New psychometric data from the Spanish versions of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale measures

Background and objective: There are no structural abnormalities in functional dyspepsia, therefore it is essential to have a viable questionnaire to measure treatment outcome according to patient perception. The aim of the study was to extensively document psychometric characteristics of the Glasgow Dyspepsia Severity Score and the Dyspepsia- Related Health Scale that are currently available in Spanish. Methods: Patients with functional dyspepsia (n = 158) were recruited from a randomized trial that assessed standard vs. standard and psychological treatment. Participants had completed the validation questionnaires and the Medical Outcome Study Short-form 36. Reliability (Cronbach’s alpha), validity (Confirmatory Factor Analysis, convergent and known group validity) and responsiveness (minimal clinically important difference) were analyzed. Results: A Confirmatory Factor Analysis of the Glasgow Dyspepsia Severity Score showed a one-factor solution model, but a low Cronbach’s alpha (0.61). With regard to the Dyspepsia-Related Health Scale, the Cronbach’s alpha (0.80-0.97) and Confirmatory Factor Analysis supported a model with four inter-correlated dimensions and suggested a need to improve the "Satisfaction with dyspepsia-related health" dimension (Cronbach’s alpha < 20). Finally, the global scores for both the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale were responsive at six months post-treatment, with a minimal clinically important difference of 4 and 6, respectively. Conclusions: Our findings support the continued application of the Dyspepsia-Related Health Scale and the need to improve the "Satisfaction with dyspepsia-related health" dimension. Although the Glasgow Dyspepsia Severity Score is a promising questionnaire, further review of the content is required to eliminate and add items in order to provide greater consistency to the evaluated construct (AU)

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New psychometric data from the Spanish versions of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale measures.

BACKGROUND AND OBJECTIVE: There are no structural abnormalities in functional dyspepsia, therefore it is essential to have a viable questionnaire to measure treatment outcome according to patient perception. The aim of the study was to extensively document psychometric characteristics of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale that are currently available in Spanish. METHODS: Patients with functional dyspepsia (n = 158) were recruited from a randomized trial that assessed standard vs. standard and psychological treatment. Participants had completed the validation questionnaires and the Medical Outcome Study Short-form 36. Reliability (Cronbach's alpha), validity (Confirmatory Factor Analysis, convergent and known group validity) and responsiveness (minimal clinically important difference) were analyzed. RESULTS: A Confirmatory Factor Analysis of the Glasgow Dyspepsia Severity Score showed a one-factor solution model, but a low Cronbach's alpha (0.61). With regard to the Dyspepsia-Related Health Scale, the Cronbach's alpha (0.80-0.97) and Confirmatory Factor Analysis supported a model with four inter-correlated dimensions and suggested a need to improve the "Satisfaction with dyspepsia-related health" dimension (Cronbach's alpha < 20). Finally, the global scores for both the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale were responsive at six months post-treatment, with a minimal clinically important difference of 4 and 6, respectively. CONCLUSIONS: Our findings support the continued application of the Dyspepsia-Related Health Scale and the need to improve the "Satisfaction with dyspepsia-related health" dimension. Although the Glasgow Dyspepsia Severity Score is a promising questionnaire, further review of the content is required to eliminate and add items in order to provide greater consistency to the evaluated construct.

Resilience in eating disorders: A qualitative study.

The objectives of the authors in this study were two-fold: (1) to explore the role of resilience in recovery from eating disorders (EDs), and (2) to develop a model of resilience in women with EDs. Semi-structured interviews with ten women were conducted in April 2011, along with two focus groups with women who had recovered from EDs (n  = 5 women each; conducted in April 2012 at the University of Deusto, Spain), one focus group with clinical experts (n = 8; conducted in April 2012 at the Foundation Against EDs of Biskay, Spain), and six narratives from primary caregivers of ED patients living in Biskay, Spain (conducted in November 2012). All data were analyzed using a grounded theory approach. All female participants acknowledged experiencing resilience in their recovery. The analysis resulted in a conceptual model of resilience composed of the following categories: deep dissatisfaction with life, turning point, acceptance, hope, determination to change, accountability for the ED, active coping, getting social support, gaining self-knowledge, getting information about EDs, increase well-being, trait resilience, initiating new projects and living in the here and now. According to the model presented, resilience preceded the experience of recovery in women with EDs in this sample and could be a useful asset for future interventions.

