Diagnosis Threat and Cognitive Performance During Pregnancy
A thesis presented to
the faculty of
the College of Arts and Sciences of Ohio University
In partial fulfillment
of the requirements for the degree
Master of Arts
Adrienne L. Isgrigg
August 2010
© 2010 Adrienne L. Isgrigg. All Rights Reserved.
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This thesis titled
Diagnosis Threat and Cognitive Performance During Pregnancy
by
ADRIENNE L. ISGRIGG
has been approved for
the Department of Psychology
and the College of Arts and Sciences by
Julie Suhr
Professor of Psychology
Benjamin M. Ogles
Dean, College of Arts and Sciences
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Abstract
ISGRIGG, ADRIENNE L., M.A., August 2010, Psychology
Diagnosis Threat and Cognitive Performance During Pregnancy (62 pp.)
Director of Thesis: Julie Suhr
It is a common belief that during pregnancy, women’s cognitive abilities
decrease, as noted in the popular pregnancy preparation book What to Expect When
You’re Expecting (Eisenberg & Murkoff, 1996). Many pregnant women report perceiving
changes in their cognitive ability during pregnancy, but there are not consistent research
findings when using objective neuropsychological tests. One factor potentially
contributing to self perceptions of impaired cognition and inconsistent
neuropsychological findings is stereotype threat. It is possible that pregnant women
believe they are cognitively impaired due to the negative expectations about pregnant
women’s cognition that are part of well-known pregnancy stereotypes, and that these
negative expectations not only lead them to notice their own normal cognitive errors and
attribute them to the pregnancy, but also to sometimes underperform on cognitive tasks.
The purpose of the present study was to investigate whether stereotype threat could be
related to self-reported cognitive skills and cognitive test performance in pregnancy. 46
pregnant women in their 2nd and 3rd trimesters were randomly assigned to negative
expectancy and control groups and were administered a battery of neuropsychological
tests. We hypothesized that women exposed to negative pregnancy stereotypes would
self-report more cognitive impairment than pregnant women who were not primed to
negative stereotypes. We also hypothesized that pregnant women primed to negative
expectations about cognition in pregnancy would perform more poorly on cognitive tests
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than pregnant women not exposed to negative expectations. Results partially supported
the hypothesis that participants primed to negative expectations would self report more
cognitive impairment. However, results did not support the hypothesis that they would
perform more poorly on cognitive tests than pregnant women not exposed to negative
expectations. The lack of significant findings may have been due to the failure of the
negative expectation manipulation and the high pre-study awareness of the negative
stereotypes. However, exploratory analysis showed that, in non-depressed participants,
the hypothesis that the negative expectation group would perform more poorly on
cognitive tests than controls was supported. Exploratory analysis also showed, for those
in the negative expectancy condition, the more a participant agreed with the negative
stereotypes, the more poorly they performed on cognitive measures. Future studies
should explore depression as a moderator of diagnosis threat effects and consider prior
awareness of and agreement with negative stereotypes when examining the role of
negative expectations on cognitive performance.
Approved: _____________________________________________________________
Julie Suhr
Professor of Psychology
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Table of Contents
Page
ABSTRACT ........................................................................................................................ 3
LIST OF TABLES .............................................................................................................. 6
LIST OF FIGURES ............................................................................................................ 7
INTRODUCTION .............................................................................................................. 8
METHOD ........................................................................................................................ 14
Participants ................................................................................................................ 14
Procedure .................................................................................................................. 15
Measures ................................................................................................................... 16
RESULTS ........................................................................................................................ 19
Demographics ........................................................................................................... 19
Self-Report Measures................................................................................................ 19
Exploratory Analyses ................................................................................................ 20
DISCUSSION ................................................................................................................... 22
REFERENCES ................................................................................................................. 34
APPENDIX A: CONSENT FORM .................................................................................. 48
APPENDIX B: RECRUITMENT FLIER ........................................................................ 52
APPENDIX C1: WORD LIST LEARNING .................................................................... 53
APPENDIX C2: DEMOGRAPHIC INFORMATION..................................................... 54
APPENDIX C3: SEMANTIC FLUENCY ....................................................................... 55
APPENDIX C4: PAIN AND PREGNANCY QUESTIONNAIRE ................................. 56
APPENDIX C5: COGNATIVE SELF-REPORT............................................................. 57
APPENDIX C6: MANIPULATION CHECK .................................................................. 59
APPENDIX C7: STEREOTYPE EXPOSURE ................................................................ 60
APPENDIX D: DEBRIEFING FORM............................................................................. 61
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List of Tables
Page
Table 1: Summary of Past Research ...............................................................................27
Table 2: Means and Standard Deviations on Demographic Variables in NE and
Control Groups…………………………….…………………………………………..29
Table 3: Mean and Standard Deviations on Self-Report Memory Measures in NE and
Control Groups…………………………..…………………………………………….30
Table 4: Mean and Standard Deviations on Objective Cognitive Measures in NE and
Control Groups ………………………………………………………………………..31
Table 5: Correlation of Stereotype Agreement and Self-Report and Objective Memory
Results in Control and NE group……………………….................................................32
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List of Figures
Page
Figure 1: Experimental Order .........................................................................................33
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Introduction
A well-known stereotype about pregnancy is a decrease in cognitive abilities (e.g.
Parsons & Redman, 1991), including forgetfulness, reading difficulties, confusion,
disorientation, memory, absent-mindedness and poor concentration (e.g. Casey et al.,
1999; Crawley et al., 2003; Poser, 1986; Janes et al., 1999). In fact, this stereotyped
phenomenon has been labeled with names such as “porridge brain”, “placenta brain”, and
“mammy brain” (Brett & Baxendale, 2001). Even well-known pregnancy books such as
What to Expect When You’re Expecting warn pregnant women about cognitive
difficulties during pregnancy (Burgoyne, 1994; Parsons & Redman, 1991). Early research
on memory difficulties during pregnancy was anecdotal. Two female physicians
documented their own cognition during pregnancy and reported problems, most markedly
in concentration and a major decline in ability to express themselves verbally (Baildamn,
1991; Burgyne, 1994). Yet, for a stereotype that is so common among pregnant women,
there is not conclusive evidence of cognitive impairment in pregnancy.
Consistent with the stereotype, pregnant women frequently self-report cognitive
problems in pregnancy, including forgetfulness, concentration, and divided attention as
problems (Casey, Huntsdale, Angus, & Janes, Casey, Huntsdale, & Angus 1999; Crawley
et al., 2003; Parsons & Redman, 1991; Janes et al., 1999; Sharp, Brindle, Brown, &
Turner, 1993). When asked, 82% of women report perceiving changes in their cognitive
ability during pregnancy (Parsons & Redman, 1991). However, self-report measures are
not the best way to measure or accurately define mental capacity, because people are not
very good at estimating their own cognitive abilities (Hermann, 1984).
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Research in the last two decades shows a serious discrepancy between subjective
findings and objective testing of cognitive changes in pregnancy. Several of these studies
were longitudinal in nature, and identified declines in processing speed and verbal
memory in the second and third trimester that improved post pregnancy (DeGroot,
Hornstra, Roozendaal, & Jolles, 2006; Keenan et al., 1998; Mickes, Wixted, Shapiro, &
Scarff, 2009; Rendell & Henry, 2008; Silber et al., 1990). However, other longitudinal
studies failed to find significant differences over trimesters and into the postpartum
period (Casey, Huntsdale, Angus, & Janes, 1999; Crawley et al., 2003). Furthermore,
even in the studies that found differences, the differences were often isolated to only one
of multiple tasks administered to the pregnant women. A number of cross sectional
studies have found relative deficits in pregnant women in implicit memory (Bringle et al.,
1991) and explicit memory performance (Buckwalter et al. 1999; Eidelman, 1993; Shartp
et al., 1993), relative to non-pregnant controls. Yet other cross sectional studies failed to
find differences between pregnant and non-pregnant groups (Casey, Huntsdale, Angus, &
Janes, 1999; Christensen, Poyser, Pollitt, & Cubis, 1999; Mc Dowall & Moriarty, 2000).
Similar to the longitudinal research, studies that did find differences between pregnant
and non-pregnant groups tended to find differences in only one or two of many tasks
administered. For example, Crawley, Grant, & Hinshaw (2008) administered 15 cognitive
tasks to pregnant and non-pregnant women in 2 studies, and found group differences on
only 2 of the measures. In all studies, pregnant participants reported experiencing more
cognitive problems than controls, yet even when relative cognitive weaknesses were
found on objective testing, the differences were not serious enough to place participants
in the subnormal performance range relative to test norms. Possible factors leading to
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inconsistent findings include limited sample sizes, focus on different periods of
pregnancy, and failing to exclude women with a history of prior head injury or
neurological health issues. The most consistent results of cognitive inefficiencies in
pregnancy have been reported in the second and third trimester and on tasks that require
both memory and executive functioning skills (often the most difficult tasks in a
cognitive battery; Henry & Rendell, 2007). Given these inconsistencies, it is important to
look at other variables that might lead to discrepancies in results.
Despite the fact that cognitive findings in pregnancy are inconsistent, some
researchers have speculated that biological mechanisms lead to cognition changes during
pregnancy. During the 2nd and 3rd trimester, where the most marked cognitive
deficiencies have been noted, there are extreme increases in estrogen, progesterone, and
glucocorticoids (Brett & Baxendale, 2001; Speroff et al., 1994). Non-pregnancy studies
have shown a relationship between better verbal and complex manual skills (Maccoby &
Jacklin, 1980) but worse performance on perceptual and spatial skills (Witkin et. al.,
1962), when estrogen and progesterone levels are high. One study found that when
women were administered doses of progesterone comparable to the level in pregnancy,
they exhibited impairment in paragraph recall (Phillips & Sherwin, 1992). Cortisol
studies have also shown that administration of cortisol at levels comparable to the level
people have in their body during a natural stressor leads to poorer performance on
declarative memory tasks (Newcomer et al., 1999). However, few studies have directly
examined the relationship of hormone changes to cognitive findings in pregnant samples.
In a longitudinal study, Buckwalter et al. (1998) found that blood hormones assayed
during last 2 months of pregnancy and at 2 months after delivery were not related to
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memory test findings. In another longitudinal study, Keenan et al. (1998) tracked
cognition and blood hormones during all three trimesters and one time postpartum.
Hormone levels were not related to memory test performance.
