Depression
The Center for Epidemiological Studies-Depression (CES-D; 28) scale
is a 20-item measure of symptoms of depression manifest in the general
population. It has been widely validated as a screening instrument for
psychological distress in diverse community samples (29). This instrument
requires respondents to endorse each item with respect to the last
week using a Likert scale with total scores ranging from 0 to 60. Higher
scores indicate greater reported depressive symptoms. The CES-D scale
was self-administered at ≤20 weeks’ gestation and between 24 and 29
weeks’ gestation.
State and trait anxiety
The Spielberger State-Trait Anxiety Inventory (STAIS/T; 30) is a wellestablished
measure of both transitory and dispositional anxiety. Each
instrument includes a set of 20 items with Likert response categories.
Higher scores on the state measure reflect greater current anxious
affect, whereas higher trait scores indicate a more stable tendency to
experience elevated levels of anxiety. Both the state and trait forms were
self-administered before 20 weeks’ gestation. The state form was readministered
between 24 and 29 weeks’ gestation.
Self-esteem
The 10-item Self-esteem Scale (31) was used to evaluate participants’
general estimations of self-worth and degree of positive or negative
orientation toward the self. This measure has been extensively used in
research that traverses multiple health-related disciplines. Respondents
indicate their level of item agreement on a 6-point scale2. Higher
scores reflect more positive self-appraisals. This instrument was self-
administered
between 17 and 22 weeks’ gestation.