Investigating the appropriateness of the Pittsburgh Sleep

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Investigating the appropriateness of the
Pittsburgh Sleep Quality Index (PSQI) in a
non-clinical Cypriot sample
Dr. Panayiotis Panayides
The PSQI is a self-rated instrument used to measure sleep quality in clinical samples.
Its development was based on:
• psychiatrists’ clinical intuition
• experience with sleep disorder patients
• a review of other sleep quality questionnaires found in the literature and
• clinical experience with the instrument during 18 months of field work.
(Buysse, Reynolds, MonK, Berman & Kupfer, 1989).
In order to:
• to provide a reliable, valid, and standardized measure of sleep quality
• to discriminate between “good” and “poor” sleepers
• to provide an index that is easy for subjects to use and for clinicians and
researchers to interpret and
• to provide a brief, clinically useful assessment of a variety of sleep disturbances
that might affect sleep quality.
(Buysse, Reynolds, MonK, Berman & Kupfer, 1989, p.194)
The PSQI Structure
- It consists of 19 self rated questions
- Grouped into 7 components
subjective sleep quality,
sleep latency,
sleep duration,
habitual sleep efficiency,
sleep disturbances,
use of sleeping medications and
daytime dysfunction.
- Each component is scored separately, weighted equally on a 0 – 3 scale.
- The scores of the 7 components are then added to give a global PSQI score, which
has a range of 0 – 21 with higher scores indicating worse sleep quality.
- Three of the components are measured by one question, two components by 2
questions, one component by 3 and one by 9.
The PSQI Items
1. During the past month, what time have you usually gone to bed at night?
BED TIME ___________
2. During the past month, how long (in minutes) has it usually taken you to fall
asleep each night?
NUMBER OF MINUTES ___________
3. During the past month, what time have you usually gotten up in the morning?
GETTING UP TIME ___________
4. During the past month, how many hours of actual sleep did you get at night?
(This may be different than the number of hours you spent in bed.)
HOURS OF SLEEP PER NIGHT ___________
For each of the remaining questions, check the one best response. Please
answer all questions.
5. During the past month, how often have you had trouble sleeping because you .
a) Cannot get to sleep within 30 minutes
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
b) Wake up in the middle of the night or early morning
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
c) Have to get up to use the bathroom
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
d) Cannot breathe comfortably
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
e) Cough or snore loudly
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
f) Feel too cold
Not during the
past month_____
Less than
Once or twice
once a week_____ a week_____
Three or more
times a week_____
g) Feel too hot
Not during the
past month_____
Less than
Once or twice
once a week_____ a week_____
Three or more
times a week_____
h) Had bad dreams
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
i) Have pain
Not during the
past month_____
Three or more
times a week_____
Less than
Once or twice
once a week_____ a week_____
j) Other reason(s), please
describe__________________________________________
How often during the past month have you had trouble sleeping because of
this?
Not during the
Less than
Once or twice
Three or more
past month_____ once a week_____ a week_____
times a week_____
6. During the past month, how would you rate your sleep quality overall?
Very good _____ Fairly good ______ Fairly bad ______Very bad ______
7. During the past month, how often have you taken medicine to help you sleep
(prescribed or "over the counter")?
Not during the
Less than
Once or twice
Three or more
past month_____ once a week_____ a week_____
times a week_____
8. During the past month, how often have you had trouble staying awake while
driving, eating meals, or engaging in social activity?
Not during the
Less than
Once or twice
Three or more
past month_____ once a week_____ a week_____
times a week_____
9. During the past month, how much of a problem has it been for you to keep up
enough enthusiasm to get things done?
No problem at all _____Only a very slight problem _____ Somewhat of a problem
_____
A very big problem __________
The seven components
Component 1: Subjective sleep quality = Score Q6
Q6. During the past month, how would you rate your sleep quality overall?
Very good _____ Fairly good ______ Fairly bad ______Very bad ______
Component 2: Sleep latency = Score Q2 + Score Q5a
Q2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night?
NUMBER OF MINUTES ___________
1
<=15,
2
16 – 30,
3
31 – 60,
4
>60
Q5. During the past month, how often have you had trouble sleeping because you . . .
a) Cannot get to sleep within 30 minutes
0
1
2
3
If sum = 0
If sum = 1 – 2
If sum = 3 – 4
If sum = 5 – 6
Component 3: Sleep duration = Score Q4
Q4. During the past month, how many hours of actual sleep did you get at night?
(This may be different than the number of hours you spent in bed.)
