Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients.

This study evaluated the psychometric characteristics of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a primary care medical setting. A principal-components analysis with Promax rotation indicated the presence of 2 correlated factors, Somatic-Affective and Cognitive, which explained 53.5% of the variance. A hierarchical, second-order analysis indicated that all items tap into a second-order construct of depression. Evidence for convergent validity was provided by predicted relationships with subscales from the Short-Form General Health Survey (SF-20; A. L. Stewart, R. D. Hayes, & J. E. Ware, 1988). A receiver operating characteristic analysis demonstrated criterion-related validity: BDI-II scores predicted a diagnosis of major depressive disorder (MDD), as determined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ). This study demonstrated that the BDI-II yields reliable, internally consistent, and valid scores in a primary care medical setting, suggesting that use of the BDI-II in this setting may improve detection and treatment of depression in these medical patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of New Zealand psychiatrists' clinical experience with the Mental Health (Compulsory Assessment and Treatment) Act of 1992

AIMS: This study examines the clinical experience of New Zealand psychiatrists with the Mental Health (and Compulsory Assessment and Treatment) Act of 1992. METHODS: A survey was distributed to all psychiatric specialists residing in New Zealand who were registered with the Medical Council of New Zealand (n = 232). The survey examined the extent of practitioners' use of the Mental Health Act, perceived strengths and weaknesses of the Mental Health Act, and experiences with the family court system. RESULTS: Psychiatrists estimated that almost half (46.4%) of patients retained under the Mental Health Act were released within 3 weeks. Inpatient consultants reported dedicating 18.6% of their working time to Mental Health Act related activities. A majority of respondents indicated that: the Mental Health Act requires major revision (55.6%), the Mental Health Act results in the inappropriate release of some psychiatric patients into the community (70.9%), and that compulsory treatment orders are a useful tool for promoting community treatment of the mentally ill (69.2%). While a majority (81.5%) indicate that individual judges are consistent in their interpretation of the Mental Health Act across cases, only 26.5% of respondents agree that the law is interpreted uniformly by different judges. CONCLUSIONS: The Mental Health Act is perceived as time-consuming and cumbersome to administer. However, compulsory treatment orders do facilitate community treatment, an explicit goal of the Mental Health Act. Proposed areas for refinement of the Mental Health Act are discussed. Further examination of the interface between psychiatrists and the family court system would be useful.     

Confirmatory factor analysis of the Consumer Assessment of Health Plans Study (CAHPS) 1.0 core survey.

The National Consumer Assessment of Health Plans Study (CAHPS) Benchmarking Database was used to assess the factor structure and invariance of the CAHPS 1.0 Core Survey. Separate analyses were conducted with Latino and non-Latino Caucasian consumers drawn from commercial and Medicaid sectors (N?=?15,092). Results demonstrated that the 23 CAHPS 1.0 report items measure consumer reports of experiences with 5 aspects of health plan performance: Access to Care, Timeliness of Care, Provider Communication, Health Plan Consumer Service, and Office Staff Helpfulness. Four items assessed global ratings of care. Analyses revealed an identical pattern of fixed and free factor loadings across all samples. Magnitude of factor loadings and correlations among factors was essentially equivalent within a common health service sector. A higher order factor analysis revealed that rating and reports of care showed marked convergence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social anxiety disorder subtypes and their mental health correlates in a nationally representative Canadian sample.

The present study aimed to assess the merit of subtyping social anxiety disorder by validating the nongeneralised subtype, differentiating the generalised and nongeneralised subtypes, and determining the role of feared social situations. Data came from the Canadian Community Health Survey Cycle 1.2 (N = 36,984) of adults aged 15 years and older. Social anxiety disorder was assessed with the World Mental Health Composite International Diagnostic Interview. In accordance with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV) criteria, generalised social anxiety disorder was defined as fearing at least 7 (i.e., most) of 13 feared social situations, whereas nongeneralised social anxiety disorder as fearing 6 or fewer. Results indicated that the nongeneralised subtype was associated with increased odds of comorbid mood, anxiety, and suicidality compared with non-socially anxious adults. Conversely, the generalised subtype was not associated with increased odds of comorbid mental disorders and suicide attempts compared with the nongeneralised subtype after controlling for sociodemographic factors and other comorbid Axis I disorders. Finally, as the number of feared social situations increased, so did the odds of suffering from comorbid mood and anxiety disorders and suicidality. The present study has important implications for the DSM–5. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Performance of the Composite International Diagnostic Interview Short Form for major depression in community and clinical samples

