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The Development and Validation of the Diagnosis Impact Scale (DIS) a Self-Report Measure of the Effect of Psychiatric Diagnoses on Recipients

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The Development and Validation of the Diagnosis Impact Scale (DIS) a Self-Report Measure of the Effect of Psychiatric Diagnoses on Recipients PSYCHD The development and validation of the Diagnosis Impact Scale (DIS) a self-report measure of the effect of psychiatric diagnoses on recipients O’Connor, Niamh Award date: 2020 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 29. Sep. 2021 The Development and Validation of the Diagnosis Impact Scale (DIS): A Self-Report Measure of the Effect of Psychiatric Diagnoses on Recipients By Niamh O’ Connor BA (Hons), H.Dip. Psychology A thesis submitted in partial fulfilment of the requirements for the degree of PsychD Department of Psychology University of Roehampton 2019 Acknowledgements I would like to thank my Director of Studies, Professor Mick Cooper, for his unwavering enthusiasm for this research. He was incredibly responsive and containing throughout. Moreover, he was someone I could be open with. In a project like this one, a student is faced with an infinite number of gaps in their knowledge and understanding, which can be very unnerving. Mick created an atmosphere in which I was comfortable to ask questions and address the gaps in my knowledge. He was a wonderfully reliable and supportive presence and I have learnt a huge amount from him. I would also like to thank my co-supervisor, Dr Gina Pauli for being so generous with her time and incredible expertise. She was extremely patient and always willing to help. Above all she helped me to trust my judgement during the research process, which was invaluable. Her kind frankness and approachability were hugely appreciated. Dr Jac Hayes, my initial co-supervisor, was very helpful in the earlier stages of this project. She was extremely generous with her time and knowledge and most of all, brought an enlivening sense of curiosity to the project. Dr Chris Evans, whom I consulted on numerous occasions during this research project, always responded with a spirit of generosity as well as huge warmth and enthusiasm for the project. I would like to thank Dr Nicholas Longpre, for his help with statistical analysis and for being so patient and generous with his time. I would also like to thank my friends for their fantastic support and belief in me. Similarly, my close friends from the PsychD course, for their encouragement and understanding. 1 My parents, who, through their hard work and love have made it possible for me to undertake this training and through their nature have given me perspective when I needed it. Finally, this research would not have been possible without the participants and the mental health organisations who notified them about the study, I was so heartened by their willingness to contribute to the research. 2 Abstract Background: Despite the dominance of psychiatric diagnosis within mental healthcare systems, there is no validated measure of diagnosis impact on those who receive them. Consequently, there is also a paucity of statistically generalisable research on the experience of receiving and living with a diagnosis. Aims: To develop a valid and reliable measure of the effect of psychiatric diagnosis on recipients, the Diagnosis Impact Scale (DIS), for clinical and research use. Method: Measure development protocols used included the generation of an item pool, expert rating of items, and Three Step Test Interviews. Psychometric properties of the DIS were investigated, including internal consistency, convergent validity, discriminant validity, and criterion validity. A principal components analysis was carried out on a sample of 248 people with psychiatric diagnoses, followed by a two-parameter IRT analysis. Findings: The principal components analysis suggested that the 19-item DIS had two discrete subscales: Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma. Each displayed excellent reliability in this sample, with Cronbach’s alphas of 0.93 (n=256) and 0.81 (n=263) for Helpfulness of Diagnosis and Diagnosis-Related Self-Stigma respectively. They were also found to have acceptable content and construct validity. Significant associations were found between both subscales and diagnosis type, perceived correct diagnosis, receipt of treatment due to diagnosis, and helpfulness of said treatment. Helpfulness of Diagnosis was significantly associated with age and time since diagnosis. Diagnosis-Related Self-Stigma was significantly associated with having multiple diagnoses, the number of these, and the type of healthcare professional who gave the diagnosis (e.g. GP or psychiatrist). The two-parameter IRT analysis showed 3 that both subscales were within acceptable ranges for discrimination and differentiation between strength of attitude. 