HOURS OF SLEEP PER NIGHT ___________
0
> 7,
1
6 – 7,
2
5 – 6,
3
<5
ScoreQ4
 .......%
Component 4: Habitual Sleep Efficiency =
ScoreQ3  ScoreQ1
0
If >= 85%,
1
75 – 84%
2
65 – 74%
3
< 65%
Component 5: Sleep Disturbances = Sum of score Q5b, …, Q5j (9 items)
0
1
2
3
If sum = 0
If sum = 1 – 9
If sum = 10 – 18
If sum = 19 – 27
b) Wake up in the middle of the night or early morning
Not during the
Less than
Once or twice
past month_____ once a week_____ a week_____
Three or more
times a week_____
c) Have to get up to use the bathroom
d) Cannot breathe comfortably
e) Cough or snore loudly
f) Feel too cold
g) Feel too hot
h) Had bad dreams
i) Have pain
j) Other reason(s), please describe__________________________________________
How often during the past month have you had trouble sleeping because of this?
Component 6: Use of Sleep Medication = Score Q7
Q7. During the past month, how often have you taken medicine to help you sleep
(prescribed or "over the counter")?
Component 7: Daytime Dysfunction = Score Q8 + Score Q9
Q8. During the past month, how often have you had trouble staying awake while driving,
eating meals, or engaging in social activity?
Q9. During the past month, how much of a problem has it been for you to keep up enough
enthusiasm to get things done?
0
1
2
3
If sum = 0
If sum = 1 – 2
If sum = 3 – 4
If sum = 5 – 6
The original study
Reliability evidence:
- Cronbach’s alpha (0.83) for the whole 19-item questionnaire and for the 7 component scores
- Test-retest correlation of 0.85 for the global scores and for the component scores
- No differences in the global scores and on the component scores from the two different applications
(stable responses across time).
Validity evidence
- Detection of differences between the 3 distinct groups
o the ‘good sleepers’ (52 healthy control subjects with no complaints about sleep),
o The ‘poor sleepers’ (34 patients with major depressive disorder) and
o another ‘poor sleepers’ group (62 patients with disorder of initiating and maintaining sleep or
disorder of excessive somnolence).
- Concurrent polysomnographic findings and
- Correlations between global score and component scores. Subjective sleep quality 0.76 and sleep
disturbances 0.35 (the 9-item component).
Another difference (between the PSQI and other instruments) is that these other questionnaires
have used factor analysis to generate specific factors, while the PSQI components are empirical
and clinical in origin rather than statistical
(Buysse, Reynolds, MonK, Berman & Kupfer, 1989, p.203)
Other validation studies with samples of
• elderly people (Buysse, Reynolds, Monk, Berman & Kupfer, 1991)
• patients with AIDS (Rubinstein & Selwyn, 1998)
• patients with panic disorders (Stein, Chartier, & Walker, 1993)
• cancer patients (Beck et al., 2004)
• patients with primary insomnia
(Backhaus, Junghanns, Broocks, Riemann & Hohagen, 2002)
• bone marrow transplant patients and women with breast cancer
(Carpenter & AndryKowski, 1998)
• Nigerian students (Aloba, Adewuya, Ola & Mapayi 2007).
Only in one study Chien, Hsu, Tai, Guo and Su (2008) have used Rasch analyses
to validate a revised version of the PSQI (9 items instead of the original 18).
The sample
Stratified sampling (By area of residence urban or rural, age and gender)
Age
Gender
18 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 +
Male
42
56
57
48
39
39
281 (47%)
Female
45
59
67
60
39
49
319 (53%)
Total
87
115
124
108
78
88
600
Total
415 (69.2%) lived in urban areas and 185 (30.8%) in rural areas
+ 15 depression patients (for validation purposes)
Rasch Rating Scale Diagnostics
1. Category frequencies
Regular distributions (Uniform, Normal, Bimodal, slightly skewed) are preferable
Low Frequencies do not provide enough observations for estimation of stable
thresholds. Recommended min frequency 10 (Linacre 1999)
2. Average measures (a.m) Average of the ability estimates for all persons who
choose that particular response category on any item in the scale.
(Useful for quick observation of initial problems with the rating scale)
They should increase monotonically, indicating that on average, those with higher
ability / stronger attitude endorse the higher categories
3. Threshold or step calibrations
Thresholds should also increase monotonically across the rating scale, otherwise they are
considered disordered.
Distances between threshold estimates should indicate that each step defines a distinct
position on the variable. (i.e. should be neither too close together nor too far apart)
Between 1.4 – 5 logits to avoid large gaps in the variable. (Linacre, 1999; Bond & Fox, 2001, p. 224)
4. Fit Statistics
Outfit > 2 indicate more misinformation than information (Linacre, 1999), meaning that the
category is introducing noise into the measurement process. Those categories warrant further
empirical investigation and might be good candidates for collapsing with adjacent categories.
