Reliability and Validity of the German Version of the DePaul Symptom Questionnaire Post-Exertional Malaise (DSQ-PEM)

Charlotte Christine Kuczyk^1*Mariel Nöhre¹Christoph Herrmann-Lingen²Maike Stolz³Christian Krauth⁴Elmar Braehler⁵Leonard A. Jason⁶Martina De Zwaan¹

• ¹Department of Psychosomatic Medicine and Psychotherapy, Medizinische Hochschule Hannover, Hanover, Germany
• ²Department of Psychosomatic Medicine and Psychotherapy, Universitatsmedizin Gottingen, Göttingen, Germany
• ³Institute for Epidemiology, Social Medicine and Health Systems Research, Medizinische Hochschule Hannover, Hanover, Germany
• ⁴Institute for Epidemiology, Social Medicine and Health Systems Research,, Medizinische Hochschule Hannover, Hanover, Germany
• ⁵Department of Psychosomatic Medicine and Psychotherapy, Universitatsmedizin der Johannes Gutenberg-Universitat Mainz, Mainz, Germany
• ⁶Center for Community Research, DePaul University, Chicago, United States

Objective: This study aimed to examine the psychometric properties (reliability and validity) of a German version of the DSQ-PEM, using a representative sample from the German general population (final n = 2,263) and a clinical sample with diagnosed post-COVID-19 condition (PCC) (final n = 1,448).The internal consistency of the German version of the DSQ-PEM was calculated separately for both samples using Cronbach's alpha. Convergent validity was assessed in both samples through correlations between the DSQ-PEM and the Patient Health Questionnaire (PHQ-4), and for the PCC sample, additionally through a correlation between the DSQ-PEM and the Chalder Fatigue Scale. To evaluate known-group validity, differences in DSQ-PEM scores between the general population sample and the PCC sample were analyzed, adjusting for relevant sociodemographic variables. Additionally, gender-and age-related differences in the DSQ-PEM were calculated separately for both samples.The DSQ-PEM items demonstrated excellent internal consistency in both the general population and PCC samples. Higher DSQ-PEM scores correlated with increased symptoms of anxiety and depression in both samples and were also associated with higher scores on the Chalder Fatigue Scale in the PCC sample, indicating good convergent validity. The knowngroup validity analyses revealed that the German version of the DSQ-PEM effectively differentiates between individuals from the general population and those with PCC, even after adjusting for relevant sociodemographic variables. Advanced age and female gender were associated with higher DSQ-PEM scores in the general population sample. No such correlation was found in the PCC sample.In summary, this study confirms the strong psychometric properties of the German version of the DSQ-PEM and supports the instrument as a reliable and valid tool for measuring PEM in Germany and other German-speaking countries.