Construct validity of the Zung’s scale in patients with heart failure
Published
Dec 30, 2021
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Lyda Zoraya Rojas Sánchez
Silvia Juliana Trujillo-Cáceres
https://orcid.org/0000-0002-7626-3822
Juliana Alexandra Hernández Vargas
https://orcid.org/0000-0001-6183-252X
Adriana Milena Jurado
https://orcid.org/0000-0002-3137-8319
Luis Eduardo Echeverría
https://orcid.org/0000-0001-5784-3859
Sergio Alejandro Gómez-Ochoa
https://orcid.org/0000-0002-1396-5042
Zayne Milena Roa-Díaz
https://orcid.org/0000-0002-0847-0969
https://orcid.org/0000-0002-7626-3822
Juliana Alexandra Hernández Vargas
https://orcid.org/0000-0001-6183-252X
Adriana Milena Jurado
https://orcid.org/0000-0002-3137-8319
Luis Eduardo Echeverría
https://orcid.org/0000-0001-5784-3859
Sergio Alejandro Gómez-Ochoa
https://orcid.org/0000-0002-1396-5042
Zayne Milena Roa-Díaz
https://orcid.org/0000-0002-0847-0969
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Abstract
Introduction: The Zung scale for depression has previously been used in patients with heart failure; however, to our knowledge, there is no evidence of its validity for the Spanish version as well as its use in the adult population with heart failure in Colombia. Objective: To determine the construct validity of the Zung scale for depression, the original version, and to propose an abbreviated version of it in adult patients with heart failure.
Materials and Methods: A cross-sectional study, carried out in 200 patients from a heart failure and transplant center, in which the Zung Self-Rating Depression Scale was applied. Internal consistency was evaluated using Cronbach's alpha coefficient and factorial analysis was used to identify the dimensions of the instrument.
Results: The internal consistency of the original version of the scale (20 items) was α=0.811. The factorial analysis showed a structure made up of three factors that explain 51.59% of the total variance. The new abbreviated version (13 items) obtained α=0.819 and the items correlated with a single factor which explained 33.54% of the total variance.
Discussion: Our findings are similar to those found by other authors in different populations than the one studied.
Conclusions: Good construct validity was showed for both, the original version of the Zung scale for depression and the abbreviated version created in the studied population. However, additional studies are required to verify these findings in a representative sample. Also, other aspects of psychometry should be evaluated.
Keywords
Validation Study; Psychiatric Status Rating Scales; Depression; Heart Failure.Estudio de Validación; Escalas de Valoración Psiquiátrica; Depresión; Insuficiencia cardíaca.Estudos de Validacão; Escalas de Graduacão Psiquiátrica; Depressão; Insuficiência cardíaca.
References
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10. Parissis J, Karavidas A, Farmakis D, Papoutsidakis N, Matzaraki V, Arapi S, et al. Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. Eur J Prev Cardiol. 2015;22(7):831-6. https://doi.org/ 10.1177/2047487314540546
11. Suzuki T, Shiga T, Kuwahara K. Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure. J Cardiol. 2014;64(6):456-62. https://doi.org/1 0.1016/j.jjcc.2014.02.031
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13. Lezama Meneses SR. Propiedades psicométricas de la escala de Zung para síntomas depresivos en población adolescente escolarizada colombiana. Psychol. 2012;6(1):91-101.
14. Campo-Arias A, Díaz-Martínez LA, Rueda-Jaimes GE, Barros-Bermúdez JA. Validación de la escala de Zung para depresión en universitarias de Bucaramanga, Colombia. Rev Colomb Psiquiatr. 2005;34(1):54-62.
15. Díaz LA, Campo A, Rueda GE, Barros JA. Propuesta de una versión abreviada de la escala de Zung para depresión. Colmb Med (Cali). 2005;36(3):168-72.
