![]() ![]() ![]() Rather than simply selecting one of the scales to use in patients with HF, we chose to shorten the entire instrument. However, the wide range of negative thinking content in the original CCI is a strength of this instrument. The original CCI contains four scales that measure four different types of negative thinking: self-rated inferiority, helplessness, hopelessness, and detachment. A shortened version of the CCI would be a valuable tool for researchers and clinicians working with patients who have HF. However, for patients hospitalized with HF who routinely experience fatigue and shortness of breath, 11 administering the CCI via interview takes 10 to 20 minutes. We have found that among healthy young adults, filling out the CCI takes approximately 3 to 5 minutes. Furthermore, although the instrument is written at the Flesch-Kincaid third grade reading level (Microsoft Word, 2007), the length of the instrument (34 negative thinking items and 11 positive thinking, non-scored buffer items) may be burdensome to patients with HF. 10 However, this instrument has not been tested in patients with HF. The CCI has been used to measure negative thinking in psychiatric outpatients, healthy adults, 8 low income single mothers, 1 and college women. The CCI is also preferable to the Cognitive Checklist-Depression subscale because it captures a wider range of depressive negative thinking content. 9 In contrast to the Automatic Thoughts Questionnaire which was developed with undergraduate students, the CCI was developed with a clinical psychiatric population. 8 In a critical review of these three instruments, we found that the Crandell Cognitions Inventory-or CCI-has the best potential for measuring negative thinking in patients with HF. Three of the most commonly used measures of negative thinking are the Automatic Thoughts Questionnaire, 6 the Cognitive Checklist-Depression subscale, 7 and the Crandell Cognitions Inventory. Researchers have begun to test cognitive therapy for depressive symptoms in patients with HF, 5 creating the need for a psychometrically sound measure of negative thinking in patients with HF. 4 Cognitive therapy is a psychotherapeutic intervention for depression that focuses on the reduction of negative thinking. 3 Depressive symptoms also have an important effect on emotional and physical health-related quality of life in patients with HF. 4 Patients with HF who have depressive symptoms are twice as likely to die and two and a half times more likely to be re-hospitalized than patients who do not have depressive symptoms. 3ĭepressive symptoms have a profound effect on morbidity, mortality, and health-related quality of life among patients with HF. In a meta-analysis of data from 23 studies, researchers estimated that the prevalence of depressive symptoms was 30% in both outpatients and inpatients with HF. The presence of depressive symptoms is a significant clinical problem in patients with HF. Negative thinking-a risk factor for depressive symptoms in the general population 1, 2-is a potential target for the treatment of depressive symptoms in patients with HF. The purpose of this study was to develop a psychometrically sound shortened measure of negative thinking for use in patients with heart failure (HF).
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