Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
권호 표지
DOI QR코드

DOI QR Code

Development and Validation of Perceived Stigma of Delirium Scale

섬망 환자의 지각된 낙인 척도 개발 및 타당성 검증

  • Kim, Seon-Young (Mental Health Clinic, Chonnam National University Hwasun Hospital) ;
  • Kim, Sung-Wan (Departments of Psychiatry, Chonnam National University Medical School) ;
  • Kim, Jae-Min (Departments of Psychiatry, Chonnam National University Medical School) ;
  • Shin, Il-Seon (Departments of Psychiatry, Chonnam National University Medical School) ;
  • Yoon, Jin-Sang (Departments of Psychiatry, Chonnam National University Medical School)
  • 김선영 (화순전남대학교병원 정신건강클리닉) ;
  • 김성완 (전남대학교 의과대학 정신건강의학교실) ;
  • 김재민 (전남대학교 의과대학 정신건강의학교실) ;
  • 신일선 (전남대학교 의과대학 정신건강의학교실) ;
  • 윤진상 (전남대학교 의과대학 정신건강의학교실)
  • Received : 2015.09.30
  • Accepted : 2015.12.16
  • Published : 2015.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives : This study developed and validated the Perceived Stigma of Delirium Scale(PSDS), which is designed to measure perceived stigma associated with delirium in patients suffering from that disorder. Methods : Based on a literature review of scales assessing stigma, a preliminary scale comprising seven items was developed. After recovering from delirium, 128 patients completed the PSDS and the Distress Thermometer (DT). Factor analysis was used to examine construct validity, and internal consistency and test-retest reliability were examined to ensure reliability. Concurrent validity was assessed using the correlation between the total scores on the PSDS and the DT. Results : Factor analysis yielded a single-factor structure from the seven candidate items. One item was excluded due to low factor loading. The internal consistency was computed and Cronbach's ${\alpha}$ was 0.85 for the total score. The overall test-retest reliability was 0.71, with items ranging from 0.58 to 0.83. The total score on the PSDS was significantly correlated with the DT score. Conclusions : The PSDS may be a reliable, valid instrument for evaluating perceived stigma in patients who have recovered from delirium. Further study of the perceived stigma by delirium patients is required to assess the implications of the PSDS for clinical practice and research.

연구목적 본 연구는 '섬망환자의 지각된 낙인 척도(Perceived Stigma of Delirium Scale, PSDS)'를 개발하고 신뢰도와 타당도를 평가하여 섬망을 경험한 환자의 지각된 낙인을 측정하고자 시행되었다. 방 법 기존 문헌과 낙인 관련 척도를 고찰 및 참고하여 7문항의 PSDS 예비 척도를 구성하고, 섬망에서 회복된 128명의 환자를 대상으로 PSDS와 디스트레스 온도계(Distress Thermometer, DT)를 측정하였다. 탐색적 요인 분석을 시행하여 낙인 척도의 요인 구조를 확인하였다. 신뢰도 검증을 위해 내적 일치도와 검사-재검사 신뢰도를 분석하였다. 공시타당도는 PSDS 총점과 DT의 상관 분석을 통해 확인하였다. 결 과 예비 척도의 요인 분석을 시행한 결과 단일 요인이 추출되었다. 예비 척도 7문항 중 1개 문항은 낮은 요인 부하량을 가져 제외하였다. PSDS의 내적 일치도의 분석을 위해 시행한 Cronbach's ${\alpha}$ 값은 0.85였다. PSDS 총점의 검사-재검사간 상관 계수는 0.71이었으며, 각 문항별 상관 계수는 0.58에서 0.83사이었다. PSDS의 총점과 DT는 유의한 상관관계를 보였다. 결 론 본 연구는 PSDS가 섬망에서 회복된 환자의 지각된 낙인을 측정하는데 있어서 신뢰할만한 도구임을 확인하 였다. 본 척도 연구를 기반으로, 후속 연구와 다기관 연구를 통해 임상적 유용성의 평가가 이루어져야 할 것이다.

