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Saracino RM, Park E, Shuk E, Rosenfeld B, Roth AJ, Nelson CJ. Considerations for Evaluating Older Adults with Cancer for Depression: A Qualitative Survey of Experts. Clin Gerontol 2024:1-11. [PMID: 38961750 DOI: 10.1080/07317115.2024.2375321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
OBJECTIVES The objective of this study was to engage national experts in geriatric psychiatry and oncology in qualitative interviews to develop consensus regarding how older adult cancer survivors (OACS) experience depressive symptoms, and how best to assess OACs for depression. METHODS Expert clinicians in geriatric oncology disciplines were interviewed about approaches to assessing depression in OACs. Interviews were audio-recorded and transcribed, and conducted until thematic saturation was achieved. Thematic Content Analysis was utilized to identify key themes. RESULTS Experts (N = 8) were board certified geriatric psychiatrists and oncologists with specialization in geriatric medicine. Two conceptual domains were identified: Key indicators of depression in OACs (e.g. anhedonia; loss of meaning and purpose; loneliness and social withdrawal) and unique considerations for depression assessment in OACs (e.g. alternative phrasing to "depression," disentangling mood and cancer or treatment-related side effects). CONCLUSIONS The approaches identified tended to depart from traditional diagnostic criteria for depression. CLINICAL IMPLICATIONS Results provide additional insight into the limitations of existing depression measures for OACs. The themes and practices identified in the present study suggest that a revised measure of depression for OACs may be useful. Future research will continue to shed light on best practices for depression assessment in OACs.
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ellen Park
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elyse Shuk
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Andrew J Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Low CE, Yau CE, Tan RY, Ong VCS, Ho RCM, Ho CSH, Lee ARYB, Chen MZ. Association of depression with all-cause and cancer-specific mortality in older adults with cancer: Systematic review, meta-analysis, and meta-regression. J Geriatr Oncol 2024; 15:101700. [PMID: 38218674 DOI: 10.1016/j.jgo.2023.101700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/30/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION The incidence and mortality of cancer is increasing worldwide with studies reporting that cumulative risk of cancer rises as age increases. Against the backdrop of the increasing prevalence of cancer amongst older patients, we conducted a systematic review and meta-analysis examining the depression-mortality relationship in older adults with cancer (OAC). MATERIALS AND METHODS This PRISMA-adherent systematic review involved a systematic search of PubMed, Medline, EMBASE, and PsycINFO for prospective and retrospective cohort studies comparing the risk of all-cause and cancer-related mortality among OAC with depression. Random effects meta-analyses and meta-regressions were used for the primary analysis. RESULTS From 5,280 citations, we included 14 cohort studies. Meta-analyses of hazard ratios (HRs) showed an increased incidence of all-cause mortality in OAC with depression (pooled HR: 1.40; 95% confidence interval [CI]: 1.25, 1.55). Subgroup analyses of other categorical study-level characteristics were insignificant. While risk of cancer-related mortality in OAC with depression was insignificantly increased with a pooled HR of 1.21 (95% CI: 0.98, 1.49), subgroup analysis indicated that risk of cancer-related mortality in OAC with depression significantly differed with cancer type. Our systematic review found that having fewer comorbidities, a higher education level, greater socioeconomic status, and positive social supportive factors lowered risk of all-cause mortality in OAC with depression. DISCUSSION Depression in OAC significantly increases risk of all-cause mortality and cancer-related mortality among different cancer types. It is imperative for healthcare providers and policy makers to recognize vulnerable subgroups among older adults with cancer to individualize interventions.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ren Ying Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Roger Chun Man Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
| | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Hospital, Singapore
| | | | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore.
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Kolobaric A, Mizuno A, Yang X, George CJ, Seidman A, Aizenstein HJ, Kovacs M, Karim HT. History of major depressive disorder is associated with differences in implicit learning of emotional faces. J Psychiatr Res 2023; 161:324-332. [PMID: 36996725 PMCID: PMC10202097 DOI: 10.1016/j.jpsychires.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023]
Abstract
Major depressive disorder is often associated with worsened reward learning, with blunted reward response persisting after remission. In this study, we developed a probabilistic learning task with social rewards as a learning signal. We examined the impacts of depression on social rewards (facial affect displays) as an implicit learning signal. Fifty-seven participants without a history of depression and sixty-two participants with a history of depression (current or remitted) completed a structured clinical interview and an implicit learning task with social reward. Participants underwent an open-ended interview to evaluate whether they knew the rule consciously. Linear mixed effects models revealed that participants without a history of depression learned faster and showed a stronger preference towards the positive than the negative stimulus when compared to the participants with a history of depression. In contrast, those with a history depression learned slower on average and displayed greater variability in stimulus preference. We did not detect any differences in learning between those with current and remitted depression. The results indicate that on a probabilistic social reward task, people with a history of depression exhibit slower reward learning and greater variability in their learning behavior. Improving our understanding of alterations in social reward learning and their associations with depression and anhedonia may help to develop translatable psychotherapeutic approaches for modification of maladaptive emotion regulation.
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Affiliation(s)
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Xiao Yang
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | | | - Andrew Seidman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maria Kovacs
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Eckerle W, Koldhekar A, Muldoon M, Stewart J, Kamarck T. Independent Associations Between Trait-Anger, Depressive Symptoms and Preclinical Atherosclerotic Progression. Ann Behav Med 2023; 57:409-417. [PMID: 36715099 PMCID: PMC10122100 DOI: 10.1093/abm/kaac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Previous research from our group found that recent depressive symptoms were associated with 3-year change in carotid intima-media thickness (CA-IMT), a biomarker of cardiovascular disease risk, in an initially healthy sample of older adults. Trait measures of anxiety, anger, and hostility did not predict 3-year CA-IMT progression in that report. PURPOSE The current study sought to reexamine these associations at a 6-year follow-up point. METHODS Two-hundred seventy-eight participants (151 males, mean age = 60.68 years) from the original sample completed an additional IMT reading 6 years following the initial baseline assessment. RESULTS Though not significant at 3-years, trait-anger emerged as a predictor of IMT progression at the 6-year point. When examined in separate regression models, both depression and trait-anger (but not anxiety or hostility) predicted 6-year IMT change (b = .017, p = .002; b = .029, p = .01, respectively). When examined concurrently, both depression and anger were independently associated with 6-year IMT progression (b = .016, p = .010, b = .028, p = .022, respectively). Exploratory analyses suggest that the relative contributions of anger and depression may differ for males and females. CONCLUSIONS The use of sequential follow-ups is relatively unique in this literature, and our results suggest a need for further research on the timing and duration of psychosocial risk exposures in early stages of cardiovascular disease.
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Affiliation(s)
- William Eckerle
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amol Koldhekar
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew Muldoon
- Department of Medicine, Cardiology Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jesse Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Tom Kamarck
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Criterion and construct validity of the Beck Depression Inventory (BDI-II) to measure depression in patients with cancer: The contribution of somatic items. Int J Clin Health Psychol 2023; 23:100350. [DOI: 10.1016/j.ijchp.2022.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
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Massa E, Donisi C, Liscia N, Madeddu C, Impera V, Mariani S, Scartozzi M, Lai E. The Difficult Task of Diagnosing Depression in Elderly People with Cancer: A Systematic Review. Clin Pract Epidemiol Ment Health 2021; 17:295-306. [PMID: 35444712 PMCID: PMC8985471 DOI: 10.2174/1745017902117010295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/08/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
Background:
Depression is a common psychiatric problem in the elderly and oncology patients. In elderly people with cancer, depression has a peculiar phenomenology. It has a significant impact on the quality of life. Moreover, it is associated with poor adherence to treatments, increased risk of suicide, and mortality. Nevertheless, the topic of depression in elderly people with cancer remains unexplored.
Objective:
The main goal of this article is to review the literature from the past 20 years on the relationships between depression, cancer, and aging.
