience, and especially the mother's feeling of helplessness concerning infant care and her maternal role [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Main and Hesse 20 reported a possible connection between parents' unresolved traumatic experiences and their relationship with their infants. They described three behavioral patterns that may characterize mothers during their interactions with their infants: frightening behavior (expressed by sudden and frightening reactions toward the child), frightened behavior (manifested by the mother's sudden expressions of fear), and dissociative behavior (physical or emotional stagnation and freeze reactions of the mother in the course of interaction) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eConsidering the lack of instruments related to the mother's disintegrative or dissociative reactions, particularly in early motherhood, the Maternal Disintegrative Responses Scale (MDRS), which was developed by examining a wide range of mothers' intrusive thoughts and dissociative experiences in infant care during the postpartum period, is a valid and reliable assessment instrument [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The scale\u0026rsquo;s original version is a 5-point Likert scale (0-never, 4-very often). The literature showed that none of the diagnostic scales used to evaluate the mother's mental health in the postpartum period in T\u0026uuml;rkiye directly assess the intrusive thoughts and dissociative experiences of the mother. The current work aimed to evaluate the suitability, validity, and reliability of the MDRS [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], developed by Chasson et al. in 2021, for Turkish society.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eResearch Type:\u003c/strong\u003e The current work is a methodological study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Questions:\u003c/strong\u003e Is the MDRS valid and reliable for Turkish society?\u003c/p\u003e\n\u003cp\u003eIs the MDRS reliable for Turkish society?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlace of Research and Its Characteristics\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The research was conducted in Kars Harakani State Hospital-Gynecology and Obstetrics Clinics between 01.05.2023 and 30.05.2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation and Sample:\u003c/strong\u003e The study\u0026rsquo;s population consisted of postpartum women who presented to Kars Harakani State Hospital Gynecology and Obstetrics clinics between 01.05.2023 and 01.05.2024. While adapting a scale to another culture, it is necessary to reach a group that is at least 5-10 times larger than the number of scale items [22] Since the number of items on the scale was 8 in the present research, the sample size must be at least 40-80. However, we determined the sample size as 150 women to reach more reliable results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInclusion criteria:\u003c/em\u003e\u003c/strong\u003e Postpartum women who could speak and understand Turkish, volunteered to take part in the research, and had children aged 0-1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTranslation and Language Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 5-stage method developed by Brislin et al. (1973) was employed when translating the MDRS into Turkish [23]. The aforesaid stages involve the initial translation, evaluation of the initial translation, back-translation, evaluation of back-translation, and expert opinions. In this regard, the MDRS developed by Chasson et al. in 2021 was initially translated into Turkish independently by two faculty members with a good command of English [21]. Ten field experts examined and compared the translations, and the statements that were considered to best represent each item were evaluated for intelligibility and cultural appropriateness. The Turkish scale obtained as a result of the evaluation was re-evaluated by three academicians, experts in the field of Turkish language. Then, this scale was compared to the original scale and finally presented to two experts\u0026rsquo; opinions. Following the expert reviews, the Turkish form of the scale was finalized. In this way, the scale\u0026rsquo;s Turkish translation was completed. Afterward, it was presented to expert opinion for content validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContent Validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe scale\u0026rsquo;s Turkish and English versions were sent to 10 academicians, experts in their fields, via e-mail to evaluate its content validity in line with the basic information. The experts were requested to assess each item on the scale between 1 and 4 points, 4: \u0026ldquo;Completely appropriate,\u0026rdquo; 3: \u0026ldquo;Appropriate,\u0026rdquo; 2: \u0026ldquo;Somewhat appropriate,\u0026rdquo; 1: \u0026ldquo;Inappropriate.\u0026rdquo; The experts\u0026rsquo; opinions were determined by employing the Davis method. As a result of the evaluation, the statements that the experts indicated as quite appropriate were accepted definitively. The statements that they wanted to change or were inappropriate were reviewed and corrected.