In addition to hormone changes, there are a number of other factors during
pregnancy that might affect cognition, such as pain, trouble sleeping, and depression.
Jacobson (2000) found few differences in sleep between pregnant women in different
trimesters, but did find that women reported sleeping more at the end of pregnancy. Sleep
deprivation studies have shown the negative influence of poor sleep on cognitive
performance, such as declines in executive attention, working memory, and higher
cognitive functions (Durmer & Dinges, 2005; Harrison & Horne, 2000; Kleitman, 1965;
Kribbs & Dinges, 1994). In addition to changes in sleep patterns, depression during
pregnancy has been reported as high as 20% (Gotlib et al., 1989). Meta-analyses indicate
decreased performance on cognitive tasks in those with depression (Burt et al., 1995;
Christensen, Griffiths, MacKinnon, & Jacomb, 1997). A number of studies have
postulated that depressed participants are unable to motivate themselves on cognitive
tasks or that they are more vulnerable to perceived failure than their non-depressed
counterparts (Channon, 1996; Channon & Green, 1999; Elliott, Sahakian, Herrod,
Robbins & Paykel, 1997; Elliott, Sahakian, McKay, Herrod, Robbins & Paykel, 1996).
Other theorists hypothesize that psychomotor retardation might play a role in cognitive
deficits seen in depression (Brebion, Smith & Widlocher, 1997; Hickie, Mason & Parker,
1996; Smith, Brebion, Banquet & Cohen, 1995). Despite these findings, studies of the
relation of sleep and depression to cognitive findings in a pregnant sample are few.
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One of the few studies to look at this topic was Buckwalter et al. (1998), who
examined depressive symptoms specific to pregnancy. Women showed significant
impairment on verbal memory during the last 2 months of pregnancy as compared to two
months after delivery. Women also reported more negative mood during this period as
well. However, they found that depressive symptoms were not related to cognitive
performance. Keenan et al. (1998) conducted the longitudinal study described above and
found that sleep loss, depression scores, and anxiety scores were not related to cognitive
performance. Further, Strothers (2008) found that depression was unrelated to cognitive
performance in a sample of pregnant women. Thus, depression has not shown a
consistent relationship to cognitive performance in pregnancy. Given that pregnancy
commonly leads to sleep disturbance, fatigue, and depression (Harris et al, 1996; Janes et
al., 1999; Kane et al., 1968), it is possible that the perception of cognitive problems in
pregnancy may be attributable to increased stressors and depression, rather than real
cognitive deficits.
In the present study, we proposed that stereotypes about cognition in pregnancy
could explain both self-reported cognitive problems and inconsistent cognitive findings in
the pregnancy literature. Negative stereotypes about cognition during pregnancy can lead
women to expect to perform in line with the stereotype or cause them to feel pressure to
disprove the idea of a deficiency. If this is the case, women would subjectively perform
more poorly if primed with the sterotype than if they were not primed (Crawley, Grant, &
Hinshaw, 2008; Kit, Tuokko & Mateer, 2008). This concept is generally known as
Stereotype Threat (Steele & Aronson, 1995). Steele and Aronson (1995, 1997) suggest
that negative expectations can compromise performance in individuals who are members
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of a group that is expected to underperform on a given task. When a person’s identity
such as race, gender, religion, age, or in this case pregnancy status, are attached to a
negative stereotype, that person tends to underachieve in a manner consistent with the
negative stereotype. Stereotype threat has been observed in neurological populations as
well. Suhr and Gunstad (2002, 2005) found that when participants with a history of mild
head injury were exposed to the stereotype of head injuries causing major impairment
cognition they performed worse on general tests of intellect and immediate and delayed
memory when compared to participants who had not been exposed to the stereotype. The
same trend was found in older adults, who performed more poorly on cognitive tests
when showed words related to negative stereotypes about aging (Levy, 1996; Levy &
Langer, 1994; Stein et al., 2002; Yoon et al., 2000). Exposure to negative stereotypes
about a participant’s given group can also physiologically increase cardiovascular
response to stress, which might be related to poorer performance on cognitive tasks
(Blascovich et al., 2001; Levy et al., 2000; Osborn, 2007; Vick et al., 2008).
Stereotype threat in pregnancy was first tested in a pilot study by Suhr & Nemitz
(2006), in which 24 pregnant women were randomly assigned to control or negative
expectation groups. The negative expectation group was placed in a stereotype threat
situation through disclosure that the study they were about to take part in was about
cognition during pregnancy. The control group was told the study was about health
experiences during pregnancy. Both groups received the same cognitive measures,
interspersed among questionnaires about health experiences and pain expectations in
pregnancy and delivery to disguise their purpose. In addition, two of the cognitive tasks
were disguised as pregnancy related (word list learning of pregnancy words, semantic
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fluency task of boy’s names). As expected, the negative expectation group scored
significantly worse on the word list learning task (effect size .65) and on a test of
semantic fluency (effect size .77). However, no group differences were found in
attention, working memory, or delayed recall.
The purpose of the present study was to replicate and expand on the pilot study
described above by including a larger sample, assessing both self-reported and actual
cognitive performance, checking to see if the stereotype manipulation was actually
effective, and also measuring whether participants had been previously exposed to
negative pregnancy stereotypes through their pregnancy reading, support groups, or
health care providers. We hypothesized that women in their second and third trimester of
pregnancy who were primed to negative expectations about cognition in pregnancy
would report more cognitive impairment than participants not exposed to the negative
expectations on cognitive tasks. In addition, we hypothesized that women exposed to the
negative stereotype would perform more poorly on cognitive tasks than pregnant women
not primed to the stereotype.
Method
Participants
Women in their second and third trimester were recruited to participate in this
study through posters displayed in doctors’ offices (see Appendix B), study information
e-mailed to faculty and female students at Ohio University, fliers handed out at local
pregnancy fairs, presentations at Lamaze and La Leche league meetings and local
pregnancy support groups in Athens County. Each participant was scheduled to
participate individually in a half hour session at their home or at the Clinical
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Neuropsychology Research Lab in Porter Hall on the campus of Ohio University.
Participants were required to be primary English-speakers, have uncomplicated
pregnancies, report no current or past drug or alcohol addiction, or head traumas, and be
in generally good health (i.e. not suffering from any metabolic, cardiovascular, renal,
psychiatric, or neurological disorders). A total of 47 women participated in the
experiment (24 controls, 23 experimental). However, data from one control participant
was excluded due to a prior head injury and an inability to read.
Procedure
Participants were assigned through a computerized randomization program to
either Negative Expectancy (NE) or control groups. Participants in the NE group were
told that the experiment was assessing cognitive difficulties experienced during
pregnancy, while the control group participants were told the experiment was assessing
health experiences during pregnancy (with no explicit mention of cognition). These
manipulations occurred during the reading of the informed consent forms (see Appendix
A).
After signing consent, participants in both groups completed self-report
questionnaires. The NE group was given a demographics questionnaire, followed by a
self-report questionnaire assessing cognitive symptoms. The control group was given the
same demographics questionnaire but then asked to complete a self-report questionnaire
that assessed the expectancies of pain during pregnancy, current depressive symptoms,
fatigue, and anxiety about motherhood (See Figure 1 for manipulation order). The goal of
the experimental order was to further emphasize the manipulation of stereotype
awareness for the NE group by drawing their attention to their cognitive abilities through
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questionnaires and tests at the beginning of the experiment, while minimizing awareness
of the true purpose of the study in the control group.
Following the questionnaires, both groups were administered a brief series of
cognitive tests (described below). Following the cognitive tests, the NE group completed
the pain, depression, fatigue, and anxiety about motherhood questionnaires, while the
control group completed the self-report cognitive symptoms questionnaire. Finally, both
groups were given a manipulation check at the end of their assessments.
At the conclusion of the study, each participant was given an oral and written
description of the full nature of the study. They were then asked not to share this
information with anyone who might participate in the study. Finally, each participant was
compensated $20 for their participation.
Measures
Word list learning task. This task was a variation of many common word list
learning tasks used in the memory literature and was used in the pilot study described
above (see Appendix C1). For the present experiment, participants were asked to recall a
list of pregnancy-related words over 5 trials, and then again after a 15-minute delay.
There is no psychometric data on the modified version of this task, although list learning
tasks have been well validated as measures of verbal learning and recall (Lezak, 2004).
Learning over trials, meaning the scores from the first three trials added together, was
used as the dependent variable in the present study.
Semantic Fluency task. This task was based on the Verbal Fluency subtest from
the Delis-Kaplan Executive Functioning System and assesses cognitive efficiency (Delis,
Kaplan & Kramer, 2001). Participants were asked on trial one to list as many boys’
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names as they could in one minute (see Appendix C3). On trial two they were asked to
list as many girls’ names as they could in one minute. The test-retest reliability
coefficient for the original task (boys’ names) is .81, with a retest interval of 25 ± 12.8
days (Delis, Kaplan & Kramer, 2001). Several studies have shown that semantic fluency
tasks are sensitive to general cognitive impairment in many neurological populations
(Delis, Kaplan & Kramer, 2001). The total number of words named, boys plus girls
names, was used as the dependent variable in the present study.
Demographics. This form provided basic information about the participants (see
Appendix C2).
Beck Depression Inventory-II. This instrument was used to screen for selfreported depressive symptoms. The Beck Depression Inventory is a well-validated selfreport measure of depressive symptoms (Beck et al., 1996). The test-retest reliability over
a 1 to 12 day period in non-psychiatric samples ranges from .82 to .93, and internal
consistency is .91 (Sprinkle et al., 2002). The Beck Depression Inventory has strong
concurrent validity with other clinical scales of depression such as the MMPI D-scale (r =
.75) and MMPI-PK scale (r = .72) (Conoley, 1992). It has also shown concurrent validity
to the Beck Hopelessness Scale (r = .68) and the Hamilton Psychiatric Rating Scale for
Depression (r = .71) (Beck, 1970).
Pain and pregnancy questionnaire. This survey was modified from existing
studies of pregnancy pain expectancies and was a replication of the form used for the
pilot study (see Appendix C4). The intent of this form was to veil the true purpose of the
present study and continue the manipulation of expectancy.
