Catastrophizing questionnaire: translation and psychometric validation in Brazilian adult orthodontic patients

FARIA, Tony Vieira; GANDINI JR, Luiz Gonzaga; CAMPOS, Lucas Arrais

doi:10.1590/2177-6709.31.2.e2625245.oar

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ORIGINAL ARTICLE • Dental Press J. Orthod. 31 (2) • 2026 • https://doi.org/10.1590/2177-6709.31.2.e2625245.oar linkcopy

Catastrophizing questionnaire: translation and psychometric validation in Brazilian adult orthodontic patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: This study aimed to translate, culturally adapt, and estimate the psychometric properties of the Catastrophizing Questionnaire (CQ) for use in Portuguese among orthodontic patients.

Methods: The translation process followed international guidelines, including forward and backward translation. Confirmatory factor analysis (CFA) was conducted to assess factorial validity, using indices such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR). Convergent validity [Average Variance Extracted (AVE)] and reliability were estimated.

Results: A total of 334 Brazilian orthodontic patients (74.6% female, mean age = 30.6 years, standard deviation 12.4) participated in the study. The factor model of the Portuguese version of CQ presented an adequate fit to the data (CFA: CFI = 0.95, TLI = 0.94, RMSEA = 0.07, and SRMR = 0.06). Reliability was acceptable (α and ω ≥ 0.93). Although the AVE was slightly below the recommended threshold (AVE = 0.41), the overall model fit and internal consistency supported the adequacy of convergent validity.

Conclusion: The Portuguese CQ showed adequate psychometric properties for assessing catastrophizing in Brazilian adult orthodontic patients. As a pain-independent measure, it enables the early identification of catastrophizing tendencies before appliance placement, supporting a patient-centered approach. By helping clinicians recognize individual psychosocial vulnerabilities, the CQ can guide tailored communication and management strategies aimed at improving the overall treatment experience.

Keywords:
Psychometrics; Catastrophization; Validation study; Orthodontics

Characteristic	n (% ; 95% CI)
Sex
Female	249 (74.6; 69.6-78.9)
Marital status
Single	208 (62.3; 57.0-67.3)
Married / Common-law marriage	101 (30.2; 25.6-35.4)
Divorced / Separated	24 (7.2; 4.9-10.5)
Widowed	1 (0.3; 0.1-1.7)
Educational level
Incomplete elementary education	2 (0.6; 0.2-2.2)
Completed elementary education	18 (5.4; 3.4-8.4)
Completed high school	199 (59.6; 54.2-64.7)
Completed higher education	115 (34.4; 29.5-39.7)
Monthly household income (US$*)
≤ 231.33	27 (8.1; 5.6-11.5)
231.34 to 369.53	36 (10.8; 7.9-14.6)
369.54 to 1,592.78	137 (41.1; 36.0-46.5)
1,592.96 to 2,077.28	55 (16.5; 12.9-20.9)
> 2,077.28	78 (23.5; 19.2-28.3)

Item	Mean	Median	Standard Deviation	Minimum	Maximum	Skewness	Kurtosis
CQ1	2.6	3.0	1.2	1.0	5.0	0.32	-0.72
CQ2	3.3	3.0	1.1	1.0	5.0	-0.11	-0.71
CQ3	2.4	2.0	1.1	1.0	5.0	0.41	-0.55
CQ4	2.7	3.0	1.1	1.0	5.0	0.36	-0.43
CQ5	3.2	3.0	1.3	1.0	5.0	-0.11	-1.14
CQ6	2.5	2.0	1.3	1.0	5.0	0.51	-0.84
CQ7	2.2	2.0	1.1	1.0	5.0	0.72	-0.18
CQ8	2.2	2.0	1.1	1.0	5.0	0.61	-0.26
CQ9	2.9	3.0	1.3	1.0	5.0	0.13	-0.99
CQ10	2.3	2.0	1.2	1.0	5.0	0.68	-0.26
CQ11	2.2	2.0	1.2	1.0	5.0	0.87	-0.07
CQ12	1.7	1.0	1.0	1.0	5.0	1.51	1.69
CQ13	2.2	2.0	1.2	1.0	5.0	0.84	-0.28
CQ14	2.3	2.0	1.1	1.0	5.0	0.60	-0.43
CQ15	2.1	2.0	1.1	1.0	5.0	1.01	0.51
CQ16	2.0	2.0	1.0	1.0	5.0	0.91	0.38
CQ17	2.3	2.0	1.2	1.0	5.0	0.75	-0.20
CQ18	2.7	3.0	1.2	1.0	5.0	0.30	-0.84
CQ19	2.5	3.0	1.1	1.0	5.0	0.31	-0.65
CQ20	2.2	2.0	1.2	1.0	5.0	0.77	-0.38
CQ21	2.4	2.0	1.1	1.0	5.0	0.51	-0.47
CQ22	1.9	2.0	1.0	1.0	5.0	1.26	1.28
CQ23	3.2	3.0	1.2	1.0	5.0	-0.15	-0.75
CQ24	2.6	3.0	1.2	1.0	5.0	0.29	-0.80
Mean score	2.4	2.4	0.7	1.0	4.8	0.36	-0.22
Sum score	58.3	57.0	16.7	24.0	116	0.36	-0.22

