Validation of the Spanish-language version of The Postpartum Specific Anxiety Scale Research Short Form: PSAS-ES-RSF

Validation of the Spanish-language version of The Postpartum Specific Anxiety Scale Research Short Form: PSAS-ES-RSF | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Validation of the Spanish-language version of The Postpartum Specific Anxiety Scale Research Short Form: PSAS-ES-RSF Natalia Costas-Ramón, Agustina María Vinagre-González, Sergio A. Silveiro, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5316469/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Postpartum anxiety is a prevalent emotional disorder affecting approximately 20% of women, often more common than postpartum depression. Despite its high prevalence, the Spanish healthcare system lacks screening programs specifically targeting this condition. Methods This study aimed to develop and validate a short version of the Postpartum Specific Anxiety Scale (PSAS-ES-RSF) to address time constraints in clinical practice and improve its usability as a screening tool. Using confirmatory factor analysis (CFA) on two independent Spanish samples (Sample 1: N = 699; Sample 2: N = 293), a 16-item version was extracted from the original 51-item PSAS-ES. Results The four-factor structure of the PSAS-ES-RSF—addressing maternal competence, infant safety, practical infant care, and psychosocial adjustment—demonstrated strong psychometric properties (CFI > .95, RMSEA < .08). Cultural context and risk factors, such as maternal self-efficacy and the return to work, influenced the selection of items, showing some variation from the English-language short form. Conclusions The PSAS-ES-RSF offers a reliable and efficient tool for exploring postpartum anxiety in Spanish-speaking populations. Further research is needed to explore its applicability in diverse cultural contexts and to continue refining postpartum anxiety screening strategies. Postpartum anxiety Postpartum Specific Anxiety Scale (PSAS) Maternal mental health Psychometric validation Postnatal emotional disorders Maternal self-efficacy Infant care anxieties Psychosocial adjustment postpartum Figures Figure 1 Background 1) Postpartum Anxiety The postpartum period is a stage particularly prone to the development of emotional disorders (1,2). These disorders occur in one out of every four women, with depression (approximately 15%), somatization (21.8%), and anxiety (23%) being the most common (3,4). Postpartum anxiety has a higher rate than more well studied conditions such as postpartum depression. Globally, signs of anxiety can be found in 20% of women during the postpartum period (5,6). Despite the high prevalence of postpartum anxiety, the Spanish healthcare system lacks screening programmes and strategic care plans for both the prenatal and postnatal stages (7,8). The presence of pre-pregnancy emotional disorders, as well as poor general health of the mother, predisposes to the development of this condition (9,10). Risk factors related to parenting and birth include premature birth, a negative birth experience, excessive crying of the baby during the first week postpartum, and low perceived maternal self-efficacy (10). Maternal age (young mothers), higher educational levels, and being employed are variables associated with anxiety (9,10). Previous studies also highlight the importance of the mother having an adequate social and family support network postpartum. Lack of family support, marital/family conflicts, social health problems (9), and low partner support (10) are risk factors. Postpartum anxiety impacts both the mother's health and the health of the newborn, being a predictor of developmental problems in babies (11). Effects include emotional problems (12), behavioral issues (13), temperament (9), and impacts on the child's cognitive and social development (9,12). It has demonstrated associations with sleep, health, internalizing behaviors, and conduct disorders in adolescents (9). The affective bond (13), attachment (14), and mother-child interactions (9) are affected by this emotional disorder. Postpartum anxiety has negative effects on breastfeeding, leading to a lower likelihood of exclusive breastfeeding and a higher likelihood of early cessation (15–17). 2) PSAS: A Specific Exploratory Tool for Postpartum Anxiety The World Health Organization emphasizes the need to include postpartum anxiety and depression screening in strategic health plans. It recommends the use of validated tools accompanied by referral and intervention circuits for women who need them (18). Compared to other emotional disorders, postpartum anxiety is more challenging to explore, detect, and treat (19) due, among others, to the difficulty in distinguishing physiological emotions (20) since some anxieties after birth are adaptive and allow adequate care. The lack of specific tools to differentiate physiological concerns and fears from an anxiety diagnosis is a significant barrier for professionals (20). Additionally, the stigmatization of emotional disorders in society and the perfectionism that some mothers impose on themselves in their maternal role can delay or prevent seeking professional help for fear of being judged (21). The Postpartum Specific Anxiety Scale (PSAS) was developed as an exploratory questionnaire for anxiety in the puerperium. The original English-language PSAS has proven to be a tool with excellent reliability and validity for researching this emotional disorder (22). Subsequent studies have reassessed its properties and studied the different tools available for detecting postpartum anxiety support and recommend its use as an exploratory resource for professionals (6,23). The PSAS with four-factor structure has been translated into several languages and validated in different cultural contexts, demonstrating that it maintains its psychometric properties. PSAS has translation and validation in French (24), Persian (25), Chinese (26) and Italian (27). 3) Need for Developing the Short Version: PSAS-ES-RSF The time required to complete the PSAS-ES was seen as a potential difficulty in establishing the questionnaire as a systematic screening tool for postpartum anxiety (28). One of the future research lines proposed after the translation and validation of the PSAS-ES was the validation of a short version of the scale, as had already been done with the 16-item English-language research short-form (16) and a 12-item research short-form for use in global crises (29), and in Persian (30,31), and in Jordanian Arabic (32). Furthermore, the psychometric analysis of the PSAS-ES showed three items with low factor loadings compared to the original English version (28). For these reasons, it was deemed important to obtain a short version of the PSAS-ES to provide a psychometrically more robust tool with fewer items, facilitating its completion by women. The present study reports the results of confirmatory factor analyses (CFA) of the PSAS-ES conducted on two independent Spanish samples. In the first sample, the CFA is performed with the 51-item version to obtain a short version of 16 items. In the second sample, a CFA is applied to the short version to check the reliability and validity of this version. Method Participants The approval for the study for Sample 1 and Sample 2 were requested and granted by the Research Ethics Committee of the Complutense University of Madrid (Ref: CE_20230112-10_SAL; CE_20240314_26_SOC). The participants for Sample 1 were 699 women, between 21 to 43 years. (M = 33.39; SD = 3.79). The participants for Sample 2 were 293 women, between 24 to 46 years (M = 34.45; SD = 3.67). Both samples were women between 0 and 16 weeks postpartum (See Table 1 ). Table 1 Demographic data of women participants on bothsamples Maternal characteristic Value first sample Value second sample Age (years) Min-Max 21–43 24–46 Mean ( SD ) 33.39 (3.79) 34.45 (3.67) Nacionalidad ( n/% ) Spain 679 (97.3) 286 (97.3) Colombia 4 (0.6) 1 (0.3) Chile 2 (0.3) 1 (0.3) Argentina 4 (0.6) Dominican Republic 3 (0.4) Peru 2 (0.3) 2 (0.7) Venezuela 3 (0.4) 1 (0.3) Mexico 1 (0.1) 1 (0.3) Portugal 2 (0.7) Marital status ( n/% ) Single 207 (29.6) 4 (1.4) Single Cohabiting 111 (15.9) 101 (34.3) Married 375 (53.6) 185 (62.9) Separated/divorced 6 (0.9) 4 (1.4) Educational attainment ( n/% ) Primary school education 1 (0.2) 4 (1.4) Secondary studies 135 (19.2) 39 (13.3) University education 563 (80.5) 251 (85.4) Employment situation ( n/% ) Active employment 133 (19.0) 10 (3.4) Not in paid occupation 59 (8.5) 17 (5.8) Maternity leave (Maternity Benefit) 507 (72.5) 267 (90.8) Birth order ( n/% ) First 530 (75.8) 