16. Campo A, Díaz LA, Rueda GE. Validez de la escala breve de Zung para tamizaje del episodio depresivo mayor en la población general de Bucaramanga, Colombia. Biomédica. 2006;26:415-23. https://doi.org/
17. Campo-Arias A, Díaz-Martínez L, Rueda-Jaimes G, Cadena L, Hernández N. Validation of Zung’s self-rating depression scale among the Colombian general population. Soc Behav Pers. 2006;34:87-94. https://doi.org/10.7705/biomedica.v26i3.360
18. Albert NM, Fonarow GC, Abraham WT, Gheorghiade M, Greenberg BH, Nunez E, et al. Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. Am J Med. 2009;122(4):366-73. https://doi.org/ 10.1016/j.amjmed.2008.09.046
19. Martensson J, Stromberg A, Dahlstrom U, Karlsson JE, Fridlund B. Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression. Eur J Heart Fail. 2005;7(3):393-403. https://doi.org/ 10.1016/j.ejheart.2004.01.016.
20. Floyd FJ, Widaman KF. Factor Analysis in the Development and Refinement of Clinical Assessment Instruments. Psychological assessment. 1995;7(3):286-99.
21. Zung WW. A Self-Rating Depression. Arch Gen Psychiatry. 1965;12:63-70. https://doi.org/ 10.1001/archpsyc.1965.01720310065008
22. Zung WW. From Art to Science Seeet. Arch Gen Psychiatry. 1973;29(3):328-37. https://doi.org/10.1001/archpsyc.1973.04200030026004
23. Romera I, Delgado-cohen H, Perez T, Caballero L, Gilaberte I. Factor analysis of the Zung self-rating depression scale in a large sample of patients with major depressive disorder in primary care. BMC Psychiatry. 2008;8(4):1-8. https://doi.org/10.1186/1471-244X-8-4
24. Cronbach JL. Coefficient alpha and the internal structre of test. Psychometrika. 1951;16(3):297-8.
25. Kaiser HF. An Index of Factorial Simplicity. Phsychometrika. 1974;39(1):31-2.
26. Bartlett MS. Tests of Significance in Factor Analysis. British Journal of Statistical Psychology. 1950;3(2):77-85.
27. Gorsuch RL. Exploratory factor analysis: its role in item analysis. J Pers Assess. 1997;68(3):532-60. https://doi.org/10.1207/s15327752jpa6803_5.
28. Van der Wal M, Tuinebreijer WE, Bloemen MC, Verhaegen PD, Middelkoop E, van Zuijlen PP. Rasch analysis of the Patient and Observer Scar Assessment Scale (POSAS) in burn scars. Qual Life Res. 2012;21(1):13-23. https://doi.org/10.1007/s11136-011-9924-5
29. Rojas Sánchez LZ, Hernández Vargas JA, Trujillo Cáceres SJ, Roa Díaz ZM, Jurado Arenales AM, Toloza Pérez YG. Usefulness of the Diagnosis Decreased Cardiac Output (00029); in Patients With Chronic Heart Failure. Int J Nurs Knowl. 2017;28(4):192-8. https://doi.org/ 10.1111/2047-3095.12148
30. Perez Adel P, Fernandez, II, Ojeda FB, Gonzalez RD, Gaos Meizoso MT. Zung scale factor invariance in male coronary patients and healthy people. Span J Psychol. 2013;16:E72. https://doi.org/10.1017/sjp.2013.62.
31. Díaz-Martínez L, Barros-Bermúdez J, Cadena L, Rueda-Jaimes G, Hernández N, Campo-Arias A. Factor analysis of the Zung’ self-rating depression scale among the general population from Bucaramanga, Colombia: a gender comparison. Arch Health. 2008;3:7-12.
