1
|
Huang L, Tang S, Rietkerk J, Appadurai V, Krebs MD, Schork AJ, Werge T, Zuber V, Kendler K, Cai N. Polygenic Analyses Show Important Differences Between Major Depressive Disorder Symptoms Measured Using Various Instruments. Biol Psychiatry 2024; 95:1110-1121. [PMID: 38056704 PMCID: PMC11139567 DOI: 10.1016/j.biopsych.2023.11.021] [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: 03/10/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Symptoms of major depressive disorder (MDD) are commonly assessed using self-rating instruments like the Patient Health Questionnaire-9 (PHQ-9) (current symptoms) and the Composite International Diagnostic Interview Short-Form (CIDI-SF) (worst-episode symptoms). We performed a systematic comparison between them for their genetic architecture and utility in investigating MDD heterogeneity. METHODS Using data from the UK Biobank (n = 41,948-109,417), we assessed the single nucleotide polymorphism heritability and genetic correlation (rg) of both sets of MDD symptoms. We further compared their rg with non-MDD traits and used Mendelian randomization to assess whether either set of symptoms has more genetic sharing with non-MDD traits. We also assessed how specific each set of symptoms is to MDD using the metric polygenic risk score pleiotropy. Finally, we used genomic structural equation modeling to identify factors that explain the genetic covariance between each set of symptoms. RESULTS Corresponding symptoms reported through the PHQ-9 and CIDI-SF have low to moderate genetic correlations (rg = 0.43-0.87), and this cannot be fully attributed to different severity thresholds or the use of a skip structure in the CIDI-SF. Both Mendelian randomization and polygenic risk score pleiotropy analyses showed that PHQ-9 symptoms are more associated with traits that reflect general dysphoria, whereas the skip structure in the CIDI-SF allows for the identification of heterogeneity among likely MDD cases. Finally, the 2 sets of symptoms showed different factor structures in genomic structural equation modeling, reflective of their genetic differences. CONCLUSIONS MDD symptoms assessed using the PHQ-9 and CIDI-SF are not interchangeable; the former better indexes general dysphoria, while the latter is more informative about within-MDD heterogeneity.
Collapse
Affiliation(s)
- Lianyun Huang
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany; School of Medicine, Technical University of Munich, Munich, Germany
| | - Sonja Tang
- School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Jolien Rietkerk
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany; School of Medicine, Technical University of Munich, Munich, Germany
| | - Vivek Appadurai
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Morten Dybdahl Krebs
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark
| | - Andrew J Schork
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark; Neurogenomics Division, The Translational Genomics Research Institute, Phoenix, Arizona; Section for Geogenetics, GLOBE Institute, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center, Sct Hans, Copenhagen University Hospital, Mental Health Services CPH, Copenhagen, Denmark; Lundbeck Foundation GeoGenetics Centre, Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Verena Zuber
- School of Public Health, Imperial College London, London, United Kingdom; MRC Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Kenneth Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Na Cai
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany; Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany; School of Medicine, Technical University of Munich, Munich, Germany.
| |
Collapse
|
2
|
Veal C, Tomlinson A, Cipriani A, Bulteau S, Henry C, Müh C, Touboul S, De Waal N, Levy-Soussan H, Furukawa TA, Fried EI, Tran VT, Chevance A. Heterogeneity of outcome measures in depression trials and the relevance of the content of outcome measures to patients: a systematic review. Lancet Psychiatry 2024; 11:285-294. [PMID: 38490761 DOI: 10.1016/s2215-0366(23)00438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 03/17/2024]
Abstract
Research waste occurs when randomised controlled trial (RCT) outcomes are heterogeneous or overlook domains that matter to patients (eg, relating to symptoms or functions). In this systematic review, we reviewed the outcome measures used in 450 RCTs of adult unipolar and bipolar depression registered between 2018 and 2022 and identified 388 different measures. 40% of the RCTs used the same measure (Hamilton Depression Rating Scale [HAMD]). Patients and clinicians matched each item within the 25 most frequently used measures with 80 previously identified domains of depression that matter to patients. Seven (9%) domains were not covered by the 25 most frequently used outcome measures (eg, mental pain and irritability). The HAMD covered a maximum of 47 (59%) of the 80 domains that matter to patients. An interim solution to facilitate evidence synthesis before a core outcome set is developed would be to use the most common measures and choose complementary scales to optimise domain coverage. TRANSLATIONS: For the French and Dutch translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Christopher Veal
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM INRAE, Centre for Research in Epidemiology and Statistics, Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, France
| | | | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Samuel Bulteau
- UMR INSERM 1246, SPHERE, University of Nantes and University of Tours, Nantes, France; CHU Nantes, Department of Addictology, Psychiatry and Old Age Psychiatry, Nantes, France
| | - Chantal Henry
- Université Paris Cité, Paris, France; Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, Paris, France
| | - Chlöé Müh
- Perception and Memory Unit, Institut Pasteur, UMR3571, CNRS, Paris, France; Université Paris Cité, Collège Doctoral, Paris, France
| | | | | | | | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Eiko I Fried
- Clinical Psychology Unit, Psychology Department, Leiden University, Leiden, Netherlands
| | - Viet-Thi Tran
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM INRAE, Centre for Research in Epidemiology and Statistics, Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, France
| | - Astrid Chevance
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM INRAE, Centre for Research in Epidemiology and Statistics, Paris, France; Centre d'Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, Paris, France.