178 (60.5) Second 154 (22.0) 103 (35.5) Third 13 (1.9) 9 (3.1) Others 2 (0.3) 4 (0.9) Multiple birth ( n/% ) Yes 6 (0.9) 5 (1.7) No 692 (99.1) 289 (98.3) Childbirth Modalities ( n/% ) Normal delivery (spontaneous labour) 401 (57.4) 227 (77.2) Caesarean section 162 (23.2) 67 (22.8) Instrumental vaginal delivery: vacuum, kiwi, forceps 136 (19.4) 39 (13.3) Mode of feeding ( n/% ) Exclusively breastfeeding 505 (72.1) 217 (73.8) Combination feeding 127 (18.3) 49 (16.7) Exclusively formula feeding 67 (9.6) 28 (9.5) Previous diagnosis of emotional disturbances Yes 90 (13.0) 47 (16.0) No 554 (79.9) 239 (81.3) For both samples, women were recruited between 0 and 16 weeks postpartum. They were recruited via word-of-mouth; snowballing; through professional social media platforms related to maternity and the postpartum; and through psychologists, midwives, obstetricians in specialized centers; and mental health forums in the puerperium. Materials The Postpartum Specific Anxiety Scale in Spanish Version (PSAS-ES) (28) is a 51-item self-report questionnaire administered to screen for the frequency of postpartum specific anxieties. The mothers should answer the questionnaire in relation to their emotions, feelings, and experiences of the last seven days. The Scale have four factors: (1) ‘Maternal Competence and Attachment Anxieties’; (2) ‘Infant Safety and Welfare Anxieties’; (3) ‘Practical Infant Care Anxieties’; (4) ‘Psychosocial Adjustment to Motherhood’. The PSAS is rated on a 4-point Likert-type scale ranging from 1 (never) to 4 (almost always). Higher scores indicate higher levels of postpartum specific anxiety. Procedure The questionnaires were disseminated, completed, and received exclusively on-line through the Google Forms tool. Prior to the main survey, an electronic consent form and information sheet were provided with a tick box to confirm the main points were correct and understood. At the beginning of the questionnaire women accepted the informed consent which detailed the objectives and phases of the study; information about data retention and contact information of the researchers (in case of any queries). Informed consent had to have been provided to continue with the rest of the questionnaires. Participants did not receive any compensation for participating in the study. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its lateramendments or comparable ethical standards. Method of analysis With the data from the first sample, we conducted a CFA to extract the 16 items into the 4 original factors that had the highest factor loadings, following the methodology used by the authors of the original research short form scale (16). With the second sample, we conducted another CFA where the structure of the abbreviated version of 16 items was verified. The CFA was performed with R Studio 4.0.4 from R (R Core Team, 2021), using the Lavaan package (33). The polychoric correlation matrix was used. As parameter estimation method, Diagonally Weighted Least Squares (WLSMV) was used, given the number of response categories and the skewness and kurtosis indexes. To assess the fit of each model individually, the following indicators were considered: the χ2 statistic, the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA) and the Root Mean Square Residual (SRMR). For the CFI and TLI indexes, values greater than .90 are considered an adequate fit of the model (34), while for the RMSEA values less than .08 are considered a reasonable fit (35). To determine the best statistical model, the chi-square test of differences was used. Results Study 1: Confirmatory Factor Analyses with PSAS-ES 51 items The factor loadings of the items on each one of the factors were statistically significant and sufficiently high (>. 40) (Table 3 ). The goodness-of-fit indexes were (χ2 (1218) = 3597.537, p < .000, CFI = .955, and RMSEA = .057, SRMR = .071, TLI = .953. The correlations between factors are found in Table 2 . Table 2 Factor structure of the PSAS-ES Factor 1 Factor 2 Factor 3 Factor 4 PSAS_39 0.759 0.000 0.000 0.000 PSAS_24 0.759 0.000 0.000 0.000 PSAS_17 0.745 0.000 0.000 0.000 PSAS_40 0.730 0.000 0.000 0.000 PSAS_23 0.727 0.000 0.000 0.000 PSAS_45 0.711 0.000 0.000 0.000 PSAS_20 0.667 0.000 0.000 0.000 PSAS_9 0.651 0.000 0.000 0.000 PSAS_18 0.629 0.000 0.000 0.000 PSAS_36 0.624 0.000 0.000 0.000 PSAS_11 0.597 0.000 0.000 0.000 PSAS_38 0.592 0.000 0.000 0.000 PSAS_4 0.544 0.000 0.000 0.000 PSAS_25 0.542 0.000 0.000 0.000 PSAS_7 0.414 0.000 0.000 0.000 PSAS_31 0.000 0.789 0.000 0.000 PSAS_16 0.000 0.751 0.000 0.000 PSAS_33 0.000 0.684 0.000 0.000 PSAS_3 0.000 0.650 0.000 0.000 PSAS_15 0.000 0.625 0.000 0.000 PSAS_50 0.000 0.617 0.000 0.000 PSAS_8 0.000 0.577 0.000 0.000 PSAS_35 0.000 0.490 0.000 0.000 PSAS_27 0.000 0.486 0.000 0.000 PSAS_19 0.000 0.437 0.000 0.000 PSAS_22 0.000 0.365 0.000 0.000 PSAS_28 0.000 0.000 0.721 0.000 PSAS_41 0.000 0.000 0.708 0.000 PSAS_49 0.000 0.000 0.699 0.000 PSAS_47 0.000 0.000 0.694 0.000 PSAS_13 0.000 0.000 0.650 0.000 PSAS_14 0.000 0.000 0.616 0.000 PSAS_34 0.000 0.000 0.601 0.000 PSAS_51 0.000 0.000 0.000 0.667 PSAS_44 0.000 0.000 0.000 0.607 PSAS_6 0.000 0.000 0.000 0.590 PSAS_42 0.000 0.000 0.000 0.581 PSAS_30 0.000 0.000 0.000 0.560 PSAS_32 0.000 0.000 0.000 0.560 PSAS_48 0.000 0.000 0.000 0.553 PSAS_1 0.000 0.000 0.000 0.546 PSAS_29 0.000 0.000 0.000 0.544 PSAS_46 0.000 0.000 0.000 0.526 PSAS_5 0.000 0.000 0.000 0.524 PSAS_37 0.000 0.000 0.000 0.503 PSAS_12 0.000 0.000 0.000 0.474 PSAS_10 0.000 0.000 0.000 0.457 PSAS_26 0.000 0.000 0.000 0.411 PSAS_43 0.000 0.000 0.000 0.373 PSAS_2 0.000 0.000 0.000 0.351 PSAS_21 0.000 0.000 0.000 0.333 The Cronbach’s coefficient of this version was 0.929 and McDonald’s Omega was 0.93. With the results obtained, we retain the 4 items with the highest factor loadings from each of the 4 factors to propose the 16-item version of the PSAS-ES-SF. Comparison of PSAS-ES short form with PSAS-RSF Once we have selected the 16 items of the short version, we compare it with the original English version (see Table 3 ): Spanish version vs British version (16). Only 3 items match in both versions of the instrument. Table 3 Comparation of two short forms: Spanish version vs British version PSAS_ES_RSF = or ≠ PSAS_EN_RSF Factor 1 Maternal competence and attachment anxieties I have felt unconfident or incapable of meeting my baby’s basic care needs ≠ I have felt that my baby would be better cared for my someone else I have felt that other mothers are coping with their babies better than me ≠ I have had negative thoughts about my relationship with my baby I have worried that my baby is picking up on my anxieties ≠ I have worried that my baby is picking up on my anxieties I have worried about the bond I have with my baby ≠ I have worried I will not know what to do when my baby cries Factor 2 Infant safety and welfare anxieties I have worried about accidentally harming my baby ≠ I have repeatedly checked on my sleeping baby I have worried about my baby being accidentally harmed by someone or something else = I have worried about my baby being accidentally harmed by someone or something else I have worried about my baby’s health even after reassurance from others ≠ I have felt frightened when my baby is not with me I have worried that my baby will stop breathing while sleeping = I have worried that my baby will stop breathing while sleeping Factor 3 Practical infant care anxieties I have worried about my baby’s milk intake = 5. I have worried about my baby’s milk intake I have worried about the length of time that my baby sleeps ≠ 6. I have worried about my baby’s weight I have worried that my baby is not developing as quickly as other babies ≠ 7. I have worried about the length of time by baby sleeps I have worried about the way that I feed my baby ≠ 8. I have worried about getting my baby into a routine Factor 4 Psychosocial adjustment to motherhood I have been less able to concentrate on simple tasks than before my baby was born ≠ I have felt that I have had less control over my day than before my baby was born I have worried about returning to work ≠ I have felt unable to juggle motherhood with other responsibilities I have had difficulty sleeping even when I have had the chance to ≠ I have worried that I am not going to get enough sleep I have felt tired even after a good amount of rest ≠ I have worried more about my finances than before my baby was born Study 2: Confirmatory Factor Analyses with PSAS-ES-RSF 16 items With the second sample, the goodness-of-fit indexes of model of four factors were χ2 (98) = 214.082, p < .000, CFI = .980, and RMSEA = .064, SRMR = .072, TLI = .975. The