Psychometric properties of the Spanish version of the Chalder Fatigue Scale in clinical and general populations
Abstract
Objective: The Chalder Fatigue Scale (CFS) is a brief self-report screening scale for fatigue that is used in Spain but has not been validated for the Spanish population. The aim of this study was to adapt and evaluate the psychometric properties of the Spanish version of the CFS (Sp-CFS). Method: The sample consisted of 3,671 participants (3,190 from the general population and 481 patients), aged 18 to 86 years (M = 28.43; DT = 12.71), 67.6% of whom were women. Psychometric properties of the scale were tested in a cross-sectional design using cross-validation (exploratory and confirmatory factor analysis) and estimation of invariance (sex and clinical condition). Results: A four-factor model (low energy, sleep problems, concentration problems and subjective cognitive dysfunction) rather than an original two-factor model (physical and mental fatigue) provided better indices of goodness of fit to the data. The internal consistency and stability of the scale were excellent. Its convergent validity was supported by its significant association with anxiety, depression, stress, and the positive and negative symptoms of the psychosis spectrum. The instrument did not show significant differences between sexes or clinical conditions, and it discriminated between the general population and the patients, with the latter obtaining significantly greater scores. Conclusions: Sp-CFS is a reliable and valid scale for measuring a transdiagnostic construct such as fatigue in Spanish general and clinical populations.
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Abrahams, H. J. G., Gielissen, M. F. M., Verhagen, C. A. H. H. V. M., & Knoop, H. (2018). The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clinical Psychology Review, 63, 1–11. https://doi.org/10.1016/j.cpr.2018.05.004
Adın, R. M., Ceren, A. N., Salcı, Y., Fil Balkan, A., Armutlu, K., & Ayhan Kuru, Ç. (2022). Dimensionality, psychometric properties, and population-based norms of the Turkish version of the Chalder Fatigue Scale among adults. Health and Quality of Life Outcomes, 20(1), 161. https://doi.org/10.1186/s12955-022-02074-x
Ahn, Y.-C., Lee, J.-S., & Son, C.-G. (2020). Reliability and Validity of the Modified Korean Version of the Chalder Fatigue Scale (mKCFQ11). Healthcare, 8(4), 427. https://doi.org/10.3390/healthcare8040427
American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders. (Fifth Edition, DSM-5). APA.
Bados, A., Solanas, A., & Andrés, R. (2005). Psychometric properties of the Spanish version of Depression, Anxiety and Stress Scales (DASS). Psicothema, 17(4), 679–683.
Barone, T. L. (2017). “Sleep is on the back burner”: Working students and sleep. The Social Science Journal, 54(2), 159–167. https://doi.org/10.1016/j.soscij.2016.12.001
Belza, B., Miyawaki, C. E., Liu, M., Aree-Ue, S., Fessel, M., Minott, K. R., & Zhang, X. (2018). A Systematic Review of Studies Using the Multidimensional Assessment of Fatigue Scale. Journal of Nursing Measurement, 26(1), 36–74. https://doi.org/10.1891/1061-3749.26.1.36
Carfì, A., Bernabei, R., Landi, F., & for the Gemelli Against COVID-19 Post-Acute Care Study Group. (2020). Persistent Symptoms in Patients After Acute COVID-19. JAMA, 324(6), 603. https://doi.org/10.1001/jama.2020.12603
Cella, M., & Chalder, T. (2010). Measuring fatigue in clinical and community settings. Journal of Psychosomatic Research, 69(1), 17–22. https://doi.org/10.1016/j.jpsychores.2009.10.007
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993). Development of a fatigue scale. Journal of Psychosomatic Research, 37(2), 147–153. https://doi.org/10.1016/0022-3999(93)90081-P
