title: Using item response theory to optimize measurement of chronic stress in pregnancy.
abstract: OBJECTIVE
  Utilize Rasch analysis to develop an optimized self-reported measure of stress in pregnancy and examine the association with patient demographics and biologic measures of stress.
  
  
  METHODS
  Measured self-reported stress in pregnant women using 12 existing scales. Collected blood for biologic measures of stress (Epstein Barr Virus [EBV], C-Reactive Protein [CRP], Corticotropin Reactive Hormone [pCRH], and Adenocorticotropin Hormone [ACTH]). Used multidimensional scaling and Rasch analysis to produce an item reduced self-report measure.
  
  
  RESULTS
  Enrolled 112 women. Survey items reduced to two factors: perceived stressors and buffers of stress. Women with a domestic partner had lower perceived stress (p = 0.003). Caucasian women reported higher buffers of stress (p = 0.045), as did women with private insurance (p < 0.001), a planned pregnancy (p < 0.01), and a domestic partner (p < 0.001). Women with higher buffers of stress had lower levels of pCRH (adjusted p = 0.01).
  
  
  CONCLUSIONS
  Item reduced, optimized measures of stress were associated with significant differences in patient demographics and biologic measures of stress.
authors.affiliation: NorthShore University HealthSystem, Department of Obstetrics and Gynecology, Evanston IL, United States; University of Chicago, Pritzker School of Medicine, Chicago IL, United States; Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago IL, United States; Center for Healthcare Studies, Chicago IL, United States. Electronic address: aborders@northshore.org.
authors.forename: Ann E B
authors.initials: AE
authors.lastname: Borders
authors.affiliation: Northwestern University Feinberg School of Medicine, Department of Medical Social Sciences, Chicago IL, United States; Department of Pediatrics, Chicago IL, United States.
authors.forename: Jin-Shei
authors.initials: JS
authors.lastname: Lai
authors.affiliation: Center for Healthcare Studies, Chicago IL, United States.
authors.forename: Kaitlin
authors.initials: K
authors.lastname: Wolfe
authors.affiliation: NorthShore University HealthSystem, Department of Obstetrics and Gynecology, Evanston IL, United States.
authors.forename: Sameen
authors.initials: S
authors.lastname: Qadir
authors.affiliation: Department of Preventative Medicine, Chicago IL, United States.
authors.forename: Jie
authors.initials: J
authors.lastname: Peng
authors.affiliation: Department of Preventative Medicine, Chicago IL, United States.
authors.forename: Kwang-Youn
authors.initials: KY
authors.lastname: Kim
authors.affiliation: NorthShore University HealthSystem, Department of Obstetrics and Gynecology, Evanston IL, United States.
authors.forename: Lauren
authors.initials: L
authors.lastname: Keenan-Devlin
authors.affiliation: Center for Healthcare Studies, Chicago IL, United States; Department of Preventative Medicine, Chicago IL, United States; Department of Pediatrics, Chicago IL, United States.
authors.forename: Jane
authors.initials: J
authors.lastname: Holl
authors.affiliation: Center for Healthcare Studies, Chicago IL, United States; Department of Obstetrics and Gynecology, Chicago IL, United States.
authors.forename: William
authors.initials: W
authors.lastname: Grobman
keywords: Biomarkers; Chronic stress; Item response theory; Pregnancy; Self-reported stress