DOI QR코드

DOI QR Code

Development of the Korean version of Postconcussional Syndrome Questionnaire

한글판 뇌진탕후증후군 척도의 개발

  • Yoon, Mi-Ri (Department of Psychiatry, Korea University College of Medicine) ;
  • Ko, Young-Hoon (Department of Psychiatry, Korea University College of Medicine) ;
  • Han, Chang-Su (Department of Psychiatry, Korea University College of Medicine) ;
  • Joe, Sook-Haeng (Department of Psychiatry, Korea University College of Medicine) ;
  • Jeon, Sang-Won (Department of Psychiatry, Korea University College of Medicine) ;
  • Han, Chang-Woo (Department of Psychiatry, Korea University College of Medicine)
  • 윤미리 (고려대학교 의과대학 정신건강의학교실) ;
  • 고영훈 (고려대학교 의과대학 정신건강의학교실) ;
  • 한창수 (고려대학교 의과대학 정신건강의학교실) ;
  • 조숙행 (고려대학교 의과대학 정신건강의학교실) ;
  • 전상원 (고려대학교 의과대학 정신건강의학교실) ;
  • 한창우 (고려대학교 의과대학 정신건강의학교실)
  • Received : 2015.04.22
  • Accepted : 2015.06.23
  • Published : 2015.06.30

Abstract

Objectives:The purpose of this study was to evaluate reliability and validity of the Korean version of the Postconcussional Syndrome Questionnaire(KPCSQ) which was originally developed in 1992 by Lees-Haley. Methods:Patients with traumatic brain injury were recruited from April 2009 to December 2011 from the Korean University Ansan Hospital. We selected patients that met the ICD-10 diagnostic criteria of postconcussional syndrome and organic mental disorder including organic mood disorder, organic emotionally labile disorder, organic anxiety disorder and organic personality disorder. The KPCSQ, Trait and State Anxiety Inventory(STAI-I, II), and Center for Epidemiologic Studies Depression Scale(CESD) were administered to all subjects. Factor analysis of the items were performed and test-retest correlation were evaluated. Internal consistency of the KPCSQ and its subscales was assessed with Cronbach's alpha. External validity of the KPCSQ were examined by correlation coefficient with the STAI-I, II, and CESD. Results:The Cronbach's alpha coefficient of the total PCSQ was 0.956. The test-retest reliability coefficient was 0.845. The PCSQ showed significant correlation with STAI-I, II and CESD. The factor analysis of the PCSQ yielded 4 factors model. Factor 1 represented 'affective and cognitive symptoms', factor 2 represented 'somatic symptoms', factor 3 represented 'infrequent symptoms' and factor 4 represented 'exaggeration or inattentive response'. There was no significant difference between the PCS group and the organic mental disorder group in the score on each measure. The scores on KPCSQ and its subscales in the subjects that had scored 5 or more in 'exaggeration or inattentive response' are significantly higher than those in the subjects had scored 4 in 'exaggeration or inattentive response'. Conclusions:This study suggests that the Korean version of PCSQ is a valid and reliable tool for assessing psychiatric symptomatology of patients with traumatic brain injury. Further investigations with greater numbers of subjects are necessary to assess the clinical usefulness of the KPCSQ.

연구목적 본 연구는 Lees-Haley가 1992년 개발한 Postconcussional Syndrome Questionnaire(PCSQ)의 한글판(K-PCSQ)을 개발하고 신뢰도와 타당도를 평가하여 임상적 유용성을 밝히고자 시행되었다. 방 법 2009년 4월 1일부터 2011년 12월 31일까지 고려대학교 안산병원 외래에 내원한 외상성 뇌 손상 환자들 중 International Classification of Disease-10(ICD-10)의 뇌진탕후증후군, 기질성 정신질환(기질성 기분장애, 기질성 불안장애, 기질성 인격장애, 기질성 감정이변성장애)의 진단기준을 만족하는 환자들을 대상으로 포함하였다. 환자들을 대상으로 자가 보고형 평가 척도인 K-PCSQ, State and Trait Anxiety inventory(STAI-I. II), Center for Epidemiologic Studies Depression Scale(CESD)를 시행하였다. 수집된 자료로 PCSQ의 신뢰도와 타당도를 평가하였으며 요인분석을 시행하였다. 결 과 K-PCSQ의 Cronbach's alpha 값은 0.956, 검사-재검사 신뢰도는 0.836이었으며 STAI-I. II, CESD와 유의한 상관관계를 보였다. 요인 분석 결과 K-PCSQ는 4개의 요인구조를 보였으며, 제 1 요인은 '기분 및 인지 증상' 요인, 제 2 요인은 '신체 증상' 요인, 제 3 요인은 '드물게 나타나는 증상' 요인, 제 4 요인은 '과장 또는 부주의한 응답' 요인으로 나타났다. 뇌진탕후 증후군 환자와 기질성 정신질환 환자 두 군에서 K-PCSQ의 총점과 4가지 하위 요인의 점수를 비교하였을 때 두 군 간에 통계적으로 유의한 차이를 보이지 않았다. '과장 또는 부주의한 응답' 항목에 답변한 대상자들은 그렇지 않은 대상자에 비해 K-PCSQ의 총점과 4가지 하위 요인의 점수가 유의하게 높았다. 결 론 본 연구는 K-PCSQ가 두부외상으로 인한 정신의학적 증상을 평가하는데 있어서 유용한 도구임을 확인하였으며, 추후 보다 많은 환자를 대상으로 하는 연구를 통해 임상적인 유용성의 평가 이루어져야 할 것으로 생각된다.