The CIDI Short Form is a brief survey instrument designed to identify episodes of major depression. The instrument was developed for inclusion in the US National Health Interview Survey, but has also been used in the Canadian National Population Health Survey (NPHS). In this study, data deriving from use of the CIDI Short Form in the NPHS are compared to published data from the Mental Health Supplement of the Ontario Health Survey, which utilized a fully validated structured interview: the Composite International Diagnostic Interview (CIDI). In an additional analysis, the sensitivity and specificity of the Short Form were evaluated in relation to the full CIDI mood disorders section in a clinical sample of 122 psychiatric in-patients. Relative to published data from the Ontario Health Survey, application of the CIDI Short Form in the NPHS resulted in an overestimation of major depression prevalence by approximately 50%. In the clinical sample, the CIDI Short Form was highly sensitive (98.4%), but not highly specific (72.7%). Active medical conditions, substance use disorders and dysthymia were frequently observed among subjects with false positive CIDI Short Form ratings. The CIDI Short Form appears to overestimate the 12-month period prevalence of major depression when it is applied in community samples. Since the Short Form does not make exclusions for organically induced symptoms, it is probable that some subjects with depressive symptoms secondary to physical illnesses and/or drug exposures score above the instrument's threshold, perhaps leading to an elevation in period prevalence rates.     

Relationship between the DSM-IV and the ICD-10..

The 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1990) and the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will both come into use in 1993 and be much more alike than the ICD-9 (World Health Organization, 1978) and the DSM-III (American Psychiatric Association, 1980). The American Psychiatric Association's controversial decision to publish a revision of the DSM-III in 1987 before setting up the Task Force to produce the DSM-IV impaired the association's ability to influence the format of the ICD-10, because by then major decisions had already been made by the World Health Organization. The DSM-IV will be more soundly based on a wider range of empirical data than any previous classification, national or international, and should not be revised again without compelling scientific reasons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factorial structure of two health belief measures among older adults.

Confirmatory factor analysis of K. A. Wallston's Multidimensional Health Locus of Control Scale and D. S. Krantz's Health Opinion Survey was conducted using 197 nondiabetic and 171 diabetic older adults. Qualified support was found for the 3-factor structure of the Wallston measure when applied to older adults. The Krantz model provided a less-than-adequate representation of the older sample's data. When the items from these 2 measures were combined, a 4-factor structure was found. Multisample simultaneous factor analyses using LISREL revealed that the factor structures of the Wallston and the Krantz measures fit the diabetic and the nondiabetic samples fairly equivalently. Despite the similarities in factor structures, diabetic individuals reported greater belief in powerful others and less desire for behavioral involvement in the health-care process than did nondiabetics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Between facets and domains: 10 aspects of the Big Five.

Factor analyses of 75 facet scales from 2 major Big Five inventories, in the Eugene-Springfield community sample (N=481), produced a 2-factor solution for the 15 facets in each domain. These findings indicate the existence of 2 distinct (but correlated) aspects within each of the Big Five, representing an intermediate level of personality structure between facets and domains. The authors characterized these factors in detail at the item level by correlating factor scores with the International Personality Item Pool (L. R. Goldberg, 1999). These correlations allowed the construction of a 100-item measure of the 10 factors (the Big Five Aspect Scales [BFAS]), which was validated in a 2nd sample (N=480). Finally, the authors examined the correlations of the 10 factors with scores derived from 10 genetic factors that a previous study identified underlying the shared variance among the Revised NEO Personality Inventory facets (K. L. Jang et al., 2002). The correspondence was strong enough to suggest that the 10 aspects of the Big Five may have distinct biological substrates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the PHQ-9 screen for depression across time since injury among persons with spinal cord injury.