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePilot Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the content validity analysis, the scale form was applied to a group of 20 postpartum women. The statements on the scale were determined to be intelligible in the group where the pilot study was conducted. As a result of the experts\u0026apos; recommendations and the preliminary application, the Turkish version of the MDRS was drafted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstruct validity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFactor analysis was used to determine the construct validity of the MDRS. Principal components analysis was employed to examine the factor structure of the MDRS. The view that the items\u0026rsquo; factor loading values should be at least 0.30 and that it would be more appropriate to remove an item below this value was adopted [19]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReliability (internal consistency)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCronbach\u0026apos;s \u0026alpha; internal consistency coefficient technique is recommended to examine the reliability of Likert scales. It is desired that the reliability coefficient to be considered adequate in an assessment instrument is close to one [21] To this end, Cronbach\u0026apos;s \u0026alpha; coefficient was assessed for the MDRS. The item-total correlation coefficients were checked to investigate the correlation between the scores obtained from the MDRS test items and the test\u0026rsquo;s total score. The items were selected based on the recommendation that the acceptable coefficient should be higher than 0.20 [22]. Furthermore, AVE values and composite reliability (CR) coefficients were computed for the scale\u0026rsquo;s discriminant validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research data were statistically analyzed using the Social Sciences Statistical Package (SPSS) for Windows (SPSS Inc, Chicago, IL) 25.0 and AMOS 24.0. Descriptive statistics were used to perform statistical analysis. Confirmatory factor analyses were conducted for the scale\u0026rsquo;s construct validity. Internal consistency and item-total correlation were investigated. Concerning internal consistency, Cronbach\u0026apos;s \u0026alpha; was computed as a recommended reliability coefficient. Item-total correlation was estimated using Pearson\u0026rsquo;s correlation coefficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen adapting the MDRS to Turkish culture, Condon who developed the scale was first contacted via e-mail, and the permissions required to use the scale were obtained. Ethics approval from Atat\u0026uuml;rk University Health Sciences Scientific Research and Publication Ethics Board (Decision No: 2018/15-24) and institutional permission from Kars Provincial Health Directorate (E-74033640-799-219986888) were received to conduct the research. Furthermore, participants were informed about the study and the confidentiality of their personal data. Finally, participants who volunteered for the research were registered.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Distribution of the sample by variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 189px;\"\u003e\n \u003cp\u003eEducational Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePrimary School Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e29.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHigh School Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e44.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUniversity Graduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eEmployment Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eUnemployed \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e74.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 189px;\"\u003e\n \u003cp\u003eIncome Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIncome more than expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIncome equals expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eIncome less than expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNumber of Births\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e3 and\u0026uarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWeek of Birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 189px;\"\u003e\n \u003cp\u003eDelivery Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e59.