‘Life is short and the art long’: it depends on how you measure it

As one of those who joined Oakley in persuading health professionals that we must not assume that new motherhood is all joy thus forcing us to explain depression by biological disequilibrium, I find it ironical to now feel compelled to remind researchers that birth can be positive and that new motherhood can have a major positive effect (Elliott, 1990, p. 155, quoted in Green & Kafetsios, 1997)

Josephine Green and Kostas Kofetsios began their thought-provoking 1997 paper on measuring positive experiences of early motherhood with the above quotation from Sandra Elliott (1990). It is over 20 years since Sandra Elliott felt the need to remind researchers to rebalance their thinking on the positive aspects of childbirth, and it struck me quite forcibly when reading it that, while there has been progress in many aspects of reproductive and infant psychology in that time, it is disappointing that her observations still ring true today. It also set me thinking about what needs to happen to avoid someone quoting this editorial to reflect a lack of progress and balance in the measurement of psychological health in the perinatal period in another 20 years’ time! This year the Cochrane Collaboration (www.cochrane.org) celebrates its 20th anniversary. The Cochrane Collaboration started in the area of pregnancy and childbirth, expanding rapidly to other fields of health and social care, and is now a large international network of people working together to produce systematic reviews that help healthcare practitioners, policy-makers and health service users to make well-informed decisions about health care. While such growth from small beginnings is exceptional, there is much to be learned from their approach.

The title of this editorial, ‘Life is short and the art long’, is a translation of ‘Ars Longa Vita Brevis’, which is attributed to Hippocrates and the ‘art’ he alludes to is medicine. In fact, the full quotation from Aphorisms roughly translates as:

Life is short, the art long, opportunity fleeting, experiment treacherous, judgment difficult. (Hippocrates, Aphorisms. Vol. IV)

The ‘art’ of psychological measurement is most definitely a ‘long’ learning experience; complex, demanding and wide open to misinterpretation. Of course, there are no easy answers, but the Cochrane Collaboration offers some insights into how to maximise our collective knowledge to assist speedier progress. How much more progress could we make if we took an international collaborative approach, made a commitment to standardising and improving reporting of the psychometric properties of the measures we use and if we put the voice and experience of service users, i.e. women and their families, at the centre of our research? As a committed systematic reviewer, I have been frustrated and concerned by the lack of good outcome measures in clinical trials for psychosocial interventions in pregnancy (Alderdice, McNeill, & Lynn, 2013). Also, a review and psychometric evaluation of pregnancy-specific stress measures we conducted suggests that there is still much to be done even with the more traditional measures of psychological health such as stress and anxiety (Alderdice, Lynn, & Lobel, 2012). The problems we currently face when measuring psychological health are wide-reaching and will hinder the progression and synthesis of knowledge in the field of perinatal health and well-being until they are addressed.

It takes a long time to master a task well, and when the acquisition of knowledge is long and arduous we can benefit far more from working collaboratively as we move forward. The Society of Reproductive and Infant Psychology workshop, on which this special journal issue is based, arose from the recognition of the need for more collaborative working when measuring psychological health in the perinatal period. It has been very valuable sharing ideas on theory and measurement with colleagues, sometimes agreeing, sometimes agreeing to differ. Most importantly, despite differences in background and perspectives, we were able to arrive at a consensus about what we think is important to enhance our knowledge of the measurement of psychological health in the perinatal period. So this is very much a reflective journal issue. We acknowledge what we do not know as much as what we do know, with the aim of bringing some of the key challenges we discussed in the workshop to a wider audience and to encourage further debate. It would be satisfying to be able to look back in 20 years’ time and to be able to identify significant progress in the measurement of psychological health in the perinatal period during that time. Whatever discoveries are ahead, we can make far more progress if we work together and focus on making the goal of improving the psychological health for women and their families in the perinatal period a reality.