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Memory Assessment Clinics measures (MAC-S and MAC-Q). These
instruments are self-report memory scales (see Appendix C5). The MAC-S contains 51
items, which ask about the self-reported frequency of memory errors all measured on a
five-point Likert-type scale. The MAC-Q assesses change in memory from the past; for
our purposes, before pregnancy. The MAC-S and the MAC-Q correlate moderately (.41)
(Crook, Feher, & Larrabee, 1992). Internal consistency of the MAC-Q was calculated
based on Cronbach’s alpha at .57 (p < .001) (Crook, Feher, & Larrabee, 1992). The testretest reliability for the MAC-Q scales is adequate at .67 over a three week period
(Crook, Feher, & Larrabee, 1992). In the present study, the MAC-Q was totaled to reflect
the participant’s perceived change in memory ability in pregnancy as compared to before
pregnancy. The MAC-S was used as a measure of the participant’s current belief about
their memory ability. The internal consistency of the MAC-S was tested in the current
study and found to be .90, while the MAC-Q’s internal consistency was .78.
Manipulation Check. This measure asked participants to describe the purpose of
the study with an open ended question (“What was the purpose of this study, to the best
of your understanding?”). Their responses were coded later by two coders (consensus
coding) as indicating the primary purpose was 1) health experiences during pregnancy, 2)
pain during pregnancy, 3) cognition/memory during pregnancy, 4) mood during
pregnancy, or 5) other (see Appendix C6).
Measure of prior exposure to stereotype. At the end of the study, participants
were asked if they had heard any pregnancy and cognition stereotypes prior to enrollment
in the study (see Appendix C7). If yes, participants were asked to specify if the
stereotypes suggested whether memory would improve or decline. They were also asked
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where they had heard about the stereotype, how often they heard it, and how much they
believed the stereotype was true. This data was used to measure the prevalence of
stereotype knowledge in the sample and whether this might be a confound for the
expectancy manipulation.
Results
Demographics
Means and standard deviations for age, education, and weeks pregnant can be
found in Table 2. Pregnant women in the NE group were not different in age, t(44)= .00,
p = 1.00, depression, t(44)= 1.19, p = .23, education level, t(44)= -.58, p = .56, or number
of weeks pregnant, t(44)= .75, p = .45, from the control group. Only four participants
were of non Caucasian descent, two per group.
Self-Report Measures
All hypotheses were directional and thus were tested using one tailed t-tests.
Please see Table 3 for a table of all the self-report means and standard deviations.
Pregnant women in the NE group self-reported significantly higher perceived deficiencies
in current memory compared to controls, t(44)=1.67, p = .048, one-tailed. Pregnant
women in the NE group tended to self-report higher perceived changes in memory
relative to pre-pregnancy ability as compared to controls, although this difference was not
significant, t(44)=1.16, p = .13, one-tailed.
Objective Cognitive Findings
Contrary to hypotheses, pregnant women in the NE group were not significantly
lower in words remembered from a word learning task as compared to controls, t(44)= 1.01, p = .16, one-tailed. Pregnant women in the NE group were not significantly lower
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on number of names produced in a semantic fluency task compared to controls, t(44)=
.31, p = .38, one-tailed.
Exploratory Analyses
Given that the second hypothesis was not supported by the data, we explored
whether the stereotype manipulation was effective. All but 2 of the 46 participants
reported knowing the study was testing memory on the manipulation check measure. We
also explored whether the groups had premorbid awareness of negative cognitive
stereotypes in pregnancy. All but one of the 46 participants reported being aware of the
negative cognitive stereotype. Thus, findings suggest that both groups came into the
study highly aware of the negative cognitive stereotypes and that the control group was
aware the study was assessing memory, which might explain the lack of group
differences.
The two groups weren’t different in their agreement with negative pregnancy
stereotypes about cognition, (NE group M = 3.00, SD = 1.04, control group M = 3.18, SD
= 1.05, t(44)= -.58, p = .56, two tailed). Given these results, we conducted an exploratory
analysis to see whether belief in the stereotype correlated with cognitive performance,
separately by group. We speculated that, if there was some contribution of stereotype
threat to cognitive performance, belief in the stereotype would be related to poorer
performance only in the group exposed to the negative expectation manipulation. Please
see Table 5. In the control group, agreement with pregnancy cognition stereotypes was
not related to cognitive performance on either task. In the NE group, agreement with
pregnancy cognition stereotypes was not significantly correlated with the cognitive tasks,
but the direction of effect was opposite that of the control group, consistent with our
21
speculations. Because these correlations were in the opposite direction, differences
between the correlations were tested using Fisher’s r-to-z. The difference between the
two groups’ correlations on the list learning task trended toward significance, z(44).98, p
= .16 (two tailed), as did the difference between the two groups’ correlations on the
naming task, z(44)1.4, p = .10, two tailed.
As stated above, the groups also did not differ on level of depression. However,
there were a fair number of people in both groups who were over the clinical threshold
for mild depression on the BDI (9 NE and 7 control). Given that depression has been
linked to poor cognitive performance as well as decreased motivation in prior research, as
reviewed above, we analyzed the data to explore if participants with different levels of
self-reported depression would react differently to stereotype threat. We split participants
into high depression and low depression groups based on a score of 16 on the BDI. In the
NE group 9 were assigned to high depression and 7 in low depression. In the control
Group 7 were in high depression while 9 were in low depression. We then conducted a
series of 2 by 2 ANOVAs (depressed, nondepressed; NE, control) on the list learning
task, semantic fluency task, and both self report memory measures (MAC-S and MACQ).
A significant interaction was found between depression and experimental group
on the list learning task F(1,42) = 4.22, p = .05. Follow-up t-tests showed that, among the
depressed participants, there was no difference in list learning scores between the two
experimental groups (NE M = 26.11, SD = 2.31, controls M = 25.00, SD = 2.00, t(14)=
1.0, p = .32, two tailed). However, among the non-depressed individuals, participants in
the NE group performed significantly worse than controls (NE M = 23.86, SD = 2.74,
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controls M = 25.62, SD = 1.78, t(28) = -2.12, p = .05, two tailed). For semantic fluency,
there was no significant interaction, F(1, 42) = .00, p = .99, and no significant main effect
for depression, F(1, 42) = .05, p = .83, or experimental group, F(1, 42) = .09, p = .72.
For self-report measures, no interaction was found between depression and
experimental group on the MAC-Q, F(1,42) = .00, p = .952. However, the main effect of
depression was significant, F(1, 42) = 7.08, p = .01, with high depressed participants
reporting more change in cognition over pregnancy than low depressed participants. No
significant interaction was found between depression and experimental group on the
MAC-S, F(1, 42) = 3.31, p = .08, and the main effects of depression, F(1, 42) = 1.35, p =
.25, and experimental group, F(1, 42) = .99, p = .33, were not significant.
Discussion
The purpose of the present study was to replicate and extend the findings of Suhr
& Nemitz (2006) with a larger sample, the addition of a manipulation check, and to
measure and identify previous exposures to negative pregnancy stereotypes. The present
results partially supported the first hypothesis, that pregnant women primed to negative
expectations (NE) about cognition in pregnancy would report more cognitive impairment
than participants not exposed to the negative expectations. Participants in the NE group
self-reported significantly higher perceived deficiencies in current memory based on the
MAC-S. Further, as tested by the MAC-Q, pregnant women in the NE group tended to
self-report higher perceived changes in memory during pregnancy as opposed to before
pregnancy compared with women in the control group, although the difference was not
significant. One reason for the lack of findings on the MAC-Q might be its lower
internal consistency, which makes that scale less reliable than the MAC-S. In addition,
23
the power of this analysis was only .32. It would have taken 196 participants per group
to reach a significance of .05.
The present results did not support the second hypothesis that women exposed to
NE would perform more poorly on cognitive tasks than those who were not primed.
Pregnant women in the NE group did not perform significantly worse on the word list
learning task as compared to control women, nor did their results significantly differ in
number of names produced in a semantic fluency task. These results suggest that, in this
sample, stereotype threat did not significantly contribute to differences in cognition
during pregnancy. Although, a potential reason for the negative findings is the small
sample size. However, the list learning task had a power of .26 and semantic fluency had
a power of .09. To reach a significance of .05, it would have taken 282 participants per
group based on the list learning task and 2,544 participants per group based on the
semantic fluency task. Thus, the non-significant results were not due to a small sample
size but more likely due no effect of stereotype threat.
Another reason for the lack of support for the cognitive performance hypothesis
might be that the tasks used in the study were not difficult. There is some evidence that
stereotype threat effects are stronger when cognitive tasks are more difficult (Neuville &
Croizet, 2007; O’Brien & Crandall, 2003; Stricker & Bejar, 2004), although that evidence
is mixed (Nguyen & Ryan, 2008).
Another potential reason for the negative findings is that, regardless of which
group they were in, all participants except two correctly reported that they believed the
study’s purpose was to measure cognition during pregnancy. Additionally, all but one
participant reported being aware of the stereotypes about cognition in pregnancy prior to
24
participation in the study. Thus the manipulation of stereotype salience was likely
ineffective in the present study. During the half-hour testing session, a disproportionately
large amount of the time was spent on cognitive tasks. Tasks meant to conceal the true
purpose of the study, including the Beck Depression Inventory and the Pain and
Pregnancy Questionnaire, consumed considerably less time than the cognitive measures.
Through exploratory post hoc analysis, we investigated the relationship between a
belief in the stereotype and participants’ objective cognitive results. In the control
condition, we found that agreement with the pregnancy stereotype was unrelated to
cognitive performance. However, in the NE, as belief in the stereotype increased,
performance on both cognitive tasks decreased, although the correlations were not
significant. Interestingly, these findings are in contrast to Steele’s (1998) contention that
belief in the stereotype should not influence vulnerability to stereotype threat. However,
the findings are consistent with the idea that identification with the stereotype may
enhance the effect of stereotype threat (Nguyen & Ryan, 2008). These preliminary
findings suggest that future research should examine participant’s belief in the pervasive
negative stereotypes about cognition in pregnancy. However, these results are entirely
speculative and should be followed up with larger samples of pregnant women in future
research.
In another exploratory analysis, we explored the role of depression. Past research
has shown that depression is related to decreased performance on cognitive tasks (Burt et
al., 1995; Christensen, Griffiths, MacKinnon, & Jacomb, 1997). Exploratory analyses
showed that, among depressed participants, the two experimental groups did not perform
differently on list learning, but among non-depressed individuals, participants in the NE
25
group performed significantly worse than controls. Thus, it is possible that participants
with moderate to severe depression are not further affected by the weak stereotype threat
manipulation, because, due to their depression, they already expect to perform poorly.