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eUpon examining the distribution of the study participants by demographic variables in Table 1, it is seen that while 4 out of 150 individuals were illiterate (2.7%), nine were literate (6.0%), 31 were primary school graduates (20.7%), 67 were high school graduates (44.7%), and 39 were university graduates (26.0%). Of the 150 women, 38 (25.3%) and 112 (74.7%) were employed and unemployed, respectively. Concerning the distribution of the 150 women by their income status, 14 (9.3%) had income more than their expenses, 95 (63.3%) had income equal to their expenses, and 41 (27.3%) had income less than their expenses. According to the number of births, whereas 86 of the 150 women (57.3%) had one birth, 34 (22.7%) had two births, 23 (15.3%) had three births, and 7 (4.7%) had four births. Considering the distribution by the birth week, women gave birth at 34 and 42 weeks. Upon examining the distribution of the 150 women by the delivery method, 61 (40.7%) and 89 (59.3%) gave birth by vaginal delivery and cesarean section, respectively. The mean age of the participating women was 28, the mean age of the youngest child was 2.4, and the mean week of birth was 38.6. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Factor Loading Values of the Maternal Disintegrative Responses Scale\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eItem Number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eItem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eDissociative experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eIntrusive thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eWhen I\u0026apos;m with the baby or caring for him/her, I feel as if I\u0026apos;m not really there but only watching from a distance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eWhen I hold the baby, I feel as if it\u0026apos;s not really me doing it.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eWhen I\u0026apos;m with the baby, I feel that what\u0026apos;s happening\u003c/p\u003e\n \u003cp\u003eisn\u0026apos;t real, as if it\u0026apos;s a dream or a movie.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eThere are moments when I feel like a stranger to my\u003c/p\u003e\n \u003cp\u003eown baby.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eI think about things that could happen to my baby that\u003c/p\u003e\n \u003cp\u003earen\u0026apos;t really logical.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e.865\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eI have unwanted thoughts about bad things that could\u003c/p\u003e\n \u003cp\u003ehappen to my baby.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e.833\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eWhen I\u0026apos;m holding the baby, the uncontrollable thought\u003c/p\u003e\n \u003cp\u003ethat I\u0026apos;m going to drop him/her flits through my mind.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e.690\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eWhen I\u0026apos;m caring for the baby, disturbing thoughts\u003c/p\u003e\n \u003cp\u003esuddenly pop into my head.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 demonstrates that the factor loading values of the items in the \u0026ldquo;Dissociative experiences\u0026rdquo; sub-scale in the Turkish version of the MDRS vary between .905 and .692, and the factor loading values of the items in the \u0026quot;Intrusive thoughts\u0026quot; sub-scale vary between .865 and .600.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 displays the path diagram of the confirmatory factor analysis conducted to reveal whether the structure of the adapted MDRS was validated in Turkish culture, and Table 3 contains the values of the analysis results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Goodness-of-Fit Values Obtained from Confirmatory Factor Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"597\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eReference Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 111px;\"\u003e\n \u003cp\u003eMeasurement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003eResult\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eIndices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eGood Fit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003cp\u003eFit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCMIN/DF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0\u0026lt; \u0026chi;2/sd \u0026le; 3\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e3\u0026lt; \u0026chi;2/sd \u0026le; 5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.95\u0026lt; TLI\u0026le; 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e.90 \u0026lt; TLI\u0026le; .94\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0 \u0026le; RMSEA \u0026le; .05\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e.05 \u0026le; RMSEA \u0026le; .08\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcceptable fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0\u0026le;SRMR\u0026le;.05\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e0.05\u0026le;SRMR\u0026le;.10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.0281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.90\u0026lt; AGFI\u0026le; 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e.80 \u0026lt; AGFI\u0026le; .90\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.90\u0026lt; GFI\u0026le; 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e.85 \u0026lt; GFI\u0026le; .90\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.95\u0026lt; IFI\u0026le; 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e.90 \u0026lt; IFI\u0026le; .95\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.95\u0026lt; CFI\u0026le; 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e.90 \u0026lt; CFI\u0026le; .94\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e.987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eGood fit\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe original structure of the MDRS comprises 4 items in the \u0026ldquo;Dissociative experiences\u0026rdquo; sub-scale and 4 items in the \u0026ldquo;Intrusive thoughts\u0026rdquo; sub-scale. A confirmatory factor analysis was carried out to identify whether this structure was also provided in Turkish culture. Upon examining the model fit criteria obtained from the confirmatory factor analysis, the values obtained were as follows: CMIN=28.439, DF=19, p\u0026lt;.001, RMSEA=0.058, TLI=0.981, SRMR= 0.0281, AGFI=0.915, GFI=0.955, IFI=0.988, and CFI=0.987. Based on the values obtained, the confirmatory factor analysis conducted for the Turkish adaptation of the scale showed a good fit according to the reference values.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Correlation values between the sub-scales of the MDRS\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"489\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDissociative experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eIntrusive thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDissociative experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.835**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eIntrusive thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e.835**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 4 shows that the correlation coefficients between the sub-scales were positive and high.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 contains Cronbach\u0026rsquo;s alpha, AVE, and CR values computed for the scale\u0026rsquo;s reliability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Cronbach\u0026rsquo;s alpha, AVE, and CR values computed for the MDRS reliability and validity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eCronbach\u0026rsquo;s Alpha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eAVE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eCR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eDissociative experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eIntrusive thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.838\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e.918\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5 presents the coefficients calculated for the reliability and validity of the Maternal Disintegrative Responses Scale. The AVE values computed for the scale\u0026rsquo;s discriminant validity vary between .643 and .569. These values being higher than .50 indicate the presence of discriminant validity. Additionally, the scale\u0026rsquo;s internal reliability coefficient and the composite reliability (CR) coefficients were also calculated. The CR values computed within the scope of composite reliability vary between .877 and .838. These values being greater than .60 indicate the presence of composite reliability.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePhysiological, psychological, and social changes that occur in mothers during the postpartum period may also bring about numerous mental health problems. One out of every five women in the world experiences a psychiatric problem during this period, and 7 out of every 10 women cannot access the necessary treatment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Intrusive thoughts determined in the early postpartum period are essential for preventing further psychological problems. However, none of the diagnostic scales used to evaluate the mother's mental health in the postpartum period in Türkiye directly assess the intrusive thoughts and dissociative experiences of the mother. Therefore, the suitability, validity, and reliability of the MDRS developed by Chasson et al. in 2021 were evaluated for Turkish society, and the results were discussed with the relevant literature [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Davis technique, which is based on expert consensus, was employed to evaluate content validity. In content validity studies using the Davis method, the CVI score must be 0.80 and above. In the current study, the content validity index score of all scale statements was 1.00, which indicates that the scale is quite adequate concerning content validity.