Journal of Dermatology 2015; 42: 975–980
doi: 10.1111/1346-8138.12976
ORIGINAL ARTICLE
Reliability and validity assessment of the revised Symptom Checklist 90 for alopecia areata patients in China Huan TAN, Xue-mei LAN, Nan-lan YU, Xi-chuan YANG Department of Dermatology, the First Affiliated Hospital of Third Military Medical University, Chongqing, China
ABSTRACT No study has tested the reliability and validity of the revised Symptom Checklist 90 (SCL-90-R) for patients with alopecia areata (AA), and few have used it to evaluate the mental health of AA patients. To assess the psychological status in Chinese AA patients using the SCL-90-R, and to evaluate its reliability and validity, the psychological status of 168 patients and 100 controls was evaluated with the Chinese-version SCL-90-R. From this study, we found that The Global Severity Index and nine subscale scores on the SCL-90-R were significantly higher in AA patients than that in the controls. Moreover, The Global Severity Index and nine subscale scores on the SCL-90-R were associated with disease duration, age of onset, sex and type of AA. In addition, the SCL-90-R presented good internal consistency (whole scale a = 0.98 and split-half coefficient = 0.95). The intercorrelations between the nine subscales and their correlations with the total scale were 0.58–0.93. Factor analysis produced 22 factors with eigenvalues more than 1.0; the first factor explained 33.88% of the variance. Only hostility and paranoid ideation merged into one factor. Taken together, our data indicated that Chinese AA patients demonstrate greater psychopathology than healthy controls. The SCL-90-R can be used to assess global psychological distress in AA patients with good reliability and validity.
Key words: validity.
alopecia areata, factor analysis, psychological status, reliability, revised Symptom Checklist 90,
INTRODUCTION Alopecia areata (AA) is a common hair loss disorder characterized by the sudden disappearance of hair from any hairbearing areas. AA affects approximately 0.27% of the Chinese population, can first occur in children or adults, and affects more men than women.1 Currently, the etiology of AA is poorly understood, but it is generally considered to be a T-cellmediated organ-specific autoimmune disease with a genetic predisposition,2 triggered or exacerbated by environmental factors.3–5 A Cochrane study revealed that few treatments for AA exist.6 AA is not painful or life-threatening, but can significantly affect patients’ quality of life7,8 and lead to various psychological problems, including depression, anxiety, lower self-esteem and altered interpersonal sensitivity.9–11 The revised Symptom Checklist 90 (SCL-90-R) is a multidimensional self-report psychometric symptom instrument originally developed by Derogatis et al. for use in clinical and research settings on the basis of Hopkins’s Checklist.12 The SCL-90-R has subsequently been translated into other languages13–17 and is widely used to evaluate the psychological status for many diseases such as breast cancer,18 multiple sclerosis,19 psoriasis20 and systemic lupus erythematosus.21 However, any measurement instrument should have its
reliability and validity retested, as they can show different reliabilities and validities in different samples or diseases.13–17,22– 24 Moreover, the SCL-90-R has rarely been applied to evaluate the mental health state of AA patients,25 and no known studies have reported the reliability or validity of the SCL-90-R within AA samples. Therefore, the purpose of this study was to assess the psychological status of Chinese patients with AA and to evaluate the reliability and validity of the Chinese-version SCL-90-R among AA patients.
METHODS Study design and population Patients older than 18 years diagnosed with AA at the Department of Dermatology at the First Affiliated Hospital of Third Military Medical University, Chongqing, China, between December 2012 and August 2013 were recruited consecutively. Patients were excluded if they had other hair loss disorders or a severe mental illness. Controls were selected from healthy volunteers at the same institution. All participants were asked to fill out the SCL-90-R according to their own feelings and opinions within 15–20 min. Completed questionnaires were collected as soon as they were finished. In addition, demographic and
Correspondence: Xi-chuan Yang, M.D., Department of Dermatology, the First Affiliated Hospital of Third Military Medical University, 29 Gaotanyan Main Street, Shapingba District, Chongqing 400038, China. Email: [email protected] Received 16 February 2015; accepted 6 May 2015.
© 2015 Japanese Dermatological Association
975
H. Tan et al.
clinical data of each patient were collected. This case–control study was conducted with the permission of the ethics committee of the First Affiliated Hospital of Third Military Medical University. Verbal informed consent was obtained from all participants.