| |
Collapse
|
3
|
Black L, Humphrey N, Panayiotou M, Marquez J. Mental Health and Well-being Measures for Mean Comparison and Screening in Adolescents: An Assessment of Unidimensionality and Sex and Age Measurement Invariance. Assessment 2024; 31:219-236. [PMID: 36864693 PMCID: PMC10822075 DOI: 10.1177/10731911231158623] [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: 03/04/2023]
Abstract
Adolescence is a period of increased vulnerability for low well-being and mental health problems, particularly for girls and older adolescents. Accurate measurement via brief self-report is therefore vital to understanding prevalence, group trends, screening efforts, and response to intervention. We drew on data from the #BeeWell study (N = 37,149, aged 12-15) to consider whether sum-scoring, mean comparisons, and deployment for screening were likely to show bias for eight such measures. Evidence for unidimensionality, considering dynamic fit confirmatory factor models, exploratory graph analysis, and bifactor modeling, was found for five measures. Of these five, most showed a degree of non-invariance across sex and age likely incompatible with mean comparison. Effects on selection were minimal, except sensitivity was substantially lower in boys for the internalizing symptoms measure. Measure-specific insights are discussed, as are general issues highlighted by our analysis, such as item reversals and measurement invariance.
Collapse
|
4
|
Cohen ZD, Barnes-Horowitz NM, Forbes CN, Craske MG. Measuring the active elements of cognitive-behavioral therapies. Behav Res Ther 2023; 167:104364. [PMID: 37429044 DOI: 10.1016/j.brat.2023.104364] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
Understanding how and for whom cognitive-behavioral therapies work is central to the development and improvement of mental health interventions. Suboptimal quantification of the active elements of cognitive-behavioral therapies has hampered progress in elucidating mechanisms of change. To advance process research on cognitive-behavioral therapies, we describe a theoretical measurement framework that focuses on the delivery, receipt, and application of the active elements of these interventions. We then provide recommendations for measuring the active elements of cognitive-behavioral therapies aligned with this framework. Finally, to support measurement harmonization and improve study comparability, we propose the development of a publicly available repository of assessment tools: the Active Elements of Cognitive-Behavioral Therapies Measurement Kit.
Collapse
Affiliation(s)
- Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States.
| | | | - Courtney N Forbes
- Department of Psychology, University of California, Los Angeles, United States
| | - Michelle G Craske
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, United States; Department of Psychology, University of California, Los Angeles, United States
| |
Collapse
|
5
|
Farber GK, Gage S, Kemmer D, White R. Common measures in mental health: a joint initiative by funders and journals. Lancet Psychiatry 2023; 10:465-470. [PMID: 37084745 PMCID: PMC10198931 DOI: 10.1016/s2215-0366(23)00139-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/23/2023]
Abstract
There is notable heterogeneity in how clinical and phenotypic data are measured by mental health researchers. There is a proliferation of self-report measures (eg, over 280 for depression alone), meaning it is challenging for researchers to compare findings across different studies from different laboratories. To begin to address this issue, a consortium of mental health research funders and journals has launched the Common Measures in Mental Health Science Initiative. The purpose of this endeavour is to identify common measures for mental health conditions that funders and journals can require all researchers to collect, in addition to any other measures they require for their specific study. These measures would not necessarily capture the full range of experiences of a given condition but could be used to link and compare across studies with different designs in different contexts. This Health Policy outlines the rationale, objectives, and potential challenges of this initiative, which aims to enhance the rigour and comparability of mental health research by promoting the adoption of standardised measures.