Resilience Scale-25 Spanish version: validation and assessment in eating disorders.

OBJECTIVES: To validate into Spanish the Wagnild and Young Resilience Scale - 25 (RS-25), assess and compare the scores on the scale among women from the general population, eating disorder (ED) patients and recovered ED patients. METHOD: This is a cross-sectional study. ED participants were invited to participate by their respective therapists. The sample from the general population was gathered via an open online survey. Participants (N general population=279; N ED patients=124; and N recovered ED patients=45) completed the RS-25, the World Health Organization Quality of Life Scale-BREF and the Hospital Anxiety and Depression Scale. Mean age of participants ranged from 28.87 to 30.42years old. Statistical analysis included a multi-group confirmatory factor analysis and ANOVA. RESULTS: The two-factor model of the RS-25 produced excellent fit indexes. Measurement invariance across samples was generally supported. The ANOVA found statistically significant differences in the RS-25 mean scores between the ED patients (Mean=103.13, SD=31.32) and the recovered ED participants (Mean=138.42, SD=22.26) and between the ED patients and the general population participants (Mean=136.63, SD=19.56). DISCUSSION: The Spanish version of the RS-25 is a psychometrically sound measurement tool in samples of ED patients. Resilience is lower in people diagnosed with ED than in recovered individuals and the general population.

Eating disorders: predictors of change in the quality of life of caregivers.

Eating disorders (EDs) have a strong impact on the quality of life (QoL) of caregivers. This study explores the longitudinal changes in the QoL of ED caregivers at 1 (T1; n=109) and 2 years (T2; n=32) follow-up, and identifies predictors of improvement at 1-year follow-up. ED outpatients also completed a battery of tests at T1 (n=69) and T2 (n=11). Multivariate hierarchical linear mixed models were used, in which the caregivers' 1-year changes in QoL, anxiety and depression scores were analysed as the dependent variables. Predictor variables were the caregivers' perception of burden, perception of the severity of the patient's ED, kinship data, and the ED person's scores on QoL, anxiety depression and ED symptoms. Higher scores in mental health and low perception of burden at baseline predicted improved caregiver QoL at 1-year follow-up. The caregivers' QoL improved if the perception of burden decreased over time and if depression of the patient improved. The results suggest that interventions directed to reduce the caregivers' perception of burden and to improve the mental health of the ED patients would lead to improved caregiver QoL. The high attrition rate at T2 made prediction analyses unviable.

Applying a coping with stress questionnaire for cancer patients to patients with non-cancer chronic illnesses.

One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.

Use of the long and short forms of the depression in the medically ill questionnaire in a Spanish population.

This study sought to translate, using a back-translation procedure, and evaluate the psychometric characteristics of Depression in the Medically Ill questionnaire (DMI-18) and its short version (DMI-10) in a Spanish population. Patients with somatic disorders (N = 366) completed the translated DMI-18 and another depression questionnaire. Among these, 167 were also assessed by a mental health professional (gold standard) to test criterion validity. Furthermore, coefficient alpha for both the versions were high (>.90), and convergent validity assessed against the Beck Depression Inventory for Primary Care, the Hospital Anxiety and Depression Scale, and the Patient Health Questionnaire-9 was satisfactory (r > .74). Confirmatory factor analysis results supported the one-factor model. When compared with the gold standard, sensitivity and specificity were 93% and 73% for DMI-18 and 87% and 74% for DMI-10, respectively. Thus, both the versions are acceptable measures that can be used by nonpsychiatric professionals to detect affective comorbidities in their patients.

Detecting depression in medically ill patients: Comparative accuracy of four screening questionnaires and physicians' diagnoses in Spanish population.