Methods:
The methods followed the Prisma model for eligibility of studies. The articles in which the keywords “depression”, “cancer”, “ elderly, aging, or geriatric” were present, either in the text or in the abstract, were selected. 8.056 articles, by matching the keywords “depression and elderly and cancer,” were identified. Only 532 papers met the eligibility criteria of search limits and selection process. Out of 532 papers, 467 were considered irrelevant, leaving 65 relevant studies. Out of 65 suitable studies, 39 (60.0%) met our quality criteria and were included.
Results:
The risk factors associated with depression in elderly people with cancer can be divided into 4 groups: 1) tumor-related; 2) anticancer treatment-related; 3) patients-related; 4) number and type of comorbidity. The main obstacles in diagnosing depression in elderly patients with cancer are the overlap of the symptoms of cancer and side effects of treatment with the symptoms of depression but also the different ways of reporting depressive symptoms of elderly people and the different clinical types of depression. There is a lack of data regarding validated scales to assess depression in geriatric patients with cancer. Any mental illness, specifically co-occurring anxiety and depression, increases the risk of diagnosis delay and anticancer treatment adherence. Cancer and the diagnosis of mental disorders prior to cancer diagnosis correlate with an increased risk for suicide. A non-pharmacological therapeutic approach, pharmacological treatment and/or a combination of both can be used to treat elderly patients with cancer, but a detailed analysis of comorbidities and the assessment of polypharmacy is mandatory in order to avoid potential side-effects and interactions between antidepressants and the other drugs taken by the patients.
Conclusion:
Future research should be conducted with the aim of developing a modified and adapted assessment method for the diagnosis and treatment of depression in elderly people with cancer in order to improve their clinical outcomes and quality of life.
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Level of active lifestyle and exercise approach among students of the University of Novi Pazar during the COVID-19 pandemic. NUTR HOSP 2021; 38:881-882. [PMID: 34041915 DOI: 10.20960/nh.03658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction
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Lamela D, Soreira C, Matos P, Morais A. Systematic review of the factor structure and measurement invariance of the patient health questionnaire-9 (PHQ-9) and validation of the Portuguese version in community settings. J Affect Disord 2020; 276:220-233. [PMID: 32697702 DOI: 10.1016/j.jad.2020.06.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/19/2020] [Accepted: 06/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3). METHODS Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity. RESULTS The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established. LIMITATIONS Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties. CONCLUSIONS Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.
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Affiliation(s)
- Diogo Lamela
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal.
| | - Cátia Soreira
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
| | - Paula Matos
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
| | - Ana Morais
- Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal
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9
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Magnuson A, Sattar S, Nightingale G, Saracino R, Skonecki E, Trevino KM. A Practical Guide to Geriatric Syndromes in Older Adults With Cancer: A Focus on Falls, Cognition, Polypharmacy, and Depression. Am Soc Clin Oncol Educ Book 2019; 39:e96-e109. [PMID: 31099668 DOI: 10.1200/edbk_237641] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Geriatric syndromes are multifactorial conditions that are prevalent in older adults. Geriatric syndromes are believed to develop when an individual experiences accumulated impairments in multiple systems that compromise their compensatory ability. In older adults with cancer, the presence of a geriatric syndrome is common and may increase the complexity of cancer treatment. In addition, the physiologic stress of cancer and cancer treatment may precipitate or exacerbate geriatric syndromes. Common geriatric syndromes include falls, cognitive syndromes and delirium, depression, and polypharmacy. In the oncology setting, the presence of geriatric syndromes is relevant; falls and cognitive problems have been shown to be predictive of chemotherapy toxicity and overall survival. Polypharmacy and depression are more common in older adults with cancer compared with the general geriatric population. Multiple screening tools exist to identify falls, cognitive problems, polypharmacy, and depression in older adults and can be applied to the oncology setting to identify patients at risk. When recognized, several interventions exist that could be considered for this vulnerable population. We review the available evidence of four geriatric syndromes in the oncology setting, including clinical implications, validated screening tools, potential supportive care, and therapeutic interventions.
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Affiliation(s)
- Allison Magnuson
- 1 Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
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10
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García-Batista ZE, Guerra-Peña K, Cano-Vindel A, Herrera-Martínez SX, Medrano LA. Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. PLoS One 2018; 13:e0199750. [PMID: 29958268 PMCID: PMC6025862 DOI: 10.1371/journal.pone.0199750] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/13/2018] [Indexed: 11/30/2022] Open
Abstract
The Beck Depression Inventory-II (BDI-II) is currently one of the most widely used measures in both research and clinical practice for assessing depression. Although the psychometric properties of the scale have been well established through many studies worldwide, so far there is no study examining the validity and reliability of BDI-II in Republic Dominican. The purpose of the present study was twofold: (a) to examine the latent structure of BDI-II by testing several competing models proposed in the literature; and (b) to provide evidence of validity and reliability of the BDI-II in Republic Dominican. Confirmatory factor analysis indicated that a bifactor model with a general depression factor and three specific factors consisting of cognitive, affective and somatic showed the best fit to the data. Internal reliability was moderate to high for all subscales and for the total scale. Scores on BDI-II discriminated between clinical and general population, supporting for external validity. Practical implications are discussed and suggestions for further research are also made.
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Affiliation(s)
| | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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Hu J, Ward MM. Screening for depression in arthritis populations: an assessment of differential item functioning in three self-reported questionnaires. Qual Life Res 2017; 26:2507-2517. [PMID: 28624902 PMCID: PMC11075049 DOI: 10.1007/s11136-017-1601-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if persons with arthritis differ systematically from persons without arthritis in how they respond to questions on three depression questionnaires, which include somatic items such as fatigue and sleep disturbance. METHODS We extracted data on the Centers for Epidemiological Studies Depression (CES-D) scale, the Patient Health Questionnaire-9 (PHQ-9), and the Kessler-6 (K-6) scale from three large population-based national surveys. We assessed items on these questionnaires for differential item functioning (DIF) between persons with and without self-reported physician-diagnosed arthritis using multiple indicator multiple cause models, which controlled for the underlying level of depression and important confounders. We also examined if DIF by arthritis status was similar between women and men. RESULTS Although five items of the CES-D, one item of the PHQ-9, and five items of the K-6 scale had evidence of DIF based on statistical comparisons, the magnitude of each difference was less than the threshold of a small effect. The statistical differences were a function of the very large sample sizes in the surveys. Effect sizes for DIF were similar between women and men except for two items on the Patient Health Questionnaire-9. For each questionnaire, DIF accounted for 8% or less of the arthritis-depression association, and excluding items with DIF did not reduce the difference in depression scores between those with and without arthritis. CONCLUSIONS Persons with arthritis respond to items on the CES-D, PHQ-9, and K-6 depression scales similarly to persons without arthritis, despite the inclusion of somatic items in these scales.
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Affiliation(s)
- Jinxiang Hu
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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Teresi JA, Ocepek-Welikson K, Toner JA, Kleinman M, Ramirez M, Eimicke JP, Gurland BJ, Siu A. Methodological issues in measuring subjective well-being and quality-of-life: Applications to assessment of affect in older, chronically and cognitively impaired, ethnically diverse groups using the Feeling Tone Questionnaire. APPLIED RESEARCH IN QUALITY OF LIFE 2017; 12:251-288. [PMID: 30220935 PMCID: PMC6136843 DOI: 10.1007/s11482-017-9516-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Quality of life assessment includes measurement of positive affect. Methods artifacts associated with positively and negatively worded items can manifest as negative items loading on a second factor, despite the conceptual view that the items are measuring one underlying latent construct. Negatively worded items may elicit biased responses. Additionally, item-level response bias across ethnically diverse groups may compromise group comparisons. The aim was to illustrate methodological approaches to examining method factors and measurement equivalence in an affect measure with 9 positively and 7 negatively worded items: The Feeling Tone Questionnaire (FTQ). The sample included 4,960 non-Hispanic White, 1,144 non-Hispanic Black, and 517 Hispanic community and institutional residents receiving long-term supportive services. The mean age was 82 (s.d.=11.0); 73% were female. Two thirds were cognitively impaired. Methods effects were assessed using confirmatory factor analyses (CFA), and reliability with McDonald's omega and item response theory (IRT) generated estimates. Measurement equivalence was examined using IRT-based Wald tests. Methods effects associated with negatively worded items were observed; these provided little IRT information, and as a composite evidenced lower reliability. Both 13 and 9 item positive affect scales performed well in terms of model fit, reliability, IRT information, and evidenced little differential item functioning of high magnitude or impact. Both CFA and IRT approaches provided complementary methodological information about scale performance. The 9-item affect scale based on the FTQ can be recommended as a brief quality-of-life measure among frail and cognitively impaired individuals in palliative and long-term care settings.