		CFA
Factor model	Refinement	CFI	TLI	RMSEA	SRMR	λ	AVE	α	ω	CC
Full model^a	-	0.95	0.94	0.07	0.06	0.31-0.81	0.40	0.94	0.93	0.94
Refined 1	Correlation between errors of item 6 and item 19 (r = 0.46)	0.96	0.95	0.06	0.06	0.29-0.81	0.41	0.93	0.92	0.94
Refined 2	Exclusion of items 6 and 19	0.96	0.95	0.06	0.05	0.43-0.81	0.43	0.94	0.93	0.94

Original version	Portuguese Version
Please indicate how often over the last two weeks the following statements have applied to you. Responses: 1- never, 2- rarely, 3- sometimes, 4- often, 5 always	Por favor, indique com qual frequência as seguintes afirmações se aplicaram a você nas últimas duas semanas. Respostas: 1- Nunca, 2- Raramente, 3- Às vezes, 4- Frequentemente 5- Sempre
1) If I have a problem, I wish somebody else would take the burden away from me.	1) Se tenho um problema, gostaria que outra pessoa tirasse esse peso de mim.
2) I think about all the ways that things can go wrong.	2) Eu penso em todas as maneiras que as coisas poderiam dar errado.
3) I imagine that I might have a serious health issue.	3) Eu imagino que posso ter algum problema sério de saúde.
4) I think about things that others would say are unlikely to happen.	4) Eu penso sobre coisas que os outros diriam ser improváveis de acontecer.
5) If I have an exam, I think that if I fail it will affect my whole future.	5) Se eu tenho que passar por alguma avaliação, penso que se eu falhar, isso afetará todo o meu futuro.
6) I think that we are facing a major environmental disaster that humankind will not survive.	6) Eu penso que estamos vivendo um grande desastre ambiental e que a humanidade não irá sobreviver.
7) I think that a disaster is going to happen to me.	7) Eu penso que algum desastre irá acontecer comigo.
8) If I have a disagreement with a person I care about, I think that we will not make up.	8) Se eu tenho um desentendimento com alguém que eu me importo, penso que não faremos as pazes.
9) I overthink and then become unable to decide what to do.	9) Eu penso demais sobre as coisas e acabo sem tomar decisões.
10) I think I am going to make a big mistake soon.	10) Eu acho que vou cometer algum grande erro em breve.
11) If I have a medical symptom (headache, heart palpitations, stomach ache), I think I must have a serious disease.	11) Se eu tenho algum sintoma físico (dor de cabeça, palpitações, dor no estômago), penso que é uma doença séria.
12) If I have an illness, I don't believe that treatment will work.	12) Se eu tenho uma doença, penso que o tratamento não vai funcionar.
13) If I text a friend and they don’t message me back, I immediately think that they're upset with me.	13) Se eu envio uma mensagem a um amigo e este(a) não responde, logo penso que esse amigo(a) está chateado(a) comigo.
14) I think that any problem will only get worse as time passes.	14) Eu acho que qualquer problema apenas irá piorar com o tempo.
15) If my partner is late home from work, I think that they have been in an accident.	15) Se meu parceiro(a) está atrasado do trabalho, penso que ele(a) se envolveu em algum acidente.
16) I think that what I am going through is much worse than what others have experienced.	16) Eu acho que o que estou passando é muito pior do que outros já passaram.
17) I think I am going to lose someone close to me forever.	17) Eu acho que vou perder alguém próximo de mim para sempre.
18) I think that I will always have money problems.	18) Eu acho que sempre vou ter problemas financeiros.
19) I think that we will see another world war in the next few years.	19) Eu acho que veremos outra guerra mundial nos próximos anos.
20) If I have a bad month at work, I think that I will get fired.	20) Eu penso que se tive um mês ruim no trabalho, serei demitido(a).
21) I think that the worst-case scenarios are very likely to happen.	21) Eu acho que as piores situações possíveis são bem prováveis de acontecer.
22) I think that my house will be burgled.	22) Eu acho que minha casa será assaltada.
23) I think about what will happen if I make a mistake.	23) Eu penso no que irá acontecer se eu cometer algum erro.
24) I think that I am not very good at finding ways to solve my problems.	24) Eu acho que não sou muito bom em encontrar maneiras de resolver os meus problemas.

Item	Mean	Median	Standard Deviation	Maximum	Skewness	Kurtosis
PSC1	1.5	1	1.1	4	0.45	-0.45
PSC2	1.0	1	1.0	4	1.04	0.73
PSC3	0.9	1	1.0	4	1.19	1.04
PSC4	0.9	1	1.1	4	1.13	0.75
PSC5	0.9	1	1.0	4	1.04	0.50
PSC6	1.4	1	1.2	4	0.47	-0.57
PSC7	1.0	1	1.1	4	0.95	0.24
PSC8	2.1	2	1.4	4	0.02	-1.26
PSC9	1.4	1	1.2	4	0.65	-0.34
PSC10	1.4	1	1.2	4	0.71	-0.21
PSC11	1.9	2	1.3	4	0.21	-1.04
PSC12	1.1	1	1.1	4	0.89	0.20
PSC13	1.3	1	1.2	4	0.76	-0.36

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[TFN1] *Estimated from the quotation of 07/06/2025 of the Central Bank of Brazil (US $1.00 = R$5.42).