correlations between factors are found in Fig. 1 . Discussion The items with the highest factor loadings in the Spanish version differ from the English-language research short form, developed from the original PSAS (PSAS-RSF; 16). Three items are common to the short versions of both scales: 39 (“I worry that my baby will pick up on my anxieties”), 16 (“I worry that someone or something will accidentally harm my baby”), 33 (“I worry that my baby will stop breathing while asleep”), 28 (“I worry about the amount of milk my baby takes”). The differences in results can be attributed to the cultural context analysis and the risk factors or variables related to postpartum anxiety. Items 17 and 24 of the PSAS-ES-RSF refer to insecurity/inability to meet the baby's needs and the feeling that other mothers are better able to care for their children. Studies in the Spanish population indicate that lack of self-efficacy in caregiving is related to postpartum anxiety (36). Specifically, after the birth of their first baby, the psycho-emotional aspects that generate the most concern among women are their low self-perception of being able to care for the baby (37). Postpartum anxiety affects mother-child interactions, the development of the affective bond between them, and attachment (9,14,13). This concern about forming an effective bond with their babies is reflected in item 40: “I have worried about the bond I have with my baby.” Work and family are established by many societies as the two most important and prioritized areas of life (38). In this vein, returning to work (item 42) is a key component of mothers' anxieties. It should be noted that the current sample are 0–16 weeks postpartum and most of them have not returned to paid work since maternity leave in Spain lasts 16 weeks. It is expected to be an aspect that generates more anxiety compared to the sample of English women (PSAS-RSF; 16) whose inclusion criterion was the first 12 months postpartum. According to our results, previous research in Spanish women also finds that breastfeeding is a source of anxiety and concerns after the birth of their children, and feeding, in general, is one of their main worries (39). Item 49 refers to the concern about how to feed the baby. Even in other cultural contexts, it has been observed that the presence of postpartum anxiety decreases the duration of breastfeeding, reduces self-efficacy, and increases difficulties in breastfeeding (22). After the birth of their child, mothers' main concerns focus on the baby's health and care, their insecurity in solving problems related to the general care of the child (40,38). These findings align with items 3 (accidentally harming the baby) and 31-41-47 (concern for the child's health, rest time, and development). Difficulty sleeping (item 44) and fatigue (item 51) are recognized in previous studies as variables related to emotional disorders (41–43). Item 6 refers to the physical manifestations related to anxiety: "I have found it harder to concentrate on simple tasks." The definition of anxiety in the context of the perinatal period includes manifestations such as palpitations, muscle tension, insomnia, and difficulty concentrating (44). The PSAS doesn’t attempt to measure physiological symptoms because they can be conflated with normal symptoms of motherhood. Strengths, Limitations, and Future Directions The PSAS-ES-RSF, like the original scale PSAS-RSF, allows exploring areas of particular concern for women in the postpartum period, considering the biopsychosocial characteristics of special vulnerability after the birth of their child. One of the main strengths of the study is the number of women who participated, allowing a robust psychometric analysis. Furthermore, obtaining a reduced number of items makes it easier for professionals to use and for mothers to complete the questionnaire in a shorter time, potentially increasing the number of responses and being more accessible in a health care setting. The research presents limitations that must be considered in the design and analysis of future studies. The study participants constitute a homogeneous sample: heterosexual couples with a medium to high sociocultural level (university or higher education). This means that the tool has not been analysed and tested in other population groups. Using the PSAS-ES-RSF in other family models (homosexual couples, single mothers) with different sociocultural levels would help to explore and better understand the needs of other populations. Future research should continue evaluating cultural differences since our study shows that there are different items in the short versions when comparing the UK and Spanish PSAS. This does not invalidate the instrument (as the full version has been validated for both samples with the same items), but indicates that when reducing the instrument, there are differences in the items which best explain postpartum anxiety in women, depending on the country. In this sense, it is advisable to make cultural adaptations for proposed short versions and not only validate the items already proposed and validated in other countries – something which the PSAS Working Group fully endorses. It is also proposed to explore the scale's validity in other time periods to benefit a larger number of women at different times postpartum such as after joining their jobs. Conclusions The PSAS-ES-RSF 16-item tool demonstrates reliability and construct validity for use in exploring postpartum anxiety during the first 16 weeks postpartum. Its use by healthcare professionals can help distinguish physiological adaptive reactions and experiences from those requiring more complex care plans. This reduced version, compared to the original scale, allows for easier inclusion in systematic screening programs for emotional disorders in the perinatal period. Abbreviations Postpartum Specific Anxiety Scale (PSAS) Confirmatory Factor Analyses (CFA) Diagonally Weighted Least Squares (WLSMV) Comparative Fit Index (CFI) Tucker-Lewis Index (TLI) Root Mean Square Error of Approximation (RMSEA) Root Mean Square Residual (SRMR) Declarations Ethics approval and consent to participate Ethical approvals were sought and granted from the Universidad Complutense de Madrid Research Ethics Committee [ref:- CE_20240314_26_SOC]. All participants consented to participate of this study. Consent for publication All participants consented to their data being published as part of this study’s analysis. Avalaibility of data and materials The datasets are not publicly available due to their sensitive nature, however they are available upon reasonable request from the corresponding author. Competing Interests The authors declare no conflict of interests in the development of this study. Funding This study did not receive any funding. Authors’ contributions NCR, MEAG, MAVG have collected the data, analyzed it and drafted the document. VF and SAS have drafted the document and reviewed the data. Clinical Trial Not applicable Acknowledgements The authors gratefully acknowledge the help of Santiago Costas-Ramón for their collaboration in the translation and Nazaret Olivera y Laia Vidal for the help during the data collection. A very special mention to the collaboration and assistance from The PSAS Working Group. References Epifanio MS, Genna V, De Luca C, Roccella M, La Grutta S. Paternal and maternal transition to parenthood: the risk of postpartum depression and parenting stress. Pediatr Rep. 2015;7(2). https://doi.org/10.4081/pr.2015.5872. García-Esteve L, Valdés Miyar M. Manual de Psiquiatría perinatal. Madrid: Editorial Médica Panamericana; 2017. p. 85-127. 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Revision and reliability and validity evaluation of the Chinese version of the postpartum specific anxiety scale. Chin J Clin Psych. 2021;29(3):554-8. https://doi.org/10.16128/j.cnki.1005-3611.2021.03.022. Ionio C, Ciuffo G, Landoni M, Smorti M, Della Vedova AM, Christiansen P, et al. The Italian Language Postpartum Specific Anxiety Scale [PSAS-IT]: Translation, Psychometric Evaluation, and Validation. Front Psychiatry. 2023;14:1208613. https://doi.org/10.3389/fpsyt.2023.1208613. Costas-Ramon N, Silverio SA, Fallon V, Aparicio-Garcia ME. Psychometric evaluation and validation of the postpartum specific anxiety scale for the Spanish-speaking population: PSAS-ES. Gen Hosp Psychiatry. 2023;83:59-65. https://doi.org/10.1016/j.genhosppsych.2023.04.011. Silverio SA, Davies SM, Christiansen P, Aparicio-García ME, Bramante A, Chen P, et al. A validation of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises with five translations. BMC Pregnancy Childbirth. 