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Affiliation(s)
- Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
- Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
| | | | - John A. Toner
- Columbia University Stroud Center at New York State Psychiatric Institute
| | - Marjorie Kleinman
- New York State Psychiatric Institute, Division of Child and Adolescent Psychiatry
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
- Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
| | - Joseph P. Eimicke
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
- Weill Cornell Medical Center, Department of Geriatrics and Palliative Medicine
| | - Barry J. Gurland
- Columbia University Stroud Center at New York State Psychiatric Institute
| | - Albert Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine
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Erford BT, Johnson E, Bardoshi G. Meta-Analysis of the English Version of the Beck Depression Inventory–Second Edition. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1177/0748175615596783] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Khambaty T, Callahan CM, Perkins AJ, Stewart JC. Depression and Anxiety Screens as Simultaneous Predictors of 10-Year Incidence of Diabetes Mellitus in Older Adults in Primary Care. J Am Geriatr Soc 2017; 65:294-300. [PMID: 27641686 PMCID: PMC5311025 DOI: 10.1111/jgs.14454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To examine depression and anxiety screens and their individual items as simultaneous predictors of incident diabetes mellitus. DESIGN Ten-year follow-up study of individuals screened for the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial. SETTING Two large urban primary care clinics in Indianapolis, Indiana. PARTICIPANTS Diverse sample (53% African American, 80% of lower socioeconomic status) of 2,156 older adults initially free of diabetes mellitus. MEASUREMENTS Depression and anxiety screens were completed during routine primary care visits between 1999 and 2001. Incident diabetes mellitus data were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytical files though 2009. RESULTS Over the 10-year period, 558 (25.9%) participants had diabetes mellitus onset. Cox proportional hazards models adjusted for demographic and diabetes mellitus risk factors revealed that a positive screen for anxiety, but not for depression, predicted incident diabetes mellitus when entered into separate models (anxiety: hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.15-1.61, P < .001; depression: HR = 1.18, 95% CI = 0.95-1.46, P = .13) and when entered simultaneously into one model (anxiety: HR = 1.35, 95% CI = 1.12-1.61, P < .001; depression: HR = 1.04, 95% CI = 0.83-1.31, P = .73). The feeling anxious (P = .03) and the worry (P = .02) items predicted incident diabetes mellitus independent of the depression screen. CONCLUSION These findings suggest that screening positive for anxiety is a risk factor for diabetes mellitus in older adults independent of depression and traditional diabetes mellitus risk factors. Anxiety requires greater consideration and awareness in the context of diabetes mellitus risk assessment and primary prevention.
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Affiliation(s)
| | - Christopher M. Callahan
- Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Anthony J. Perkins
- Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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Bravo IM, Arrufat O. The Illness Attitude Scales: Adaptation and Translation Into Spanish for Use With Older Adults. J Appl Gerontol 2016. [DOI: 10.1177/0733464805278133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Illness Attitude Scales (IAS) were simplified from a 5-point Likert-type scale to a yes-or-no format and translated into Spanish using Brislin’s method. Because of the linkage between hypochondriasis and depression, the new version was administered to immigrant, Hispanic, older adults suffering from major depressive disorder (MDD) (n= 21) and their controls (n = 21), and to non-Hispanic older adults with MDD (n = 32) and their controls (n = 32). Both versions of the IAS were equivalent and had adequate internal consistency. As hypothesized, Hispanic immigrants with MDD endorsed more hypochondriacal beliefs and were more concerned about the effect of their symptoms than controls. Non-Hispanics were more concerned about pain than controls. The two IAS simplified versions will be useful in the assessment of English- and Spanish-speaking older adults in both clinical and research settings.
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Toups M, Carmody T, Trivedi MH, Rush AJ, Hedayati SS. Performance of depression rating scales in patients with chronic kidney disease: an item response theory-based analysis. Gen Hosp Psychiatry 2016; 42:60-6. [PMID: 27638974 PMCID: PMC5724363 DOI: 10.1016/j.genhosppsych.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/18/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Because there is overlap between somatic symptoms of depression and symptoms of chronic kidney disease (CKD), it is unclear if self-reported depression rating scales can be used accurately in predialysis CKD patients, especially if CKD and other comorbidities are symptomatic. We assessed the performance of two depression scales - the Beck Depression Inventory (BDI) and the Quick Inventory of Depression Symptomatology (QIDS-SR16) - by CKD stage, diagnosis of diabetes and total medical comorbidity burden - using item response theory (IRT) in a sample of 272 predialysis CKD patients. METHODS We performed IRT by low versus high CKD stage, diabetes versus no diabetes and high (>3 diagnoses) versus low medical comorbidity burden. RESULTS IRT models of each rating scale were affected in a limited way by CKD stage, diabetes and medical comorbidity burden. Sleep disturbances on the QIDS-SR16 were more discriminatory for depression in diabetics and those with high comorbidity burden. Pessimism and guilt from the BDI compared to QIDS-SR16 were more discriminatory of depression in the high CKD and high comorbidity groups, respectively. CONCLUSIONS Overall item differences were modest, and chronic disease severity by CKD stage, diabetes mellitus or other medical comorbidities did not appreciably contribute to differences in scale performance.
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Affiliation(s)
- Marisa Toups
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA, 75390-9119
| | - Thomas Carmody
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA, 75390-9119,Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA, 75390-9066
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA, 75390-9119
| | - A. John Rush
- Division of Clinical Sciences, Duke-NUS, 8 College Rd, Singapore, 169857
| | - S. Susan Hedayati
- Division of Nephrology, Department of Medicine, Veterans Affairs North Texas Health Care System, 4500 S. Lancaster Rd MC 111G1, Dallas, TX, USA, 75216,Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA, 75390-8516,Corresponding author at: VA North Texas Health Care System, Nephrology Section, 4500 South Lancaster Road MC 111G1, Dallas, TX, 75216-7167. Tel.: +1-214-857-2214; fax: +1-214-857-1514. (S.S. Hedayati)
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Teresi JA, Jones RN. Methodological Issues in Examining Measurement Equivalence in Patient Reported Outcomes Measures: Methods Overview to the Two-Part Series, "Measurement Equivalence of the Patient Reported Outcomes Measurement Information System ® (PROMIS ®) Short Forms". PSYCHOLOGICAL TEST AND ASSESSMENT MODELING 2016; 58:37-78. [PMID: 28983448 PMCID: PMC5625814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this article is to introduce the methods used and challenges confronted by the authors of this two-part series of articles describing the results of analyses of measurement equivalence of the short form scales from the Patient Reported Outcomes Measurement Information System® (PROMIS®). Qualitative and quantitative approaches used to examine differential item functioning (DIF) are reviewed briefly. Qualitative methods focused on generation of DIF hypotheses. The basic quantitative approaches used all rely on a latent variable model, and examine parameters either derived directly from item response theory (IRT) or from structural equation models (SEM). A key methods focus of these articles is to describe state-of-the art approaches to examination of measurement equivalence in eight domains: physical health, pain, fatigue, sleep, depression, anxiety, cognition, and social function. These articles represent the first time that DIF has been examined systematically in the PROMIS short form measures, particularly among ethnically diverse groups. This is also the first set of analyses to examine the performance of PROMIS short forms in patients with cancer. Latent variable model state-of-the-art methods for examining measurement equivalence are introduced briefly in this paper to orient readers to the approaches adopted in this set of papers. Several methodological challenges underlying (DIF-free) anchor item selection and model assumption violations are presented as a backdrop for the articles in this two-part series on measurement equivalence of PROMIS measures.