Collapse
Affiliation(s)
| | | | - Danielle Kemmer
- Graham Boeckh Foundation, Montreal, QC, Canada; International Alliance of Mental Health Research Funders, Montreal, QC, Canada
| | - Rory White
- Graham Boeckh Foundation, Montreal, QC, Canada; International Alliance of Mental Health Research Funders, Montreal, QC, Canada
| |
Collapse
|
6
|
Bryant E, Broomfield C, Burrows J, McLean S, Marks P, Maloney D, Touyz S, Maguire S. Gaining consensus on clinical quality outcomes for eating disorders: Framework for the development of an Australian national minimum dataset. BMJ Open 2023; 13:e071150. [PMID: 37076147 PMCID: PMC10124290 DOI: 10.1136/bmjopen-2022-071150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Eating disorders (EDs) are complex psychiatric illnesses requiring multidisciplinary care across both mental and medical healthcare settings. Currently, no nationally comprehensive, consistent, agreed on or mandated data set or data collection strategy exists for EDs in Australia: thus, little is known about the outcomes of care nor treatment pathways taken by individuals with EDs. InsideOut Institute was contracted by the Australian Government Department of Health to develop a minimum dataset (MDS) for the illness group with consideration given to data capture mechanisms and the scoping of a national registry. DESIGN A four-step modified Delphi methodology was used, including national consultations followed by three rounds of quantitative feedback by an expert panel. SETTING Due to social distancing protocols throughout the global SARS-CoV-2 pandemic, the study was conducted online using video conferencing (Zoom and Microsoft Teams) (Step 1), email communication and the REDCap secure web-based survey platform (Steps 2-4). PARTICIPANTS 14 data management organisations, 5 state and territory government departments of health, 2 Aboriginal and Torres Strait Islander advising organisations and 28 stakeholders representing public and private health sectors across Australia participated in consultations. 123 ED experts (including lived experience) participated in the first quantitative round of the Delphi survey. Retention was high, with 80% of experts continuing to the second round and 73% to the third. MAIN OUTCOME MEASURES Items and categories endorsed by the expert panel (defined a priori as >85% rating an item or category 'very important' or 'imperative'). RESULTS High consensus across dataset items and categories led to the stratification of an identified MDS. Medical status and quality of life were rated the most important outcomes to collect in an MDS. Other items meeting high levels of consensus included anxiety disorders, depression and suicidality; type of treatment being received; body mass index and recent weight change. CONCLUSIONS Understanding presentation to and outcomes from ED treatment is vital to drive improvements in healthcare delivery. A nationally agreed MDS has been defined to facilitate this understanding and support improvements.
Collapse
Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Catherine Broomfield
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Jennifer Burrows
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sian McLean
- Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, Victoria, Australia
- Australia and New Zealand Academy for Eating Disorders, Castlecrag, New South Wales, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Camperdown, Sydney, Australia
| |
Collapse
|
7
|
Huang L, Tang S, Rietkerk J, Appadurai V, Krebs MD, Schork AJ, Werge T, Zuber V, Kendler K, Cai N. Polygenic analyses show important differences between MDD symptoms collected using PHQ9 and CIDI-SF. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.27.23286527. [PMID: 36909638 PMCID: PMC10002792 DOI: 10.1101/2023.02.27.23286527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Symptoms of Major Depressive Disorder (MDD) are commonly assessed using self-rating instruments like the Patient Health Questionnaire 9 (PHQ9, for current symptoms), and the Composite International Diagnostic Interview Short-Form (CIDI-SF, for lifetime worst-episode symptoms). Using data from the UKBiobank, we show that corresponding symptoms endorsed through PHQ9 and CIDI-SF have low to moderate genetic correlations (rG=0.43-0.87), and this cannot be fully attributed to different severity thresholds or the use of a skip-structure in CIDI-SF. Through a combination of Mendelian Randomization (MR) and polygenic prediction analyses, we find that PHQ9 symptoms are more associated with traits which reflect general dysphoria, while the skip-structure in CIDI-SF allows for the identification of heterogeneity among likely MDD cases. This has important implications on factor analyses performed on their respective genetic covariance matrices for the purpose of identification of genetic factors behind MDD symptom dimensions and heterogeneity.
