Factor structure, validity, and reliability of the fear questionnaire in a Hong Kong Chinese population

Fear of childbirth: Validation study of the Chinese version of Wijma delivery expectancy/experience questionnaire version A

INTRODUCTION

Fear of childbirth causes significant distress and impact on women's wellbeing. It contributed to the rising trend of non-medically indicated Caesarean births worldwide. The objective of this study was to translate and validate the Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) (W-DEQ-A), which is a comprehensive instrument for the assessment of fear of childbirth among antenatal women.

METHODS

The translated questionnaire was finalised after back-translation and review by an expert panel. Hong Kong Chinese women at an antenatal clinic completed the translated questionnaire, Edinburgh Postpartum Depression Scale (EPDS), and State-trait Anxiety Inventory (STAI). The reliability of the translated questionnaire was analysed using Cronbach's alpha coefficient and intraclass correlation coefficient. Convergent validity was measured by Pearson's correlation between the W-DEQ-A and STAI or EPDS scores. The subscales of the questionnaire were determined using exploratory factor analysis.

RESULTS

One hundred and fifty women completed the study. The Cronbach's alpha coefficient and test-retest reliability of the Chinese version were 0.907 and 0.867, respectively. Convergent validity was demonstrated by the moderate correlation between the translated W-DEQ-A and STAI or EPDS. Exploratory factor analysis of the W-DEQ-A revealed a multi-dimensional structure with four factors: sense of isolation, moment of birth, negative emotion, and lack of positive self-evaluation. Using a standard cut-off of 85, 11.3% of women were found to suffer from fear of childbirth.

CONCLUSION

The Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) is a reliable and valid instrument to measure antenatal fear of childbirth among Chinese women.

Oxidative stress in major depressive and anxiety disorders, and the association with antidepressant use; results from a large adult cohort

BACKGROUND

Oxidative stress has been implicated in the pathophysiology of major depressive disorder (MDD) and anxiety disorders and may be influenced by antidepressant use. This study investigated the association of oxidative stress, measured by plasma levels of F2-isoprostanes and 8-hydroxy-2'-deoxyguanosine (8-OHdG) reflecting oxidative lipid and DNA damage respectively, with MDD, anxiety disorders and antidepressant use in a large cohort.

METHOD

Data was derived from the Netherlands Study of Depression and Anxiety including patients with current (N = 1619) or remitted (N = 610) MDD and/or anxiety disorder(s) (of which N = 704 antidepressant users) and 612 controls. Diagnoses were established with the Composite International Diagnostic Interview. Plasma 8-OHdG and F2-isoprostanes were measured using LC-MS/MS. ANCOVA was performed adjusted for sampling, sociodemographic, health and lifestyle variables.

RESULTS

F2-isoprostanes did not differ between controls and patients, or by antidepressant use. Patients with current disorders had lower 8-OHdG (mean 42.1 pmol/l, 95% CI 40.4-43.8) compared to controls (45.0 pmol/l, 95% CI 42.9-47.2; p < 0.001) after adjustment for sampling, sociodemographics and lifestyle, but these differences disappeared after further adjustment for antidepressant use (p = 0.562). Antidepressant users had lower 8-OHdG levels (38.2 pmol/l, 95% CI 36.5-39.9) compared to controls (44.9 pmol/l, 95% CI 43.2-46.6; Cohen's d = 0.21, p < 0.001). Results for 8-OHdG were comparable across disorders (MDD and/or anxiety disorders), and all antidepressant types (SSRIs, TCAs, other antidepressants).

CONCLUSION

Contrary to previous findings this large-scale study found no increased oxidative stress in MDD and anxiety disorders. Antidepressant use was associated with lower oxidative DNA damage, suggesting antidepressants may have antioxidant effects.

Psychometric Properties of the Catastrophic Cognitions Questionnaire-Modified (CCQ-Modified) Among Community Samples in Malaysia

The Catastrophic Cognitions Questionnaire-Modified (CCQ-M) is a common instrument for measuring catastrophic thoughts. In some countries, however, CCQ-M still poses concerns following the lack of appropriate validation among their populations. The current study aimed to examine the factor structure of the CCQ-M, the reliability, and the validity in community samples in Malaysia. The Malay version of CCQ-M and additional measures assessing the symptoms and cognitions relevant to anxiety disorders were completed by 682 university students and general community. Exploratory factor analysis revealed a two-factor structure accounting for 62.2% of the total variance. Confirmatory factor analysis confirmed the two-factor model by deleting four items. The Cronbach's alpha coefficients for the total and the two subscales were .94, .90, and .92, respectively. Test-retest reliability analysis was conducted on 82 university students in the interval period of 14 days, and the result was r = .58. Evidence supported the concurrent, convergent, and discriminant validity. In conclusion, the 17-item CCQ-M-Malaysia is a valid and reliable instrument for assessing catastrophic cognitions among Malaysian populations. Copyright © 2015 John Wiley & Sons, Ltd.