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Affiliation(s)
- Jeanne A. Teresi
- Weill Cornell Medical College, Division of Geriatrics and Palliative Medicine
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University
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Teresi JA, Ocepek-Welikson K, Kleinman M, Ramirez M, Kim G. Psychometric Properties and Performance of the Patient Reported Outcomes Measurement Information System ® (PROMIS ®) Depression Short Forms in Ethnically Diverse Groups. PSYCHOLOGICAL TEST AND ASSESSMENT MODELING 2016; 58:141-181. [PMID: 28553573 PMCID: PMC5443256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Short form measures from the Patient Reported Outcomes Measurement Information System® (PROMIS®) are used widely. The present study was among the first to examine differential item functioning (DIF) in the PROMIS Depression short form scales in a sample of over 5000 racially/ethnically diverse patients with cancer. DIF analyses were conducted across different racial/ethnic, educational, age, gender and language groups. METHODS DIF hypotheses, generated by content experts, informed the evaluation of the DIF analyses. The graded item response theory (IRT) model was used to evaluate the five-level ordinal items. The primary tests of DIF were Wald tests; sensitivity analyses were conducted using the IRT ordinal logistic regression procedure. Magnitude was evaluated using expected item score functions, and the non-compensatory differential item functioning (NCDIF) and T1 indexes, both based on group differences in the item curves. Aggregate impact was evaluated with expected scale score (test) response functions; individual impact was assessed through examination of differences in DIF adjusted and unadjusted depression estimates. RESULTS Many items evidenced DIF; however, only a few had slightly elevated magnitude. No items evidenced salient DIF with respect to NCDIF and the scale-level impact was minimal for all group comparisons. The following short form items might be targeted for further study because they were also hypothesized to evidence DIF. One item showed slightly higher magnitude of DIF for age: nothing to look forward to; conditional on depression, this item was more likely to be endorsed in the depressed direction by individuals in older groups as contrasted with the cohort aged 21 to 49. This item was also hypothesized to show age DIF. Only one item (failure) showed DIF of slightly higher magnitude (just above threshold) for Whites vs. Asians/Pacific Islanders in the direction of higher likelihood of endorsement for Asians/Pacific Islanders. This item was also hypothesized to show DIF for minority groups. The impact of DIF was negligible. Conditional on depression, the items, worthless and hopeless were more likely to be endorsed in the depressed direction by respondents with less than high school education vs. those with a graduate degree; the magnitude of DIF was slightly above the T1 threshold, but not that of NCDIF. These items were also hypothesized to show DIF in the direction of more feelings of worthlessness by groups with lower education. While the magnitude and aggregate impact of DIF was small, in a few instances, individual impact was observed. Information provided was relatively high, particularly in the middle upper (depressed) tail of the distribution. Reliability estimates were high (> 0.90) across all studied groups, regardless of estimation method. CONCLUSIONS This was the first study to evaluate measurement equivalence of the PROMIS Depression short forms across large samples of ethnically diverse groups. There were few items with DIF, and none of high magnitude, thus supporting the use of PROMIS Depression short form measures across such groups. These results could be informative for those using the short forms in minority populations or clinicians evaluating individuals with the depression short forms.
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Affiliation(s)
- Jeanne A. Teresi
- New York State Psychiatric Institute
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
- Department of Geriatrics and Palliative Medicine, Weill Cornell Medical Center
| | | | | | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale; RiverSpring Health
- Department of Geriatrics and Palliative Medicine, Weill Cornell Medical Center
| | - Giyeon Kim
- Center for Mental Health and Aging, Department of Psychology, University of Alabama, Tuscaloosa
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Harris KM, Syu JJ, Lello OD, Chew YLE, Willcox CH, Ho RHM. The ABC's of Suicide Risk Assessment: Applying a Tripartite Approach to Individual Evaluations. PLoS One 2015; 10:e0127442. [PMID: 26030590 PMCID: PMC4452484 DOI: 10.1371/journal.pone.0127442] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 11/24/2022] Open
Abstract
There is considerable need for accurate suicide risk assessment for clinical, screening, and research purposes. This study applied the tripartite affect-behavior-cognition theory, the suicidal barometer model, classical test theory, and item response theory (IRT), to develop a brief self-report measure of suicide risk that is theoretically-grounded, reliable and valid. An initial survey (n = 359) employed an iterative process to an item pool, resulting in the six-item Suicidal Affect-Behavior-Cognition Scale (SABCS). Three additional studies tested the SABCS and a highly endorsed comparison measure. Studies included two online surveys (Ns = 1007, and 713), and one prospective clinical survey (n = 72; Time 2, n = 54). Factor analyses demonstrated SABCS construct validity through unidimensionality. Internal reliability was high (α = .86-.93, split-half = .90-.94)). The scale was predictive of future suicidal behaviors and suicidality (r = .68, .73, respectively), showed convergent validity, and the SABCS-4 demonstrated clinically relevant sensitivity to change. IRT analyses revealed the SABCS captured more information than the comparison measure, and better defined participants at low, moderate, and high risk. The SABCS is the first suicide risk measure to demonstrate no differential item functioning by sex, age, or ethnicity. In all comparisons, the SABCS showed incremental improvements over a highly endorsed scale through stronger predictive ability, reliability, and other properties. The SABCS is in the public domain, with this publication, and is suitable for clinical evaluations, public screening, and research.
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Affiliation(s)
- Keith M. Harris
- School of Psychology, University of Queensland, St Lucia, Qld, Australia
| | - Jia-Jia Syu
- School of Public Health, University of Queensland, Herston, Qld, Australia
| | - Owen D. Lello
- School of Psychology, University of Newcastle, Newcastle, NSW, Australia
| | | | - Christopher H. Willcox
- Hunter New England Mental Health, Newcastle, NSW, Australia
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Roger H. M. Ho
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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Depressive symptom clusters as predictors of 6-year increases in insulin resistance: data from the Pittsburgh Healthy Heart Project. Psychosom Med 2014; 76:363-9. [PMID: 24846000 PMCID: PMC4065635 DOI: 10.1097/psy.0000000000000063] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine longitudinal bidirectional associations between two depressive symptom clusters-the cognitive-affective and somatic-vegetative clusters--and insulin resistance, a marker of prediabetes. METHODS Participants were 269 adults aged 50 to 70 years without diabetes enrolled in the Pittsburgh Healthy Heart Project, a prospective cohort study. At baseline and 6-year visits, participants completed the Beck Depression Inventory-II (BDI-II) and underwent a blood draw to quantify fasting insulin and glucose. We examined baseline BDI-II total, cognitive-affective, and somatic-vegetative scores as predictors of 6-year change in the homeostatic model of assessment (HOMA) score, an estimate of insulin resistance computed from fasting insulin and glucose. We also examined baseline HOMA score as a predictor of 6-year change in BDI-II total and subscale scores. RESULTS Regression analyses, adjusted for demographic factors and baseline HOMA score, revealed that the baseline BDI-II somatic-vegetative score (β = 0.14, p = .025), but not the cognitive-affective (β = 0.001, p = .98) or total (β = 0.10, p = .11) scores, predicted 6-year HOMA change. This result persisted in models controlling for anxiety symptoms and hostility. Several factors were examined as candidate mediators; however, only change in body mass index was a significant mediator (p = .042), accounting for 23% of the observed association. Baseline HOMA score did not predict 6-year change in BDI-II total or subscale scores (all p values >.56). CONCLUSIONS Among adults aged 50 to 70 years, the somatic-vegetative symptoms of depression (e.g., fatigue, sleep disturbance, and appetite changes) may worsen insulin resistance and increase diabetes risk, partly, by increasing body mass index.
