Quality of Life Research

, Volume 24, Issue 6, pp 1491–1501 | Cite as

The emotional distress of children with cancer in China: an item response analysis of C-Ped-PROMIS Anxiety and Depression short forms

  • Yanyan Liu
  • Jingting Wang
  • Pamela S. Hinds
  • Jichuan Wang
  • Nanping Shen
  • Xiufang Zhao
  • Jian Ding
  • Changrong Yuan



The pediatric patient-reported outcomes measurement information system (PROMIS) was developed to provide self-reported item banks and short forms for children and adolescents (aged 8–17 years) experiencing a chronic illness to assess their quality of life and symptoms. The pediatric PROMIS short forms have been translated into Chinese and applied in children with cancer in China. This study aimed to describe psychometric properties of the Anxiety and Depression measures.


A total of 232 children and adolescents with cancer were recruited in hospital-based inpatient and outpatient clinics. Eight Chinese versions of pediatric PROMIS (C-Ped-PROMIS) measures were administered. Categorical confirmatory factor analysis (CCFA) were conducted to evaluate scale dimensionality and item local dependence of the C-Ped-PROMIS Anxiety and Depression items. Multiple indicator multiple cause models were used to analyze differential item functioning (DIF), item response theory parameters were calculated, and test information against T scores was reported for each measure.


The results of the CCFA confirmed that both C-Ped-PROMIS Anxiety and Depression scales appropriately measure the theoretical constructs as designed. No significant DIF was found for the items of the two scales according to age and gender. Both scales have high test reliability as long as their T scores are not on the low or high extremes.


The pediatric PROMIS Anxiety and Depression measures were developed to provide efficient and flexible assessment of emotional distress domains. Our results provide evidence that the two C-Ped-PROMIS measures can be readily applied to measure anxious and depressive symptoms in Chinese children with cancer.


PROMIS Anxiety Depression PRO IRT Pediatrics 



Patient-reported outcomes measurement information system


Chinese version of pediatric PROMIS


Quality of life


Patient-reported outcomes


Categorical confirmatory factor analysis


Item response theory


Local dependence


Multiple indicator multiple cause


Differential item function



This study was supported by the Science and Technology Commission of Shanghai Municipality, China (Project No. 12410707900) and Oncology Nursing Society (ONS) Foundation.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Yanyan Liu
    • 1
  • Jingting Wang
    • 2
    • 3
  • Pamela S. Hinds
    • 2
    • 3
  • Jichuan Wang
    • 1
  • Nanping Shen
    • 4
  • Xiufang Zhao
    • 5
  • Jian Ding
    • 6
  • Changrong Yuan
    • 1
  1. 1.Second Military Medical UniversityShanghaiChina
  2. 2.Department of Nursing Research and Quality Outcomes, and the Center for Translational ScienceChildren’s National Medical CenterWashingtonUSA
  3. 3.School of MedicineThe George Washington UniversityWashingtonUSA
  4. 4.Nursing DepartmentShanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
  5. 5.Nursing DepartmentWest China Second University Hospital Affliated to Sichuan UniversityChengduChina
  6. 6.Department of Hospital officeChildren’s Hospital of Shanghai Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina

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