Questionnaire The Chinese-version SCL-90-R questionnaire with established reliability and validity is widely used in measuring psychological distress in Chinese clinical practice and research.18,26–28 It consists of 90 items, each rated on a 5-point scale of distress (1–5) from “not at all” to “extremely serious”. It measures nine symptom dimensions including somatization, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism, as well as a class of additional items that assess other symptoms. The
Table 1. Demographic and clinical characteristics for patients with AA (n = 168) n Sex Male Female Marital status Single Non-single Mean age (years, mean SD) Age of onset (years)
doi: 10.1111/1346-8138.12976
ORIGINAL ARTICLE
Reliability and validity assessment of the revised Symptom Checklist 90 for alopecia areata patients in China Huan TAN, Xue-mei LAN, Nan-lan YU, Xi-chuan YANG Department of Dermatology, the First Affiliated Hospital of Third Military Medical University, Chongqing, China
ABSTRACT No study has tested the reliability and validity of the revised Symptom Checklist 90 (SCL-90-R) for patients with alopecia areata (AA), and few have used it to evaluate the mental health of AA patients. To assess the psychological status in Chinese AA patients using the SCL-90-R, and to evaluate its reliability and validity, the psychological status of 168 patients and 100 controls was evaluated with the Chinese-version SCL-90-R. From this study, we found that The Global Severity Index and nine subscale scores on the SCL-90-R were significantly higher in AA patients than that in the controls. Moreover, The Global Severity Index and nine subscale scores on the SCL-90-R were associated with disease duration, age of onset, sex and type of AA. In addition, the SCL-90-R presented good internal consistency (whole scale a = 0.98 and split-half coefficient = 0.95). The intercorrelations between the nine subscales and their correlations with the total scale were 0.58–0.93. Factor analysis produced 22 factors with eigenvalues more than 1.0; the first factor explained 33.88% of the variance. Only hostility and paranoid ideation merged into one factor. Taken together, our data indicated that Chinese AA patients demonstrate greater psychopathology than healthy controls. The SCL-90-R can be used to assess global psychological distress in AA patients with good reliability and validity.
Key words: validity.
alopecia areata, factor analysis, psychological status, reliability, revised Symptom Checklist 90,
INTRODUCTION Alopecia areata (AA) is a common hair loss disorder characterized by the sudden disappearance of hair from any hairbearing areas. AA affects approximately 0.27% of the Chinese population, can first occur in children or adults, and affects more men than women.1 Currently, the etiology of AA is poorly understood, but it is generally considered to be a T-cellmediated organ-specific autoimmune disease with a genetic predisposition,2 triggered or exacerbated by environmental factors.3–5 A Cochrane study revealed that few treatments for AA exist.6 AA is not painful or life-threatening, but can significantly affect patients’ quality of life7,8 and lead to various psychological problems, including depression, anxiety, lower self-esteem and altered interpersonal sensitivity.9–11 The revised Symptom Checklist 90 (SCL-90-R) is a multidimensional self-report psychometric symptom instrument originally developed by Derogatis et al. for use in clinical and research settings on the basis of Hopkins’s Checklist.12 The SCL-90-R has subsequently been translated into other languages13–17 and is widely used to evaluate the psychological status for many diseases such as breast cancer,18 multiple sclerosis,19 psoriasis20 and systemic lupus erythematosus.21 However, any measurement instrument should have its
reliability and validity retested, as they can show different reliabilities and validities in different samples or diseases.13–17,22– 24 Moreover, the SCL-90-R has rarely been applied to evaluate the mental health state of AA patients,25 and no known studies have reported the reliability or validity of the SCL-90-R within AA samples. Therefore, the purpose of this study was to assess the psychological status of Chinese patients with AA and to evaluate the reliability and validity of the Chinese-version SCL-90-R among AA patients.
METHODS Study design and population Patients older than 18 years diagnosed with AA at the Department of Dermatology at the First Affiliated Hospital of Third Military Medical University, Chongqing, China, between December 2012 and August 2013 were recruited consecutively. Patients were excluded if they had other hair loss disorders or a severe mental illness. Controls were selected from healthy volunteers at the same institution. All participants were asked to fill out the SCL-90-R according to their own feelings and opinions within 15–20 min. Completed questionnaires were collected as soon as they were finished. In addition, demographic and
Correspondence: Xi-chuan Yang, M.D., Department of Dermatology, the First Affiliated Hospital of Third Military Medical University, 29 Gaotanyan Main Street, Shapingba District, Chongqing 400038, China. Email: [email protected] Received 16 February 2015; accepted 6 May 2015.
© 2015 Japanese Dermatological Association
975
H. Tan et al.
clinical data of each patient were collected. This case–control study was conducted with the permission of the ethics committee of the First Affiliated Hospital of Third Military Medical University. Verbal informed consent was obtained from all participants.
Questionnaire The Chinese-version SCL-90-R questionnaire with established reliability and validity is widely used in measuring psychological distress in Chinese clinical practice and research.18,26–28 It consists of 90 items, each rated on a 5-point scale of distress (1–5) from “not at all” to “extremely serious”. It measures nine symptom dimensions including somatization, obsessive–compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism, as well as a class of additional items that assess other symptoms. The
Table 1. Demographic and clinical characteristics for patients with AA (n = 168) n Sex Male Female Marital status Single Non-single Mean age (years, mean SD) Age of onset (years)