Chen, F. F. (2007). Sensitivity of Goodness of Fit Indexes to Lack of Measurement Invariance. Structural Equation Modeling: A Multidisciplinary Journal, 14(3), 464–504. https://doi.org/10.1080/10705510701301834
Chilcot, J., Norton, S., Kelly, M. E., & Moss-Morris, R. (2016). The Chalder Fatigue Questionnaire is a valid and reliable measure of perceived fatigue severity in multiple sclerosis. Multiple Sclerosis Journal, 22(5), 677–684. https://doi.org/10.1177/1352458515598019
Cho, H. J., Costa, E., Menezes, P. R., Chalder, T., Bhugra, D., & Wessely, S. (2007). Cross-cultural validation of the Chalder Fatigue Questionnaire in Brazilian primary care. Journal of Psychosomatic Research, 62(3), 301–304. https://doi.org/10.1016/j.jpsychores.2006.10.018
Cicero, D. C., Kerns, J. G., & McCarthy, D. M. (2010). The Aberrant Salience Inventory: A new measure of psychosis proneness. Psychological Assessment, 22(3), 688–701. https://doi.org/10.1037/a0019913
Cohen, J. (2013). Statistical Power Analysis for the Behavioral Sciences (0 ed.). Routledge. https://doi.org/10.4324/9780203771587
Dittner, A. J., Wessely, S. C., & Brown, R. G. (2004). The assessment of fatigue. Journal of Psychosomatic Research, 56(2), 157–170. https://doi.org/10.1016/S0022-3999(03)00371-4
Dollfus, S., Mach, C., & Morello, R. (2016). Self-Evaluation of Negative Symptoms: A Novel Tool to Assess Negative Symptoms. Schizophrenia Bulletin, 42(3), 571–578. https://doi.org/10.1093/schbul/sbv161
Doyle, F., Conroy, R., McGee, H., & Delaney, M. (2010). Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis. Journal of Psychosomatic Research, 68(2), 121–130. https://doi.org/10.1016/j.jpsychores.2009.07.013
Ferentinos, P., Kontaxakis, V., Havaki-Kontaxaki, B., Dikeos, D., & Papadimitriou, G. (2010). The Fatigue Questionnaire: Standardization in patients with major depression. Psychiatry Research, 177(1–2), 114–119. https://doi.org/10.1016/j.psychres.2009.01.029
Ferrando, P. J., Lorenzo-Seva, U., Hernández-Dorado, A., & Muñiz, J. (2022). Decálogo para el Análisis Factorial de los Ítems de un Test [Decalogue for the Factor Analysis of Test Items]. Psicothema, 34.1, 7–17. https://doi.org/10.7334/psicothema2021.456
Fong, T. C. T., Chan, J. S. M., Chan, C. L. W., Ho, R. T. H., Ziea, E. T. C., Wong, V. C. W., Ng, B. F. L., & Ng, S. M. (2015). Psychometric properties of the Chalder Fatigue Scale revisited: An exploratory structural equation modeling approach. Quality of Life Research, 24(9), 2273–2278. https://doi.org/10.1007/s11136-015-0944-4
Fonseca-Pedrero, E., Paino, M., Lemos-Giráldez, S., & Muñiz, J. (2012). Validation of the community assessment psychic experiences -42 (CAPE-42) in Spanish college students and patients with psychosis. Actas Espanolas de Psiquiatria, 40(4), 169–176.
Gross, G. M., Silvia, P. J., Barrantes-Vidal, N., & Kwapil, T. R. (2012). Psychometric properties and validity of short forms of the Wisconsin Schizotypy Scales in two large samples. Schizophrenia Research, 134(2–3), 267–272. https://doi.org/10.1016/j.schres.2011.11.032
Ha, H., Jeong, D., Hahm, B.-J., & Shim, E.-J. (2018). Cross-Cultural Validation of the Korean Version of the Chalder Fatigue Scale. International Journal of Behavioral Medicine, 25(3), 351–361. https://doi.org/10.1007/s12529-017-9701-0
Häfner, H., Riecher-Rössler, A., Hambrecht, M., Maurer, K., Meissner, S., Schmidtke, A., Fätkenheuer, B., Löffler, W., & van der Heiden, W. (1992). IRAOS: An instrument for the assessment of onset and early course of schizophrenia. Schizophrenia Research, 6(3), 209–223. https://doi.org/10.1016/0920-9964(92)90004-O
Hernández, P., Berrios, G. E., & Bulbena, A. (2000). Concepto y evaluación de la sensación de fatiga [Concept and assesment of the sensation of fatigue]. In Medición clínica en psiquiatría y psicología [Clinical measurement in psychiatry and psychology] (pp. 125–135). Masson.