2021;21:1-12. https://doi.org/10.1186/s12884-021-03597-9. Mashayekh-Amiri S, Jafarabadi MA, Davies SM, Silverio SA, Fallon V, Montazeri M, et al. Psychometric evaluation of the postpartum specific anxiety scale - research short-form among Iranian women (PSAS-IR-RSF). BMC Pregnancy Childbirth. 2023;23(1):531. https://doi.org/10.1186/s12884-023-05855-4. Mashayekh-Amiri S, Jafarabadi MA, Montazeri M, Fallon V, Silverio SA, Mirghafourvand M. Validation of the Iranian version of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises (PSAS-IR-RSF-C). BMC Psychiatry. 2023;23(1):511. https://doi.org/10.1186/s12888-023-04998-0. Hijazi HH, Alolayyan MN, Al Abdi RM, Hossain A, Fallon V, Silverio SA. Validity and reliability of an Arabic-language version of the postpartum specific anxiety scale research short-form in Jordan. Birth. 2024. Advance online publication. https://doi.org/10.1111/birt.12840. Rosseel Y. lavaan: An R Package for Structural Equation Modeling. J Stat Softw. 2012;48(2):1-36. Shumacher RE, Y Lomax RG. A beginner's guide to SEM. Manwah; 1996 Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park, CA: Sage; 1993. p. 136–62. Feligreras-Alcalá D, Frías-Osuna A, del-Pino-Casado R. Personal and family resources related to depressive and anxiety symptoms in women during puerperium. Int J Environ Res Public Health. 2020;17(14):5230. https://doi.org/10.3390/ijerph17145230. Escuriet R, Figueroa LM. Problemas de salud y motivos de preocupación percibidos por las puérperas antes del alta hospitalaria. Matronas Profesión. 2004;5(15):30-5. Pascual CP, Pinedo IA, Grandes G, Cifuentes ME, Inda IG, Gordon JP. Necesidades percibidas por las mujeres respecto a su maternidad. Estudio cualitativo para el rediseño de la educación maternal. Aten Primaria. 2016;48(10):657-64. https://doi.org/10.1016/j.aprim.2015.12.004. Urrutia VG, Figueroa AJ. Corresponsabilidad familiar y el equilibrio trabajo-familia: medios para mejorar la equidad de género. Polis Rev Latinoam. 2015;14(40):1-15. Nunes C, Ayala M. ¿Qué piensan las madres sobre el programa de seguimiento de la salud infantil? Pediatr Aten Primaria. 2007;9(35):411-25. Caparros-Gonzalez RA, Romero-Gonzalez B, Peralta-Ramirez MI. Depresión posparto, un problema de salud pública mundial. Rev Panam Salud Pública. 2018;42. . https://doi.org/10.26633/RPSP.2018.97. Gunst A, Sjöström E, Sundén M, Antfolk J. The Mother–Offspring Conflict: The Association Between Maternal Sleep, Postpartum Depression, and Interbirth Interval Length. Evol Psychol. 2021;19(4). https://doi.org/10.1177/14747049211046162. Parfitt Y, Ayers S. Transition to parenthood and mental health in first-time parents. Infant Ment Health J. 2014;35(3):263-73. https://doi.org/10.1002/imhj.21443. Azúa Morera E, Carvajal Barboza F. Actualización del trastorno de ansiedad durante el embarazo. Rev Med Sinergia. 2024;9(2). https://doi.org/10.31434/rms.v9i2.1140. 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-5316469","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371890587,"identity":"425c0736-d78d-434d-b55e-21a750c7f0b1","order_by":0,"name":"Natalia Costas-Ramón","email":"","orcid":"","institution":"Clínica Universidad de Navarra","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"","lastName":"Costas-Ramón","suffix":""},{"id":371890588,"identity":"f2ba83b9-0a0c-46e9-ac11-6c9d177c19ac","order_by":1,"name":"Agustina María Vinagre-González","email":"","orcid":"","institution":"Universidad Internacional De La Rioja","correspondingAuthor":false,"prefix":"","firstName":"Agustina","middleName":"María","lastName":"Vinagre-González","suffix":""},{"id":371890589,"identity":"f589505a-6dfa-43d9-975b-4918c299c30b","order_by":2,"name":"Sergio A. Silveiro","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Sergio","middleName":"A.","lastName":"Silveiro","suffix":""},{"id":371890590,"identity":"e6e75db2-ea98-4e27-974c-689320c67606","order_by":3,"name":"Victoria Fallon","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Fallon","suffix":""},{"id":371890591,"identity":"6f776519-408b-44c6-80be-0af7205c6abf","order_by":4,"name":"Marta Evelia Aparicio García","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAr0lEQVRIiWNgGAWjYPACCQZ+0rVINpBsj8EBYlXqtjc/e/Bzj4W88Y3kpxsYKuoIazE7c8zcsOeZhOG2G2lmNxjOHCZCy40EMwmeAxIJZjdy2G4wthHhPLP7z79J/gFqMZ4B0vKPGIfd4DGTBtliIAHS0sBMhJYzOeXGMgckDGeceQZ05DFi/HL8+LaHbw7UyfO3Jz+78aGGCIcBARuCmUCUBhQto2AUjIJRMAqwAQD5tzqrM2WY9wAAAABJRU5ErkJggg==","orcid":"","institution":"Complutense University of Madrid","correspondingAuthor":true,"prefix":"","firstName":"Marta","middleName":"Evelia Aparicio","lastName":"García","suffix":""}],"badges":[],"createdAt":"2024-10-23 07:08:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5316469/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5316469/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69354110,"identity":"5975772c-460e-4d53-affe-3f7ccccfc656","added_by":"auto","created_at":"2024-11-19 13:34:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":85022,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelations between factors in PSAS-ES-RSF\u003c/p\u003e\n\u003cp\u003eNote of Figure 1: The name of the factors are: One: Maternal competence and attachment anxieties; Two: Infant safety and welfare anxieties; Three: Practical infant care anxieties; Four: Psychosocial adjustment to motherhood.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5316469/v1/f8046db2d9fad031b85b103e.png"},{"id":78777475,"identity":"0a6b2cd4-f5a2-43e4-8ad2-79cb0ed2e7ba","added_by":"auto","created_at":"2025-03-18 18:16:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1215970,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5316469/v1/3e77de29-b3a2-4cf2-92c9-5884b3ad88fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Validation of the Spanish-language version of The Postpartum Specific Anxiety Scale Research Short Form: PSAS-ES-RSF","fulltext":[{"header":"Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1) Postpartum Anxiety\u003c/h2\u003e \u003cp\u003eThe postpartum period is a stage particularly prone to the development of emotional disorders (1,2). These disorders occur in one out of every four women, with depression (approximately 15%), somatization (21.8%), and anxiety (23%) being the most common (3,4). Postpartum anxiety has a higher rate than more well studied conditions such as postpartum depression. Globally, signs of anxiety can be found in 20% of women during the postpartum period (5,6). Despite the high prevalence of postpartum anxiety, the Spanish healthcare system lacks screening programmes and strategic care plans for both the prenatal and postnatal stages (7,8).\u003c/p\u003e \u003cp\u003eThe presence of pre-pregnancy emotional disorders, as well as poor general health of the mother, predisposes to the development of this condition (9,10). Risk factors related to parenting and birth include premature birth, a negative birth experience, excessive crying of the baby during the first week postpartum, and low perceived maternal self-efficacy (10). Maternal age (young mothers), higher educational levels, and being employed are variables associated with anxiety (9,10). Previous studies also highlight the importance of the mother having an adequate social and family support network postpartum. Lack of family support, marital/family conflicts, social health problems (9), and low partner support (10) are risk factors.\u003c/p\u003e \u003cp\u003ePostpartum anxiety impacts both the mother's health and the health of the newborn, being a predictor of developmental problems in babies (11). Effects include emotional problems (12), behavioral issues (13), temperament (9), and impacts on the child's cognitive and social development (9,12). It has demonstrated associations with sleep, health, internalizing behaviors, and conduct disorders in adolescents (9). The affective bond (13), attachment (14), and mother-child interactions (9) are affected by this emotional disorder. Postpartum anxiety has negative effects on breastfeeding, leading to a lower likelihood of exclusive breastfeeding and a higher likelihood of early cessation (15\u0026ndash;17).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2) PSAS: A Specific Exploratory Tool for Postpartum Anxiety\u003c/h2\u003e \u003cp\u003eThe World Health Organization emphasizes the need to include postpartum anxiety and depression screening in strategic health plans. It recommends the use of validated tools accompanied by referral and intervention circuits for women who need them (18).