The Component Structure of the Dizziness Handicap Inventory (DHI): A Reappraisal

Kelly M. Van De Wyngaerde, Minji K. Lee, Gary P. Jacobson, Kalyan Pasupathy, Santiago Romero-Brufau, Devin L. McCaslin

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objective: The Dizziness Handicap Inventory (DHI) is a 25-item self-report questionnaire developed to measure the disabling and handicapping impact of dizziness. The present investigation was conducted in an effort to re-assess the factor structure of the DHI. Study Design: Retrospective study. Setting: Tertiary care center. Patients: Subjects were 1,991 patients who were evaluated in the Mayo Clinic-Rochester Vestibular and Balance Laboratory. Main Outcome Measures: Exploratory factor analysis: an exploratory bifactor analysis (EFA) with bifactor rotation was used to analyze a random sample of 999 patients. Analyses were used to determine the dominance of the general factor (i.e., total score) relative to the group factor (i.e., subscales). Confirmatory factor analysis: a confirmatory bifactor graded response model was fit with appropriate item-to-group relationships that was discovered by our exploratory analyses. To validate the bifactor model that was identified with the exploratory analyses, a bifactor model with three grouping factors (i.e., Physical manifestations, Catastrophic impact of dizziness, and the Emotional impact of dizziness) were fit to a different random sample of 992 patients using the new item-to-group factor specifications. Results: In the confirmatory analyses, all items had a positive factor loading on the general factor. There were 14 items that loaded on the general factor only. The rest of the items (n = 11) loaded on both the general factor and one of three group factors. Conclusions: Conclusions of the study revealed several findings: 1) reporting the result as a total score (i.e., a single general factor) is warranted, and, 2) there is statistical support for the existence of three subscales representing: the Physical manifestations, Catastrophic impact, and Emotional impact of dizziness and vertigo.

Original languageEnglish (US)
Pages (from-to)1217-1223
Number of pages7
JournalOtology and Neurotology
Issue number9
StatePublished - Oct 1 2019


  • Dizziness
  • Dizziness Handicap Inventory
  • Self-report dizziness handicap

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology


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