Supplementary Material for: Screening second victims for emotional distress: Assessment of the clinimetric properties of the WITHSTAND-PSY Questionnaire (WS-PSY-Q)

Introduction: Adverse events (AEs) are a leading cause of patient morbidity and mortality, greatly impacting healthcare providers’ well-being (second victim (SV) phenomenon). Since it is not accurately captured by existing psychometric instruments, we developed a clinimetric instrument for assessing SVs’ emotional distress before and after an AE.
Methods: Content validity and clinical utility of the WITHSTAND-PSY Questionnaire (WS-PSY-Q) were examined using cognitive interviews. Rasch analysis (n=284) was applied for clinimetric assessment (i.e., construct, concurrent, and clinical validity, internal consistency), considering two crucial psychological facets of the SV phenomenon (1st: Emotional impact of the adverse event, 2nd: Current emotional state).
Results: The Rasch partial credit model was used. The 1st facet demonstrated overall acceptable clinimetric properties with the subscale anxiety meeting clinimetric threshold values (e.g., all items with ordered thresholds, Loevinger’s coefficient h≥0.40; Person Separation Reliability Index (PSI)=0.7). The 2nd facet showed overall better clinimetric properties for both subscales (e.g., h ≥0.40, PSI=0.82 and 0.79, respectively; ROC area of 0.80 and 0.86, respectively). For both datasets, item fit statistics, except those for item 19, were within the critical range (z-score<±2.5) and meaningful differential functioning analysis was observed for only 4 (out of 24) items. Local dependency was not observed, except for two item couples in the depression subscales.
Conclusions: The WS-PSY-Q is the first clinimetric tool assessing SVs’ emotional distress. It should be regarded as part of the armamentarium used by clinicians to assess in-depth healthcare providers’ psychological reactions in the aftermath of an AE to mitigate burnout and allostatic overload.

引言：不良事件（Adverse Events, AEs）是导致患者发病与死亡的主要原因之一，同时也会严重影响医疗服务提供者的身心健康，即第二受害者（Second Victim, SV）现象。现有心理计量工具无法准确量化这一现象，为此我们开发了一款用于评估第二受害者在不良事件发生前后情绪困扰状况的临床计量工具。

方法：本研究通过认知访谈法评估了WITHSTAND-PSY问卷（WS-PSY-Q）的内容效度与临床实用性。研究纳入284名受试者，采用拉希分析（Rasch analysis）开展临床计量学评估，涵盖结构效度、同时效度、临床效度以及内部一致性四个维度，同时聚焦第二受害者现象的两大核心心理层面：其一为不良事件带来的情绪冲击，其二为当前情绪状态。

结果：本研究采用拉希部分计分模型开展分析。第一心理层面整体具备可接受的临床计量学特性，其中焦虑子量表达到了临床计量学阈值标准（例如所有条目均具备有序阈值，勒文格h系数≥0.40，个体分离信度指数（PSI）为0.7）。第二心理层面的两个子量表则整体展现出更优的临床计量学性能：二者的勒文格h系数均≥0.40，PSI分别为0.82与0.79，ROC曲线下面积分别为0.80与0.86。在两份数据集内，除第19号条目外，其余条目的拟合统计量均处于临界范围内（z分数<±2.5）；24个条目中仅4个存在具有统计学意义的差异性功能分析结果。局部依赖性仅在抑郁子量表的两组条目对中被观测到，其余均未出现该情况。

结论：WS-PSY-Q是首款用于评估第二受害者情绪困扰的临床计量工具，可作为临床医生的诊疗工具库之一，用于评估医疗服务提供者在不良事件发生后的深层心理反应，以帮助缓解从业者的职业倦怠与稳态负荷过载。