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Global Distress (Well-being) Factor

It has become apparent over the last two decades that virtually all patient self-report outcome measures commonly used in psychotherapy research are, to a large extent, measuring a common factor, usually referred to as global distress. While many outcome questionnaires have subscales that reflect different domains of psychiatric symptoms, interpersonal problems, productivity, quality of life, well-being, etc., factor analyses have revealed that these subscales tend to correlate strongly with one another and a single global factor.

As we would expect if there was a common factor, the most popular outcome measures are highly correlated with one another. For example, Christopher et al (1988) found that the SLC-90 subscales all load on a common factor, and likewise correlate with similar scales from other measures. Doefler et al (2002) found that the OQ-45 and the BASIS-32 are highly correlated with one another. Miller et al (2003) likewise found that the Outcome Rating Scale correlates with the OQ-45.

Enns et al (1998) performed factor analyses on the Beck Depression Inventory and the Beck Anxiety Inventory. To quote from the abstract...

"However, the parameter estimate was very high (0.784) and a unidimensional, single-factor model of negative affectivity approached the criteria for good fit. It was concluded that the Beck Anxiety and Depression Inventories assess distinct anxiety and depression phenomena to a limited extent when used in a clinically depressed sample."

The ACORN collaboration has made possible acquisition of very large clinical samples for each item, with multiple assessments through treatment. Factor analysis of these samples confirms that items reflecting a broad range of symptoms and problems, including those of eating disorders, PTSD, depression, anxiety, attention problems, quality of relationships, day to day functioning and workplace productivity all correlate highly with the global factor.

More recently, as part of ongoing ACORN collaborations, the Center for Clinical Informatics has been testing items for questionnaires designed to measure well-being and quality of life. These item also correlate highly with the common factor referred to as global distress. In fact, the factor could equally be referred to as global well-being or quality of life. For more information on this analysis, see: Quality of Life & Well-being Questionnaires.

The existence of a global distress/well-being factor and the fact that multiple outcome questionnaires, including widely used measures of depression, are all found to be correlated with one another other, provide strong evidence of the construct validity patient self-report outcome measures designed to measure assess global subjective distress/well-being.

The global distress/well-being factor also correlates strongly with measures of "presenteeism" and lost productivity. See Absenteeism & Presenteeism

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