A clinimetric analysis of the euthymia, resilience, and positive mental health scales

The "bubbles"-study: Validation of ultra-short scales for the assessment of depression, anxiety and stress symptoms

Depression, anxiety and stress symptoms cause substantial psychological and economic burdens around the globe. To mitigate the negative consequences, the negative symptoms should be identified at an early stage. Therefore, the implementation of very brief valid screening tools in mental health prevention programs and in therapeutic settings is advantageous. In two studies on representative German population samples, we developed and validated three ultra-short scales-the "bubbles"-that consist of only one item based on the Depression Anxiety Stress 21 subscales (DASS-21) for the assessment of depression, anxiety and stress symptoms. The results of Study 1 (N = 1,001) and Study 2 (N = 894) revealed that the bubbles are valid instruments that fit the DASS-21 subscales on the factor level. Moreover, the bubbles replicated the association pattern of the DASS-21 subscales with demographic variables, and with variables that belong to the negative and the positive dimension of mental health. Thus, due to their time- and cost-efficiency, the bubbles can be used as brief screening tools in research (e.g., large-scale studies, longitudinal studies, experience sampling paradigms) and in praxis. Their shortness can prevent fatigue, motivation decrease, and participants' drop-out.

Euthymia scale as a protective factor for depressive symptoms: a one-year follow-up longitudinal study

OBJECTIVES

This study aimed to examine whether a high score on the euthymia scale (ES) predicts a low incidence of depressive symptoms one year later.

METHODS

The baseline online survey was conducted in February 2020, and a follow-up survey was done in February 2021. Japanese over 20 years old were enrolled. Respondents who answered both baseline and follow-up, and without depressive symptoms at baseline were included in the analysis. The euthymia scores at baseline was measured by the 10 items of the Japanese version of the ES. Depressive symptoms at follow-up were determined if participants showed either depressive feelings or anhedonia. The odds ratio (OR) was calculated using multivariate logistic regression analysis, adjusting for age, gender, marital status, educational attainment, and clinical visit for depressive episode before the baseline survey.

RESULTS

The total of 624 participants were analyzed. A total of n = 63 (10.1%) presented depressive symptom at follow-up. A high ES score significantly predicted a lower incidence of depressive symptoms, after adjusting for covariates (aOR = 0.81 [95% confidence interval: 0.72-0.89]). Using the cutoff score retrieved from this data, a high ES score (7 or more) showed the same tendency, compared to a low ES score (< 7) (aOR = 0.46 [0.25-0.83]).

CONCLUSIONS

This study suggests the predictive usefulness of euthymia for subsequent depressive symptoms. Further investigation is needed by employing rigid diagnostic criteria.

The relationship among psychological distress, well-being and excessive social media use during the outbreak of Covid-19: A longitudinal investigation

INTRODUCTION

The corona pandemic has been a life event causing negative consequences on mental health. Mental health consists of positive and negative dimensions. The present longitudinal study investigated how positive and negative dimensions changed over 15 months after the Covid-19 outbreak. Potential changes of excessive social media use (SMU) and its relationship with mental health were also investigated.

METHOD

Data (N = 189) on distress (measured overall and as depression, anxiety, and stress), well-being and excessive SMU were collected at three time points (baseline, BL; 3-month follow-up, FU1; 15-month follow-up, FU2) via online surveys in Italy. Repeated analyses of variance were used to test differences among the three measurement time points. Mediational models were applied.

RESULTS

Distress did not change over time, well-being decreased and excessive SMU increased significantly. The relationship between distress at BL and excessive SMU at FU2 was significant (total effect, c: p < .001). The relationship between distress at BL and well-being at FU1 (a: p < .001), and between well-being at FU1and excessive SMU at FU2 (b: p = .004) was significant. Including FU1 well-being in the model, the relationship between distress at BL and excessive SMU at FU2 was not significant (direct effect, c': p = .078). The indirect effect (ab) was significant.

CONCLUSION

Well-being mediated the relationship between baseline stress and excessive SMU. Enhanced stress may reduce well-being which, in turn, increases the risk of excessive SMU. This emphasizes the urgency of programmes that foster well-being, especially during stressful events such as a pandemic.

Evaluating a Comprehensive Model of Euthymia

INTRODUCTION

In research and treatment of mood disorders, "euthymia" traditionally denotes the absence of clinically significant mood disturbance. A newer, expanded definition of euthymia also includes positive affect and psychological well-being.

