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A Chinese version of the Rheumatology Attitudes Index is a valid and reliable measure of learned helplessness in patients with SLE

Department of Medicine, National University of Singapore, Singapore; Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074

P-H Feng

Departments of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore

S-P Chan

Clinical Epidemiology, Tan Tock Seng Hospital, Singapore

M-L Boey

Mount Elizabeth Medical Centre, Singapore

S-t Thio

K-Y Fong

Department of Medicine, National University of Singapore, Singapore

Despite the prognostic importance of learned helplessness (LH) in rheumatic diseases, there are no validated measures of LH in Chinese or other Asian languages. We therefore assessed the validity of a Chinese translation of the Rheumatology Attitudes Index (CRAI; a widely used measure of LH) and its Helplessness (CHS) and Internality (CIS) subscales in patients with SLE. Chinese-speaking SLE patients (n = 69) completed identical, self-administered questionnaires containing the CRAI and assessing demographic/socio-economic variables twice within 2 weeks. SLE activity, damage and quality of life were assessed using the BILAG, SLICC/ACR Damage Index and SF-36 respectively. Scale psychometric properties were assessed through Cronbach's , intra-class correlations, quantifying test–retest differences, factor analysis and known-groups construct validity. Internal consistency and reliability were acceptable, with Cronbach's for the CHS, CIS and CRAI being 0.70, 0.69 and 0.74, respectively. Mean differences in test–retest scores spanned 1.6–2.4% of possible scale ranges and intra class correlations ranged from 0.72 to 0.88. Factor analysis identified two major factors corresponding to the CHS and CIS subscales of the CRAI. Eight of 10 a priori hypotheses relating the CRAI and CHS to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales.

The CRAI and its helplessnesssubscale are valid and reliable measures of learned helplessness in Chinese-speaking SLE patients.

Key Words: learned helplessness • systemic lupus erythematosus • translations • Asia • Singapore

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