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Preview: International Journal of Methods in Psychiatric Research

International Journal of Methods in Psychiatric Research

Wiley Online Library : International Journal of Methods in Psychiatric Research

Published: 2017-12-01T00:00:00-05:00


Violence and child mental health in Brazil: The Itaboraí Youth Study methods and findings


Objectives To demonstrate a study design that could be useful in low-resource and violent urban settings and to estimate the prevalence of child violence exposure (at home, community, and school) and child mental health problems in a low-income medium-size city. Methods The Itaboraí Youth Study is a Norway–Brazil collaborative longitudinal study conducted in Itaboraí city (n = 1409, 6–15 year olds). A 3-stage probabilistic sampling plan (random selection of census units, eligible households, and target child) generated sampling weights that were used to obtain estimates of population prevalence rates. Results Study strengths include previous pilot study and focus groups (testing procedures and comprehension of questionnaire items), longitudinal design (2 assessment periods with a mean interval of 12.9 months), high response rate (>80%), use of standardized instruments, different informants (mother and adolescent), face-to-face interviews to avoid errors due to the high frequency of low-educated respondents, and information gathered on a variety of potential predictors and protective factors. Children and adolescents presented relevant levels of violence exposure and clinical mental health problems. Conclusions Prevalence estimates are probably valid to other Brazilian low-income medium-size cities due to similarities in terms of precarious living conditions. Described study methods could be useful in other poor and violent world regions.

Methods to reduce false reporting of substance abstinence in clinical research


Objectives Substance use may influence study results in human subjects research. This study aims to report the concordance between self-report and biochemical assessments of substance use and test the effect of methods to reduce false reports of abstinence in trauma-exposed women participating in a research study. Methods In this pilot study, substance use was assessed during telephone prescreening and via self-report and biochemical verification (i.e., urine toxicology and alcohol breathalyzer tests) at an in-person evaluation. Due to the high number of participants who tested positive for substances despite self-reporting abstinence during prescreening, study procedures were modified to disincentivize false self-reports of substance use two thirds of the way through recruitment. New potential participants were explicitly informed during prescreening and informed consent that a positive drug or alcohol test during screening would result in exclusion from the study and withholding of payment. Results Prior to modifying study methods, 20% of participants who had reported abstinence during the telephone prescreen had a positive substance use test at the in-person visit. Modifying study procedures resulted in an 81% decrease in positive substance use assessments. Conclusions Adoption of this methodology may decrease inadvertent confounding of clinical research outcomes by undetected and/or misreported substance use.

Decision curve analysis as a framework to estimate the potential value of screening or other decision-making aids


Objectives There is an increasing debate about the impact of mental health screening. We illustrate the use of a decision making framework that can be applied when there is no sufficient data to support a traditional cost-benefit analysis. Methods We conducted secondary analyses of data from 459 male prisoners who were screened upon intake. We compared the potential benefit of different approaches (screening, history taking, and universal interventions) to allocating treatment resources using decision curve analysis. Results Screening prisoners for distress at typical levels of sensitivity (75%) and specificity (71%) were estimated to provide the greatest net benefit if between 2 and 5 false positives per detected illness are tolerable. History taking and self-harm screening provide the largest net benefit when only 1 or 2 false positives per detected illness would be tolerable. The benefits of screening were less among those without a recent psychiatric history, ethnic minorities, and those with fewer psychosocial needs. Conclusions Although screening has potential to increase detection of treatment, important subgroup differences exist. Greater consideration of responses to positive screens or alternatives to screening are needed to maximize the impact of efforts to improve detection and treatment of mental illness.

Automatic mining of symptom severity from psychiatric evaluation notes


Objectives As electronic mental health records become more widely available, several approaches have been suggested to automatically extract information from free-text narrative aiming to support epidemiological research and clinical decision-making. In this paper, we explore extraction of explicit mentions of symptom severity from initial psychiatric evaluation records. We use the data provided by the 2016 CEGS N-GRID NLP shared task Track 2, which contains 541 records manually annotated for symptom severity according to the Research Domain Criteria. Methods We designed and implemented 3 automatic methods: a knowledge-driven approach relying on local lexicalized rules based on common syntactic patterns in text suggesting positive valence symptoms; a machine learning method using a neural network; and a hybrid approach combining the first 2 methods with a neural network. Results The results on an unseen evaluation set of 216 psychiatric evaluation records showed a performance of 80.1% for the rule-based method, 73.3% for the machine-learning approach, and 72.0% for the hybrid one. Conclusions Although more work is needed to improve the accuracy, the results are encouraging and indicate that automated text mining methods can be used to classify mental health symptom severity from free text psychiatric notes to support epidemiological and clinical research.

The Frankfurt Complaint Questionnaire for self-assessment of basic symptoms in the early detection of psychosis—Factor structure, reliability, and predictive validity


Objectives Patients with schizophrenia often experience subtle disturbances in several domains of information processing—so-called basic symptoms (BS). BS are already present before onset of frank psychosis and can be assessed by interviews but also by the self-administered Frankfurt Complaint Questionnaire (FCQ). We investigated the factor structure, reliability, and predictive validity for transition to psychosis of the FCQ, comparing previously proposed factor solutions containing 1, 2, 4, and 10 factors. Methods Confirmatory factor analysis was used in a sample of 117 at-risk mental state and 92 first-episode psychosis participants of the Basel FePsy (early detection of psychosis) study. Results Although all factor models fitted to the data, the 2- or 4-factor solutions performed best among the models that used at least half of the FCQ items, suggesting the covariance between FCQ items is best explained by 2 to 4 underlying factors. No FCQ-scale predicted transition to psychosis. Conclusion We could confirm a 2- to 4-factor structure of the FCQ in a sample of at-risk mental state and first-episode psychosis patients using confirmatory factor analysis. Contrary to interview-assessed cognitive–perceptive BS, self-assessed BS do not seem to improve prediction of psychosis. This result reinforces reports of poor correspondence between interview- and questionnaire-assessed BS.

