Introduction
The purpose of this paper is to report an extension of a Roy Adaptation Model (RAM) 1-guided preliminary situation-specific theory of correlates (physical and psychological symptoms, physical energy, relationship quality) of maternal and paternal functional status during high-risk childbearing 2. The content of this paper adds correlations between already collected data for psychological state and maternal and paternal functional status, as measured by maternal and paternal functional status inventories, to the theory.
The RAM depicts people as adaptive systems that adapt to focal and contextual environmental stimuli 1. Adaptation occurs in physiological, self-concept, role function, and interdependence adaptive modes, which are thought to be interrelated. This paper presents the results of data analyses for the relation between the self-concept mode, represented by the psychological state as measured by three Multiple Affect Adjective Checklist-Revised (MAACL-R) subscales (anxiety, depression, positive affect) 3, and the role function mode, represented by functional status during high-risk childbearing, as measured by maternal and paternal functional status inventories 4,5,6. The definitions for the relevant RAM concepts (self-concept mode, role function mode), the theory concepts (psychological state, functional status), and the empirical indicators used to measure the theoretical concepts are given in Table 1.
Roy Adaptation Model Concepts | Preliminary Theory Concepts | Empirical Indicators |
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Self-Concept Mode: Concerned with the conception of the physical and personal self | Psychological State: An individual’s perceptions of affect/feelings, including multiple items for each of three dimensions-anxiety, depression, and positive affect | Multiple Affect Adjective Checklist-Revised (MAACL-R) subscales for Anxiety, Depression, and Positive Affect 3,7 |
Role Function Mode: Concerned with the performance of roles based on position within society | Functional Status: Continued performance of an individual’s usual household, social and community, family, personal care, occupational, and educational activities during pregnancy and the postpartum, with the addition of assumption of childcare activities during the postpartum | Inventory of Functional Status-Antepartum Period 4 Inventory of Functional Status After Childbirth 5 Inventory of Functional Status-Fathers 6 |
Source: Own elaboration.
Materials and Methods
Psychological state was not included in data analysis for the preliminary theory 2 due to the complexity of identifying and writing computer code for the MAACL-R subscales at that time (the early 2000s), as the subscale scores were available only by paper and pencil calculations. Considerable time and effort were involved in preparing MAACL-R subscale data for analysis, which are now available. The addition of psychological state, measured by the multiple items MAACL-R 3,7, to the theory may provide a more comprehensive understanding of the influence of the parents’ psychological experience during high-risk childbearing than did the three single-item psychological symptoms (feeling anxious, feeling depressed, feeling better than usual) measured by the Symptoms Checklist 8. Details of the pilot study sample, research methods, and results for the preliminary theory are available in Fawcett and Tulman’s 2 paper. University and hospital institutional review boards approved the pilot study, and participants gave either oral or written informed consent.
Briefly, the sample included 103 individuals: 48 pregnant women who had been classified as high-risk and 34 of their male partners, 11 postpartum women who had had high-risk pregnancies, and 10 of their male partners at 4-6 weeks postpartum at the time of data collection. “The typical study participant was 31 years of age; White, non-Hispanic; had at least a high school education; and was employed outside the home or on maternity or paternity leave” (1, p410). High-risk status was self-reported when the participants were recruited from clinics in teaching hospitals in a New England state (n = 34 total participants; 20 pregnant women and 13 of their male partners; one woman and no male partners during the postpartum) and a Southeastern state (n = 69 total participants; 28 pregnant women and 21 of their male partners; ten women and ten of their male partners during the postpartum).
Results
The results for correlational analyses of the measures of psychological state and maternal and paternal functional status are given in Table 2. Complete data were available for all 48 pregnant women, although for only 32 of the 34 male partners and all 11 women and 10 male partners during the postpartum. Effect sizes 9 are reported rather than inferential statistical probabilities due to the small sample sizes. Note that r is the metric for the effect size for correlational analyses. A small effect size is r = 0.1, a medium effect size is r = 0.3, and a large effect size is r= 0.5 9.
Functional Status | Psychological State (MAACL-R Subscales) |
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*Small effect sizes (r = .10) are considered relations of low magnitude. **Medium effect sizes (r = .30) are considered relations of moderate magnitude. ***Large effect sizes (r = .50) are considered relations of large magnitude (9). Effect sizes in bold font indicate no evidence of a relation.
Source: Own elaboration.
Based on the analysis of MACCL-R subscale scores with scores for inventories of maternal and paternal functional status (see Table 2), the preliminary theory can now be extended to assert these propositions:
During pregnancy, for women:
There is a negative relation of low magnitude (small effect size) between psychological state anxiety and maternal functional status; so, the lower the psychological state anxiety, the higher the maternal functional status.
