The development and initial validation of self-report measures of ICD-11 depressive episode and generalized anxiety disorder: The International Depression Questionnaire (IDQ) and the International Anxiety Questionnaire (IAQ)

Testing the distinctiveness of prolonged grief disorder from posttraumatic stress disorder and depression in large bereaved community samples

BACKGROUND

This study sought to test the distinctiveness of symptoms of prolonged grief disorder (PGD) from posttraumatic stress disorder (PTSD) and depression.

METHODS

Confirmatory factor analysis (CFA) and target exploratory factor analysis (EFA), were used to test the distinctiveness of PGD from PTSD and depression symptoms in a large sample of adults bereaved for at least six months (N = 1917). Identified factors were explored in relation to demographic (i.e., age, gender) and loss-related (i.e., time since bereavement, nature of death, relationship to deceased, age of deceased, and frequency of contact with deceased) correlates.

RESULTS

The CFA model provided a good fit to the data, while the target EFA provided a slightly improved fit. All items loading strongly and significantly onto their respectively factors, and the IGQ items had few significant cross-factor loadings. All demographic and loss-related variables (except for death of a sibling and death from other causes) were associated with each of the factors, however, these associations were strongest for the PGD factor.

LIMITATIONS

Participants were recruited using a non-probability sampling method and were from a relatively affluent Western nation.

CONCLUSION

Findings from the current study demonstrate that PGD reflects an empirically distinguishable albeit related disorder to PTSD and depression in a sample of bereaved adults. The identification of correlates common to PGD, PTSD, and depression, as well as those unique to PGD, affords a comprehensive understanding of the risk factors associated with bereavement-related psychopathology.

Efficacy of an internet-based guided trauma-focused intervention in reducing ICD-11 posttraumatic stress disorder symptoms: study protocol of a randomized controlled trial

BACKGROUND

Posttraumatic stress disorder (PTSD) is a common mental disorder. However, many cases of PTSD remain untreated because of limited healthcare resources and other treatment-seeking barriers. Effective internet-based interventions could help to improve access to PTSD treatments. Therefore, the main objective of the planned randomized controlled trial is to evaluate the efficacy of the Lithuanian version of the guided internet-based self-help programme (Spring) in reducing ICD-11 PTSD symptoms.

METHODS

The planned sample size is 50 participants exposed to different traumatic experiences. Participants eligible for the study will be randomized into two study groups: the immediate treatment group and the delayed treatment control group. Both groups will receive guided trauma-focused ICBT intervention, but the delayed treatment group will receive access to the programme five months after randomization. The International Trauma Interview (ITI) will be used for the assessment of ICD-11 PTSD symptoms at pre-treatment, post-treatment, and at a 3-month follow-up. Changes in disturbances in self-organization, depression and anxiety levels, as well as posttraumatic cognitions and trauma-related shame, will also be evaluated. In addition, associations between changes in symptoms of PTSD and readiness for treatment, treatment expectations and working alliance will be explored. Changes in treatment outcomes will be evaluated using multiple Latent Change Models.

DISCUSSION

This study is expected to contribute to valuable knowledge on the efficacy of internet-based interventions for posttraumatic stress disorder.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06475716. Registered on 25 June 2024.

Using natural language processing to facilitate the harmonisation of mental health questionnaires: a validation study using real-world data

BACKGROUND

Pooling data from different sources will advance mental health research by providing larger sample sizes and allowing cross-study comparisons; however, the heterogeneity in how variables are measured across studies poses a challenge to this process.

METHODS

This study explored the potential of using natural language processing (NLP) to harmonise different mental health questionnaires by matching individual questions based on their semantic content. Using the Sentence-BERT model, we calculated the semantic similarity (cosine index) between 741 pairs of questions from five questionnaires. Drawing on data from a representative UK sample of adults (N = 2,058), we calculated a Spearman rank correlation for each of the same pairs of items, and then estimated the correlation between the cosine values and Spearman coefficients. We also used network analysis to explore the model's ability to uncover structures within the data and metadata.

RESULTS

We found a moderate overall correlation (r = .48, p < .001) between the two indices. In a holdout sample, the cosine scores predicted the real-world correlations with a small degree of error (MAE = 0.05, MedAE = 0.04, RMSE = 0.064) suggesting the utility of NLP in identifying similar items for cross-study data pooling. Our NLP model could detect more complex patterns in our data, however it required manual rules to decide which edges to include in the network.

