Psychosocial Adjustment to Illness Scale
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  2. Psychosocial Adjustment to Illness Scale

Psychosocial Adjustment to Illness Scale

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Purpose

A 46-item instrument designed to assess the psychological and social adjustment of patients and/or the patient’s immediate family to the patient’s medical illness.

Link to Instrument

Psychosocial Adjustment to Illness Scale

Acronym PAIS

Area of Assessment

Activities & Participation
Bodily Functions

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Not free--cost unknown. The PAIS and PAIS-SR are exclusively distributed by Clinical Psychometric Research, Inc.

CDE Status

Not a CDE as of 5/2/2023.

Populations

Cancer
Chronic Pain
Spinal Cord Injuries
Cardiovascular Disease
Renal Disease

Key Descriptions

  • The PAIS is designed as a semi-structured clinical interview, and it is also available in a self-report modality (PAIS-SR).
  • The PAIS has 46 items rated on a 4-point Likert scale from 0-3, where higher responses indicate a poorer adjustment status.
  • The PAIS evaluates seven domains of psychosocial adjustment: Health Care Orientation, Vocational Environment, Domestic Environment, Sexual Relationships, Extended Family Relationships, Social Environment, and Psychological Distress.
  • The PAIS may also be used to measure the spouses’, parents’, and relatives’ adjustment to the patient's illness and their perceptions of the patients’ adjustment to their illness.

Number of Items

46

Time to Administer

20-30 minutes

Required Training

No Training

Required Training Description

The PAIS should be conducted by a trained healthcare professional and interviewer. No training required for the PAIS-SR.

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 - 99

years

Instrument Reviewers

Eliza Tilson, BS

Terri Alexander, BS

Megan Baumunk, BS

Wing Ng, BS

ICF Domain

Activity
Participation

Measurement Domain

General Health

Considerations

  • Self-report versions of the PAIS (PAIS-SR) exist.
  • The PAIS has been translated in various languages, including English, Italian, Portuguese, Hebrew, Danish, Norwegian, French, Japanese, Chinese, Korean, Icelandic, Hungarian, Spanish, Swedish, & Taiwanese.

Cancer

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Interrater/Intrarater Reliability

Hodgkin’s disease patients (and parents of children with Hodgkin’s Disease): (Morrow et al., 1978; n = 75; 49% Hodgkin’s Disease patients, 51% parents of children who have been treated for Hodgkin’s Disease or solid tumors)

  • Excellent interrater reliability on the total scale (ICC = .83)
  • Excellent interrater reliability on the Psychological Distress subscale (ICC = .82)
  • Excellent interrater reliability on the Sexual Relationships subscale (ICC = .81) 

Breast Cancer patients (Derogatis, 1986; n = 17)

  • Excellent interrater reliability for Total Score (ICC = .86)
    • Adequate interrater reliability on the Health Care Orientation subscale (ICC = .74)
    • Adequate interrater reliability on the Vocational Environment subscale (ICC = .68)
    • Adequate interrater reliability on the Domestic Environment subscale (ICC = .61)
    • Excellent interrater reliability on the Sexual Relationships subscale (ICC = .86)
    • Adequate interrater reliability on the Extended Family Relationships subscale (ICC = .56)
    • Excellent interrater reliability on the Social Environment subscale (ICC = .82)
    • Excellent interrater reliability on the Psychological Distress subscale (ICC = .84)

Hodgkin's disease patients (Derogatis, 1986; n = 37)

  • Excellent interrater reliability for Total Score (ICC = .83)
    • Adequate interrater reliability on the Health Care Orientation subscale (ICC = .70)
    • Adequate interrater reliability on the Vocational Environment subscale (ICC = .62)
    • Adequate interrater reliability on the Domestic Environment subscale (ICC = .52)
    • Excellent interrater reliability on the Sexual Relationships subscale (ICC = .81)
    • Poor interrater reliability on the Extended Family Relationships subscale (ICC = .33)
    • Excellent interrater reliability on the Social Environment subscale (ICC = .72)
    • Excellent interrater reliability on the Psychological Distress subscale (ICC = .82)

Internal Consistency

Lung cancer patients (Derogatis, 1986; n = 89)

  • Excellent internal consistency on the Health Care Orientation subscale (Cronbach’s alpha = .83)
  • Excellent internal consistency on the Vocational Environment subscale (Cronbach’s alpha = .87)
  • Poor internal consistency on the Domestic Environment subscale (Cronbach’s alpha = .68)
  • Excellent internal consistency on the Sexual Relationships subscale (Cronbach’s alpha = .93)
  • Poor internal consistency on the Extended Family Relationships subscale (Cronbach’s alpha = .12)
  • Excellent internal consistency on the Social Environment subscale (Cronbach’s alpha = .93)
  • Excellent internal consistency on the Psychological Distress subscale (Cronbach’s alpha = .81)

Breast cancer patients (Kolokotroni et al., 2017; n = 243 women; utilized Greek version of PAIS-SR)