\u003c/p\u003e \u003cp\u003eCompared to other emotional disorders, postpartum anxiety is more challenging to explore, detect, and treat (19) due, among others, to the difficulty in distinguishing physiological emotions (20) since some anxieties after birth are adaptive and allow adequate care. The lack of specific tools to differentiate physiological concerns and fears from an anxiety diagnosis is a significant barrier for professionals (20). Additionally, the stigmatization of emotional disorders in society and the perfectionism that some mothers impose on themselves in their maternal role can delay or prevent seeking professional help for fear of being judged (21).\u003c/p\u003e \u003cp\u003eThe Postpartum Specific Anxiety Scale (PSAS) was developed as an exploratory questionnaire for anxiety in the puerperium. The original English-language PSAS has proven to be a tool with excellent reliability and validity for researching this emotional disorder (22). Subsequent studies have reassessed its properties and studied the different tools available for detecting postpartum anxiety support and recommend its use as an exploratory resource for professionals (6,23).\u003c/p\u003e \u003cp\u003eThe PSAS with four-factor structure has been translated into several languages and validated in different cultural contexts, demonstrating that it maintains its psychometric properties. PSAS has translation and validation in French (24), Persian (25), Chinese (26) and Italian (27).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e3) Need for Developing the Short Version: PSAS-ES-RSF\u003c/h3\u003e\n\u003cp\u003eThe time required to complete the PSAS-ES was seen as a potential difficulty in establishing the questionnaire as a systematic screening tool for postpartum anxiety (28). One of the future research lines proposed after the translation and validation of the PSAS-ES was the validation of a short version of the scale, as had already been done with the 16-item English-language research short-form (16) and a 12-item research short-form for use in global crises (29), and in Persian (30,31), and in Jordanian Arabic (32). Furthermore, the psychometric analysis of the PSAS-ES showed three items with low factor loadings compared to the original English version (28).\u003c/p\u003e \u003cp\u003eFor these reasons, it was deemed important to obtain a short version of the PSAS-ES to provide a psychometrically more robust tool with fewer items, facilitating its completion by women. The present study reports the results of confirmatory factor analyses (CFA) of the PSAS-ES conducted on two independent Spanish samples. In the first sample, the CFA is performed with the 51-item version to obtain a short version of 16 items. In the second sample, a CFA is applied to the short version to check the reliability and validity of this version.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003e The approval for the study for Sample 1 and Sample 2 were requested and granted by the Research Ethics Committee of the Complutense University of Madrid (Ref: CE_20230112-10_SAL; CE_20240314_26_SOC).\u003c/p\u003e \u003cp\u003eThe participants for Sample 1 were 699 women, between 21 to 43 years. (M\u0026thinsp;=\u0026thinsp;33.39; SD\u0026thinsp;=\u0026thinsp;3.79). The participants for Sample 2 were 293 women, between 24 to 46 years (M\u0026thinsp;=\u0026thinsp;34.45; SD\u0026thinsp;=\u0026thinsp;3.67). Both samples were women between 0 and 16 weeks postpartum (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of women participants on bothsamples\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue first sample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValue second sample\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMin-Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u0026ndash;46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.39 (3.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.45 (3.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNacionalidad (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e679 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e286 (97.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArgentina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominican Republic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeru\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVenezuela\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePortugal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle Cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (34.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e375 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (62.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated/divorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational attainment (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e135 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e563 (80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e251 (85.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment situation (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActive employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (3.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot in paid occupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (5.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternity\u0026nbsp;leave (Maternity Benefit)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e507 (72.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (90.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth order (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e530 (75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178 (60.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (35.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMultiple birth (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e692 (99.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e289 (98.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildbirth Modalities (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal delivery\u003c/p\u003e \u003cp\u003e(spontaneous labour)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e401 (57.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e227 (77.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaesarean\u0026nbsp;section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (23.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (22.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInstrumental vaginal delivery: vacuum, kiwi, forceps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of feeding (\u003c/b\u003e\u003cb\u003en/%\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExclusively breastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e505 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217 (73.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombination feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (16.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExclusively formula feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (9.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious diagnosis of emotional disturbances\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (16.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e554 (79.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239 (81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor both samples, women were recruited between 0 and 16 weeks postpartum. They were recruited via word-of-mouth; snowballing; through professional social media platforms related to maternity and the postpartum; and through psychologists, midwives, obstetricians in specialized centers; and mental health forums in the puerperium.\u003c/p\u003e \u003cp\u003eMaterials\u003c/p\u003e \u003cp\u003eThe Postpartum Specific Anxiety Scale in Spanish Version (PSAS-ES) (28) is a 51-item self-report questionnaire administered to screen for the frequency of postpartum specific anxieties. The mothers should answer the questionnaire in relation to their emotions, feelings, and experiences of the last seven days. The Scale have four factors: (1) \u0026lsquo;Maternal Competence and Attachment Anxieties\u0026rsquo;; (2) \u0026lsquo;Infant Safety and Welfare Anxieties\u0026rsquo;; (3) \u0026lsquo;Practical Infant Care Anxieties\u0026rsquo;; (4) \u0026lsquo;Psychosocial Adjustment to Motherhood\u0026rsquo;. The PSAS is rated on a 4-point Likert-type scale ranging from 1 (never) to 4 (almost always). Higher scores indicate higher levels of postpartum specific anxiety.\u003c/p\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003cp\u003eThe questionnaires were disseminated, completed, and received exclusively on-line through the Google Forms tool.