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Hawkins MA, Callahan CM, Stump TE, Stewart JC. Depressive symptom clusters as predictors of incident coronary artery disease: a 15-year prospective study. Psychosom Med 2014; 76:38-43. [PMID: 24367122 PMCID: PMC3891500 DOI: 10.1097/psy.0000000000000023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Because it is not known whether particular clusters of depressive symptoms are associated with a greater risk of adverse cardiac outcomes, we compared the utility of four clusters in predicting incident coronary artery disease (CAD) events during a 15-year period in a large cohort of primary care patients 60 years and older. METHODS Participants were 2537 primary care patients 60 years or older who were screened for depression between 1991 and 1993 and had no existing CAD diagnosis. Depressive symptoms cluster scores (depressed affect, somatic symptoms, interpersonal distress, and positive affect) were computed from responses on the Center for Epidemiologic Studies Depression Scale administered at baseline. CAD events, defined as the occurrence of a nonfatal acute myocardial infarction or CAD death during the follow-up period, were identified using electronic medical record and National Death Index data. RESULTS There were 678 CAD events. In separate fully adjusted Cox proportional hazard models (controlling for demographics and cardiovascular risk factors), the depressed affect (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.04-1.20), somatic (HR = 1.17, 95% CI = 1.08-1.26), and positive affect (HR = 0.88, 95% CI = 0.82-0.95) clusters each predicted CAD events. When the depressive symptom clusters were entered simultaneously into the fully adjusted model, however, only the somatic cluster remained predictive of CAD events (HR = 1.13, 95% CI = 1.03-1.23). CONCLUSIONS Our findings suggest that the longitudinal relationship between overall depressive symptom severity and incident CAD events may be driven primarily by the somatic cluster.
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Abstract
This article discusses characteristic factors in the presentation of depressive disorders in persons older than age 65 years. Clinical presentation is discussed along with risk and protective factors. Detailed descriptions of tests useful for screening and diagnosis of depression in the elderly are presented. Each test is reviewed according to time to administer, sensitivity and specificity, outcomes, advantages, and disadvantages. The importance of clinical history and the diagnostic interview, as well as the role of laboratory studies and neuroimaging in the clinical evaluation are discussed.
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Affiliation(s)
- Juliet Glover
- Geriatric Psychiatry Fellowship Program, Palmetto Health, University of South Carolina School of Medicine, 3555 Harden Street, Suite 301, Columbia, SC 29203, USA
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23
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Pilkonis PA, Choi SW, Salsman J, Butt Z, Moore TL, Lawrence SM, Zill N, Cyranowski JM, Kelly MAR, Knox SS, Cella D. Assessment of self-reported negative affect in the NIH Toolbox. Psychiatry Res 2013; 206:88-97. [PMID: 23083918 PMCID: PMC3561498 DOI: 10.1016/j.psychres.2012.09.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/26/2012] [Accepted: 09/20/2012] [Indexed: 11/15/2022]
Abstract
We report on the selection of self-report measures for inclusion in the NIH Toolbox that are suitable for assessing the full range of negative affect including sadness, fear, and anger. The Toolbox is intended to serve as a "core battery" of assessment tools for cognition, sensation, motor function, and emotional health that will help to overcome the lack of consistency in measures used across epidemiological, observational, and intervention studies. A secondary goal of the NIH Toolbox is the identification of measures that are flexible, efficient, and precise, an agenda best fulfilled by the use of item banks calibrated with models from item response theory (IRT) and suitable for adaptive testing. Results from a sample of 1763 respondents supported use of the adult and pediatric item banks for emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS(®)) as a starting point for capturing the full range of negative affect in healthy individuals. Content coverage for the adult Toolbox was also enhanced by the development of a scale for somatic arousal using items from the Mood and Anxiety Symptom Questionnaire (MASQ) and scales for hostility and physical aggression using items from the Buss-Perry Aggression Questionnaire (BPAQ).
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Affiliation(s)
- Paul A. Pilkonis
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA,Corresponding Author: Paul A. Pilkonis, Mailing address: Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213, Telephone: 412.246.5833, Fax: 412.246.5840,
| | - Seung W. Choi
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - John Salsman
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL,Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL,Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tara L. Moore
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Suzanne M. Lawrence
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Jill M. Cyranowski
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Morgen A. R. Kelly
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA,Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Sarah S. Knox
- Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL,Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
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Teresi JA, Ramirez M, Jones RN, Choi S, Crane PK. Modifying measures based on differential item functioning (DIF) impact analyses. J Aging Health 2012; 24:1044-76. [PMID: 22422759 PMCID: PMC4030595 DOI: 10.1177/0898264312436877] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Measure modification can impact comparability of scores across groups and settings. Changes in items can affect the percent admitting to a symptom. METHODS Using item response theory (IRT) methods, well-calibrated items can be used interchangeably, and the exact same item does not have to be administered to each respondent, theoretically permitting wider latitude in terms of modification. RESULTS Recommendations regarding modifications vary, depending on the use of the measure. In the context of research, adjustments can be made at the analytic level by freeing and fixing parameters based on findings of differential item functioning (DIF). The consequences of DIF for clinical decision making depend on whether or not the patient's performance level approaches the scale decision cutpoint. High-stakes testing may require item removal or separate calibrations to ensure accurate assessment. DISCUSSION Guidelines for modification based on DIF analyses and illustrations of the impact of adjustments are presented.
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Stewart JC, Zielke DJ, Hawkins MAW, Williams DR, Carnethon MR, Knox SS, Matthews KA. Depressive symptom clusters and 5-year incidence of coronary artery calcification: the coronary artery risk development in young adults study. Circulation 2012; 126:410-7. [PMID: 22711275 PMCID: PMC3422690 DOI: 10.1161/circulationaha.112.094946] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 06/06/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Because depression is a multidimensional construct and few studies have compared the relative importance of its facets in predicting cardiovascular risk, we evaluated the utility of depressive symptom clusters in predicting the 5-year incidence of coronary artery calcification (CAC). METHODS AND RESULTS Participants were 2171 middle-aged adults (58% female; 43% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of cardiovascular disease. Depressive symptom clusters (z scores) were measured by questionnaires in 2000 to 2001, and CAC was measured by electron beam computed tomography in 2000 to 2001 and 2005 to 2006. There were 243 cases (11%) of incident CAC, defined as the absence of CAC at baseline and the presence of CAC at follow-up. Total depressive symptoms (odds ratio, 1.16; 95% confidence interval, 1.02-1.33; P=0.03) and the depressed affect cluster (odds ratio, 1.17; 95% confidence interval, 1.03-1.33; P=0.02) predicted incident CAC; however, the somatic, interpersonal distress, low positive affect, and pessimism clusters did not. The depressed affect-incident CAC relationship was independent of age, sex, race, education, and antidepressant use; was similar across sex and racial groups; and was partially accounted for by tobacco use and mean arterial pressure. CONCLUSIONS In contrast to recent results indicating that the somatic cluster is the most predictive of cardiovascular outcomes, we found that the prospective association between depressive symptoms and incident CAC was driven by the depressed affect cluster. Our findings raise the possibility that there may not be 1 facet of depression that is the most cardiotoxic across all contexts.
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Affiliation(s)
- Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N Blackford St, LD 100E, Indianapolis, IN 46202, USA.
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Hooper LM, Qu L, Crusto CA, Huffman LE. Scalar Equivalence in Self-Rated Depressive Symptomatology as Measured by the Beck Depression Inventory-II: Do Racial and Gender Differences in College Students Exist? ACTA ACUST UNITED AC 2012. [DOI: 10.4236/psych.2012.329116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pilkonis PA, Choi SW, Reise SP, Stover AM, Riley WT, Cella D. Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment 2011; 18:263-83. [PMID: 21697139 PMCID: PMC3153635 DOI: 10.1177/1073191111411667] [Citation(s) in RCA: 1331] [Impact Index Per Article: 102.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report on the development and calibration of item banks for depression, anxiety, and anger as part of the Patient-Reported Outcomes Measurement Information System (PROMIS®). Comprehensive literature searches yielded an initial bank of 1,404 items from 305 instruments. After qualitative item analysis (including focus groups and cognitive interviewing), 168 items (56 for each construct) were written in a first person, past tense format with a 7-day time frame and five response options reflecting frequency. The calibration sample included nearly 15,000 respondents. Final banks of 28, 29, and 29 items were calibrated for depression, anxiety, and anger, respectively, using item response theory. Test information curves showed that the PROMIS item banks provided more information than conventional measures in a range of severity from approximately -1 to +3 standard deviations (with higher scores indicating greater distress). Short forms consisting of seven to eight items provided information comparable to legacy measures containing more items.
