Dimensionality, Stability, and Validity of the Beck Hopelessness Scale in Cancer Patients Receiving Curative and Palliative Treatment

Lena Spangenberg; Markus Zenger; Francisco Garcia-Torres; Volkmar Mueller; Martin Reck; Anja Mehnert; Sigrun Vehling

doi:10.1016/j.jpainsymman.2015.11.008

Dimensionality, Stability, and Validity of the Beck Hopelessness Scale in Cancer Patients Receiving Curative and Palliative Treatment

J Pain Symptom Manage. 2016 Mar;51(3):615-22. doi: 10.1016/j.jpainsymman.2015.11.008. Epub 2015 Dec 2.

Authors

Lena Spangenberg¹, Markus Zenger², Francisco Garcia-Torres³, Volkmar Mueller⁴, Martin Reck⁵, Anja Mehnert⁶, Sigrun Vehling⁷

Affiliations

¹ Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany. Electronic address: lena.spangenberg@medizin.uni-leipzig.de.
² Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany; Faculty of Applied Human Studies, University of Applied Sciences Magdeburg and Stendal, Stendal, Germany.
³ Department of Psychology, Córdoba University/IMIBIC/Reina Sofía University Hospital, Córdoba, Spain.
⁴ Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁵ Department of Thoracic Oncology, LungenClinic Großhansdorf, Großhansdorf, Germany.
⁶ Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany.
⁷ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

PMID: 26654946
DOI: 10.1016/j.jpainsymman.2015.11.008

Abstract

Context: Hopelessness is a clinically important construct in patients with advanced illness.

Objectives: To evaluate the dimensionality, stability, and validity of the Beck Hopelessness Scale (BHS) in cancer patients receiving either curative or palliative treatment.

Methods: Following a longitudinal design, we assessed a sample of cancer patients receiving either curative or palliative treatment (N = 315) at baseline and at follow-up after 12 months (N = 158). In addition to hopelessness, we measured depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder-7), and health-related quality of life (Short-Form Health Survey-8). We analyzed dimensionality, stability, and construct validity of the BHS using confirmatory factor analysis, exploratory factor analysis and correlational analysis.

Results: Independent of treatment intention, confirmatory factor analyses resulted in unsatisfactory model fits. Exploratory factor analysis yielded a two-factor solution in both groups receiving curative or palliative treatment. Factor 1 reflected pessimistic/resigned beliefs (Cronbach alpha ≥ 0.85), Factor 2 reflected positive beliefs toward the future (Cronbach alpha = 0.73). Both subscales showed significant associations with anxiety, depression, and decreased health-related quality of life. The factorial structure was partially replicated in patients being reexamined after 12 months (CMIN/DF = 2.130, Standardized Root Mean Square Residual = 0.0716, Comparative Fit Index = 0.904, Tucker-Lewis-Index = 0.883, Root Mean Square Error of Approximation = 0.085). Hopelessness scores were significantly higher in patients reporting suicidal ideation according to the Patient Health Questionnaire-9.

Conclusion: Our study demonstrates psychometric limitations of the BHS in patients receiving both curative and palliative treatment, suggesting reduced utility in cancer populations. Given the clinical importance of the construct, a cancer-specific approach to capture the unique meaning of hopelessness in patients with severe medical illness is recommended.

Keywords: Beck Hopelessness Scale; Hopelessness; advanced illness; cancer; confirmatory factor analysis.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Factor Analysis, Statistical
Female
Follow-Up Studies
Hope*
Humans
Longitudinal Studies
Male
Neoplasms / diagnosis*
Neoplasms / psychology*
Neoplasms / therapy
Observational Studies as Topic
Palliative Care / methods
Prospective Studies
Psychiatric Status Rating Scales*
Psychometrics