Assessing the suitability and psychometric properties of the Spanish version of the YP-CORE for adolescents in Latin America: a study in Ecuador

BACKGROUND

This study had two main objectives: firstly, to assess the suitability of the Spanish translation of the Young Person's Clinical Outcome in Routine Evaluation (YP-CORE) for use in Latin America, and secondly, to investigate its psychometric properties specifically with Ecuadorian adolescents.

METHODS

The research consisted of two phases. In Phase 1, insights were gathered from 19 adolescents and 12 experts regarding their comprehension of the YP-CORE. Based on the feedback received during this phase, a revised version of the YP-CORE was developed. In Phase 2, a psychometric assessment of this modified version was conducted with 298 adolescents in Ecuador, aged 11 to 17 years.

RESULTS

The psychometric analysis revealed that this adapted version of the YP-CORE demonstrated satisfactory levels of acceptability, internal consistency, and test-retest reliability. The factor analysis favored a two-factor model over a single factor, yet the minimal substantive distinctions between these two factors do not justify the use of subscale scoring. Furthermore, the scores indicated age-related differences, with older adolescents (aged 14 to 17 years) obtaining higher scores, and gender-related variations, with females scoring higher.

CONCLUSIONS

This study addresses the need for, and provides, a Spanish-adapted YP-CORE tailored for use in Latin America. This freely available version has the potential to offer valuable insights into interventions for adolescents in the region and to enhance our understanding of their psychological distress.

Comorbid Attention Deficit Hyperactivity Disorder in Women with Premenstrual Dysphoric Disorder

Background: This study evaluated the associations between inattention, impulsivity, and attention deficit hyperactivity disorder (ADHD) in women with premenstrual dysphoric disorder (PMDD) across the menstrual cycle. Methods: This study enrolled 58 women with PMDD and 50 controls. Symptoms were assessed using the Attention and Performance Self-Assessment Scale and the Dickman Impulsivity Inventory during the pre-ovulatory (PO), mid-luteal (ML), and late luteal (LL) phases of the menstrual cycle. Results: The chi-square analysis revealed a significant association between ADHD and PMDD. Women with PMDD experienced a greater increase in scores of prospective everyday memory problems and difficulties maintaining focused attention from the PO phase to LL phase than the controls; in addition, they had higher scores in dysfunctional impulsivity during the LL phase than the controls. Among women in the PMDD group, those with ADHD had higher scores in prospective everyday memory problems and dysfunctional impulsivity during the PO and ML phases than those without ADHD. Women in the PMDD group without ADHD had a greater increase in scores of prospective everyday memory problems, difficulties maintaining focused attention, and dysfunctional impulsivity from the PO phase to the LL phase than the controls. Conclusion: Our study demonstrated that women with PMDD were more likely to have comorbid ADHD and higher levels of inattention across the menstrual cycle. PMDD was associated with increased impulsivity during the LL phase, independent of ADHD, but it was not associated with a persistent elevation of impulsivity. Furthermore, PMDD women with comorbid ADHD experienced higher inattention and impulsivity during the PO and ML phases than those without it. Thus, ADHD comorbidity should be assessed when assessing or intervening in the symptoms of inattention and impulsivity in women with PMDD.

Rigorous idiography: Exploring subjective and idiographic data with rigorous methods-The method of derangements

Psychological research often seeks general rules applying across individuals, an aim that is in tension with examining that which is unique to any individual. There are general statistical regularities across individuals' subjective self-report which enable much psychology and psychotherapy research to combine data from self-report questionnaire responses with statistical and psychometric methods to create a fundamental part of Cronbach and Meehl's foundational nomological networks of validity. However, these methods only apply when most participants answer the same questions on measures creating nomothetic data and this has led to a neglect of idiographic data. This paper reviews a method of analysis of idiographic data, of "rigorous idiography": the method of derangements. This is a remarkably simple statistical test of whether purely idiographic data convey reliable information. We show how the method appeared to become stuck in a bibliometric backwater but we expand on its potential for research and practise and hope it will be taken up and used correctly and more widely.