Collapse
Affiliation(s)
- Lianyun Huang
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
- Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Sonja Tang
- School of Public Health, Imperial College London, UK
- MRC Centre for Environment and Health, Imperial College London, UK
| | - Jolien Rietkerk
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
- Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Vivek Appadurai
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Morten Dybdahl Krebs
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
| | - Andrew J. Schork
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Neurogenomics Division, The Translational Genomics Research Institute (TGEN), Phoenix, AZ, USA
- Section for Geogenetics, GLOBE Institute, Faculty of Health and Medical Sciences, Copenhagen University
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Center - Sct Hans, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
- Lundbeck Foundation GeoGenetics Centre, Natural History Museum of Denmark, University of Copenhagen, Copenhagen 1350, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Verena Zuber
- School of Public Health, Imperial College London, UK
- MRC Centre for Environment and Health, Imperial College London, UK
| | - Kenneth Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Na Cai
- Helmholtz Pioneer Campus, Helmholtz Zentrum München, Neuherberg, Germany
- Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
8
|
Measuring general mental health in early‐mid adolescence: A systematic meta‐review of content and psychometrics. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
9
|
Campbell LA, Clark SE, Chorney J, Emberly D, MacDonald J, MacKenzie A, Warner G, Wozney L. Choice and Partnership Approach to community mental health and addiction services: a realist-informed scoping review. BMJ Open 2022; 12:e064436. [PMID: 36261240 PMCID: PMC9582326 DOI: 10.1136/bmjopen-2022-064436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The Choice and Partnership Approach (CAPA) was developed to create an accessible, child-centred and family-centred model of child and adolescent mental health service delivery that is adaptable to different settings. We sought to describe the state of evidence regarding the extent, outcomes and contextual considerations of CAPA implementation in community mental health services. DESIGN Scoping review. DATA SOURCES Published and grey literature were searched using MEDLINE, Embase, CINAHL, PsycINFO, Scopus and Google to 13 and 20 July 2022, respectively. ELIGIBILITY CRITERIA We included reports focused on the implementation, outcomes (clinical, programme or system) or a discussion of contextual factors that may impact CAPA implementation in either child and adolescent or adult mental health services. DATA EXTRACTION AND SYNTHESIS Data were extracted using a codebook that reflected the five domains of the Consolidated Framework for Implementation Research (CFIR) and reviewed for agreement and accuracy. Data were synthesised according to the five CFIR domains. RESULTS Forty-eight reports describing 36 unique evaluations were included. Evaluations were observational in nature; 10 employed pre-post designs. CAPA implementation, regardless of setting, was largely motivated by long wait times. Characteristics of individuals (eg, staff buy-in or skills) were not reported. Processes of implementation included facilitative leadership, data-informed planning and monitoring and CAPA training. Fidelity to CAPA was infrequently measured (n=9/36) despite available tools. Health system outcomes were most frequently reported (n=28/36); few evaluations (n=7/36) reported clinical outcomes, with only three reporting pre/post CAPA changes. CONCLUSIONS Gaps in evidence preclude a systematic review and meta-analysis of CAPA implementation. Measurement of clinical outcomes represents an area for significant improvement in evaluation. Consistent measurement of model fidelity is essential for ensuring the accuracy of outcomes attributed to its implementation. An understanding of the change processes necessary to support implementation would be strengthened by more comprehensive consideration of contextual factors.
Collapse
Affiliation(s)
- Leslie Anne Campbell
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychiatry, IWK Health, Halifax, Nova Scotia, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health, Halifax, Nova Scotia, Canada
| | - Julie MacDonald
- Mental Health and Addictions, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Research, Innovation, and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Mental Health and Addictions, Nova Scotia Health, Halifax, Nova Scotia, Canada
| |
Collapse
|
10
|
O'Connor M, Spry E, Patton G, Moreno-Betancur M, Arnup S, Downes M, Goldfeld S, Burgner D, Olsson CA. Better together: Advancing life course research through multi-cohort analytic approaches. ADVANCES IN LIFE COURSE RESEARCH 2022; 53:100499. [PMID: 36652217 DOI: 10.1016/j.alcr.2022.100499] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/22/2022] [Accepted: 07/15/2022] [Indexed: 06/17/2023]
Abstract
Longitudinal cohorts can provide timely and cost-efficient evidence about the best points of health service and preventive interventions over the life course. Working systematically across cohorts has the potential to further exploit these valuable data assets, such as by improving the precision of estimates, enhancing (or appropriately reducing) confidence in the replicability of findings, and investigating interrelated questions within a broader theoretical model. In this conceptual review, we explore the opportunities and challenges presented by multi-cohort approaches in life course research. Specifically, we: 1) describe key motivations for multi-cohort work and the analytic approaches that are commonly used in each case; 2) flag some of the scientific and pragmatic challenges that arise when adopting these approaches; and 3) outline emerging directions for multi-cohort work in life course research. Harnessing their potential while thoughtfully considering limitations of multi-cohort approaches can contribute to the robust and granular evidence base needed to promote health and wellbeing over the life span.
Collapse
Affiliation(s)
- Meredith O'Connor
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia.