There are, however, some limitations to these findings. First, the BDI- II was given at
different times for each experimental group. The control group was given the BDI-II as
the third task, before the cognitive tasks, while the NE group was given the BDI- II as the
sixth task, after the cognitive tasks. It is possible that the experimental order could have
played a role in the way people reported their depressive symptoms. These findings,
while interesting, are speculative and should be followed up with a larger sample
including depressed and non-depressed women. However, it does suggest the stereotype
effect is more influential in those who don’t already have negative expectations.
Results of the present study may not generalize to pregnant women generally,
because most participants were college-educated Caucasians. Furthermore, exclusionary
criteria specified participants were to be primary English-speakers, have uncomplicated
pregnancies, report no current or past drug or alcohol addiction, no past head traumas,
and be in generally good health. Thus the sample was likely very healthy pregnant
women, and perhaps inclusion of a more diverse sample with regard to health or mental
health issues (such as depression) would yield different results.
Future exploration of this study’s hypotheses should seek to better conceal the
true purpose of the study from the control participants, as well as seek out a new measure
of memory change to replace the MAC-Q. For example, Levy (1996) successfully used
subliminal priming of older adults with negative stereotypes of memory in aging, thus
finding stereotype threat effects on memory performance even though participants were
26
unaware of their exposure to negative stereotype words and phrases. Future studies may
also explore reasons for the effect of negative stereotypes on both self-report and
cognitive performance, such as physiological arousal and cardiovascular reactivity
(Blascovich et al., 2001; Levy et al., 2000; Osborn, 2007; Vick et al., 2008).
Should future studies provide more consistent evidence of self-reported cognitive
difficulties as in the present study or cognitive differences as in Suhr & Nemitz (2006), it
would be important to consider the impact of the findings on pregnant women’s care
during pregnancy. Participants in this study indicated pregnancy preparation books such
as What to Expect When Your Expecting, doctors, friends, movies, and other pregnant
women were sources from which they learned about the poor memory performance in
pregnancy. However, this is inconsistent with the cognitive test data from prior studies
and from the present data; none of the pregnant women in the current study scored in an
impaired range. Providing women with accurate information with regard to memory
performance in pregnancy could minimize a potential impact of the negative stereotype
on their pregnancy experience.
27
Table 1
Summary of Past Research
Author,
Year
Bringle,
1991
#PG/
CT
32/9
Sample
Description
1st and 2nd PG
Control
Description
Matched
Compared on
Results
Stem completion, Photo recall, List recall
1st PGN impaired implicit memory as
compared to 2nd PGN and CT.
None
Test of Nonverbal Intellignence, CVLT,
Boston Naming Test, Digit Span, Trail
Making, Stroop
Shipley Institute of Living Scale, Digit
span
PG impaired in verbal memory before
birth versus PP
Shipley Institute of Living Scale, Digit
span, Sentence recall, Category listing
task
Recall task, Dot probe, Stem completion
No difference between groups
Buckwalte
r, 1999
25/0
Casey,
1999
44/4
5
Uncomplicated PG,
tested 20 days prior
& 26 days PP
22- 1st PG 22-2nd
PG
Casey,
2000
18/1
0
Started testing in 1st
TRI
Christense
n, 1999
52/3
5
21 2nd TRI, 31 3rd
TRI all over age 27
Childless women
over age 27
Crawley,
2003
Crawley et
al, 2008
15/1
4
50/2
5
Test 2, 3, 6 wks and
1 yr PP
25 2nd tri, 25 3rd tri,
25 control
Matched
Stroop, Trail Making, Text memory
No difference between groups.
Matched
Immediate and delayed memory,
Language processing speed, prospective
memory, attention
DeGroot
et al, 2003
71/5
7
1st trimester
Matched
DeGroot
et al, 2006
57/5
0
Matched
Eidelman,
1993
100/
20
Tested 14, 17, 29,
and 36 week of PG
and 32 wks PP
All PP
Verbal learning, fluency task, concept
shifting test, stroop, letter-digit
sequencing
Concept shifting test, Stroop, Letter digit
substitution test, Visual verbal word
learning task
Logical Memory and Visual
Reproduction of Wechsler Memory Scale
Nonpreg completed more speed
comp.items, 3rd tri slower than 2nd tri and
controls on visual elevator task, No
difference on all other tasks
Preg group lower on verbal and fluency
tasks but not significant difference
Harris et
al., 1996
20/2
0
Started testing in
last 3 mo of PG, 48
hours after delivery
and 4 wks after
delivery
22-NPG w/ kids,
23-NPG w/o
kids
Matched
NGP, 3rd TRI
risk PG, and new
dads
Matched
working and long-term memory,
information processing, subjective
memory, and mood states, to investigate
their relationship with any cognitive
changes
No differences.
PG better than CT on PG-related stems
Impaired processing speed in early PG, PG
had lower list learning scores
PP lower than NPG on first day PP. High
risk PG lower than NPG on Logical
Memory.
PG lower scores on digit symbol and
paced auditory serial addition tests 48 hrs
after delivery. No differences between the
groups on logical memory, trail making, or
letter cancellation tasks.
28
1st time PG, Never
PG, & Had 1st child
in the last year.
2nd and 3rd TRI
Janes et
al., 1999
20/2
0
Keenan et
al., 1998
10/1
0
McDowall
et al.,
2000
Mickes et
al, 2009
Rendell &
Henry,
2008
Sharp,
1993
16/1
6
8= 1st PG, 8=2nd PG
37/0
tested during & post
pregnancy
3rd TRI
None
Verbal list learning and memory
List learning significantly worst during PG
Matched
Prospective Memory
48/1
9
All TRI, Both 1st
and 2nd time PG
Matched
Silber,
1990
20/2
0
Tested 5 times.
Begin at the end of
PG.
Matched
Word-stem, Incidental recall, Repeated
recognition of words and photography,
Object recall
Benton Visual Retention, Associate
Learning Test, Simple Reaction Time
Test, Pattern Memory Test, Late Recall
Test
Boston naming, Letter number
sequencing, Digit span
PG impaired in naturalistic measures but
not laboratory measures of prospective
memory
PG impaired on list recall
20/2
0
Matched
Implicit, Explicit, & Working Memory
Matched
Word Stem , NAART, WAIS
vocabulary, Logical Memory, California
discourse memory test
Word fragment, Semantic cue recall
8 no kid, 8 w/
kid
No difference on implicit or explicit
memory. PG impaired on working
memory as compared to CT.
PG decline in verbal memory from from
2nd to 3rd TRI as compared to controls.
No difference between groups
PG improved compared to CT from 3 to 6
and 12 month after PGN.
Between 2nd & 3rd TRI acceleration in
delayed recall & delay on letter number
sequencing.
Note:PP=postpartum,PG=pregnant,CT=controls,PGN=pregnancy,NPG=nonpregnant,TRI=trimester,MTH=matchedforageandeducation,
MEM=memory
Strothers,
2008
52/0
Repeated measures
1st, 2nd, & 3rd TRI
None
29
Table 2
Means and Standard Deviations for Negative Expectancy and Control groups on Age,
Depression, Education, Stereotype Agreement, and Weeks Pregnant
Negative Expectancy
(n=23)
Control (n=23)
M (SD)
M (SD)
Age
27.65 (3.93)
27.65 (3.66)
Depression
13.78 (5.89)
11.78 (5.47)
Education
16.96 (1.55)
17.30 (2.40)
Weeks Pregnant
24.64 (7.53)
23.00 (7.26)
30
Table 3
Means and Standard Deviations of Negative Expectancy and Control Groups on Self
Report Measures
Current Memory Difficulty,
Memory Assessment ClinicsS (MAC-S)
Change in Memory,
Memory Assessment
Clinics-Q
(MAC-Q)
Note: *p < .05.
Negative Expectancy
(n=23)
M (SD)
34.22 (14.27)*
Control
(n=23)
M (SD)
27.35
(13.20)*
Effect
Size
r
0.24
13.57 (2.83)
12.59 (2.82)
0.21
31
Table 4
Mean and Standard Deviations of Negative Expectancy and Control Groups on Word
List Learning and Semantic Fluency
Negative Expectancy (n=23) Control (n=23)
Effect Size
M (SD)
M (SD)
r
Word List Learning
24.74 (2.77)
25.43 (1.83)
-0.15
Semantic Fluency
43.57 (8.54)
42.83 (7.73)
0.05
32
Table 5
Summary of Correlations between Stereotype Agreement and Cognitive Variables in Both
Groups
Measure
List Learning
Semantic Fluency
Control Group (n=23)
r (p)
-.09 (.70)
.19 (.41)
Negative Expectancy (n=23)
r (p)
-.38 (. 08)
-.25 (.26)
33
Figure 1.
Experimental Order
Control Group
1. Demographics
2. Pain
Questionnaires
3. Beck
Depression
Inventory
4. Word List
Learning
Task &
5. Semantic
Fluency
Task
6. Memory Assessment
Center- Self-Report &
Questionnaire
7. Manipulation Check
8. Measure of
Stereotype exposure
Negative Expectation Group
1. Demographics
6. Memory
Assessment
CenterSelf-Report &
Questionnaire
4. Word List
Learning Task &
5. Semantic
Fluency Task
2. Pain Questionnaires
3. Beck Depression
Inventory
7. Manipulation check
8. Measure of Stereotype
exposure
34
References
Alderson, A., & Novack, T. (2002). Neurophysiological and clinical aspects of
glucocorticoids and memory: a review. Journal of Clinical and Experimental
Neuropsychology, 24(3), 335-355. doi:10.1076/jcen.24.3.335.987
Baildam, E. (1991). Doctor as mum. British Medical Journal, 303, 424.
doi:10.1136/bmj.303.6799.424
Beck, A. (1970). Depression: Causes and Treatment. Philadelphia: University of
Pennsylvania Press.
Beck, A., Steer, R., & Brown, G. (1996). Beck Depression Inventory, 2nd ed. San
Antonio, TX: The Psychological Corporation.
