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

Objective To develop the Cognitive Appraisal Scale for Infertility (CASI) and assess it for reliability and validity. Design Cross-sectional and longitudinal study. Setting A 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.