Objective: The overlap of somatic-depressive symptoms and physical sequelae of spinal cord injury (SCI) has raised concerns regarding the validity of depression screens used within the SCI population. The Patient Health Questionnaire-9 (PHQ-9) measure parallels Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) criteria of major depression. The authors investigated PHQ-9 factor structure among persons with SCI at various times postinjury. Design: Data from 2,570 participants at 1 year (N = 682), 5 years (N = 517), 15 years (N = 653), and 25 years (N = 718) postinjury were used. Emergent factors were correlated with satisfaction with life. Results: A 2-factor solution emerged for all groups, with 3 affective referenced items (feeling depressed/hopeless, feeling bad about self/failure, and suicidal ideation) and 3 somatic referenced items (sleep disturbance, low energy/fatigue, and appetite disturbance) loading consistently on Affective and Somatic factors, respectively, at all time points. Factor scores negatively correlated with satisfaction with life. Conclusions: Dual factor structure of the PHQ-9 is present at various times postinjury in the SCI population. It remains unclear whether somatic item endorsement reflects depressive symptomatology per se; however, endorsement is still associated with satisfaction with life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analysis of the PTSD Checklist and the Clinician-Administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero.

Although posttraumatic stress disorder (PTSD) factor analytic research has yielded little support for the DSM-IV 3-factor model of reexperiencing, avoidance, and hyperarousal symptoms, no clear consensus regarding alternative models has emerged. One possible explanation is differential instrumentation across studies. In the present study, the authors used confirmatory factor analysis to compare a self-report measure, the PTSD Checklist (PCL), and a structured clinical interview, the Clinician-Administered PTSD Scale (CAPS), in 2,960 utility workers exposed to the World Trade Center Ground Zero site. Although two 4-factor models fit adequately for each measure, the latent structure of the PCL was slightly better represented by correlated reexperiencing, avoidance, dysphoria, and hyperarousal factors, whereas that of the CAPS was slightly better represented by correlated reexperiencing, avoidance, emotional numbing, and hyperarousal factors. After accounting for method variance, the model specifying dysphoria as a distinct factor achieved slightly better fit. Patterns of correlations with external variables provided additional support for the dysphoria model. Implications regarding the underlying structure of PTSD are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The composition and structure of depressive symptomatology in renal disease.

Renal disease is an increasingly common illness among middle-aged and older adults, and is often associated with depression. The Center for Epidemiologic Studies Depression Scale (CES–D) is a widely used self-report screening measure on which responses generally conform to a 4-factor structure, with each factor loading onto a higher-order Depression factor. The current study examines whether this structure is supported among individuals with renal disease (both predialysis and posttransplant kidney disease patients). Persons with renal disease (n = 225) and healthy control participants (n = 230) were recruited from Vancouver General Hospital and the community. Participants completed the CES–D as part of an extended assessment. Confirmatory factor analytic models were computed for the renal disease and healthy control groups. Results support a 4-factor structure for CES–D responses in persons with renal disease and healthy controls. The hierarchical structure of CES–D responses also appears invariant between groups. Factor structure was similar between groups; only for Depressive Affect was the strength of association with the second-order factor greater among the renal disease than healthy control participants. Findings support similarity of CES–D factor structures between patients with renal disease and healthy individuals. Results suggest that the CES–D's 4 factors contribute to measurement of a higher-order Depression factor in both groups; furthermore, 3 of 4 factors appear invariant between groups. As such, this measure can be used confidently to quantify depressive symptoms in individuals with renal disease. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The structure of psychological distress and well-being in general populations.

