Reducing mental health stigma among nursing students through an educational intervention.

BACKGROUND: Patient-centred care must consider service consumers' needs and improve their health and well-being as well as their satisfaction and the quality of their healthcare assistance. However, individuals experiencing mental illness often struggle with barriers and misunderstandings by health care professionals. Nursing Faculties are uniquely positioned to reduce stigmatising attitudes via new educational interventions that could align nursing curricula and individuals with mental illness needs. However, there are few studies about the stigma toward mental illness among nursing students in Spain. OBJECTIVES: The present study aimed to analyse the effect of a 9-month educational intervention on the level of stigma in nursing students. DESIGN: a one-group pre-postintervention design with no control group was conducted. METHODS: A total of 194 nursing students completed the EVEPEM scale before and after the intervention. The intervention comprised 55 hours of campus sessions and 150 h practicum in mental health settings. RESULTS: A destigmatising tendency was captured by a large main effect and a statistically significant stigma reduction. CONCLUSIONS: The educational 9-month intervention was effective in reducing students' stigma by providing theoretical education, personal contact with mental health service consumers, and critical reflection activities.

Definition and validation of the nursing diagnosis label "wish to die": a research protocol.

BACKGROUND: Euthanasia has been incorporated into the health services of seven countries. The legalisation of these practices has important repercussions for the competences of nurses, and it raises questions about their role. When a patient with advanced disease expresses a wish to die, what is expected of nurses? What are the needs of these patients, and what kind of care plan do they require? What level of autonomy might nurses have when caring for these patients? The degree of autonomy that nurses might or should have when it comes to addressing such a wish and caring for these patients has yet to be defined. Recognising the wish to die as a nursing diagnosis would be an important step towards ensuring that these patients receive adequate nursing care. This study-protocol aims to define and validate the nursing diagnosis wish to die in patients with advanced disease, establishing its defining characteristics and related factors; to define nursing-specific interventions for this new diagnosis. METHODS: A prospective three-phase study will be carried out. Phase-A) Foundational knowledge: an umbrella review of systematic reviews will be conducted; Phase-B) Definition and validation of the diagnostic nomenclature, defining characteristics and related factors by means of an expert panel, a Delphi study and application of Fehring's diagnostic content validation model; Phase-C) Definition of nursing-specific interventions for the new diagnosis. At least 200 academic and clinical nurses with expertise in the field of palliative care or primary health care will be recruited as participants across the three phases. DISCUSSION: The definition of the wish to die as a nursing diagnosis would promote greater recognition and autonomy for nurses in the care of patients who express such a wish, providing an opportunity to alleviate underlying suffering through nursing-specific interventions and drawing attention to the needs of patients with advanced disease. The new diagnosis would be an addition to nursing science and would provide a framework for providing care to people with advanced disease who express such a wish. Nurses would gain professional autonomy about identifying, exploring and responding clinically to such a wish.

Family caregiver emotional distress in advanced cancer: the DME-C scale psychometric properties.

BACKGROUND: Family caregivers of patients with advanced illness at end of life often report high levels of emotional distress. To address this emotional distress is necessary to have adequate and reliable screening tools. AIM: This study analyses the psychometric properties and clinical utility of the Family Caregiver Emotional Detection Scale for caregivers of patients with end-stage cancer (DME-C, Spanish acronym) who are receiving palliative care (PC). DESIGN: Multicentre, cross-sectional study. SETTINGS/PARTICIPANTS: Family caregivers of patients with advanced cancer at end of life receiving palliative treatment were interviewed to explore their emotional distress through the DME-C scale and other instruments measuring anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), distress thermometer (DT) and overload (B), as well as a clinical psychological assessment (CPA). RESULTS: 138 family caregivers, 85 (61.6%) female and 53 (38.4%) male, with an average age of 59.69±13.3 participated in the study. The reliability of the scale, as measured by Cronbach's alpha, was 0.76, and its stability over time was 0.734. Positive, significant correlations were found between the DME-C and the scores for anxiety and depression registered on the HADS scale, as well as with the total result of this latter scale and the results for B, the DT and the CPA. A statistical analysis of the receiver-operating characteristic curves showed that the scale has a sensitivity and specificity of 75%, and that the cut-off point for the detection of emotional distress was a score ≥11. Fifty-four per cent of the caregivers displayed emotional distress according to this scale. CONCLUSIONS: The DME-C displays good psychometric properties. It is simple, short, reliable and easy to administer. We believe that the instrument is useful for the detection of emotional distress in the family caregivers of hospitalised patients suffering from end-stage illnesses and receiving PC.

