Adaptation and validation of the chronic disease helplessness survey for Chinese patients with chronic conditions

BACKGROUND: Patients with chronic diseases often experience learned helplessness (LH), which affects their psychological state and triggers physical symptoms, seriously affecting their quality of life. The Chronic Disease Helplessness Survey (CDHS) was developed to measure LH in patients with chronic diseases, but it has not been validated in the Chinese population. The aim of this study was to translate the CDHS into Chinese and validate its reliability and validity in Chinese patients with chronic diseases, thus providing an appropriate assessment tool for the Chinese population. METHODS: A forward-backward English-Chinese-English translation of the CDHS was performed according to standard practice. This study recruited 106 chronic disease patients from March to May 2024, and 100 cases in September 2025. The Chinese CDHS has 12 items in three dimensions: cognitive, motor, and emotional. The criterion-related tools used included the Learned Helplessness Scale-18 (LHS-18), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD). Criterion-related validity was assessed by examining the correlations between CDHS scores and the scores of these tools. The internal consistency was tested via Cronbach's α, the test-retest reliability was tested via the intraclass correlation coefficient (ICC), and the construct validity was tested via Exploratory Factor Analysis and Confirmatory Factor Analysis. RESULTS: /df = 1.623, CFI = 0.961, TLI = 0.949, NFI = 0.905, RMSEA = 0.078). CDHS scores were positively correlated with LHS-18 (r = 0.659, P < 0.001), GAD-7 (r = 0.659, P < 0.001), and PHQ-9 (r = 0.714, P < 0.001) scores and negatively correlated with SEMCD scores (r = -0.614, P < 0.001), demonstrating good criterion-related validity. CONCLUSION: The Chinese CDHS has good reliability and validity for assessing learned helplessness in Chinese chronic disease patients and is a valuable tool for early psychological intervention, it could be used in screening, clinical decision-making, or monitoring psychological states over time.