\u003c/p\u003e \u003cp\u003e Prior to the main survey, an electronic consent form and information sheet were provided with a tick box to confirm the main points were correct and understood. At the beginning of the questionnaire women accepted the informed consent which detailed the objectives and phases of the study; information about data retention and contact information of the researchers (in case of any queries). Informed consent had to have been provided to continue with the rest of the questionnaires. Participants did not receive any compensation for participating in the study. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its lateramendments or comparable ethical standards.\u003c/p\u003e \u003cp\u003eMethod of analysis\u003c/p\u003e \u003cp\u003eWith the data from the first sample, we conducted a CFA to extract the 16 items into the 4 original factors that had the highest factor loadings, following the methodology used by the authors of the original research short form scale (16). With the second sample, we conducted another CFA where the structure of the abbreviated version of 16 items was verified.\u003c/p\u003e \u003cp\u003eThe CFA was performed with R Studio 4.0.4 from R (R Core Team, 2021), using the Lavaan package (33). The polychoric correlation matrix was used. As parameter estimation method, Diagonally Weighted Least Squares (WLSMV) was used, given the number of response categories and the skewness and kurtosis indexes.\u003c/p\u003e \u003cp\u003eTo assess the fit of each model individually, the following indicators were considered: the χ2 statistic, the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA) and the Root Mean Square Residual (SRMR). For the CFI and TLI indexes, values greater than .90 are considered an adequate fit of the model (34), while for the RMSEA values less than .08 are considered a reasonable fit (35). To determine the best statistical model, the chi-square test of differences was used.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy 1: Confirmatory Factor Analyses with PSAS-ES 51 items\u003c/h2\u003e \u003cp\u003eThe factor loadings of the items on each one of the factors were statistically significant and sufficiently high (\u0026gt;. 40) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The goodness-of-fit indexes were (χ2 (1218)\u0026thinsp;=\u0026thinsp;3597.537, p\u0026thinsp;\u0026lt;\u0026thinsp;.000, CFI\u0026thinsp;=\u0026thinsp;.955, and RMSEA\u0026thinsp;=\u0026thinsp;.057, SRMR\u0026thinsp;=\u0026thinsp;.071, TLI\u0026thinsp;=\u0026thinsp;.953. The correlations between factors are found in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor structure of the PSAS-ES\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFactor 4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_39\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.759\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.759\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_17\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.745\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.730\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.789\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.751\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_33\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.684\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.650\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.486\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.721\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_41\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.708\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_49\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.699\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.694\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_51\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.667\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_44\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.607\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.590\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSAS_42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.581\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.560\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.524\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe Cronbach\u0026rsquo;s coefficient of this version was 0.929 and McDonald\u0026rsquo;s Omega was 0.93.\u003c/p\u003e \u003cp\u003eWith the results obtained, we retain the 4 items with the highest factor loadings from each of the 4 factors to propose the 16-item version of the PSAS-ES-SF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eComparison of PSAS-ES short form with PSAS-RSF\u003c/h2\u003e \u003cp\u003eOnce we have selected the 16 items of the short version, we compare it with the original English version (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e): Spanish version vs British version (16). Only 3 items match in both versions of the instrument.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparation of two short forms: Spanish version vs British version\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePSAS_ES_RSF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e= or \u0026ne;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePSAS_EN_RSF\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaternal competence and attachment anxieties\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have felt unconfident or incapable of meeting my baby\u0026rsquo;s basic care needs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have felt that my baby would be better cared for my someone else\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have felt that other mothers are coping with their babies better than me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have had negative thoughts about my relationship with my baby\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried that my baby is picking up on my anxieties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have worried that my baby is picking up on my anxieties\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about the bond I have with my baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have worried I will not know what to do when my baby cries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInfant safety and welfare anxieties\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about accidentally harming my baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have repeatedly checked on my sleeping baby\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about my baby being accidentally harmed by someone or something else\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have worried about my baby being accidentally harmed by someone or something else\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about my baby\u0026rsquo;s health even after reassurance from others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have felt frightened when my baby is not with me\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried that my baby will stop breathing while sleeping\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have worried that my baby will stop breathing while sleeping\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePractical infant care anxieties\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about my baby\u0026rsquo;s milk intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5. I have worried about my baby\u0026rsquo;s milk intake\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about the length of time that my baby sleeps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6. I have worried about my baby\u0026rsquo;s weight\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried that my baby is not developing as quickly as other babies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7. I have worried about the length of time by baby sleeps\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about the way that I feed my baby\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8. I have worried about getting my baby into a routine\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePsychosocial adjustment to motherhood\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have been less able to concentrate on simple tasks than before my baby was born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have felt that I have had less control over my day than before my baby was born\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have worried