Beck, A., Steer, R., & Carbin, M. (1988). Psychometric properties of the Beck
Depression Inventory: Twenty-five years of evaluation. Clinical Psychology
Review, 8(1), 77. doi:10.1016/0272-7358(88)90050-5
Blascovich, J., Spencer, S., Quinn, D., & Steele, C. (2001). African Americans and high
blood pressure: The role of stereotype threat. Psychological Science, v. 12, 3,
2001, p. 225-229. doi:10.1111/1467-9280.00340
Brebion, G, Smith, M. J. & Widlocher, D. (1997). Discrimination and response bias in
memory: Effects of depression severity and psychomotor retardation. Psychiatry
Research, 70, 95-103.
Brett, M., & Baxendale, S. (2001). Motherhood and memory: A review.
Psychoneuroendocrinology, 26, 339-362. doi:10.1016/S0306-4530(01)00003-8
35
Brindle, P., Brown, M., Brown, J., Griffith, H., & Turner, G. (1991). Objective and
subjective memory impairment in pregnancy. Psychological Medicine, 21, 647653. doi:10.1017/S0033291700022285
Buckwalter, J., Stanczyk, F., McCleary, C., Bluestein, B., Buckwalter, B., Rankin, K., et
al. (1999). Pregnancy, the postpartum and steroid hormones: Effects on
cognition and mood. Psychoneuroendocrinology, 24, 69-84. doi:10.1016/S03064530(98)00044-4
Burgoyne, T., (1994). The brain drain. Nursing Standard, 8, 44. PMid:8038074
Burt, D., Zembar, M., & Niederehe, G. (1995). Depression and memory impairment: a
meta-analysis of the association, its pattern, and specificity. Psychological
Bulletin, 117, 285-305.
Casey, M., MacDonald, P., Sargent, I., & Starkey, P. (1993). Placental endocrinology. In:
Redman, C.W.G., (Ed.) The Human Placenta, 237-272. Oxford: Blackwell
Scientific Publication.
Casey, P., Huntsdale, C., Angus, G., & Janes, C. (1999). Memory in pregnancy II:
Implicit, incidental, explicit, semantic, short term, working, and prospective
memory in primigravid, multigravid, and postpartum women. Journal of
Psychosomatic Obstetrics and Gynaecology, 20, 158–164.
doi:10.3109/01674829909075590
Channon, S. (1996). Executive dysfunction in depression: The Wisconsin Card Sorting
Test. Journal of Affective Disorders, 39, 107-114.
36
Channon, S. & Green, P. S. (1999). Executive function in depres¬ sion: The role of
performance strategies in aiding depressed and non-depressed participants.
Journal of Neurology, Neurosurgery and Psychiatry, 66, 162-171.
Christensen, H., Griffiths, K., MacKinnon, A., & Jacomb, P. (1997). A quantitative
review of cognitive deficits in depression and Alzheimer-type dementia. Journal
of the International Neuropsychological Society, 3, 631-651.
Christensen, H., Poyser, C., Pollitt, P., & Cubis, J. (1999). Pregnancy may confer a
selective cognitive advantage. Journal of Reproductive and Infant Psychology,
17(1), 7-25. doi:10.1080/02646839908404581
Cohen, R., Weingeriner, H., Smallberg, S., Pickar, D., & Murphy D. (1982). Effort and
cognition in depression. Archives of General Psychiatry, 145, 164-167.
Conoley, C. (1992). Review of the BDI (Rev. ed.). In J. J. Kramer & J. C. Conoley
(Eds.), Mental Measurements Yearbook (11th ed.). Highland Park, NJ: Gryphon.
Crawley, R., Grant, S., Hinshaw, K. (2008). Cognitive changes in pregnancy: Mild
decline or societal stereotype? Applied Cognitive Psychology, v. 22, 8, 11421162. doi:10.1002/acp.1427
Crook, T., & Larrabee, G (1990). A self-rating scale for evaluating memory in everyday
life. Psychology and Aging, 5, 48-57. doi:10.1037/0882-7974.5.1.48
Crook, T., & Larrabee, G. (1992). Normative data on self-rating scale for the evaluation
of memory in everyday life. Archives of Clinical Neuropsychology, 7, 41-51.
PMid:14589677
Crook, T., & Larrabee, G. (2002). Cognition in pregnancy and the first year postpartum.
Psychology and Psychotherapy: Theory, Research, and Practice, 76, 69-84.
37
Crook, T., Feher, E., & Larrabee, G. (1992). Assessment of memory complaint in ageassociated memory impairment: the MAC-Q. International Psychogeriatrics,
4(2), 165-176. doi:10.1017/S1041610292000991
Crawley, R., Dennison, K., & Carter, C. (2002). Cognition in pregnancy and the first
year post partum. Psychology and Psychotherapy: Theory, Research, and
Practice, 76, 69-84. doi:10.1348/14760830260569265
Crawley, R., Grant, S., & Hinshaw, K. (2008). Cognitive changes in pregnancy: Mild
decline or societal stereotype? Applied Cognitive Psychology, v. 22, 8, 2008,
1142-1162. doi: 10.1002/acp.1427
Cutler, S., & Hodgson, L. (1996). Anticipatory dementia: A link between memory
appraisals and concerns about developing Alzheimer's disease. The Gerontologist,
36(5), 657-664. PMid:8942109
Davey, D. (1995). Normal Pregnancy: Anatomy, Endocrinology and Physiology. In:
Whitfield, C.R., (Ed.) Dewhurst’s Textbook of Obstetrics and Gynecology for
Postgraduates, 5 edn. 87-108. Oxford: Blackwell Scientific Publications.
DeAngelis, T. (2008). Priming for a new roll. Monitor on Psychology, 39(8), 29-31.
Delis, D., Kaplan, E., & Kramer, J. (2001). The Delis Kaplan Executive Functioning
System. San Antonio, TX: Psychological Corporation.
DeGroot, R., Hornstra, G., Roozendaal, N., & Jolles, J. (2003). Memory performance,
but not information processing speed, may be reduced during early pregnancy.
Journal of Clinical and Experimental Neuropsychology, 25, 482-488.
doi:10.1076/jcen.25.4.482.13871
38
Dinges, D. (1992). Probing the limits of functional capability: the effects of sleep loss on
short-duration tasks. Sleep, Arousal, and Performance. Boston: Birkha.
Durmer, J., & Dinges, D. (2005). Neurocognitive consequences of sleep deprivation.
Seminar in Neurology. 25(1), 117-129. doi:10.1055/s-2005-867080
Eidelman, A., Hoffmann, N., & Kaitz, M. (1993). Cognitive deficits in women after
childbirth. Obstetrics and Gynecology, 81, 764-767. PMid:8469469
Eisenberg, A., & Murkoff, H. (1996). What to Expect When You’re Expecting. New
York, New York: Workman Publishing Company.
Elliott, R., Sahakian, B. X, Herrod, X X, Robbins, T. W & Paykel, E. S. (1997).
Abnormal response to negative feedback in uni¬ polar depression: Evidence for a
diagnosis specific impairment. Journal of Neurology, Neurosurgery and
Psychiatry, 63, 74-82.
Elliott, R., Sahakian, B. X, McKay, A. P., Herrod, X X, Robbins, T. W & Paykel, E. S.
(1996). Neuropsychological impairments in unipolar depression: The influence of
perceived failure on subsequent performance. Psychological Medicine, 26, 975989.
Ellison, K. (2005) The Mommy Brain: How Motherhood Makes Us Smarter. New York,
New York: Basic Books.
Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of
depressed mod during pregnancy and after childbirth. British Medical Journal.
323(4), 257-260. doi:10.1136/bmj.323.7307.257
39
Feehan, M., Knight, R., & Partridge F. (1991). Cognitive complaint and test performance
in elder patients suffering depression or dementia. International Journal of
Geriatric Psychiatry, 6, 287-293. doi:10.1002/gps.930060505
Fening, S., Levine, Y., Naisberg, S., & Elizur, A. (1987). The effect of trihexphenidyl
(artane) on memory in schizophrenic patients. Progress in neuropsychopharmacology and biological psychiatry, 11, 71-78. doi:10.1016/02785846(87)90033-9
Gotlib, H., Whiffen, V., Mount, J., Milne, K., & Cordy, N. (1989). Prevalence rates and
demographic characteristics associated with depression in pregnancy and the
postpartum. Journal of Consulting and Clinical Psychology, 57(2), 269-274.
doi:10.1037/0022-006X.57.2.269
Grut, M., Jorm, A., Fratiglioni, L., Forsell, Y., Vitanen, M., & Winblad, B. (1993).
Memory complaints of elderly people in a population survey- variation according
to dementia stage and depression. Journal of the American Geriatrics Society, 41,
1295–1300. PMid:8227910
Harris, N., Deary, I., Harris, M., Lees, M., & Wilson, J. (1996). Peripartal cognitive
impairment: Secondary to depression? British Journal of Health Psychology, 1,
127–136.
Hampson, E. (1990). Estrogen-related variations in human spatial and articulatory-motor
skills. Psychoneuroendocrinology, 15(2), 97-111. doi:10.1016/03064530(90)90018-5
40
Harrison, Y., & Horne, J. (2000). The impact of sleep deprivation on decision making: a
review. Journal of Experimental Psychology: Applied, 6, 236-249.
doi:10.1037/1076-898X.6.3.236
Heckhausen, J., Dixon, R., & Baltes, P. (1989). Gains and losses in development
throughout adulthood as perceived by different adult age groups. Developmental
Psychology, 25, 109-121. doi:10.1037/0012-1649.25.1.109
‡”›ǡǤƬ‡†‡ŽŽǡǤȋʹͲͲ͹ȌǤ”‡˜‹‡™‘ˆ–Š‡‹’ƒ…–‘ˆ’”‡‰ƒ…›‘‡‘”›
ˆ—…–‹‘ǤJournalofClinicalandExperimentalNeuropsychologyǡ˜Ǥʹͻ‹••—‡ͺǡ
’Ǥ͹ͻ͵ǦͺͲ͵Ǥ
Hermann, D. (1984). Questionnaires about memory. In J.E. Harris & P.E. Morris (Eds.),
Everyday memory, actions and absent-mindedness (133-151). London: Academic
Press.
Hertzog, C., & Hultsch, D. (2000). Metacognition in adulthood and old age. Handbook of
Aging and Cognition II (417-466). Mahwah, NJ: Erlbaum.
Hickie, I., Mason, C. & Parker, G. (1996). Comparative validity of two measures of
psychomotor function in patients with severe depression. Journal of Affective
Disorders, 12, 143-149.