Jing, M.-J., Lin, W.-Q., Wang, Q., Wang, J.-J., Tang, J., Jiang, E.-S., Lei, Y.-X., & Wang, P.-X. (2016). Reliability and Construct Validity of Two Versions of Chalder Fatigue Scale among the General Population in Mainland China. International Journal of Environmental Research and Public Health, 13(1), 147. https://doi.org/10.3390/ijerph13010147
Kanchanatawan, B., Sriswasdi, S., & Maes, M. (2019). Supervised machine learning to decipher the complex associations between neuro-immune biomarkers and quality of life in schizophrenia. Metabolic Brain Disease, 34(1), 267–282. https://doi.org/10.1007/s11011-018-0339-7
Kanchanatawan, B., Thika, S., Sirivichayakul, S., Carvalho, A. F., Geffard, M., & Maes, M. (2018). In Schizophrenia, Depression, Anxiety, and Physiosomatic Symptoms Are Strongly Related to Psychotic Symptoms and Excitation, Impairments in Episodic Memory, and Increased Production of Neurotoxic Tryptophan Catabolites: A Multivariate and Machine Learning Study. Neurotoxicity Research, 33(3), 641–655. https://doi.org/10.1007/s12640-018-9868-4
Kirkpatrick, B., Fenton, W. S., Carpenter, W. T., & Marder, S. R. (2006). The NIMH-MATRICS Consensus Statement on Negative Symptoms. Schizophrenia Bulletin, 32(2), 214–219. https://doi.org/10.1093/schbul/sbj053
Lenzenweger, M. F., Bennett, M. E., & Lilenfeld, L. R. (1997). The Referential Thinking Scale as a measure of schizotypy: Scale development and initial construct validation. Psychological Assessment, 9(4), 452–463. https://doi.org/10.1037/1040-3590.9.4.452
Li, S. H., Lloyd, A. R., & Graham, B. M. (2020). Physical and mental fatigue across the menstrual cycle in women with and without generalised anxiety disorder. Hormones and Behavior, 118, 104667. https://doi.org/10.1016/j.yhbeh.2019.104667
Loriol, M. (2017). A sociological stance on fatigue and tiredness: Social inequalities, norms and representations. Neurophysiologie Clinique/Clinical Neurophysiology, 47(2), 87–94. https://doi.org/10.1016/j.neucli.2016.12.001
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U
McCallum, S. M., Batterham, P. J., Calear, A. L., Sunderland, M., Carragher, N., & Kazan, D. (2019). Associations of fatigue and sleep disturbance with nine common mental disorders. Journal of Psychosomatic Research, 123, 109727. https://doi.org/10.1016/j.jpsychores.2019.05.005
Meehl, P. E. (1990). Toward an Integrated Theory of Schizotaxia, Schizotypy, and Schizophrenia. Journal of Personality Disorders, 4(1), 1–99. https://doi.org/10.1521/pedi.1990.4.1.1
Menting, J., Tack, C. J., Bleijenberg, G., Donders, R., Droogleever Fortuyn, H. A., Fransen, J., Goedendorp, M. M., Kalkman, J. S., Strik-Albers, R., van Alfen, N., van der Werf, S. P., Voermans, N. C., van Engelen, B. G., & Knoop, H. (2018). Is fatigue a disease-specific or generic symptom in chronic medical conditions? Health Psychology, 37(6), 530–543. https://doi.org/10.1037/hea0000598
Morriss, R., Wearden, A., & Mullis, R. (1998). Exploring the validity of the chalder fatigue scale in chronic fatigue syndrome. Journal of Psychosomatic Research, 45(5), 411–417. https://doi.org/10.1016/S0022-3999(98)00022-1
Nyer, M., Mischoulon, D., Alpert, J. E., Holt, D. J., Brill, C. D., Yeung, A., Pedrelli, P., Baer, L., Dording, C., Huz, I., Fisher, L., Fava, M., & Farabaugh, A. (2015). College students with depressive symptoms with and without fatigue: Differences in functioning, suicidality, anxiety, and depressive severity. Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists, 27(2), 100–108.
Oxford English Dictionary. (2023). Fatigue, n., sense 1.a. Oxford University Press; Oxford English Dictionary. https://doi.org/10.1093/OED/3601200885
Parnas, J., Møller, P., Kircher, T., Thalbitzer, J., Jansson, L., Handest, P., & Zahavi, D. (2005). EASE: Examination of Anomalous Self-Experience. Psychopathology, 38(5), 236–258. https://doi.org/10.1159/000088441
Perera, N. D., Prathapan, S. P., Wass, D. A., & Wijewickrama, A. (2021). Construct validity and reliability of the Sinhala version of the Chalder fatigue questionnaire in a cohort following dengue infection in Sri Lanka. Journal of the National Science Foundation of Sri Lanka, 49(3), 441. https://doi.org/10.4038/jnsfsr.v49i3.9979
Rodríguez-Testal, J. F., Bendala-Rodríguez, P., Perona-Garcelán, S., & Senín-Calderón, C. (2019a). Examining the structure of ideas of reference in clinical and community samples. Comprehensive Psychiatry, 93, 48–55. https://doi.org/10.1016/j.comppsych.2019.06.006
Rodríguez-Testal, J. F., Fuentes-Márquez, S., Senín-Calderón, C., Fernández-León, S., Ceballos -Munuera, C., Perona-Garcelán, S., & Fonseca-Pedrero, E. (2022). Validation of the aberrant salience inventory in a general and clinical Spanish population. Comprehensive Psychiatry, 118, 152343. https://doi.org/10.1016/j.comppsych.2022.152343
Rodríguez-Testal, J. F., Perona-Garcelán, S., Dollfus, S., Valdés-Díaz, M., García-Martínez, J., Ruíz-Veguilla, M., & Senín-Calderón, C. (2019b). Spanish validation of the self-evaluation of negative symptoms scale SNS in an adolescent population. BMC Psychiatry, 19(1), 327. https://doi.org/10.1186/s12888-019-2314-1
Schultze-Lutter, F., Addington, J., Ruhrmann, S., & Klosterkötter, J. (2007). Schizophrenia Proneness Instrument, Adult Version (SPI-A). Giovanni Fioriti Editore s.r.l.
