Trial development of the Cognitive Appraisal Scale for Infertility (CASI) (version 1)

ObjectiveTo develop the Cognitive Appraisal Scale for Infertility (CASI) and assess it for reliability and validity.DesignCross-sectional and longitudinal study.SettingA private fertility institute in Japan.Patient(s)223 infertile women being treated at the institute.Intervention(s)Administration of questionnaire at initial consultation and 6 months later.Main Outcome Measure(s)A self-rating questionnaire of perceptions and feelings about infertility on a four-point Likert scale, the State-Trait Anxiety Inventory (STAI), and the Self-rating Depression Scale (SDS). Internal consistency (Cronbach's α), test–retest reliability coefficients, and concurrent validity correlations.Result(s)Factor analysis identified eight factors with 35 items: difficulty accepting infertility, decrease in self-esteem, acceptance/coming to terms with new self-identity, despair, loss of libido and erosion of marital relationship, guilt, denial, and self-imposed isolation. Internal consistency for factors 1 and 2 was 0.88 and 0.82, for factors 3 to 8 was from 0.68 to 0.58. Test–retest reliability coefficients were 0.90 to 0.72. Concurrent validity correlations between CASI and STAI, and SDS ranged from 0.54 to 0.29.Conclusion(s)The CASI, a new and potentially useful scale to assess emotional responses to infertility, is still in development. Further refined CASI and standardized scores of each subscale could be efficient for clinical practice.