Janes, C., Casey, P., Huntsdale, C., & Angus, G. (1999). Memory in pregnancy. I:
Subjective experiences and objective assessment of implicit, explicit and working
memory in primigravid and primiparous women. Journal of Psychosomatic
Obstetrics and Gynecology, 20, 80-87. doi:10.3109/01674829909075580
41
Kane, F., Harman, W., Keller, M., & Erving, J. (1968). Emotional and cognitive
disturbances in the early puerperium. British Journal of Psychiatry, 114, 99–102.
doi:10.1192/bjp.114.506.99
Keenan, P., Yaldoo, D., Stress, M., Fuerst, D., & Ginsburg, K. (1998). Explicit memory
in pregnant women, American Journal of Obstetrics and Gynecology, 179, 731737. doi:10.1016/S0002-9378(98)70073-0
Kimura, D. (1992). Sex differences in the brain. Scientific American, 267, 118-125.
doi:10.1038/scientificamerican0992-118
Kirschbaum, C., Wolf, O., May, M., Wippich, W., & Hellhammer, D. (1996). Stress and
treatment induced elevations of cortisol levels associated with impaired
declarative memory in healthy humans. Life Sciences, 58, 1475-1483.
doi:10.1016/0024-3205(96)00118-X
Kit, K., Tuokko, H., & Mateer, C. (2008). A review of the stereotype threat literature and
its application in a neurological population. Neuropsychology Review, v. 18 issue
2, 2008, p. 132-148. doi: 10.1007/s11065-008-9059-9
Kleitman, N. (1963). Sleep and wakefulness. Chicago: The University of Chicago Press.
Kribbs, N., & Dinges, D. (1994). Vigilance decrement and sleepiness. Sleep Onset
Mechanism 113-125. Washington, DC: American Psychological Association.
Levy, B. (1996). Improving memory in old age through implicit self-stereotyping.
Journal of Personality and Social Psychology, 71, 1092-1107. doi:10.1037/00223514.71.6.1092
42
Levy, B., & Langer, E. (1994). Aging free from negative stereotypes: Successful memory
in China and among the American deaf. Journal of Personality and Social
Psychology, 66, 989-997. doi:10.1037/0022-3514.66.6.989
Levy, B., Hausdorff, J., Hencke, R., & Wei, J. (2000). Reducing cardiovascular stress
with positive self-stereotypes of aging. Journal of Gerontology: Psychological
Sciences, 55B, 205–213.
Lezak, M. (2004). Neuropsychological Assessment. Oxford University Press Inc.
Lineweaver, T., & Hertzog, C. (1998). Adults' efficacy and control beliefs regarding
memory and aging: Separating general from personal beliefs. Aging,
Neuropsychology, and Cognition, 5, 264-296. doi:10.1076/anec.5.4.264.771
Lupien, S., Gaudreau, S., Tchiteya, B., Maheu, F., Sharma, S., Nair, N., et al. (1997).
Stress-induced declarative memory impairment in healthy elderly subjects:
Relationship to cortisol reactivity. Journal of Clinical Endocrinology and
Metabolism, 82, 2070-2075. doi:10.1210/jc.82.7.2070
Maccoby, E., & Jacklin, C. (1980). “Sex differences in aggression: A rejoinder and
reprise.” Child Development. 51, 964–980. doi:10.2307/1129535
McDowall, J., & Moriarty, R. (2000). Implicit and explicit memory in pregnant women:
An analysis of data-driven and conceptually driven processes. The Quarterly
Journal of Experimental Psychology A: Human Experimental Psychology, 53a
(3), 729-740. doi:10.1080/027249800410526
Mickes, Laura; Wixted, John T.; Shapiro, Alice; Scarff, J. Michael. The effects of
pregnancy on memory: Recall is worse but recognition is not. Journal of Clinical
43
and Experimental Neuropsychology, v. 31 issue 6, 2009, p. 754-761.
PMid:19105075
Millikin, C., Rourke, S., Halman, M., & Power, C. (2003). Fatigue in HIV/AIDS is
associated with depression and subjective neurocognitive complaints but not
neuropsychological functioning. Journal of Clinical and Experimental
Neuropsychology, 25, 201–215. doi:10.1076/jcen.25.2.201.13644
Mindell, J., & Jacobson, B. (2000). Sleep disturbances during pregnancy. Journal of
Obstetric, Gynecologic, & Neonatal Nursing, 29(6), 590-597. doi:10.1111/j.15526909.2000.tb02072.x
Munson, A., Mueller, J. & Yanonne, M. (1970). Free plasma 17 estradiol in normal
pregnancy, labor, and the puerperium. American Journal of Obstetrics and
Gynecology, 108, 340-344. PMid:5484592
Neuville, E. & Croizet, J. “Can salience of gender identity impair math performance
among 7-8 year old girls? The moderating role of task difficulty.” European
Journal of Psychology of Education, v. 22 issue 3, 2007, p. 307-316. doi:
10.1007/BF03173428
Newcomer, J., Selke, G., Melson, A., Hershey, T., Craft, S., Richards, K., &Alderson, A.
(1999). Decreased memory performance in healthy humans induced by stresslevel cortisol treatment. Archives of General Psychiatry, 56, 527-533.
doi:10.1001/archpsyc.56.6.527
Nguyen, H. & Ryan, A. (2008). Does stereotype threat affect test performance of
minorities and women? A meta-analysis of experimental evidence. Journal of
Applied Psychology, v. 93, 6, 1314-1334. doi: 10.1037/a0012702
44
Nott, P., Franklin, M., Armitage, C., & Gelder, M. (1976). Hormonal changes and mood
in the puerperium. British Journal of Psychiatry, 128, 379-383.
doi:10.1192/bjp.128.4.379
O'Brien, L. & Crandall, C. (2003) Stereotype threat and arousal: Effects on women's
math performance. Personality and Social Psychology Bulletin, v. 29, 6, 782-789.
doi: 10.1177/0146167203029006010
Osborne, j. (2007). Linking Stereotype Threat and Anxiety. Educational Psychology, v.
27, 1, 135 - 154.
Parsons, C., & Redman, S. (1991). Self-reported cognitive change during pregnancy.
Australian Journal of Advanced Nursing, 9, 20-29. PMid:1823795
Phillips, S. & Sherwin, B. (1992). Effects of estrogen on memory function in surgically
menopausal women. Psychoneuroendocrinology, 17(5), 485-495.
doi:10.1016/0306-4530(92)90007-T
Popkin, S., Gallagher, D., Thompson, L., & Moore, M. (1982). Memory complaint and
performance in normal and depressed older adults. Experimental Aging Research,
8, 141-145. PMid:7169071
Poser, C., Kassirer, M., & Peyser, J. (1986). Benign encephalopathy of pregnancy.
Preliminary clinical observations. Acta Neurological Scandinavia, 73, 39-43.
PMid:3953258
Poyser, C. (1998). Memory complaints and objective memory performance in first
pregnancy. Master of Science thesis submitted to the Australian National
University, Caberra.
45
Rendell, P., Henry, J. (2008). Prospective-memory functioning is affected during
pregnancy and postpartum. Journal of Clinical and Experimental
Neuropsychology, v. 30, 8, 913-919. doi: 10.1080/13803390701874379
Reyes, F., Winter, J. & Faiman, C. (1972). Pituitary-ovarian interrelationships during the
puerperium. American Journal of Obstetrics and Gynecology, 114, 589-594.
PMid:4673969
Roozendaal, B. (2002). Stress and Memory: Opposing effects of glucocorticoids on
memory consolidation and memory retrieval. Neurobiology of Learning and
Memory Retrieval, 78, 578-595. doi:10.1006/nlme.2002.4080
Sharp, K., Brindle, P., Brown, M., & Turner, G. (1993). Memory loss during pregnancy.
British Journal of Obstetrics and Gynecology. 100, 209-215. PMid:8476824
Sherwin, B. (1994). Estrogenic effects on memory in women. Annuals of the New York
Academy of Sciences, 743, 213-231. doi:10.1111/j.1749-6632.1994.tb55794.x
Sherwin, B., & Tulandi, T. (1996). “Add-Back” Estrogen reverses cognitive deficits
induced by gonadotropin-releasing hormone agonist in women with leiomyomata
uteri. Journal of Clinical Endocrinology and Metabolism, 61(7), 2545-2549.
doi:10.1210/jc.81.7.2545
Silber, M., Almkvist, O., Larsson, B., & Uvnas, M. (1990). Temporary peripheral
impairment in memory and attention and its possible relation to oxytocin
concentration. Life Science. 47, 57-65. doi:10.1016/0024-3205(90)90566-A
Smith, M. X, Brebion, G, Banquet, X P. & Cohen, L. (1995). Retardation of mentation in
depressives: Posner's covert orientation of visual attention test. Journal of
Affective Disorders, 35, 107-115.
46
Sprinkle, S., Lurie, D., Insko, S., Atkinson, G., Jone, G., Logan, A., & Bissada, N.
(2002). Criterion Validity, Severity Cut Scores, and Test–Retest Reliability of the
Beck Depression Inventory—II in a University Counseling Center Sample.
Journal of Counseling Psychology, 49(3), 381-385. doi: 10.1037//00220167.49.3.381
Steele, C., & Aronson, J. (1995). Stereotype threat and the intellectual test performance
of African Americans. Journal of Personality and Social Psychology, 69, 797811. doi:10.1037/0022-3514.69.5.797
Stein, R., Blanchard-Fields, F., & Hertzog, D. (2002). The effects of age stereotype
priming on the memory performance of older adults. Experimental Aging
Research, 28, 169-181. doi:10.1080/03610730252800184
Sternberg, D., & Jarvik, M. (1976). Memory function in depression. Archives of General
Psychiatry, 33, 219-224. PMid:1252098
Stricker, L. & Bejar, I. (2004). Test Difficulty and Stereotype Threat on the GRE General
Test. Journal of Applied Social Psychology, v. 34, 3, 563-597. doi:
10.1111/j.1559-1816.2004.tb02561.x
Strother, D. (2008). Pregnancy and cognition: Effects of nausea and mood. Dissertation
Abstracts International: Section B: The Sciences and Engineering Vol 69(1-B),
p.713.