Assessing body awareness and autonomic reactivity: Factor structure and psychometric properties of the Body Perception Questionnaire-Short Form (BPQ-SF)


Body awareness and reactivity dysfunction are characteristic of a range of psychiatric disorders. Although the neural pathways communicating between the body and brain that contribute to these experiences involve the autonomic nervous system, few research tools for studying subjective bodily experiences have been informed by these neural circuits. This paper describes the factor structure, reliability, and convergent validity of the Body Awareness and Autonomic Reactivity subscales of the Body Perception Questionnaire-Short Form (BPQ-SF). Exploratory and confirmatory factor analyses were applied to data from three samples collected via the internet in Spain and the US and a college population in the US (combined n = 1320). Body awareness was described by a single factor. Autonomic reactivity reflected unique factors for organs above and below the diaphragm. Subscales showed strong reliability; converged with validation measures; and differed by age, sex, medication use, and self-reported psychiatric disorder. Post hoc analyses were used to create the 12-item Body Awareness Very Short Form. Results are discussed in relation to the distinct functions of supra- and sub-diaphragmatic autonomic pathways as proposed by the Polyvagal Theory and their potential dysfunction in psychiatric disorders.

Profile analysis of treatment effect changes in eating disorder indicators


We investigated differential treatment effects on specific eating disorder (ED) indicators to enhance conclusions about treatment efficacy. Profile Analysis via Multidimensional Scaling, which identifies core profiles in a population and interprets person profiles with core profile information, was utilized to identify core profiles from a sample of 5,177 patients who were repeatedly measured with the ED inventory-2 at admission and at discharge. To assess differential treatment effects for individual ED indicators, we compared the core profiles at admission with those at discharge. Three core profiles were identified and labeled as High Body Dissatisfaction with Low Bulimia (Core Profile 1), High Interoceptive Awareness with Low Body Dissatisfaction (Core Profile 2), and High Ineffectiveness with Low Bulimia (Core Profile 3). Treatment had the greatest effects on Core Profile 2. The patients whose profile patterns were similar to that of Core Profiles 1 and 2 were positively related with weight gain. However, treatment was least on Core Profile 3, and the patients whose profile patterns were like that of Core Profile 3 were negatively related with weight gain. In conclusion, those patients who fit Core Profile 3 may benefit from different treatment modalities than those that are standard in inpatient settings.

The Cannabis Abuse Screening Test and the DSM-5 in the general population: Optimal thresholds and underlying common structure using multiple factor analysis


The Cannabis Abuse Screening Test (CAST) aims at screening the problematic use of cannabis. It has never been validated against the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and its relationships with this latter have never been studied. We used a probabilistic telephone survey collected in 2014 (1351 past-year cannabis users aged 15–64) implementing the CAST and a DSM-5 adaptation of the Munich Composite International Diagnostic Interview assessing cannabis use disorders. Data were weighted, and CAST items were considered categorical. Factorial structures were assessed with confirmatory factor analyses; the relationships between the instruments were studied with multiple factor analysis (MFA). One factor for the DSM-5 and two correlated factors for the CAST were the best confirmatory factor analyses solutions. The CAST thresholds for screening moderate/severe and severe cannabis use disorders were 5 (sensitivity = 78.2% and specificity = 79.6%) and 8 (sensitivity = 86.0% and specificity = 86.7%), respectively. The MFA identified two orthogonal dimensions: The first was equally shared by both instruments; the second was the second CAST dimension (extreme frequencies of use before midday and alone, memory problems, and reproaches from friends/family). The CAST structure and screening properties were confirmed. The MFA explains its screening performances by its first dimension and identified the problematic patterns (the second dimension) that are not captured by the DSM-5.

The Screen for Cognitive Impairment in Psychiatry: Proposal for a polytomous scoring system


The Screen for Cognitive Impairment in Psychiatry is a simple, fast, and easy to administer scale that has been validated in clinical and community samples. The aim of this study was to propose a polytomous scoring system for the Screen for Cognitive Impairment in Psychiatry and to demonstrate its functioning, thus providing new and complementary information regarding the utility and precision of this screening tool. Three hundred seventy-six Spanish patients diagnosed with schizophrenia spectrum disorder were evaluated. A polytomous scoring system was generated and analyzed by means of the partial credit model. Category assessment revealed optimal functioning after collapsing the 7-category system to 1 with either 5 or 4 categories, depending on the item. The proposed polytomous scoring system shows good psychometric properties and an adequate fit to the partial credit model. These results provide further confirmation of the test's utility in clinical settings and of its suitability for detecting cognitive impairment.

Cognitive functioning in the general population: Factor structure and association with mental disorders—The neuropsychological test battery of the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH)


The objective of this study is to obtain population level data about cognitive functions and their association with mental disorders. We here report factor analytic and psychometric findings of a neuropsychological test battery and examine the association of current and past mental disorders with cognitive function in a large nationwide population-based sample of 18- to 79-year-old adults in Germany (n = 3,667) participating in the mental health module of the German Health Interview and Examination Survey for Adults 2008–2011. Confirmatory factor analysis confirmed verbal memory and executive function factors. Older age was strongly associated with lower verbal memory and executive function and with higher vocabulary scores. After adjustment for age, sex, and education, rather modest decrements were found for verbal memory (β = −.118, p = .002) and executive functions (β = −.191, p < .001) in participants with any current mental disorder (n = 442) compared to those without (n = 3,201). Small decrements in memory (β = −.064, p = .031) and executive function (β = −.111, p < .001) were found in participants with any mental disorder in the last 12 months but not in those with past (fully or partially remitted) mental disorders, compared to participants without a history of mental disorder. More fine-grained analyses of these data will investigate the complex interplay between cognition, health behaviors, and specific mental and somatic diseases.

The assessment of nonverbal behavior in schizophrenia through the Formal Psychological Assessment


The nonverbal behavior (NVB) of people diagnosed with schizophrenia consistently interacts with their symptoms during the assessment. Previous studies frequently observed such an interaction when a prevalence of negative symptoms occurred. Nonetheless, a list of NVBs linked to negative symptoms needs to be defined. Furthermore, a list of items that can exhaustively assess such NVBs is still needed. The present study aims to introduce both lists by using the Formal Psychological Assessment. A deep analysis was performed on both the scientific literature and the DSM-5 for constructing the set of nonverbal behaviors; similarly, an initial list of 138 items investigating the behaviors was obtained from instruments used to assess schizophrenia. The Formal Psychological Assessment was then applied to reduce the preliminary list. A final list of 23 items necessary and sufficient to investigate the NVBs emerged. The list also allowed us to analyze specific relations among items. The present study shows how it is possible to deepen a patient's negative symptomatology, starting with the relations between items and the NVBs they investigate. Finally, this study examines the advantages and clinical implications of defining an assessment tool based on the found list of items.

