Article

Fragebogen zur gesundheitsbezogenen Lebensqualität: Wie sinnvoll ist die Zusammenfassung von Einzelskalen zu Gesamtscores?

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  • University of Leipzig, Germany
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Abstract

Klinisch-psychologische Fragebogen und Fragebogen zur gesundheitsbezogenen Lebensqualität setzen sich häufig aus mehreren Teilskalen zusammen. Die Berechtigung der Zusammenfassung dieser Teilskalen zu einem Gesamt- oder Summenwert soll aus statistischer Sicht geprüft werden. Anhand einer repräsentativen Stichprobe der deutschen Allgemeinbevölkerung (n = 1981) werden die korrelativen Beziehungen der folgenden sechs Fragebogen analysiert: NHP, EORTC QLQ-C30, HADS, MFI-20, GBB-24 und Whiteley-Index. Die Korrelationen zwischen den Gesamtwerten der Fragebogen übersteigen deutlich die mittleren Korrelationen der Subskalen zwischen verschiedenen Fragebogen. Selbst in den Fällen, in denen die Subskalen den gleichen Gegenstandsbereich betreffen, sind deren Korrelationen im Mittel nicht höher als die Korrelationen zum (unspezifischeren) Gesamtwert. Der Vorteil der inhaltlichen Spezifik der Einzelskalen wird durch den Nachteil der geringeren Itemzahl ausgeglichen. Über psychometrische Berechnungen anhand der Spearman-Brown-Formel wird die Beziehung zwischen Itemzahl und Reliabilität differenziert dargestellt. Es lässt sich schlussfolgern, dass die Bestimmung von Gesamtwerten aus statistischer Sicht eindeutig vorteilhaft ist.

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... Suchbegriff e waren " empowerment " und " health promotion " in Kombination mit " concept " oder " theory " (644 Funde) oder mit Synonyma f ü r Operationalisierungen und Erhebungsinstrumente (264 Funde oder als Off enheit f ü r das Experimentieren mit dem eigenen Verhalten und Umfeld. Ein komplexes Konstrukt wie Empowerment kann distinkte Dimensionen umfassen, wie etwa Gesundheitsbezogene Lebensqualit ä t die somatische, psychische, konative, sozio ö konomische u. a. Dimensionen mit entsprechenden Subskalen einbezieht [14] . Um ein Konstrukt beizubehalten, sind jedoch empirische und ä tiologische Belege des Zusammenhangs aller Teildimensionen zu fordern; diese stehen f ü r Empowerment aus, die Studien verwenden die angef ü hrten Dimen sionen zudem eklektisch. ...
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At the end of 1994 a shortened version of the Giessen Subjective Complaints List (GBB-24), was standardised using a sample of 2182 subjects aged 18 to 60 years, representative of the population of re-unified Germany (720 from East Germany, 1462 from West-Germany). The item norms are given for the whole group, while the scale norms are also subdivided according to gender, age (18-30, 31-40, 41-50 and 51-60 years) and place of residence (East/West). The dependence of physical complaints on age and gender has diminished significantly since 1975, whereas the factor structure and the internal consistency of the scales have changed only slightly. The relative influence of further socio-demographic variables (education, income, partnership status, town/country, unemployment) and attitudes health on the scale scores of the GBB-24 are described. The results were also correlated with data from Giessen-Test (GT) and a questionnaire on life satisfaction (Fragebogen zur Lebenszufriedenheit FLZ), collected at the same time. As expected, significant relationships were found between Scale 4 (Depression) of the Giessen-Test and all scales of the GBB-24, particularly Scale 1 "Exhaustion". A significant relationship with life satisfaction was also found, i.e. absence of complaints corresponded with greater life satisfaction. As anticipated, this relationship became most evident in the area of physical health.
