Åström Jenny, Holmström Linda, Karshikoff Bianka, Andreasson Anna, Kemani Mike K
Theme Women's Health and Allied Health Professionals, Medical Unit Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Scand J Pain. 2021 Dec 19;22(1):88-96. doi: 10.1515/sjpain-2021-0070. Print 2022 Jan 27.
Low-grade inflammation is a possible contributing factor in the development and persistence of chronic primary pain syndromes. Related to inflammatory activity is sickness behavior, a set of behavioral responses including increased pain sensitivity, fatigue, malaise, fever, loss of appetite, as well as depressive behavior and anhedonia. To capture these behavioral responses and their relation to longstanding pain, psychometrically sound self-report questionnaires are needed. The Sickness Questionnaire (SicknessQ) was developed to assess self-reported sickness behavior based on studies on acute immune activation while maintaining relevance for persistent conditions. The aim of the current study was to evaluate aspects of the validity and reliability of the SicknessQ in a Swedish sample of persons with longstanding pain.
Aspects of construct validity were evaluated by means of performing a confirmatory factor analysis (CFA) (testing structural validity) and by relevant hypothesis testing i.e., that ratings of sickness behavior in combination with other related factors (e.g., depression and anxiety) would be significantly related to ratings of avoidance. Reliability was evaluated by means of analyzing the internal consistency of items.
Following the CFA, a non-significant Chi-Square test (χ [32, =190] = 42.95, p=0.094) indicated perfect model fit. Also, the relative fit indices supported adequate model fit (CFI = 0.978; TLI = 0.969; RMSEA = 0.0430). Sickness behavior (p<0.0001), depression (p<0.05) and pain duration (p<0.05) significantly contributed to the regression model, explaining 45% of the total variance in avoidance. Internal consistency was adequate, as indicated by a Cronbach's α value of 0.82 for the entire questionnaire.
Results indicate that the SicknessQ has adequate structural validity as well as adequate internal consistency, and is significantly associated with avoidance. The SicknessQ appears to have utility as a self-report questionnaire to assess symptoms of sickness behavior for adults with longstanding pain.
低度炎症可能是慢性原发性疼痛综合征发生和持续存在的一个促成因素。与炎症活动相关的是疾病行为，这是一组行为反应，包括疼痛敏感性增加、疲劳、不适、发热、食欲不振，以及抑郁行为和快感缺失。为了捕捉这些行为反应及其与长期疼痛的关系，需要心理测量学上可靠的自我报告问卷。疾病问卷（SicknessQ）是基于对急性免疫激活的研究而开发的，用于评估自我报告的疾病行为，同时保持对持续性疾病的相关性。本研究的目的是评估SicknessQ在瑞典长期疼痛患者样本中的效度和信度方面。
通过进行验证性因素分析（CFA）（测试结构效度）和相关假设检验来评估结构效度方面，即疾病行为评分与其他相关因素（如抑郁和焦虑）相结合将与回避评分显著相关。通过分析项目的内部一致性来评估信度。
在CFA之后，一个不显著的卡方检验（χ[32, =190] = 42.95，p = 0.094）表明模型拟合良好。此外，相对拟合指数支持充分的模型拟合（CFI = 0.978；TLI = 0.969；RMSEA = 0.0430）。疾病行为（p < 0.0001）、抑郁（p < 0.05）和疼痛持续时间（p < 0.05）对回归模型有显著贡献，解释了回避总方差的45%。整个问卷的Cronbach's α值为0.82，表明内部一致性良好。
结果表明SicknessQ具有充分的结构效度和良好的内部一致性，并且与回避显著相关。SicknessQ似乎可用作自我报告问卷，以评估长期疼痛成人的疾病行为症状。
