Psychological Assessment 1997, Vol. 9, No. 3, 269-276 Copyright 1997 by the American Psychological Association, Inc. 1040-3590/97/S3.00 Factor Structure of the Psychosocial Adjustment to Illness Scale (Self-Report) for Persons With Cancer Thomas V. Merluzzi and Mary Ann Martinez Sanchez University of Notre Dame The Psychosocial Adjustment to Illness Scale (PAIS-SR) is a frequently used self-report measure, yet its factor structure, reliability, and validity have not been tested adequately on a sample of persons with cancer. A group of persons with cancer (N = 502) completed the PAIS-SR and other measures of adjustment and coping. A principal-axis factor analysis with varimax rotation yielded 7 factors: Social and Leisure Activities (.86), Job and Household Duties (.85), Psychological Distress (.87), Sexual Relationship (.92), Relationships With Partner and Family (.70), Health Care Orientation (.61), and Help From Others (.63). Values in parentheses are Cronbach's as for the factors; a for the entire scale was .93. Correlations with measures of disease impact, adjustment, and coping support the validity of the PAIS-SR and its use for cancer research. Advances in medical care and changing attitudes toward ill- nesses such as cancer and renal disease have resulted in increas- ing numbers of people who are living longer with chronic dis- eases. Treatments for many serious and chronic diseases have severe side effects that may tax the person's coping capacity. This increase in longevity and the severity of side effects have provoked a concomitant interest in the psychosocial adjustment of those who survive serious diseases and endure treatments for those diseases. That interest has spawned a number of measures to assess adjustment (e.g., Derogatis & Derogatis, 1990; Viet & Ware, 1983) and quality of life (e.g., Cella et al., 1993). The relevance of the concept of adjustment to illness is underscored by the finding from a prospective longitudinal study that for the same disease the cost of health care for people who are poorly adjusted to chronic illness is approximately $24,000 an- nually compared with approximately $10,000 for their well- adjusted counterparts (Browne et al., 1990). One of the most prevalent measures of adjustment appearing in the health psychology literature is the Psychosocial Adjust- ment to Illness Scale, which was devised by Derogatis and his colleagues (Derogatis & Derogatis, 1990; Morrow, Chiarello, & Derogatis, 1978). There are two versions of the Psychosocial Adjustment to Illness Scale. One is administered in a structured interview format (PAIS); the other is a self-report form (PAIS-SR). Thomas V. Merluzzi and Mary Ann Martinez Sanchez, Department of Psychology, University of Notre Dame. We wish to acknowledge the support of Rafat Ansari, Thomas Troeger, David Taber, Juan Garcia, Rhonda Critchlow, and the staff of Michiana Hematology-Oncology; Marti Verfurth, executive director of Memorial Hospital's Regional Cancer Center, and her staff; and the many dedicated undergraduates in the seminar on psychooncology who served as research assistants. Also, we would like to extend our gratitude to the many persons with cancer who graciously agreed to participate in this research. Correspondence concerning this article should be addressed to Thomas V. Merluzzi, Department of Psychology, University of Notre Dame, Notre Dame, Indiana 46556. Electronic mail may be sent via the Internet to merluzzi.l@nd.edu. The PAIS was devised originally for, and initially validated on, persons with cancer and their families (Morrow et al., 1978). A recent review of measures of psychological function- ing used in.research on adjustment to cancer (Gotay & Stern, 1995) indicated that the PAIS is still widely used to assess psychosocial adjustment in persons with cancer. However, Gotay and Stern (1995) have strongly endorsed the need for research on the psychometric properties of those measures and their re- finement. Furthermore, they suggest that factor analytic and va- lidity studies need to be conducted to ascertain the structure and quality of measures used in psychosocial oncology research. The PAIS-SR is very similar to the PAIS in that both mea- sures contain 46 items that cover seven domains of psychosocial functioning. The subscale Health Care Orientation assesses "pa- tient attitudes, quality of information, and the nature of the patient's expectations about his/her disorder and its treatment" (Derogatis & Derogatis, 1990, p. 8). Vocational Environment taps "perceived quality of job performance, job satisfaction, lost time, job interest, and a number of other variables that are associated with the nature of vocational adjustment'' (p. 8). The items that compose the Domestic Environment scale ' 'measure a number of aspects of family living, including financial impact of the illness, quality of relationships, family communications, and effects of physical disabilities" (p. 9). The Sexual Relation- ship scale assesses "sexual interest, frequency, quality of perfor- mance, and level of satisfaction" (p. 10). Extended Family Relationships contains items that assess "any negative impact of the illness upon communication, quality of relationships, in- terest in interacting with family and other variables reflective of this domain" (p. 11). The Social Environment scale is used to "determine the degree to which the patient has suffered incur- sions due to illness into his/her typical social and leisure activi- ties" (p. 12). Finally, Psychological Distress covers "indicators of psychological distress such as anxiety, depression and hostil- ity, as well as reduced self-esteem, body image problems and inappropriate guilt" (p. 13). The PAIS-SR continues to be used in research on adjustment to cancer (e.g., Gotcher, 1992; Howes, Hoke, Winterbottom, & Delafield, 1994; Lowery, Jacobsen, & DuCette, 1993; Mer- 269 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.