Article
In verschiedenen Fachdisziplinen wurde unabhangig voneinander auf ein empirisches Phanomen hingewiesen, das der Intuition so sehr widerspricht, dass es „paradox” genannt wurde. Es handelt sich um das „Zufriedenheitsparadox” in der medizinischen Lebensqualitatsforschung bzw. das „Wohlbefindensparadox” in der Sozialwissenschaft. Gemeint ist in beiden Fallen, dass sich objektiv negative Lebensumstande nur in relativ geringem Ausmas auf die subjektive Lebensqualitat niederschlagen. Es werden aus beiden Fachgebieten Beispiele entsprechender Befunde geschildert. Anschliesend wird versucht, einer Erklarung naher zu kommen. Dabei werden sowohl methodische Uberlegungen angestellt, als auch personlichkeits-, kognitions- und sozialpsychologische. Schlieslich werden Konsequenzen fur Forschung und Klinik gezogen. In quality-of-life research an empirical phenomenon has been observed independently in medicine and in the social sciences which is so contrary to what intuition tells us that it has been called paradoxical. In medicine it is called the „satisfaction paradox” and in the social sciences the „well-being paradox”. What is meant in both cases is that objectively negative factors in one’s life have relatively little effect on subjective quality of life. In the present paper examples are given of relevant research findings from both fields. An attempt is then made to explain the phenomenon, with the topic being examined not only from a methodological but also from a personality, cognition and social psychology perspective. Finally, the implications for research and clinical work are discussed.
Article
Der Whiteley-Index ist ein Instrument zur Erfassung von Hypochondrie. Für diesen Fragebogen wurde eine Normierungs- und Validierungsstudie anhand einer bevölkerungsrepräsentativen Stichprobe (n = 1996) durchgeführt. Hypochondrie zeigt eine etwa lineare Altersabhängigkeit (r = .24). Frauen haben in allen Altersstufen höhere Hypochondrie- Ausprägungen als Männer. Für verschiedene Alters- und Geschlechtsgruppen werden Normwerte bereit gestellt. Die in der Literatur beschriebene dreidimensionale Struktur des Whiteley-Index (Krankheitsängste, somatische Beschwerden und Krank- heitsüberzeugung) konnte mit gewissen Einschränkungen bestätigt werden. Validierungsuntersuchungen mit anderen Instru- menten (Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Gießener Beschwerdebogen, Screening für Somatoforme Störungen und Nottingham Health Profile) zeigten, dass eine auf sieben Items reduzierte Kurzskala der Gesamtskala mit 14 Items ebenbürtig ist. Für differenzierte Analysen wird jedoch die Originalskala empfohlen. Durch die angegebenen Normwerte ist es künftig besser möglich, Patientengruppen verschiedener Alters- und Geschlechtsverteilungen untereinander oder auch mit Stichproben der Normalbevölkerung zu vergleichen.
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
All measuring instruments require further validation both in the setting for which they were designed and in other fields. The Hospital Anxiety and Depression Scale was designed for detection and assessment of those mood disorders in the setting of hospital medical and surgical clinics. Reasons are given for supposing it has advantages over other similar scales. The present study undertakes a further validation of the scale in a general hospital setting. The opportunity is taken to assess the usefulness, in this setting of the Irritability Depression and Anxiety Scale and also of two subscales of the General Health Questionnaire, the one relating to the concept of depression and the other to the concept of anxiety. Score ranges of the latter two subscales are suggested and will require replication for confirmation of their usefulness.
Article
In order to investigate the concept of hypochondriasis a questionnaire has been devised. Evidence of its validity and reliability has been presented. This has been followed by a principal component analysis. Three factors have been identified as reflecting three dimensions of hypochondriasis, viz: Bodily Pre-occupation", "Disease Phobia" and "Conviction of the Presence of Disease with Non-Response to Reassurance". These three factors are discussed in relation to the literature on hypochondriasis. Their nature lends support to those observations which have been based on clinical experience.
