Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia

Abstract

AimTo develop and psychometrically test the distress thermometer for caregivers (DT‐C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia.DesignA validation diagnostic accuracy study and descriptive cross‐sectional survey.MethodsDT‐C was adopted based on Harverman's distress thermometer for parents. The cut‐off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale‐21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018.ResultsOne‐item DT of DT‐C indicated a good retest reliability (r = 0.86) and one‐item DT and the Problem List (PL) indicated good convergent validity (r = 0.67–0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70–0.90). Setting seven as the cut‐off score, the values of sensitivity (0.72–0.81), specificity (0.86–0.90), Youden's index (0.61–0.70), positive predictive value (0.67–0.74), and negative predictive value (0.84–0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88–0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut‐off. Caregivers above the cut‐off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains.ConclusionThe DT‐C, with six domains containing 35 items in Problem List and with the cut‐off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers’ distress.ImpactThis study adapted a reliable DT‐C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.

Feasibility of brief distress screening for family caregivers of adults diagnosed with schizophrenia in Changsha, Hunan, China

“…We think FGs may show different possibilities of distress in patients with different age groups. Therefore, the current study is focusing on FGs of adults diagnosed with schizophrenia, which is an obvious difference from the previous publication (Bai et al., 2019).…”

“…In the present study, DASS21 was selected as the criterion to determine an optimal cut‐off for DT. Its sensitivity and specificity based on the following reasons: (a) DASS21 is more applicable to measure distress amongst FGs as DASS21 measures psychological distress in the general population (Henry & Crawford, 2011), whilst HADS was created to identify possible patients of anxiety and depression in non‐psychiatric hospital outpatients (Theodore, Doyle, Ward, & McGee, & Hannah., 2012); (b) both DT and DASS21 are valid and effective measures in Chinese general populations (Henry & Crawford, 2011; Tang et al., 2011); and (c) DASS21 (Stanley et al., 2017) and DT have been used to evaluate distress amongst FGs of patients diagnosed with schizophrenia (Bai et al., 2019). To be more specific, Stanley et al.…”

“…Bai et al. (2019) determined a DT cut‐off score of seven against DASS21 amongst FGs of adolescents diagnosed with schizophrenia (Bai et al., 2019). It has been reported that the disease burden from adults diagnosed with schizophrenia is the heaviest amongst all age groups diagnosed with schizophrenia, as adults are most likely to be economically productive (Charlson et al, 2018).…”

“…The DT has been widely used and examined for clinical utility in screening distress amongst FGs and care recipients with cancer and other chronic diseases (Lotte et al., 2013; Wiener, Battles, Zadeh, Widemann, & Pao, 2017). Considering the different caregiving tasks and treatments between chronic diseases and mental illnesses, the sources of stress that FGs perceived may vary, but distress commonly occurs amongst these FGs (Bai et al., 2019; Wiener et al., 2017), indicating potential feasibility amongst FGs of adults diagnosed with schizophrenia. Previous studies show that optimal cut‐off scores of the DT vary with cultures and populations, according to results from receiver operating characteristic (ROC) curve analysis.…”

“…In another study, a cut‐off of seven was determined based on thresholds from the three subscales of the 21‐item Depression Anxiety and Stress Scale (DASS21) amongst FGs of adolescents and children diagnosed with schizophrenia (Sensitivity 0.72–0.81, specificity 0.86–0.90). The scores of DT correlated positively with depression ( r = 0.78), anxiety ( r = 0.77) and stress ( r = 0.78) scores on DASS21, indicating DASS21 can function as a validity criterion of DT (Bai et al., 2019).…”