Suhr, J., & Gunstad, J. (2002). “Diagnosis threat”: The effect of negative expectation on
cognitive performance in head injury. Journal of Clinical and Experimental
Neuropsychology, 24, 448-457. doi:10.1076/jcen.24.4.448.1039
Suhr, J., & Gunstad, J. (2005). Further Exploration of the Effect of “Diagnosis Threat” on
Cognitive Performance in Individuals with Mild Head Injury. Journal of the
47
International Neuropsychological Society. 11(1), 23-29.
doi:10.1017/S1355617705050010
Suhr, J., & Nemitz, J. (2006, February). Diagnosis threat and neuropsychological
performance in pregnancy. Annual meeting of the International
Neuropsychological Society, Boston, MA.
Vick, B., Seery, M., Blascovich, J., & Weisbuch, M. (2008). The effect of gender
stereotype activation on challenge and threat motivational states. Journal of
Experimental Social Psychology, v. 44, 3, p. 624-630.
doi:10.1016/j.jesp.2007.02.007
Wechsler, D. (1997). Wechsler Adult Intelligence Scale- 3rd edition administration and
scoring manual. San Antonio, TX: Psychological Corporation.
West, C., & McNeilly, A. (1979). Hormonal profiles in lactating and non-lactating
women immediately after delivery and their relationship to breast engorgement.
British Journal of Obstetrics and Gynaecology, 86, 501-506. PMid:476015
Wilkinson, R. (1969). Sleep deprivation: performance tests for partial and selective sleep
deprivation. Progress in Clinical Psychology, New York: Grune and Stratton, 2843.
Wilcox, D., Yovich, J., McCom, S., & Phillips, J. (1985). Progesterone, cortisol and
ocstradiol-17 beta in the initiation of human parturition: partitioning between free
and bound hormone in plasma. British Journal of Obstetrics and Gynaecology,
92, 65-71
Yoon, C., Hasher, L., Feinberg, R., Rahhal, T., & Winocur, G. (2000). Cross-cultural
differences in memory: The role of culture-based stereotypes about aging.
Psychology and Aging, 15, 694-704. doi:10.1037/0882-7974.15.4.694
48
Appendix A
Ohio University Consent Form
Title of Research: Health Experiences During Pregnancy
Researchers: Dr. Julie Suhr, Adrienne Isgrigg
You are being asked to participate in research. For you to be able to decide whether you
want to participate in this project, you should understand what the project is about, as
well as the possible risks and benefits in order to make an informed decision. This
process is known as informed consent. This form describes the purpose, procedures,
possible benefits, and risks. It also explains how your personal information will be used
and protected. Once you have read this form and your questions about the study are
answered, you will be asked to sign it. This will allow your participation in this study.
You should receive a copy of this document to take with you.
Explanation of Study
The purpose of this project is to study health experiences in pregnancy, specifically
the nature of cognitive changes (i.e., thinking and memory problems) that pregnant
women sometimes report as occurring during pregnancy. If you decide to
participate in the study, you will be asked to complete paper-and-pencil
questionnaires assessing your experiences of cognitive changes during pregnancy.
You will then complete a short series of cognitive test, primarily assessing memory
and processing speed. Finally, you will complete some questionnaires looking at
your current depressive symptoms and your experiences of and expectations for
pain during labor. Participation should take no more than one hour.
Risks and Discomforts
There are minimal risks associated with this project. Sometimes people are
uncomfortable answering questions about their experience of cognitive
problems, pain, or depression. If you are uncomfortable with any of the
questions, please let the examiner know.
Benefits
We hope that the results of the study will provide a better understanding of the
health experiences of pregnant women, and may help in designing interventions
to address some of their health concerns.
Confidentiality and Records
All data will be collected in a confidential manner. All data forms will record
only a participant identification number, which will not be connected to your
name or other identifying information in any way. This consent form will be
stored separately from that data. All data will be stored in a locked filing
cabinet in the locked research office of the Principal Investigator.
Additionally, while every effort will be made to keep your study- related information
confidential, there may be circumstances where this information must be shared
with:
49
Appendix A (continued)
Ohio University Consent Form
* Federal agencies, for example the Office of Human Research
Protections, whose responsibility is to protect human subjects in
research;
* Representatives of Ohio University (OU), including the
Institutional Review Board, a committee that oversees the research at OU;
Compensation
To compensate you for your time, you will be paid $20.
Participants
who complete only part of the study will only be compensated for the
part they complete (i.e., participants who stop halfway through would
be compensated 5 dollars).
Contact Information
If you have any questions regarding this study, please contact Dr. Julie Suhr,
593-1091, [email protected] or Adrienne Isgrigg, (740) 593-0910 or
[email protected].
If you have any questions regarding your rights as a research participant, please
contact Jo Ellen Sherow, Director of Research Compliance, Ohio University,
(740)593- 0664.
By signing below, you are agreeing that:
x you have read this consent form (or it has been read to you) and
have been given the opportunity to ask questions
x known risks to you have been explained to your satisfaction.
x you understand Ohio University has no policy or plan to pay for
any injuries you might receive as a result of participating in this
research protocol
x you are 18 years of age or older
x your participation in this research is given voluntarily
x you may change your mind and stop participation at any time
without penalty or loss of any benefits to which you may
otherwise be entitled.
Signature
Date________
Printed Name
Version Date: [insert
08/20/08]
50
Appendix A (continued)
Ohio University Consent Form
Title of Research: Health Experiences During Pregnancy
Researchers: Dr. Julie Suhr, Adrienne Isgrigg
You are being asked to participate in research. For you to be able to decide whether you
want to participate in this project, you should understand what the project is about, as
well as the possible risks and benefits in order to make an informed decision. This
process is known as informed consent. This form describes the purpose, procedures,
possible benefits, and risks. It also explains how your personal information will be used
and protected. Once you have read this form and your questions about the study are
answered, you will be asked to sign it. This will allow your participation in this study.
You should receive a copy of this document to take with you.
Explanation of Study
The purpose of this project is to study health experiences in pregnancy,
specifically pain experiences and expectations for pain during labor. If you
decide to participate in the study, you will be asked to complete paper-and-pencil
questionnaires assessing your experiences of current pain and your expectations
for pain during labor, as well as self-reported depressive symptoms. You will
also complete a short series of thinking and memory tasks and will also
complete self-report instruments assessing your sense of your cognitive skills.
Participation should take no more than one hour.
Risks and Discomforts
There are minimal risks associated with this project. Someti
mes people are uncomfortable answering questions about their experience of
pain, depression, or cognitive problems. If you are uncomfortable with any
of the questions, please let the examiner know.
Benefits
We hope that the results of the study will provide a better understanding of
the health experiences of pregnant women, and may help in designing
interventions to address some of their health concerns.
Confidentiality and Records
All data will be collected in a confidential manner. All data forms will record
only a participant identification number, which will not be connected to your
name or other identifying information in any way. This consent form will be
stored separately from that data. All data will be stored in a locked filing
cabinet in the locked research office of the Principal Investigator.
Additionally, while every effort will be made to keep your study- related
information confidential, there may be circumstances where this information
must be shared with:
Appendix A (continued)
51
Ohio University Consent Form
* Federal agencies, for example the Office of Human Research
Protections, whose responsibility is to protect human subjects in
research;
* Representatives of Ohio University (OU), including the
Institutional Review Board, a committee that oversees the research at OU;
Compensation
To compensate you for your time, you will be paid $20.
Participants
who complete only part of the study will only be compensated for the
part they complete (i.e., participants who stop halfway through would
be compensated 5 dollars).
Contact Information
If you have any questions regarding this study, please contact Dr. Julie Suhr,
593-1091, [email protected] or Adrienne Isgrigg, (740) 593-0910 or
[email protected].
If you have any questions regarding your rights as a research participant, please
contact Jo Ellen Sherow, Director of Research Compliance, Ohio University,
(740)593- 0664.
By signing below, you are agreeing that:
x you have read this consent form (or it has been read to you) and
have been given the opportunity to ask questions
x known risks to you have been explained to your satisfaction.
x you understand Ohio University has no policy or plan to pay for
any injuries you might receive as a result of participating in this
research protocol
x you are 18 years of age or older
x your participation in this research is given voluntarily
x you may change your mind and stop participation at any time
without penalty or loss of any benefits to which you may
otherwise be entitled.
Signature
Date
Printed Name
Version Date: [insert
08/20/08]
52
Appendix B
Sample Recruitment Flier
Pregnant?
Interested in helping science?
The psychology department at Ohio University
is conducting a study exploring health
experiences during pregnancy. Your
participation would take approximately one hour,
and you will complete several questionnaires and
paper and pencil tests. All information would be confidential.
Participation will be limited to the first 60 eligible women who contact the
lab.
As compensation for your time, all participants will be paid $20.
If you are
- Currently pregnant
- In your second or third trimester
- Between the ages of 19 - 34
- Have no other medical conditions or diagnoses
If you or someone you know is interested in participating, please contact
Adrienne Isgrigg (740) 593- 0910 or [email protected]
53
Appendix C1
Copy of Instruments
Cognitive Tests
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Pregnancy Research
Contact : [email protected]
7405930910
Word List Learning
ID NUMBER __________________
List A
1
2
3
List B
List A
Im med Recall
30’
Recall
(Don’t say words)
Baby___ ___ ___ Mother ___ Baby
___
Bottle___ ___ ___ Breast ___ Bottle ___
Diaper___ ___ ___ Crib ___ Diaper ___
Sleep ___ ___ ___ Stroller___ Sleep
___
Playpen___ ___ ___ Nurse ___ Playpen ___
Birth ___ ___ ___ Doctor___ Birth
___
Hospital___ ___ ___ Womb___ Hospital___
Pain
___ ___ ___ Labor ___ Pain
___
Carseat ___ ___ ___ Blanket___ Carseat ___
Stitches ___ ___ ___ Rattle ___ Stitches ___
TOTAL ___ ___ ___
Total over all trials
___
= ____
___
20’ DELAYED RECOGNITION (circle if correct, X if
incorrect)
BO T TLE Y
PAIN
Y
BABY
___
___
___
___
___
___
___
___
___
___
___
Y
54
BLANKET
SLEEP
RATTLE
STROLLER
DIAPER
DOCTOR
N
Y
N
N
Y
N
WOMB
N
CARSEAT Y
BREAST
N
PLAYPEN Y
CRIB
N
H OSPITAL Y
20 MIN TOTAL Y___ OF 10
POSITIVE___OF 10
LABOR
N
MOTHER
N
BIRTH
Y
NURSE
N
STITCHES Y
FATHER
N
TOTAL FALSE
Appendix C2
Copy of Instruments
Demographic Information Sheet
ID NUMBER__________________
EDUCATION__________
AGE__________
ETHNICITY___________________CURRENT EMPLOYMENT
STATUS_______________________
NUMBER OF WEEKS PREGNANT____________ ANTICIPATED DELIVERY
DATE_____________
HAVE YOU HA D A HEA D TRAUMA IN THE PAST? Y N
HAVE YOU SUFFERED FROM EPILEPSY OR A BRAIN TUMOR? Y
HAVE YOU EXPERIENCED COMPLICATIONS DURING YOUR
PREGNANCY?
