Assessing baldness’ psychosocial impact

From our systematic review of the baldness psychosocial impact research (Frith & Jankowski., forthcoming), we have found a poor range of measures to assess baldness’ psychosocial impact. These measures tend to either be unvalidated, overly long or not hair loss specific (instead being dermatologically significant).

However a recent alternative measure has been developed from the work of Josip Razum. His measure has the following advantages in my view 1) brevity, 2) being hair loss specific, 3) having some psychometric validity and arising from qualitative and quantitative work on baldness’ psychosocial impact.

Fortunately Josip has agreed to share the measure which apepars in the appendix of his and Tena Vukasović Hlupić’s work. For ease , however the measure and scoring instructions are pasted below.

QUALAGA Measure
Cite: Razum, Josip, and Tena Vukasović Hlupić. ‘Quality of Life in Young Men with Androgenetic Alopecia: A Mixed Methods Study’. Journal of Cosmetic Dermatology, 16 April 2021, jocd.14132. https://doi.org/10.1111/jocd.14132.

Josip Razum contact details: Research gate profile: https://www.researchgate.net/profile/Josip-Razum & Josip.Razum@pilar.hr

Table 1. QUALAGA questionnaire items (N=129; (Razum & Vukasović Hlupić, 2021). Instructions for participants: Please carefully read the following statements regarding hair loss and indicate to what extent do they apply to you on a scale from 0=strongly disagree to 4=strongly agree. Item number and wording (in English and Croatian).
	M (1-5 scale)	SD (1-5 scale)
I’m generally worried about hair loss.	3.28	1.48
Općenito sam zabrinut zbog gubitka kose.
Hair loss makes me feel like I’m losing a part of myself.	2.61	1.46
Gubitkom kose gubim dio sebe.
Hair loss makes me panic.	2.42	1.44
Hvata me panika zbog gubitka kose.
I’m generally less satisfied with myself because of hair loss.	2.57	1.45
Zbog gubitka kose sam općenito manje zadovoljan sobom.
Hair loss worsens the impression I leave on others.	2.15	1.25
Ostavljam lošiji dojam na druge zbog gubitka kose.
Hair loss makes me less confident in flirting with potential partners.	2.58	1.43
Zbog gubitka kose sam manje samouvjeren u zavođenju.
I think about my hair loss in different situations, not just when I’m in front of a mirror.	2.71	1.47
O svom gubitku kose mislim i kad nisam pred ogledalom.
I spend a lot of time covering up my hair loss (e.g., by fixing my hair).	2.11	1.42
Trošim dosta vremena na to da prikrijem gubitak kose (namještanjem kose itd.)
I make sure that my hair loss is less visible in some situations (e.g., when photos are taken).	2.55	1.57
Pazim na to da mi gubitak kose bude manje vidljiv u nekim situacijama (npr. na fotografijama).

Note: To facilitate easier total score interpretation, each item is presented with a response scale from 0=strongly disagree to 4=strongly agree. Scores should be totalled with higher scores indicating higher distress. In this study (Razum & Vukasović Hlupić, 2021) the response scale was 1-5 and the presented item means and standard deviations correspond to that. Sentences in italic represent the original Croatian items. A score of 27 (using the 0-4 scale) could potentially indicate ‘distress’ or “having a lower quality of life due to AGA” (Razum, personal communication, 2021) although further research in other samples with clinical expertise is needed to strengthen this cut off value. Nonetheless, this would mean 15.5% of Razum & Vukasović Hlupić’s  (2021) sample were “distressed” (though note the cut off in this study would have been a score of 36 as previously the response scale was on a 1-5 scale).