Reliability and validity of severity dimensions of psychopathology assessed using the Structured Clinical Interview for DSM-5 (SCID)


This study examined whether the Structured Clinical Interview for DSM (SCID), a widely used semistructured interview designed to assess psychopathology categorically, can be adapted to identify reliable and valid severity dimensions of psychopathology. The present study also examined whether these severity dimensions have better psychometric properties (internal consistency, test–retest reliability, and concurrent and predictive validity) than categorical diagnoses. Participants (N = 234) were recruited from the community and clinics. Retest reliability and prospective predictive validity (symptoms and functioning 1 year later) were examined in subsamples of participants. Dimensional severity scales were created from an adapted version of the SCID for both current and lifetime major depression, alcohol, substance, post-traumatic stress disorder, panic, agoraphobia, social anxiety, specific phobia, obsessive–compulsive disorder, and generalized anxiety disorder. The SCID's severity scales demonstrated substantial internal consistency (all Cronbach's αs >.80), test–retest reliability, and concurrent and predictive validity. Symptom severity scales demonstrated significant incremental validity over and above categorical diagnoses for both current and prospective outcomes. The psychometric properties of SCID-identified symptom scales were far superior to the psychometrics of categorical diagnoses for both current and lifetime psychopathology. These results highlight the feasibility and utility of the SCID to assess reliable and valid symptom severity dimensions of both current and lifetime psychopathology.

Age of onset or age at assessment—that is the question: Estimating newly incident alcohol drinking and rapid transition to heavy drinking in the United States, 2002–2014


Age-specific incidence estimates are important and useful facts in psychiatric epidemiology, but incidence estimation can be challenging. Methods artifacts are possible. In the United States, where the minimum legal drinking age is 21 years, recent cross-sectional field research on 12- to 25-year-olds applied conventional “age-at-assessment” approaches (AAA) for incidence estimation based on 12-month recall. Estimates disclosed unexpected nonlinear patterns in age-specific incidence estimates for both drinking onset and for transitioning from first drink to heavy drinking. Here, our aim is to draw attention to an “age of onset” (AOO) alternative to AAA approaches and to verify whether the AOO approach also discloses nonlinearity. Yearly data are from U.S. nationally representative samples drawn and assessed for National Surveys on Drug Use and Health, 2002–2014, with standardized audio computer-assisted self-interview assessments for drinking outcomes. Both AAA and AOO approaches show nonlinearities, with an unexpected dip in drinking incidence rates after age 18 and before the age 21 minimum legal drinking age. The AOO and the AAA approaches disclosed similar age-specific patterns. We discuss advantages of the AOO approach when nonlinear incidence patterns can be anticipated, but we conclude that the AAA approach has not created an artifactual nonlinear pattern.

Patient experiences with care across various types of mental health care: Questionnaire development, measurement invariance, and patients' reports


To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty-five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after-care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168). Exploratory structural equation modelling was conducted on a random split-half sample to examine dimensionality. Confirmatory factor analysis and multiple group confirmatory factor analyses were conducted on the holdout sample to confirm dimensionality and assess measurement invariance across type of service and patient characteristics. Multilevel logistic regression models linking subscale top box scores to overall rating items were used to assess criterion validity. The hypothesized dimensionality was partly confirmed, and configural and scalar invariance were demonstrated across types of organizations and patient characteristics. Subscale scores were significantly associated with overall ratings. Process evaluation showed that participating organizations strongly support continued use of this questionnaire. This validated patient experience questionnaire supports comparison across organizations from different types of services to improve the quality of mental health care.

Modeling count data in the addiction field: Some simple recommendations


Analyzing count data is frequent in addiction studies but may be cumbersome, time-consuming, and cause misleading inference if models are not correctly specified. We compared different statistical models in a simulation study to provide simple, yet valid, recommendations when analyzing count data.We used 2 simulation studies to test the performance of 7 statistical models (classical or quasi-Poisson regression, classical or zero-inflated negative binomial regression, classical or heteroskedasticity-consistent linear regression, and Mann-Whitney test) for predicting the differences between population means for 9 different population distributions (Poisson, negative binomial, zero- and one-inflated Poisson and negative binomial, uniform, left-skewed, and bimodal). We considered a large number of scenarios likely to occur in addiction research: presence of outliers, unbalanced design, and the presence of confounding factors. In unadjusted models, the Mann-Whitney test was the best model, followed closely by the heteroskedasticity-consistent linear regression and quasi-Poisson regression. Poisson regression was by far the worst model. In adjusted models, quasi-Poisson regression was the best model. If the goal is to compare 2 groups with respect to count data, a simple recommendation would be to use quasi-Poisson regression, which was the most generally valid model in our extensive simulations.

Understanding parent–teacher agreement of the Strengths and Difficulties Questionnaire (SDQ): Comparison across seven European countries


Assessments of child psychopathology are often derived from parental and teacher reports, yet there is substantial disagreement. This study utilized data from 7 European countries to examine parent–teacher agreement and possible explanatory factors for parent–teacher disagreement such as child and family characteristics, parenting dimensions, and maternal distress were explored. Parent–teacher agreement of the Strengths and Difficulties Questionnaire were assessed using a cross-sectional survey of 4,894 school aged children 6–11 from the School Children Mental Health Europe Project. Parent–teacher agreement was low to moderate (Pearson correlation ranging from .24 (Prosocial) to .48 (Hyperactivity) for the 5 subscales across 7 countries); kappa coefficient ranged from .01 (Turkey) to .44 (Italy) for internalizing problems and .19(Romania) to .44(Italy) for externalizing problems. Child's gender and age, mother's employment status, single parent home, number of children in household, and selected parenting dimension were found to be explanatory of informant disagreement. This study not only serves to advance our understanding of parent–teacher agreement of the Strengths and Difficulties Questionnaire in 7 European countries but provides a novel approach to examining the factors that contribute to informant disagreement.