| | - Elizabeth Spry
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia; Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| | - George Patton
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia
| | - Margarita Moreno-Betancur
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia
| | - Sarah Arnup
- Murdoch Children's Research Institute, Parkville, Australia
| | - Marnie Downes
- Murdoch Children's Research Institute, Parkville, Australia
| | - Sharon Goldfeld
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia; Royal Children's Hospital, Centre for Community Child Health, Parkville, Australia
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia; Royal Children's Hospital, Department of General Medicine, Parkville, Australia; Monash University, Department of Pediatrics, Clayton, Australia
| | - Craig A Olsson
- Murdoch Children's Research Institute, Parkville, Australia; University of Melbourne, Department of Paediatrics, Parkville, Australia; Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia
| |
Collapse
|
11
|
Osborne RH, Cheng CC, Nolte S, Elmer S, Besancon S, Budhathoki SS, Debussche X, Dias S, Kolarčik P, Loureiro MI, Maindal H, Nascimento do O D, Smith JA, Wahl A, Elsworth GR, Hawkins M. Health literacy measurement: embracing diversity in a strengths-based approach to promote health and equity, and avoid epistemic injustice. BMJ Glob Health 2022. [PMCID: PMC9462086 DOI: 10.1136/bmjgh-2022-009623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Definitions of health literacy have evolved from notions of health-related literacy to a multidimensional concept that incorporates the importance of social and cultural knowledge, practices and contexts. This evolution is evident in the development of instruments that seek to measure health literacy in different ways. Health literacy measurement is important for global health because diverse stakeholders, including the WHO, use these data to inform health practice and policy, and to understand sources of inequity. In this Practice paper, we explore the potential for negative consequences, bias and epistemic injustice to occur when health literacy instruments are used across settings without due regard for the lived experiences of people in various contexts from whom data are collected. A health literacy measurement approach that is emic-sensitive, strengths based and solution oriented is needed to minimise biased data interpretation and use and to avoid epistemic injustice.
Collapse
Affiliation(s)
- Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Christina C Cheng
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | | | - Shandell Elmer
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Stephane Besancon
- Santé Diabète Headquarter, Grenoble, France
- Santé Diabète delegation of Mali, Bamako, Mali
| | - Shyam Sundar Budhathoki
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, St. Mary’s Campus, London, UK
- Nepalese Society of Community Medicine, Lalitpur, Nepal
| | - Xavier Debussche
- Centre Expert Plaies Chroniques, Centre Hospitalier Max Querrien Paimpol, Paimpol, France
| | - Sónia Dias
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Peter Kolarčik
- Department of Health Psychology and Research Methodology, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Maria Isabel Loureiro
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helle Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dulce Nascimento do O
- NOVA National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
- Associação Protectora dos Diabéticos, Lisbon, Portugal
| | - James A Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Astrid Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
A multi-group confirmatory factor analysis of the revised children's anxiety and depression scale (RCADS) in Spain, Chile and Sweden. J Affect Disord 2022; 310:228-234. [PMID: 35561880 DOI: 10.1016/j.jad.2022.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/25/2022] [Accepted: 05/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a need for a measure that can be used across countries and cultures to advance cross-cultural research about internalizing mental health symptoms in children and adolescents. The Revised Children's Anxiety and Depression Scale (RCADS) is a potential candidate, but no study has examined whether its scales are measured similarly in youth populations from different countries. METHODS In this study, we use confirmatory factor analysis (CFA) and multi-group CFA to examine the cross-cultural properties of a short and free to use 30-item version of RCADS that assesses social, generalized, panic, and separation anxiety alongside depression and obsessive-compulsive symptoms. We tested the factor structure of RCADS in children and adolescents from Chile, Spain, and Sweden, recruited using different research designs (i.e., school-based studies and an anonymous web survey), and whether the factor structure showed measurement invariance across the three countries. RESULTS The proposed factor structure of RCADS showed good model/data fit in all three countries and was superior to a unidimensional model in which correlations among scale items were explained by a single broad internalizing factor. Each RCADS subscale showed adequate to excellent internal consistency in all three countries and multi-group CFA supported scalar invariance across the three countries. LIMITATIONS No clinical sample was included. CONCLUSIONS This study provides an important first step in supporting the use of RCADS in cross-cultural research on depression, anxiety and obsessive-compulsive symptoms in children and adolescents, but more work on validity aspects of the scale across cultures is needed.
Collapse
|
13
|
Brattmyr M, Lindberg MS, Solem S, Hjemdal O, Havnen A. Factor structure, measurement invariance, and concurrent validity of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder scale-7 in a Norwegian psychiatric outpatient sample. BMC Psychiatry 2022; 22:461. [PMID: 35818021 PMCID: PMC9275259 DOI: 10.1186/s12888-022-04101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to test factor structure, measurement invariance, and concurrent validity of the nine item Patient Health Questionnaire-9 (PHQ-9) and the seven item Generalized Anxiety Disorder scale-7 (GAD-7) in a heterogeneous outpatient sample. METHOD Outpatients completed the PHQ-9, GAD-7, and the Working Social Adjustment Scale (WSAS) before starting treatment. Study design was cross-sectional, with convenience sampling. The total sample consisted of 831 participants (61% women). RESULTS Both PHQ-9 and GAD-7 demonstrated better fit statistics with two-factor and bifactor solutions consisting of a cognitive and somatic factor. Omega hierarchical was .78 for PHQ-9 and .81 for GAD-7. Both instruments achieved scalar invariance across gender, diagnosis, and comorbidity. However, the somatic factors demonstrated poor discriminant validity. These factors are not well separatable and risks being too similar if used together. The general factors of both instruments were most associated with functional impairment, although PHQ-9 demonstrated a stronger association with WSAS (γ = .74, r2 = .62) than GAD-7 (γ = .54, r2 = .32). Using latent mean difference, women and patients with comorbidity had significantly higher scores of both depression and anxiety. CONCLUSION This study shows that the PHQ-9 and GAD-7 may be used as one-dimensional instruments in clinical settings. Tests for measurement invariance supported that both measures are understood and interpreted comparably across gender and diagnostic subgroups.