Spanish Version of the Bedtime Procrastination Scale: Cross-Cultural Adaptation and Psychometric Evaluation in a Sample of Nursing Students.

A recent line of research concerns bedtime procrastination, its effects on sleep quality and duration, and the associated repercussions for health and wellbeing. The Bedtime Procrastination Scale is a brief, self-report instrument developed by Kroese et al. with the aim of evaluating this behavior and exploring its association with insufficient sleep, and hence with health. The aim was to develop and validate a Spanish version of the Bedtime Procrastination Scale (BPS-Sp) and to examine the relationship between bedtime procrastination and both general procrastination and self-control. The original BPS was translated from English into Spanish in accordance with international guidelines on the cross-cultural adaptation of measurement instruments. The sample for the validation study comprised 177 nursing students who completed a questionnaire requesting demographic data and which included the following instruments: the newly developed BPS-Sp, the Tuckman Procrastination Scale, and the Brief Self-Control Scale. Statistical analysis involved tests of normality (Kolmogorov-Smirnov), reliability (Cronbach's alpha, test-retest), construct validity, and confirmatory factor analysis. Scores on the BPS-Sp showed excellent internal consistency (α = .83) and temporal stability (test-retest r = .84), as well as significant correlations with general procrastination (r = .26; p < .01) and self-control (r = -.17; p < .05). Confirmatory factor analysis showed an adequate fit for the single-factor solution proposed by Kroese et al. The results suggest that the BPS-Sp is a valid and reliable instrument for assessing bedtime procrastination in the Spanish-speaking population.

The suicidal behaviors questionnaire-revised. Spanish form.

This study consists of a translation, intercultural adaptation and analysis of the psychometric properties of the Spanish version of Suicide Behavior Questionnaire Revised using a sample of 325 undergraduates. Internal consistency, reliability and temporal stability, calculated through Cronbach's alpha (α =.81) and test-retest correlations (ICC =. 88), respectively, were excellent. The criterion-related validity of the SBQ-R was established by correlating SBQ-R with other psychological constructs. A confirmatory factor analysis demonstrated adequate fit of the measurement model. This SBQ-R Spanish adaptation is a reliable and valid tool that might be useful to researchers and clinicians wishing to identify young people at a high risk of suicide.

Development and psychometric testing of a scale for assessing the associative stigma of mental illness in nursing.

AIMS AND OBJECTIVES: To develop a new scale for assessing the associative stigma of mental illness in nursing based on Peplau's model of psychodynamic nursing and to examine its psychometric properties. BACKGROUND: The stigma of mental illness continues to cause problems today for patients, families and mental health professionals. For individuals with a mental disorder, stigma can result in restricted opportunities, social exclusion and the denial of rights. Associative stigma in mental health professionals is becoming a major problem and is related to increased depersonalisation, higher levels of emotional exhaustion and diminished job satisfaction among mental health professionals. Nursing may play a key role in reducing the stigma associated with mental illness, but there are no specific scales for the measurement of associative stigma in nursing. DESIGN: Development of an instrument. A STROBE checklist was completed. METHODS: This study involved two stages: (a) item generation and content validation; (b) examining the reliability and convergent/discriminant validity of the scale. A developmental and methodological design was used. Data were collected between November 2016-December 2017 from a sample of 737 nursing undergraduates. RESULTS: The results indicated good internal consistency for the final 20-item scale for assessing the associative stigma of mental illness in nursing, which is considered in terms of three dimensions: Violence/Dangerousness, Disability, and Irresponsibility/Lack of Competence. Exploratory and confirmatory factor analyses supported a three-factor structure consistent with the theoretical model. CONCLUSIONS: The 20-item EVEPEM (from its Spanish acronym) derived from Peplau's theory was shown to be a valid and reliable tool for assessing the stigma of mental illness in the nursing setting. RELEVANCE TO CLINICAL PRACTICE: Reliable instruments are needed to measure the effectiveness of anti-stigma interventions for mental health professionals. The results indicate that the tool developed is a valid and reliable instrument for use in the nursing setting.