ANALYSES 1 – Component 5 (Sleep Disturbances, 9 items)
component STATISTICS: MISFIT ORDER
----------------------------------------------------------------------------------------|ENTRY
RAW
MODEL|
INFIT | OUTFIT |PTMEA|EXACT MATCH|
|
|NUMBER SCORE COUNT MEASURE S.E. |MNSQ ZSTD|MNSQ ZSTD|CORR.| OBS% EXP%| component|
|------------------------------------+----------+----------+-----+-----------+----------|
|
9
265
526
.29
.05|1.27
3.3|1.15
1.2|A .36| 52.7 56.3| item 5j |
|
4
411
526
-.06
.05|1.15
2.4|1.27
2.6|B .42| 39.9 44.6| item 5e |
|
5
254
526
.32
.05|1.18
2.2|1.18
1.3|C .34| 58.2 60.6| item 5f |
|
6
196
526
.51
.06|1.13
1.3|1.10
.7|D .32| 67.5 67.6| item 5g |
|
7
291
526
.22
.05| .88 -1.7|1.10
.9|E .37| 53.2 55.6| item 5h |
|
3
220
526
.42
.06|1.06
.7| .86 -1.0|d .39| 68.1 66.5| item 5d |
|
2
785
526
-.74
.04| .91 -1.9| .88 -1.8|c .63| 28.9 27.8| item 5c |
|
8
464
526
-.17
.04| .90 -1.8| .82 -2.1|b .54| 41.3 40.2| item 5i |
|
1
816
526
-.79
.04| .77 -5.2| .70 -4.9|a .70| 36.3 29.8| item 5b |
|------------------------------------+----------+----------+-----+-----------+----------|
| MEAN
411.3 526.0
.00
.05|1.03
-.1|1.01
-.4|
| 49.6 49.9|
|
| S.D.
223.6
.0
.45
.01| .16
2.6| .18
2.2|
| 13.0 14.1|
|
-----------------------------------------------------------------------------------------
Table of STANDARDIZED RESIDUAL variance (in Eigenvalue units)
-- Empirical -Modeled
Total raw variance in observations
=
14.1 100.0%
100.0%
Raw variance explained by measures
=
5.1 36.0%
35.8%
Raw variance explained by persons =
2.7 19.0%
18.8%
Raw Variance explained by items
=
2.4 17.0%
16.9%
Raw unexplained variance (total)
=
9.0 64.0% 100.0%
64.2%
Unexplned variance in 1st contrast =
1.6 11.5% 18.0%
STANDARDIZED RESIDUAL CONTRAST 1 PLOT
-1
0
1
During the past month, how often have you had trouble sleeping because you:
-+--------------------------------+--------------------------------+- COUNT
.8 +
|
+
b) Wake up in the middle of |the
|
1
|
1 night or early morning
.7 +
|
+
c) Have to get up to use the |bathroom
|
2
|
1
C .6 +
|
+
O
|
|
|
N .5 +
|
+
T
|
|
|
R .4 +
|
+
A
|
|
|
S .3 +
|
+
T
|
|
|
.2 +
|
+
1
|
|
|
.1 +
|
9
+ 1
L
|
|
|
O .0 +---------------------------------|---------------------------------+
A
|
|
|
D -.1 +
|
+
I
|
|
|
N -.2 +
8
|
7
+ 2
G
|
|
3
| 1
-.3 +
|
6
+ 1
|
|
|
-.4 +
|
5
+ 1
|
4 |
| 1
-+--------------------------------+--------------------------------+-1
0
1
component MEASURE
COUNT:
1 1
1
1
1 1 1 1 1
ANALYSES 2 – The seven Components
component STATISTICS: MISFIT ORDER
---------------------------------------------------------------------------------------|ENTRY
RAW
MODEL|
INFIT | OUTFIT |PTMEA|EXACT MATCH|
|
|NUMBER SCORE COUNT MEASURE S.E. |MNSQ ZSTD|MNSQ ZSTD|CORR.| OBS% EXP%| component|
|------------------------------------+----------+----------+-----+-----------+----------|
|
6
78
585
2.53
.13|2.27
8.2|1.04
.3|A .43| 92.5 88.7| comp 6
|
|
7
445
585
-.09
.07|1.47
6.9|1.41
5.7|B .46| 50.6 54.8| comp 7
|
|
4
287
585
.68
.08|1.30
4.1| .98
-.2|C .65| 70.1 66.7| comp 4
|
|
2
599
585
-.69
.06|1.12
2.0|1.07
1.3|D .69| 47.9 52.3| comp 2
|
|
3
660
585
-.91
.06|1.11
2.0|1.11
1.9|c .59| 46.5 52.0| comp 3
|
|
5
666
585
-.93
.06| .54 -9.9| .64 -7.2|b .66| 66.3 51.9| comp 5
|
|
1
569
585
-.58
.06| .54 -9.7| .55 -9.3|a .77| 70.3 52.1| comp 1
|
|------------------------------------+----------+----------+-----+-----------+----------|
| MEAN
472.0 585.0
.00
.07|1.19
.5| .97 -1.1|
| 63.4 59.8|
|
| S.D.