Is adjustment disorder unidimensional or multidimensional? Implications for ICD-11


In preparation for ICD-11, the adjustment disorder (AjD) diagnosis has undergone considerable revisions; however, the latent structure of AjD remains uncertain. It is unclear whether AjD is best represented as a unidimensional or multidimensional construct. This study performed a comprehensive assessment of the latent structure of AjD symptomatology and assessed its concurrent and discriminant validity. Individuals who experienced involuntary job loss (N = 333) completed a self-report measure of AjD symptoms. Seven alternative models of AjD were tested using confirmatory factor analysis. General psychological distress, impairment in social functioning, occupational self-efficacy, and sense of coherence were used as criterion variables for construct validity. In the confirmatory factor analysis, a bifactor solution with one dominant general AjD factor and 5 correlated group factors (preoccupation, failure-to-adapt, avoidance, affective reaction, and impulsivity) provided optimal fit. As expected, the AjD factor showed strong positive associations with general psychological distress and impairments in social functioning and moderately negative associations with occupational self-efficacy and sense of coherence. With regard to unidimensionality or multidimensionality of AjD symptoms, the current results indicate the plausibility of a unidimensional conceptualization. Future research should focus on essential key characteristics and a reduction of symptoms for the AjD definition.

Measuring the hierarchical general factor model of psychopathology in young adults


There is evidence that models of psychopathology specifying a general factor and specific second-order factors fit better than competing structural models. Nonetheless, additional tests are needed to examine the generality and boundaries of the general factor model. In a selected second wave of a cohort study, first-order dimensions of psychopathology symptoms in 499 23- to 31-year-old twins were analyzed. Using confirmatory factor analysis, a bifactor model specifying a general factor and specific internalizing and externalizing factors fit better than competing models. Factor loadings in this model were sex invariant despite greater variances in the specific internalizing factor among females and greater variances in the general and specific externalizing factors among males. The bifactor structure was robust to the exclusion of any single first-order dimension of psychopathology. Furthermore, the results were essentially unchanged when all overlapping symptoms that define multiple disorders were excluded from symptom dimensions. Furthermore, the best-fitting bifactor model also emerged in exploratory structural equation modeling with freely estimated cross-loadings. The general factor of psychopathology was robust across variations in measurement and analysis.

Categorical and dimensional perspectives on depression in elderly primary care patients – Results of the AgeMooDe study


An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study “Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)” a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.

A new method for analysing transition to psychosis: Joint modelling of time-to-event outcome with time-dependent predictors


An active area in psychosis research is the identification of predictors of transition to a psychotic state among those who are assessed as being at high risk of psychosis. Many of the potential predictors are time dependent in the sense that they may change over time and are measured at a number of assessment time points. Examples are various psychopathological measures such as negative symptoms, positive symptoms, depression, and anxiety. Most research in transition to psychosis has not made use of the dynamic nature of these measures, probably because suitable statistical methods and software have not been easily available. However, a relatively new statistical methodology is well suited to include such time-dependent predictors in transition to psychosis analysis. This methodology is called joint modelling and has recently been incorporated in mainstream statistical software. This paper describes this methodology and demonstrates its usefulness using data from one of the pioneering studies on transition to psychosis.

Assessing risk of bias in randomized controlled trials of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)


To test how reliable the tool recommend by Cochrane Collaboration for assessing risk of bias systematic reviews of randomized clinical trials is in the context of methylphenidate for children and adolescents with attention deficit hyperactivity disorder. Confirmatory factor analysis was used to evaluate a unidimensional model for the 7 indicators, applied to 184 Randomized Clinical Trial (RCTs) within a 2015 Cochrane systematic review titled “Methylphenidate for children and adolescents with attention deficit hyperactivity disorder.” A unidimensional model resulted in excellent adequacy indices, but only 2 indicators had very high factor loadings and low measurement errors. In terms of content, the 7 indicators showed poor reliability (ω = 0.642); however, the set of indicators was precise in evaluating studies with a high amount of bias risk. The Cochrane model of risk of bias as it is, exhibited good fit indices but the majority of the items were not reliable to adequately capture risk of bias in the context of clinical trials of methylphenidate for ADHD.

Finding “hard to find” literature on hard to find groups: A novel technique to search grey literature on refugees and asylum seekers


There is a lack of information on how to execute effective searches of the grey literature on refugee and asylum seeker groups for inclusion in systematic reviews. High-quality government reports and other grey literature relevant to refugees may not always be identified in conventional literature searches. During the process of conducting a recent systematic review, we developed a novel strategy for systematically searching international refugee and asylum seeker-related grey literature. The approach targets governmental health departments and statistical agencies, who have considerable access to refugee and asylum seeker populations for research purposes but typically do not publish findings in academic forums. Compared to a conventional grey literature search strategy, our novel technique yielded an eightfold increase in relevant high-quality grey sources that provided valuable content in informing our review. Incorporating a search of the grey literature into systematic reviews of refugee and asylum seeker research is essential to providing a more complete view of the evidence. Our novel strategy offers a practical and feasible method of conducting systematic grey literature searches that may be adaptable to a range of research questions, contexts, and resource constraints.

Prediction of outcome in internet-delivered cognitive behaviour therapy for paediatric obsessive-compulsive disorder: A machine learning approach


Background There are no consistent predictors of treatment outcome in paediatric obsessive–compulsive disorder (OCD). One reason for this might be the use of suboptimal statistical methodology. Machine learning is an approach to efficiently analyse complex data. Machine learning has been widely used within other fields, but has rarely been tested in the prediction of paediatric mental health treatment outcomes. Objective To test four different machine learning methods in the prediction of treatment response in a sample of paediatric OCD patients who had received Internet-delivered cognitive behaviour therapy (ICBT). Methods Participants were 61 adolescents (12–17 years) who enrolled in a randomized controlled trial and received ICBT. All clinical baseline variables were used to predict strictly defined treatment response status three months after ICBT. Four machine learning algorithms were implemented. For comparison, we also employed a traditional logistic regression approach. Results Multivariate logistic regression could not detect any significant predictors. In contrast, all four machine learning algorithms performed well in the prediction of treatment response, with 75 to 83% accuracy. Conclusions The results suggest that machine learning algorithms can successfully be applied to predict paediatric OCD treatment outcome. Validation studies and studies in other disorders are warranted.

Psychometric investigation of the specific phobia of vomiting inventory: A new factor model


Well-validated, standardized measures are lacking for the assessment of emetophobia, the specific phobia of vomiting. The Specific Phobia of Vomiting Inventory (SPOVI) was recently developed and shows promise as a useful measure of emetophobia. The goal of the present study was to further examine and investigate the psychometric properties of the SPOVI in a large student sample (n = 1626), specifically focusing on its factor structure, measurement invariance across gender, and convergent/divergent validity. Confirmatory factor analysis results provide support for a one-factor model of the SPOVI, in contrast to the previously proposed two-factor model. Internal consistency of the SPOVI was good (α = 0.89) and measurement invariance across gender invariance was supported. The SPOVI also demonstrated good psychometric properties with respect to convergent and divergent validity. The present study's demonstration of the reliability and validity of the SPOVI suggests that the instrument may be a valuable tool for assessing emetophobia symptoms based on its one-factor structure.

