To our knowledge, this was the first study to validate the LEIDS-RR-CV in a sample of perinatal women. We conducted a comprehensive psychometric evaluation based on CTT and IRT of the LEIDS-RR-CV that confirmed the predictive effect of CR on depression and that the scale has satisfactory structural, criterion-related, known-group, and predictive validity, robust internal consistency, and test-retest reliability. Therefore, the 26-item LEIDS-RR-CV can serve as a valid and reliable scale to quantify CR in perinatal women in China, and for screening women at high-risk for depression during perinatal periods.
In our study, the LEIDS-RR-CV showed a Cronbach’s alpha, ICC, and marginal reliability with values > 0.7, indicating a satisfactory internal consistency and temporal stability. Further, through CFA, we confirmed that a five-factor structure provided a good fit to the data, similar to the results of the original version of the scale and those of the Chinese version, which was validated on undergraduate students and depression remission women[21, 28]. However, our results differed from those of the Spanish version of the LEIDS-RR, which presented a four-factor model, and the Persian version, which involved a sample of patients with depression from the general population that showed a six-factor model. Thus, our finding extends the scientific evidence on the application of the LEIDS-RR in different samples and cultural contexts. Specifically, we showed that the LEIDS-RR-CV can be used to measure CR and its subscales (i.e., hopelessness/suicidality, acceptance/coping, aggression, control/perfectionism, and avoidant coping) in perinatal Chinese women.
As expected, the total score for CR was higher in women with depression than in women without depression. This was also confirmed by the IRT analysis : the LEIDS-RR-CV has high discrimination and performed well over diverse individuals with low and high CR. The findings showed that the LEIDS-RR-CV has high discrimination and is expected to perform well when applied to perinatal women with various levels of CR.
We observed a significant correlation between our data for the LEIDS-RR-CV and the scores for the EPDS, indicating good criterion-related validity. When we used the LEIDS-RR-CV to predict future depression across the perinatal period, it showed acceptable test performance (i.e., AUC values > 0.7). Therefore, the 26-item LEIDS-RR-CV can be used to identify women at high-risk for depression and to predict future depression during the perinatal period, thus being clinically useful for stakeholders interested in the accurate assessment of CR in this population.
To our knowledge, our study first attempts to establish optimal cut-off scores on the LEIDS-RR-CV among perinatal women; the optimal assessment scores were 58 and 60 points for the third trimester and the six-weeks postpartum, respectively. Thus, women assessed in the third trimester, showing a total score for CR ≥ 58, were at a higher risk for depression than those with results below this value; at six-weeks postpartum, this cut-off value was ≥ 60. Specifically, our results showed that the cut-off score for this scale varied in individuals according to their particular context . We suggest future scholars explore how the LEIDS-RR-CV performs when used in different clinical settings and subgroups. Our findings on the optimal cut-off score of CR in perinatal women may improve the ability of healthcare professionals to quickly recognize patients with depressive thoughts and those at risk of clinical PND. Knowledge on this index may also prove helpful in developing referral, intervention, and treatment strategies to reduce the incidence of PND.
First, there were some characteristics of our research that may have introduced sample bias and affected the generalizability of our results, that is, the use of convenience sampling; all women in our sample were recruited from Fujian province, southern China; and we used data collected only through online self-reported questionnaires. Second, additional evidence on the validity of the scale is needed, particularly regarding its measurement invariance; hence, differential item function analysis may be an important next step to confirm that the items in the scale function similarly across different groups of women. Finally, although we established a cut-off value for CR to identify groups of women at high risk for depression at both the third trimester and six-weeks postpartum, we have not defined the cut-off values for mild, moderate, and severe CR scores—a suggestion for future research.
This study attempts to make a valid tool for indirectly predicting depression to aid healthcare providers or public health service providers manage, specifically by prevention, perinatal depression in China, where there seems to be no such tool to predict this construct. We recommend testing and applying the LEIDS-RR with a larger representative group of perinatal women in different countries, then comparing CR between western and Chinese groups. The LEIDS-RR will facilitate the design of psychological interventions aimed at curbing CT in perinatal women and is crucial to the effective development and evaluation of interventions to decrease CR, even PND, in the cross-cultural context.