203.1
.0
1.16
.02| .55
6.9| .27
4.9|
| 15.3 12.8|
|
---------------------------------------------------------------------------------------Use of Sleep Medication
Component 1: Subjective sleep quality
600
500
Component 2: Sleep latency
569
Component 3: Sleep duration
Component 4: Habitual Sleep Efficiency
Component 5: Sleep Disturbances
Component 6: Use of Sleep Medication
Component 7: Daytime Dysfunction
Frequency
400
300
200
100
5
5
2
3
21
0
1
Categories
4
MOST UNEXPECTED RESPONSES
component
MEASURE |person
| 21 1
254 443443511421 421 555432221114 533145
|721968 4132353292149968328751878741188764141371215
|81964380250977973701308737495940821386012204097199
high-------------------------------------------------5 comp 5
-.93 5|...11...1.........................................
3 comp 3
-.91 3|............00.00....0............................
2 comp 2
-.69 2|2........00........0...........33.3...3.33......2.
1 comp 1
-.58 1|...........................................3......
7 comp 7
-.09 7|2010...0.0............333...3.3..3..33......2222.1
4 comp 4
.68 4|...................33....3...3.....2...2..........
6 comp 6
2.53 6|.333333.33.33223223..3....33..............1.......
|----------------------------------------------low|72196184125454434435114218421875554322211141533145
|821648 0232373292149968327751948741188764144371215
| 19 3
509 797370130873 495 082138601220 097199
1,99
- 0.19
- 1.32
15 out of the 21 3s
4 out of the 5 2s
Table of STANDARDIZED RESIDUAL variance (in Eigenvalue units)
-- Empirical -Modeled
Total raw variance in observations
=
13.6 100.0%
100.0%
Raw variance explained by measures
=
6.6 48.4%
50.0%
Raw variance explained by persons =
4.3 31.5%
32.6%
Raw Variance explained by items
=
2.3 16.9%
17.5%
Raw unexplained variance (total)
=
7.0 51.6% 100.0%
50.0%
Unexplned variance in 1st contrast =
1.6 11.6% 22.4%
Unexplned variance in 2nd contrast =
1.4 10.7% 20.7%
Unexplned variance in 3rd contrast =
1.1
8.4% 16.3%
Unexplned variance in 4th contrast =
1.1
7.9% 15.3%
Unexplned variance in 5th contrast =
1.0
7.2% 13.9%
STANDARDIZED RESIDUAL CONTRAST 1 PLOT
-1
0
1
2
3
-+---------------+---------------+---------------+---------------+|
|
|
.7 +
|
4
+
|
|
|
.6 +
|
+
| 3
|
|
.5 +
|
+
C
|
|
|
O .4 +
|
+
N
|
|
|
T .3 +
|
+
R
|
|
|
A .2 +
|
+
S
|
|
|
T .1 +
|
+
|
2
|
|
1 .0 +----------------|------------------------------------------------+
|
1
|
|
L -.1 +
|
6
+
O
|
|
|
A -.2 +
|
+
D
|
|
|
I -.3 +
|
+
N
|
|
|
G -.4 +
|
+
|
|
|
-.5 + 5
|
+
|
|
|
-.6 +
|
+
|
|
|
-.7 +
7|
+
-+---------------+---------------+---------------+---------------+-1
0
1
2
3
component MEASURE
COUNT: 2
1 1
1
1
1
COUNT
1
1
1
1
1
1
1
SUMMARY OF CATEGORY STRUCTURE. Model="R"