Academic procrastination in nursing students. Spanish adaptation of the Academic Procrastination Scale-Short Form (APS-SF). / Procrastinación académica en estudiantes de enfermería. Adaptación española de la Academic Procrastination Scale-Short Form (APS-SF).

AIM: The aim of this paper was the translation and adaptation to Spanish of the Academic Procrastination Scale-Short Form of McClosky / Yockey, and to determine its preliminary psychometric properties of validity and reliability in a sample of nursing students. METHOD: 178 nursing students, 143 female and 35 male, participated in the study. They answered an anonymous and self-administered questionnaire, which contained demographic data, the Academic Procrastination Scale-Short Form (APS-SF) and the Tuckman Procrastination Scale (TPS). RESULTS: A Cronbach's alpha coefficient of 0.87 and a two-week test-retest coefficient of 0.89 was obtained. The correlation between the 2administered scales was 0.70. The confirmatory factor analysis shows a suitable fit to the unifactorial model proposed for the original version of the scale. No significant floor or ceiling effects were observed in the APS-SF scores. DISCUSSION: The results of the study seem to confirm that the Spanish version of the Brief Scale of Academic Procrastination is a valid and reliable instrument, which, due to its characteristics, can be useful to quickly evaluate procrastinating behaviours related to the academic activities of Spanish-speaking students.

Spanish translation and psychometric evaluation of the Healthcare Professional Knowledge of Radiation Protection scale.

The objective of this work was to make an intercultural adaptation and provide a Spanish translation and psychometric evaluation of the original English version of the Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale. The Spanish translation was carried out following international guidelines for the process of cross-cultural adaptation of self-report measures. A cross-sectional design study was carried out. One hundred and thirty-eight nurses from four different hospitals in Barcelona (Spain) completed the Spanish version of the scale. The total score of the scale was calculated. The Pearson correlation coefficient (PCC) was used to evaluate a possible correlation between score and years of experience. A t-test for independent samples was used to evaluate significant differences between different groups. Cronbach's alpha, the corrected item-total correlation coefficient and the test-retest coefficient were used to determine internal consistency. The exploratory factor and parallel analysis were also calculated. All statistical tests were carried out with a level of significance α = 0.05. The mean scale score was poor among Spanish nurses. The PCC between total score and years of experience showed a non-significant correlation (p > 0.05). No differences were found between nurses who worked in radiation-exposed units and those who worked in units without radiation exposure (p > 0.05). A Cronbach α of 0.98 was obtained for the items of the scale. The corrected item-total correlation range was 0.5-0.8. The test-retest correlation coefficient was 0.9. The exploratory analysis factor showed a single factorial structure which explained 60.86% of the variance. The new scale translated into Spanish (Sp-HPKRP) could be used to evaluate the degree of knowledge about radiological protection.

Translation, cross-cultural adaptation, validation, and measurement properties of the Spanish version of the anterior cruciate ligament-return to sport after injury (ACL-RSI-Sp) scale.

PURPOSE: To translate into Spanish and validate the anterior cruciate ligament-return to sport after injury (ACL-RSI) scale, and to evaluate the psychological factors that have the greatest impact on the return to play among Spanish football players. METHODS: The ACL-RSI was first translated into Spanish by two teams of bilingual experts. At the time of discharge, 114 amateur and semi-professional football players who underwent ACL reconstruction answered a questionnaire regarding demographic and injury-related data, along with the translated ACL-RSI, the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Tampa Scale for Kinesiophobia (TSK-11SV) and the injury-psychological readiness to return to sport (I-PRRS). Statistical analysis included reliability tests (Cronbach's alpha and test-retest), construct validity and exploratory factor analysis. RESULTS: The ACL-RSI-Sp showed excellent internal consistency (Cronbach's α = 0.9), temporal stability (test-retest r = 0.9) and significant moderate correlations with the KOOS subscales of symptoms (r = 0.4; p < 0.01), pain (r = 0.4; p < 0.01), daily life (r = 0.4; p < 0.01), "sport" (r = 0.5; p < 0.01) and quality of life (r = 0.6; p < 0.01). Significant moderate and strong correlations were also observed for the ACL-RSI-Sp with the TSK (r = - 0.5; p < 0.01) and the I-PRRS (r = 0.8; p < 0.01), respectively. Confidence in performance (1) and fear and insecurity (2) explained 62.6% of the total variance in ACL-RSI-Sp. CONCLUSIONS: The ACL-RSI-Sp was a valid and reliable instrument to evaluate the relevant psychological factors in the return to sports of Spanish football players after ACL reconstruction. Players' confidence in performance and fear and insecurity were the most important factors influencing the return to play in this population. LEVEL OF EVIDENCE: Level IV.