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Affiliation(s)
- Paul A Pilkonis
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA, USA.
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Ready RE, Vaidya JG, Watson D, Latzman RD, Koffel EA, Clark LA. Age-group differences in facets of positive and negative affect. Aging Ment Health 2011; 15:784-95. [PMID: 21547744 DOI: 10.1080/13607863.2011.562184] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The higher order structure of Positive Affect (PA) and Negative Affect (NA) is comparable in self-report affect data from younger and older adults. The current study advances this work by comparing the factor structure of facets of PA and NA in older and younger adults using exploratory and confirmatory factor analyses. METHOD Older (N = 203; M age = 73.5 years, range 65-92) and younger (N = 349; M age = 19.1 years, range 18-30) adults completed the Positive and Negative Affect Schedule-Expanded Form (PANAS-X) (Watson, D., & Clark, L.A. (1999). Manual for the Positive and Negative Affect Schedule -- Expanded Form. Iowa City, IA: The University of Iowa), which measures General PA and NA as well as three facets of PA (Joviality, Self-Assurance, and Attentiveness) and four facets of NA (Fear, Sadness, Guilt, and Hostility). RESULTS Item-level exploratory factor analyses of the facet scales revealed structures that were similar in older and younger adults; however, older adult solutions were more diffuse and diverged more from the PANAS-X scale structure. The facet of Sadness exhibited the largest age-group difference, relating more to guilt and anxiety in older than younger adults. CONCLUSION Older adults may discriminate less amongst specific affect terms or may experience greater affective heterogeneity. Further, Sadness may manifest in age-specific ways. The construct variance of Sadness, and how this issue might be related to the assessment of depression in older adults, is discussed.
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Affiliation(s)
- R E Ready
- Department of Psychology, The University of Massachusetts, Amherst, MA, USA.
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Vaccarino AL, Anderson K, Borowsky B, Duff K, Giuliano J, Guttman M, Ho AK, Orth M, Paulsen JS, Sills T, van Kammen DP, Evans KR. An item response analysis of the motor and behavioral subscales of the unified Huntington's disease rating scale in huntington disease gene expansion carriers. Mov Disord 2011; 26:877-84. [PMID: 21370269 PMCID: PMC3157755 DOI: 10.1002/mds.23574] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/05/2010] [Accepted: 11/11/2010] [Indexed: 11/06/2022] Open
Abstract
Although the Unified Huntington's Disease Rating Scale (UHDRS) is widely used in the assessment of Huntington disease (HD), the ability of individual items to discriminate individual differences in motor or behavioral manifestations has not been extensively studied in HD gene expansion carriers without a motor-defined clinical diagnosis (ie, prodromal-HD or prHD). To elucidate the relationship between scores on individual motor and behavioral UHDRS items and total score for each subscale, a nonparametric item response analysis was performed on retrospective data from 2 multicenter longitudinal studies. Motor and behavioral assessments were supplied for 737 prHD individuals with data from 2114 visits (PREDICT-HD) and 686 HD individuals with data from 1482 visits (REGISTRY). Option characteristic curves were generated for UHDRS subscale items in relation to their subscale score. In prHD, overall severity of motor signs was low, and participants had scores of 2 or above on very few items. In HD, motor items that assessed ocular pursuit, saccade initiation, finger tapping, tandem walking, and to a lesser extent, saccade velocity, dysarthria, tongue protrusion, pronation/supination, Luria, bradykinesia, choreas, gait, and balance on the retropulsion test were found to discriminate individual differences across a broad range of motor severity. In prHD, depressed mood, anxiety, and irritable behavior demonstrated good discriminative properties. In HD, depressed mood demonstrated a good relationship with the overall behavioral score. These data suggest that at least some UHDRS items appear to have utility across a broad range of severity, although many items demonstrate problematic features.
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Castro SMDJ, Trentini C, Riboldi J. Item response theory applied to the Beck Depression Inventory. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2011; 13:487-501. [PMID: 20857035 DOI: 10.1590/s1415-790x2010000300012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/12/2010] [Indexed: 11/22/2022] Open
Abstract
The Beck Depression Inventory (BDI), a scale that measures the latent trait intensity of depression symptoms, can be assessed by the Item Response Theory (IRT). This study used the Graded-Response model (GRM) to assess the intensity of depressive symptoms in 4,025 individuals who responded to the BDI, in order to efficiently use the information available on different aspects enabled by the use of this methodology. The fit of this model was done in PARSCALE software. We identified 13 items of the BDI in which at least one response category was not more likely than others to be chosen, so that these items had to be categorized again. The items with greater power of discrimination were sadness, pessimism, feeling of failure, dissatisfaction, self-hatred, indecision, and difficulty of work. The most serious items were weight loss, suicidal ideas, and social withdrawal. The group of 202 individuals with the highest levels of depressive symptoms was comprised by 74% of women and almost 84% had a diagnosis of a psychiatric disorder. The results show gains resulting from use of IRT in the analysis of latent traits.
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Weinberger MI, Bruce ML, Roth AJ, Breitbart W, Nelson CJ. Depression and barriers to mental health care in older cancer patients. Int J Geriatr Psychiatry 2011; 26:21-6. [PMID: 21157847 PMCID: PMC3052769 DOI: 10.1002/gps.2497] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the literature on depression in cancer patients with a particular focus on depression assessment and barriers to mental health treatment in older cancer patients. DESIGN We conducted a review of the literature on depression and barriers to mental health treatment in older cancer patients. RESULTS Depression is prevalent in cancer patients. However, little is known about prevalence rates of depression in older adults with cancer, assessing depression in older cancer patients and barriers that impede proper mental health treatment in this sample. CONCLUSION Improved diagnostic clarity and a better understanding of barriers to mental health treatment can help clarify and facilitate mental health referrals and ultimately improve access to care among older cancer patients in need. Continuing to consider the complexities associated with diagnosing depression in older cancer patients is necessary. Further work may be needed to develop new diagnostic measures for such detection, determine the prevalence of depression among older cancer and ways in which to overcome barriers to mental health care.
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Affiliation(s)
- Mark I. Weinberger
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA
| | - Martha L. Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA
| | - Andrew J. Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Christian J. Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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Hambrick JP, Rodebaugh TL, Balsis S, Woods CM, Mendez JL, Heimberg RG. Cross-ethnic measurement equivalence of measures of depression, social anxiety, and worry. Assessment 2009; 17:155-71. [PMID: 19915199 DOI: 10.1177/1073191109350158] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although study of clinical phenomena in individuals from different ethnic backgrounds has improved over the years, African American and Asian American individuals continue to be underrepresented in research samples. Without adequate psychometric data about how questionnaires perform in individuals from different ethnic samples, findings from both within and across groups are arguably uninterpretable. Analyses based on item response theory (IRT) allow us to make fine-grained comparisons of the ways individuals from different ethnic groups respond to clinical measures. This study compared response patterns of African American and Asian American undergraduates to White undergraduates on measures of depression, social anxiety, and worry. On the Beck Depression Inventory-II, response patterns for African American participants were roughly equivalent to the response patterns of White participants. On measures of worry and social anxiety, there were substantial differences, suggesting that the use of these measures in African American and Asian American populations may lead to biased conclusions.
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Nelson CJ, Weinberger MI, Balk E, Holland J, Breitbart W, Roth AJ. The chronology of distress, anxiety, and depression in older prostate cancer patients. Oncologist 2009; 14:891-9. [PMID: 19738000 DOI: 10.1634/theoncologist.2009-0059] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Current research suggests that older cancer patients report less distress than younger cancer patients. However, this research has generally not teased apart the differences among general distress, anxiety, and depression. METHODS We conducted a secondary analysis of merged datasets using cross-sectional data on 716 men with prostate cancer (mean age, 68 +/- 10 years; range, 50-93 years). Approximately half the participants were recruited from doctors' offices throughout the U.S. and the other half were from Memorial Sloan-Kettering Cancer Center (New York). Participants were asked to complete the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy-Prostate Quality of Life questionnaire, and a demographic questionnaire. RESULTS Aging was related to less distress (r = -0.14), less anxiety (r = -0.22), and greater emotional quality of life (r = 0.16). In contrast, aging was associated with greater depressive symptoms in these cancer patients (r = 0.18). The mean depression scores of 5-year cohorts consistently trended upward. The significant association between age and depression remained after controlling for stage of disease, hormone therapy use, time since diagnosis, and social, physical, and functional well-being. CONCLUSIONS Despite theoretical and empirical evidence that older cancer patients may cope more effectively than younger cancer patients, depressive symptoms remain an important concern for aging cancer patients, and greater attention to this area is warranted. The increase in depression is in contrast to some findings in the general aging literature, raising the possibility that this trend is unique to older cancer patients.
