A psychometric analysis of the Clinically Useful Depression Outcome Scale (CUDOS) in Spanish patients

A psychometric analysis of the Japanese version of the clinically useful depression outcome scale supplemented with questions for the DSM-5 anxious distress specifier (CUDOS-A)

AIM

The aim of the study was to identify the clinical significance of anxiety in those with depression, the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) defined criteria for an anxious distress specifier for major depressive disorder (MDD). The Clinically Useful Depression Outcome Scale (CUDOS) supplemented with questions for the DSM-5 anxious distress specifier (CUDOS-A) is a self-report instrument to assess the clinical significance of anxiety in addition to assess symptoms and the severity of depression. This study aimed to evaluate the psychometric properties of the Japanese version of the CUDOS-A.

METHODS

An observational, prospective study was conducted with 131 MDD outpatients and 200 healthy controls. The Japanese version of the CUDOS-A, along with other measures, was administered to assess depressive symptoms, anxiety, social function, and biological rhythm. Reliability and validity analyses were performed, including internal consistency, test-retest reliability, convergent validity, and contrasted-groups validity.

RESULTS

The Japanese version of the CUDOS-A demonstrated excellent internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.78). Significant positive correlations were found between the CUDOS-A and measures of depression, anxiety, social function, and biological rhythm (all, p < 0.001), supporting its convergent validity. The CUDOS-A effectively differentiated between patients with MDD and healthy controls (p < 0.001), indicating good contrasted-groups validity.

CONCLUSIONS

The Japanese version of the CUDOS-A is a useful measure for research and for clinical practice, enabling the efficient assessment of anxious distress in individuals with depression.

Rasch analysis of the Chinese version of the clinically useful depression outcome scale in patients with major depressive disorder

OBJECTIVE

To examine the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale (CUDOS) in the Chinese patients with major depressive disorder (MDD) using Rasch analysis.

METHODS

The sample consisted of 283 patients with MDD (69% females). The Rasch model was applied to examine the overall fit of the Chinese version of CUDOS and the fit of the 18 items. Dimensionality, item-model fit, differential item functioning (DIF), reliability, ordering of response category and targeting were tested to examine the psychometric properties of the Chinese version of CUDOS.

RESULTS

Rasch analysis demonstrated the unidimensionality of the Chinese version of CUDOS. Of the 18 items, three items (item 4, item 5, item 6) showed misfit in the model. After merging item 4 into item 3 and item 6 into item 5, the overall model fit improved. The person separation index (PSI) was 3.0 and the person reliability coefficient was 0.90. No evidence of significant DIF was found when associated with gender and age. No disordered category and threshold of the rating response were observed, which meant the response category setting was reasonable. The mean ability of person was - 0.53.

CONCLUSION

The results suggested that the Chinese version of CUDOS has acceptable psychometric properties. In order to improve the quality and applicability of the Chinese version of CUDOS, the merging of item 4 into item 3 and item 6 into item 5 are suggested.

Reliability and validity of clinically useful depression outcome scale identifying mixed features in patients with manic episode

OBJECTIVES

This study aims to explore the reliability, validity, and feasibility of Clinically Useful Depression Outcome Scale (CUDOS) in screening mixed features in patients diagnosed with mania.

METHODS

A total of 109 patients with (hypo-) manic episode were recruited. The reliability of Chinese version of CUDOS (CUDOS-C) were analyzed with Cronbach's alpha and intraclass correlation coefficient (ICC). Spearman correlation coefficient was used to analyze the validity by comparing the correlation between CUDOS-C and Patient Health Questionnaire-9 (PHQ-9), 32-item Hypomania Checklist (HCL-32). The score of MINI (hypo-) manic episode with mixed features-DSM-5 Module-Chinese version(MINI-M-C) ≥ 2 was considered as the gold standard of mixed features, and the receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cut-off values of CUDOS-C score.

RESULTS

The Cronbach's alpha value of CUDOS-C was 0.898, and the ICC of CUDOS-C test-retest was 0.880 (95% CI: 0.812-0.923, p < .05).The CUDOS-C score was significantly correlated with PHQ-9 score (r = 0.893, p = .000), but not with HCL-32 score(r = 0.088, p = .364).The area under ROC curve was 0.909 (95% CI: 0.855 to 0.963, p < .001) for CUDOS-C identifying mixed features in mania. The optimal cut-off value was 11 with a sensitivity of 0.854 and a specificity of 0.868. The CUDOS-C (score ≥ 12) identified 40.4% of the patients with mixed features, which was higher than those diagnosed by clinicians (18.3%) and screened using MINI-M-C (37.6%).

CONCLUSIONS

The results indicate the CUDOS-C is a reliable and valid self-administered questionnaire for assessing depressive symptoms and screening patients with mixed mania.

Psychometric Properties of the Chinese Version of the Clinically Useful Depression Outcome Scale for Patients with Major Depressive Disorder

OBJECTIVE

This study aimed to evaluate the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale (CUDOS).

METHODS

One hundred ninety patients with major depressive disorder (MDD) according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria were recruited to the study. The English version of the CUDOS was translated into Chinese using a forward and backward translation method, which was according to the guidelines of adaptation and validation of instruments in cross-cultural health care research. The Chinese version of the CUDOS, the 17-item Hamilton Rating Scale for Depression (HRSD) and the improved Clinical Global Impression-Severity Scale (iCGI-S) were used to evaluate depressive symptoms in one hundred ninety patients with MDD. One week after the first evaluation, sixteen patients were selected randomly for a second assessment. Reliability and validity tests and receiver operating characteristic curves were performed.