------------------------------------------------------------------|CATEGORY
OBSERVED|OBSVD SAMPLE|INFIT OUTFIT||STRUCTURE|CATEGORY|
|LABEL SCORE COUNT %|AVRGE EXPECT| MNSQ MNSQ||CALIBRATN| MEASURE|
|-------------------+------------+------------++---------+--------|
| 0
0
1845 45| -2.73 -2.66|
.97
.98|| NONE
|( -2.80)|
| 1
1
1407 34| -1.10 -1.20|
.85
.58||
-1.58 |
-.83 |
| 2
2
632 15| -.06 -.21|
.92
.92||
.09 |
.87 |
| 3
3
211
5|
.57 1.09| 1.55 2.06||
1.49 |( 2.74)|
-------------------------------------------------------------------
0
1
2
3
CATEGORY PROBABILITIES: MODES - Structure measures at intersections
P
-+---------+---------+---------+---------+---------+---------+R 1.0 +
+
O
|
|
B
|
|
A
|
|
B
.8 +00
333+
I
| 00
33
|
L
|
000
33
|
I
|
00
33
|
T
.6 +
00
33
+
Y
|
0
33
|
.5 +
00 111111111111
2222222
33
+
O
|
1**
111 2222
22*2
|
F
.4 +
111
0
2*1
33 22
+
|
11
00
222
11
33
222
|
R
|
111
00
22
11
3
222
|
E
|
11
0022
1*3
222
|
S
.2 +111
2200
333 111
222+
P
|
222
000
33
11
|
O
|
2222
0***3
1111
|
N
|
2222222
333333
000000
1111111
|
S
.0 +*******3333333333333333
00000000000000000******+
E
-+---------+---------+---------+---------+---------+---------+-3
-2
-1
0
1
2
3
person [MINUS] component MEASURE
MOST MISFITTING RESPONSE STRINGS
person
OUTMNSQ |component
|5321746
high------259 1259
9.90 A|......3
474 1474
9.90 B|......3
160 1160
8.48 C|.0....3
57 1057
5.60 D|.0....3
397 1397
5.55 E|.0....3
235 1235
5.49 F|..0.0.3
340 1340
5.38 G|......3
96 1096
5.11 H|1...0.3
221 1221
4.33 I|....0.3
439 1439
4.62 J|......3
64 1064
3.52 K|1.....3
12 1012
3.49 L|1.....3
355 1355
2.91 M|....1.3
440 1440
3.23 N|......1
542 1542
2.89 O|....3..
119 1119
2.72 P|....1.3
423 1423
3.17 Q|.0....2
Should component 6 be removed from the PSQI ?
(in the case of using it in a non-clinical sample)
ANALYSES 3 – The whole PSQI
component STATISTICS: MISFIT ORDER
----------------------------------------------------------------------------------------|ENTRY
RAW
MODEL|
INFIT | OUTFIT |PTMEA|EXACT MATCH|
|
|NUMBER SCORE COUNT MEASURE S.E. |MNSQ ZSTD|MNSQ ZSTD|CORR.| OBS% EXP%| component|
|------------------------------------+----------+----------+-----+-----------+----------|
|
15
78
585
1.30
.10|1.81
4.3| .88
-.6|A .30| 94.2 88.6| item 7
|
|
16
308
585
.17
.05|1.44
5.4|1.57
4.5|B .28| 51.5 58.1| item 8
|
|
8
411
585
-.10
.05|1.39
5.8|1.52
4.8|C .35| 43.2 48.6| item 5e |
|
13
265
585
.30
.06|1.51
5.6|1.18
1.5|D .35| 60.0 62.3| item 5ja |
|
10
196
585
.55
.07|1.41
3.9|1.34
2.3|E .27| 69.9 71.2| item 5g |
|
9
254
585
.33
.06|1.40
4.4|1.35
2.7|F .31| 60.3 62.7| item 5f |
|
7
220
585
.45
.06|1.35
3.6|1.11
.9|G .35| 69.2 67.6| item 5d |
|
11
291
585
.22
.05|1.03
.4|1.11
1.0|H .34| 56.6 59.9| item 5h |
|
3
660
585
-.60
.04| .84 -3.4|1.07
1.1|I .40| 39.8 35.2| item 4
|
|
12
464
585
-.22
.05|1.07
1.3| .94
-.6|h .51| 41.0 43.1| item 5i |
|
6
785
585
-.82
.04|1.03
.6| .99
-.1|g .57| 30.9 33.4| item 5c |
|
17
378
585
-.02
.05| .84 -2.6|1.00
.1|f .41| 49.9 52.0| item 9
|
|
2
287
585
.23
.06| .88 -1.6| .75 -2.4|e .47| 62.1 60.0| comp 4
|
|
4
638
585
-.56
.04| .82 -3.8| .75 -3.8|d .63| 41.4 37.4| item 5a |
|
5
816
585
-.87
.04| .80 -4.6| .73 -4.7|c .67| 37.4 33.9| item 5b |
|
1
348
585
.06
.05| .66 -5.8| .79 -2.1|b .47| 59.8 55.1| item 2
|
|
14
569
585
-.43
.04| .36 -9.9| .44 -9.3|a .65| 63.2 39.7| item 6
|
|------------------------------------+----------+----------+-----+-----------+----------|
| MEAN
409.9 585.0
.00
.05|1.10
.2|1.03
-.3|
| 54.7 53.5|
|
| S.D.
207.2
.0
.53
.01| .36
4.5| .29
3.4|
| 15.0 14.8|
|
----------------------------------------------------------------------------------------7. During the past month, how often have you taken medicine to help you sleep (prescribed or "over the counter")?
8. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in
social activity?
