Measurement properties of self-report instruments assessing distress tolerance and tolerance for mental pain in adults: a COSMIN systematic review

To evaluate the psychometric properties of patient-reported outcome measures (PROMs) assessing distress tolerance and tolerance for mental pain in adults using the COSMIN methodology and a modified GRADE approach. This COSMIN systematic review of patient-reported outcome measures (PROMs) followed PRISMA 2020 guidelines. We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Library, and Chinese databases from inception to April 21, 2026. Eligible studies included self-report PROMs assessing distress tolerance or tolerance for mental pain in adults. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated using COSMIN criteria, and certainty of evidence was rated using a modified GRADE approach. Instruments were classified into COSMIN recommendation categories based on the overall evidence. Seventeen studies evaluating DTS, TMPS, and related instruments were included. Evidence was strongest for structural validity and internal consistency, whereas content validity, measurement error, cross-cultural validity, and responsiveness were insufficiently investigated. Instruments assessing distress tolerance and tolerance for mental pain were generally classified as Category B, indicating potential utility but insufficient evidence to support high-confidence recommendations. PROMs assessing distress tolerance and tolerance for mental pain show promising structural validity and internal consistency, but evidence for comprehensive validation remains limited. Further studies are required to evaluate content validity, measurement error, cross-cultural validity, and responsiveness before firm recommendations can be made.