Fator 1:

Itens eliminados: arrependimento de ter tido o bebê, me sinto encurralada, meu bebê me enerva, me desespera e chora demais.

Os itens eliminados não representam, do ponto de vista clínico, uma perda significativa. Me dá a impressão que já se encontram bem representados nos itens que permaneceram.

Fator 2:

Itens eliminados: gosto de brincar com meu bebê, sinto-me zangada com meu bebê, meu bebê me irrita.

Itens que ficaram: adoro fazer carinho no meu bebê, sinto-me distante do meu bebê e arrependo-me de ter tido ele, sinto que outra pessoa deve tomar conta do meu bebê.

Os itens eliminados não representam, do ponto de vista clínico, uma perda significativa, pois acredito que se encontram bem representados nos itens que permaneceram.

Fator 3:

Itens eliminados: meu bebê me deixa ansiosa e é fácil consolar meu bebê.

Itens que permaneceram: tenho medo do meu bebê e sinto-me confiante ao cuidar do meu bebê.

O item 19 (meu bebê me deixa ansiosa) é o único item que faz referência ao construto ansiedade e talvez fosse interessante dele “aparecer”. Mas, penso que ansiedade é absolutamente normal frente ao cuidado que se tem com um bebê e não reflete necessariamente nenhuma possibilidade de perturbação na relação mãe-bebê. Então, penso não haver problema em eliminá-lo.

Fator 4 (problema!!!):

Reck (Alemanha) – 1 só fator com 16 itens (eliminou o F4 todo – itens 18 e 24)Wittkowski (Inglaterra) – 3 fatores com 22 itens (eliminou o F4 todo - itens 18 e 24)Nazaré (Portugal, 2011) – 4 fatores com 24 itens (eliminou o 6)Nazaré (Portugal, 2012) – 1 fator com 12 itens (eliminou todo o F4)Kinsey (EUA) – 1 fator com 10 itens (eliminou o F4 todo)Kaneko (Japão – validação fraca – 1 fator com 16 itens (eliminou o F4 todo)Suetsugu (Japão) – 4 fatores com 14 itens (eliminou o F4 todo)

Brockington (2001) - originalAs for Scale 4, concerned with incipient abuse, it is unlikely that a self-rating instrument can ever be adequate to explore these very sensitive matters. Nevertheless it seems that this schedule could help to detect at least a proportion of these mothers at high risk of abusing their infants.

Brockington (2006) – “revalidação”Factor 4This was based on only two questions, ‘‘I feel like hurting my baby’’ and ‘‘I have done harmful things to my baby’’, with a maximum score of 10. In the first validity study, a cut-off score of 2=normal, 3=high was selected, but only 5 mothers scored above this threshold. In the present study, only 33 mothers had a score above zero: fifteen had a score of 1, twelve a score of 2 and six a score of 3–7, of whom five had established rejection and one a normal bond. The purpose of this factor is the identification of dangerous mothers. But only 5=40 with any degree of pathological anger and 3=15 with severe anger scored above threshold. This is a very low sensitivity (0.13 and 0.20).(...)This study has confirmed the value of the PBQ, especially scales 1 and 2.(…)Neither scale 2 nor scale 4 was sensitive in picking out mothers who were a danger to their infants. It may be that self-rating questionnaires are not effective in penetrating the defences of these mothers.

Wittkowski et al. (2010) – utilizou amostras CLÍNICAS da Inglaterra

Confirmatory factor analysis:The complete dataset of 132 was used for the CFA of the original four-factor solution. As this model could not be specified due to difficulties with the fourth scale pertaining to abuse, a second CFA was undertaken omitting items 18 and 24. A significant difference between the present solution and the three-factor solution was observed (x2 ¼ 1,326.37, df ¼ 230, p , .001).

Exploratory factor analysis (EFA) or principal component analysis:

… one item (18) was not loading on to any factor. (…) However, some items (i.e. 23 and 24) were split across factors and could not easily be assigned to a specific one, using the above mentioned criteria. In addition, due to methodological concerns about the use of the fourth scale, item 24 (‘I feel like hurting my baby’) was omitted.

Conclusion. The findings suggest that the original four factors of the PBQ should be used with caution. Items pertaining to risk of abuse had to be omitted alongside one other item, resulting in a 22-item solution. Further psychometric evaluation of this scale is recommended.

Wittkowski et al. (2007)Discussion:(...)The exception was the fourth subscale pertaining to abuse. This subscale consists of only two items which were not endorsed by this group of mothers. Brockington et al. (2001) reported that this subscale accounted for only 3.4% of the total variance and acknowledged that a self-rating scale was unlikely to identify incipient abuse correctly. Indeed using the scale in clinical samples, we have observed that mothers with obsessional thoughts tended to score false positively on these items. For these reasons we would suggest to omit this subscale from the PBQ.

Estou bem tranquila, tanto do ponto de vista teórico como clínico, que os itens do Fator 4 podem ser eliminados sem perda significativa do propósito do questionário.