OBJECTIVE: The purpose of this study is to compare the diagnostic accuracy of four depression screening tools commonly used in patients with medical disorders, relative to a reference diagnostic standard-a structured psychiatric interview. METHODS: The Depression in the Medically Ill-18 (DMI-18) questionnaire was administered to 167 patients with medical disorders; of those, 53 completed the Beck Depression Inventory for Primary Care (BDI-PC), 67 the Hospital Anxiety and Depression Scale (HADS), and 46 the Patient Health Questionnaire-9 (PHQ-9). The entire sample was also interviewed with a structured psychiatric interview conducted by a mental health professional. Sensitivity, specificity, likelihood ratios (LRs), and area under the curve (AUC) were calculated and compared for the different measures. RESULTS: At their respective recommended cutoff points, sensitivities [95% confidence interval (CI)] were 86% (70-95), 82% (63-94), 93% (86-97), and 68% (47-85) for the HADS-D, BDI-PC, DMI-18, and PHQ-9, respectively, while specificities ranged from 72% (47-90) for BDI-PC to 89% (72-98) for PHQ-9. The sensitivities of DMI-18 were significantly higher compared to those of HADS-D (P=.045) and PHQ-9 (P=.01). The PHQ-9 questionnaire obtained the most favorable positive LR (6.35; 95% CI, 2.48-18.36). In contrast, the DMI-18 showed the best negative LR (0.09; 95% CI, 0.04-0.18). Areas under the curves (95% CI) ranged from 0.92 (0.83-1.02) to 0.84 (0.74-0.94). Statistically significant differences were found between the AUCs of the DMI-10 and the BDI-PC. CONCLUSION: Our results suggest that all evaluated scales have acceptable abilities and can be used as screening instruments for depression in patients with medical disorders. The DMI stands out for its sensitivity.

Use of Rasch methodology to develop a short version of the health related quality of life for eating disorders questionnaire: a prospective study.

BACKGROUND: To confirm the internal structure of the Health Related Quality of Life for Eating Disorders version 2 questionnaire (HeRQoLEDv2) and create and validate a shortened version (HeRQoLED-S). METHODS: 324 patients with eating disorders were assessed at baseline and one year later (75.6% of whom responded). We performed a confirmatory factor analysis of the HeRQoLEDv2 using baseline data, and then a Rasch analysis to shorten the questionnaire. Data obtained at year one was used to confirm the structure of the HeRQoLED short form and evaluate its validity and reliability. RESULTS: Two latent second-order factors -- social maladjustment and mental health and functionality -- fit the data for the HeRQoLEDv2. Rasch analysis was computed separately for the two latent second-order factors and shortened the HeRQoLEDv2 to 20 items. Infit and outfit indices were acceptable, with the confirmatory factor analysis of the HeRQoLED short form giving a root mean square error of approximation of 0.07, a non-normed fit index and a comparative fit index exceeding 0.90. The validity was also supported by the correlation with the convergent measures: the social maladjustment factor correlated 0.82 with the dieting concern factor of the Eating Attitudes Test-26 and the mental health and functionality factor correlated -0.69 with the mental summary component of the Short Form-12. Cronbach alphas exceeded 0.89. CONCLUSIONS: Two main factors, social maladjustment and mental health and functionality, explain the majority of HeRQoLEDv2 scores. The shortened version maintains good psychometric properties, though it must be validated in independent samples.

Health-Related Quality of Life for Eating Disorders questionnaire version-2 was responsive 1-year after initial assessment.

