Psychometric properties of the Patient Dignity Inventory in an acute psychiatric ward: an extension study of the preliminary validation

Figures & data

Table 1 Demographic variables

Variables	Males, n=75 (45%)	Females, n=90 (55%)	Total, n=165 (100%)
Age (mean±SD)
Years	43.29±14.96	44.57±13.90	43.89±14.42
Nationality, n (%)
Italian	65 (86)	80 (89)	145 (87)
European extra-Italian	1 (1)	2 (2)	3 (2)
Extra-European	9 (12)	8 (9)	17 (11)
Marital status, n (%)
Single	52 (69)	41 (45)	93 (56)
Married	19 (25)	25 (27)	44 (27)
Divorced/widowed	4 (5)	24 (26)	28 (17)
Schooling, n (%)
Primary school	11 (15)	10 (11)	21 (13)
Secondary school	25 (33)	27 (30)	52 (31)
High school	31 (41)	36 (40)	67 (41)
Degree	8 (11)	17 (19)	25 (15)
Work activity, n (%)
Employed	25 (33)	34 (38)	59 (36)
Unemployed	39 (52)	31 (34)	70 (42)
Retired	6 (8)	15 (17)	21 (13)
Other	5 (7)	10 (11)	15 (9)
Family and surrounding, n (%)
Single	16 (21)	31 (34)	47 (28)
Parental family	39 (52)	22 (24)	61 (37)
Marital family	17 (23)	34 (38)	51 (31)
Community/residential facility	3 (4)	3 (3)	6 (4)
Social and economic conditions, n (%)
Sufficient	63 (84)	74 (82)	137 (83)
Insufficient	12 (16)	16 (17)	28 (17)

Table 2 Clinical variables

Variables	Males, n=75 (45%)	Females, n=90 (55%)	Total, n=165 (100%)
Psychiatric illness duration (mean±SD)
Years	9.35±9.55	9.80±9.08	9.58±9.28
Previous psychiatric hospitalizations, n (%)
First psychiatric hospitalization	31 (41)	27 (30)	58 (35)
One or more previous psychiatric hospitalizations	44 (59)	63 (70)	107 (65)
Psychiatric diagnosis at discharge (ICD-9CM), n (%)
Schizophrenic and other psychotic disorders	30 (40)	39 (43)	69 (42)
Bipolar disorders, manic episode	16 (21)	21 (23)	37 (22)
Personality disorders	18 (24)	18 (20)	36 (22)
Anxious disorders and dysthymia	7 (9)	6 (7)	13 (8)
Organic psychosis	2 (3)	4 (4)	6 (4)
Other	2 (3)	2 (2)	4 (2)
Organic comorbidity, n (%)
Present	29 (38)	34 (37)	63 (38)
Absent	46 (61)	56 (63)	102 (62)
Substance abuse, n (%)
Present	30 (40)	20 (23)	50 (30)
Absent	45 (60)	70 (77)	115 (70)
Duration of hospitalization (m±SD)
Days	16.04±20.94	16.16±13.40	15.96±17.22
State of hospitalization, n (%)
Involuntary treatment	28 (37)	47 (52)	78 (47)
Voluntary treatment	50 (66)	40 (44)	87 (53)
Destination at discharge, n (%)
Home	45 (60)	59 (65)	104 (63)
Transfer to private hospital	24 (32)	25 (28)	49 (30)
Transfer to community or residential facilities	6 (8)	6 (7)	12 (7)
Need for supplementary laboratory and clinical tests, n (%)
Present	37 (49)	39 (43)	76 (46)
Absent	38 (51)	51 (57)	89 (54)
Drug administration, n (%)
Oral	50 (47)	56 (42)	106 (64)
Parental or more than one route	25 (53)	34 (58)	59 (36)
Outpatient service therapeutic-rehabilitative programs, n (%)
Present	69 (92)	80 (89)	149 (90)
Absent	5 (7)	10 (11)	15 (10)
Suicide risk, n (%)
Present	18 (24)	17 (19)	35 (21)
Absent	57 (76)	73 (81)	130 (79)

Abbreviation: ICD-9CM, International Classification of Diseases, 9th Revision, Clinical Modification.