Placebo response and its determinants in children with ADHD across multiple observers and settings: A randomized clinical trial


This study aims to quantify placebo response (PR) in children with attention deficit hyperactivity disorder (ADHD) as assessed by parents and teachers and to explore some of its determinants. Five hundred and forty children with ADHD (ages 6–12) were recruited to a randomized, double-blind, placebo-controlled crossover trial with methylphenidate. The main outcome variable was Conners' Global Index (CGI), based on assessment of behaviour by parents (CGI-P) and teacher (CGI-T). PR was calculated as the difference between CGI-P/T scores at baseline and placebo week. There was a highly significant PR as assessed by the parents' and teachers' (p < 0.001). The magnitude of PR as assessed by parents was greater (10.57 points) compared to that assessed by teachers (3.93 points). The determinants of PR were different between parents and teachers. For parents, income, marital status, education, maternal smoking during pregnancy, and prior psychostimulant exposure (PPE) showed a significant effect on PR. For teachers, only ethnicity and PPE had an effect. The pattern of PR revealed two distinct profiles that may shed some light on the mechanisms involved in PR. PR in children with ADHD varies depending on the setting of the observations and the evaluator. Several psychosocial factors have been identified as modulators of PR. This is relevant for the design and interpretation of clinical trials and for clinical practice.

Subtypes of depression and their overlap in a naturalistic inpatient sample of major depressive disorder


Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.

Adult executive functioning inventory (ADEXI): Validity, reliability, and relations to ADHD


This study examined the psychometric properties of the Adult Executive Functioning Inventory (ADEXI). This new executive functioning (EF) rating instrument has the advantage of being brief (14 items) and focusing specifically on working memory and inhibitory control. Results showed that scores on the ADEXI had high internal consistency and adequate test–retest reliability, but low concurrence between self-ratings and other ratings. High and statistically significant correlations were found between ADEXI scores and scores from another EF rating instrument, whereas the correlations between ADEXI scores and neuropsychological test scores were weak and often non-significant. Furthermore, with regard to discriminant validity, individuals with attention deficit hyperactivity disorder (ADHD) had significantly higher scores on both the inhibition and working memory subscales compared to clinical as well as non-clinical controls. The results showed high specificity, but relatively low sensitivity, when discriminating between adults with ADHD and non-clinical controls. Conclusively, the ADEXI can be a valuable screening instrument for assessing deficits in working memory and inhibitory control. However, similarly to other EF ratings, the ADEXI should be used as a complement rather than as a replacement for neuropsychological tests, and the low interrater reliability suggests that ratings from multiple sources is preferable compared to relying solely on self-ratings.

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Classifying child and adolescent psychiatric disorder by problem checklists and standardized interviews


This paper discusses the need for research on the psychometric adequacy of self-completed problem checklists to classify child and adolescent psychiatric disorder based on proxy assessments by parents and self-assessments by adolescents. We put forward six theoretical arguments for expecting checklists to achieve comparable levels of reliability and validity with standardized diagnostic interviews for identifying child psychiatric disorder in epidemiological studies and clinical research. Empirically, the modest levels of test–retest reliability exhibited by standardized diagnostic interviews – 0.40 to 0.60 based on kappa – should be achievable by checklists when thresholds or cut-points are applied to scale scores to identify a child with disorder. The few studies to conduct head-to-head comparisons of checklists and interviews in the 1990s concurred that no construct validity differences existed between checklist and interview classifications of disorder, even though the classifications of youth with psychiatric disorder only partially overlapped across instruments. Demonstrating that self-completed problem checklists can classify disorder with similar reliability and validity as standardized diagnostic interviews would provide a simple, brief, flexible way to measuring psychiatric disorder as both a categorical or dimensional phenomenon as well as dramatically lowering the burden and cost of assessments in epidemiological studies and clinical research.

Defining the hidden evidence in autism research. Forty per cent of rigorously designed clinical trials remain unpublished - a cross-sectional analysis


Autism spectrum disorders (ASD) have a prevalence of up to 2.7% and show significant rates of comorbidities. Pharmacological treatment can be difficult. New treatment options are needed, several are currently under investigation. Publication bias presents a major problem in current clinical research. This study was designed to quantify publication bias in rigorously designed ASD research. The database at was searched for all completed randomized controlled clinical trials investigating interventions in ASD and their results made public. If results could neither be retrieved through search of the database, nor of scientific databases nor by enquiries of the responsible parties or sponsors listed, a trial was defined as not published. The search delivered N = 30 (60%) trials were published, N = 20 (40%) remained unpublished, N = 2,421 (59%) patients were enrolled in the published trials, N = 1,664 (41%) patients in the unpublished trials, time to publication was 21.4 months [standard deviation (SD) = 18.48; range = −5 to 80 months]. Results of N = 22 trials were available through Characteristics of published compared to unpublished trials did not show apparent differences. The majority of trials investigated drugs. The results emphasize the serious issue of publication bias. The large proportion of unpublished results precludes valuable information and has the potential to distort evidence for treatment approaches in ASD.

Person misfit on the Inventory of Depressive Symptomatology: Low quality self-report or true atypical symptom profile?


Person misfit on a self-report measure refers to a response pattern that is unlikely given a theoretical measurement model. Person misfit may reflect low quality self-report data, for example due to random responding or misunderstanding of items. However, recent research in the context of psychopathology suggests that person misfit may reflect atypical symptom profiles that have implications for diagnosis or treatment. We followed-up on Wanders et al. (Journal of Affective Disorders, 180, 36–43, 2015) who investigated person misfit on the Inventory of Depressive Symptomatology (IDS) in the Netherlands Study of Depression and Anxiety (n = 2,981). Our goal was to investigate the extent to which misfit on the IDS reflects low-quality self-report patterns and the extent to which it reflects true atypical symptom profiles. Regression analysis showed that person misfit related more strongly to self-report quality indicators than to variables quantifying theoretically-derived atypical symptom profiles. A data-driven atypical symptom profile explained most variance in person misfit, suggesting that person misfit on the IDS mainly reflects a sample- and questionnaire-specific atypical symptom profile. We concluded that person-fit statistics are useful for detecting IDS scores that may not be valid. Further research is necessary to support the interpretation of person misfit as reflecting a meaningful atypical symptom combination.