OBJECTIVES: To assess the responsiveness of the Health-Related Quality of Life for Eating Disorders questionnaire version-2 (HeRQoLEDv2) and present the psychometric characteristics of a new binge domain. STUDY DESIGN AND SETTING: Patients with an eating disorder completed the HeRQoLEDv2, the Eating Attitudes Test-26, Short Form Health Survey-12, and two items from the Eating Disorder Inventory-2, at baseline and after 1 year. At the second assessment, patients completed the HeRQoLEDv2, as part of the battery of tests, along with health transitional questions. Validity and reliability analyses of the new binge domain were performed. Responsiveness was evaluated using distributional and anchor-based approaches, comparison of mean changes, mean change correlations, the minimal detectable change (MDC) at the individual and group level, and the minimal important difference (MID). RESULTS: Items in the binge domain loaded above 0.40. Cronbach alpha was 0.82. Regarding responsiveness, the mean changes detected by the HeRQoLEDv2 correlated above 0.30 with the criterion measures. Patients who reported improvement showed significant changes, and effect sizes above 0.30. The MDC(90%ind) was larger than the MID. CONCLUSION: The HeRQoLEDv2 includes the new binge domain. It responded to change at the group level. Further research regarding the MID is needed.

Validez del cuestionario de calidad de vida SF-36 como indicador de resultados de procedimientos médicos y quirúrgicos / Clinical usefunlness of the SF-36 in several clinical problems

Objetivo: Estudiar la utilidad clínica del cuestionario genérico de calidad de vida relacionada con la salud (CVRS) SF-36 en los servicios de asistencia sanitaria. Método: Se llevó a cabo un estudio descriptivo con 691 pacientes con distintos diagnósticos médicos reclutados en el ámbito de consultas externas de un hospital general. Los grupos diagnósticos fueron cáncer de pulmón (CP) y hematológico (CH), osteoartrosis de cadera (OAC), trastornos de la alimentación (TA) y enfermedad inflamatoria intestinal crónica (EIIC). Los pacientes incluidos en el estudio cumplimentaron el SF-36, un instrumento genérico de CVRS. Con los pacientes con OAC que iban a ser operados de prótesis de cadera (PC) fue realizado un estudio de seguimiento antes y después de la intervención. Resultados: Los pacientes con TA presentaban puntuaciones bajas en las áreas mentales, funcionamiento social y rol físico. Aquellos con CP contaban con valores bajos en todas las áreas del SF-36, que eran menores en las físicas y ligeramente más bajas que en los pacientes con CH. Los pacientes con OAC presentaban un impacto importante en las áreas físicas, principalmente en el área de dolor corporal; las mejoras tras la intervención eran mayores en las áreas físicas. Aquellos pacientes con EIIC, evidenciaban afección principal en el área de salud general. Conclusiones: El SF-36 es capaz de discriminar entre distintas enfermedades. Estos resultados apoyan su validez discriminante como un indicador para la evaluación de resultados de procedimientos médicos entre centros y entre grupos de pacientes (AU)

Calidad de vida en pacientes con trastornos de alimentación / Quality of life in eating disorders patients

El objetivo de este estudio ha sido obtener información directa de pacientes con trastornos de alimentación y de sus familiares y clínicos sobre cómo su enfermedad afecta a diferentes aspectos de su vida., Se realizaron cuatro grupos focales con personas afectadas por un problema de alimentación, dos con familiares y uno con profesionales especializados en esta patología. Los grupos de pacientes se estructuraron según el diagnóstico (Anorexia Nerviosa o Bulimia) y el tiempo de evolución de la enfermedad. Pacientes, familiares y profesionales coincidieron en que las relaciones sociales y familiares y el estado de ánimo eran los aspectos más afectados, junto con la salud física, la alimentación, los estudios y la vida laboral. Esta técnica cualitativa, usada por primera vez con esta población en este estudio, demuestra ser un instrumento útil para recoger información sobre la afectación de la calidad de vida de pacientes con trastornos alimentarios (AU)

The aim of this study has been to obtain direct information from eating disorder patients and their relatives and clinicians about how the disease affect on different aspects of their life. Four focus groups with eating disorder patients, two with relatives and one with specialised professionals were run. The patients groups were structured according to two criteria: diagnosis (Anorexia and Bulimia Nervosa) and time of evolution of the disease. Patients, relatives and clinicians agreed that the social and family relationships and the mood state were the most affected aspects, together with physical health, nutrition, studies and work. This qualitative technique, used for first time with this population in this study, is a useful tool in order to get information on the affectation about the quality of life on eating disorder patients (AU)