Collapse
Affiliation(s)
- Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Martin Schevik Lindberg
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Audun Havnen
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
14
|
Fried EI, Flake JK, Robinaugh DJ. Revisiting the theoretical and methodological foundations of depression measurement. NATURE REVIEWS PSYCHOLOGY 2022; 1:358-368. [PMID: 38107751 PMCID: PMC10723193 DOI: 10.1038/s44159-022-00050-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/19/2023]
Abstract
Depressive disorders are among the leading causes of global disease burden, but there has been limited progress in understanding the causes and treatments for these disorders. In this Perspective, we suggest that such progress crucially depends on our ability to measure depression. We review the many problems with depression measurement, including limited evidence of validity and reliability. These issues raise grave concerns about common uses of depression measures, such as diagnosis or tracking treatment progress. We argue that shortcomings arise because depression measurement rests on shaky methodological and theoretical foundations. Moving forward, we need to break with the field's tradition that has, for decades, divorced theories about depression from how we measure it. Instead, we suggest that epistemic iteration, an iterative exchange between theory and measurement, provides a crucial avenue for depression measurement to progress.
Collapse
Affiliation(s)
- Eiko I. Fried
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Jessica K. Flake
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, US
| |
Collapse
|
15
|
O'Connor M, Moreno-Betancur M, Goldfeld S, Wake M, Patton G, Dwyer T, Tang MLK, Saffery R, Craig JM, Loke J, Burgner D, Olsson CA. Data Resource Profile: Melbourne Children's LifeCourse initiative (LifeCourse). Int J Epidemiol 2022; 51:e229-e244. [PMID: 35536352 PMCID: PMC9557929 DOI: 10.1093/ije/dyac086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/07/2022] [Indexed: 12/22/2022] Open
Affiliation(s)
- Meredith O'Connor
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Margarita Moreno-Betancur
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Sharon Goldfeld
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Liggins Institute, University of Auckland, Grafton, Auckland, New Zealand
| | - George Patton
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Terence Dwyer
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Mimi L K Tang
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Jeffrey M Craig
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - Jane Loke
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - David Burgner
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Inflammatory Origins Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Pediatrics, Monash University, Melbourne, Australia
| | - Craig A Olsson
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia.,Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Australia
| | | |
Collapse
|
16
|
Abstract
Introduction: In several sub-fields of psychology, there has been a renewed focus on measurement practices. As far as we are aware, this has been absent in hallucinations research. Thus, we investigated (a) cross-study variation in how hallucinatory experiences are measured and (b) the reliability of measurements obtained using two tasks that are widely employed in hallucinations research.Method: In Study 1, we investigated to what extent there was variation in how the Launay-Slade Hallucination Scale (LSHS) has been used across 100 studies. In Study 2, we investigated the reliability of the measurements obtained through source monitoring and signal detection tasks, using data from four recent publications. Materials/data are available at doi: 10.17605/osf.io/d3gnk/.Results: In Study 1, we found substantial variation in how hallucinatory experiences were assessed using the LSHS and that descriptions of the LSHS were often incomplete in important ways. In Study 2, we reported a range of reliability estimates for the measurements obtained using source monitoring and signal discrimination tasks. Some measurements obtained using source monitoring tasks had unacceptably low levels of reliability.Conclusions: Our findings suggest that suboptimal measurement practices are common in hallucinations research and we suggest steps researchers could take to improve measurement practices.
