Michael A. Andrykowski

Psychometric evaluation of the pittsburgh sleep quality index

The Pittsburgh Sleep Quality Index (PSQI) measures sleep quality and disturbance retrospectively over a 1-month period using self-reports. Although the PSQI has been used in a variety of populations, published psychometric data are limited. The goal of this study was to examine psychometric properties of the PSQI among four populations: bone marrow transplant patients (n=155); renal transplant patients (n=56); women with breast cancer (n=102); and women with benign breast problems (n=159). Results supported PSQI internal consistency reliability and construct validity. Cronbachs alphas were 0.80 across groups and correlations between global and component scores were moderate to high. PSQI scores were moderately to highly correlated with measures of sleep quality and sleep problems, and poorly correlated with unrelated constructs. Individuals with sleep problems, poor sleep quality, and sleep restlessness had significantly higher PSQI scores in comparison to individuals without such problems.

Short Form of the Profile of Mood States (POMS-SF): Psychometric information.

The Profile of Mood States (POMS; P. M. McNair, M. Lorr, & L. F. Droppleman, 1981) is a commonly used measure of psychological distress. The length of this scale (65 items) may limit its use with physically ill or otherwise impaired populations or prevent its inclusion in multiinstrument assessment protocols. This study evaluated the psychometric properties of a shorter, 37-item version of the POMS developed by S. Shacham (1983; POMS-SF). Data were provided by 600 respondents representing five different clinical samples and one sample of healthy adults. For all samples, internal consistency estimates for the POMS-SF subscales were very comparable to those for the original POMS. Furthermore, correlations between total mood disturbance and subscale scores on the POMS-SF and those from the original POMS all exceeded .95. The POMS-SF is considered an excellent alternative to the original POMS when a brief measure of psychological distress is desired.

Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument.

The presence of a posttraumatic stress disorder (PTSD) diagnosis in women (n = 82) diagnosed with Stage 0-IIIA breast cancer was assessed 6 to 72 months after cancer therapy. The PTSD Checklist-Civilian Version (PCL-C) and the PTSD module for the Structured Clinical Interview for DSM-IV, Nonpatient Version, PTSD module (SCID-NP-PTSD) were administered in a telephone interview. SCID-NP-PTSD results indicated prevalence rates of 6% and 4% for current and lifetime PTSD, respectively. Use of the recommended cutoff score of 50 on the PCL-C to determine diagnosis of current cancer-related PTSD resulted in a sensitivity of .60 and a specificity of .99 with 2 false-negative diagnoses. In conclusion, PTSD can be precipitated by diagnosis and treatment of breast cancer, and the PCL-C can be a cost-effective screening tool for this disorder.

Off-treatment fatigue in breast cancer survivors : A controlled comparison

Fatigue is a common and distressing symptom following cancer treatment. Research examining “off-treatment” fatigue has been weakened by limited assessments of fatigue and lack of suitable comparison groups. The extent of off-treatment fatigue following treatment for breast cancer (BC) was examined. Women with BC (n = 88; mean, 28 months posttreatment) and age-matched women (n = 88) with benign breast problems (BBP), completed a set of fatigue questionnaires at an Initial assessment and a 4-month Follow-up assessment. The BC group reported more fatigue, more weakness, and less vitality relative to the BBP group at both assessments. No relationship was found in the BC group between fatigue and extent of treatment or time since treatment completion. While the results document the existence of off-treatment fatigue following BC, elucidation of the psychobiological processes underlying this symptom and development of clinical management strategies remain as challenges for future research.

Hot flashes in postmenopausal women treated for breast carcinoma: prevalence, severity, correlates, management, and relation to quality of life.

Research on hot flashes (HFs) after the diagnosis and treatment of breast carcinoma (BC) is scarce. To our knowledge, this research represents the second study of HF prevalence and severity in women with BC and the first study of 1) correlates of HF prevalence and severity, 2) use of HF management strategies, and 3) the relation between HFs and quality of life (QOL) among women with BC.

Positive and negative psychosocial sequelae of bone marrow transplantation : Implications for quality of life assessment

Life-threatening disease can trigger positive effects such as greater appreciation for life and enhanced interpersonal relationships. Little research has examined these salutary effects or their association with quality of life (QOL). Adult bone marrow transplantation (BMT) survivors (n=90) were interviewed regarding psychosocial sequelae of BMT and completed indices of QOL and psychological adjustment. Thematic analysis was used to code interview responses into discrete categories of negative and positive sequelae. Multiple regression analyses indicated POSTOTAL scores were inversely associated with time post-BMT and positively associated with negative prognostic factors at BMT. Scores on indices of QOL and psychological adjustment were significantly correlated with reports of negative post-BMT sequelae but unrelated to positive sequelae. It was concluded that life-threatening disease can trigger positive sequelae that can contribute to QOL. However, standard QOL indices may not measure this positive QOL dimension, thus yielding a potentially incomplete picture of current QOL.