CONCLUSIONS

This research shows that it is possible to quantify the semantic similarity between pairs of questionnaire items from their meta-data, and these similarity indices correlate with how participants would answer the same two items. This highlights the potential of NLP to facilitate cross-study data pooling in mental health research. Nevertheless, researchers are cautioned to verify the psychometric equivalence of matched items.

Development and validation of the caregiver-report version of the international depression questionnaire (IDQ-CG) and international anxiety questionnaire (IAQ-CG)

The International Depression Questionnaire (IDQ) and International Anxiety Questionnaire (IAQ) are self-report measures of ICD-11 single episode depressive disorder (DD) and generalised anxiety disorder (GAD). The present study sought to describe the development and psychometric evaluation of the caregiver-report versions of the IDQ and IAQ for children, referred to as the IDQ-CG and IAQ-CG, respectively. Participants were 639 parents living in Ukraine who provided data on themselves and one child in their household as part of "The Mental Health of Parents and Children in Ukraine Study: 2023 Follow-up" study. The latent structure of the IDQ-CG and IAQ-CG were tested using confirmatory factor analysis (CFA), composite reliability (CR) estimates were estimated, and convergent validity was assessed. Prevalence rates of probable ICD-11 DD and GAD were also estimated. CFA results indicated that the IDQ-CG and IAQ-CG were unidimensional, while the internal reliability of both scales was excellent. Convergent validity was established via associations with external measures of internalizing, externalizing, and attention problems as well as trauma exposure. Factors associated with increased IDQ-CG and IAQ-CG scores included pharmacological support for emotional or behavioural problems, delayed milestone development, being forced to move to another part of Ukraine, serious life disruption due to the war, and having experienced a bereavement. Of the total sample, 1.6% met diagnostic requirements for ICD-11 DD and 5.8% met diagnostic requirements for ICD-11 GAD. This study supports the psychometric properties of the IDQ-CG and IAQ-CG. These measures can be effectively used to identify young people in need of mental health support.

Prevalence and correlates of ICD-11 prolonged grief disorder among adults living in Ukraine during the war with Russia

BACKGROUND

Although high rates of bereavement are evident in war-affected populations, no study has investigated the prevalence and correlates of probable ICD-11 prolonged grief disorder (PGD) under these circumstances.

METHODS

Participants were 2050 adults who participated in a nationwide survey exploring the effects of the Ukraine-Russia war on the daily lives and mental health of Ukrainian people.

RESULTS

Of the total sample, 87.7% (n = 1797) of people indicated a lifetime bereavement. In the full sample, 11.4% met the diagnostic requirements for probable ICD-11 PGD, and amongst those with a lifetime bereavement, the conditional rate of probable ICD-11 PGD was 13.0%. Significant risk factors of ICD-11 PGD included the recent loss of a loved one (6 months to a year ago), being most affected by a partner or spouse's death, loved one dying in the war, no recent contact with the deceased prior to their death, and meeting depression and anxiety diagnostic requirements.

CONCLUSION

The study reveals that a significant percentage of Ukrainian bereaved individuals have probable ICD-11 PGD, and identifying risk factors, particularly war-related losses, will aid in the development of intervention and prevention programs for bereaved adults.

Mental health in Ukraine in 2023

BACKGROUND

Very little is known about the mental health of the adult population of Ukraine following Russia's full-scale invasion in February 2022. In this study, we estimated the prevalence of seven mental health disorders, the proportion of adults screening positive for any disorder, and the sociodemographic factors associated with meeting requirements for each and any disorder.

METHODS

A non-probability quota sample (N = 2,050) of adults living in Ukraine in September 2023 was collected online. Participants completed self-report questionnaires of the seven mental health disorders. Logistic regression was used to determine the predictors of the different disorders.

RESULTS

Prevalence estimates ranged from 1.5% (cannabis use disorder) to 15.2% (generalized anxiety disorder), and 36.3% screened positive for any of the seven disorders. Females were significantly more likely than males (39.0% vs. 33.8%) to screen positive for any disorder. Disruption to life due to Russia's 2014 invasion of Ukraine, greater financial worries, and having fewer positive childhood experiences were consistent risk factors for different mental health disorders and for any or multiple disorders.