Table 3 PDI score, inter-item correlations, and Cronbach’s alpha coefficient in our sample

PDI items		Mean±SD	Min–max	Item-test, correlation	Cronbach’s alpha coefficient
1	Not being able to carry out tasks associated with daily living (eg, washing myself, getting dressed)	1.57±1.13	1–5	0.56	0.94
2	Not being able to attend to my bodily functions independently (eg, needing assistance with toileting-related activities)	1.39±0.93	1–5	0.49	0.94
3a	Experiencing physically distressing symptoms (such as pain, shortness of breath, nausea) as drug adverse effects	1.93±1.17	1–5	0.37	0.94
4	Feeling that how I look to others has changed significantly	1.82±1.19	1–5	0.56	0.94
5	Feeling depressed	2.35±1.47	1–5	0.68	0.94
6	Feeling anxious	2.26±1.37	1–5	0.67	0.94
7	Feeling uncertain about my illness and treatment	1.96±1.22	1–5	0.7	0.94
8	Worrying about my future	2.53±1.47	1–5	0.66	0.94
9	Not being able to think clearly	1.89±1.28	1–5	0.76	0.94
10	Not being able to continue with my usual routines	2.28±1.44	1–5	0.57	0.94
11	Feeling like I am no longer who I was	1.79±1.20	1–5	0.68	0.94
12	Not feeling worthwhile or valued	1.88±1.24	1–5	0.71	0.94
13	Not being able to carry out important roles (eg, spouse, parent)	2.07±1.49	1–5	0.72	0.94
14	Feeling that life no longer has meaning or purpose	1.91±1.32	1–5	0.75	0.94
15	Feeling that I have not made a meaningful and lasting contribution during my lifetime	2.01±1.31	1–5	0.79	0.94
16	Feeling I have “unfinished business” (eg, things left unsaid or incomplete)	2.34±1.34	1–5	0.65	0.94
17a	Concern that my spiritual life is not meaningful	1.60±1.08	1–5	0.53	0.94
18	Feeling that I am a burden to others	2.20±1.49	1–5	0.68	0.94
19	Feeling that I do not have control over my life	2.14±1.43	1–5	0.83	0.94
20	Feeling that my illness and care needs have reduced my privacy	1.97±1.25	1–5	0.59	0.94
21	Not feeling supported by my community of friends and family	1.99±1.32	1–5	0.6	0.94
22	Not feeling supported by my health care providers	1.59±1.05	1–5	0.44	0.94
23	Feeling like I am no longer able to mentally “fight” the challenges of my illness	1.78±1.18	1–5	0.74	0.94
24	Not being able to accept the way things are	2.01±1.34	1–5	0.71	0.94
25	Not being treated with respect or understanding by others	1.91±1.28	1–5	0.66	0.94
Total		48.58±21.11	25–125	–	0.94

Note:

a Items modified.

Abbreviation: PDI, Patient Dignity Inventory.

Figure 1 Scree plot of the factorial analysis.

Table 4 Initial factor loading for the PDI

Initial factors	Eigenvalues	Proportion	Cumulative
Factor 1	10.54	0.69	0.69
Factor 2	1.16	0.07	0.76
Factor 3	1.00	0.06	0.83
Factor 4	0.79	0.05	0.88
Factor 5	0.66	0.04	0.93
Factor 6	0.52	0.03	0.96
Factor 7	0.44	0.02	0.99
Factor 8	0.38	0.02	1.01
Factor 9	0.31	0.02	1.04
Factor 10	0.24	0.01	1.05

Note: The 10 largest initial eigenvalues of the 1–10 Factors are summarized.

Abbreviation: PDI, Patient Dignity Inventory.

Table 5 Rotated factor loadings and uniqueness in the PDI factorial analysis

Items		Factor 1 “loss of self-identity and anxiety for future”	Factor 2 “concerns for social dignity and spiritual life”	Factor 3 “loss of personal autonomy”	Uniqueness
1	Not being able to carry out tasks associated with daily living	0.18	0.15	0.84	0.24
2	Not being able to attend to my bodily functions independently	0.23	0.06	0.8	0.31
3	Experiencing physically distressing symptoms as drug adverse effects	0.26	0.08	0.26	0.86
4	Feeling that how I look to others has changed significantly	0.46	0.14	0.25	0.71
5	Feeling depressed	0.79	0.05	0.11	0.3
6	Feeling anxious	0.79	0.04	0.14	0.35
7	Feeling uncertain about my illness and treatment	0.6	0.31	0.29	0.45
8	Worrying about my future	0.66	0.19	0.11	0.5
9	Not being able to think clearly	0.44	0.44	0.49	0.38
10	Not being able to continue with my usual routines	0.34	0.36	0.18	0.72
11	Feeling like I am no longer who I was	0.51	0.38	0.16	0.57
12	Not feeling worthwhile or valued	0.57	0.33	0.22	0.51
13	Not being able to carry out important roles (eg, spouse, parent)	0.51	0.32	0.37	0.5
14	Feeling that life no longer has meaning or purpose	0.68	0.26	0.26	0.39
15	Feeling that I have not made a meaningful and lasting contribution during my lifetime	0.7	0.39	0.20	0.32
16	Feeling I have “unfinished business” (eg, things left unsaid or incomplete)	0.45	0.43	0.22	0.56
17	Concern that my spiritual life is not meaningful	0.24	0.59	0.00	0.6
18	Feeling that I am a burden to others	0.52	0.33	0.26	0.55
19	Feeling that I do not have control over my life	0.68	0.44	0.32	0.25
20	Feeling that my illness and care needs have reduced my privacy	0.31	0.55	0.14	0.58
21	Not feeling supported by my community of friends and family	0.22	0.63	0.21	0.51
22	Not feeling supported by my health care providers	0.15	0.42	0.22	0.75
23	Feeling like I am no longer able to mentally “fight” the challenges of my illness	0.66	0.38	0.17	0.39
24	Not being able to accept the way things are	0.67	0.21	0.29	0.42
25	Not being treated with respect or understanding by others	0.31	0.57	0.29	0.5