[Adapting and validating a questionnaire to measure the self-care practices in healthy child population residing in Spain]. / Adaptación y validación de un cuestionario para evaluar las prácticas de autocuidado en población infantil sana residente en España.

OBJECTIVE: To adapt and validate the Child and Adolescent Self-Care Performance Questionnaire (CASPQ) to the context of healthy children aged 8 to 12years residing in Spain and evaluate their metric properties. DESIGN: Validation study based on Classical Test Theory. LOCATION: Four schools participating in the Salut i Escola programme of a Primary Care Centre of Barcelona (Spain). PARTICIPANTS: Four hundred and ninety-eight elementary school students participated in the study during the first six months of 2016. MAIN MEASUREMENTS: Cultural adaptation of the questionnaire was carried out. Response process and factorial structure were evaluated and the relationships of the adapted questionnaire scores with those of the KIDSCREEN-27 questionnaire were analysed. Likewise, internal consistency and reproducibility of the scores were evaluated. RESULTS: Four hundred and eighty-nine questionnaires were obtained. The confirmatory factor analysis of its theoretical structure showed a sufficient adjustment. A positive association was observed between the questionnaire scores and those of KIDSCREEN-27. The overall internal consistency was satisfactory; nevertheless, that of each factor was marginal or moderate. The reproducibility of the scores was optimal. CONCLUSIONS: The CASPQ adapted to the healthy child population of 8 to 12years old shows appropriate metric properties and similar to those of the original questionnaire. Therefore, it is a useful tool to assess self-care practices and plan interventions aimed at its promotion.

Relationship of academic procrastination with perceived competence, coping, self-esteem and self-efficacy in nursing students. / Relación de la procrastinación académica con la competencia percibida, el afrontamiento, la autoestima y la autoeficacia en estudiantes de enfermería.

OBJECTIVE: The aim of this study was to study the role that perceived competence, resilient coping, self-esteem and self-efficacy can have as protective factors of the academic procrastination of nursing students. METHOD: Participants were 237 nursing students, 202 women and 35 men. The participants answered a questionnaire that contained the Spanish forms of the following instruments: Tuckman Procrastination Scale (TPS), Perceived Personal Competence Scale (PPC), Brief Resilient Coping Scale (BRCS), Rosenberg Self-Esteem Scale (RSES) and General Self-Efficacy Scale (GSE). RESULTS: Significant and negative correlation coefficients (p<.01) were obtained between the procrastination scale and the rest of the measures used. The linear regression analysis identified Perceived Competence (PPC) as the only predictive variable of procrastinating behaviour, explaining 21.5% (R2aj) of the variance. DISCUSSION: The results of the study show the important protective role that the variables associated with 'positive' psychology have on procrastination. Of special relevance for the theory and practice of teaching is the result that indicates the predictive role of Perceived Competence on the academic procrastination of students.

Instruments to assess mental health-related stigma among health professionals and students in health sciences: A systematic psychometric review.

