| Aim:As the most common type of child maltreatment,infant neglect has been associated with considerable adverse physical and mental health outcomes in children.However,valid and convenient measurement tools that could be used to assess infant neglect in China are scarce.This situation inhibits the development of research in this field,which aims to identify risk factors and further establish prevention and intervention programs for infant neglect.To narrow this gap,this study introduced the Signs of Neglect in Infants Assessment Scale(SIGN)and examined its psychometrics.Further,based on Social Information Processing theory,this study explored the relationship between infant neglect and maternal executive functions from multiple perspectives.Methods:By using the cross-sectional study design,this study was conducted between October 2020 and October 2021 in Jinan City,Shandong Province,consisting of two study parts with independent samples.In the first part of this study,SIGN was firstly translated into Chinese and adapted according to the standard guideline.Then,a total of 542 postpartum women and their infants were included in the analysis.Principal component analysis,Explorative factor analysis,Confirmative factor analysis,and Pearson correlation test were used to testify the validity and reliability of the Chinese version of SIGN.The ceiling effect and floor effect were also presented.In the second part of this study,427 postpartum women and their infants were included.Infant neglect and maternal executive functions were measured by the Chinese version of SIGN introduced in the first part of this study and Behavior Rating and Inventory of Executive Function-Adult Version(BRIEF-A),respectively.Other relevant information,including maternal socioeconomics(e.g.maternal age,educational status),maternal depression,obstetrics information(e.g.parity,gestational duration),and infant characteristics(e.g.difficulty infant,infant age,infant gender)were also collected.Multivariable linear regression was used to explore the direction(negative or positive)of the relationship between each subdomain of maternal executive functions and infant neglect.Random forest regression was used to identify which subdomain of maternal executive functions had the closest relationship with infant neglect,considering the high collinearity among nine subdomains of executive functions.Latent profile analysis was used to identify the latent classes in executive functions among postnatal women.Multivariable linear regression was further used to explore the relationship between latent classes in executive functions and infant neglect.Covariates were adjusted in all the above statistical analysis models according to the literature review.Results:Study one(1)The Cronbach’s a coefficient for the composite index of the Chinese version of SIGN was 0.843.For each dimension of SIGN,the coefficient for the lack of basic supervisory was 0.800,for the child underdevelopment was 0.647,and for the lack of emotional behavior was 0.733.In general,the internal consistency of the Chinese version of SIGN was good.(2)In the Exploratory factor analysis,three common factors were identified in the Chinese version of SIGN with λ>1 and the cumulative contribution rate was 53.21%.The factor loading structure of the three-factor Chinese version of SIGN was the same as that of the original scale.Confirmative factor analysis showed the overall fitness of the three-factor model was good,demonstrating the good structural validity of SIGN.The correlation coefficients between the total and each dimension of infant neglect and depression ranged from 0.315 to 0.423,which indicated the good concurrent validity.(3)In the composite and each dimension of the Chinese version of SIGN,the percentage of mothers who scored the lowest was higher than 15%,but the percentage of those who scored the highest was lower than 15%.These results showed the Chinese version of SIGN had a floor effect but no ceiling effect in the total and each dimension of the scale.Study two(1)Multivariable linear regression showed that nine subdomains of maternal executive functions problems were all positively correlated with infant neglect after controlling for covariates(P<0.05).(2)Random forest regression showed that there existed differences in the intensity of the relationship between each subdomain of maternal executive functions and infant neglect.The value of the final mean residual square was 0.035 and the variance was interpreted as 18.14%.The intensity of the relationship between task initiation and infant neglect was the highest,followed by organization,working memory,inhibition,self-monitoring,task monitoring,emotional control,planning,and shifting.(3)Latent profile analysis identified three subgroups in maternal executive functions,namely the sub-healthy group in executive functions("sub-healthy group"),the impaired group in executive functions("impaired group"),and the healthy group in executive functions("healthy group").Further,the multivariable linear regression showed that infant neglect was more serious in the sub-healthy group(B=0.090,P=0.002)and the impaired group(B=0.185,P<0.001)than that in the healthy group;infant neglect in the impaired group was more serious than that in the sub-healthy group(B=0.095,P=0.044).Conclusion:(1)This study translated and adapted the SIGN and further verified its good reliability and validity in the Chinese population.Floor effect,but no ceiling effect was found.(2)This study explored relationships between maternal executive functions from both group and individual perspectives.From the group-level perspective,the more severe each subdomain of maternal executive functions problems was,the more severe infant neglect was.However,the relationship between infant neglect and each subdomain of maternal executive functions differed in degree,of which task initiation,material organization,working memory,and inhibition were the first four most important subdomains.From the individual-level perspective,mothers whose executive functions problems generally exceeded the clinical standard had the highest level of infant neglect. |
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