32. Michalakeas CA, Parissis JT, Douzenis A, Nikolaou M, Varounis C, Andreadou I, et al. Effects of sertraline on circulating markers of oxidative stress in depressed patients with chronic heart failure: a pilot study. J Card Fail. 2011;17(9):748-54. https://doi.org/ 10.1016/j.cardfail.2011.05.004
33. Corbineau S, Breton M, Mialet-Perez J, Costemale-Lacoste JF. Major depression and heart failure: Interest of monoamine oxidase inhibitors. Int J Cardiol. 2017;247:1-6. https://doi.org/ 10.1016/j.ijcard.2017.07.005
34. Ghosh RK, Ball S, Prasad V, Gupta A. Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies. Int J Cardiol. 2016;224:170-7. https://doi.org/10.1016/j.ijcard.2016.09.063
2. Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Rubin EH. Cognitive behavior therapy for depression and self-care in heart failure patients a randomized clinical trial. JAMA Intern Med. 2015;175(11):1773-82. http://dx.doi.org/10.1001/jamainternmed.2015.5220
3. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006;48(8):1527-37. http://dx.doi.org/10.1016/j.jacc.2006.06.055
4. Mbakwem AC, Aina OF. Comparative study of depression in hospitalized and stable heart failure patients in an urban Nigerian teaching hospital. Gen Hosp Psychiatry. 2008;30:435-40. https://doi.org/10.1016/j.genhosppsych.2008.04.008
5. Newhouse A, Jiang W. Heart failure and depression. Heart Fail Clin. 2014;10(2):295-304. https://doi.org/10.1016/j.hfc.2013.10.004
6. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239. https://doi.org/10.1016/j.jacc.2013.05.019
7. Shafer AB. Meta-analysis of the Factor Structures of Four Depression Questionnaires. J Clin Psychol. 2006;62(1):123-46. https://doi.org/10.1002/jclp.20213
8. Ruiz-grosso P, Mola CLD, Vega-dienstmaier JM, Arevalo JM. Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: A Comparative Validation Study. PloS ONE. 2012;7(10):E45413-E. https://doi.org/ 10.1371/journal.pone.0045413
9. Kourkoveli P, Rammos S, Parissis J. Depressive Symptoms in Patients with Congenital Heart Disease : Incidence and Prognostic Value of Self-Rating Depression Scales. Congenit Heart Dis. 2015;10:240-7. https://doi.org/ 10.1111/chd.12200
10. Parissis J, Karavidas A, Farmakis D, Papoutsidakis N, Matzaraki V, Arapi S, et al. Efficacy and safety of functional electrical stimulation of lower limb muscles in elderly patients with chronic heart failure: A pilot study. Eur J Prev Cardiol. 2015;22(7):831-6. https://doi.org/ 10.1177/2047487314540546
11. Suzuki T, Shiga T, Kuwahara K. Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure. J Cardiol. 2014;64(6):456-62. https://doi.org/1 0.1016/j.jjcc.2014.02.031
12. Cogollo Z, Díaz CE, Campo A. Exploración de la validez de constructo de la escala de Zung para depresión en adolescentes escolarizados. Colomb Med (Cali). 2006;37(2):102-6.
13. Lezama Meneses SR. Propiedades psicométricas de la escala de Zung para síntomas depresivos en población adolescente escolarizada colombiana. Psychol. 2012;6(1):91-101.
14. Campo-Arias A, Díaz-Martínez LA, Rueda-Jaimes GE, Barros-Bermúdez JA. Validación de la escala de Zung para depresión en universitarias de Bucaramanga, Colombia. Rev Colomb Psiquiatr. 2005;34(1):54-62.
15. Díaz LA, Campo A, Rueda GE, Barros JA. Propuesta de una versión abreviada de la escala de Zung para depresión. Colmb Med (Cali). 2005;36(3):168-72.
16. Campo A, Díaz LA, Rueda GE. Validez de la escala breve de Zung para tamizaje del episodio depresivo mayor en la población general de Bucaramanga, Colombia. Biomédica. 2006;26:415-23. https://doi.org/
17. Campo-Arias A, Díaz-Martínez L, Rueda-Jaimes G, Cadena L, Hernández N. Validation of Zung’s self-rating depression scale among the Colombian general population. Soc Behav Pers. 2006;34:87-94. https://doi.org/10.7705/biomedica.v26i3.360
18. Albert NM, Fonarow GC, Abraham WT, Gheorghiade M, Greenberg BH, Nunez E, et al. Depression and clinical outcomes in heart failure: an OPTIMIZE-HF analysis. Am J Med. 2009;122(4):366-73. https://doi.org/ 10.1016/j.amjmed.2008.09.046
19. Martensson J, Stromberg A, Dahlstrom U, Karlsson JE, Fridlund B. Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression. Eur J Heart Fail. 2005;7(3):393-403. https://doi.org/ 10.1016/j.ejheart.2004.01.016.