Schultze-Lutter, F., Marshall, M., & Koch, E. (2012). Schizophrenia Proneness Instrument, Child & Youth version (SPI-CY). Giovanni Fioriti Editore s.r.l.
Shahid, A., Shen, J., & Shapiro, C. M. (2010). Measurements of sleepiness and fatigue. Journal of Psychosomatic Research, 69(1), 81–89. https://doi.org/10.1016/j.jpsychores.2010.04.001
Stefanis, N. C., Hanssen, M., Smirnis, N. K., Avramopoulos, D. A., Evdokimidis, I. K., Stefanis, C. N., Verdoux, H., & Van Os, J. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine, 32(2), 347–358. https://doi.org/10.1017/S0033291701005141
Tanaka, M., Fukuda, S., Mizuno, K., Imai-Matsumura, K., Jodoi, T., Kawatani, J., Takano, M., Miike, T., Tomoda, A., & Watanabe, Y. (2008). Reliability and Validity of the Japanese Version of the Chalder Fatigue Scale among Youth in Japan. Psychological Reports, 103(3), 682–690. https://doi.org/10.2466/pr0.103.3.682-690
ter Wolbeek, M., van Doornen, L. J. P., Kavelaars, A., Tersteeg-Kamperman, M. D. J., & Heijnen, C. J. (2011). Fatigue, depressive symptoms, and anxiety from adolescence up to young adulthood: A longitudinal study. Brain, Behavior, and Immunity, 25(6), 1249–1255. https://doi.org/10.1016/j.bbi.2011.04.015
Townsend, L., Dyer, A. H., Jones, K., Dunne, J., Mooney, A., Gaffney, F., O’Connor, L., Leavy, D., O’Brien, K., Dowds, J., Sugrue, J. A., Hopkins, D., Martin-Loeches, I., Ni Cheallaigh, C., Nadarajan, P., McLaughlin, A. M., Bourke, N. M., Bergin, C., O’Farrelly, C., … Conlon, N. (2020). Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLOS ONE, 15(11), e0240784. https://doi.org/10.1371/journal.pone.0240784
Üzer, A., & Güleç, H. (2020). Obstrüktif uyku apne sendromlu hastalarda Chalder Yorgunluk Ölçeği’nin Türkçe formunun psikometrik özellikleri. Cukurova Medical Journal, 45(1), 114–118. https://doi.org/10.17826/cumj.629710
Whitehead, L. (2009). The Measurement of Fatigue in Chronic Illness: A Systematic Review of Unidimensional and Multidimensional Fatigue Measures. Journal of Pain and Symptom Management, 37(1), 107–128. https://doi.org/10.1016/j.jpainsymman.2007.08.019
Williams, B., Onsman, A., & Brown, T. (2010). Exploratory Factor Analysis: A Five-Step Guide for Novices. Australasian Journal of Paramedicine, 8, 1–13. https://doi.org/10.33151/ajp.8.3.93
Wolfe, F., Rasker, J. J. J., ten Klooster, P., & Häuser, W. (2021). Subjective Cognitive Dysfunction in Patients With and Without Fibromyalgia: Prevalence, Predictors, Correlates, and Consequences. Cureus. https://doi.org/10.7759/cureus.20351
Wong, W. S., & Fielding, R. (2010). Construct validity of the Chinese version of the Chalder Fatigue Scale in a Chinese community sample. Journal of Psychosomatic Research, 68(1), 89–93. https://doi.org/10.1016/j.jpsychores.2009.05.008
Worm-Smeitink, M., Gielissen, M., Bloot, L., van Laarhoven, H. W. M., van Engelen, B. G. M., van Riel, P., Bleijenberg, G., Nikolaus, S., & Knoop, H. (2017). The assessment of fatigue: Psychometric qualities and norms for the Checklist individual strength. Journal of Psychosomatic Research, 98, 40–46. https://doi.org/10.1016/j.jpsychores.2017.05.007
Zdun-Ryżewska, A., Basiński, K., & Michalik, A. (2020). A confirmatory factor analysis for an adapted and validated Polish version of the Chalder Fatigue Questionnaire. International Journal of Occupational Medicine and Environmental Health, 33(1), 67–76. https://doi.org/10.13075/ijomeh.1896.01497
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
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