AIM: To evaluate the psychometric properties of the instruments to assess the mental health-related stigma among health professionals and students in health sciences. BACKGROUND: Evidence on the stigmatization by health professionals of people with mental health illness is increasingly compelling. Valid and reliable instruments are needed for the assessment of mental health-related stigma and effectiveness of anti-stigma interventions. DESIGN: Systematic psychometric review. DATA SOURCES: MEDLINE (via PubMed), CINAHL (via EBSCO), PsycINFO, Scopus, and Open Grey from their inception to August 2017. No limits were applied. REVIEW METHODS: We included studies on the development of a measurement instrument or on the evaluation of one or more of its measurement properties. The methodological quality of the included studies and quality of the measurement instruments identified were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. RESULTS: We included 25 studies involving 15 measurement instruments. The "Atributtion Questionnaire" (five studies) and the "Opening Minds Scale for Health Care providers (OMS-HC)" (four studies) were the most investigated instruments. Internal consistency, content validity, structural validity, and hypothesis testing were the measurement properties most commonly evaluated. Measurement error and responsiveness were investigated in only two studies. Eight psychometric properties of OMS-HC were evaluated, three of which have a positive strong level of evidence. CONCLUSIONS: A substantial number of instruments have been developed to assess mental health-related stigma among health professionals. There is a lack of any assessment of certain measurement properties. The OMS-HC is the instrument that had the strongest evidence.

Self-competence in death work. Spanish version of the Self-Competence in Death Work Scale. / Autocompetencia para el trabajo en final de vida. Versión española de la Self-Competence in Death Work Scale.

OBJECTIVE: The aim of this study was to translate into Spanish the Self Competence in Death Work Scale (SC-DWS) and to explore its psychometric properties of validity and reliability. METHOD: Participants were 106 nursing professionals, who worked in units related to care at the end of life. Participants answered a questionnaire containing the Spanish forms of the Self-Competence in Death Work Scale (SC-DWS), Perceived Life Significance Scale (PLSS), Death Anxiety Inventory-Revised (DAI-R), Hospital Anxiety and Depression Scale (HADS) and General Self Efficacy Scale (GSE). RESULTS: A Cronbach's alpha coefficient of .71 was obtained. The factorial analysis yielded five significant factors that accounted for 59.9% of the variance. The scores of the SC-DWS presented a positive and significant coefficient of correlation with Self-efficacy (GSE) and Meaning of life (PLSS) and negative with General anxiety and Depression (HADS) and Death anxiety (DAI-R). DISCUSSION: The Spanish form of the SC-DWS has acceptable psychometric properties. This instrument could be used for evaluating competences of the professionals that work in environments related to the end of life. Likewise, it could be used to assess the efficiency of interventions directed to the acquisition of skills and coping strategies for suffering and death.

Correction: An International Consensus Definition of the Wish to Hasten Death and Its Related Factors.

[This corrects the article DOI: 10.1371/journal.pone.0146184.].

Spanish Adaptation of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-S) in Nursing Undergraduates.

The Frommelt Attitude Toward Care of the Dying Scale (FATCOD) is designed to assess the attitudes of professionals and trainees toward caring for the dying patient and their family members. In this study the main aim is to adapt the FATCOD to a Spanish context (FATCOD-S). In addition, the relations between FATCOD-S, sociodemographic variables, emotional intelligence, and death attitudes have been analyzed. A sample of 669 Spanish nursing students from four Universities responded to a questionnaire. The exploratory factor analysis (EFA) concludes a structure composed of two significant factors. A confirmatory factor analysis (CFA) was carried out. The CFA supported a two-factor model. Students with past experience of death and those who had received training in palliative care scored significantly higher on both factors of the FATCOD-S ( p < 0.01). The FATCOD-S is an effective and valid tool for measuring the attitudes of Spanish nursing students toward caring for patients at the end of life.

Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer.

CONTEXT: Meaning in life (MiL) is a key factor for ensuring spiritual well-being and quality of life among patients with life-threatening illnesses. However, the role of MiL in relation to the wish to hasten death (WTHD) and its interaction with other physical and psychological factors in patients with advanced cancer has not yet been studied. OBJECTIVE: The objective of this study was to analyze the relationship between the WTHD and MiL and to propose a theoretical model of functional relationships among WTHD, performance status, depression, and MiL. METHODS: This is a cross-sectional study of 101 patients in a palliative care unit, who were assessed in the context of a clinical interview. Outcome measures included performance status, depression, MiL, and the WTHD. Structural equation modeling was used to analyze the functional relationships between these factors. RESULTS: The WTHD correlated significantly (P < 0.01) with MiL (r = 0.60), performance status (r = 0.548), and depression (r = 0.397). The structural equation modeling analysis showed that although there was no significant direct effect between performance status and the WTHD, there was a significant total effect because of the mediation of depression and MiL. The latter played the most significant role, accounting for 76.5% of the mediation. CONCLUSION: These results support the proposed model and provide evidence of a mediator effect of MiL and depression on the relationship between physical impairment and the WTHD in advanced patients. Our findings suggest that interventions to enhance MiL could help to address and/or prevent the emergence of a WTHD in this population.