CONCLUSION

Our findings show that approximately one in three adults living in Ukraine report problems consistent with meeting diagnostic requirements for a mental health disorder 18 months after Russia's full-scale invasion. Ukraine's mental healthcare system has been severely compromised by the loss of infrastructure and human capital due to the war. These findings may help to identify those most vulnerable so that limited resources can be used most effectively.

Effects of peritraumatic reactions on post-traumatic stress among Kahramanmaras earthquake survivors

PURPOSE

Peritraumatic reactions play a crucial role in the development of mental health problems, including depression and post-traumatic stress disorder. Therefore, this study sought to examine the influence of the peritraumatic reactions, including peritraumatic dissociation, peritraumatic distress, mental defeat, and tonic immobility, on post-traumatic stress disorder and major depressive disorder in earthquake survivors.

MATERIALS AND METHODS

A total of 261 adult participants aged between 18 and 65 (Mage=29.20, SD = 28.06, 162 were female, and 99 were male) who were exposed to the Kahramanmaras earthquake in February 2023 were recruited in the study. Data were collected between April 10 and 18 2023, two months after the earthquake. Participants completed questionnaires, including The International Trauma Questionnaire, The International Depression Questionnaire, The Mental Defeat Questionnaire, The Tonic Immobility Scale, and The Peritraumatic Dissociative Experiences Questionnaire.

RESULTS

Two-step multiple linear regression analyses indicated all peritraumatic reactions predicted both post-traumatic stress disorder and depression. Dominance analysis results showed that the contribution of peritraumatic dissociation in predicting PTSD and depression was higher among other peritraumatic reactions.

CONCLUSION

The findings of the study revealed a robust association between peritraumatic reactions and both depression and PTSD, shedding light on the underlying processes in the development of trauma-related disorders. Early assessment of peritraumatic reactions may be useful in identifying individuals at risk of developing PTSD and depression.

The International Grief Questionnaire (IGQ): A new measure of ICD-11 prolonged grief disorder

Prolonged grief disorder (PGD) is included in the 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). This study sought to test the validity and reliability of a new brief measure to screen for ICD-11 PGD-the International Grief Questionnaire (IGQ). The psychometric properties of the IGQ were tested using data collected from two bereaved samples of adults from the United Kingdom (n = 1,012) and Ireland (n = 1,011). Confirmatory factor analysis demonstrated that a correlated two-factor model best captured the latent dimensionality of the IGQ in both samples. Estimates of internal reliability were high, whereas the convergent and concurrent validity of the scale were supported through strong associations with external measures. Measurement invariance and differential item functioning testing showed no statistically significant difference in the latent structure of the IGQ nor the functioning of the IGQ items by age, sex, and nationality. For participants who were bereaved for more than 6 months, the rates of probable PGD derived from the IGQ were 10.9% and 15.3% for the Irish and U.K. samples, respectively. The IGQ is a brief, easy-to-use, self-report screening measure that captures all diagnostic criteria of PGD set forth in the ICD-11. Findings from this study provide initial support for the validity, measurement invariance, and reliability of the IGQ among two national samples.

Differences in mental indicators and state-hope related to the level of engagement in social unrest: Israel 2023

Background

This study examined the interplay between engagement in social unrest, mental indicators, state-hope and demographic variables. In addition, mental indicators and state-hope were compared in line with levels of engagement in social unrest.

Methods

In a cross-sectional study, conducted from March 23 to April 10, 2023, 2031 Israelis were recruited via a survey company. Participants completed self-report questionnaires to assess engagement in social unrest, anxiety, social unrest related distress, state-hope and demographic variables.

Results

Participants with higher engagement in social unrest, who opposed the law reform, were prone to higher levels of social unrest related distress, anxiety, and lower levels of state-hope compared to those not engaged in social unrest activities or those who supported the law reform.

Conclusions

Concerns regarding unmet mental health needs, during and following social unrest, regardless of the engagement level, should be actively addressed by mental health professionals and health policy makers.