Keywords

References

  1. Bullinger M, Azouvi P, Brooks N, Basso A, Christensen AL, Gobiet W, Greenwood R, Hutter B, Jennett B, Maas A, Truelle JL, von Wild KR. Quality of life in patients with traumatic brain injury-basic issues, assessment and recommendations. Restor Neurol Neurosci 2002;20:111-124.
  2. Hoofien D, Gilboa A, Vakil E, Donovick PJ. Traumatic brain injury(TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Inj 2001;15:189-209. https://doi.org/10.1080/026990501300005659
  3. Fann JR, Katon WJ, Uomoto JM, Esselman PC. Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. Am J Psychiatry 1995;152:1493-1499. https://doi.org/10.1176/ajp.152.10.1493
  4. Fleminger S. Long-term psychiatric disorders after traumatic brain injury. Eur J Anaesthesiol Suppl 2008;42:123-130.
  5. Ponsford J, Draper K, Schonberger M. Functional outcome 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status. J Int Neuropsychol Soc 2008;14:233-242.
  6. Draper K, Ponsford J, Schonberger M. Psychosocial and emotional outcomes 10 years following traumatic brain injury. J Head Trauma Rehabil 2007;22:278-287. https://doi.org/10.1097/01.HTR.0000290972.63753.a7
  7. Kreutzer JS, Seel RT, Gourley E. The prevalence and symptom rates of depression after traumatic brain injury: a comprehensive examination. Brain Inj 2001;15:563-576. https://doi.org/10.1080/02699050116884
  8. Deb S, Lyons I, Koutzoukis C, Ali I, McCarthy G. Rate of psychiatric illness 1 year after traumatic brain injury. Am J Psychiatry 1999;156:374-378.
  9. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization;1992. p.362.
  10. Hall RC, Chapman MJ. Definition, diagnosis, and forensic implications of postconcussional syndrome. Psychosomatics 2005; 46:195-202. https://doi.org/10.1176/appi.psy.46.3.195
  11. Jang KJ, Yi HJ, Jwa CS, Kim KH, Chun HJ. Factors Associated with Post-Concussion Syndrome after Mild Head Injury. J Kor Neurotraumatol Soc 2008;4:31-36. https://doi.org/10.13004/jknts.2008.4.1.31
  12. Dikmen SS, Bombardier CH, Machamer JE, Fann JR, Temkin NR. Natural history of depression in traumatic brain injury. Arch Phys Med Rehabil 2004;85:1457-1464. https://doi.org/10.1016/j.apmr.2003.12.041
  13. Gouvier WD, Cubic B, Jones G, Brantley P, Cutlip Q. Postconcussion symptoms and daily stress in normal and head-injured college populations. Arch Clin Neuropsychol 1992;7: 193-211. https://doi.org/10.1016/0887-6177(92)90162-G
  14. Rees PM. Contemporary issues in mild traumatic brain injury. Arch Phys Med Rehabil 2003;84:1885-1894. https://doi.org/10.1016/j.apmr.2003.03.001
  15. Boake C, McCauley SR, Levin HS, Pedroza C, Contant CF, Song JX, Brown SA, Goodman H, Brundage SI, Diaz-Marchan PJ. Diagnostic criteria for postconcussional syndrome after mild to moderate traumatic brain injury. J Neuropsychiatry Clin Neurosci 2005;17:350-356. https://doi.org/10.1176/jnp.17.3.350
  16. Meares S, Shores EA, Taylor AJ, Batchelor J, Bryant RA, Baguley IJ, Chapman J, Gurka J, Dawson K, Capon L, Marosszeky JE. Mild traumatic brain injury does not predict acute postconcussion syndrome. J Neurol Neurosurg Psychiatry 2008; 79:300-306. https://doi.org/10.1136/jnnp.2007.126565
  17. Dunn JT, Lees-Haley PR, Brown RS, Williams CW, English LT. Neurotoxic complaint base rates of personal injury claimants: implications for neuropsychological assessment. J Clin Psychol 1995;51:577-584. https://doi.org/10.1002/1097-4679(199507)51:4<577::AID-JCLP2270510418>3.0.CO;2-E
  18. Tsanadis J, Montoya E, Hanks RA, Millis SR, Fichtenberg NL, Axelrod BN. Brain injury severity, litigation status, and self-report of postconcussive symptoms. Clin Neuropsychol 2008;22:1080-1092. https://doi.org/10.1080/13854040701796928