Keywords

References

  1. Saxena S, Lawley D. Delirium in the elderly: a clinical review. Postgrad Med J 2009;85:405-413. https://doi.org/10.1136/pgmj.2008.072025
  2. Siddiqi N, House AO, Holmes JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing 2006;35:350-364. https://doi.org/10.1093/ageing/afl005
  3. Ogawa A, Shimizu K, Akizuki N, Uchitomi Y. Involvement of a psychiatric consultation service in a palliative care team at the Japanese cancer center hospital. Jpn J Clin Oncol 2010; 40:1139-1146. https://doi.org/10.1093/jjco/hyq147
  4. Kim SW, Kim SY, Kim SJ, Kim JM, Shin IS, Yoon JS. Psychiatric Consultation for 5 Years in a University Hospital. Korean J Psychosomatic Medicine 2011;19:28-33.
  5. Cole MG, McCusker J, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. The course of delirium in older long-term care residents. Int J Geriatr Psychiatry 2012;27:1291-1297. https://doi.org/10.1002/gps.3782
  6. Wolters AE, van Dijk D, Pasma W, Cremer OL, Looije MF, de Lange DW, Veldhuijzen DS, Slooter AJ. Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study. Crit Care 2014; 18:R125. https://doi.org/10.1186/cc13929
  7. Breitbart W, Gibson C, Tremblay A. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics 2002;43:183-194. https://doi.org/10.1176/appi.psy.43.3.183
  8. Bruera E, Bush SH, Willey J, Paraskevopoulos T, Li Z, Palmer JL, Cohen MZ, Sivesind D, Elsayem A. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer 2009;115:2004-2012. https://doi.org/10.1002/cncr.24215
  9. Davydow DS. Symptoms of depression and anxiety after delirium. Psychosomatics 2009;50:309-316. https://doi.org/10.1176/appi.psy.50.4.309
  10. Bull MJ, Boaz L, Sjostedt JM. Family Caregivers' Knowledge of Delirium and Preferred Modalities for Receipt of Information. J Appl Gerontol 2014 Jun 18. pii: 0733464814535484. [Epub ahead of print]
  11. Link BG, Cullen FT, Frank J, Wozniak JF. The Social Rejection of Former Mental Patients: Understanding Why Labels Matter. American Journal of Sociology 1987;92:1461-1500. https://doi.org/10.1086/228672
  12. Corrigan PW, Watson AC. The paradox of self-stigma and mental illness. Clin Psychol Sci Pract 2002;9:35-53. https://doi.org/10.1093/clipsy.9.1.35
  13. Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP. A modified labeling theory approach to mental disorders: An empirical assessment. Am Sociol Rev 1989;54:400-423. https://doi.org/10.2307/2095613
  14. Rusch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry 2005;20:529-539. https://doi.org/10.1016/j.eurpsy.2005.04.004
  15. Ritsher JB, Phelan JC. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res 2004;129:257-265. https://doi.org/10.1016/j.psychres.2004.08.003
  16. Fife BL, Wright ER. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav 2000;41:50-67. https://doi.org/10.2307/2676360
  17. Lee SE, Lee HY, Diwan S. What do Korean American immigrants know about Alzheimer's disease(AD)? The impact of acculturation and exposure to the disease on AD knowledge. Int J Geriatr Psychiatry 2010;25:66-73.
  18. Torrey EF. Stigma and violence: isn't it time to connect the dots? Schizophr Bull 2011;37:892-896. https://doi.org/10.1093/schbul/sbr057
  19. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003;121:31-49. https://doi.org/10.1016/j.psychres.2003.08.008
  20. Hwang TY, Lee WK, Han ES, Kwon EJ. A study on the reliability and validity of the Korean version of Internalized Stigma of Mental Illness scale(K-ISMI). J Korean Neuropsychiatr Assoc 2006;45:418-426.
  21. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders(4th edn). Washington, DC;1994.
  22. Inouye SK, Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Ann Int Med 1990;113:941-948. https://doi.org/10.7326/0003-4819-113-12-941
  23. Leonard M, Raju B, Conroy M, Donnelly S, Trzepacz PT, Saunders J, Meagher D. Reversibility of delirium in terminally ill patients and predictors of mortality. Palliat Med 2008;22:848-454. https://doi.org/10.1177/0269216308094520
  24. Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: an overview. Ann Intensive Care 2012;2:49. https://doi.org/10.1186/2110-5820-2-49
  25. Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC. Rapid screening for psychologic distress in men with prostate carcinoma. Cancer 1998;82:1904-1908. https://doi.org/10.1002/(SICI)1097-0142(19980515)82:10<1904::AID-CNCR13>3.0.CO;2-X
  26. Shim EJ, Shin YW, Jeon HJ, Hahm BJ. Distress and its correlates in Korean cancer patients: pilot use of the distress thermometer and the problem list. Psychooncology 2008;17:548-555. https://doi.org/10.1002/pon.1275
  27. Barney LJ, Griffiths KM, Christensen H, Jorm AF. The Self-Stigma of Depression Scale(SSDS): development and psychometric evaluation of a new instrument. Int J Methods Psychiatr Res 2010;19:243-254. https://doi.org/10.1002/mpr.325
  28. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001;24:518-529. https://doi.org/10.1002/nur.10011
  29. Kwon YH. Suicidal ideation of people living with HIV/AIDS and its determinants(Dissertation), Daejon: Graduate School Chungnam National University;2009.
  30. Burgener SC, Buckwalter K, Perkhounkova Y, Liu MF, Riley R, Einhorn CJ, Fitzsimmons S, Hahn-Swanson C. Perceived stigma in persons with early-stage dementia: Longitudinal findings: Part 1. Dementia(London) 2015;14:589-608.
  31. Jones EE, Farina A, Hastorf A, Marksu H, Mella D, Scott R. Social stigma: the psychology of a marked relationship. New York, NY: Freeman and Company;1984.
  32. Link BG, Phelan JC. Conceptualizing stigma. Annual Review of Sociology 2001;27:363-385. https://doi.org/10.1146/annurev.soc.27.1.363
  33. Torrey EF. Stigma and violence: isn't it time to connect the dots? Schizophr Bull 2011;37:892-896. https://doi.org/10.1093/schbul/sbr057
  34. Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Raue P, Friedman SJ, Meyers BS. Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. Am J Psychiatry 2001;158:479-481. https://doi.org/10.1176/appi.ajp.158.3.479