\u003c/p\u003e\u003cp\u003eConfirmatory factor analysis (CFA) is a frequently used analysis method that provides significant convenience in developing measurement models. This method aims to create a latent variable (factor) based on observed variables through a previously created model. It is usually employed in scale development and validity analyses or aims to verify a predetermined structure [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The original structure of the Maternal Disintegrative Responses Scale comprises 4 items in the “Dissociative experiences” sub-scale and 4 items in the “Intrusive thoughts” sub-scale. A confirmatory factor analysis was carried out with the objective of determining whether this structure was also provided in Turkish culture. Upon examining the model fit criteria obtained from the confirmatory factor analysis, the values obtained were as follows: CMIN = 28.439, DF = 19, p \u0026lt; .001, RMSEA = 0.058, TLI = 0.981, SRMR = 0.0281, AGFI = 0.915, GFI = 0.955, IFI = 0.988, and CFI = 0.987. Based on the values obtained, the confirmatory factor analysis carried out for the Turkish adaptation of the scale showed a good fit according to the reference values.\u003c/p\u003e\u003cp\u003eFornell and Larcker (1981) recommend that CR be above 0.8 and an AVE value be above 0.5 for a good convergent validity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, the AVE values calculated for the scale’s discriminant validity vary between .643 and .569. The CR values calculated within the scope of composite reliability vary between .877 and .838. This is a supported and positive result.\u003c/p\u003e\u003cp\u003eIn scale adaptation studies, it is also essential to test the reliability of the scale adapted to the target language. Cronbach's α coefficient, which is used to measure the internal consistency of Likert scales, takes a value between 0.00 and 1.00, and reliability increases as the value approaches 1.00. Cronbach's alpha was 0.918 in the adaptation study of the Maternal Disintegrative Responses Scale, which indicates a high reliability of the scale. In conclusion, the Turkish version of the MDRS appears to be valid and reliable.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eWhen the MDRS used to evaluate maternal mental health in the postpartum period was adapted into Turkish, it showed good fit values with the original scale. Hence it can be safely used to evaluate early dissociative experiences and intrusive thoughts of Turkish women in the postpartum period. Due to inadequate assessment instruments evaluating dissociative experiences and intrusive thoughts in Turkish literature, it will contribute to early detecting psychiatric problems in the postpartum period and taking necessary precautions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCFA: Confirmatory factor analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCR: composite reliability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMDRS \u0026apos;Maternal Disintegrative Responses Scale\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Institutional Review Board of Atat\u0026uuml;rk University Health Sciences Scientific Research and Publication Ethics Board (Decision No: 2018/15-24). This study has been performed in accordance with the Declaration of Helsinki. All women included in the study were informed and provided oral consent .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eThe data of this study can be used by anyone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that there is no conflict of interest. The authors alone are responsible for the content and writing of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e Study design: SEA, ML, SET; Data collection: ML;SET; Data analysis: SEA, Draft preparation: SEA, ML, \u0026nbsp; SET; Critical review for content: SEA, Final approval of the version to be published: SEA, ML, SET.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments :\u0026nbsp;\u003c/strong\u003eThe authors thank the women who participated in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eD. Agrati and J. S. Lonstein. Affective changes during the postpartum period: Influences of genetic and experiential factors. Hormones and Behavior, (2016): 77, 141\u0026ndash;152. https://doi.org/10.1016/j.yhbeh.2015.07.016.\u003c/li\u003e\n\u003cli\u003eC. Stramrood and P. A. Slade. Woman Afraid of Becoming Pregnant Again: Posttraumatic Stress Disorder Following Childbirth. K.M. Paarlberg, H.B.M. Van de Wiel, (Ed.), Bio-Psycho-Social Obstetrics and Gynecology. Switzerland: Springer, (2017): 33-47.\u003c/li\u003e\n\u003cli\u003eA. Fonseca, F. Monteiro and M. C. Canavarro. Dysfunctional beliefs towards motherhood and postpartum depressive and anxiety symptoms: Uncovering the role of experiential avoidance. Journal of Clinical Psychology, (2018): 74(12), 2134\u0026ndash;2144. https://doi.org/10.1002/jclp.22649.\u003c/li\u003e\n\u003cli\u003eTPD - T\u0026uuml;rk Psikiyatri Derneği [Turkish Psychiatric Association] (2018), \u0026quot;Obsesif - Kompulsif Bozukluk\u0026quot; [Obsessive-Compulsive Disorder], E-Article, http://www.psikiyatri.org.tr/halka-yonelik/29/obsesif-kompulsif-bozukluk (Date Accessed:) KOCAKULA, \u0026Ouml;zge and ALTUNOĞLU, Ali Ender - Obsesif Kompulsif Kişilik Bozukluğunun Karar S\u0026uuml;re\u0026ccedil;lerine Etkisi [The Effect of Obsessive Compulsive Personality Disorder on Decision Making Processes].\u003c/li\u003e\n\u003cli\u003eP Y\u0026ouml;r\u0026uuml;k, A. Tosun. Obsesif Kompulsif Bozuklukta \u0026Uuml;st-Bilişsel Model Psikiyatride G\u0026uuml;ncel Yaklaşımlar-Current Approaches in Psychiatry, (2015): 7(2):190-207 doi:10.5455/cap.20140807024558.