  • Poor internal consistency on the Health Care Orientation subscale (Cronbach’s alpha = .58)
  • Excellent internal consistency on the Vocational Environment subscale (Cronbach’s alpha = .80)
  • Adequate internal consistency on the Domestic Environment subscale (Cronbach’s alpha = .75)
  • Excellent internal consistency on the Sexual Relationships subscale (Cronbach’s alpha = .88)
  • Excellent internal consistency on the Extended Family Relationships subscale (Cronbach’s alpha = .83)
  • Excellent internal consistency on the Social Environment subscale (Cronbach’s alpha = .92)
  • Excellent internal consistency on the Psychological Distress subscale (Cronbach’s alpha = .83)
  • Excellent internal consistency on the total score for the PAIS-SR (Cronbach’s alpha = .92)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Hodgkin’s disease patients (and parents of children with Hodgkin’s disease): (Morrow et al., 1978; n = 75; 49% Hodgkin’s Disease patients, 51% parents of children who have been treated for Hodgkin’s Disease)

  • Poor correlation between scores on the Health Care Orientation subscale and level of satisfaction with health care (r = 0.27)
  • Adequate correlation between scores on the Health Care Orientation subscale and expectations regarding the quality of care (r = 0.47)

Construct Validity

Convergent Validity

Breast Cancer patients (Derogatis, 1986; n = 17)

Pearson correlations between the PAIS, the Global Adjustment to Illness scale (GAIS), and the Symptom Checklist 90 Scale (SCL-90):

PAIS Subscale

Correlation with GAIS

Correlation with SCL-90

Health Care Orientation

Excellent (0.80)

Adequate (0.34)

Vocational Environment

Adequate (0.54)

Adequate (0.39)

Domestic Environment

Excellent (0.76)

Adequate (0.45)

Sexual Relationships

Adequate (0.46)

Poor (0.13)

Extended Family Relationships

Adequate (0.40)

Adequate (0.57)

Social Environment

Adequate (0.54)

Poor (0.30)

Psychological Distress

Excellent (0.70)

Excellent (0.83)

Total Instrument

Excellent (0.81)

Excellent (0.60)

Breast Cancer patients (Derogatis, 1986; n = 17)

Pearson correlations between the PAIS, the Affect Balance Scale (ABS), which measures mood and affect, and the Patient’s Attitudes, Information, and Expectancies (PAIE) scale, which measures patients’ attitudes toward their illness:

PAIS Subscale

Correlation with ABS Scale

Correlation with PAIE Scale

Health Care Orientation

Adequate (0.31)

Excellent (0.88)

Vocational Environment

Adequate (0.46)

Poor (0.28)

Domestic Environment

Excellent (0.67)

Adequate (0.52)

Sexual Relationships

Adequate (0.42)

Adequate (0.40)

Extended Family Relationships

Adequate (0.57)

Poor (0.06)

Social Environment

Adequate (0.31)

Poor (0.14)

Psychological Distress

Excellent (0.77)

Adequate (0.42)

Total Instrument

Excellent (0.69)

Excellent (0.64)

 

Breast cancer patients (Kolokotroni et al., 2017; n = 243 women; utilized Greek version of PAIS-SR)

  • Partial* Pearson correlations between the PAIS, the PTSD Checklist-Civilian Version (PCL-C), the SF-36 Physical Health Total Score (SF-36 PHT), and SF-36 Mental Health Total Score (SF-36 MHT):

PAIS-SR Subscale

PCL-C

SF-36 PHT

SF-36 MHT

 

Health Care Orientation

 

-0.268**

-0.216**

 

Vocational Environment

0.460**

-0.524**

-0.472**

 

Domestic Environment

0.337**

-0.342**

-0.420**

 

Sexual Relationships

0.272**

-0.237**

-0.268**

 

Extended Family Relationships

0.288**

-0.311**

-0.387**

 

Social Environment

0.348**

-0.529**

-0.522**

 

Psychological Distress

0.695**

-0.564**

-0.704**

 

Total Instrument

0.596**

-0.631**

-0.690**

 

*Age, time since completion of therapy, and disease stage were controlled in the partial correlations.

**p < .001.

Cardiovascular Disease

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Normative Data

Coronary Heart Disease (Karatas & Bostanoglu, 2017; n = 250; mean age (SD) = 54.84 (11.3); 52% male)

Mean (SD) scores on the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR) by subscale and for total instrument

PAIS Subscale

Mean (SD)

Health Orientation

11.41 (5.03)

Vocational Environment

10.53 (4.77)

Domestic Environment

9.68 (5.92)

Sexual Relationships

8.39 (5.31)*

Extended Family Relationships

6.06 (4.18)

Social Environmental

13.36 (5.27)

Psychological Distress

12.58 (7.29)

Total Instrument

67.39 (29.29)

*Note: 113 of the 250 total participants completed the Sexual Relationships subscale.