Assessing the validity and reliability of the International Anxiety Questionnaire and the International Depression Questionnaire in two bereaved national samples

The International Anxiety Questionnaire (IAQ) and International Depression Questionnaire (IDQ) are self-report measures of ICD-11 Generalized Anxiety Disorder (ICD-11 GAD) and ICD-11 Single Episode Depressive Disorder (ICD-11 DD). This study tested the psychometric properties of these scales in two samples of bereaved adults from the United Kingdom and the Republic of Ireland. Confirmatory factor analysis (CFA) was used to test the combined dimensionality and measurement invariance of the IAQ and IDQ across the United Kingdom (n = 1012) and Irish (n = 1011) samples. Differential item functioning (DIF) was tested using multiple indicator multiple cause (MIMIC) modelling while convergent validity was also assessed. CFA results supported a correlated two-factor model in both samples. The MIMIC model showed that the IDQ item "Had recurrent thoughts of death or suicide" showed DIF and the effect was small. Internal reliability of the scales were high and convergent validity was supported. The prevalence of ICD-11 GAD was 18.6% and 16.1% and ICD-11 DD was 13.8% and 10.5% in the United Kingdom and Irish samples, respectively. Findings of the study provide support for the validity, measurement invariance, and reliability of the IAQ and IDQ among two bereaved national samples.

Translation and validation of the Turkish forms of the International Depression Questionnaire (IDQ) and the International Anxiety Questionnaire (IAQ)

BACKGROUND

The 11th version of the International Classification of Diseases (ICD-11) included revised formulations of single episode depressive disorder (DD) and generalized anxiety disorder (GAD). Consequently, the International Depression Questionnaire (IDQ) and International Anxiety Questionnaire (IAQ) have been developed as self-report measures which directly align with the ICD-11 description of DD and GAD, respectively.

OBJECTIVE

The current study sought to (1) test the factorial validity of the Turkish translations of the IDQ and IAQ, (2) evaluate their internal reliability, (3) determine how meeting diagnostic requirements for ICD-11 DD and ICD-11 GAD vary across different demographic variables, and (4) determine the convergent validity of the Turkish translations of the IDQ and IAQ.

METHODS

Participants were a community sample of 1455 Turkish adults and largely comprised of university students. This study used confirmatory factor analysis (CFA) to test the latent structure of both scales. Prevalence rates of ICD-11 GAD and DD were also estimated, and differences in prevalence rates according to gender and relationship status were examined.

RESULTS

The CFA results indicated that both scales were unidimensional. Both scales demonstrated high levels of internal consistency. The prevalence of ICD-11 DD and GAD was 26.6 % and 28.5 %, respectively. Rates of probable ICD-11 DD and GAD were highest for females and single participants. Convergent validity was indicated by strong associations with external measures of depression and anxiety.

CONCLUSION

Findings from this study provide support for the validity and reliability of the Turkish versions of the IDQ and IAQ in a large community sample.

Using artificial intelligence to identify the top 50 independent predictors of subjective well-being in a multinational sample of 37,991 older European & Israeli adults

Subjective well-being (SWB) is widely recognized as an important health outcome, but its complexity, myriad predictors, and analytic requirements pose significant challenges to identifying the relative order and impact of SWB determinants. This study involved a representative sample of 37,991 older adults from 17 European countries and Israel. An aggregate index of SWB was developed and compared across countries, and machine-learning algorithms were used to rank-order the strongest 50 (of an initial 94) SWB predictors from 15 categories. General Additive Modeling (GAM) and low-degree polynomials (i.e., splines) were used to determine the independent effect sizes and significance levels for each of these top-50 SWB predictors. Of the 18 countries included in this study, Denmark had the highest mean SWB, while Greece had the lowest. The two top-ranked SWB predictors (loneliness, social activity satisfaction) were social factors, which also had the highest overall group ranking, followed by physical health, demographics, financial status and personality. Self-reported health was the strongest health-related predictor, neuroticism was the strongest personality predictor, and women reported higher SWB than men. SWB decreased with age, and increased with income up to 350,000 euros/year, after which it declined. Social factors were of primary importance for subjective well-being in this research, while childhood experiences and healthcare status exerted the smallest effects. The vast majority of the top 50 SWB predictors were statistically significant, with the notable exceptions of body mass index and most health behaviors, which may impact SWB indirectly through their effects on physical health. Future multivariate modeling is recommended to clarify the mechanisms for these and other observed relationships.