Is personality stable and symptoms fleeting? A longitudinal comparison in adolescence

Few investigations have directly compared personality and internalizing symptoms stability within the same sample and have not included personality facets. This study examined rank-order stability and mean-level change of Big Five domains, facets of neuroticism and extraversion, and internalizing symptoms in a sample of 550 adolescent females. Personality and symptoms were assessed every nine months for three years. Three year rank-order stability was higher for personality domains and facets compared to symptoms. Notable exceptions included lower stability of depressivity and positive emotionality facets. Facets and symptoms showed similar mean level change. Overall, we observed modest and variable temporal differences between symptoms and traits; symptoms exhibited high rank-order stability and low mean-level change, but domains and facets were generally more stable.

What Happens When Individuals Answer Questionnaires in Two Different Languages

The aim of the present study was to compare scores from the English and the Spanish versions of two well-known measures of psychological distress using a within-subject approach. This method involved bilingual participants completing both measures in four conditions. For two groups of people, measures were offered in the same language both times and for the other two groups, each language version was offered, the order differing between the groups. The measures were the Clinical Outcomes in Routine Evaluation-Outcome Measure and the Schwartz Outcome Scale-10, both originally created in English and then translated to Spanish. In total, 109 bilingual participants (69.7% women) completed the measures in two occasions and were randomly allocated to the four conditions (English-English, English-Spanish, Spanish-English and Spanish-Spanish). Linear mixed effects models were performed to provide a formal null hypothesis test of the effect of language, order of completion and their interaction for each measure. The results indicate that for the total score of the Clinical Outcomes in Routine Evaluation-Outcome Measure just language had a significant effect, but no significant effects were found for completion order or the language by order interaction. For the Schwartz Outcome Scale-10 scores, none of these effects were statistically significant. This method offers some clear advantages over the more prevalent psychometric methods of testing score comparability across measure translations.

Acceptability and Psychometric Properties of the Spanish Translation of the Schwartz Outcome Scale-10 (SOS-10-E) Outside the United States: A Replication and Extension in a Latin American Context

The Schwartz Outcome Scale-10 is a 10-item measure that has proven utility for assessing well-being and mental health and measuring change over time. Although there is a Spanish translation of the measure created in the United States for the Latino population, its acceptability and psychometric properties have not been studied in unilingual Spanish speakers, nor outside the United States. The aim of the present study is to explore these properties in larger samples, clinical and non-clinical, from Latin America adding convergent validity checking and exploration of effects of gender and age on scores. A qualitative study was conducted with 11 participants to test for dialect/language issues, then a psychometric exploration of data from 886 participants in a non-clinical sample and 172 in a clinical sample. The results showed good psychometric characteristics and suggest that the SOS-10-E can be used in Latin America. A cutoff of 42.51 differentiates clinical scores from non-clinical. Future studies are needed to explore sensitivity to change and check replication in other Spanish speaking populations.

Exploration of the psychometric properties of the Clinical Outcomes in Routine Evaluation-Outcome Measure in Ecuador

Background

The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a pan-theoretical and pan-diagnostic measure of mental health designed to cover issues that people wish to change in psychotherapy. The objective of this study was to explore the psychometric properties of the Spanish translation of the CORE-OM, in a country, Ecuador for which there is not a single measure suitable for this purpose with empirically demonstrated local acceptability and psychometric properties.

Methods

In total, 886 adults not currently receiving psychotherapy treatment or taking psychotropic medication were included in the analysis. The analyses broadly followed and compared with results from previous studies. These analyses consisted of assessment of acceptability, internal consistency, test-retest reliability, influences of demographic variables, correlations between domain scores, and convergent validity with Spanish versions of the Outcome Questionnaire 45.2 and Schwartz Outcome Scale-10.