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Affiliation(s)
- Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Seventh Floor, New York, New York 10022, USA.
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Becker J, Fliege H, Kocalevent RD, Bjorner JB, Rose M, Walter OB, Klapp BF. Functioning and validity of a Computerized Adaptive Test to measure anxiety (A-CAT). Depress Anxiety 2009; 25:E182-94. [PMID: 18979458 DOI: 10.1002/da.20482] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the Computerized Adaptive Test to measure anxiety (A-CAT), a patient-reported outcome questionnaire that uses computerized adaptive testing to measure anxiety. METHODS The A-CAT builds on an item bank of 50 items that has been built using conventional item analyses and item response theory analyses. The A-CAT was administered on Personal Digital Assistants to n=357 patients diagnosed and treated at the department of Psychosomatic Medicine and Psychotherapy, Charité Berlin, Germany. For validation purposes, two subgroups of patients (n=110 and 125) answered the A-CAT along with established anxiety and depression questionnaires. RESULTS The A-CAT was fast to complete (on average in 2 min, 38 s) and a precise item response theory based CAT score (reliability>.9) could be estimated after 4-41 items. On average, the CAT displayed 6 items (SD=4.2). Convergent validity of the A-CAT was supported by correlations to existing tools (Hospital Anxiety and Depression Scale-A, Beck Anxiety Inventory, Berliner Stimmungs-Fragebogen A/D, and State Trait Anxiety Inventory: r=.56-.66); discriminant validity between diagnostic groups was higher for the A-CAT than for other anxiety measures. CONCLUSIONS The German A-CAT is an efficient, reliable, and valid tool for assessing anxiety in patients suffering from anxiety disorders and other conditions with significant potential for initial assessment and long-term treatment monitoring. Future research directions are to explore content balancing of the item selection algorithm of the CAT, to norm the tool to a healthy sample, and to develop practical cutoff scores.
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Affiliation(s)
- Janine Becker
- Department of Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.
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Vaccarino AL, Evans KR, Sills TL, Kalali AH. Symptoms of anxiety in depression: assessment of item performance of the Hamilton Anxiety Rating Scale in patients with depression. Depress Anxiety 2009; 25:1006-13. [PMID: 18800370 DOI: 10.1002/da.20435] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although diagnostically dissociable, anxiety is strongly co-morbid with depression. To examine further the clinical symptoms of anxiety in major depressive disorder (MDD), a non-parametric item response analysis on "blinded" data from four pharmaceutical company clinical trials was performed on the Hamilton Anxiety Rating Scale (HAMA) across levels of depressive severity. METHODS The severity of depressive symptoms was assessed using the 17-item Hamilton Depression Rating Scale (HAMD). HAMA and HAMD measures were supplied for each patient on each of two post-screen visits (n=1,668 observations). Option characteristic curves were generated for all 14 HAMA items to determine the probability of scoring a particular option on the HAMA in relation to the total HAMD score. Additional analyses were conducted using Pearson's product-moment correlations. RESULTS Results showed that anxiety-related symptomatology generally increased as a function of overall depressive severity, though there were clear differences between individual anxiety symptoms in their relationship with depressive severity. In particular, anxious mood, tension, insomnia, difficulties in concentration and memory, and depressed mood were found to discriminate over the full range of HAMD scores, increasing continuously with increases in depressive severity. By contrast, many somatic-related symptoms, including muscular, sensory, cardiovascular, respiratory, gastro-intestinal, and genito-urinary were manifested primarily at higher levels of depression and did not discriminate well at lower HAMD scores. CONCLUSIONS These results demonstrate anxiety as a core feature of depression, and the relationship between anxiety-related symptoms and depression should be considered in the assessment of depression and evaluation of treatment strategies and outcome.
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Fliege H, Becker J, Walter OB, Rose M, Bjorner JB, Klapp BF. Evaluation of a computer-adaptive test for the assessment of depression (D-CAT) in clinical application. Int J Methods Psychiatr Res 2009; 18:23-36. [PMID: 19194856 PMCID: PMC6878570 DOI: 10.1002/mpr.274] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the past, a German Computerized Adaptive Test, based on Item Response Theory (IRT), was developed for purposes of assessing the construct depression [Computer-adaptive test for depression (D-CAT)]. This study aims at testing the feasibility and validity of the real computer-adaptive application.The D-CAT, supplied by a bank of 64 items, was administered on personal digital assistants (PDAs) to 423 consecutive patients suffering from psychosomatic and other medical conditions (78 with depression). Items were adaptively administered until a predetermined reliability (r > or = 0.90) was attained. For validation purposes, the Hospital Anxiety and Depression Scale (HADS), the Centre for Epidemiological Studies Depression (CES-D) scale, and the Beck Depression Inventory (BDI) were administered. Another sample of 114 patients was evaluated using standardized diagnostic interviews [Composite International Diagnostic Interview (CIDI)].The D-CAT was quickly completed (mean 74 seconds), well accepted by the patients and reliable after an average administration of only six items. In 95% of the cases, 10 items or less were needed for a reliable score estimate. Correlations between the D-CAT and the HADS, CES-D, and BDI ranged between r = 0.68 and r = 0.77. The D-CAT distinguished between diagnostic groups as well as established questionnaires do.The D-CAT proved an efficient, well accepted and reliable tool. Discriminative power was comparable to other depression measures, whereby the CAT is shorter and more precise. Item usage raises questions of balancing the item selection for content in the future.
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Affiliation(s)
- Herbert Fliege
- Department of Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin Berlin, Germany.
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Abstract
This review article discusses the complexities of diagnosing depression in older, geriatric cancer patients. There has been little research conducted with this population on the assessment, recognition, and treatment of depression, and thus increased attention is required to improve care for these individuals. Depressive symptoms often manifest themselves differently in both cancer patients and older patients, and therefore a modified and adapted way of assessment must be employed when thinking about diagnosing and treating these patients.
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Affiliation(s)
- Mark I. Weinberger
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605
| | - Andrew J. Roth
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
| | - Christian J. Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021
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Giavoni A, Melo GFD, Parente I, Dantas G. Elaboração e validação da Escala de Depressão para Idosos. CAD SAUDE PUBLICA 2008; 24:975-82. [DOI: 10.1590/s0102-311x2008000500004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 10/05/2007] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi desenvolver e validar a Escala de Depressão para Idosos (EDI). Foi elaborado um modelo teórico explicativo da depressão, composto por três categorias: cognitiva, afetiva e somático-motora. Os itens elaborados foram submetidos à análise semântica e de juizes. O instrumento piloto foi aplicado a 340 sujeitos, sendo 88% do sexo feminino, com ensino fundamental completo (67,9%) e idade média de 63,74 (DP = 6,87) anos. A amostra respondeu também ao Inventário de Depressão de Beck (BDI). Para a validação da escala, foram realizadas análises fatoriais e análise da consistência interna dos itens (alfa de Cronbach). Regressões múltiplas avaliaram o poder de predição dos fatores da EDI sobre o escore final do BDI. A validação da escala demonstrou que a EDI é composta por dois fatores: cognitivo-afetivo e somático-motor, que explicam 53% do BDI (validade convergente). Pode-se afirmar, portanto, que a EDI é formada por fatores que avaliam diferentes aspectos do constructo depressão (validade fatorial), os quais apresentam índices de consistência interna dentro dos padrões psicométricos.