Article
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Article
The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue. It covers the following dimensions: General Fatigue, Physical Fatigue, Mental Fatigue, Reduced Motivation and Reduced Activity. This new instrument was tested for its psychometric properties in cancer patients receiving radiotherapy, patients with the chronic fatigue syndrome, psychology students, medical students, army recruits and junior physicians. We determined the dimensional structure using confirmatory factor analyses (LISREL's unweighted least squares method). The hypothesized five-factor model appeared to fit the data in all samples tested (AGFIs > 0.93). The instrument was found to have good internal consistency, with an average Cronbach's alpha coefficient of 0.84. Construct validity was established after comparisons between and within groups, assuming differences in fatigue based on differences in circumstances and/or activity level. Convergent validity was investigated by correlating the MFI-scales with a Visual Analogue Scale measuring fatigue (0.22 < r < 0.78). Results, by and large, support the validity of the MFI.
Article
More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.
Article
The Hospital Anxiety and Depression Scale (HAD) was evaluated in a Swedish population sample. The purpose of the study was to compare the HAD with the Beck Depression Inventory (BDI) and Spielberger's State Trait Anxiety Inventory (STAI). A secondary aim was to examine the factor structure of the HAD. The results indicated that the factor structure was quite strong, consistently showing two factors in the whole sample as well as in different subsamples. The correlations between the total HAD scale and BDI and STAI, respectively, were stronger than those obtained using the different subscales of the HAD (the anxiety and depression subscales). As expected, there was also a stronger correlation between the HAD and the non-physical items of the BDI. It was somewhat surprising that the factor analyses were consistently extracting two factors, 'depression' and 'anxiety', while on the other hand both BDI and STAI tended to correlate more strongly with the total HAD score than with the specific depression and anxiety HAD subscales. Nevertheless, the HAD appeared to be (as was indeed originally intended) a useful clinical indicator of the possibility of depression and clinical anxiety.
Article
The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only hypochondriasis but also for somatoform disorders in general.
Article
For the Hospital Anxiety and Depression Scale (HADS) psychometric properties were tested and standardised values were calculated on the basis of a representative sample of the German adult population with 2037 persons. The main result was the evidence of age and gender differences for anxiety and depression. Females were more anxious than males. For both dimensions of the HADS a nearly linear age dependency was found which was more pronounced for depression (r = 0.36) than for anxiety (r = 0.14). Standardised values are given for different age and gender groups, and the results of regression analyses are presented. The psychometric properties were satisfying or good, the two-dimensional factorial structure could be replicated. By means of the standardised values and regression coefficients it is now possible to compare patient groups of different age and gender distributions with the general population.
Article
The objective of this study was to obtain age- and sex-specific reference values for the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30. A randomly selected sample of the German adult population (3015 subjects) was used, 2081 subjects agreed to take part in the investigation. Most of the scales and symptom items of the questionnaire proved to be dependent on age and sex. Men reported fewer symptoms than women. Age differences were even more pronounced. Younger people reported better functioning and fewer symptoms. Compared with the results of a similar Norwegian study (Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Health related quality of life in the general Norwegian population assessed by the European Organization for research and treatment of cancer core quality-of-life questionnaire: The QLQ-C30(+3). J Clin Oncol 1998, 16, 1188-1196) the prevalence of some symptoms was markedly less. Norm values for age and sex groups are given and regression analyses are performed which help to calculate expected mean scores. The results show that age and sex differences must be taken into consideration when different groups of cancer patients are compared. The norm values help to interpret quality of life data for clinicians.
Article
Fatigue symptoms are often found in cancer patients. One test to assess fatigue is the Multidimensional Fatigue Inventory (MFI-20). It has been successfully applied to specific groups of cancer patients. However, until now population-based norm values are missing. We conducted an investigation on a representative sample of the adult German population, which comprised 2,037 subjects aged 14-92 years. The reliability of the 5 MFI-20 subscales (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) is satisfying. The correlations between MFI-20 subscales and the fatigue scale of the quality-of-life questionnaire EORTC indicate convergent validity. As an important result we found that all subscales of the MFI-20 showed a clear and nearly linear dependency on age with higher fatigue values for older subjects (p < 0.0001). Females as compared with males are characterized by higher mean values in all MFI-20 subscales (p < 0.001). The results show that it is necessary to take into account age and sex when different groups of cancer patients have to be compared.
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