\u003c/li\u003e\n\u003cli\u003eJ. Joormann, S. M. Levens, and I. H. Gotlib. 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Deacon, R. Rygwall. The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behav Res Ther, (2006): 44(9):1361\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eJ. S. Abramowitz, C. A. Nelson, R. Rygwall, M. Khandker. The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. J Anxiety Disord, (2007): 21(1):91\u0026ndash;104.\u003c/li\u003e\n\u003cli\u003eN. Fairbrother, R. G. Barr, M. Chen, S. Riar, E. Miller, R. Brant and A. Ma. Prepartum and postpartum mothers\u0026apos; and fathers\u0026apos; unwanted, intrusive thoughts in response to infant crying. Behavioural and Cognitive Psychotherapy, (2019): 47, 129\u0026ndash;147. https://doi.org/10.1017/S1352465818000474.\u003c/li\u003e\n\u003cli\u003eJ. L. Buchholz, S. N. Hellberg and J. S. Abramowitz. Phenomenology of perinatal obsessive\u0026ndash;compulsive disorder. In J. L. Payne, \u0026amp; L. M. Osborne (Eds.), Biomarkers of Postpartum Psychiatric Disorders, (2020): 79\u0026ndash;93. Academic Press. https://doi.org/10.1016/C2017-0-03209-3.\u003c/li\u003e\n\u003cli\u003eN. Fairbrother, D. S. Thordarson, F. L. Challacombe, and J. K. Sakaluk. Correlates and predictors of new mothers\u0026apos; responses to postpartum thoughts of accidental and intentional harm and obsessive‐compulsive symptoms. Behavioral and Cognitive Psychotherapy, (2018): 46, 437\u0026ndash;453. https://doi.org/10.1017/S1352465817000765.\u003c/li\u003e\n\u003cli\u003eG. Liotti. A model of dissociation based on attachment theory and research. Journal of Trauma \u0026amp; Dissociation, (2006): 7, 55\u0026ndash;73. https://doi.org/10.1300/J229v07n04_04.\u003c/li\u003e\n\u003cli\u003eM. Ş. \u0026Ouml;zden. Travma ve Dissosiyatif Bozukluklar: Genel Bir Bakış [Trauma and Dissociative: An Overview] Bartın \u0026Uuml;niversitesi Edebiyat Fak\u0026uuml;ltesi Dergisi. 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Erdoğan S, Nahcivan N, Esin N, editors. Hemşirelikte Araştırma: S\u0026uuml;re\u0026ccedil;, Uygulama ve Kritik [Research in Nursing: Process, Practice, and Critique]. Ankara: Nobel Tıp Kitapevleri Tic. Ltd. Şti.( 2014): pp. 193-232.\u003c/li\u003e\n\u003cli\u003eR. W. Brislin, W. J. Lonner and R. M. Thorndike. Cross-Cultural Research Methods, New York, (1973): John Wiley \u0026ndash; SonsPub.\u003c/li\u003e\n\u003cli\u003eN. Bayram. Yapısal Eşitlik Modellemesine Giriş [Introduction to Structural Equation Modeling], (2010): Ekin Kitabevi, Bursa.\u003c/li\u003e\n\u003cli\u003eC. Fornell, and D. F. Larcker. Structural Equation Models with Unobservable Variables and Measurement Error: Algebra and Statistics. Journal of Marketing Research, (1981): 18, 382-388. http://dx.doi.org/10.2307/315098.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Maternal, Intrusive thoughts, dissociative experiences, validity, reliability","lastPublishedDoi":"10.21203/rs.3.rs-6810254/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6810254/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003eIt was aimed to evaluate the suitability, validity and reliability of the scale called 'Maternal Disintegrative Responses Scale (MDRS)', developed in Israel in 2021, for the Turkish society.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThis methodological research was carried out with 150 puerperants \u0026nbsp;women with a 0-12 month old child who applied to Kars Harakani State Hospital- Obstetrics and Gynecology Service and Obstetrics Hall. Language validity and pilot application studies of the MDRS, which can be used in women with postpartum children aged 0-12 months, were conducted. Cronbach Aplha, discriminant validity and CR values regarding the reliability and validity of the scale were calculated.Confirmatory factor analysis was performed to determine whether the scale was validated in Turkish culture and fit values were calculated. Correlation values between factor loadings and sub-dimensions of the scale were calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe Turkish version of the MDRS a 8-item scale with two sub-dimensions was obtained. These two sub-dimensions found as a result of confirmatory factor analysis support the structure of the scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eCronbach α reliability coefficient was found to be sufficient for the total (0.91) and sub-dimensions of the scale.\u003c/p\u003e","manuscriptTitle":"Turkish Validity and Reliability Study of the Maternal Disintegrative Responses Scale","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-16 05:45:22","doi":"10.21203/rs.3.rs-6810254/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54c7fde2-c7bb-40cf-ba68-4f79185c0536","owner":[],"postedDate":"July 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-01T05:38:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-16 05:45:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6810254","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6810254","identity":"rs-6810254","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}