DAS59 - Derriford Appearance Scales

More documents

Recommendations

Info

The Derriford Appearance Scale (DAS59) 219 Table 2 Mean preoperative DAS59 scores (full-scale and factorial sub-scales) of patients in a range of treatment-defined sub-groups of plastic surgery Operation n Full-scale GSC SSC NSC SBSC FSC abdominoplasty 123 124.2 48.2 28.5 14.9 27.3 1.8 breast reduction 125 123.6 44.4 32.8 15.7 24.8 1.8 breast augmentation 49 119.7 46.1 27.1 17.2 24.7 1.6 otoplasty, men 31 113.8 42.3 29.5 16.6 13.6 6.3 gynaecomastia 34 110.6 42.2 28.5 13.1 20.9 2.2 mastopexy 20 107.4 38.4 23.6 16.3 22.1 2.7 rhinoplasty, women 128 103.2 42.6 25.9 14.5 11.1 4.4 breast asymmetry 13 102.5 34.1 26.7 15.1 21.2 2.5 otoplasty, women 47 101.1 35.7 24.1 15.5 14.8 7.5 breast reconstruction 11 95.1 32.7 21.3 15.8 21.6 1.2 rhinoplasty, men 80 83.2 30.5 22.2 14.9 8.7 2.6 facelift, women 32 77.6 32.2 16.7 13.8 8.7 2.4 cosmetic, women 698 112.1 43.4 26.7 15.2 20.4 2.5 cosmetic, men 116 89.4 32.9 23.7 14.4 11.6 2.5 reconstructive, women 287 103.6 40.8 24.1 14.7 15.3 4.2 reconstructive, men 147 96.8 37.1 24.4 15.4 10.9 3.7 GSC: general self-consciousness of appearance; SSC: social self-consciousness of appearance; NSC: negative self-concept; SBSC: sexual and bodily self-consciousness of appearance; FSC: facial self-consciousness of appearance. Table 3 DAS59 full-scale normative data for general and clinical populations by gender and by age bands (18–30 years, 31–60 years and 61 years and over): minimum, maximum and quartile (Q1, Q2 and Q3) values, means and standard deviations General population: not concerned General population: concerned Clinical population Age (year) 18–30 31–60 61� 18–30 31–60 61� 18–30 31–60 61� Men minimum 8 8 8 30 8 9 26 10 10 Q1 17 13 12 66 57 24 73 58 29 Q2 28 21 19 83 77 35 93 85 64 Q3 46 51 46 107 97 74 124 118 76 maximum * 70 76 71 153 143 137 174 179 130 mean 33.3 32.0 29.3 85.5 76.7 52.6 98.3 89.8 60.6 (�s.d.) (18.5) (22.0) (20.7) (34.2) (33.3) (42.3) (38.1) (44.4) (34.8) n 50 156 80 60 80 16 146 121 27 Women minimum 8 8 8 21 13 17 17 11 12 Q1 15 12 12 63 55 44 88 71 53 Q2 37 17 19 83 77 60 110 102 76 Q3 59 23 28 102 104 80 144 131 109 maximum * 92 56 57 160 161 114 172 191 155 mean) 40.0 22.0 24.0 86.1 82.2 62.6 115.3 103.9 81.4 (�s.d.) (26.2) (16.9) (16.3) (37.1) (39.2) (25.6) (38.4) (43.4) (36.8) n 57 123 61 102 188 27 400 637 67 * Excludes outliers: value�mean�2 s.d. The general-population database was constructed from respondents to a postal study that involved 2700 residents of southwest Devon aged 18 years and over who were randomly selected from a total population of 583 000 with constraints for sex, socio-economic status, urban/rural residence and age. 25 Table 3 lists the DAS59 full-scale scores that subdivide these populations into quartiles (minimum–Q1, Q1–Q2, Q2–Q3 and Q3–maximum) together with the mean scores and standard deviations. As the DAS59 discriminates significant differences in levels of distress and dysfunction between men and women and between different times of life, normative data for each sex are tabulated for early adulthood (age: 18–30 years), mid-adulthood (age: 31–60 years) and late adulthood (age: 61 years and over). For all age groups, all scores for the clinical population exceed the scores for the general population concerned about appearance, and both are substantially higher than the scores for the general population not concerned about appearance. In the general population concerned about appearance and in the clinical population, the mean scores for women are consistently higher than those for men and in the clinical population the difference is significant (P�0.0001). In both populations there is a serial reduction in the mean DAS59 scores with increasing age. Among women in the clinical population, the reduction is significant from early to mid-adulthood (P�0.001) and from mid- to late adulthood (P�0.001). For men, the reduction is significant from mid- to late adulthood (P�0.01). Factorial sub-scales of the DAS59 Factor analysis groups together scale-items that score in similar ways. This helps in the selection of items during the refinement of a scale and contributes to an understanding of what a scale is measuring. Factor analysis (Principal components and Varimax
220 British Journal of Plastic Surgery Table 4 Preoperative to postoperative changes in mean DAS59 full-scale and factorial sub-scale scores (with standard deviations in parentheses) of patients treated for abnormalities of bodily features and facial features compared with the general-population values n full-scale GSC SSC NSC SBSC FSC Bodily features preoperative 59 112.3 (38.1) 43.3 (13.6) 24.8 (15.6) 16.0 (4.1) 24.8 (15.6) 1.5 (2.0) postoperative 59 46.2 (31.2) 14.2 (11.9) 12.3 (10.9) 9.7 (3.5) 7.3 (6.3) 1.3 (1.6) significance t�10.3, t�12.2, t�5.4, t�9.0, t�11.1, ns * P�0.0001 P�0.0001 P�0.0001 P�0.0001 P�0.0001 percentage change Facial features �59 �67 �50 �39 �71 �13 preoperative 63 83.0 (36.0) 35.9 (13.9) 20.1 (13.6) 13.8 (4.0) 7.9 (6.4) 3.1 (3.6) postoperative 