Collapse
Affiliation(s)
- David Smailes
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK, David Smailes Department of Psychology, Northumbria University, Newcastle upon TyneNE1 8ST, UK
| | - Ben Alderson-Day
- Department of Psychology, Science Laboratories, Durham University, Durham, UK
| | - Cassie Hazell
- School of Social Sciences, University of Westminster, London, UK
| | - Abigail Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Peter Moseley
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| |
Collapse
|
17
|
Basso M, Johnstone N, Knytl P, Nauta A, Groeneveld A, Cohen Kadosh K. A Systematic Review of Psychobiotic Interventions in Children and Adolescents to Enhance Cognitive Functioning and Emotional Behavior. Nutrients 2022; 14:nu14030614. [PMID: 35276975 PMCID: PMC8840038 DOI: 10.3390/nu14030614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
This systematic review brings together human psychobiotic interventions in children and adolescents (aged 6-25 years) to evaluate the efficacy of pre- and probiotic supplements on stress, anxiety, and cognitive outcomes. Psychobiotic interventions in animal studies highlighted sensitivity to effects during development and maturation in multiple domains from emotion to cognitive processing. Several translational psychobiotic interventions in humans have been carried out to assess effects on emotion and cognition during childhood and into adulthood. The findings illustrate that there are limited consistent psychobiotic effects in developing human populations, and this is proposed to be due to heterogeneity in the trials conducted. Consequentially, it is recommended that three specific factors are considered in future psychobiotic trials: (1) Specificity of population studied (e.g., patients, developmental age), (2) specificity of intervention, and (3) homogeneity in outcome measures.
Collapse
Affiliation(s)
- Melissa Basso
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
| | - Nicola Johnstone
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
- Correspondence: (N.J.); (K.C.K.); Tel.: +44-(0)-1483-68-3968 (K.C.K.)
| | - Paul Knytl
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
| | - Arjen Nauta
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (A.N.); (A.G.)
| | - Andre Groeneveld
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; (A.N.); (A.G.)
| | - Kathrin Cohen Kadosh
- Department of Psychological Sciences, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK; (M.B.); (P.K.)
- Correspondence: (N.J.); (K.C.K.); Tel.: +44-(0)-1483-68-3968 (K.C.K.)
| |
Collapse
|
18
|
de Beurs E, Boehnke JR, Fried EI. Common measures or common metrics? A plea to harmonize measurement results. Clin Psychol Psychother 2022; 29:1755-1767. [PMID: 35421265 PMCID: PMC9796399 DOI: 10.1002/cpp.2742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE There is a great variety of measurement instruments to assess similar constructs in clinical research and practice. This complicates the interpretation of test results and hampers the implementation of measurement-based care. METHOD For reporting and discussing test results with patients, we suggest converting test results into universally applicable common metrics. Two well-established metrics are reviewed: T scores and percentile ranks. Their calculation is explained, their merits and drawbacks are discussed, and recommendations for the most convenient reference group are provided. RESULTS We propose to express test results as T scores with the general population as reference group. To elucidate test results to patients, T scores may be supplemented with percentile ranks, based on data from a clinical sample. The practical benefits are demonstrated using the published data of four frequently used instruments for measuring depression: the CES-D, PHQ-9, BDI-II and the PROMIS depression measure. DISCUSSION Recent initiatives have proposed to mandate a limited set of outcome measures to harmonize clinical measurement. However, the selected instruments are not without flaws and, potentially, this directive may hamper future instrument development. We recommend using common metrics as an alternative approach to harmonize test results in clinical practice, as this will facilitate the integration of measures in day-to-day practice.
Collapse
Affiliation(s)
- Edwin de Beurs
- Department of Clinical PsychologyLeiden University & Arkin GGZAmsterdamThe Netherlands
| | | | - Eiko I. Fried
- Department of Clinical PsychologyLeiden UniversityLeidenZuid‐HollandThe Netherlands
| |
Collapse
|
19
|
Krause KR, Chung S, Sousa Fialho MDL, Szatmari P, Wolpert M. The challenge of ensuring affordability, sustainability, consistency, and adaptability in the common metrics agenda. Lancet Psychiatry 2021; 8:1094-1102. [PMID: 34656284 DOI: 10.1016/s2215-0366(21)00122-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
Mental health research grapples with research waste and stunted field progression caused by inconsistent outcome measurement across studies and clinical settings, which means there is no common language for considering findings. Although recognising that no gold standard measures exist and that all existing measures are flawed in one way or another, anxiety and depression research is spearheading a common metrics movement to harmonise measurement, with several initiatives over the past 5 years recommending the consistent use of specific scales to allow read-across of measurements between studies. For this approach to flourish, however, common metrics must be acceptable and adaptable to a range of contexts and populations, and global access should be as easy and affordable as possible, including in low-income countries. Within a measurement landscape dominated by fixed proprietary measures and with competing views of what should be measured, achieving this goal poses a range of challenges. In this Personal View, we consider tensions between affordability, sustainability, consistency, and adaptability that, if not addressed, risk undermining the common metrics agenda. We outline a three-pronged way forward that involves funders taking more direct responsibility for measure development and dissemination; a move towards managing measure dissemination and adaptation via open-access measure hubs; and transitioning from fixed questionnaires to item banks. We argue that now is the time to start thinking of mental health metrics as 21st century tools to be co-owned and co-created by the mental health community, with support from dedicated infrastructure, coordinating bodies, and funders.