Construct Validity

Convergent validity:

Coronary Heart Disease (Karatas & Bostanoglu, 2017; n = 250; mean age (SD) = 54.84 (11.3); 52% male)

Pearson correlations between the PAIS-SR and the Multidimensional Scale of Perceived Social Support (MSPSS), which measures perceived support from friends, family, and significant others, by PAIS-SR subscale and for total instrument:

PAIS-SR Subscale

MSPSS Perceived Social Support-Friends

MSPSS Perceived Social Support-Family

MSPSS Total

Health Care Orientation

Poor (-.238)

Adequate (-.574)

Adequate (-.469)

Vocational Environment

Adequate (-.335)

Adequate (-.576)

Adequate (-.526)

Domestic Environment

Adequate (-.429)

Excellent (-.683)

Excellent (-.641)

Sexual Relationships

Excellent (-.659)

Adequate (-.396)

Excellent (-.656)

Extended Family Relationships

Adequate (-.346)

Excellent (-.620)

Adequate (-.558)

Social Environment

Poor (-.172)

Adequate (-.421)

Adequate (-.343)

Psychological Distress

Poor (-.197)

Adequate (-.398)

Adequate (-.343)

Total Instrument

Adequate (-.350)

Adequate (-.558)

Adequate (-.523)

Spinal Cord Injuries

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Normative Data

Traumatic Spinal Cord Injury: (Judd et al., 1991; n = 52; mean age = 31.8 (14.2); age range = 17 to 72; 15% female; 60% paraplegic, 40% quadriplegic)

Mean (SD) scores on the Psychosocial Adjustment to Illness Scale - Self Report (PAIS-SR) by subscale and for total instrument

PAIS-SR Subscale

Mean Score (SD)

Health Orientation

    7.00 (2.88)

Vocational Environment

    8.14 (3.99)

Domestic Environment

    7.40 (2.90)

Sexual Relationships

    5.69 (4.43)

Extended Family Relationships

    1.75 (2.09)

Social Environmental

    5.90 (4.38)

Psychological Distress

    4.49 (3.38)

Total Instrument

  39.59 (13.53)

Renal Disease

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Normative Data

Hemodialysis Patients: (De-Nour, 1981; 102 chronic hemodialysis patients; 59 (58%) male)

Mean scores for each subscale and for total instrument on (the Psychosocial Adjustment to Illness Scale (PAIS):

PAIS Subscale

Mean Score

Health Orientation

       8.8

Vocational Environment

       9.0

Domestic Environment

       7.7

Sexual Relationships

       7.5

Extended Family Relationships

       2.2

Social Environmental

       7.9

Psychological Distress

       6.4

Total Instrument

     49.5

Internal Consistency

Renal dialysis (Derogatis, 1986; n = 269; mean (SD) age = 48.9 (14.6); 57% male; 64% White, 31% Black, 5% race not otherwise specified)

  • Poor internal consistency on the Health Orientation subscale (Cronbach’s alpha = .63)
  • Excellent internal consistency on the Vocational Environment subscale (Cronbach’s alpha = .81)
  • Excellent internal consistency on the Domestic Environment subscale (Cronbach’s alpha = .87)
  • Excellent internal consistency on the Sexual Relationships subscale (Cronbach’s alpha = .80)
  • Poor internal consistency on the Extended Family Relationships subscale (Cronbach’s alpha = .66)
  • Adequate internal consistency on the Social Environment subscale (Cronbach’s alpha = .78)
  • Excellent internal consistency on the Psychological Distress subscale (Cronbach’s alpha = .80)

Construct Validity

Convergent Validity:

Hemodialysis Patients: (De-Nour, 1981; 102 chronic hemodialysis patients; 59 (58%) male)

  • Significant correlations between scores on PAIS and scores of anxiety, depression, and hostility on the Multiple Affect Adjective Checklist (MAACL):

 

PAIS

Anxiety

Depression

Hostility

Mean Score

50.1

7.22

11.64

7.31

SD

20.95

3.07

5.87

3.85

 

r =

0.270*

0.370**

0.226*

*Significant at 0.05 level

**Significant at 0.01 level

 

Bibliography

De-Nour, A. K. (1982). Psychosocial adjustment to illness scale (PAIS): A study of chronic hemodialysis patients. Journal of Psychosomatic Research, 26(1), 11-22.

Derogatis, L. R. (1986). The psychosocial adjustment to illness scale (PAIS). Journal of Psychosomatic Research, 30(1), 77-91.

Judd, F. K., Webber, J. E., Brown, D. J., Norman, T. R., & Burrows, G. D. (1991). Psychological adjustment following traumatic spinal cord injury: A study using the Psychosocial Adjustment to Illness Scale. International Medical Society of Paraplegia, 29, 173-179.

Karataş, T., & Bostanoğlu, H. (2017). Perceived social support and psychosocial adjustment in patients with coronary heart disease. International Journal of Nursing Practice, 23(4), e12558. https://doi.org/10.1111/ijn.12558.

Kolokotroni, P., Anagnostopoulos, F., & Missitzis, I. (2017). Psychological Adjustment to Illness Scale: Factor structure, reliability, and validity assessment in a sample of Greek breast cancer patients. Women & Health, 57(6), 705-722. http://doi.org/10.1080/03630242.2016.1186780.

Morrow, G. R., Chiarello, R. J., & Derogatis, L. R. (1978). A new scale for assessing patients' psychosocial adjustment to medical illness. Psychological Medicine, 8, 605-610.

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