The assessment of psychological well-being in systemic sclerosis: a clinimetric validation

Abstract Background The assessment of psychological well-being has been largely neglected in clinical settings, particularly in patients with systemic sclerosis (SSc), where the focus of clinical attention was mainly on symptoms. This is the first study in which the validity, reliability, and sensib...

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Main Authors: Danilo Carrozzino, Kaj Sparle Christensen, Serena Guiducci, Alessia Marangoni, Sara Romanazzo, Fiammetta Cosci
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Psychology
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Online Access:https://doi.org/10.1186/s40359-025-02820-y
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author Danilo Carrozzino
Kaj Sparle Christensen
Serena Guiducci
Alessia Marangoni
Sara Romanazzo
Fiammetta Cosci
author_facet Danilo Carrozzino
Kaj Sparle Christensen
Serena Guiducci
Alessia Marangoni
Sara Romanazzo
Fiammetta Cosci
author_sort Danilo Carrozzino
collection DOAJ
description Abstract Background The assessment of psychological well-being has been largely neglected in clinical settings, particularly in patients with systemic sclerosis (SSc), where the focus of clinical attention was mainly on symptoms. This is the first study in which the validity, reliability, and sensibility of two patient-reported outcome measures (PROMs) of psychological well-being, the five-item World Health Organization Well-Being Index (WHO-5) and the six-item version of the Ryff’s Psychological Well-Being Scales (PWB-6), have been tested according to clinimetric criteria to determine their current and potential clinical applications in SSc patients. Methods A cross-sectional study was conducted involving 219 patients with a diagnosis of SSc. Rasch and Mokken analyses were performed to assess the clinimetric properties of the two PROMs and determine their clinical utility. Results All items of WHO-5 and PWB-6 fitted the Rasch model, had an optimal scalability, and the dimensionality analyses yielded less than 5% of significant t-tests, thus indicating that the two PROMs were unidimensional measures. Person separation reliability indices revealed acceptable internal consistency and inspection of the person-item distribution map showed that WHO-5 and PWB-6 were reasonably well-targeted for use with SSc patients. Conclusions Findings indicate that WHO-5 and PWB-6 are valid indices of psychological well-being that may provide unique prognostic information and help researchers and clinicians tailor personalized treatment strategies. The two PROMs can be used jointly but for different clinical purposes. WHO-5 is particularly suitable to assess the degree of subjective vitality, a positive feeling of aliveness and energy that may help SSc patients cope with their illness. The PWB-6 can be used to identify unique experiences of psychological well-being that may help SSc patients not only cope with their feelings of loneliness and uncertainty but also experience a meaningful life despite the progression of disease. In clinical research and daily practice, the baseline and follow-up use of WHO-5 and PWB-6 may thus lead to a substantial improvement in the quality of care of patients with SSc. Given the cross-sectional design of the present investigation, future prospective studies are, however, recommended to further assess the predictive validity and prognostic utility of the two PROMs.
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spelling doaj-art-ff23b617fa324e92aee216d8d99a03132025-08-20T02:25:08ZengBMCBMC Psychology2050-72832025-05-0113111010.1186/s40359-025-02820-yThe assessment of psychological well-being in systemic sclerosis: a clinimetric validationDanilo Carrozzino0Kaj Sparle Christensen1Serena Guiducci2Alessia Marangoni3Sara Romanazzo4Fiammetta Cosci5Department of Psychology “Renzo Canestrari”, Alma Mater Studiorum University of BolognaResearch Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus UniversityRheumatology Unit, Department of Experimental and Clinical Medicine, University of FlorenceDepartment of Health Sciences, University of FlorenceDepartment of Health Sciences, University of FlorenceDepartment of Health Sciences, University of FlorenceAbstract Background The assessment of psychological well-being has been largely neglected in clinical settings, particularly in patients with systemic sclerosis (SSc), where the focus of clinical attention was mainly on symptoms. This is the first study in which the validity, reliability, and sensibility of two patient-reported outcome measures (PROMs) of psychological well-being, the five-item World Health Organization Well-Being Index (WHO-5) and the six-item version of the Ryff’s Psychological Well-Being Scales (PWB-6), have been tested according to clinimetric criteria to determine their current and potential clinical applications in SSc patients. Methods A cross-sectional study was conducted involving 219 patients with a diagnosis of SSc. Rasch and Mokken analyses were performed to assess the clinimetric properties of the two PROMs and determine their clinical utility. Results All items of WHO-5 and PWB-6 fitted the Rasch model, had an optimal scalability, and the dimensionality analyses yielded less than 5% of significant t-tests, thus indicating that the two PROMs were unidimensional measures. Person separation reliability indices revealed acceptable internal consistency and inspection of the person-item distribution map showed that WHO-5 and PWB-6 were reasonably well-targeted for use with SSc patients. Conclusions Findings indicate that WHO-5 and PWB-6 are valid indices of psychological well-being that may provide unique prognostic information and help researchers and clinicians tailor personalized treatment strategies. The two PROMs can be used jointly but for different clinical purposes. WHO-5 is particularly suitable to assess the degree of subjective vitality, a positive feeling of aliveness and energy that may help SSc patients cope with their illness. The PWB-6 can be used to identify unique experiences of psychological well-being that may help SSc patients not only cope with their feelings of loneliness and uncertainty but also experience a meaningful life despite the progression of disease. In clinical research and daily practice, the baseline and follow-up use of WHO-5 and PWB-6 may thus lead to a substantial improvement in the quality of care of patients with SSc. Given the cross-sectional design of the present investigation, future prospective studies are, however, recommended to further assess the predictive validity and prognostic utility of the two PROMs.https://doi.org/10.1186/s40359-025-02820-yAssessmentClinimetricsPatient-reported outcome measuresPsychological well-beingSystemic sclerosisPWB-6
spellingShingle Danilo Carrozzino
Kaj Sparle Christensen
Serena Guiducci
Alessia Marangoni
Sara Romanazzo
Fiammetta Cosci
The assessment of psychological well-being in systemic sclerosis: a clinimetric validation
BMC Psychology
Assessment
Clinimetrics
Patient-reported outcome measures
Psychological well-being
Systemic sclerosis
PWB-6
title The assessment of psychological well-being in systemic sclerosis: a clinimetric validation
title_full The assessment of psychological well-being in systemic sclerosis: a clinimetric validation
title_fullStr The assessment of psychological well-being in systemic sclerosis: a clinimetric validation
title_full_unstemmed The assessment of psychological well-being in systemic sclerosis: a clinimetric validation
title_short The assessment of psychological well-being in systemic sclerosis: a clinimetric validation
title_sort assessment of psychological well being in systemic sclerosis a clinimetric validation
topic Assessment
Clinimetrics
Patient-reported outcome measures
Psychological well-being
Systemic sclerosis
PWB-6
url https://doi.org/10.1186/s40359-025-02820-y
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