4 Table of Content Acknowledgements p1 Abstract p3 Chapter 1: Introduction p10 1.1. Introduction to Psychiatric Diagnosis p10 1.1.1. Definition of psychiatric diagnosis. p10 1.1.2. History of psychiatric classification and diagnosis. p11 1.1.3. Diagnostic classifications. p14 1.1.4. Psychiatric diagnosis: the current context. p16 1.2. Academic Debates on Psychiatric Diagnosis p18 1.2.1. Reliability. p19 1.2.2. Validity. p20 1.2.3. Evidence for diagnostic categories. p21 1.3. Alternatives to Diagnosis p22 1.3.1. Person-centred therapy. p22 1.3.2. The Psychodynamic Diagnostic Manual. p22 1.3.3. Psychological formulation. p23 1.3.4. Power Threat Meaning Framework. p24 1.3.5. Psychosocial codes. p25 1.3.6. Phenomenological terminology. p26 1.4. Researcher Position on Psychological Distress, Psychiatric Disorders, p27 and Diagnosis Chapter 2: Literature Review p32 2.1. Introduction to Literature Review p32 2.2. Impact of Psychiatric Diagnosis on Service Users and Carers p33 2.2.1. Diagnosis and emotion. p33 2.2.1.1. Positive emotional impact of diagnosis. p33 2.2.1.2. Negative emotional impact of diagnosis. p34 5 2.2.2. Diagnosis and identity. p36 2.2.2.1. Negative impact on identity. p37 2.2.2.2. Positive impact on identity. p39 2.2.3. Diagnosis and power. p39 2.2.3.1. Diagnosis and disempowerment. p40 2.2.3.2. Diagnosis and agency. p41 2.2.3.3. Diagnosis and access to information. p42 2.2.4. Diagnosis and social life. p43 2.2.4.1. Stigma. p43 2.2.4.2. Impact of stigma. p44 2.2.4.3. Social benefits of diagnosis. p45 2.2.5. Diagnosis and treatment. p46 2.2.5.1. Positive impact of diagnosis on treatment. p46 2.2.5.2. Limited impact of diagnosis on treatment. p47 2.2.6. Diagnosis and finance. p48 2.2.7. Diagnosis and employment. p48 2.2.7. Diagnosis and education. p50 2.3. Factors Affecting the Impact of Psychiatric Diagnosis p50 2.3.1. Diagnosis and communication. p50 2.3.1.1. Service user awareness of diagnosis. p51 2.3.1.2. Service user attitude to diagnosis communication. p51 2.3.1.3. Unsatisfactory communication. p52 2.3.1.4. Clinician reluctance to diagnose. p52 2.3.1.5. Hope and support. p53 2.3.1.6. Collaboration. p53 2.3.2. Diagnosis and Time. p54 2.3.2.1. Time since diagnosis. p54 2.3.2.2. Delays in receiving a diagnosis. p54 2.3.3. Diagnosis fit. p54 2.3.4. Multiple diagnoses. p55 2.3.5. Type of diagnosis. p55 2.4. Psychiatric Diagnosis and Counselling Psychology p57 6 2.5. Rationale for the Current Study p58 2.5.1. Contribution to research. p58 2.5.2. Clinical applications. p59 Chapter 3: Methods and Results p61 3.1. Ethical approval p61 3.2. Epistemology p61 3.2.1. Critical realism. p61 3.2.2. Summary. p66 3.3. Design p66 3.4. Study 1: Item Pool Development p66 3.4.1. Creation of the item pool. p66 3.4.2. Expert online rating. p69 3.4.3. Item selection. p71 3.4.4. Three-Step Test Interviews. p72 3.4.4.1. Piloting the Three-Step Test Interviews. p72 3.4.4.2. Three-Step Test Interview participants. p72 3.4.4.3. Measure. p73 3.4.4.4. Procedure. p73 3.4.4.5. Three-Step Test Interview results. p75 3.5. Study 2: Psychometric Exploration p77 3.5.1. Psychometric exploration study participants. p78 3.5.1.1. Sample size. p78 3.5.1.2. Target population. p79 3.5.1.3. Recruitment of participants. p80 3.5.1.4. Participant demographics. p81 3.5.3. Measures p83 3.5.3.1. The Diagnosis Impact Scale (DIS). p84 3.5.3.2. Criterion validity items. p84 3.5.3.3. The Patient Feedback on Consultation Skills p85 Questionnaire (PFC). 3.5.3.4. Satisfaction with Life Scale (SWLS). p86 3.5.3.5. Single-item diagnosis helpfulness measure. p87 7 3.5.3.6. Social Desirability Scale- SDS-17. p87 3.5.3.7. CORE-10. p88 3.5.3.8. Positive and Negative Affect Schedule (PANAS). p89 3.5.4. Procedure. p90 3.5.5. Outline of the study p91 3.5.5.1. A priori aims. p91 3.5.5.2. Hypotheses. p91 3.5.6. Results of psychometric exploration study. p92 3.5.6.1. Outline of the analysis. p92 3.5.6.2.
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