Describes the development of the Mental Health Inventory (MHI), a 38-item measure of psychological distress and well-being, developed for use in general populations. The MHI was fielded in 4 large samples (N?=?5089) of Ss aged 13–69 yrs. One data set was used to explore the MHI's factor structure, and confirmatory factor analyses were used for cross validation. Results support a hierarchical factor model composed of a general underlying psychological distress vs well-being factor; a higher order structure defined by 2 correlated factors—Psychological Distress and Well-Being; and 5 correlated lower order factors—Anxiety, Depression, Emotional Ties, General Positive Affect, and Loss of Behavioral Emotional Control. Summated rating scales produced high internal consistency estimates and substantial stability over a 1-yr interval. Results provide strong psychometric support for a hierarchical model and scoring options ranging from 5 distinct constructs to reliance on 1 summary index. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Police may underuse Section 136

A one-year prospective study comparing Section 136 patients (39) and the severe Section 2 or 4 patients (29) of the Mental Health Act 1983 in a hospital with inner London catchment areas. The assessments were clinical, nurses' ratings and socio-demographic. The results showed that clinical and nursing ratings did not differentiate the two groups. Most social/demographic data showed similar trends with both groups being disadvantaged but Section 136 patients slightly more so. The differences were smaller than anticipated, suggesting a recent shift of patients admitted under Section 2 or 4 towards a more socially disadvantaged position. In conclusion, police did not overuse Section 136. Our comparison suggests: (a) police may underuse Section 136, and (b) Section 136 acts as a valuable 'back-up' for those patients who would otherwise fail to benefit from the Mental Health Act.     

The Structure of Child and Adolescent Psychopathology: Generating New Hypotheses.

To begin to resolve conflicts among current competing taxonomies of child and adolescent psychopathology, the authors developed an interview covering the symptoms of anxiety, depression, inattention, and disruptive behavior used in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994), the International Statistical Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992), and several implicit taxonomies. This interview will be used in the future to compare the internal and external validity of alternative taxonomies. To provide an informative framework for future hypothesis-testing studies, the authors used principal factor analysis to induce new testable hypotheses regarding the structure of this item pool in a representative sample of 1,358 children and adolescents ranging in age from 4 to 17 years. The resulting hypotheses differed from the DSM-IV, particularly in suggesting that some anxiety symptoms are part of the same syndrome as depression, whereas separation anxiety, fears, and compulsions constitute a separate anxiety dimension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A confirmatory factor analysis of the Impact of Event Scale using a sample of World War II and Korean War Veterans.

This study assessed the factor structure of the Impact of Event Scale (IES), a measure of intrusion and avoidance, using a sample of World War II and Korean War veterans who had experienced combat 40–50 years earlier. A series of 3 confirmatory factor analytic models were specified and estimated using LISREL 8.3. Model 1 specified a 1-factor model. Model 2 specified a correlated 2-factor model. Model 3 specfied a 2-factor model with additional cross-factor loadings for Items 2 and 12. Model 3 was found to fit the data. In addition, this model was found to be a better explanation of the data than the other models. Also in addition, the correlations between the Intrusion and Avoidance factors and the 4 subscales of the 28-item General Health Questionnaire were examined to determine the distinctiveness of the two IES factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor structure of the acute stress disorder scale in a sample of Hurricane Katrina evacuees.

Acute stress disorder (ASD) is a poorly understood and controversial diagnosis (A. G. Harvey & R. A. Bryant, 2002). The present study used confirmatory factor analysis (CFA) to test the factor structure of the most widely used self-report measure of ASD, the Acute Stress Disorder Scale (R. A. Bryant, M. L. Moulds, & R. M. Guthrie, 2000), in a sample of Hurricane Katrina evacuees relocated to a Red Cross emergency shelter in Austin, Texas. Results indicated that the proposed 4-factor structure did not fit the data well. However, an alternate 2-factor model did fit the data well. This model included a second-order Distress factor (onto which the Reexperiencing, Arousal, and Avoidance factors loaded strongly) that was positively correlated with the Dissociation factor. Implications for the ASD construct and its measurement are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent variable analyses of age trends of cognition in the Health and Retirement Study, 1992-2004.

