Abstract
Background
Although a range of generic and diabetes-specific instruments are available to assess emotional distress, no studies have evaluated sensitivity in relation to sample size requirement. The present study sets out to compare the sensitivity among the Diabetes Health Profile Psychological Distress scale (DHP-PD), Problem Areas in Diabetes (PAID) and Kessler-10 Psychological Distress scale (K10). We hypothesized that the diabetes-specific measures (DHP-PD and PAID) would require smaller sample sizes than the generic measure (K10), yet remain specific.
Research design
A total of 208 patients with type 2 diabetes mellitus (mean age 45.2 (12.4) years; 63.1 % males, 45.8 % Chinese, 11.3 % Malay and 26.6 % Indian), recruited from a Singapore tertiary hospital diabetes clinic, completed the English DHP-PD, PAID and K10. Clinical information derived from medical records and HbA1c was recorded. Effect sizes (ES), ratio of ES and sample size requirement relative to the most sensitive questionnaire were computed.
Results
A comparison of patients with good versus poor glycaemic control (HbA1c ≥7.0) revealed that using K10 will require 4 times the sample size of a study using the PAID in order to detect the same level of psychological distress. The DHP-PD and PAID had similar sensitivity when comparing between patients with good versus poor glycaemic control.
Conclusions
As hypothesized, sample size requirement is largest for K10 and remarkably similar for PAID and DHP-PD. This information is useful for designing clinical trials and studies.
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References
Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24(6), 1069–1078. Epub 2001/05/26.
Katon, W. J. (2008). The comorbidity of diabetes mellitus and depression. The American Journal of Medicine, 121(11 Suppl 2), S8–S15. Epub 2008/10/29.
Pawaskar, M. D., Anderson, R. T., & Balkrishnan, R. (2007). Self-reported predictors of depressive symptomatology in an elderly population with type 2 diabetes mellitus: A prospective cohort study. Health and Quality of Life Outcomes, 5, 50. Epub 2007/08/09.
Ali, S., Stone, M. A., Peters, J. L., Davies, M. J., & Khunti, K. (2006). The prevalence of co-morbid depression in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine: A Journal of the British Diabetic Association, 23(11), 1165–1173. Epub 2006/10/24.
Chong, S. A., Subramaniam, M., Chan, Y. H., Chua, H. C., Liow, P. H., Pek, E., et al. (2009). Depressive symptoms and diabetes mellitus in an Asian multiracial population. Asian Journal of Psychiatry, 2(2), 66–70. Epub 2009/06/01.
Verma, S. K., Luo, N., Subramaniam, M., Sum, C. F., Stahl, D., Liow, P. H., et al. (2010). Impact of depression on health related quality of life in patients with diabetes. Annals of the Academy of Medicine, Singapore, 39(12), 913–917. Epub 2011/01/29.
Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25(6), 494–497. Epub 2002/02/05.
Cairney, J., Veldhuizen, S., Wade, T. J., Kurdyak, P., & Streiner, D. L. (2007). Evaluation of 2 measures of psychological distress as screeners for depression in the general population. Canadian Journal of Psychiatry Revue canadienne de psychiatrie, 52(2), 111–120. Epub 2007/03/23.
Furukawa, T. A., Kessler, R. C., Slade, T., & Andrews, G. (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being. Psychological Medicine, 33(2), 357–362. Epub 2003/03/08.
Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. Epub 2002/09/07.
Kessler, R. C. (1999). The World Health Organization International Consortium in Psychiatric Epidemiology (ICPE): Initial work and future directions—The NAPE Lecture 1998. Nordic Association for Psychiatric Epidemiology. Acta Psychiatrica Scandinavica, 99(1), 2–9. Epub 1999/03/05.
Meadows, K., Steen, N., McColl, E., Eccles, M., Shiels, C., Hewison, J., et al. (1996). The Diabetes Health Profile (DHP): A new instrument for assessing the psychosocial profile of insulin requiring patients—Development and psychometric evaluation. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation., 5(2), 242–254. Epub 1996/04/01.
Meadows, K. A., Abrams, C., & Sandbaek, A. (2000). Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with type 2 diabetes mellitus: Psychometric evaluation and cross-cultural comparison. Diabetic Medicine: A Journal of the British Diabetic Association, 17(8), 572–580. Epub 2000/11/10.
Meadows, K. (2010) Scoring the DHP-18. DHP Research & Consultancy. 113 Lower Camden, Chislehurst, Kent BR7 5JD 2010.
