Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.
Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
J Psychosom Res. 2021 Feb;141:110340. doi: 10.1016/j.jpsychores.2020.110340. Epub 2020 Dec 11.
Symptom misattribution is a central process in the nocebo effect but it is not accurately assessed in current side effect measures. We have developed a new measure, the Side Effect Attribution Scale (SEAS), which examines the degree to which people believe their symptoms are treatment side effects.
The SEAS was tested in three New Zealand studies: a vaccination sample (n = 225), patients with gout or rheumatoid arthritis (n = 102), and patients switching to a generic medicine (n = 69). The internal reliability of the scale was examined using Cronbach's alpha. To assess validity, the Side Effect Attribution Total Score and Side Effect Attribution Binary Score were related to a number of psychological measures associated with side effect reporting.
The scale showed good internal reliability across the three studies, with Cronbach alphas ranging from 0.840 to 0.943. Analysis of the effect sizes showed that the Attribution Total Score was generally more strongly associated with nocebo responding than Attribution Binary Score. Participants had greater Side Effect Attribution Total Scores if they had higher expectations for vaccination side effects (r = 0.18, p = .028), more worry about future vaccine effects (r = 0.16, p = .046), a higher perceived sensitivity to medicines (r = 0.50, p < .001), greater anxiety (r = 0.25, p = .016), greater intentional non-adherence (r = 0.30, p = .003), greater medicine information seeking (r = 0.26, p = .010), lower trust in pharmaceutical agencies (r = -0.29, p = .026), and lower medicine efficacy beliefs (r = -0.46, p < .001).
The SEAS provides a more nuanced assessment of symptom attribution beliefs. It appears to be more sensitive measure than just a side effect total, as it is associated with a greater number of relevant psychological variables. Future research should examine the scale in other populations and settings.
症状归因是安慰剂效应的核心过程，但在当前的副作用测量中并没有得到准确评估。我们开发了一种新的测量工具，即副作用归因量表（SEAS），用于检查人们认为自己症状是治疗副作用的程度。
SEAS 在新西兰的三项研究中进行了测试：疫苗接种样本（n=225）、痛风或类风湿关节炎患者（n=102）和转用仿制药的患者（n=69）。使用 Cronbach's alpha 检验量表的内部信度。为了评估有效性，将副作用归因总分和副作用归因二分法得分与与副作用报告相关的一些心理测量指标相关联。
该量表在三项研究中均表现出良好的内部信度，Cronbach 阿尔法值范围为 0.840 至 0.943。分析效应大小表明，归因总分通常与安慰剂反应的相关性更强，而归因二分法得分则较弱。如果参与者对疫苗副作用的期望更高（r=0.18，p=0.028），对未来疫苗效果的担忧更多（r=0.16，p=0.046），对药物的感知敏感性更高（r=0.50，p<0.001），焦虑程度更高（r=0.25，p=0.016），故意不遵医嘱的程度更高（r=0.30，p=0.003），对药物信息的搜索更多（r=0.26，p=0.010），对制药机构的信任度更低（r=-0.29，p=0.026），药物疗效信念更低（r=-0.46，p<0.001），则他们的副作用归因总分更高。
SEAS 提供了对症状归因信念的更细致评估。它似乎是比仅副作用总分为更敏感的测量工具，因为它与更多相关的心理变量相关联。未来的研究应该在其他人群和环境中检验该量表。