5e. During the past month, how often have you had trouble sleeping because you cough or snore loudly
Table of STANDARDIZED RESIDUAL variance (in Eigenvalue units)
-- Empirical -Modeled
Total raw variance in observations
=
26.2 100.0%
100.0%
Raw variance explained by measures
=
9.2 35.1%
35.4%
Raw variance explained by persons =
5.5 21.0%
21.2%
Raw Variance explained by items
=
3.7 14.1%
14.2%
Raw unexplained variance (total)
=
17.0 64.9% 100.0%
64.6%
Unexplned variance in 1st contrast =
2.0
7.8% 12.0%
STANDARDIZED RESIDUAL CONTRAST 1 PLOT
-1
0
1
2
-+---------------------+---------------------+---------------------+|
A
|
|
.6 +
B
|
+
|
|
|
C .5 +
|
+
O
|
|
|
N .4 +
|D
C
+
T
|
|
|
R .3 +
|
+
A
|
E
|
|
S .2 +
|
+
T
|
|
G
F
|
.1 +
H
|
+
1
|
|
|
.0 +----------------------|--------------------------------------------+
L
|
|
|
O -.1 +
h
I
|
+
A
|
|
|
D -.2 +
|
g
f
+
I
|
|
e
d
|
N -.3 +
|
+
G
|
|
|
-.4 +
c b
+
|
|
|
-.5 +
|
+
|
|
a
|
-+---------------------+---------------------+---------------------+-1
0
1
2
component MEASURE
COUNT:
11
11 1
1 1 11 12 2 1 1
1
COUNT
1
1
2
1
2
1
2
2
2
2
1
SUMMARY OF CATEGORY STRUCTURE. Model="R"
------------------------------------------------------------------|CATEGORY
OBSERVED|OBSVD SAMPLE|INFIT OUTFIT||STRUCTURE|CATEGORY|
|LABEL SCORE COUNT %|AVRGE EXPECT| MNSQ MNSQ||CALIBRATN| MEASURE|
|-------------------+------------+------------++---------+--------|
| 0
0
6099 61| -1.36 -1.35|
.98
.98|| NONE
|( -1.49)|
| 1
1
1748 18| -.73 -.79|
.85
.75||
.19 |
-.40 |
| 2
2
1074 11| -.38 -.36| 1.02 1.01||
-.08 |
.39 |
| 3
3
1024 10|
.00
.02| 1.05 1.27||
-.11 |( 1.51)|
------------------------------------------------------------------P
R
O
B
A
B
I
L
I
T
Y
O
F
R
E
S
P
O
N
S
E
CATEGORY PROBABILITIES: MODES - Structure measures at intersections
-+--------------+--------------+--------------+--------------+1.0 +
+
|
|
|00
3|
| 00000
33333 |
.8 +
000
3333
+
|
000
333
|
|
000
33
|
|
00
333
|
.6 +
00
33
+
|
00
33
|
.5 +
0
3
+
|
00
33
|
.4 +
00
33
+
|
0
3
|
|
00 33
|
|
11111111111***2222222222222
|
.2 +
1111111
222** 11**1
222222
+
|
111111
2222333
0**111
2222222
|
|11111
222223333
00011111
222|
|
222222222*33333
00000**11111111
|
.0 +*****333333333
00000000******+
-+--------------+--------------+--------------+--------------+-2
-1
0
1
2
0
1
2
3
0123
0122
P
R
O
B
A
B
I
L
I
T
Y
O
F
R
E
S
P
O
N
S
E
CATEGORY PROBABILITIES: MODES - Structure measures at intersections
-+--------------+--------------+--------------+--------------+1.0 +
+
|
|
|0000
2222|
|
0000
2222
|
.8 +
0000
2222
+
|
000
222
|
|
000
222
|
|
00
22
|
.6 +
00
22
+
|
00
22
|
.5 +
00
22
+
|
00
22
|
.4 +
00 22
+
|
2*0
|
|
222
000
|
|
111**111111111**111
|
.2 +
1111111222
0001111111
+
|
1111111
222
000
1111111
|
|1111111
22222
00000
1111111|
|
222222222
000000000
|
.0 +2222
0000+
-+--------------+--------------+--------------+--------------+-2
-1
0
1
2
person [MINUS] component MEASURE
SUMMARY OF CATEGORY STRUCTURE. Model="R"
------------------------------------------------------------------|CATEGORY
OBSERVED|OBSVD SAMPLE|INFIT OUTFIT||STRUCTURE|CATEGORY|
|LABEL SCORE COUNT %|AVRGE EXPECT| MNSQ MNSQ||CALIBRATN| MEASURE|
|-------------------+------------+------------++---------+--------|
| 0
0
6099 61| -1.99 -1.98|
.97
.98|| NONE
|( -1.89)| 0
| 1
1
2822 28| -.81 -.85|
.93
.84||
-.62 |
.00 | 1
| 2
2
1024 10| -.04
.03| 1.08 1.27||
.62 |( 1.89)| 3
------------------------------------------------------------------P
R
O
B
A
B
I
L
I
T
Y
O
F
R
E
S
P
O
N
S
E
CATEGORY PROBABILITIES: MODES - Structure measures at intersections
-+--------------+--------------+--------------+--------------+1.0 +
+
|
|
|
|
|
|
.8 +00
22+
| 000
222 |
|
0000
2222
|
|
00
22
|
.6 +
000
222
+
|
000
222
|
.5 +
00
1111111
22
+
|
0**11111
11111**2
|
.4 +
11111 00
22 11111
+
|
1111
000
222
1111
|
|
1111
000 222
1111
|
|
1111
22*00
1111
|
.2 +111
222
000
111+
|
2222
0000
|
|
22222
00000
|
|
22222222222
00000000000
|
.0 +22222
00000+
-+--------------+--------------+--------------+--------------+-2
-1
0
1
2
person [MINUS] component MEASURE
0112
Original 4-category model
PCA of st.