Instruments to assess self-care among healthy children: A systematic review of measurement properties.

AIM: To identify, critically appraise and summarize the measurement properties of instruments to assess self-care in healthy children. BACKGROUND: Assessing self-care is a proper consideration for nursing practice and nursing research. No systematic review summarizes instruments of measurement validated in healthy children. DESIGN: Psychometric review in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Web of Science and Open Grey were searched from their inception to December 2016. REVIEW METHODS: Validation studies with a healthy child population were included. Search was not restricted by language. Two reviewers independently assessed the methodological quality of included studies using the COSMIN checklist. RESULTS: Eleven studies were included in the review assessing the measurement properties of ten instruments. There was a maximum of two studies per instrument. None of the studies evaluated the properties of test-retest reliability, measurement error, criterion validity and responsiveness. Internal consistency and structural validity were rated as "excellent" or "good" in four studies. Four studies were rated as "excellent" in content validity. Cross-cultural validity was rated as "poor" in the two studies (three instruments) which cultural adaptation was carried out. CONCLUSION: The evidence available does not allow firm conclusions about the instruments identified in terms of reliability and validity. Future research should focus on generate evidence about a wider range of measurement properties of these instruments using a rigorous methodology, as well as instrument testing on different countries and child population.

Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments.

BACKGROUND: Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it. AIM: To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties. DESIGN: Systematic review based on PRISMA guidelines. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of validation studies and the measurement properties of the instrument described. DATA SOURCES: The CINAHL, PsycINFO, Pubmed and Web of Science databases were searched from inception to November 2015. RESULTS: A total of 50 articles involving assessment of the wish to hasten death were included. Eight concerned instrument validation and were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments criteria. They reported data for between two and seven measurement properties, with ratings between fair and excellent. Of the seven instruments identified, the Desire for Death Rating Scale or the Schedule of Attitudes toward Hastened Death feature in 48 of the 50 articles. The Schedule of Attitudes toward Hastened Death is the most widely used and is the instrument whose psychometric properties have been most often analysed. Versions of the Schedule of Attitudes toward Hastened Death are available in five languages other than the original English. CONCLUSION: This systematic review has analysed existing instruments for assessing the wish to hasten death. It has also explored the methodological quality of studies that have examined the measurement properties of these instruments and offers ratings of the reported properties. These results will be useful to clinicians and researchers with an interest in a phenomenon of considerable relevance to advanced patients.

Development of a short form of the Spanish schedule of attitudes toward hastened death in a palliative care population.

PURPOSE: The schedule of attitudes toward hastened death (SAHD) is widely used to assess the wish to hasten death (WTHD) among patients with life-threatening conditions. A short form of the SAHD would increase its clinical applicability in this population. METHOD: Rasch analysis of data from 101 Spanish palliative inpatients. Item reduction involved selecting items with a high discrimination index (point-biserials ≥0.70), removing items with inadequate fit statistics, and assessing unidimensionality and local dependency. We examined the test probability function to establish an empirical risk score for suffering a WTHD and tested convergence between the original and the reduced set of items. RESULTS: A set of five items met all quality criteria. In this sample, 20.8 % of participants had a higher risk of a WTHD (p > 50 %) at a score of 3. Correlation analysis confirmed convergent validity between the original and reduced forms. Concurrent validity was confirmed by the similar correlations shown by both versions of the SAHD (5 and 20 items) with other measures. CONCLUSION: This 5-item Spanish form of the SAHD could be a suitable alternative to the full instrument. The cut-off score derived from the Rasch analysis may be able to detect patients at risk of a WTHD.