Psychosocial Adjustment to Illness Scale

Last Updated

May 04, 2023

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

Social Relationships
Social Support
Negative Affect
Quality of Life

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.

Cardiovascular Disease

Spinal Injuries

Chronic Pain

Cancer

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

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.

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.

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.

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)

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)

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.

Last Updated

Purpose

Link to Instrument

Area of Assessment

Assessment Type

Administration Mode

Cost

Cost Description

CDE Status

Number of Items

Required Training

Required Training Description

Instrument Reviewers

ICF Domain

Measurement Domain

Considerations

Interrater/Intrarater Reliability

Internal Consistency

Criterion Validity (Predictive/Concurrent)

Construct Validity

Normative Data

Construct Validity

Normative Data

Normative Data

Internal Consistency

Construct Validity

Bibliography

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