Results

The questionnaire showed good acceptability (overall omission rate of 0.56%), good reliability (α = .93 [.92, .94], test-retest correlations ranged from .59 to .85), and good convergent validity with the Outcome Questionnaire 45.2 (r = .84) and the Schwartz Outcome Scale-10 (r = −.73). Statistically significant gender differences were found in two domains: females scored higher on Well-being (M = 1.23) than males (M = 1.01), though effect size was small (g = 0.31); and males (M = 0.31) scored higher than females on Risk (M = 0.25), with even smaller effect size (g = 0.06). Age was negatively correlated with psychological distress in all domains and coefficients ranged from −.14 for Risk to −.29 for Functioning.

Conclusions

The results support the use of the CORE-OM as a valid and reliable instrument in a non-clinical Ecuadorean population. Exploration of the psychometric properties in a clinical population is recommended to assure its use in clinical settings.

Therapeutic conversations: Therapists' use of observational language contributes to optimal therapeutic outcomes

OBJECTIVE

Reflexivity is the process of critically examining one's own experience. Emerging literature suggests that reflexivity is a positive predictor of outcomes in psychotherapy. However, limited research has been conducted regarding therapists' use of reflexivity as a therapeutic technique. In particular, we have a limited understanding of how therapists use language to initiate reflexive conversations. This study investigates the characteristics of therapist language that elicit reflexivity focused on internal and external processes.

DESIGN AND METHODS

Therapeutic outcomes of 42 trainee-therapists who provided psychotherapy to 173 clients were tracked with the OQ-45.2 with the view of identifying client-trainee-therapist dyads (CTTDs) with the best and poorest outcomes. Six best outcome and six poorest outcome CTTDs were identified. Thirty-six therapy transcripts were initially coded with the Narrative Process Coding System to identify each Narrative Process Mode (NPM). Sixty external, internal, and reflexive NPMs (N = 180 NPMs) were randomly selected across all therapy transcripts for the best outcome group and the same number for the poorest outcome group. The Narrative Initiating Language Element Coding Manual, developed for this study, was used to code therapists' use of language to initiate each NPM.

RESULTS

Therapists belonging to the best outcome group utilized more observational language to initiate internal and reflexive NPMs. Therapists belonging to the poorest outcome group evidenced high proportions of questioning language to elicit each NPM.

CONCLUSIONS

Examining how therapists use language to elicit NPMs provides further insight as to how therapeutic language may contribute to successful therapeutic outcomes.

PRACTITIONER POINTS

Reflexive therapeutic conversations characterized by a greater use of observational language were associated with positive therapeutic outcomes. Therapeutic conversations characterized by a high proportion of questioning language were associated with poorer therapeutic outcomes. Supervisors of trainee-therapists have a key role in coaching supervisees to use language that contributes to client treatment outcomes.

Does involvement in a cohort study improve health and affect health inequalities? A natural experiment

BACKGROUND

Evidence suggests that the process of taking part in health research can improve participants' health, independent of any intended intervention. However, no research has yet explored whether these effects differ across socioeconomic groups. If the effect of mere participation in health research also has a social gradient this could increase health inequalities and bias research results. This study used the Born in Bradford family cohort (BIB) to explore whether simply taking part in BIB had improved participants' health and, if so, whether this effect was mediated by socioeconomic status.

METHODS

Survey data on self-reported health behaviours were collected between 2007 and 2010 as part of BIB. These were augmented by clinical data on birth weight. Pregnant women on their second pregnancy, joining BIB for the first time formed the control group. Their health was compared to women on their second pregnancy who had both pregnancies within the study, who formed the exposed group. In order to limit the inherent bias in a non-randomised study, propensity score analysis was used, matching on age, ethnicity, education and date of questionnaire. The results were then compared according to mothers' education.

RESULTS

Of six outcomes tested, only alcohol consumption showed a statistically significant reduction with exposure to BIB (OR: 0.35, 95% CIs 0.13, 0.92). Although effect estimates were larger for women with higher education compared to lower education, these effects were not statistically significant.

