The development of a dysfunctional attitudes scale for medically ill elders (dasmie)

Objective: In this paper we developed a scale to measure dysfunctional attitudes in medically ill elderly, examined its test characteristics, and explored associations with other health variables. Sample and Methods: Eight items were selected from Weissman and Beck’s Dysfunctional Attitudes Scale based on factor loadings from an earlier analysis of the scale. Twenty-two additional items, based on information learned from elderly patients during a pilot study and the clinical experience of a geropsychiatrist and cognitive therapist, were added to create a 30-item scale called DASMIE. The scale was administered to 92 consecutive vatients aged 60 or over admitted to the general medicine, cardiology, and neurology services of a university teaching hospital. It was then factor analyzed and its test characteristics determined Individual items and total scale score was next correlated with depressive symptoms (CES-D); relationships between total score and functional disability, cognitive status, medical diagnosis, insurance status, sex, race, and religiosity were also examined. Results: Dysfunctional attitudes were prevalent in this population. Over half (54%) strongly agreed that having to rely on others was a terrible thing; 46% strongly believed that if someone was sick and disabled, he or she could only be a burden on others; 24% felt that until their physical condition improved, they could not experience pleasure; 32% strongly disagreed that they could be happy if living in a nursing home; 44% strongly indicated that it was awful to be disapproved of by people close to them; and 15% either slightly or strongly agreed that they had no special talents or abilities that would be useful to others. Factor analysis of the 30-item DASHMIE revealed nine distinct factors; internal reliability of the scale was acceptable (Cronbach’s alpha = 0.86). Total score was related to both depression and cognitive status. The factors "performance evaluation," "ability to function," and "approval by others" contained items that were strongly related to depression. An abbreviated 15-item DASMIE was developed to minimize respondent burden, enhance face validity, and maximize response variability. Conclusions: Dysfunctional attitudes are prevalent in this population and are associated with depression. We have developed both a standard 30-item and an abbreviated 15-item instrument to identify and track these attitudes. © 1994 Taylor & Francis Group, LLC.

Duke Scholars

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