OBJECTIVE

We aimed to test this comprehensive model of euthymia and estimate the coherence and predictive power of each factor in the model.

METHODS

Community-dwelling adults (N = 601), including both mental health outpatients and non-patients at high risk for personality pathology, completed a battery of interviews and questionnaires at time 1. Most (n = 497) were reassessed on average 8 months later (time 2). We modeled euthymia using standard mood, personality, and psychosocial functioning assessments rather than measures designed specifically for euthymia.

RESULTS

The hypothesized model of euthymia was supported by confirmatory factor analysis: specific measures loaded on three lower order factors (mood disturbance, positive affect, and psychological well-being) that reflected general euthymia at time 1. Each factor (general euthymia plus lower order factors) demonstrated moderately strong concurrent (time 1) and predictive (time 1-2) correlations with outcomes, including employment status, income, mental health treatment consumption, and disability. Compared to positive affect and psychological well-being, mood disturbance had stronger incremental (i.e., nonoverlapping) relations with these outcomes.

CONCLUSIONS

Support for a comprehensive model of euthymia reinforces efforts to improve assessment and treatment of mood and other disorders. Beyond dampening of psychological distress, euthymia-informed treatment goals encompass full recovery, including enjoyment and meaning in life.

Social media use, mental health, and suicide-related outcomes in Russian women: A cross-sectional comparison between two age groups

BACKGROUND

Women who belong to the age group "emerging adulthood" (18 to 29 years) are vulnerable to mental health issues and suicide-related outcomes.

OBJECTIVES

This study investigated potential predictors of suicide-related outcomes in females emerging adulthood and compared them to older women.

DESIGN AND METHODS

Data of 2537 women from Russia (group "18 to 29 years": n = 1123; group "> 29 years": n = 1414) on lifetime suicide-related outcomes, (problematic) social media use, daily stress, depression and anxiety symptoms, and positive mental health were assessed via online cross-sectional surveys.

RESULTS

The younger group spent significantly more time on social media use than the older group. It had significantly higher levels of daily stress, problematic social media use, depression and anxiety symptoms, and suicide-related outcomes. The older group showed significantly higher levels of positive mental health. Only in the younger group, problematic social media use significantly mediated the relationship between daily stress and suicide-related outcomes in a moderated mediation analysis. Positive mental health significantly moderated the association between problematic social media use and suicide-related outcomes. Specifically, the higher the positive mental health level, the less close the link between both variables.

CONCLUSION

The current results reveal that young women in Russia could be at enhanced risk for daily stress, problematic social media use, and low levels of mental health. The interaction between these variables could foster suicide-related outcomes. Public governmental communication in Russia should call attention to potential negative impact of intensive social media use.

Cross-cultural validity of the WHO-5 Well-Being Index and Euthymia Scale: A clinimetric analysis

BACKGROUND

The assessment of psychological well-being and euthymia represents an emerging issue in clinical psychology and psychiatry. Rating scales and indices such as the 5-item version of the World Health Organization Well-Being Index (WHO-5) and the Euthymia Scale (ES) were developed but insufficient attention has been devoted to the evaluation of their cross-cultural validity. This is the first study using Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to assess cross-cultural validity and sensitivity of five different versions of the WHO-5 and ES.

METHODS

A multicenter cross-sectional study involving a total of 3762 adult participants from different European (i.e., Italy, Poland, Denmark) and non-European (i.e., China, Japan) countries was conducted. Item Response Theory models (Mokken and Rasch analyses) were applied.

RESULTS

Mokken coefficients of scalability were found to range from 0.42 to 0.84. The majority of the versions of the WHO-5 fitted the Rasch model expectations. Paired t-tests revealed that the Italian and Danish WHO-5 versions were unidimensional. Person Separation Reliability indices showed that the Polish, Danish, and Japanese ES versions could reliably discriminate between subjects with different levels of euthymia.

LIMITATIONS

A convenience sampling was used, thus limiting the generalizability of study findings. In addition, no measures of negative mental health were administered.

CONCLUSIONS

WHO-5 can be used in international studies for cross-cultural comparisons since it covers transcultural components of subjective well-being. Findings also suggest that the ES can be used as a cross-cultural screening tool since it entailed the clinimetric property of sensitivity.

