Development and validation of the Japanese version of the Hyperarousal Scale

Naoko Ayabe; Shun Nakajima; Isa Okajima; Ken Inada; Wataru Yamadera; Hidehisa Yamashita; Hisateru Tachimori; Yuichi Kamei; Masahiro Takeshima; Yuichi Inoue; Kazuo Mishima

doi:10.1186/s12888-022-04243-0

Development and validation of the Japanese version of the Hyperarousal Scale

BMC Psychiatry. 2022 Sep 19;22(1):617. doi: 10.1186/s12888-022-04243-0.

Authors

Naoko Ayabe^{1

2}, Shun Nakajima³, Isa Okajima^{4

5}, Ken Inada^{6

7}, Wataru Yamadera⁸, Hidehisa Yamashita⁹, Hisateru Tachimori^{10

11}, Yuichi Kamei^{2

12}, Masahiro Takeshima¹³, Yuichi Inoue⁵, Kazuo Mishima^{14

15

16}

Affiliations

¹ Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, 1-1 Tegata-Gakuenmachi, Akita, 010-8502, Japan.
² Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
³ National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
⁴ Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, 1-18-1 Kaga, Itabashi-ku, Tokyo, 173-8602, Japan.
⁵ Japan Somnology Center, Institute of Neuropsychiatry, 1-24-10 Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
⁶ Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.
⁷ Department of Psychiatry, Kitasato University, School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
⁸ Department of Psychiatry, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
⁹ Minna no Sleep and Stress care Clinic, 2-1-2 Ushitahonmachi, Higashi-ku, Hiroshima-shi, Hiroshima, 732-0066, Japan.
¹⁰ Endowed Course for Health System Innovation, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
¹¹ Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan.
¹² Kamisuwa Hospital, 1-17-1 Oote, Suwa, Nagano, 392-0026, Japan.
¹³ Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.
¹⁴ Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan. mishima@med.akita-u.ac.jp.
¹⁵ Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan. mishima@med.akita-u.ac.jp.
¹⁶ International Institute for Integrative Sleep Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. mishima@med.akita-u.ac.jp.

Abstract

Background: The objectives of this study were to develop a Japanese version of the Hyperarousal Scale (HAS-J) and investigate its factor structure, reliability, and validity, as well as to calculate a cutoff score for the HAS-J and assess different levels of hyperarousal in insomnia patients and community dwellers.

Methods: We recruited 224 outpatients receiving insomnia treatment (56.3% women; mean age 51.7 ± 15.6 years) and 303 community dwellers aged 20 years or older (57.8% women; mean age 43.9 ± 15.2 years). Exploratory and confirmatory factor analysis was performed to examine the factor structure of the HAS-J. Cronbach's α and McDonald's ω were then used to test internal consistency. To examine the scale's validity, we determined correlations between the HAS-J and other indexes and compared HAS-J scores between insomnia patients and community dwellers. We also compared HAS-J scores between two community-dweller groups (normal and poor sleepers) and two insomnia patient groups (with and without alleviation after treatment).

Results: Following exploratory and confirmatory factor analysis, a 20-item measure emerged comprising three factors: "Introspectiveness and Reactivity," "Neuroticism," and "Insomnia." Confirmatory factor analysis showed a generally good fit for the model of the three-factor structure suggested by the exploratory factor analysis loadings (χ² (163) = 327.423, (p < 0.001), CFI = 0.914, GFI = 0.872, AGFI = 0.835, RMSEA = 0.067). In insomnia patients, internal consistency indicated sufficient reliability of the HAS-J. Correlation analysis showed weak to moderate positive correlations of the HAS-J score with other indexes, indicating concurrent validity of the HAS-J. All HAS-J subscale scores were significantly higher in insomnia patients than in community dwellers. Additionally, the total score in patients with alleviation of insomnia was comparable to that in poor sleepers and significantly higher than that in normal sleepers.

Conclusions: This study demonstrated the reliability and validity of the HAS-J, indicating that it is useful as a clinical scale of hyperarousal. The high level of hyperarousal in insomnia patients who were assessed to be in remission by the Insomnia Severity Index suggests a risk of insomnia recurrence in these patients.

Keywords: Depression; Hyperarousal; Hyperarousal scale; Insomnia.

Publication types

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

MeSH terms

Adult
Aged
Arousal
Female
Humans
Japan
Male
Middle Aged
Psychometrics
Reproducibility of Results
Sleep Initiation and Maintenance Disorders* / diagnosis
Sleep Initiation and Maintenance Disorders* / therapy