about returning to work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have felt unable to juggle motherhood with other responsibilities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have had difficulty sleeping even when I have had the chance to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have worried that I am not going to get enough sleep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI have felt tired even after a good amount of rest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ne;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI have worried more about my finances than before my baby was born\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy 2: Confirmatory Factor Analyses with PSAS-ES-RSF 16 items\u003c/h3\u003e\n\u003cp\u003eWith the second sample, the goodness-of-fit indexes of model of four factors were χ2 (98)\u0026thinsp;=\u0026thinsp;214.082, p\u0026thinsp;\u0026lt;\u0026thinsp;.000, CFI\u0026thinsp;=\u0026thinsp;.980, and RMSEA\u0026thinsp;=\u0026thinsp;.064, SRMR\u0026thinsp;=\u0026thinsp;.072, TLI\u0026thinsp;=\u0026thinsp;.975. The correlations between factors are found in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eThe items with the highest factor loadings in the Spanish version differ from the English-language research short form, developed from the original PSAS (PSAS-RSF; 16). Three items are common to the short versions of both scales: 39 (\u0026ldquo;I worry that my baby will pick up on my anxieties\u0026rdquo;), 16 (\u0026ldquo;I worry that someone or something will accidentally harm my baby\u0026rdquo;), 33 (\u0026ldquo;I worry that my baby will stop breathing while asleep\u0026rdquo;), 28 (\u0026ldquo;I worry about the amount of milk my baby takes\u0026rdquo;). The differences in results can be attributed to the cultural context analysis and the risk factors or variables related to postpartum anxiety.\u003c/p\u003e \u003cp\u003e Items 17 and 24 of the PSAS-ES-RSF refer to insecurity/inability to meet the baby's needs and the feeling that other mothers are better able to care for their children. Studies in the Spanish population indicate that lack of self-efficacy in caregiving is related to postpartum anxiety (36). Specifically, after the birth of their first baby, the psycho-emotional aspects that generate the most concern among women are their low self-perception of being able to care for the baby (37).\u003c/p\u003e \u003cp\u003ePostpartum anxiety affects mother-child interactions, the development of the affective bond between them, and attachment (9,14,13). This concern about forming an effective bond with their babies is reflected in item 40: \u0026ldquo;I have worried about the bond I have with my baby.\u0026rdquo;\u003c/p\u003e \u003cp\u003eWork and family are established by many societies as the two most important and prioritized areas of life (38). In this vein, returning to work (item 42) is a key component of mothers' anxieties. It should be noted that the current sample are 0\u0026ndash;16 weeks postpartum and most of them have not returned to paid work since maternity leave in Spain lasts 16 weeks. It is expected to be an aspect that generates more anxiety compared to the sample of English women (PSAS-RSF; 16) whose inclusion criterion was the first 12 months postpartum.\u003c/p\u003e \u003cp\u003eAccording to our results, previous research in Spanish women also finds that breastfeeding is a source of anxiety and concerns after the birth of their children, and feeding, in general, is one of their main worries (39). Item 49 refers to the concern about how to feed the baby. Even in other cultural contexts, it has been observed that the presence of postpartum anxiety decreases the duration of breastfeeding, reduces self-efficacy, and increases difficulties in breastfeeding (22).\u003c/p\u003e \u003cp\u003eAfter the birth of their child, mothers' main concerns focus on the baby's health and care, their insecurity in solving problems related to the general care of the child (40,38). These findings align with items 3 (accidentally harming the baby) and 31-41-47 (concern for the child's health, rest time, and development).\u003c/p\u003e \u003cp\u003eDifficulty sleeping (item 44) and fatigue (item 51) are recognized in previous studies as variables related to emotional disorders (41\u0026ndash;43).\u003c/p\u003e \u003cp\u003eItem 6 refers to the physical manifestations related to anxiety: \"I have found it harder to concentrate on simple tasks.\" The definition of anxiety in the context of the perinatal period includes manifestations such as palpitations, muscle tension, insomnia, and difficulty concentrating (44). The PSAS doesn\u0026rsquo;t attempt to measure physiological symptoms because they can be conflated with normal symptoms of motherhood.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths, Limitations, and Future Directions\u003c/h2\u003e \u003cp\u003eThe PSAS-ES-RSF, like the original scale PSAS-RSF, allows exploring areas of particular concern for women in the postpartum period, considering the biopsychosocial characteristics of special vulnerability after the birth of their child. One of the main strengths of the study is the number of women who participated, allowing a robust psychometric analysis.\u003c/p\u003e \u003cp\u003eFurthermore, obtaining a reduced number of items makes it easier for professionals to use and for mothers to complete the questionnaire in a shorter time, potentially increasing the number of responses and being more accessible in a health care setting.\u003c/p\u003e \u003cp\u003eThe research presents limitations that must be considered in the design and analysis of future studies. The study participants constitute a homogeneous sample: heterosexual couples with a medium to high sociocultural level (university or higher education). This means that the tool has not been analysed and tested in other population groups. Using the PSAS-ES-RSF in other family models (homosexual couples, single mothers) with different sociocultural levels would help to explore and better understand the needs of other populations.\u003c/p\u003e \u003cp\u003eFuture research should continue evaluating cultural differences since our study shows that there are different items in the short versions when comparing the UK and Spanish PSAS. This does not invalidate the instrument (as the full version has been validated for both samples with the same items), but indicates that when reducing the instrument, there are differences in the items which best explain postpartum anxiety in women, depending on the country. In this sense, it is advisable to make cultural adaptations for proposed short versions and not only validate the items already proposed and validated in other countries \u0026ndash; something which the PSAS Working Group fully endorses.\u003c/p\u003e \u003cp\u003eIt is also proposed to explore the scale's validity in other time periods to benefit a larger number of women at different times postpartum such as after joining their jobs.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe PSAS-ES-RSF 16-item tool demonstrates reliability and construct validity for use in exploring postpartum anxiety during the first 16 weeks postpartum. Its use by healthcare professionals can help distinguish physiological adaptive reactions and experiences from those requiring more complex care plans. This reduced version, compared to the original scale, allows for easier inclusion in systematic screening programs for emotional disorders in the perinatal period.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePostpartum Specific Anxiety Scale (PSAS)\u003c/p\u003e \u003cp\u003eConfirmatory Factor Analyses (CFA)\u003c/p\u003e \u003cp\u003eDiagonally Weighted Least Squares (WLSMV)\u003c/p\u003e \u003cp\u003eComparative Fit Index (CFI)\u003c/p\u003e \u003cp\u003eTucker-Lewis Index (TLI)\u003c/p\u003e \u003cp\u003eRoot Mean Square Error of Approximation (RMSEA)\u003c/p\u003e \u003cp\u003eRoot Mean Square Residual (SRMR)\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approvals were sought and granted from the Universidad Complutense de Madrid Research Ethics Committee [ref:- CE_20240314_26_SOC]. All participants consented to participate of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants consented to their data being published as part of this study\u0026rsquo;s analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvalaibility of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets are not publicly available due to their sensitive nature, however they are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interests in the development of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNCR, MEAG, MAVG have collected the data, analyzed it and drafted the document. VF and SAS have drafted the document and reviewed the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the help of Santiago Costas-Ram\u0026oacute;n for their collaboration in the translation and Nazaret Olivera y Laia Vidal for the help during the data collection. A very special mention to the collaboration and assistance from The PSAS Working Group.