Participants
The data was collected in December 2020. Participants were recruited by Rakuten Research, Inc., an online marketing research company that possesses the contact details of approximately 2.3 million Japanese survey respondents. Randomly selected individuals from Japan,stratified by gender and age, were sent an e-mail containing a link to an online questionnaire.
The participants were 2,000 mothers of children aged 0 - 3 (500 mothers of 0-year-olds, 500 mothers of 1-year-olds, 500 mothers of 2-year-olds, and 500 mothers of 3-year-olds); the children’s mean age was 1.57 ± 0.74 years; the mothers’ mean age was 33.58 ± 4.7 years. The inclusion criterion included mothers whose children were aged 0 - 3. There were no exclusion criteria. Mothers who had multiple children in the targeted age group were asked to answer the questionnaire, considering only one of them. Out of these, 1,000 participants (223 one-year-olds, 234 two-year-olds, 291 three-year-olds, and 252 four-year-olds) underwent another survey fourteen months later to examine test-retest reliability.
Measures
Demographic information
We asked the participants to provide information on their age, existing infirmities (mental, physical, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD)), employment status, and number of births. We also collected information regarding the number of children, the target child, age of the child, and status of the child birth order.
Japanese version of Parental Acceptance and Action Questionnaire (PAAQ-J)
The PAAQ is a 15-item self-reporting-style questionnaire and is evaluated on a 7-point scale (from 1 [Never True] to 7 [Always True]) (14). The PAAQ-J was developed and structured by Mizusaki and Sato (15). However, its reliability and validity were insufficiently examined owing to its small sample size (n = 47). The higher the PAAQ-J score, the higher the tendency to avoid experiences. The questionnaire comprises two subscales, “Inaction” and “Unwillingness.” “Inaction” indicates a caregiver’s inability to functionally control their reactions to a child’s emotions, and “Unwillingness” indicates a caregiver’s inhibition to witness a child’s negative emotional experiences. The α-coefficients for Inaction and Unwillingness in the original PAAQ were 0.64 and 0.65 respectively; the total α-coefficient was 0.65.
Acceptance and Action Questionnaire-II(AAQ-II)
The AAQ-II is a self-reporting-style questionnaire comprising seven items that evaluate the important aspects of an adult’s avoidance of experiences and psychological flexibility on a 7-point scale (from 1 [Never True] to 7 [Always True]). The higher the score, the greater an individual’s tendency to avoid experiences (6). The Japanese edition of AAQ-II, which has an α-coefficient of 0.88, representing high reliability and validity; was developed by Shima et. al (16).
Hospital Anxiety and Depression Scale (HADS)
The HADS is a 14-item scale that evaluates anxiety and depressive symptoms: it comprises seven items for anxiety and for depressive symptoms (17). The subjects are asked to answer questions about each symptom on a scale of 1 - 4. The higher the scores, the stronger the symptoms are. The Japanese edition of HADS was developed by Hatta et al. (18). Cronbach's α-coefficient was 0.80 for anxiety symptoms, and between 0.59 and 0.61 for depressive symptoms.
Method of analysis
This study examines the scale’s reliability and validity according to COSMIN’s framework (19, 20).
Firstly, to verify structural validity, we conducted Confirmatory Factor Analysis (CFA), and assessed whether a two-factor structure could be hypothesized for PAAQ-J, as in the original PAAQ (14). Whenever a two-factor structure was invalid, we used exploratory factor analysis, employing maximum likelihood promax rotation, to investigate a new factor structure. The final extracted factors were subjected to CFA to ascertain the degree of fit.
Further, to examine the reliability of PAAQ-J, Cronbach's α coefficients were calculated for each of the factors. We then calculated the intraclass correlation coefficient (ICC) for each factor to examine the test-retest reliability of the PAAQ-J.
We also conducted a correlation analysis with AAQ-II to ascertain the PAAQ-J’s criterion validity. We further conducted a correlation analysis between PAAQ-J and HADS-depression/HADS-anxiety to investigate construct validity. We used SPSS Statistics ver. 27 (IBM Corp., Armonk, NY) and SPSS AMOS ver. 27 (IBM Corp., Armonk, NY) for our statistical analysis.