residuals
Item fit
Reliability
Categories
3-category models
0123
0122
0112
Var. explained by Measures
35.1 %
33.6 %
33.8 %
1st factor eigenvector
2.0
2.1
2.0
% of Unexplained variance
12 %
12.2 %
12.2 %
% of Total variance
7.8 %
8.1 %
8.0 %
Infit msq
One (1.81)
Outfit msq
Two (1.57, 1.52)
One (1.53)
Person Reliability
0.67
0.69
0.71
Person Separation
1.44
1.50
1.56
Strata
2.25
2.33
2.41
Disordered
Disordered
Ordered
---
One (1.54)
---
b) Wake up in the middle of the night or early morning
Not during the Less than
Once or twice Three or more
past month
once a week a week_____ times a week
c) Have to get up to use the bathroom
d) Cannot breathe comfortably
e) Cough or snore loudly
f) Feel too cold
9 items
g) Feel too hot
h) Had bad dreams
i) Have pain
j) Other reason(s), please describe__________________________________________
How often during the past month have you had trouble sleeping because of this?
5 b) Wake up in the middle of the night or early in the morning
5 c) Have to get up to use the bathroom
5 de) Having breathing problems or snoring
5 fg) Feeling too cold or too hot
5 hij) Have any other problems (like pains, bad dreams, …. )
5 items
PSQI
17
items
13
misfitting persons
Outfit > 2.30
PCA of st.
residuals
Item fit
Reliability
Categories
13 (2.2%)
removed
15 (2.5%)
0112
0112
Var. explained by Measures
34.7 %
39.0 %
1st factor eigenvector
2.0
2.0
% of Unexplained variance
12 %
15.4 %
% of Total variance
7.8 %
9.4 %
Infit msq
---
---
Outfit msq
---
---
Person Reliability
0.71
0.73
Person Separation
1.58
1.64
Strata
2.44
2.52
Nicely ordered
Nicely ordered
.8 +0
I
L
I
T
.6
Y
.5
O
F
.4
R
E
S
P
O
N
S
E
2+
| 0000
2222 |
|
000
222
|
|
000
222
|
+
000
222
+
|
00
22
|
+
000
11111111111
222
+
|
**1111
1111**
|
+
1111 000
222 1111
+
|
1111
000
222
1111
|
|
1111
00
22
1111
|
| 11111
***
11111 |
.2 +11
2222
0000
11+
|
2222
0000
|
|
22222
00000
|
|
22222222222
00000000000
|
.0 +22222
00000+
-0.66
0.66
-+--------------+--------------+--------------+--------------+-2
-1
0
1
2
1.32
|00
A
B
I
L
I
T
Y
.8
.6
.5
O
F
R
E
S
P
O
N
S
E
17 items
.4
.2
22|
| 0000
2222 |
+
000
222
+
|
00
22
|
|
000
222
|
|
00
22
|
+
00
22
+
|
0
111111111
2
|
+
00 111
111 22
+
|
1**
**1
|
+
111
00
22
111
+
|
11
00
22
11
|
|
111
0
2
111
|
|
111
00*22
111
|
+
111
22 00
111
+
| 1111
222
000
1111 |
|11
2222
0000
11|
|
2222222
0000000
|
-0.88
0.88
+22222222222222
00000000000000+
-+---------+---------+---------+---------+---------+---------+-3
-2
-1
0
1
2
3
1.76
.0
13 items
6
r = 0.991
5
4
3
2
Measure 13
1
0
-6
-4
-2
0
-1
-2
-3
-4
-5
-6
m easure 17
2
4
6
FINAL CALIBRATION
component STATISTICS:
MISFIT ORDER
----------------------------------------------------------------------------------------|ENTRY
RAW
MODEL|
INFIT | OUTFIT |PTMEA|EXACT MATCH|
|
|NUMBER SCORE COUNT MEASURE S.E. |MNSQ ZSTD|MNSQ ZSTD|CORR.| OBS% EXP%| component|
|------------------------------------+----------+----------+-----+-----------+----------|
|
9
194
570
.76
.09|1.47
6.1|1.43
3.8|A .32| 67.9 72.7| item 8
|
|
8
38
570
2.82
.17|1.44
2.6| .48 -2.2|B .35| 95.4 93.7| item 7
|
|
11
325
570
-.08
.07|1.41
6.6|1.44
5.5|C .42| 53.7 62.2| item 5de |
|
12
256
570
.33
.08|1.30
4.6|1.22
2.5|D .43| 62.6 65.8| item 5fg |
|
6
512
570
-1.01
.07|1.11
2.2|1.09
1.6|E .61| 49.6 55.8| item 5c |
|
10
275
570
.21
.08| .96
-.7|1.08
1.0|F .43| 61.9 65.1| item 9
|
|
3
438
570
-.66
.07| .89 -2.2|1.07
1.3|G .37| 57.7 57.1| item 4
|
|
13
481
570
-.87
.07| .95
-.9| .92 -1.4|f .63| 58.6 56.9| item 5hij|
|
1
259
570
.31
.08| .77 -4.1| .93
-.8|e .49| 68.9 65.6| item 2
|
|
4
435
570
-.64
.07| .92 -1.6| .86 -2.5|d .68| 56.5 57.1| item 5a |
|
2
207
570
.66
.09| .91 -1.4| .81 -2.1|c .55| 73.3 70.9| comp 4
|
|
5
536
570
-1.12
.07| .90 -2.0| .84 -2.9|b .72| 58.2 56.1| item 5b |
|
7
448
570
-.71
.07| .50 -9.9| .55 -9.1|a .65| 75.4 57.3| item 6
|
|------------------------------------+----------+----------+-----+-----------+----------|
| MEAN
338.8 570.0
.00
.08|1.04
-.1| .98
-.4|
| 64.6 64.3|
|
| S.D.