Psychometric analysis of the questionnaires for the assessment of upper limbs available in their Italian version: a systematic review of the structural and psychometric characteristics

INTRODUCTION

There is no systematic review that analyzes the psychometric properties of questionnaires in Italian. Previous studies have analyzed the psychometric characteristics of instruments for the measurement of pathologies of upper limbs and their joints in different languages. The aim of the present study was to analyze the psychometric properties of the questionnaires published in Italian for the evaluation of the entire upper limb or some of its specific regions and related dysfunctions.

EVIDENCE ACQUISITION

For the development of this systematic review, the following databases were used: PubMed, Scopus, Cochrane, Dialnet, Cinahl, Embase and PEDro. The selection criteria used in this study were: studies of transcultural adaptation to Italian of questionnaires oriented to the evaluation of upper limbs or any of their structures (specifically shoulder, elbow and wrist/hand), and contribution of psychometric variables of the questionnaire in its Italian version.

EVIDENCE SYNTHESIS

After reading the titles and applying the inclusion and exclusion criteria to the complete documents, 16 documents were selected: 3 for the upper limb, 8 for the shoulder, 1 for the elbow and 4 for the wrist and hand. The cross-sectional psychometric variables show levels between good and excellent in all the questionnaires. Longitudinal psychometric variables had not been calculated in the vast majority of the analyzed questionnaires.

CONCLUSIONS

Italian versions of the questionnaires show good basic structural and psychometric characteristics for the evaluation of patients with musculoskeletal disorders of the upper limb and its joints (shoulder, elbow and wrist/hand).

New resilience instrument for family caregivers in cancer: a multidimensional item response theory analysis

OBJECTIVE

Resilience instruments specific to family caregivers (FCs) in cancer are limited. This study was designed to validate the 10-item Resilience Scale Specific to Cancer (RS-SC-10) in FCs using multidimensional item response theory (MIRT) analysis.

METHODS

382 FCs were enrolled from Be Resilient to Cancer Program (BRCP) and administered with RS-SC-10 and 36-item Short Form Health Survey (SF-36). MIRT was performed to evaluate item parameters while Generalized Additive Model (GAM) and Latent Profile Analysis (LPA) were performed to test the non-linear relationship between resilience (RS-SC-10) and Quality of Life (QoL, SF-36).

RESULTS

RS-SC-10 retained 10 items with high multidimensional discrimination, monotonous thresholds and its original two-factor structure (Generic and Shift-Persist). Four latent resilience subgroups were identified and a non-linear dose-response pattern between resilience and QoL was confirmed (per-SD increase OR = 1.62, 95% CI 1.16-2.13, p = 0.0019).

CONCLUSION

RS-SC-10 is a brief and suitable resilience instrument for FCs in cancer. The resilience screening of patients and FCs can be performed simultaneously in clinical practice.

Sensitivity and concurrent validity of the Japanese version of the Euthymia scale: a clinimetric analysis

BACKGROUND

Euthymia is characterized by the lack of mood disorders, the presence of positive affects, psychological flexibility and well-being, a unifying outlook on life, and resistance to stress. The Euthymia Scale (ES) is a 10-item self-rating clinimetric index assessing euthymia.

OBJECTIVES

The present study was conducted to examine the clinimetric sensitivity and concurrent validity of the Japanese version of the Euthymia Scale (ES-J).

METHODS

A cross-sectional online survey was conducted. The Mini-International Neuropsychiatric Interview was used to determine the presence of past or current major depressive episodes (MDE). The clinimetric sensitivity was evaluated using the Analysis of Variance (ANOVA). Pearson's correlation coefficients were performed to examine the concurrent validity of the ES-J.

RESULTS

A total of 1030 eligible participants completed the survey. The ES-J differentiated healthy subjects from complete remission (i.e., those with a past history of MDE without current MDE) (p < 0.001), from those with past or current history of MDE (p < 0.001), subjects with current MDE from those with sub-threshold symptoms of depression (p < 0.001), and healthy participants from subjects with moderate to severe symptoms of psychological distress (p < 0.001). The associations between the ES-J and measures of psychological well-being, resilience, life satisfaction, and social support were significantly positive (0.353 < r < 0.666, p < 0.001). A negative relationship between the ES-J and measures of psychological distress was also found (r = - 0.595, p < 0.001).

CONCLUSIONS

The findings of the present study indicated that the ES-J is a valid and highly sensitive clinimetric index, which can be used as a screening measure in the clinical process of assessment of recovery, particularly when symptoms are expected to be mild and/or when dealing with subclinical symptoms of psychological distress and depression. The findings of this study also support the use of the ES-J to detect vulnerability to depression and to identify subjects at higher risk of relapse.