Language-related differential item functioning between English and German PROMIS Depression items is negligible


To investigate differential item functioning (DIF) of PROMIS Depression items between US and German samples we compared data from the US PROMIS calibration sample (n = 780), a German general population survey (n = 2,500) and a German clinical sample (n = 621). DIF was assessed in an ordinal logistic regression framework, with 0.02 as criterion for R2-change and 0.096 for Raju's non-compensatory DIF. Item parameters were initially fixed to the PROMIS Depression metric; we used plausible values to account for uncertainty in depression estimates. Only four items showed DIF. Accounting for DIF led to negligible effects for the full item bank as well as a post hoc simulated computer-adaptive test (< 0.1 point on the PROMIS metric [mean = 50, standard deviation =10]), while the effect on the short forms was small (< 1 point). The mean depression severity (43.6) in the German general population sample was considerably lower compared to the US reference value of 50. Overall, we found little evidence for language DIF between US and German samples, which could be addressed by either replacing the DIF items by items not showing DIF or by scoring the short form in German samples with the corrected item parameters reported.

Measuring the ICD-11 adjustment disorder concept: Validity and sensitivity to change of the Adjustment Disorder – New Module questionnaire in a clinical intervention study


Adjustment disorder (AjD) is a frequent but under-researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD-11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder – New Module (ADNM), the first symptom severity measure for AjD according to the ICD-11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM-IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18–0.31), functional impairment (Sheehan Disability Scale; r = 0.18–0.47), and depression (Montgomery–Asberg Depression Scale; r = 0.13–0.30). At baseline 78% of the individuals with a DSM-IV diagnosis of AjD were also classified so by the ADNM. Repeated-measures ANOVA indicated significant ADNM-symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD-11 AjD in a randomized-controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment.

Evaluation and comparison of tools for diagnosing problematic prescription opioid use among chronic pain patients


Prescription opioid medications are commonly used for the treatment of chronic pain. Assessments of problematic opioid use among pain patients are inconsistent across studies, partially due to differences between various measures. Therefore, the most appropriate measure to use is often unclear. In this study we assessed problematic opioid use in a sample of 551 individuals receiving treatment for chronic pain, using three questionnaires: the Alcohol Use Disorder and Associated Disabilities Interview Schedule – Fourth Edition (AUDADIS-IV), the Current Opioid Misuse Measure (COMM) questionnaire and Portenoy's criteria (PC). These questionnaires yielded discordant positive rates of problematic use: 52.6%, 28.7%, and 17.1%, respectively, which did not change substantially when excluding AUDADIS-IV criteria of physical symptoms of tolerance and withdrawal. Although these three questionnaires share some statistically correlated content-based congruent questions, positive response rates to them were significantly different based on construction features, including questionnaires' referred time-frame, wording of questions and response alternatives. The findings of the present study illustrate strengths and limitations of the AUDADIS-IV, COMM and PC in diagnosing problematic opioid use in a population of adults suffering from chronic pain, and highlight the importance of recognizing and addressing specific questionnaire and question-related differences when identifying problematic opioid use in this population.

A new statistical model for the Day Reconstruction Method


The Day Reconstruction Method (DRM) is a method to measure one's subjective affective status by soliciting information in a questionnaire about the previous day's activities. We developed a new model to examine the association of daily activities, the friendliness of interacting partners, and time-of-day on net affect scores among 10,377 adults participating in the World Health Organization's Study on global ageing and adult health (SAGE). A multilevel regression was fitted and the time-of-day effect was modeled by restricted cubic spline. The net affect score was a serpentine curve; stable from 4 a.m. to 6 a.m., increased from 7 a.m. to 12 noon, and became stable onwards. Participants had the highest net affect scores during religious activities (0.48, 95% confidence interval [CI]: 0.44, 0.53), and they enjoyed leisure activities, exercising, and household responsibilities more than work. Compared with events that lacked interacting partners, activities with very friendly interacting partners were associated with higher net affect scores (0.21, 95% CI: 0.19, 0.22), but events with slightly friendly interacting partners, slightly irritating or very irritating partners had lower net affect scores. To conclude, researchers using DRM for assessing well-being status across time should include the type of activities and the friendliness of the interacting partners.

Psychosis risk screening: Validation of the youth psychosis at-risk questionnaire – brief in a community-derived sample of adolescents


There have been several attempts to identify individuals potentially at high risk for psychotic-spectrum disorders using brief screening measures. However, relatively few studies have tested the psychometric properties of the psychosis screening measures in representative samples of adolescents. The main purpose of the present study was to analyse the prevalence, factorial structure, measurement invariance across gender, and reliability of the Youth Psychosis At-Risk Questionnaire – Brief (YPARQ-B) in a community-derived sample of adolescents. Additionally, the relationship between YPARQ-B, depressive symptoms, psychopathology, stress manifestations, and prosocial skills was analysed. One thousand and twenty students from high schools participated in a cross-sectional survey. The YPARQ-B, the Reynolds Adolescent Depression Scale, the Strengths and Difficulties Questionnaire, and the Student Stress Inventory – Stress Manifestations were used. A total of 85.1% of the total sample self-reported at least one subclinical psychotic experience. We observed a total of 10.9% of adolescents with a cutoff score of ≥11 or 6.8% with a cutoff score of ≥13. The analysis of internal structure of the YPARQ-B yielded an essentially unidimensional structure. The YPARQ-B scores showed measurement invariance across gender. The internal consistency of the YPARQ-B total score was 0.94. Furthermore, self-reported subclinical psychotic experiences were associated with depressive symptoms, emotional and behavioural problems, poor prosocial skills, and stress manifestations. These results would appear to indicate that YPARQ-B is a brief and easy tool to assess self-reported subclinical psychotic experiences in adolescents from the general population. The assessment of these experiences in community settings, and its associations with psychopathology, may help us to enhance the possibility of an early identification of adolescents potentially at risk for psychosis and mental health problems.