Prediction of 6-yr symptom course trajectories of anxiety disorders by diagnostic, clinical and psychological variables

This study aimed to identify course trajectories of anxiety disorder using a data-driven method and to determine the incremental predictive value of clinical and psychological variables over and above diagnostic categories. 703 patients with DSM-IV panic disorder with or without agoraphobia, agoraphobia, social phobia, or generalized anxiety disorder were selected from a prospective cohort study. Latent Growth Mixture Modeling was conducted, based on symptoms of anxiety and avoidance as assessed with the Life Chart Interview covering a 6-year time period. In 44% of the participants symptoms of anxiety and avoidance improved, in 24% remained stable, in 25% slightly increased, and in 7% severely increased. Identified course trajectories were predicted by baseline DSM-IV anxiety categories, clinical variables (i.e., severity and duration and level of disability) and psychological predictors (i.e., neuroticism, extraversion, anxiety sensitivity, worry, and rumination). Clinical variables better predicted unfavorable course trajectories than psychological predictors, over and above diagnostic categories.

Avoidance Ratings and Fears of Chinese Adults by Age, Ethnic Group, Sex, and Residency

Few studies among the Chinese population concerning avoidance out of fear have been reported. Existing studies are limited to school and collegiate samples while overlooking ethnic minorities, of which China has more than 50. In this study, a general population sample in China indicated the level at which they would avoid certain situations. The data were analyzed relative to age, ethnicity, sex, and the amount of time living in urban or rural areas. Three samples (urban Han, n = 144; rural Han, n = 144; Urban Huí, n = 72) were selected using stratified quota sampling. Respondents identified that they avoided social situations the most and agoraphobic situations the least. Overall, women expressed significantly greater fear. This sex difference was less marked in the urban sample where the Chinese tradition of male dominance has been diluted due to urbanization and modernization. There were few age-related differences, although some fears among the elderly were explained by age-related vulnerabilities and folklore. The Hui minority group had significantly lower overall scores than the Han group; this was attributed to the role of their Islamic beliefs.

The Driving Cognitions Questionnaire: development and preliminary psychometric properties

Recent research has suggested that fear of driving is common in the general population. People may have various concerns when driving, and instruments for the assessment of these concerns are lacking. The present paper describes the development and preliminary evaluation of the Driving Cognitions Questionnaire (DCQ). The DCQ is a 20-item scale that measures three areas of driving-related concerns--panic-related, accident-related, and social concerns. In three separate samples from different countries (n=69, 100, and 78), the scale showed good internal consistency and substantial correlations with measures of the severity of driving fear. It discriminated well between people with and without driving phobia. It also showed convergent validity with other measures. The questionnaire shows promise for use in research and clinical practice.

Cultural Effects on the Expression of Some Fears by Chinese and British Female Students

To compare the culturally acquired aspects of fears in two different cultures, the author gave an augmented version of the I. M. Marks and A. M. Mathews Fear Scale (1979) to 50 female students in China and 49 female students in England. When the rank ordering of the fears measured in both groups was compared, the author found a high positive correlation, suggesting cross-cultural consistencies in the ranking of fearful objects. Both groups most feared social criticism and appraisal by others, followed by fears of blood, pain, and injury. The students feared least aspects related to agoraphobia. When the expressed levels of fear were compared, the Chinese students had significantly lower fear scores for many items. The reasons for those scores are discussed in terms of lower actual fear levels, moderating response sets, or socialization practices. The fears that showed no cultural differences were the ones that had early biologically relevance, such as fear of the dark and of high places. Only the socially learned fears showed cultural differences.

Assessment of depression and anxiety in East Asia

This article provides a critical review of the literature on research with self-report measures of depression and anxiety in East Asia. Three trends are noteworthy. First, research on depression and anxiety in East Asia has relied heavily on the use of a limited number of translated instruments. Second, available research suggests that the Asian language versions of these instruments are reliable and valid for use with Asian populations. Third, some subpopulations in East Asia have been studied extensively with respect to depression and anxiety, but there are many regions of Asia where little research literature is available outside of those published in native language journals. The review concludes with recommendations for future research.

Confirmatory factor analysis of the Fear Questionnaire in injured workers with chronic pain

In an effort to extend the validity of the Fear Questionnaire (FQ) in a sample of patients with high levels of blood/injury phobia, the FQ responses of 255 injured workers with chronic pain were subjected to confirmatory factor analysis. Results indicated that an intercorrelated three-factor model of the FQ provided a better fit to the data than unidimensional, two-factor, hierarchical three-factor, or categorical three-factor models. These findings provide further support for the factorial validity of the FQ and the corresponding multidimensional theory of fear.