  19. Park KC, Kim HJ. Psychosocial Outcome after Head Injury. Neurosug Soc 2000;29:196-202.
  20. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol 2006;21:303-310. https://doi.org/10.1016/j.acn.2005.12.008
  21. Eyres S, Carey A, Gilworth G, Neumann V, Tennant A. Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire. Clin Rehabil 2005;19:878-887. https://doi.org/10.1191/0269215505cr905oa
  22. King NS, Crawford S, Wenden FJ, Moss NE, Wade DT. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. J Neurol 1995;242:587-592. https://doi.org/10.1007/BF00868811
  23. Herrmann N, Rapoport MJ, Rajaram RD, Chan F, Kiss A, Ma AK, Feinstein A, McCullagh S, Lanctot KL. Factor analysis of the Rivermead Post-Concussion Symptoms Questionnaire in mild-to-moderate traumatic brain injury patients. J Neuropsychiatry Clin Neurosci 2009;21:181-188. https://doi.org/10.1176/jnp.2009.21.2.181
  24. Crawford S, Wenden FJ, Wade DT. The Rivermead head injury follow up questionnaire: a study of a new rating scale and other measures to evaluate outcome after head injury. J Neurol Neurosurg Psychiatry 1996;60:510-514. https://doi.org/10.1136/jnnp.60.5.510
  25. Elgmark Andersson E, Emanuelson I, Olsson M, Stalhammar D, Starmark JE. The new Swedish Post-Concussion Symptoms questionnaire: a measure of symptoms after mild traumatic brain injury and its concurrent validity and inter-rater reliability. J Rehabil Med 2006;38:26-31. https://doi.org/10.1080/16501970500310564
  26. Axelrod BN, Fox DD, Lees-Haley PR, Earnest K, Dolezal-Wood S, Goldman RS. Latent structure of the Postconcussion Syndrome Questionnaire. Psychological Assessment 1996;8:422. https://doi.org/10.1037/1040-3590.8.4.422
  27. Axelrod BN, Fox DD, Lees-Haley PR, Earnest K, Dolezal- Wood S. Application of the Postconcussive Syndrome Questionnaire with medical and psychiatric outpatients. Arch Clin Neuropsychol 1998;13:543-548. https://doi.org/10.1093/arclin/13.6.543
  28. Eun HJ, Kwon TW, Lee SM, Kim TH, Choi MR, Cho SJ. A study on reliability and validity of the Korean version of impact of event scale-revised. Journal of Korean Neuropsychiatric Association 2005;44:303-310.
  29. Marteau TM, Bekker H. The development of a six-item shortform of the state scale of the Spielberger State-Trait Anxiety Inventory(STAI). Br J Clin Psychol 1992;31( Pt 3):301-306. https://doi.org/10.1111/j.2044-8260.1992.tb00997.x
  30. Bieling PJ, Antony MM, Swinson RP. The State-Trait Anxiety Inventory, Trait version: structure and content re-examined. Behav Res Ther 1998;36:777-788. https://doi.org/10.1016/S0005-7967(98)00023-0
  31. Chon KKC, Choi SC, Yang BC. Integrated Adaptation of CES-D in Korea. Korean Journal of Health Psychology 2001;6:59-76.
  32. Lim HE, Lee MS, Ko YH, Park YM, Joe SH, Kim YK, Han C, Lee HY, Pedersen SS, Denollet J. Assessment of the type D personality construct in the Korean population: a validation study of the Korean DS14. J Korean Med Sci;26:116-123.
  33. Radloff LS. The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement 1977;1:385-401. https://doi.org/10.1177/014662167700100306
  34. Go HJ, Kim DJ, Lee HP. A validation study of the suicide probability scale for adolescents(SPS-A). Journal of Korean Neuropsychiatric Association 2000;39:680-690.
  35. Austin MP, Mitchell P, Goodwin GM. Cognitive deficits in depression: possible implications for functional neuropathology. Br J Psychiatry 2001;178:200-206. https://doi.org/10.1192/bjp.178.3.200
  36. Marazziti D, Consoli G, Picchetti M, Carlini M, Faravelli L. Cognitive impairment in major depression. Eur J Pharmacol 2010;626:83-86. https://doi.org/10.1016/j.ejphar.2009.08.046