The present study was conducted to better describe age trends in cognition among older adults in the longitudinal Health and Retirement Study (HRS) from 1992 to 2004 (N = 17,000). The authors used contemporary latent variable models to organize this information in terms of both cross-sectional and longitudinal inferences about age and cognition. Common factor analysis results yielded evidence for at least 2 common factors, labeled Episodic Memory and Mental Status, largely separable from vocabulary. Latent path models with these common factors were based on demographic characteristics. Multilevel models of factorial invariance over age indicated that at least 2 common factors were needed. Latent curve models of episodic memory were based on age at testing and showed substantial age differences and age changes, including impacts due to retesting as well as several time-invariant and time-varying predictors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Swedish SF-36 Health Survey II. Evaluation of clinical validity: results from population studies of elderly and women in Gothenborg

The validity of the Swedish SF-36 Health Survey was examined, replicating techniques used in the U.S. validation. Principal components analysis was used to test the internal structure of the eight SF-36 scales in relation to hypothesized associations with the two major dimensions of health--physical and mental. Hypothesized relationships between scales and external criteria were also examined by means of clinical group contrasts. Both the principal components analysis and clinical group contrasts largely replicated U.S. findings, which supported the cross-cultural stability of the SF-36 in Sweden. As expected, the Physical Functioning and Mental Health scales were most sensitive to clinical manifestations of medical and mental health, respectively. The General Health scale was associated more with physical than mental health. However, the Social Functioning scale and particularly the Vitality scale were more related to mental health in Sweden than in the corresponding U.S. study. Cultural differences and variation in study samples and selection criteria were suggested as possible explanatory factors for these differences.     

The Nutrition Attitude Survey: Associations with dietary habits, psychological and physical well-being, and coronary risk factors.

Developed a nutrition attitude survey (NAS) to measure attitudes pertaining to the adoption of a low-fat, low-cholesterol diet. Factor analysis identified 4 primary attitudinal factors: (a) Helpless and Unhealthy, (b) Food Exploration, (c) Meat Preference, and (d) Health Consciousness. For a community sample of 357 healthy men and women, relationships were examined among these attitudinal factors and dietary habits, family food patterns, medical and psychological symptoms (as assessed by the Cornell Medical Index and SCL-90—Revised), and traditional coronary risk factors. Findings provide initial support for the reliability and predictive validity of the NAS and underscore the importance of addressing the attitudes and preferences of participants in dietary intervention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One day survey by the Mental Health Act Commission of acute adult psychiatric inpatient wards in England and Wales

OBJECTIVES: To provide (via the Mental Health Act Commission's "national visit") empirical evidence on ward occupancy levels, use of the Mental Health Act 1983, nurse staffing, and care of female patients on acute adult psychiatric wards. DESIGN: One day survey of a stratified random sample. SETTINGS: 119/250 (47%) acute adult psychiatric inpatient units in England and Wales. SUBJECTS: End sample of 263 acute psychiatric inpatient wards. MAIN OUTCOME MEASURES: Ward occupancy rates; number of patients detained under the Mental Health Act and proportion "absent without leave"; nurse staffing levels, skill mix, and vacancies;proportion of women with self contained, women-only facilities. RESULTS: Mean ward occupancy was 99% (95% confidence interval 97% to 102%). A ward mean of 30% (28% to 32%) of patients were detained under the Mental Health Act; of all detained patients, 1% (1% to 2%) were absent without leave. A ward mean of 0.3 (0.29 to 0.31) nurses were on duty per patient at the time of the visit. An estimated ward mean of 31% (30% to 32%) of nurse staffing may have been through casual contracts--higher in inner (48% (43% to 53%)) and outer London (45% (41% to 48%)). On 26% (21% to 32%) of wards, there were no nurses interacting with patients. A ward mean of 36% (30% to 41%) of female patients had self contained, women-only facilities. CONCLUSIONS: Attention should focus on improving the quality of acute inpatient psychiatric care as well as of community care.