Collapse
Affiliation(s)
- Karolin Rose Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada; Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.
| | | | | | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK; Wellcome Trust, London, UK
| |
Collapse
|
20
|
Mullarkey MC, Schleider JL. Embracing Scientific Humility and Complexity: Learning "What Works for Whom" in Youth Psychotherapy Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:443-449. [PMID: 34096811 PMCID: PMC8497399 DOI: 10.1080/15374416.2021.1929252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Clinical psychological scientists have spent decades attempting to understand "what works for whom" in the context of youth psychotherapy, toward the longstanding goal of personalizing psychosocial interventions to fit individual needs and characteristics. However, as the articles in this Special Issue jointly underscore, more than 50 years of psychotherapy research has yet to help us realize this goal. In this introduction to the special issue, we outline how and why "aspiration-method mismatches" have hampered progress toward identifying moderators of youth psychotherapy; emphasize the need to embrace etiological complexity and scientific humility in pursuing new methodological solutions and propose individual and structural strategies for better-aligning clinical research methods with the goal of personalizing mental health care for youth with diverse identities and treatment needs.
Collapse
|
21
|
Malgaroli M, Calderon A, Bonanno GA. Networks of major depressive disorder: A systematic review. Clin Psychol Rev 2021; 85:102000. [DOI: 10.1016/j.cpr.2021.102000] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/06/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022]
|
22
|
Morvan Y, Frajerman A. [Student's mental health: better measurement and considereration of the challenges]. Encephale 2021; 47:620-629. [PMID: 33745696 PMCID: PMC7972866 DOI: 10.1016/j.encep.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/13/2020] [Accepted: 10/30/2020] [Indexed: 01/05/2023]
Abstract
Mental health represents a high cost for society, estimated at 109 billion euros per year in France, 80 % of which are indirect costs. Mental diseases start before the age of 24 for 75 % of patients. Students, whose age is predominantly between 18 and 25, are a particularly high-risk population and for whom mental illness can have very serious consequences. The Observatoire de la vie Etudiante surveys from 2016 found a 12 month prevalence of depression of 15 % with suicidal thoughts in 8 % of the students higher than what is observed in the French general population, respectively 10 % and 5 %. The confinement itself and its consequences both economic (unemployment, difficulty for young people to find a job…) and social (isolation) could have a very bad effect on their mental health. The survey made by a governmental organization (Santé Publique France) revealed a significant increase in the prevalence of anxiety disorders at the start of confinement in the general population. This prevalence decreased during confinement but remained significantly higher than in 2017. Economic simulated data indicate that prevention in mental health could not only be effective but also profitable. In France, reimbursement by national health insurance of 12 sessions of psychologists for young people (between 11 to 21) is being tested in order to further and widely implement psychological prevention strategies rather than relying on already widely reimbursed pharmacological treatments. There are, however, several issues to discuss. First of all, is the need to define what psychopathology is considered to be. Then, it should be understood how measures of these concepts are created, how tools are constructed and how they operate in their environment. For depression, many different scales exist and even if the most used one are taken into account, they have very little content or symptoms in common. In addition, for the same scale, many different cut-offs exist to define whether a case should be considered as pathological or not, and so it is with the period of time studied being considered that may vary, both leading to consequences such as the differences observed in prevalence. Other biases should also be considered such as the age of the participants, the gender, the size of the sample, the response rate, the method of assessment and recruitment. Finally, it is necessary to question the assumptions and models used concerning the causes of psychic pathologies. Biological hypotheses on the origin of depression involve genetics and inflammation, but sociological and psychological factors must also be considered as well as the underlying complexity both in their nature and interactions at different structural levels of space and time. We should avoid drifting towards a biological or a sociological reductionism and move forward through complex systems approaches and models. With regard to student mental health in France, unfortunately, quality data are still lacking, and existing studies are difficult to compare as some may also have methodological issues. This article leads to the conclusion that there is a need for policies to assess student mental health at both local and national levels with a reflexional thinking on the tools and scales to use as measurements of these phenomena. This approach does not require being too assertive, but should have full transparency on the way the measures were designed and obtained. Measures are as much needed as are the needs for coordinated prevention and care in mental health.
Collapse
Affiliation(s)
- Y Morvan
- Université Paris Nanterre, UFR SPSE, laboratoire CLIPSYD, EA4430, Nanterre, France; Inserm U1018, CESP, épistémologie et méthodes de la recherche en pédopsychiatrie et santé mentale des enfants et des adolescents, Paris, France.
| | - A Frajerman
- Inserm U1266-GDR 3557, institut de psychiatrie et neurosciences de Paris, institut de Psychiatrie, Paris, France; Université de Paris, Paris, France
| |
Collapse
|