20. Floyd FJ, Widaman KF. Factor Analysis in the Development and Refinement of Clinical Assessment Instruments. Psychological assessment. 1995;7(3):286-99.
21. Zung WW. A Self-Rating Depression. Arch Gen Psychiatry. 1965;12:63-70. https://doi.org/ 10.1001/archpsyc.1965.01720310065008
22. Zung WW. From Art to Science Seeet. Arch Gen Psychiatry. 1973;29(3):328-37. https://doi.org/10.1001/archpsyc.1973.04200030026004
23. Romera I, Delgado-cohen H, Perez T, Caballero L, Gilaberte I. Factor analysis of the Zung self-rating depression scale in a large sample of patients with major depressive disorder in primary care. BMC Psychiatry. 2008;8(4):1-8. https://doi.org/10.1186/1471-244X-8-4
24. Cronbach JL. Coefficient alpha and the internal structre of test. Psychometrika. 1951;16(3):297-8.
25. Kaiser HF. An Index of Factorial Simplicity. Phsychometrika. 1974;39(1):31-2.
26. Bartlett MS. Tests of Significance in Factor Analysis. British Journal of Statistical Psychology. 1950;3(2):77-85.
27. Gorsuch RL. Exploratory factor analysis: its role in item analysis. J Pers Assess. 1997;68(3):532-60. https://doi.org/10.1207/s15327752jpa6803_5.
28. Van der Wal M, Tuinebreijer WE, Bloemen MC, Verhaegen PD, Middelkoop E, van Zuijlen PP. Rasch analysis of the Patient and Observer Scar Assessment Scale (POSAS) in burn scars. Qual Life Res. 2012;21(1):13-23. https://doi.org/10.1007/s11136-011-9924-5
29. Rojas Sánchez LZ, Hernández Vargas JA, Trujillo Cáceres SJ, Roa Díaz ZM, Jurado Arenales AM, Toloza Pérez YG. Usefulness of the Diagnosis Decreased Cardiac Output (00029); in Patients With Chronic Heart Failure. Int J Nurs Knowl. 2017;28(4):192-8. https://doi.org/ 10.1111/2047-3095.12148
30. Perez Adel P, Fernandez, II, Ojeda FB, Gonzalez RD, Gaos Meizoso MT. Zung scale factor invariance in male coronary patients and healthy people. Span J Psychol. 2013;16:E72. https://doi.org/10.1017/sjp.2013.62.
31. Díaz-Martínez L, Barros-Bermúdez J, Cadena L, Rueda-Jaimes G, Hernández N, Campo-Arias A. Factor analysis of the Zung’ self-rating depression scale among the general population from Bucaramanga, Colombia: a gender comparison. Arch Health. 2008;3:7-12.
32. Michalakeas CA, Parissis JT, Douzenis A, Nikolaou M, Varounis C, Andreadou I, et al. Effects of sertraline on circulating markers of oxidative stress in depressed patients with chronic heart failure: a pilot study. J Card Fail. 2011;17(9):748-54. https://doi.org/ 10.1016/j.cardfail.2011.05.004
33. Corbineau S, Breton M, Mialet-Perez J, Costemale-Lacoste JF. Major depression and heart failure: Interest of monoamine oxidase inhibitors. Int J Cardiol. 2017;247:1-6. https://doi.org/ 10.1016/j.ijcard.2017.07.005
34. Ghosh RK, Ball S, Prasad V, Gupta A. Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies. Int J Cardiol. 2016;224:170-7. https://doi.org/10.1016/j.ijcard.2016.09.063
How to Cite
Rojas Sánchez, L. Z., Trujillo-Cáceres, S. J., Hernández Vargas, J. A., Jurado, A. M., Echeverría, L. E., Gómez-Ochoa, S. A., & Roa-Díaz, Z. M. (2021). Construct validity of the Zung’s scale in patients with heart failure. Investigación En Enfermería Imagen Y Desarrollo, 23. https://doi.org/10.11144/Javeriana.ie23.vcez
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