Note: The items excluded are in italics and the items loading factors are in bold.

Abbreviation: PDI, Patient Dignity Inventory.

Table 6 Correlations of PDI and three factors with scale scores

Scale	PDI (m=49.10±20.9 SD)	Factor 1 (m=31.01±14.65 SD)	Factor 2 (m=9.04±4.32 SD)	Factor 3 (m=4.84±2.85 SD)
GAF (mean±SD)
71.67±15.04	NS	NS	NS	NS
Ham-D (mean±SD)
14.54±8.13	Spearman’s rho=0.3439 (p<0.0001)	Spearman’s rho=0.3526 (p<0.0001)	Spearman’s rho=0.2408 (p=0.0049)	Spearman’s rho=0.2781 (p=0.0011)
Ham-A (mean±SD)
10.44±7.91	Spearman’s rho=0.3224 (p<0.0001)	Spearman’s rho=0.3413 (p=0.0001)	Spearman’s rho=0.2448 (p=0.042)	Spearman’s rho=0.2059 (p=0.0166)
HoNOS at admission (mean±SD)
24.99±8.45	NS	NS	NS	NS
HoNOS at discharge (mean±SD)
17.80±6.8a	NS	NS	NS	NS

Notes:

a HoNOS at admission vs HoNOS at discharge, p<0.001, t=14.19, paired t-test. Factor 1: “Loss of self-identity and anxiety for future”; Factor 2: “Concerns for social dignity and spiritual life”; Factor 3: “Loss of personal autonomy”.

Abbreviations: GAF, Global Assessment of Functioning; Ham-A, Hamilton Anxiety Rating Scale; Ham-D, Hamilton Rating Scale for Depression; HoNOS, Health of the Nation Outcome Scales; PDI, Patient Dignity Inventory; NS, not significant.

Table 7 Variables related to PDI and Factors 1, 2, and 3 (stepwise multiple linear regression)

Variablea (reference category)	Coefficient	Standard error	95% CI	p-value
PDI score
Social and economic conditions (sufficient)
Insufficient	13.11	4.19	4.83 to 21.38	0.002
Suicidal risk (absent)
Present	11.07	3.82	3.53 to 18.61	0.004
Need for clinical and instrumental test (present)
Absent	7.99	3.12	1.83 to 14.15	0.011
Factor 1
Social and economic conditions (sufficient)
Insufficient	7.19	2.84	1.58 to 12.80	0.012
Suicidal risk (absent)
Present	6.96	2.54	1.93 to 11.99	0.007
Need for clinical and instrumental test (present)
Absent	4.77	1.99	0.83 to 8.70	0.018
Marital status (single)
Divorced/widowed	5.55	2.73	0.16 to 10.94	0.044
Factor 2
Social and economic conditions (sufficient)
Insufficient	2.74	0.66	1.44 to 4.04	<0.001
Need for supplementary laboratory and clinical tests (present)
No need	1.13	0.48	0.19 to 2.07	0.019
Outpatient service therapeutic-rehabilitative programs (present)
Absent	−2.24	0.85	−3.91 to −0.56	0.009
Factor 3
Age (years)	0.032	0.015	0.00 to 0.06	0.036
Number of previous psychiatric hospitalizations (one or more than one)
First psychiatric hospitalization	1.12	0.45	0.24 to 2.01	0.013

Notes:

a Only the statistically significant variables are reported. Factor 1: “Loss of self-identity and anxiety for future”; Factor 2: “Concerns for social dignity and spiritual life”; Factor 3: “Loss of personal autonomy”.

Abbreviation: PDI, Patient Dignity Inventory.