The development and validation of static and adaptive screeners to measure the severity of panic disorder, social anxiety disorder, and obsessive compulsive disorder


A series of static and adaptive screeners for panic disorder, social anxiety disorder (SAD), and obsessive compulsive disorder (OCD) were developed and compared using data-driven methods to facilitate the measurement of each disorder in community samples. Data comprised 3175 respondents for the development sample and 3755 respondents for the validation sample, recruited independently using Facebook advertising. Item Response Theory (IRT) was utilized to develop static continuous screeners and to simulate computerized adaptive algorithms. The screeners consisted of a small subset of items from each bank (79% reduction in items for panic disorder, 85% reduction in items for SAD, and 84% reduction in items for OCD) that provided similar scores (r = 0.88–0.96). Both static and adaptive screeners were valid with respect to existing scales that purportedly measure similar constructs (r > 0.70 for panic disorder, r > 0.76 for SAD, and r > 0.68 for OCD). The adaptive scales were able to maintain a higher level of precision in comparison to the static scales and evidenced slightly higher concordance with scores generated by the full item banks. The screeners for panic disorder, SAD, and OCD could be used as a flexible approach to measure and monitor the severity of psychopathology in tailored treatment protocols.

Evaluating psychological distress data


Kessler k6 psychological distress scores are analyzed using a count model and item response theory (IRT) models are applied to the items which produce the k6 score and generate an alternative distress score, θ*. Other ways of utilizing the constituent items are also examined. The data used in the analysis comes from the 2014 National Survey of Drug Use and Health. Three important results emerge. First, θ* and k6 are not highly correlated and their distributions are quite different. The k6 score gives a much more favourable picture of mental health than θ*. Second, k6 does a much better job in explaining participation in treatment programs than θ* suggesting a very limited role for IRT methods in the analysis of psychological distress data. As a diagnostic tool k6 is an effective and simple way of summarizing the item data. Third, for researchers interested in which individual characteristics determine psychological distress better results are obtained by analyzing the six constituent items which are used to generate the k6 score using ordered probability models rather than k6 itself.

Mercy Pregnancy and Emotional Well-being Study (MPEWS): Understanding maternal mental health, fetal programming and child development. Study design and cohort profile


Maternal mental health represents a significant global health burden. The Mercy Pregnancy and Emotional Well-being Study (MPEWS) was established to provide a comprehensive investigation of early developmental mechanisms and modifiers for maternal, fetal and child emotional well-being. MPEWS is a prospective, longitudinal study from pregnancy to 36 months postpartum that includes diagnostic measures of maternal mental health, observational measures of the mother–infant relationship, measures of child development, and repeat biological sampling. A total of 282 pregnant women were recruited in early pregnancy from the Mercy Hospital for Women in Melbourne, Australia, including 52 women on antidepressant medication, 31 non-medicated women meeting diagnostic criteria for current unipolar depression or dysthymia, and 65 women with a past history of depression. Sample recruitment characteristics included a mean age of 31 years and average gestation of 16 weeks. The MPEWS cohort was comparable to national averages for Australia on key pregnancy and birth variables. Those participants taking antidepressant medication had higher mean Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI) scores than the cohort as a whole but were comparable on other key variables. The MPEWS protocol provides a unique opportunity to evaluate the impact of pregnancy mental health on future maternal mental health and child development to aid the development of evidence-based interventions. The study is open for collaborative proposals via approach to the principal investigators.

Effects of sample size and distributional assumptions on competing models of the factor structure of the PANSS and BPRS


Factor analytic work on the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) has yielded varied and conflicting results. The current study explored potential causes of these discrepancies. Prior research has been limited by small sample sizes and an incorrect assumption that the items are normally distributed when in practice responses are highly skewed ordinal variables. Using simulation methodology, we examined the effects of sample size, (in)correctly specifying item distributions, collapsing rarely endorsed response categories, and four factor analytic models. The first is the model of Van Dorn et al., developed using a large integrated data set, specified the item distributions as multinomial, and used cross-validation. The remaining models were developed specifying item distributions as normal: the commonly used pentagonal model of White et al.; the model of Van der Gaag et al. developed using extensive cross-validation methods; and the model of Shafer developed through meta-analysis. Our simulation results indicated that incorrectly assuming normality led to biases in model fit and factor structure, especially for small sample size. Collapsing rarely used response options had negligible effects.

Application of randomized response techniques for investigating cannabis use by Spanish university students


Cannabis is the most widely used illicit drug in developed countries, and has a significant impact on mental and physical health in the general population. Although the evaluation of levels of substance use is difficult, a method such as the randomized response technique (RRT), which includes both a personal component and an assurance of confidentiality, provides a combination which can achieve a considerable degree of accuracy. Various RRT surveys have been conducted to measure the prevalence of drug use, but to date no studies have been made of the effectiveness of this approach in surveys with respect to quantitative variables related to drug use. This paper describes a probabilistic, stratified sample of 1146 university students asking sensitive quantitative questions about cannabis use in Spanish universities, conducted using the RRT. On comparing the results of the direct question (DQ) survey and those of the randomized response (RR) survey, we find that the number of cannabis cigarettes consumed during the past year (DQ = 3, RR = 17 approximately), and the number of days when consumption took place (DQ = 1, RR = 7) are much higher with RRT. The advantages of RRT, reported previously and corroborated in our study, make it a useful method for investigating cannabis use. Copyright © 2016 John Wiley & Sons, Ltd.

The Cannabis Abuse Screening Test (CAST) revisited: examining measurement invariance by age


Defensible use of self-reported cannabis use problem scales in age comparative frameworks requires that measured constructs have equal psychometric properties across age groups. This study compares the psychometric properties of the Cannabis Abuse Screening Test (CAST) across three age groups (18–24, 25–29, 30–40). Data was collected online from an accessible sample of 1316 cannabis users. Factor analysis compared the optimal factor structure and dimensionality diffraction. Multi-group Model Invariance tests examined measurement invariance across the three age groups. CAST was two-dimensional in all age groups with one factor measuring cannabis use problems and the other measuring deviation from a common standard of use. The two-dimensional structure was more pronounced in older age groups. Weak factorial invariance was supported, suggesting that the meaning of the CAST factors is equivalent across age groups. Partial, but not full, strong factorial invariance was supported, indicating that only the cannabis use problem factor can be defensibly used to measure age group mean differences. Results confirm a well-defined two-dimensional CAST structure and factorial invariance across age groups. However, caution is needed when using the two items measuring deviation from a common standard in an age-comparative framework. Replication studies based on a representative sample are needed.

