Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Multimodal Imaging Group, Research Imaging Centre, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2018 Oct 1;144(10):906-912. doi: 10.1001/jamaoto.2018.1863.
Catastrophizing is a maladaptive thought process that involves irrational fear and worry about anticipated or actual symptoms. Although clinically relevant, the role of catastrophizing in patients with chronic dizziness or imbalance has not yet been explored to our knowledge.
To validate a measure of dizziness catastrophizing and to assess its association with dizziness-related disability compared with other negative affect constructs (eg, anxiety and depression).
DESIGN, SETTING, AND PARTICIPANTS: For this retrospective medical record review, the Dizziness Catastrophizing Scale (DCS), a dizziness-specific catastrophizing assessment tool, was adapted from the previously validated Pain Catastrophizing Scale. Psychometric evaluation of the DCS was performed. In addition, the associations of dizziness catastrophizing and positive and negative affectivity with dizziness-related disability were assessed using structural equation modeling and regression analyses. Data were collected using a retrospective medical record review from April 27, 2010, to June 25, 2014. The dates of analysis were June 3 to August 15, 2017. The setting was the Multidisciplinary Neurotology Clinic at the Toronto General Hospital (Toronto, Ontario, Canada). Participants were 457 adult outpatients with dizziness or imbalance who were referred to the clinic.
Psychometric properties of the DCS and its association with dizziness-related disability, as measured with the Dizziness Handicap Inventory.
Among 457 patients (mean [SD] age, 53.4 [15.4] years; 154 [33.7%] male), the DCS demonstrated good convergent (r = 0.78, P < .001) and discriminant validity (r = -0.40, P < .001) with the negative and positive affectivity, respectively; internal consistency (α = .95); and test-retest reliability (intraclass correlation coefficient, 0.92; P < .001 at the 95% CI). An exploratory dimension reduction analysis revealed a single latent component of the DCS. The results of the structural equation modeling and regression analyses revealed that dizziness catastrophizing, although associated with negative affectivity (eg, symptoms of anxiety and depression), was independently associated with dizziness-related disability (standardized β = 0.378; P < .001). Furthermore, a strong association was found between catastrophizing and dizziness-related disability across different dizziness-related diagnoses (r ≥ 0.6; P < .001).
In this study, the DCS was a valid and reliable measure for evaluating catastrophic thinking in patients with dizziness, which was independently associated with dizziness-related disability. Future studies should investigate the influence of alleviating symptoms of catastrophizing on functional outcomes in patients with dizziness or imbalance, the results of which will help guide novel approaches to the clinical care of patients with chronic dizziness.
灾难化是一种适应不良的思维过程，涉及对预期或实际症状的非理性恐惧和担忧。尽管具有临床相关性，但我们的知识范围内尚未探讨灾难化在慢性头晕或失衡患者中的作用。
验证一种头晕灾难化量表，并评估其与头晕相关残疾的相关性，与其他负性情感结构（如焦虑和抑郁）相比。
设计、地点和参与者：在这项回顾性病历审查中，头晕灾难化量表（DCS）是一种专门用于评估头晕的灾难化评估工具，它是从先前验证的疼痛灾难化量表改编而来的。对 DCS 进行了心理测量学评估。此外，还使用结构方程模型和回归分析评估了头晕灾难化与正性和负性情感与头晕相关残疾的相关性。数据是通过 2010 年 4 月 27 日至 2014 年 6 月 25 日的回顾性病历审查收集的。分析日期为 2017 年 6 月 3 日至 8 月 15 日。地点是加拿大安大略省多伦多总医院的神经耳科多学科诊所。参与者是 457 名头晕或失衡的成年门诊患者，他们被转介到该诊所。
DCS 的心理测量特性及其与头晕相关残疾的相关性，使用头晕残疾量表进行测量。
在 457 名患者（平均[标准差]年龄，53.4[15.4]岁；154[33.7%]为男性）中，DCS 与负性和正性情感分别表现出良好的收敛（r=0.78，P<0.001）和判别效度（r=-0.40，P<0.001）；内部一致性（α=0.95）；以及测试-重测可靠性（组内相关系数，0.92；P<0.001，95%置信区间）。探索性维度减少分析显示 DCS 存在单一潜在成分。结构方程模型和回归分析的结果表明，尽管头晕灾难化与负性情感有关（如焦虑和抑郁症状），但它与头晕相关残疾独立相关（标准化β=0.378；P<0.001）。此外，在不同的头晕相关诊断中，灾难化与头晕相关残疾之间存在很强的相关性（r≥0.6；P<0.001）。
在这项研究中，DCS 是一种评估头晕患者灾难性思维的有效且可靠的测量工具，它与头晕相关残疾独立相关。未来的研究应探讨减轻灾难化症状对头晕或失衡患者功能结局的影响，其结果将有助于指导慢性头晕患者的临床护理的新方法。
