Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus.
BACKGROUND
People with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience.


METHODS
The CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from 'not a problem' to 'a very big problem'. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA.


RESULTS
The best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus 'not a problem', and 'a small problem' or 'a moderate problem.'


CONCLUSIONS
This study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy.
National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Otology and Hearing Group, Division of Clinical Neuroscience, University of Nottigham, 113 The Ropewalk, Nottingham, NG1 5DU, UK. l.handscomb@ucl.ac.uk.|UCL Ear Institute, 332 Gray's Inn Road, London, WC1X 8EE, UK. l.handscomb@ucl.ac.uk.
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http://orcid.org/0000-0001-8388-948X
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Handscomb
National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Otology and Hearing Group, Division of Clinical Neuroscience, University of Nottigham, 113 The Ropewalk, Nottingham, NG1 5DU, UK.
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Hall
National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Otology and Hearing Group, Division of Clinical Neuroscience, University of Nottigham, 113 The Ropewalk, Nottingham, NG1 5DU, UK.
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Hoare
Alcohol and Public Health Team, Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BA, UK.|Northern Ireland Association for Mental Health, 80 University St, Belfast, BT7 1HE, UK.|Psychotraumatology, Mental Health, and Suicidal Behaviour Group, Psychology Research Institute, Ulster University, Coleraine, BT52 1SA, UK.
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Shorter
D000328:Adult; D000704:Analysis of Variance; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000523:psychology*
CORE-OM; Confirmatory factor analysis; Emotional distress; Tinnitus