A beginning theoretical model was developed to show the relationships among general pregnancy attitudes, ambivalence, and psychological symptom distress during pregnancy. Women from all trimesters were included in the tool development sample of 120 women, and the sample of 602 who participated in the descriptive, survey research.

Pregnancy Attitudes were measured using the Pregnancy Questionnaire, an investigator-developed, 86-item, modified visual analogue tool which contains two scales. The first scale, the Rich Pregnancy Attitude (RPA) Scale (Coefficient alpha,.97), was used to assess general pregnancy attitudes. The second scale, the Rich Ambivalence (RA) Scale (Coefficient alpha,.98), was used to assess ambivalence of pregnant women. Psychological symptom distress was measured using scores obtained on Derogatis' (1977) Symptom Checklist-90-Revised. The nine symptom dimensions of the self-report checklist had coefficient alphas between.76 and.86 with the study sample.

Women from three participating military hospitals were provided research instruments in pre-paid mailers. The response rate was 72%, or 433 women. A sub-sample of 110 women completed a second Pregnancy Questionnaire after one week. Data from this group were used to assess test-retest reliability; values for the RPA and RA Scales were.86 and.65 respectively. Qualitative data were obtained using focused interviews with a second sub-sample of 40 women.

A panel of experts, a series of item analyses followed by tool revision, and factor analysis were used to obtain the final version of the Pregnancy Questionnaire. The instrument was found to be reliable. Results of a factor analysis and a multi-trait, multi-method matrix were used to provide support for construct validity. Preliminary content analysis was performed on the qualitative data, and used to support the construct validity of the RPA/RA Scales.

Relationship between general pregnancy attitudes, ambivalence, and PSD were explored using correlation matrixes and a series of multiple regression analyses and analyses of variance. Findings supported three hypothesized relationships between the key variables. Negative attitudes were associated with higher levels of ambivalence and psychological distress. Conversely, positive attitudes were associated with less ambivalence and psychological distress. Surprisingly, hypothesized differences based on pregnancy trimester were not found; perhaps because data were collected during Operation Desert Storm.