Polonsky William H, Fisher Lawrence, Earles Jay, Dudl R James, Lees Joel, Mullan Joseph, Jackson Richard A
Department of Psychiatry, University of California, San Diego, USA.
Diabetes Care. 2005 Mar;28(3):626-31. doi: 10.2337/diacare.28.3.626.
The purpose of this study was to describe the development of the Diabetes Distress Scale (DDS), a new instrument for the assessment of diabetes-related emotional distress, based on four independent patient samples.
In consultation with patients and professionals from multiple disciplines, a preliminary scale of 28 items was developed, based a priori on four distress-related domains: emotional burden subscale, physician-related distress subscale, regimen-related distress subscale, and diabetes-related interpersonal distress. The new instrument was included in a larger battery of questionnaires used in diabetes studies at four diverse sites: waiting room at a primary care clinic (n = 200), waiting room at a diabetes specialty clinic (n = 179), a diabetes management study program (n = 167), and an ongoing diabetes management program (n = 158).
Exploratory factor analyses revealed four factors consistent across sites (involving 17 of the 28 items) that matched the critical content domains identified earlier. The correlation between the 28-item and 17-item scales was very high (r = 0.99). The mean correlation between the 17-item total score (DDS) and the four subscales was high (r = 0.82), but the pattern of interscale correlations suggested that the subscales, although not totally independent, tapped into relatively different areas of diabetes-related distress. Internal reliability of the DDS and the four subscales was adequate (alpha > 0.87), and validity coefficients yielded significant linkages with the Center for Epidemiological Studies Depression Scale, meal planning, exercise, and total cholesterol. Insulin users evidenced the highest mean DDS total scores, whereas diet-controlled subjects displayed the lowest scores (P < 0.001).
The DDS has a consistent, generalizable factor structure and good internal reliability and validity across four different clinical sites. The new instrument may serve as a valuable measure of diabetes-related emotional distress for use in research and clinical practice.
本研究旨在基于四个独立的患者样本，描述糖尿病困扰量表（DDS）的开发过程，该量表是一种用于评估糖尿病相关情绪困扰的新工具。
与来自多个学科的患者和专业人员协商，基于与四种困扰相关的领域预先开发了一个包含28个条目的初步量表：情绪负担子量表、与医生相关的困扰子量表、与治疗方案相关的困扰子量表以及与糖尿病相关的人际困扰子量表。该新工具被纳入在四个不同地点进行的糖尿病研究中使用的大量问卷中：初级保健诊所候诊室（n = 200）、糖尿病专科诊所候诊室（n = 179）、糖尿病管理研究项目（n = 167）以及一个正在进行的糖尿病管理项目（n = 158）。
探索性因素分析揭示了在各个地点一致的四个因素（涉及28个条目中的17个），这些因素与先前确定的关键内容领域相匹配。28条目量表与17条目量表之间的相关性非常高（r = 0.99）。17条目总分（DDS）与四个子量表之间的平均相关性很高（r = 0.82），但量表间相关性的模式表明，尽管子量表并非完全独立，但它们涉及到糖尿病相关困扰的相对不同领域。DDS及其四个子量表的内部信度足够（α> 0.87），效度系数与流行病学研究中心抑郁量表、饮食计划、运动和总胆固醇有显著关联。胰岛素使用者的DDS总分均值最高，而饮食控制的受试者得分最低（P < 0.001）。
DDS具有一致的、可推广的因素结构，并且在四个不同临床地点具有良好的内部信度和效度。该新工具可作为研究和临床实践中用于评估糖尿病相关情绪困扰的有价值指标。