Tan, L., Khoo, E., Griva, K., Lee, Y., Amir, M., Zuniga, Y., et al. (2014). Reliability, Validity and Sensitivity of the Diabetes Health Profile-18 in Singapore.
Snoek, F. J., Pouwer, F., Welch, G. W., & Polonsky, W. H. (2000). Diabetes-related emotional distress in Dutch and U.S. diabetic patients: Cross-cultural validity of the problem areas in diabetes scale. Diabetes Care, 23(9), 1305–1309. Epub 2000/09/08.
Polonsky, W. H., Anderson, B. J., Lohrer, P. A., Welch, G., Jacobson, A. M., Aponte, J. E., et al. (1995). Assessment of diabetes-related distress. Diabetes Care, 18(6), 754–760. Epub 1995/06/01.
Welch, G. W., Jacobson, A. M., & Polonsky, W. H. (1997). The Problem Areas in Diabetes Scale. An evaluation of its clinical utility. Diabetes Care, 20(5), 760–766. Epub 1997/05/01.
Rajaram, R. (2012). Validation of the Problem Areas in Diabetes Questionnaire among patients with type 2 diabetes mellitus in Singapore: A pilot study. Singapore: National University of Singapore, Department of Pharmacy.
Ismail-Beigi, F. (2012). Clinical practice. Glycemic management of type 2 diabetes mellitus. The New England Journal of Medicine, 366(14), 1319–1327. Epub 2012/04/06.
Sherbourne, C., & Kamberg, C. (1992). Measuring functioning and well-being: The medical outcomes study approach (pp. 183–193). Durham, NC: Duke University Press.
Meadows, K. (2010). Scoring the DHP-18.
Australian Mental Health Outcomes and Classification Network: Kessler-10 Training Manual. Commonwealth of Australia 2005: NSW Institute of Psychiatry; 2005.
Kazis, L. E., Anderson, J. J., & Meenan, R. F. (1989). Effect sizes for interpreting changes in health status. Medical Care, 27(3 Suppl), S178–S189. Epub 1989/03/01.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.
Wyrwich, K. W., Nienaber, N. A., Tierney, W. M., & Wolinsky, F. D. (1999). Linking clinical relevance and statistical significance in evaluating intra-individual changes in health-related quality of life. Medical Care, 37(5), 469–478. Epub 1999/05/21.
Machin, D., Campbell, M., Fayers, P., & Pinol, A. (1997). Sample size tables for clinical studies (2nd ed.). Malden, MA: Blackwell Science.
Team RC. (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org/.
Support ST. StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.
Thomas, M. C., MacIsaac, R. J., Tsalamandris, C., Power, D., & Jerums, G. (2003). Unrecognized anemia in patients with diabetes: A cross-sectional survey. Diabetes Care, 26(4), 1164–1169. Epub 2003/03/29.
Beurskens, A. J., de Vet, H. C., & Koke, A. J. (1996). Responsiveness of functional status in low back pain: A comparison of different instruments. Pain, 65(1), 71–76. Epub 1996/04/01.
Welch, G., Weinger, K., Anderson, B., & Polonsky, W. H. (2003). Responsiveness of the Problem Areas in Diabetes (PAID) questionnaire. Diabetic Medicine: A Journal of the British Diabetic Association, 20(1), 69–72. Epub 2003/01/10.
Singapore Census of Population. (2000). Singapore. Department of Statistics Singapore: Oct 2001. Report No.
Information Paper on Diabetes in Singapore. (2011). In: Board HP (Ed.) National Registry of Diseases Office 2011.
Krosnick, J. A. (1999). Survey research. Annual Review of Psychology, 50, 537–567.
Jena, A. B., Press, V. G., Arora, V. M. (2013) Social desirability bias in self-rated presenteeism among resident physicians—Reply. JAMA Internal Medicine, 173(2), 166 (Epub 2013/01/30).
Acknowledgments
This work was supported by the grant from Ministry of Education Singapore Academic Research Fund Tier 1 (Grant No.: FY2011-FRC3-007).
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Tan, L.S.M., Khoo, E.Y.H., Tan, C.S. et al. Sensitivity of three widely used questionnaires for measuring psychological distress among patients with type 2 diabetes mellitus. Qual Life Res 24, 153–162 (2015). https://doi.org/10.1007/s11136-014-0747-z
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DOI: https://doi.org/10.1007/s11136-014-0747-z