CONCLUSIONS

Despite one significant finding, these results overall are insufficient to conclude that simply taking part in BIB affected participants' health. We recommend that socioeconomic status is considered in future studies testing effects of research participation, and that randomised studies with larger sample sizes are conducted.

Cut-off Scores and Clinical Change Indices for the Dutch Outcome Questionnaire (OQ-45) in a Large Sample of Normal and Several Psychotherapeutic Populations

The Outcome Questionnaire-45 (OQ-45; Lambert et al., ) has been designed for frequent assessment of a patient's functioning during the course of psychotherapy and has become one of the most frequently used outcome measures in the Netherlands. The OQ-45 was originally normed on outpatients in secondary care only, but is applied in a wide variety of patient populations. As such, it has become increasingly important to provide cut-off scores with the normal population, as well as between different patient populations. The present large-scale Dutch study aims to provide cut-off scores between several populations. Data were collected from the normal population (n = 1810) and patients in five different treatment settings: outpatient primary care (n = 1581), outpatient secondary care (n = 9433), private practice (n = 457), day patient (n = 481) and inpatient therapies (n = 485), a total of more than 14.000 administrations. Reliable change indices and cut-off scores were calculated using the method of Jacobson and Truax (). The reliable change index for the patient population was calculated as 18 and the cut-off between the normal and patient population as 56. Sensitivity, specificity and area under the curves of cut-off scores between the normal population and the treatment settings were satisfactory and generally higher than 0.80. Between the patient populations, these measures were generally too low for strict use. The OQ-45 total score can satisfactorily discriminate between the normal and patient populations. For assignment to specific treatment types, the OQ-45 may help, but its use is somewhat limited in practice. Copyright © 2015 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

The Dutch OQ-45 has satisfactory levels of reliability, sensitivity, specificity and area under the curve. The new overall cut-off score for normal function for the Dutch OQ-45 is 56 and the new reliable change index is 18. Cut-off scores for several therapeutic treatments are provided.

Youth psychotherapy change trajectories and early warning system accuracy in a managed care setting

OBJECTIVES

To examine change trajectories in routine outpatient mental health services for children and adolescents in a managed care setting, and to use these trajectories to test the accuracy of two variations of an early warning system designed to identify cases at risk for deterioration.

METHOD

Multilevel modeling procedures were used to examine longitudinal Youth Outcome Questionnaire (YOQ) data for 16,091 youth aged 4-17 years (39% female, mean age 10.5) referred for treatment in a managed care system.

RESULTS

Clients with more frequent YOQ administrations had slightly lower baselines and faster rates of change. Both the traditional and simplified versions of the early warning system demonstrated good accuracy in identifying clients who deteriorated, with a sensitivity of .63, specificity of .83, and hit rate of .81.

CONCLUSIONS

Results provide further evidence that patient-focused early warning systems can accurately identify most youth who are at risk for negative outcomes in routine mental health services.

Do drivers become less risk-prone after answering a questionnaire on risky driving behaviour?

Two studies showed that answering a questionnaire regarding self-reported risky driving behaviour and attitudes led to a significant (p < 0.001) decrease in self-reported risky driving behaviour at a follow-up some five weeks after answering the first questionnaire. In Study I participants (193 men, 18-20 years old) also reported more concern about hurting others, increased subjective probability of accidents, but less thinking about injuries at follow-up. In Study 2 (149 men, 18-19 years old) effects on attitudes at follow-up were not tested. The results are discussed in terms of the question-behaviour effect, that is, questioning a person about a certain behaviour can influence his future performance of that behaviour. Assuming that most young male drivers essentially disapprove of traffic violations, it is argued that answering the questionnaire served as an intervention that made attitudes more accessible and led to a polarization towards stronger disapproval of traffic violations, which in turn influenced reported risky driving behaviour. The need to develop alternative instruments for evaluating effects of experimental traffic safety interventions is also discussed.