Y
N
D O YOU NOW OR HAVE YOU EVER HA D A DRUG OR ALCH OL
PROBLEM?
Y
N
GROUP ASSIGNMENT
NE
CONTROL
WORD LIST TASK TRIAL 1____ 2____ 3____ LIST B____ IR____ DR____
RECOG____ FP_____
WORD FLUENCY TASK (TOTAL WORDS) _____
MAC- S_______________
BDI____________________
MAC- Q_______________
N
55
CURRENT PAIN__________ CURRENT FATIGUE________
SLEEP________
CURRENT
Appendix C3
Copy of Instruments
Cognitive Tests
SEMANTIC FLUENCY TASK
ID NUMBER_____________
I WOULD LIKE YOU TO NAME, AS QUICKLY AS YOU CAN, ALL THE BOY’S
NAMES THAT YOU CAN THINK OF. YOU WILL HAVE 1 MINUTE TO THINK
OF AS MANY AS YOU CAN. READY, BEGIN.
TOTAL NUMBER OF WORDS____________________________
THIS TIME, I WOULD LIKE YOU TO NAME, AS QUICKLY AS YOU CAN, ALL
THE GIRL’S NAMES THAT YOU CAN THINK OF. YOU WILL HAVE 1 MINUTE
TO THINK OF AS MANY AS YOU CAN. READY, BEGIN.
56
TOTAL NUMBER OF WORDS____________________________
Appendix C4
Copy of Instruments
Pain and Pregnancy Questionnaire
ID NUMBER__________________
HEALTH AND PREGNANCY QUESTIONNAIRE
1. HAVE YOU CHANGED YOUR DIET DURING YOUR PREGNANCY?
NO
YES
2. DO YOU TAKE MULTIVITAMENS TO SUPLAMENT YOUR DIET?
NO
YES
3. HOW MANY HOURS OF SLEEP DO YOU GET A NIGHT?
0-4
5 - 6 7 - 8 9 - 10 11 +
4. AT WHAT TIME DO YOU NORMALY GET UP IN THE MORNING?
BEFORE 5AM 5 7911AM OR AFTER
6AM
8AM
10AM
5. HOW MANY TIMES IN A NIGHT DO YOU WAKE?
0
1-2 3-4 5+
6. HAVE YOU EXPERENCED A CHANGE OF SLEEP DURING YOUR PREGNANCY?
NO
YES IF YES, ARE YOU GET TING MORE OR LESS___________
7. ARE YOU IN PAIN TODAY?
NO
YES IF YES, PLEASE RA TE BETWEEN 1 - 10 (1 = LOW
10 = HIGH)________
8. HOW PAINFUL DO YOU EXPECT YOUR LABOR TO BE? (PLEASE CHECK)
NO PAIN
UNNO TICEABLE
MILD
MO DERA TE
STRONG
SEVER
9. HOW NERVOUS OR ANXIOUS ARE YOU ABOUT LABOR PAIN? (PLEASE
CHECK)
NO T AT ALL
MILDLY
MO DERA TE
STRONGLY SEVERLY
10. WHAT LEVEL OF CONTROL DO YOU THINK YOU WILL HAVE OVER YOUR
LABOR PAIN?
COMPLETE
HIGH
MO DERA TE
FAIRLY LOW PO OR
NONE
57
11. PLEASE RATE YOUR CURRENT LEVEL OF DAILY FATIGUE
UNNO TICEABLE MILDLY
MO DERA TE STRONGLY HIGHLY SEVERELY
12. WHAT PAIN COPING STRATEGIES DO YOU PLAN TO USE DURING DELIVERY? (CIRCLE ALL
THAT APPLY)
BREATHING TECHNIQUES
DISTRACTION
EPIDURAL
RELAXATION
NITROUS OXIDE
PHYSICALLY MOVING AROUND
NARC O TICS
NO PLANS T O USE ANY STRATEGIES
MEDITATION
O THER(DESCRIBE)_
Appendix C5
Copy of Instruments
Self-report Rating of Current Cognitive Abilities
ID NUMBER_______________
MAC- S
PLEASE RATE HOW OFTEN YOU DO THE FOLLOWING THINGS:
Very
SomeVery
HOW OFTEN DO YOU…
Often
Often
times
Rarely
Rarely
Go into a room to get something and forget what
you are after?
Forget to bring up an important point you had
intended to mention during a conversation?
Forget that you told someone something and tell
them again?
Have difficulty recalling a word you wish to use?
Have to stop and think when distinguishing left
from right?
Forget an entire event, such as attending a party
or having a visitor?
Miss the point someone else is making during a
conversation?
Feel that a word or name you want to remember is
‘on the tip of your tongue’ but cannot be recalled?
Forget the name of a familiar object?
Call someone you recently met by the wrong
name?
Fail to remember a name or word when trying, but
recall it later?
Dial a number and forget whom you were calling
before the phone is answered?
Forget an appointment or other event that is very
important to you?
Take a surprisingly long time to recall a fact that
you know quite well (and do eventually
remember)?
Have difficulty following a conversation when there
are distractions in the environment such as noise
from a TV or radio?
Forget which waiter took your order in a
restaurant?
Have to re- read earlier paragraphs from a news
paper or magazine story to understand the point?
Pass the point where you intended to exit while
driving a car or public transportation?
58
Fail to recognize people who recognize you?
Have trouble finding your place again when
interrupted in reading?
Arrive at the grocery store or pharmacy and forget
what you intended to buy?
Meet people who seem familiar but can’t
remember where you met them?
Task
Much
Better
Now
Somewhat
Better
Now
Same
Somewhat
poorer
now
Much
poorer
now
Remembering the name of someone just
introduced to you
Recalling telephone numbers or zip codes
that you use on a daily/weekly basis
Confuse a word with another when they sound the
same?
Store an important item in a place where it will be
save and then forget where it is?
Appendix C5 (continued)
Copy of Instruments
Self-report Rating of Current Cognitive Abilities
ID NUMBER____________
MAC- Q (REVISED)
As compared to your experiences prior to pregnancy, how would you
describe your ability to perform the following tasks?
59
Recalling where you have put objects (i.e.
keys)
Remembering specific facts from a news
paper or magazine article you have just
finished reading
Remembering the items you intended to
buy when you arrived at the grocery store
or pharmacy
In general, how would you describe your
memory and thinking skills as compared
to prior to your pregnancy
Appendix C6
Copy of Instruments
Manipulation Check
Id code________________
What was the purpose of this study, to the best of your understanding?
60
Appendix C7
Copy of Instruments
Measure of Prior Stereotype Exposure
Id code__________________
1. Prior to this study did you hear or read any stereotypes about cognition in
pregnancy? (please circle your answer)
Y
N (if No, then stop here)
If yes, answer the questions below:
2. Whom did you hear stereotypes from? (circle all that apply)
Books
Magazines
TV show
Radio
Movie
Other pregnant women
3. The stereotypes about cognition and
you heard most)
Spouse
Friends
Parents
Lamaze Classes
Doctor
Other:________________________
pregnancy said: (circle the one
2
Cognitive abilities improved during pregnancy
Cognitive abilities decreased during pregnancy
4. How often did your hear this stereotype (circle one)
Constantly
Often
Rarely
Once or twice
5. How much do you believe the stereotypes about cognition and
pregnancy?
Strongly Agree- - - - - - - - - - - Agree- - - - - - - - - Neutral- - - - - - - - - Disagree- - - - - - Strongly Disagree
6. Did you change the activities or things that you did because of what
you had heard about cognition in pregnancy?
No
Yes If yes, what did you change:
7. Did you try to avoid tasks based on what you had heard about
cognition in pregnancy?
No
Yes If yes, what did you avoid:
Appendix D
Debriefing Form
The purpose of the study was to examine health experiences in
pregnancy. Although some participants were led to believe our focus was on
pain expectation, our particular interest was actually on the experience of
cognitive changes associated with pregnancy. We needed to mislead some
participants in order to manipulate their expectations for changes to our
cognitive abilities in pregnancy.
Women sometimes report that their cognitive skills decline during
pregnancy. However, existing studies do not provide clear and convincing
evidence that there are cognitive declines during pregnancy when cognitive
skills are actually tested.
Why might women feel as though their cognitive skills are changing?
Researchers have suggested that hormone changes, experiences with
depression, anxiety, pain, or sleep/fatigue may contribute to the perception of
cognitive change. What is hopefully reassuring to you is that there is not strong
evidence to support the negative stereotype of pregnancy- related cognitive
decline.
In this study, we were specifically examining whether simply exposing
pregnant women to the negative stereotype could alter their expectation of their
own cognitive skills and potentially even alter their cognitive performance. We
hypothesized that this might occur, as there is substantial evidence linking
negative expectation about many physical symptoms (including cognitive
61
symptoms) to actual experience of those symptoms (sort of a “self- fulfilling
prophecy”). In fact, for some disorders when negative expectations play a large
role in the experience of symptoms, interventions have been designed to
counteract these negative expectations. Thus, learning about the role of
negative expectations and their influence on beliefs about cognitive skills in
pregnancy could lead to better education for pregnant women, or even
intervention techniques for those who have severe concerns about their
cognitive skills.
We thank you for your participation. Please remember not to discuss the
true purpose of our study with any of your pregnant friends, who may also want
to participate in the study, so as not to unduly influence our results.
If you have serious concerns about your own cognitive skills or are
feeling distressed about pain or feeling depressed, we urge you to discuss your
concerns with your obstetrician. You can also contact Tri County Mental Health
and Counseling Services at 592- 3091. Finally, Dr. Suhr can provide you with a
free clinical cognitive evaluation through the Ohio University Psychology and
Social Work Clinic if you wish; you can contact her at 593- 1091.