There is a negative relation of low magnitude (small effect size) between psychological state depression and maternal functional status; so, the lower the psychological state depression, the higher the maternal functional status.
There is a positive relation approaching moderate magnitude (small to medium effect size) between psychological state positive affect and maternal functional status; so, the higher the psychological state positive affect, the higher the maternal functional status.
During pregnancy, for male partners:
There is a positive relation of high magnitude (large effect size) between psychological state anxiety and paternal functional status; so, the higher the psychological state anxiety, the higher the paternal functional status.
There is a positive relation of low magnitude (small effect size) between psychological state depression and paternal functional status; so, the higher the psychological state depression, the higher the paternal functional status.
There is a negative relation of low magnitude (small effect size) between psychological state positive affect and paternal functional status; so, the lower the psychological state positive affect, the higher the paternal functional status.
During the postpartum, for women:
There is a negative relation of low magnitude (small effect size) between psychological state anxiety and maternal functional status; so, the lower the psychological state anxiety, the higher the maternal functional status.
There is a negative relation of moderate magnitude (medium effect size) between psychological state depression and maternal functional status; so, the lower the psychological state depression, the higher the maternal functional status.
During the postpartum, for male partners:
There is a negative relation of low magnitude (small effect size) between psychological state depression and paternal functional status; so, the lower the psychological state depression, the higher the paternal functional status.
There is a positive relation of low magnitude (small effect size) between psychological state positive affect and paternal functional status; so, the higher the psychological state positive affect, the higher the paternal functional status.
The data indicate that the effect sizes for the relations between psychological state positive affect and maternal functional status during the postpartum, and psychological state anxiety and paternal functional status during the postpartum were too low to consider (see Table 2).
Discussion
The direction of the relations between psychological state anxiety, depression, and positive affect and paternal functional status during pregnancy are inconsistent with expectations. Expected would have been negative relations between psychological state anxiety and depression and paternal functional status; so, the higher the anxiety and depression, the lower the functional status. Similarly, expected would have been a positive relation between psychological state positive affect and paternal functional status; so, the higher the positive affect, the higher the paternal functional status. The reason for these unexpected results is elusive. Inasmuch as effect size tends to be stable regardless of sample size, it is unclear whether obtaining a larger sample of male partners from the same population would yield different results.
As seen in Table 2, there is no substantial difference in effect sizes for MAACL-R measured psychological state and functional status for women and their male partners during pregnancy and the postpartum. Overall, there is a significant effect size for the positive relation between the male partner’s psychological state anxiety and paternal functional status during pregnancy. Perhaps feelings of anxiety motivate the male partner to perform a high level of activities that comprise paternal functional status. Furthermore, there is a medium effect size for the positive relation between the women’s psychological state depression and maternal functional status during the postpartum, for if a woman feels depressed, she probably will decrease the level of her performance of activities that comprise maternal functional status.
A review of related literature revealed a few relevant journal articles for this study.
Regarding women, Maloni and colleagues 10) found relatively high levels of depression among a sample of 89 primarily Caucasian (82 %) or African American (14.6 %) pregnant women who were hospitalized on bed rest. Their study did not include any measure of maternal functional status. McKee and colleagues 11 found a negative correlation between depression and maternal functional status during pregnancy for 114 Hispanic and Black women in the United States.
McVeigh 12 reported a negative correlation between anxiety and maternal functional status for 200 Australian women during the postpartum. Posmontier 13 found a negative correlation between postpartum depression and maternal functional status for 23 women in the United States. Barkin and colleagues 14,15 also reported a negative correlation between postpartum depression and maternal functional status in their studies of women (N = 189; N = 128) in the United States.
Regarding male partners, Sevil and Özkan 16 found that the paternal functional status of 155 expectant and 93 fathers residing in Turkey was related to sociodemographic factors but did not study the relation between any measures of mood and paternal functional status. McVeigh, St. John, and Cameron 17 reported that of the 165 Australian fathers who participated in their study of the postpartum, most appeared to engage in a balancing act that required them to relinquish some personal activities to be an involved parent. They did not, however, report any correlates of paternal functional status in their descriptive study.
No studies of the relation between positive affect and maternal or paternal functional status during pregnancy or the postpartum were located.
Conclusion
The study findings support the utility of the Roy Adaptation Model 1 as a guide for research and indicate, as proposed in the model, that the modes of adaptation (self-concept mode and role function mode in this study) are interrelated. As the Fawcett and Tulman’s 2 paper indicate, the theory is too preliminary to recommend application in nursing practice. More research with participants of diverse cultures is needed to determine whether the effect sizes are stable across diverse populations and which relations contribute to an empirically adequate situation-specific theory.