Health Distress

These questions are about how you feel and how things have been with you during the past month. For each question, please circle the one number that comes closest to the way you have been feeling.

How much time during the past month... None
of the time		 A little
of the time		 Some
of the time		 A good bit
of the time		 Most
of the time		 All
of the time
1.   were you discouraged by your health problems?
0
1
2
3
4
5
2.   were you fearful about your future health?
0
1
2
3
4
5
3.   was your health a worry in your life?
0
1
2
3
4
5
4.   were you frustrated by your health problems?
0
1
2
3
4
5

Scoring

Score each item as the number circled. If two consecutive numbers are circled, score the higher (more distress) number. If the numbers are not consecutive, do not score the item. The scale score is the mean of the four items. If more than 1 item missing, set the value of the scale to missing. Scores range from 0-5; higher score indicating more distress about health.

Characteristics

Tested on 1,130 subjects with chronic disease. N=51 for test-retest.

No. of
items
Observed
Range

Mean
Standard
Deviation
Internal Consistency
Reliability
Test-Retest
Reliability
4
0-5
2.04
1.16
.87
.87

Source of Psychometric Data

Stanford Chronic Disease Self-Management Study. Psychometrics reported in: Lorig R., Sobel, DS, Stewart AL, Brown BW, Bandura, A, Ritter P, Gonzalez VM, Laurent, DD and Holman, HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization. Medical Care, 37, 1999, pp. 3-14.

Comments

This is a modified version of the Medical Outcomes Study health distress scale. We use 4 of the original 6 items, and changed the wording slightly. Items should be scrambled among other items using the same response categories, if possible (e.g., Energy/Fatigue scale). Because of the problems we have had using scales to measure negative emotion (e.g., depression) across cultures, we have substituted this scale. While it is not a depression or an anxiety scale, it does give us a good idea of distress caused by illness. It correlates .61 with the MOS depressive symptoms scale and .63 with the CES-D scale. Reprinted with permission, Duke University Press. This scale available in Spanish.

References

Lorig K, Stewart A, Ritter P, González V, Laurent D, & Lynch J, Outcome Measures for Health Education and other Health Care Interventions. Thousand Oaks CA: Sage Publications, 1996, pp.25,52-53.

Stewart AL, Hays RD, & Ware JE, Health Perceptions, energy/fatigue, and health distress measures, in Stewart AL & Ware JE, Measuring Functioning and Well-Being: The Medical Outcomes Study Approach. Durham NC: Duke University Press, pp. 143-172.

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