Dunn S M, Smartt H H, Beeney L J, Turtle J R
Diabetes Care. 1986 Sep-Oct;9(5):480-9. doi: 10.2337/diacare.9.5.480.
The ATT39 scale was developed as a norm-referenced measure of emotional adjustment in diabetic patients. Scores on three parallel forms of the parent scale changed in response to educational intervention, and the change in scores was predictive of subsequent improvement in metabolic control. We describe further reliability and validity studies with six factorially derived subscales of the ATT39, which measured perceived levels of stress, adaptation, guilt, alienation, illness conviction, and tolerance for ambiguity. Internal consistency (Cronbach alpha) of the unweighted total score was 0.78, and the Guttman lower bound estimate of reliability was 0.86. The test-retest reliability of the total score varied from 0.70 to 0.87, over intervals of 2 wk, 3 mo, and 6 mo, and reliability coefficients for the six factor scores averaged 0.56. ATT39 factor scores, in 134 insulin-dependent diabetes mellitus (IDDM) and 166 non-insulin-dependent diabetes mellitus (NIDDM) patients, were correlated with scores on the Cattell 16 personality factor questionnaire and the locus of control of behavior scale (LCB). In IDDM, age was related to better adaptation, increased feelings of guilt, and a more cooperative attitude to staff and treatment. In NIDDM, age was associated with increasing resignation to a conviction of chronic illness and less tolerance for the ambiguities involved in diabetes. Intelligence was correlated with less guilt and more tolerance. Anxiety was associated with significant diabetes-related stress, regardless of treatment, and with poorer adaptation and guilt in NIDDM. An external LCB was related to increased stress and guilt. The results confirm that emotional adjustment in diabetes involves dynamic interactions among feelings that are relatively stable over periods up to 6 mo and that relate meaningfully to other aspects of personality functioning.
ATT39量表是作为一种对糖尿病患者情绪调适的常模参照测量工具而开发的。母量表的三种平行形式的得分会因教育干预而改变，且得分变化可预测随后代谢控制的改善情况。我们描述了对ATT39的六个因子衍生子量表进行的进一步信效度研究，这些子量表测量了感知到的压力、适应、内疚、疏离、疾病信念以及对模糊性的容忍水平。未加权总分的内部一致性（克朗巴哈α系数）为0.78，古特曼下限信度估计值为0.86。总分的重测信度在2周、3个月和6个月的时间间隔内从0.70到0.87不等，六个因子得分的信度系数平均为0.56。在134名胰岛素依赖型糖尿病（IDDM）患者和166名非胰岛素依赖型糖尿病（NIDDM）患者中，ATT39因子得分与卡特尔16种人格因素问卷得分以及行为控制点量表（LCB）得分相关。在IDDM患者中，年龄与更好的适应、更多的内疚感以及对医护人员和治疗更合作的态度有关。在NIDDM患者中，年龄与对慢性病信念的日益顺从以及对糖尿病相关模糊性的容忍度降低有关。智力与较少的内疚感和较高的容忍度相关。焦虑与显著的糖尿病相关压力有关，无论治疗情况如何，并且在NIDDM患者中与较差的适应和内疚感有关。外部行为控制点与压力和内疚感增加有关。结果证实，糖尿病患者的情绪调适涉及在长达6个月的时间段内相对稳定且与人格功能其他方面有意义关联的各种情绪之间的动态相互作用。
