DAPOS FAQs
- Q: What is the DAPOS?
- A: The DAPOS is a new questionnaire, designed to measure Depression, Anxiety and Positive Outlook in people who suffer from pain.
- Q: How was the DAPOS developed?
- A: Psychological factors are important in the development and maintenance of chronic low back pain. Widely used measures can be long to complete and suffer from containing items that may be ambiguous for a patient suffering with musculoskeletal pain. For example, sleep disturbance is often part of a person’s experience of depression and is included as an item in questionnaires measuring depression. However for many patients with pain, sleep may be disturbed due to pain rather than due to the effects of depression. We developed the DAPOS to contribute to the improvement of current measures.
Using data from 900 patients from a chronic pain management centre (Input, St Thomas’ Hospital) we systematically identified and removed questions from commonly used measures that highly correlated to pain levels. This effectively removed the “somatic” items from the questionnaire and left us with a short 11 item questionnaire measuring depression, anxiety and positive outlook.
This new questionnaire was then tested with interviews to see if it made sense to patients and whether they were able to identify the questions measuring the three attributes we were interested in. This was successful.
In the next stage we tested the questionnaire in a “new” population of people attending the chronic pain management centre and in a group of patients attending an outpatients teaching clinic providing osteopathic treatment (The British School of Osteopathy). The structure of the questionnaire held up well. The work has been presented and well received at international conferences. The final write up was published in Pain earlier this year.
This work represents a successful collaboration between several institutions and researchers. We have
had requests for use of the instrument from research teams in the UK and internationally. We have been successful in winning
further support from our original funders BackCare. This new funding has been used to build this website that enables
researchers and clinicians to
access the questionnaire and to further contribute to its development. As a research team we are continuing our collaboration to validate the questionnaire in primary care populations and in different ethnic groups.
- Q: Who has the DAPOS been developed for?
- A: The original research was carried out in secondary care (a pain
management clinic) and in an osteopathic teaching outpatient clinic. The majority of patients suffered from chronic pain,
mostly musculoskeletal. The
DAPOS is currently being tested on several other groups, in different environments. The DAPOS is still in early stages of testing. We invite researchers to report their findings having used the DAPOS in various environments and with varied groups. To find about studies in new populations, click here.
- Q: Why do we need to measure Depression in pain?
- A: Many people who suffer from pain for long periods of time get
depressed. This isn't surprising, as pain can interfere with all aspects of life. Research suggests that depression is
important, because it affects long term prognosis, levels of disability and even the use of health care. One of the problems
in measuring depression in people with pain is that many measures were adapted from questionnaires developed in groups with
clinical depression.
They included questions on somatic (physical) problems such as lack of appetite or fatigue, which, although they occur in
clinical depression, also result from pain. Thus scores on these questions by people with pain are difficult to interpret. This problem is known as criterion contamination. The DAPOS includes only items that measure the affective component of depression, which could be conceptualised as negative/ low mood, or feeling blue.
- Q: Why do we need to measure Anxiety in pain?
- A: There is a growing interest in the concept of anxiety in pain.
Anxiety affects the intensity of pain and may also influence the course of painful musculoskeletal conditions. There is increasing interest in a range of related concepts, such as worry, specific health –related anxieties and fear. The DAPOS anxiety scale drew items from the widely used Hospital Anxiety and Depression Questionnaire (Zigmond and Snaith, 1983), which measure General Anxiety, rather than measuring pain-focused anxiety. The DAPOS offers a brief set of items that measure anxiety in people suffering from pain.
- Q: Why do we need to measure positive outlook in pain?
- A: Positive outlook, positive mood and optimism have been relatively neglected in the pain area. There is interest in positive outlook in psychology in general and specifically for people suffering from persistent pain. It has been shown to have an effect on the course and experience of chronic diseases. The DAPOS is currently the only measurement to include a scale of positive affect alongside depressionand anxiety.
- Q: Why is the DAPOS better than other measurements on the market?
- A: The DAPOS is still at early stages of development, and we can’t guarantee that it will perform well under all circumstances, for all groups. However, it has several theoretical and practical advantages over other measurements. These include the exclusion of somatic items from the depression scale, the inclusion of a positive out-look scale, brevity and relative simplicity in responses and coding.
- Q: Who can use it?
- A: Anyone carrying out ethical, valid research. We recommend that it be used by trained researchers, and the research team preferably includes a psychologist.
- Q: How much will it cost?
- A: For academic and other non-profit groups, use of the DAPOS is entirely free of charge. We ask you to register with us on this website, so that we can keep track of the use and development of the DAPOS. This includes our detailed guidelines concerning translation.
The DAPOS is copyrighted, and terms of use apply. By registering to use the DAPOS for research purposes you will automatically become a member of this website and have the opportunity to interact with other researchers investigating similar problems through this website. For non-profit free use of the DAPOS for research click here.
Profit-making groups will be charged a small administrative fee for use of the DAPOS, and depending on the intended use, may be charged a fee. To register for use of the DAPOS by a profit-making organization click here.
All profits from DAPOS licensing go towards further research of the DAPOS, support of this website,
and towards the BackCare charity.
- Q: Can I be trained/supervised during my research?
- A: Our team can provide limited feedback and advice through the e-mail link dapos@rhul.ac.uk. We also provide consultancy for use of the DAPOS at all levels, and the fees for this can be discussed. Please contact us using the same e-mail link: dapos@rhul.ac.uk. Finally, you might find that joining the discussion forum for members on this website provides you with excellent advice.
- Q: Can you diagnose depression or anxiety by using the DAPOS?
- A: Using the DAPOS for clinical purposes is currently not recommended. We are interested in the performance of the DAPOS in clinically based research. However, there are no cut points or thresholds for identifying risk or caseness. This is for three reasons:
- it is not a diagnostic measure
- the underlying variables have been assumed to be continuous in their distribution, consistent with a normal rather than psychopathological model of pain
- cutpoints are the property of a measure in the particular population on which it was tested, therefore cannot be applied uncritically to other populations.
In time, consistent relationships may be established between scores on the DAPOS and clinical signs and symptoms. Watch this space for development in this area.
