Application of the Chinese Version of the Pittsburgh Sleep Quality Index in People Living With HIV: Preliminary Reliability and Validity

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Abstract

Background: The Pittsburgh Sleep Quality Index (PSQI) has been a widely used instrument measuring sleep quality among people living with HIV (PLWH) in China while its psychometric properties have yet to be examined in this population. We aimed to assess the reliability and validity of the Chinese version of PSQI in PLWH and identify factors associated with sleep quality.

Methods: This study was based on a longitudinal study of newly diagnosed PLWH, among whom the PSQI was used to measure sleep quality 5 years after HIV diagnosis ( n = 386). To evaluate internal consistency, Cronbach's alpha and corrected item-total correlation were calculated. To assess construct validity, Pearson's correlation coefficients were calculated between PSQI scores and depression, anxiety, stress, and health-related quality of life (HRQoL). Known group validity was evaluated by comparing PSQI scores between participants with probable depression and those without. Binary logistic regression was conducted to identify factors associated with sleep disturbances.

Results: The internal consistency Cronbach's alpha for the Chinese version of PSQI in PLWH was 0.713. Construct validity was established by significant relationships between PSQI and depression, anxiety, stress, and HRQoL. The PSQI scores in participants with probable depression were significantly higher than those without, indicating good known-group validity. Sleep disturbances were associated with less income, higher CD4 counts, antiretroviral treatment (ART) initiation, exercise, depression, and higher stress levels.

Conclusions: The Chinese version of PSQI is feasible for use among Chinese PLWH. Over a third of PLWH reported sleep disturbances. More attention should be given to individuals with less income and on ART. Intervention aimed at improving mental health or facilitating exercise may improve sleep quality.

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Most cited references 50

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A brief measure for assessing generalized anxiety disorder: the GAD-7.

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Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

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While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

Daniel J. Buysse, Charles Reynolds III, Timothy H Monk … (1989)

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

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Author and article information

Contributors

Dong-Qin Yan: URI : http://loop.frontiersin.org/people/1219367/overview

Min Wang: URI : http://loop.frontiersin.org/people/850328/overview

Dan Luo: URI : http://loop.frontiersin.org/people/1219323/overview

Journal

Journal ID (nlm-ta): Front Psychiatry

Journal ID (iso-abbrev): Front Psychiatry

Journal ID (publisher-id): Front. Psychiatry

Title: Frontiers in Psychiatry

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-0640

Publication date (Electronic): 06 July 2021

Publication date Collection: 2021

Volume: 12

Electronic Location Identifier: 676022

Affiliations

[1] ¹Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University , Changsha, China

[2] ²Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University , Chengdu, China

[3] ³Hunan Provincial Center for Disease Prevention and Control , Changsha, China

[4] ⁴Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Research Institute, The First Hospital of Changsha , Changsha, China

[5] ⁵Furong District Center for Disease Prevention and Control , Changsha, China

Author notes

Edited by: Seog Ju Kim, Sungkyunkwan University, South Korea

Reviewed by: Daniela Adamo, University of Naples Federico II, Italy; Lorenzo Tonetti, University of Bologna, Italy

*Correspondence: Dan Luo luodan_csu_2011@ 123456126.com

This article was submitted to Sleep Disorders, a section of the journal Frontiers in Psychiatry

†These authors have contributed equally to this work

Article

DOI: 10.3389/fpsyt.2021.676022

PMC ID: 8291081

PubMed ID: 34295273

SO-VID: 900d4374-a115-483d-b579-1d5ec910e4cc

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 04 March 2021

Date accepted : 24 May 2021

Page count

Figures: 0, Tables: 5, Equations: 0, References: 51, Pages: 8, Words: 5918

Funding

Funded by: Natural Science Foundation of Hunan Province 10.13039/501100004735

Funded by: Development and Reform Commission of Hunan Province 10.13039/100012830

Application of the Chinese Version of the Pittsburgh Sleep Quality Index in People Living With HIV: Preliminary Reliability and Validity

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Most cited references 50

A brief measure for assessing generalized anxiety disorder: the GAD-7.

The PHQ-9: validity of a brief depression severity measure.

The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

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