Cross-cultural measurement invariance of the General Health Questionnaire-12 in a German and a Colombian population sample


While the General Health Questionnaire, 12-item version (GHQ-12) has been widely used in cross-cultural comparisons, rigorous tests of the measurement equivalence of different language versions are still lacking. Thus, our study aims at investigating configural, metric and scalar invariance across the German and the Spanish version of the GHQ-12 in two population samples. The GHQ-12 was applied in two large-scale population-based samples in Germany (N = 1,977) and Colombia (N = 1,500). To investigate measurement equivalence, confirmatory factor analyses were conducted in both samples. In the German sample mean GHQ-12 total scores were higher than in the Colombian sample. A one-factor model including response bias on the negatively worded items showed superior fit in the German and the Colombian sample; thus both versions of the GHQ-12 showed configural invariance. Factor loadings and intercepts were not equal across both samples; thus GHQ-12 showed no metric and scalar invariance. As both versions of the GHQ-12 did not show measurement equivalence, it is not recommendable to compare both measures and to conclude that mental distress is higher in the German sample, although we do not know if the differences are attributable to measurement problems or represent a real difference in mental distress. The study underlines the importance of measurement equivalence in cross-cultural comparisons.

Applications for self-administered mobile cognitive assessments in clinical research: A systematic review


Frequent, brief and repeated self-administered mobile assessments of cognitive function, conducted in everyday life settings, are a promising complementary tool to traditional assessment approaches. Mobile cognitive assessments promote patient-centered care and might enhance capacity to inform individual-level outcomes over time (i.e. detecting subtle declines in cognitive function), as well as in assessing cognition and its correlates in the naturalistic environment. The goal of this systematic review was to assess the feasibility and psychometric properties of mobile cognitive assessments. Through a comprehensive search, we identified 12 articles using self-administered, mobile phone-based cognitive assessments. Studies sampled participants between 1 and 6 times per day for 1–14 days. Samples ranged in age from 14 to 83 years old and were generally healthy populations without cognitive impairment. Working memory was the most frequently-assessed cognitive domain (n = 7), followed by attention/reaction time (n = 4). Seven studies reported adherence, with mean adherence rates of 79.2%. In addition to positive evidence of feasibility, there was general support for high levels of between- and within-person reliability and construct validity. While research has only begun to explore the utility of mobile cognitive assessments, studies to-date indicate they may be a promising complementary tool to traditional assessment methods with potential to improve clinical care and research.

Psychometric properties of the apathy evaluation scale in patients with Parkinson's disease


Parkinson's disease (PD) frequently entails non-motor symptoms, worsening the course of the disease. Apathy is one of the core neuropsychiatric symptoms that has been investigated in recent years; research is however hampered by the limited availability of well-evaluated apathy scales for these patients. We evaluated the psychometric properties of the Apathy Evaluation Scale (AES) in a sample of PD patients. Psychometric properties, convergent and discriminant validity and sensitivity/specificity were evaluated in patients with (n = 582) or without dementia/depression (n = 339). Internal consistency was high in the entire sample as well as in patients without dementia/depression. Correlations were moderate for convergent validity (UPDRS I item 4: motivation). While apathy could be differentiated from cognitive decline, it was related to depression (Geriatric Depression Scale, GDS-15). The overall classification accuracy based on the UPDRS I item 4 was comparable for AES and GDS scores. The AES exhibits good psychometric properties in PD patients with and without dementia and/or depression. Commonly used screenings on the presence of apathy had low detection rates compared to the AES and reflected both apathetic and depressive symptoms. Psychometric evaluation of available instruments will support further research on the clinical relevance of apathy for disease progression and treatment approaches in PD patients.

Psychometric properties of the Mental Health and Social Inadaptation Assessment for Adolescents (MIA) in a population-based sample


We report on the psychometric properties of the Mental Health and Social Inadaptation Assessment for Adolescents (MIA), a self-report instrument for quantifying the frequency of mental health and psychosocial adaptation problems using a dimensional approach and based on the DSM-5. The instrument includes 113 questions, takes 20–25 minutes to answer, and covers the past 12 months. A population-based cohort of adolescents (n = 1443, age = 15 years; 48% males) rated the frequency at which they experienced symptoms of Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, Oppositional Defiant Disorder, Depression, Generalized Anxiety, Social Phobia, Eating Disorders (i.e. DSM disorders), Self-harm, Delinquency, Psychopathy as well as social adaptation problems (e.g. aggression). They also rated interference with functioning in four contexts (family, friends, school, daily life). Reliability analyses indicated good to excellent internal consistency for most scales (alpha = 0.70–0.97) except Psychopathy (alpha = 0.46). The hypothesized structure of the instrument showed acceptable fit according to confirmatory factor analysis (CFA) [Chi-square (4155) = 9776.2, p = 0.000; Chi-square/DF = 2.35; root mean square error of approximation (RMSEA) = 0.031; Comparative Fit Index (CFI) = 0.864], and good convergent and discriminant validity according to multitrait-multimethods analysis. This initial study showed adequate internal validity and reliability of the MIA. Our findings open the way for further studies investigating other validity aspects, which are necessary before recommending the wide use of the MIA in research and clinical settings.

Review of the strengths and difficulties questionnaire translated into languages spoken by children and adolescents of refugee background


The Strengths and Difficulties Questionnaire (SDQ), routinely used to screen for children's and adolescents' emotional and behavioural problems, has been translated into at least 80 languages. As children of refugee background are particularly vulnerable to mental health problems resulting from their refugee experiences, this review examines whether SDQs translated into languages spoken by major refugee groups are validated and culturally equivalent to the original SDQ and sensitive to change following interventions. No reviewed studies of translated SDQs reported on challenges in achieving conceptual and linguistic equivalence in translation. Factor analysis predominantly showed structural inequivalence with the original 5-factor model, suggesting translated SDQ subscales may measure different constructs. Predictive equivalence findings tended to show somewhat higher sensitivity for detecting disorder than the original SDQ's low sensitivity, and somewhat lower specificity. Outcome studies yielded equivocal results with refugee and immigrant groups. SDQ items do not detect the psychological sequelae of trauma; hence it is recommended that the SDQ be used with caution to screen refugee children, with a follow-up clinical interview for verification. Cross-cultural qualitative research is needed into parents' and adolescents' interpretation of translated SDQ items.