143.2
.0
1.02
.03| .28
4.3| .28
3.5|
| 11.5 10.1|
|
-----------------------------------------------------------------------------------------
persons - MAP - components
<more>|<rare>
| item 7
|
. |
|
. |
2
+T
. |
|
# |
|
. |
1
.## T+S
| item 8
.# | comp 4
.# |
.## | item 2
item 5fg
.#### | item 9
0
.#### +M item 5de
S|
.##### |
######## |
.####### | item 4
item 5a
item 6
########## | item 5hij
-1
######### +S item 5c
M| item 5b
.########## |
.########## |
|
.######### |
-2
+T
.######### |
S|
.######## |
|
|
-3
.####### +
|
|
T|
.##### |
|
-4
### +
<less>|<frequ>
EACH '#' IS 5.
Use of sleep medication
Staying awake
Sleep efficiency
How long to sleep, Too cold or too hot
To keep enough enthusiasm
Breathing or snoring
Hours actual sleep, Can’t sleep 30 min, Rate Quality of Sleep
Other reason
Bathroom
Wake up middle of night/early morning
Distinct Group Comparisons
Depression patients vs Non-clinical subjects
(Doi et al., 2000; Buysse, Reynolds, Monk, Berman and Kupfer, 1989)
Group Statistics
measure
Depression Or Not
1,00
2,00
N
600
15
Mean
-1,3648
-,0785
Std. Deviation
1,25538
,69317
Std. Error
Mean
,05125
,17898
p = 0.000
Gender, with higher rate of complaints and worse quality of sleep found in women
(Campbell, Gillin, Kripke, Erikson & Clopton, 1989;
Lindberg, Janson, Gislason, Bjornsson, Hetta & Boman, 1997;
Manni, Ratti, Marchioni, Castelnovo, Murelli, Sartori, Galimberti & Tartara, 1997).
Group Statistics
measure
Gender
Male
Female
N
281
319
Mean
-1,6329
-1,1287
Std. Deviation
1,30826
1,15850
Std. Error
Mean
,07804
,06486
p = 0.000
Age, with older people having a higher sleep disorder rate
(Foret, Bensimon, Benoit, & Vieux, 1981; Marquie and Foret, 1999)
Descriptives
measure
ANOVA
N
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 +
Total
87
115
124
108
78
88
600
Mean
-1,8267
-1,6616
-1,5673
-1,3040
-1,2348
-,4249
-1,3648
Std. Deviation
1,15633
1,03212
1,31490
1,10876
1,27582
1,19776
1,25538
Std. Error
,12397
,09625
,11808
,10669
,14446
,12768
,05125
Minimum
-4,96
-4,96
-4,96
-4,96
-4,96
-4,96
-4,96
Maximum
,53
,74
1,77
2,12
1,47
2,54
2,54
measure
Between Groups
Within Groups
Total
Sum of
Squares
113,233
830,780
944,013
df
5
594
599
Mean Square
22,647
1,399
F
16,192
Sig .
,000
People living in Urban areas vs Rural areas
Group Statistics
measure
Area
Urban
Rural
N
415
185
Mean
-1,4431
-1,1893
Std. Deviation
1,22200
1,31370
Std. Error
Mean
,05999
,09659
Correlations
measure
Mass Index
Pearson Correlation
Sig . (2-tailed)
N
Pearson Correlation
Sig . (2-tailed)
N
measure
1
Mass Index
,265**
,000
615
600
,265**
1
,000
600
600
**. Correlation is significant at the 0.01 level (2-tailed).
p = 0.022
PSQI 13 - Invariance Plot
Item Estimates (Rural)
4
3
2
1
0
-1
-2
-2
-1
0
1
2
3
4
Item Estimates (Urban)
THANK YOU FOR YOUR ATTENTION
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