Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, UK.
J Psychosom Res. 2010 Jan;68(1):67-71. doi: 10.1016/j.jpsychores.2009.06.008.
Symptoms of hoarseness (dysphonia) are common and often associated with psychological distress. The Voice Symptom Scale (VoiSS) is a 30-item self-completed questionnaire concerning voice and throat symptoms. Psychometric and clinical studies on the VoiSS show that it has good reliability and validity, and a clear factorial structure. The present article presents a further advance in voice measurement from the patient's point of view. To date, there has been no examination of whether voice-related symptoms form a hierarchy; that is, whether people who suffer voice problems progress through a reliable set of problems from mild to severe. To address this question, the technique of Mokken scaling was applied to the VoiSS in 480 patients with dysphonia. A strong and reliable Mokken scale--a symptom hierarchy--was found, which included 17 of the 30 items. This new information on dysphonia shows that voice symptoms progress from voice-oriented difficulties, through practical problems, to disturbances of social relationships and mood (dysphoria). The results add information about the structured phenomenology of voice problems, further establish the relationship between voice impairment and psychosocial impairment, and suggest practical applications in the assessment of dysphonic voices.
声音嘶哑（发音困难）的症状很常见，且常与心理困扰相关。嗓音症状量表（VoiSS）是一个包含 30 个项目的自我报告问卷，涉及嗓音和喉咙症状。针对 VoiSS 的心理测量学和临床研究表明，其具有良好的信度和效度，以及清晰的因子结构。本文从患者角度进一步推进了嗓音测量的发展。迄今为止，尚未有研究检验嗓音相关症状是否存在等级结构；也就是说，是否存在嗓音问题患者从轻到重经历一系列可靠问题的情况。为了解决这个问题，Mokken 分层法被应用于 480 名发音困难患者的 VoiSS 中。发现了一个强大且可靠的 Mokken 量表——一个症状等级结构，其中包括 30 个项目中的 17 个。发音困难的这些新信息表明，嗓音症状从以嗓音为导向的困难开始，逐渐发展为实际问题，最后导致社会关系和情绪（苦恼）紊乱。研究结果提供了关于嗓音问题结构化表现的更多信息，进一步确立了嗓音损伤与心理社会损伤之间的关系，并为评估发音困难的嗓音提供了实际应用。