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEpifanio MS, Genna V, De Luca C, Roccella M, La Grutta S. Paternal and maternal transition to parenthood: the risk of postpartum depression and parenting stress. Pediatr Rep. 2015;7(2). https://doi.org/10.4081/pr.2015.5872.\u003c/li\u003e\n\u003cli\u003eGarc\u0026iacute;a-Esteve L, Vald\u0026eacute;s Miyar M. 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Rev Med Chil. 2015;143:887-94.\u003c/li\u003e\n\u003cli\u003eFallon V, Halford JCG, Bennett KM, Harrold JA. The postpartum specific anxiety scale: development and preliminary validation. Arch Womens Ment Health. 2016;19(6):1079-90. https://doi.org/10.1007/s00737-016-0658-9.\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Carroll J, Kazuo ANDO N, YUN R, Panelli D, Nicklin A, Kennedy N, et al. A systematic review of patient-reported outcome measures used in maternal postpartum anxiety. Am J Obstet Gynecol MFM. 2023:101076. https://doi.org/10.1016/j.ajogmf.2023.101076.\u003c/li\u003e\n\u003cli\u003eInfante-Gil L, Silverio SA, Fallon V, Wendland J. Postpartum specific anxiety in a French population: Validation of the French version of the Postpartum Specific Anxiety Scale (PSAS-FR). Perspect Psychiatr Care. 2021;58(1):418-28. https://doi.org/10.1111/ppc.12808.\u003c/li\u003e\n\u003cli\u003eHasanzadeh R, Jafarabadi MA, Hasanpour S, Fallon V, Silverio SA, Montazeri R, et al. Psychometric evaluation of the postpartum specific anxiety scale in an Iranian population (PSAS-IR). BMC Pregnancy Childbirth. 2021;21(1):597. https://doi.org/10.1186/s12884-021-04085-w.\u003c/li\u003e\n\u003cli\u003eXu J, Sun C, Yan P, Liu X. Revision and reliability and validity evaluation of the Chinese version of the postpartum specific anxiety scale. Chin J Clin Psych. 2021;29(3):554-8. https://doi.org/10.16128/j.cnki.1005-3611.2021.03.022.\u003c/li\u003e\n\u003cli\u003eIonio C, Ciuffo G, Landoni M, Smorti M, Della Vedova AM, Christiansen P, et al. The Italian Language Postpartum Specific Anxiety Scale [PSAS-IT]: Translation, Psychometric Evaluation, and Validation. Front Psychiatry. 2023;14:1208613. https://doi.org/10.3389/fpsyt.2023.1208613.\u003c/li\u003e\n\u003cli\u003eCostas-Ramon N, Silverio SA, Fallon V, Aparicio-Garcia ME. Psychometric evaluation and validation of the postpartum specific anxiety scale for the Spanish-speaking population: PSAS-ES. Gen Hosp Psychiatry. 2023;83:59-65. https://doi.org/10.1016/j.genhosppsych.2023.04.011.\u003c/li\u003e\n\u003cli\u003eSilverio SA, Davies SM, Christiansen P, Aparicio-Garc\u0026iacute;a ME, Bramante A, Chen P, et al. A validation of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises with five translations. BMC Pregnancy Childbirth. 2021;21:1-12. https://doi.org/10.1186/s12884-021-03597-9.\u003c/li\u003e\n\u003cli\u003eMashayekh-Amiri S, Jafarabadi MA, Davies SM, Silverio SA, Fallon V, Montazeri M, et al. Psychometric evaluation of the postpartum specific anxiety scale - research short-form among Iranian women (PSAS-IR-RSF). BMC Pregnancy Childbirth. 2023;23(1):531. https://doi.org/10.1186/s12884-023-05855-4.\u003c/li\u003e\n\u003cli\u003eMashayekh-Amiri S, Jafarabadi MA, Montazeri M, Fallon V, Silverio SA, Mirghafourvand M. Validation of the Iranian version of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises (PSAS-IR-RSF-C). BMC Psychiatry. 2023;23(1):511. https://doi.org/10.1186/s12888-023-04998-0.\u003c/li\u003e\n\u003cli\u003eHijazi HH, Alolayyan MN, Al Abdi RM, Hossain A, Fallon V, Silverio SA. Validity and reliability of an Arabic-language version of the postpartum specific anxiety scale research short-form in Jordan. Birth. 2024. Advance online publication. https://doi.org/10.1111/birt.12840.\u003c/li\u003e\n\u003cli\u003eRosseel Y. lavaan: An R Package for Structural Equation Modeling. J Stat Softw. 2012;48(2):1-36.\u003c/li\u003e\n\u003cli\u003eShumacher RE, Y Lomax RG. A beginner\u0026apos;s guide to SEM. Manwah; 1996\u003c/li\u003e\n\u003cli\u003eBrowne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. 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Corresponsabilidad familiar y el equilibrio trabajo-familia: medios para mejorar la equidad de g\u0026eacute;nero. Polis Rev Latinoam. 2015;14(40):1-15.\u003c/li\u003e\n\u003cli\u003eNunes C, Ayala M. \u0026iquest;Qu\u0026eacute; piensan las madres sobre el programa de seguimiento de la salud infantil? Pediatr Aten Primaria. 2007;9(35):411-25.\u003c/li\u003e\n\u003cli\u003eCaparros-Gonzalez RA, Romero-Gonzalez B, Peralta-Ramirez MI. Depresi\u0026oacute;n posparto, un problema de salud p\u0026uacute;blica mundial. Rev Panam Salud P\u0026uacute;blica. 2018;42. . https://doi.org/10.26633/RPSP.2018.97.\u003c/li\u003e\n\u003cli\u003eGunst A, Sj\u0026ouml;str\u0026ouml;m E, Sund\u0026eacute;n M, Antfolk J. The Mother\u0026ndash;Offspring Conflict: The Association Between Maternal Sleep, Postpartum Depression, and Interbirth Interval Length. Evol Psychol. 2021;19(4). https://doi.org/10.1177/14747049211046162.\u003c/li\u003e\n\u003cli\u003eParfitt Y, Ayers S. Transition to parenthood and mental health in first-time parents. Infant Ment Health J. 2014;35(3):263-73. https://doi.org/10.1002/imhj.21443.\u003c/li\u003e\n\u003cli\u003eAz\u0026uacute;a Morera E, Carvajal Barboza F. Actualizaci\u0026oacute;n del trastorno de ansiedad durante el embarazo. Rev Med Sinergia. 2024;9(2). https://doi.org/10.31434/rms.v9i2.1140.\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":"Postpartum anxiety, Postpartum Specific Anxiety Scale (PSAS), Maternal mental health, Psychometric validation, Postnatal emotional disorders, Maternal self-efficacy, Infant care anxieties, Psychosocial adjustment postpartum","lastPublishedDoi":"10.21203/rs.3.rs-5316469/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5316469/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003ePostpartum anxiety is a prevalent emotional disorder affecting approximately 20% of women, often more common than postpartum depression. Despite its high prevalence, the Spanish healthcare system lacks screening programs specifically targeting this condition.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study aimed to develop and validate a short version of the Postpartum Specific Anxiety Scale (PSAS-ES-RSF) to address time constraints in clinical practice and improve its usability as a screening tool. Using confirmatory factor analysis (CFA) on two independent Spanish samples (Sample 1: N\u0026thinsp;=\u0026thinsp;699; Sample 2: N\u0026thinsp;=\u0026thinsp;293), a 16-item version was extracted from the original 51-item PSAS-ES.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe four-factor structure of the PSAS-ES-RSF\u0026mdash;addressing maternal competence, infant safety, practical infant care, and psychosocial adjustment\u0026mdash;demonstrated strong psychometric properties (CFI\u0026thinsp;\u0026gt;\u0026thinsp;.95, RMSEA\u0026thinsp;\u0026lt;\u0026thinsp;.08). Cultural context and risk factors, such as maternal self-efficacy and the return to work, influenced the selection of items, showing some variation from the English-language short form.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe PSAS-ES-RSF offers a reliable and efficient tool for exploring postpartum anxiety in Spanish-speaking populations. Further research is needed to explore its applicability in diverse cultural contexts and to continue refining postpartum anxiety screening strategies.\u003c/p\u003e","manuscriptTitle":"Validation of the Spanish-language version of The Postpartum Specific Anxiety Scale Research Short Form: PSAS-ES-RSF","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-19 13:34:19","doi":"10.21203/rs.3.rs-5316469/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":"f683855b-64f7-4531-84f2-f1f8557a4e24","owner":[],"postedDate":"November 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-18T18:08:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-19 13:34:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5316469","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5316469","identity":"rs-5316469","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}