RESULTS

The internal consistency of the CUDOS was 0.95, and the split-half reliability coefficient of the CUDOS was 0.92. The correlation coefficient of the retest in sixteen patients was 0.77 (P < 0.01). There was a significant difference in the total score of the Chinese version of the CUDOS between the different levels of depression severity groups (P < 0.01). The ability of the CUDOS to identify patients in remission was high (area under ROC curve= 0.97). A cut-off score of 14/15 yielded 90.20% sensitivity and 93.60% specificity when iCGI-S=1.

CONCLUSION

The Chinese version of the CUDOS is valuable as a brief and reliable instrument to assess depressive symptoms and clinical outcome. The findings suggest that the optimal cut-off score to identify patients in remission was 14/15.

Measurement invariance and psychometric analysis of Kutcher Adolescent Depression Scale across gender and marital status

BACKGROUND

The Kutcher Adolescent Depression Scale (KADS) has been studied across Canada and some other countries during the past almost 15 years. The scale is a self-report tool to diagnose and monitor clinical depression in adolescents. A brief review of previous studies on KADS showed the lack of evaluation of KADS fairness/equivalence in measuring depression among identified groups.

METHODS

To examine the psychometric properties and measurement invariance of the KADS, responses of 407 participants were analyzed using item response theory (IRT) and ordinal logistic regression (OLR). Relevant measures of effect size were utilized to interpret the results.

RESULTS

Findings of the parallel factor analysis confirmed unidimensionality of the KADS and the partial credit IRT model found to be the best fitting model for analyzing the scale. OLR analysis detected three items across gender and one item across marital status to function differentially. An assessment of effect sizes implied negligible differences for practical considerations.

LIMITATIONS

A note of caution is necessary with respect to interpreting results of measurement invariance across Gender. The sample analyzed in this study was predominantly female and this might have affected our findings. A similar analysis with a more balanced sample is recommended.

CONCLUSIONS

This study was a significant step towards providing theoretical and practical information regarding the assessment of depression among adolescents by presenting adequate evidence regarding the psychometric properties of KADS-11. Future studies may look at different methods for assessing invariance and different groups for strengthening conclusions with respect to the KADS.

Looking into the effect of multi-item symptom domains on psychometric characteristics of the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16)

Exploring depressive symptom severity is progressively shifting from the traditional assessment of symptom domains to detailed examination of individual symptoms. This study aimed at determining whether using an alternative scoring method (i.e., summing all scorable items instead of summing symptom domains) for the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR₁₆) would not compromise the measurement properties. This is a secondary analysis of data collected in a psychometric study of the Spanish version of the QIDS-SR₁₆. One hundred and sixty-six patients were assessed by means of the QIDS-SR₁₆ and two interviewer-rated instruments: the Hamilton Depression Rating Scale and the Clinical Global Impression-Severity scale. Factor structure, internal consistency reliability and convergent construct validity of the QIDS-SR₁₆ scored using the alternative method were examined. Exploratory factor analysis replicated the one-factor structure of the original scoring system. Good to excellent internal consistency and convergent validity were found, which did not differ significantly from the ones of the original scoring method. Using a simplified and easier scoring method, the Spanish QIDS-SR₁₆ retained the soundness of psychometric characteristics of both the original English version and the Spanish one scored according to the original scoring system, supporting the alternative scoring method as a reliable and valid option.

The Spanish version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16): a psychometric analysis in a clinical sample

BACKGROUND

Psychometrically robust and easy-to-administer scales for depressive symptoms are necessary for research and clinical assessment. This is a psychometric study of the Spanish version of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) in a clinical sample.

METHOD

One-hundred and seventy-three patients (65% women) with a psychiatric disorder including depressive symptoms were recruited. Such symptoms were assessed by means of the QIDS-SR16 and two interviewer-rated instruments: the 17-item Hamilton Depression Rating Scale (HDRS17) and the Clinical Global Impression-Severity (CGI-S) scale. Self-rated measures of health-related quality of life, subjective happiness and perceived social support were also obtained. Dimensionality, internal consistency, construct validity, criterion validity, and responsiveness to change of the QIDS-SR16 were examined.

RESULTS

Exploratory and confirmatory factor analyses replicated the original one-factor structure. The Spanish version of the QIDS-SR16 showed good to excellent internal consistency (α=0.88), convergent validity [HDRS17 (r=0.77), CGI-S (r=0.78)], and divergent validity [EuroQol-5D Visual Analogue Scale (r=-0.78), Subjective Happiness Scale (r=-0.72)]. The QIDS-SR16 was excellent in discriminating clinically significant from non-significant depressive symptomatology (area under ROC curve=0.93). It also showed a high sensitivity to treatment-related changes: patients with greater clinical improvement showed a greater decrease in QIDS-SR16 scores (p<0.001).

LIMITATIONS

The study was conducted in a single center, which may limit the generalizability of the findings.

CONCLUSIONS

The Spanish version of the QIDS-SR16 retains the soundness of metric characteristics of the original version which makes the scale an invaluable instrument to assess depressive symptoms.