Sharif-Nia Hamid, Marôco João, Jackson Alun C, Salehi Safoura, Kaveh Omolhoda, Miraghai Fateme, Hosseini Seyed Hamzeh
Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
Sci Rep. 2025 May 16;15(1):17011. doi: 10.1038/s41598-025-02092-x.
Psychological distress is common among patients with heart disease, necessitating valid and reliable assessment tools for measuring cardiac distress. The Cardiac Distress Inventory (CDI) has been developed for this purpose, but its psychometric properties require validation in different cultural contexts. This study aimed to evaluate the psychometric properties of the Farsi version of the CDI in an Iranian population with heart disease, focusing on its validity, reliability, and factor structure. A cross-sectional study was conducted from October to December 2024 with 400 adult patients diagnosed with heart disease. Participants were recruited from cardiac departments and clinics using convenience sampling. The CDI was translated into Farsi following WHO guidelines and assessed for face and content validity. Exploratory factor analysis using Maximum Likelihood Estimation (MLEFA) with Promax rotation and confirmatory factor analysis were conducted to determine construct validity. Convergent and discriminant validity were examined using average variance extracted (AVE) and heterotrait-monotrait (HTMT) ratio, while reliability was assessed via Cronbach's alpha, McDonald's omega, and composite reliability. Measurement invariance across gender groups was also analyzed. The mean age of participants was 42.95 years (SD = 14.02), and 56.8% were women. EFA identified a two-factor structure-Existential and Emotional Distress and Uncertainty and Maladaptive Coping-explaining 69.15% of the variance, with 10 retained items. CFA confirmed the model fit (χ = 45.714, p = 0.086, CFI = 0.991, RMSEA = 0.036). The CDI demonstrated strong internal consistency (Cronbach's alpha > 0.8) and good convergent (AVE > 0.5) and discriminant validity (HTMT = 0.374). Measurement invariance across gender was established at the configural, metric, and scalar levels. The Farsi version of the CDI is a valid and reliable tool for assessing cardiac distress in Iranian patients with heart disease. These findings support its use in clinical and research settings to better understand and address the psychosocial challenges faced by this population, ultimately improving psychological assessment and intervention strategies.
心理困扰在心脏病患者中很常见，因此需要有效且可靠的评估工具来测量心脏困扰。心脏困扰量表（CDI）就是为此目的而开发的，但其心理测量特性需要在不同文化背景下进行验证。本研究旨在评估波斯语版CDI在伊朗心脏病患者群体中的心理测量特性，重点关注其有效性、可靠性和因子结构。2024年10月至12月进行了一项横断面研究，纳入了400名被诊断患有心脏病的成年患者。采用便利抽样法从心脏科和诊所招募参与者。按照世界卫生组织的指南将CDI翻译成波斯语，并对其表面效度和内容效度进行评估。使用最大似然估计探索性因子分析（MLEFA）和Promax旋转以及验证性因子分析来确定结构效度。使用平均方差抽取量（AVE）和异质特质-同质特质（HTMT）比率来检验聚合效度和区分效度，同时通过克朗巴哈系数、麦克唐纳ω系数和组合信度来评估信度。还分析了不同性别组之间的测量不变性。参与者的平均年龄为42.95岁（标准差=14.02），56.8%为女性。探索性因子分析确定了一个两因素结构——存在性和情绪困扰以及不确定性和适应不良应对，解释了69.15%的方差，保留了10个项目。验证性因子分析证实了模型拟合良好（χ=45.714，p=0.086，CFI=0.991，RMSEA=0.036）。CDI表现出很强的内部一致性（克朗巴哈系数>0.8）以及良好的聚合效度（AVE>0.5）和区分效度（HTMT=0.374）。在构型、度量和标量水平上建立了不同性别之间的测量不变性。波斯语版CDI是评估伊朗心脏病患者心脏困扰的有效且可靠的工具。这些发现支持其在临床和研究环境中的使用，以更好地理解和应对该人群面临的心理社会挑战，最终改善心理评估和干预策略。