PSYCHOMETRICS FOR TWO SHORT FORMS OF THE CENTER FOR EPIDEMIOLOGIC STUDIES± DEPRESSION SCALE

The Center for Epidemiologic Studies-Depression Scale (CES-D; L. S. Radloff, 1977) assesses the presence and severity of depressive symptoms occurring over the past week. Although it contains only 20 items, its length may preclude its use in a variety of clinical populations. This study evaluated psychometric properties of 2 shorter forms of the CES-D developed by F. J. Kohout, L. F. Berkman, D. A. Evans, and J. Cornoni-Huntley (1993): the Iowa form and the Boston form. Data were pooled from 832 women representing 6 populations. Internal consistency estimates, correlations with the original version of the CES-D, and omitted-included item correlations supported use of the Iowa form over the Boston form when a shortened version of the scale is desired. Regression statistics are provided for use in estimating scores on the original CES-D when either shortened form is used. Factor analytic results from two populations support a single-factor structure for the original CES-D as well as the short forms.

Social constraints, cognitive processing, and adjustment to breast cancer.

This cross-sectional study of 70 breast cancer survivors examined relationships among social constraints, behavioral and self-report indicators of cognitive processing, depression, and well-being. On the basis of a social-cognitive processing (SCP) model, it was predicted that social constraints would inhibit cognitive processing of the cancer experience, leading to poorer adjustment. Constraints were positively associated with intrusions, avoidance, and linguistic uncertainty in cancer narratives. Greater uncertainty, intrusions, and avoidance, as well as less talking about cancer were associated with greater depression and less well-being. Intrusions partially mediated the positive constraints-depression relationship. Talking about cancer partially mediated the inverse avoidance-well-being relationship. Findings support the SCP model and the importance of using behavioral indicators of cognitive processing to predict positive and negative psychosocial outcomes of cancer.

Factors Associated with PTSD Symptoms Following Treatment for Breast Cancer: Test of the Andersen Model

The utility of Andersens (1993, 1994) model of psychologic morbidity following cancer treatment for predicting PTSD symptoms in breast cancer survivors (N = 82) was examined. PTSD symptoms, physical comorbidity, social support, depression history, and pre-cancer traumatic stressors were assessed in a structured telephone interview. Multiple regression analysis indicated that Andersen model variables (physical comorbidity, education, disease stage, cancer treatment, depression history, social support) accounted for 39% of variance in PTSD symptom reports ( p < .001). Addition to the model of time since treatment completion, pre-cancer traumatic stressors, age at diagnosis, and tamoxifen usage accounted for an additional 16% of variance (p < .001). Higher levels of PTSD symptoms were associated with less social support, greater pre-cancer trauma history, less time since treatment completion, and more advanced disease.

PSYCHOSOCIAL ADJUSTMENT AND QUALITY OF LIFE IN WOMEN WITH BREAST CANCER AND BENIGN BREAST PROBLEMS: A CONTROLLED COMPARISON

Comparison of psychosocial adjustment in women with breast cancer (BC) and women with benign breast problems (BBP) has been hampered by a failure to control for age differences between these groups, as well as a failure to assess positive psychosocial adaptation in addition to psychological distress. Age-matched women with breast cancer (n = 80) and benign breast problems (n = 80) completed measures of psychological distress, positive psychosocial adaptation, and general quality of life (QOL). Breast cancer patients had completed primary treatment for breast cancer a mean of 24.6 months prior to participation (range, 6-57 months). Comparison of the BC and BBP groups indicated that the BC group reported (1) poorer physical health and functioning, (2) no differences in psychological distress, and (3) greater positive psychosocial adaptation, such as improved life outlook, enhanced interpersonal relationships, and deeper spiritual and religious satisfaction. Results support the theoretical position that cancer is a transitional event, that is, a traumatic event that alters an individuals assumptive world with the potential to produce long-lasting changes of both a positive as well as negative nature. This underscores the importance of using measures of both psychological distress and positive psychosocial adaptation when assessing psychological adjustment following transitional events such as breast cancer.