63 45.0 (25.0) 15.8 (11.1) 11.0 (8.9) 9.6 (3.5) 5.5 (5.4) 1.6 (1.9) significance t�6.8, t�9.2, t�3.7, t�6.2, ns * t�2.6, P�0.0001 P�0.0001 P�0.001 P�0.0001 P�0.01 percentage change General population �46 �56 �45 �30 �30 �48 total 1001 53.1 (38.9) 17.9 (16.9) 20.3 (21.5) 6.9 (7.9) 11.7 (4.2) 1.9 (2.6) unconcerned 529 29.3 (20.9) 5.8 (6.8) 9.1 (13.1) 2.9 (4.1) 10.0 (3.7) 1.3 (2.0) GSC: general self-consciousness of appearance; SSC: social self-consciousness of appearance; NSC: negative self-concept; SBSC: sexual and bodily self-consciousness of appearance; FSC: facial self-consciousness of appearance; * ns: P�0.1. rotation) of the combined general population and clinical population databases indicated an optimum five-factor solution comprising three factors that are not feature specific and two that are: 18 general self-consciousness of appearance (GSC); social self-consciousness of appearance (SSC); negative self-concept (NSC); sexual and bodily self-consciousness of appearance (SBSC); and facial self-consciousness of appearance (FSC). The item contents of these sub-scales are given in Table 1, which reveals the extent of symptomatology covered by each of these factors. Table 2 gives mean preoperative DAS59 scores (full-scale and factorial sub-scales) for a number of treatmentdefined sub-groups of plastic surgery patients together with scores for men and women undergoing cosmetic or reconstructive surgery for comparison. Data for the treatment-defined subgroups are ranked according to mean full-scale scores, revealing abdominoplasty patients to have the highest levels of measured distress and dysfunction, and male rhinoplasty and female facelift patients to have the lowest levels. Mean scores for the SBSC factor are highest in patients undergoing breast surgery, abdominoplasty and excision of gynaecomastia, whilst mean scores for the FSC factor are highest in men and women having prominent-ear correction and in women having rhinoplasty. These data illustrate the appropriateness of the featurespecific factors. Mean full-scale and factorial sub-scale scores for women undergoing reconstructive surgery are consistently lower than the scores for women undergoing cosmetic surgery. Out of the sub-groups of breast surgery, mean scores were lowest among patients having reconstructive surgery after mastectomy or for congenital asymmetry and highest among patients having breast reduction. These findings reflect clinical experience. Although fewer data are available for men, those undergoing otoplasty and excision of gynaecomastia tend to have higher scores. Physical distress and dysfunction Included in the DAS59 are two items that assess how often the ‘feature’ causes pain or discomfort and how often the ‘feature’ physically limits the respondent’s ability to do things. The mean of these totals for patients undergoing breast reduction (6.1) was significantly higher than the mean for patients undergoing breast augmentation (3.9) (t�7.3, P�0.0001). Sensitivity of the DAS59 to change in condition after treatment Table 4 gives the mean DAS59 full-scale and factorial sub-scale scores for patients undergoing cosmetic surgery of bodily features (mainly breast and abdomen, n�59) and facial features (n�63) who were tested preoperatively and 3 months postoperatively. For both groups, there were large and significant preoperative to postoperative reductions in full-scale scores and in the scores on the factorial sub-scales that are not feature specific (GSC, SSC, NSC). Percentage changes were greatest for patients treated for bodily features in whom preoperative scores were highest. Data for the feature-specific sub-scales showed a significant reduction in the mean SBSC scores of patients treated for bodily features and a significant reduction in the mean FSC scores of patients undergoing facial surgery. The mean postoperative scores of both groups were closely similar and fell between the mean scores of the total general population and the mean scores of the general population unconcerned about appearance. Preoperative to postoperative changes in item scores are given in Table 1. Discussion The DAS59 (and its parallel short form, the DAS24) provides, for the first time, a self-report questionnaire that generates a series of valid and reliable measures of the specific psychological distress and disruption to everyday life that are associated with self-consciousness of appearance. By basing its item content on autobiographical data from a representative sample of the clinical population, we have ensured that the DAS59 is fully descriptive of the condition measured, both for people who are self-conscious of visible disfigurements and deformities, and for people who are self-conscious of aesthetic problems of appearance. During the scale’s development, an open ‘comments’
Page 1 and 2: British Journal of Plastic Surgery
Page 3: 218 British Journal of Plastic Surg
Page 7: 222 British Journal of Plastic Surg

DAS59 - Derriford Appearance Scales

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?