Avaliação de resultado em psicoterapia com adultos : evidências de validade da escala outcome questionnaire short form (oq-10.2) para o Brasil

Abstract

Introduction: The Outcome Questionnaire Short Form (OQ-10.2) is an American self-report scale that assesses the overall psychological functioning of the patient, including both positive and negative aspects, without the expectation that the score will reveal a psychiatric diagnosis. This instrument is an abridged version of an easy and quick application of the Outcome Questionnaire (OQ-45), which was designed and used for outcome evaluation in psychotherapy. OQ-10.2 has good psychometric properties in studies conducted in its home country and consists of two subscales - psychological well-being and psychological distress (Lambert et al., 1997). Objective: The objective of this study is to translate, adapt and investigate evidence of validity for Brazilian Portuguese OQ-10.2. Method: The study describes the procedures adopted in the translation, cross-cultural adaptation and investigation of the validity evidences of OQ-10.2, addressing how the dimensions of the instrument correlate with each other and with the other scales collected. The procedures for translation and adaptation followed the standardized process recommended by the editorial team of OQ Measures (Wild et al., 2005), consisting of the following steps: two independent translations from the original instrument into Portuguese; the synthesis of the two translations by a third translator; the evaluation of the clarity, relevance and representativeness of the items by a committee of experts, followed by a semantic adjustment; the reverse translation to the original language by a fourth translator that was sent for approval by the original authors; a pilot study with the target population; and finally, the formal study with the instrument in Portuguese. A total of 235 adults, 45 males (19.1%) and 189 females (80.4%), aged 18-63 years (M = 28.82, males and females) were included in the study to validate and analyze the psychometric properties of OQ-10.2. SD = 9.25). Of these subjects 71.1% were single, 14.0% married and 11.1% were in a stable union and 3.8% were separated or divorced. The predominant level of education was Incomplete Higher Education, with 40.0%; followed by Higher Education with 22.1%; Post Graduation Complete with 19.6%; Postgraduate Incomplete with 11.1%; High School with 6.0%; and, finally, Incomplete High School with 1.3%. The Sociodemographic Data Questionnaire, the OQ-10.2, the Depression Anxiety and Stress Scale Short Form (DASS-21), the Rosenberg Self-Esteem Scale (RSS) and the Life Satisfaction Scale (SWLS) were applied. The participants were selected because they sought the care service of an educational institution in psychoanalytic psychotherapy; and for convenience and snowball in an online collection through the Qualtrics website. In compliance with the Directives and Norms Regulating the research with human beings provided for in Resolutions n ° 466/2012 and n ° 510/2016 of the National Health Council (2012, 2016) and Resolution n ° 016/2000 of the Federal Council of Psychology (2000 ), this study protected the ethical care that ensures anonymity in the treatment of the data and in the dissemination of the findings of this research and the inexistence of any type of damage to the participants. This research was approved by the Ethics Committee of the Pontifical Catholic University of Rio Grande do Sul (PUCRS) under the number CAAE: 82075318.6.0000.5336. In order to investigate evidence of validity of the instrument's internal structure, factorial and parallel analyzes were conducted using the R software package (Revelle, 2018). An exploratory factorial analysis with oblique rotation promax) was performed (Kaiser, 1958). To calculate the general index of psychological distress, a Principal Component Analysis (PCA) was used, forcing the extraction of a component. The software R was also used to calculate the Cronbach alphas of the general scale and the two subscales. The network analysis (Epskamp & Fried, 2018) was used to investigate the relationship pattern between OQ-10.2 items. Complementing the network analysis, a community analysis was conducted (Robinaug, Millner & McNally, 2016). Evidence of validity with respect to external variables was also investigated and bivariate correlation and partial correlation were estimated through network analysis. Spearman correlation analyzes of the OQ-10.2 were also performed with self-esteem scales; satisfaction with life; and symptoms of stress, anxiety and depression. Results: Parallel analysis, performed with R software, suggested the presence of two factors on the OQ-10.2 scale - psychological well-being and psychological distress. The correlation between the two factors was r = -0.65. Only one item (9) presented a cross load in the factorial analysis, and its permanence in the subscale of psychological distress found subsidies in the network and community analysis. In order to estimate an index of psychological distress, a main component was calculated. The instrument showed good internal consistency with Cronbach's alpha of 0.88 for the full scale; 0.87 for the subscale of psychological well-being; and 0.77 for the subscale of psychological distress. The network analysis used to investigate the structure and dynamics of the OQ-10.2 items confirmed the presence of two factors and showed directions of associations between the appropriate items considering the subscales to which they belong. The item that presented the most centrality (closeness) (Robinaug et al., 2016) was item 8 ("I feel sad") and items with the largest expected influence were items 3 ("I am satisfied with my relationship with other people ") and 2 (" I am satisfied with my life "). To investigate evidence of validity with respect to external variables, correlation analyzes were performed with the instruments mentioned above. Negative associations with variables of self-esteem (RSS) and satisfaction with life (SWLS) and positive associations with psychopathological variables (DASS-21) were observed and were expected. All correlations were significant (<0.01) and confirmed initial hypotheses. The network analysis was also used to investigate the relationship between OQ-10.2 and the instruments mentioned above. Discussion: Considering the presence of two factors, we questioned the use of the scale as a one-dimensional measure, since well-being and psychological distress are two different constructs. With the intention of forming a useful measure to evaluate the progress and the clinical outcome, an index of psychological distress was proposed, taking into account the dimensions of well-being and distress. Considering the purpose of the instrument, the other analyzes were performed based on the index of psychological distress, considered as a single measure. The OQ-10.2 presented adequate reliability indexes. Relations between items and variables that stand out in the instrument, such as feelings of loneliness, sadness and interpersonal relationships are discussed. The correlation with external variables also corroborates evidence of OQ-10.2 validity as a measure of psychological distress. Conclusion: Evidences of validity of the OQ-10.2, regarding its internal structure and with respect to external variables, were found for Brazilian Portuguese. However, it is suggested that studies be carried out investigating its use for the evaluation of psychotherapeutic treatment and seeking new evidence of validity for this scale that may be widely used by clinic and research in medicine and psychology.