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Karp JF, Rudy T, Weiner DK. Persistent pain biases item response on the Geriatric Depression Scale (GDS): preliminary evidence for validity of the GDS-PAIN. PAIN MEDICINE 2008; 9:33-43. [PMID: 18254765 DOI: 10.1111/j.1526-4637.2007.00406.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Differential item functioning (DIF) assesses the consistency of items on a metric across clinical samples in relation to the attribute being measured. We hypothesized that in older adults with persistent pain, items of the Geriatric Depression Scale (GDS) would evidence DIF based on presence or intensity of pain. DESIGN Unidimensionality was determined by factor and item analyses. DIF was tested using Rasch Modeling. We then evaluated the psychometric properties of a revised GDS (GDS-PAIN), comprised of items that did not evidence DIF. PATIENT AND SETTINGS: A total of 677 community dwelling older adults (age 65-91) participating in observational or treatment studies of low back or knee pain who endorsed at least moderate pain for at least 3 months. A total of 201 pain-free controls were included in the analysis. RESULTS Ten of the 30 items displayed significant DIF. These items were: 1) dropping activities and interests; 2) bothered by persistent thoughts; 3) often get fidgety and restless; 4) prefer to stay home; 5) do not feel full of energy; 6) do not enjoy getting up in the morning; 7) mind is not as clear as it was, 8) feel life is empty; 9) feel more problems with memory; and 10) do not find life very exciting. The modified GDS-PAIN scale did not adversely affect the psychometric properties of the scale. CONCLUSIONS The performance of the GDS is affected by pain. When unstable items are removed, the revised GDS (GDS-PAIN) appears to be psychometrically stable and maintains both internal consistency and similar correlation values with a measure of pain as the original scale.
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Affiliation(s)
- Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Ahmed S, Ernst P, Tamblyn R, Colman N. Evaluating asthma control: a comparison of measures using an item response theory approach. J Asthma 2007; 44:547-54. [PMID: 17885858 DOI: 10.1080/02770900701537024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Self-reported symptoms, FEV(1), and clinician judgment are all used to evaluate asthma control. The relative utility of each measure of control cannot be easily assessed. Item response theory (IRT) approaches allow for the direct comparison of the utility of different types of measures used to assess control. The objective of this study was to evaluate the validity and reliability of evaluating asthma control using symptom, clinical, and physiologic measures by applying an IRT approach. Subjects receiving care at an asthma clinic were evaluated on measures of asthma control. Based on 114 evaluations, IRT parameters were estimated to evaluate whether measures assessed a single underlying construct, the hierarchical relationship between the measures and the level of control each measure assessed, whether measures targeted all levels of asthma control, and whether the scoring categories distinguished between different levels of control. Infit statistics (0.74-1.5) for individual items showed that all items fit the underlying concept of asthma control. The reproducibility of the hierarchal scale was high (0.9). The results also demonstrated that items differentiated two strata (high, low) of control. The gaps in the hierarchal scale showed that for many subjects (37%) there were no items at their level of asthma control. The IRT approach identified gaps in current measurement that need to be addressed to provide more precise evaluations of control required to accurately monitor changes in patient status.
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Affiliation(s)
- Sara Ahmed
- Department of Medicine, McGill University, Montreal, Canada.
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Urry HL, van Reekum CM, Johnstone T, Kalin NH, Thurow ME, Schaefer HS, Jackson CA, Frye CJ, Greischar LL, Alexander AL, Davidson RJ. Amygdala and ventromedial prefrontal cortex are inversely coupled during regulation of negative affect and predict the diurnal pattern of cortisol secretion among older adults. J Neurosci 2006; 26:4415-25. [PMID: 16624961 PMCID: PMC6673990 DOI: 10.1523/jneurosci.3215-05.2006] [Citation(s) in RCA: 740] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Among younger adults, the ability to willfully regulate negative affect, enabling effective responses to stressful experiences, engages regions of prefrontal cortex (PFC) and the amygdala. Because regions of PFC and the amygdala are known to influence the hypothalamic-pituitary-adrenal axis, here we test whether PFC and amygdala responses during emotion regulation predict the diurnal pattern of salivary cortisol secretion. We also test whether PFC and amygdala regions are engaged during emotion regulation in older (62- to 64-year-old) rather than younger individuals. We measured brain activity using functional magnetic resonance imaging as participants regulated (increased or decreased) their affective responses or attended to negative picture stimuli. We also collected saliva samples for 1 week at home for cortisol assay. Consistent with previous work in younger samples, increasing negative affect resulted in ventral lateral, dorsolateral, and dorsomedial regions of PFC and amygdala activation. In contrast to previous work, decreasing negative affect did not produce the predicted robust pattern of higher PFC and lower amygdala activation. Individuals demonstrating the predicted effect (decrease < attend in the amygdala), however, exhibited higher signal in ventromedial prefrontal cortex (VMPFC) for the same contrast. Furthermore, participants displaying higher VMPFC and lower amygdala signal when decreasing compared with the attention control condition evidenced steeper, more normative declines in cortisol over the course of the day. Individual differences yielded the predicted link between brain function while reducing negative affect in the laboratory and diurnal regulation of endocrine activity in the home environment.
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Affiliation(s)
- Heather L Urry
- Waisman Laboratory for Brain Imaging and Behavior, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA.
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Abstract
Often quantitative data in the social sciences have only ordinal justification. Problems of interpretation can arise when least squares multiple regression (LSMR) is used with ordinal data. Two ordinal alternatives are discussed, dominance-based ordinal multiple regression (DOMR) and proportional odds multiple regression. The Q2 statistic is introduced for testing the omnibus null hypothesis in DOMR. A simulation study is discussed that examines the actual Type I error rate and power of Q2 in comparison to the LSMR omnibus F test under normality and non-normality. Results suggest that Q2 has favorable sampling properties as long as the sample size-to-predictors ratio is not too small, and Q2 can be a good alternative to the omnibus F test when the response variable is non-normal.
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Affiliation(s)
- Jeffrey D Long
- Department of Educational Psychology, University of Minnesota, MN 55455-0211, USA.
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Waller NG, Compas BE, Hollon SD, Beckjord E. Measurement of Depressive Symptoms in Women With Breast Cancer and Women With Clinical Depression: A Differential Item Functioning Analysis. J Clin Psychol Med Settings 2005. [DOI: 10.1007/s10880-005-3273-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Trentini CM, Xavier FMDF, Chachamovich E, Rocha NSD, Hirakata VN, Fleck MPDA. The influence of somatic symptoms on the performance of elders in the Beck Depression Inventory (BDI). BRAZILIAN JOURNAL OF PSYCHIATRY 2005; 27:119-23. [PMID: 15962136 DOI: 10.1590/s1516-44462005000200009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: The Beck Depression Inventory (BDI) has been widely used to assess the prevalence of depressive symptomatology in clinical and non-clinical samples. On elders, however, the Beck Depression Inventory total score can be influenced by the increased scores on somatic and performance subscale due to the impact of ageing process itself and clinical diseases. PURPOSE: To verify if there are differences between answers of adults and elders for the BDI Somatic and Performance subscale. METHODS: Five hundred and fifty six subjects were interviewed. Two hundred and seventeen were adults (between 18 and 59 years old) and 339 were elders (> 60 years). Adults and elders with terminal diseases or dementia were excluded. The convenience sampling method was used. RESULTS: Elders answered significantly with higher scores in the Somatic and Performance subscale compared to adults (p < 0.001). Female gender and educational level were also associated to higher scores in the Somatic subscale. No differences between both age groups were found in the Cognitive-Affective subscale (p = 0.332). CONCLUSIONS: Positive answers in the BDI Somatic and Performance subscale must be carefully assessed among elder subjects. The age factor, either by aging or due to several diseases, can bring signs that are not necessarily symptoms of major depression. Further studies are suggested.
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Sébille V, Auget JL. Evaluating Health-Related Quality of Life: A Case-Study of Differential Item Functioning Analysis in Small Trials. COMMUN STAT-THEOR M 2004. [DOI: 10.1081/sta-120030157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Current awareness in geriatric psychiatry. Bibliography. Int J Geriatr Psychiatry 2003; 18:91-98. [PMID: 12569951 DOI: 10.1002/gps.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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