Assessing cross-cultural differences through use of multiple-group invariance analyses

Measurement Invariance of the SOC-13 Sense of Coherence Scale Across Gender and Age Groups

Abstract. Sense of coherence (SOC) describes an individual’s ability to deal with life challenges (manageability), comprehend the environment (comprehensibility), and perceive life and its challenges as meaningful (meaningfulness). We examine measurement invariance (MI) of the SOC-13 scale across gender and age groups in a matched sample of N = 1,816 (50% females; age range 16–83 years). A two-factor model, with a common factor for manageability/comprehensibility items and a second factor for meaningfulness items, best represented the SOC-13 in all groups. Full metric, partial scalar, and full strict invariance held across gender groups. Across age groups, full metric, partial scalar, and partial strict invariance could be established. We conclude that SOC-13 is a reliable and valid measure. Measurement is comparable across gender and age.

Important relation between self-efficacy, sense of coherence, illness perceptions, depression and anxiety in patients with inflammatory bowel disease

INTRODUCTION

Anxiety and depression are common disturbances in patients with inflammatory bowel diseases (IBD), and were found to impact the disease course. Illness perceptions (IPs), self-efficacy (SE) and sense of coherence (SOC) are important psychological functions, used by the individual to cope with his chronic disease.

AIMS

to investigate the association of IP, SE and SOC on anxiety and depression among patients with IBD.

PATIENTS AND METHODS

Patients filled questionnaires including: demographic, socioeconomic and clinical features. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. IP, SE and SOC were assessed using the Brief Illness perception Questionnaire, IBD-SE and SOC scales.

RESULTS

The study sample consisted of 299 patients with IBD, median age 34.15, 63% females, 70.9% had Crohn's disease, filled the questionnaires. In the multivariate analysis, lower results in IP, SE and SOC were found to be associated with significantly increase anxiety (OR 8.35, p<0.001; OR 4.18, p=0.001; OR 4.67, p<0.001, respectively) and depression (OR 15.8, p=0.001; OR 10.99, p=0.029; OR 6.12, p=0.014.

CONCLUSIONS

Anxiety and depression are associated with IP, SE and SOC in patients with IBD. Clinicians should be aware of this impact, recognise their patients' psychological abilities to cope with the disease and improve those abilities, when needed, in order to achieve a better coping with the disease and to prevent the development of anxiety and depression.

Structural Validation and Multiple Group Assessment of the Short Internalized Homonegativity Scale in Homosexual and Bisexual Men in 38 European Countries: Results From the European MSM Internet Survey

Internalized homonegativity (IH) is the internalization of negative attitudes and assumptions about homosexual people by homosexual people themselves. To measure IH, Smolenski, Diamond, Ross, and Rosser (2010) and Ross, Rosser, and Smolenski (2010) revised the Reactions to Homosexuality Scale (RHS) to develop the Short Internalized Homonegativity Scale (SIHS) with eight items. Using the European Men Who Have Sex With Men Internet Survey (EMIS) data, with an analytic sample of 130,718 gay and bisexual men in 38 European countries, we confirmed the validity of the SIHS scale in both training and validation data, in strata of Ross, Berg, et al.'s (2013) three "homosexual discrimination" country clusters, of age, and of education level. However, the performance was less adequate in comparison of gay versus bisexually identified individuals. The latent SIHS structure contains only minor variations across these three strata. The seven-item scale performed as well as the eight-item scale. The SIHS is a promising candidate for standard IH measures, which is invariant across cultural, age, and educational strata.

Longitudinal Factor Analysis and Measurement Invariance of Sense of Coherence and General Self-Efficacy in Adolescence

Abstract. Sense of coherence (SOC) and General Self-efficacy (GSE) are trait-like self-regulatory attributes, supposedly benefitting health. Previous data on their factorial validity and longitudinal stability in adolescent samples have been inconclusive. The present study examined the factor structure, measurement invariance (MI), and stability coefficients of SOC and GSE among German adolescents in a longitudinal design over the course of nine years from age 15 to age 24. Results supported the factorial validity of both scales. GSE parameters were invariant up to the level of strict invariance, whereas for SOC partial scalar and strict invariance were attainable after modifications. Here we document reliability, validity, and factor mean changes of the SOC and GSE scales from adolescence to young adulthood. Interindividual differences in SOC were moderately stable. Though this implies limited sensitivity to intraindividual developmental changes, it qualifies SOC for long-term predictions. GSE was conspicuously less stable, raising questions about its long-term criterion validity.

Testing Robustness of UTAUT Model

In order to compare a research model accurately across different conditions, the model's measures must be invariant across them. In this study, the invariance of the UTAUT model's measures was tested along three dimensions: country, technology, and gender. Data were collected from two countries (Korea and the U.S.) for two technologies (Internet banking and MP3 players). The results show that although the UTAUT model is robust overall across different conditions, possible differences due to measurement non-invariance should be taken into account. The paper discusses implications of the study results and makes recommendations for future research.

Measurement Invariance of the Brief Symptom Inventory in Survivors of Torture and Trauma

The United States accepts more refugees than any other industrialized nation. As refugee populations grow, mental health professionals must implement culturally and ethnically appropriate strategies to assess and treat individuals from diverse backgrounds. Culture can exert a powerful and often misunderstood influence on psychological assessment, and few structured measures have been demonstrated to have adequate cross-cultural validity for use with diverse and vulnerable populations such as survivors of torture. This study examined the factor structure and equivalency of underlying construct(s) of psychological distress as measured by the Brief Symptom Inventory (BSI) in three samples who had survived torture and other severe trauma from Tibet, West Africa and the Punjab region of India. Confirmatory factor analyses provided support for configural invariance of a two-factor model across the three samples, suggesting that the two latent factors of Complex Dysphoria and Somatic Distress were present in each subgroup. The data provide additional support for the strict invariance model in the West African-Tibetan dyad suggesting that scores are comparable across those two groups. Implications for research and treatment are discussed.

Measurement Invariance and the Five-Factor Model of Personality

This study examined measurement invariance of the NEO Five-Factor Inventory (NEO-FFI), assessing the five-factor model (FFM) of personality among Euro American ( N = 290) and Asian international ( N = 301) students (47.8% women, Mage = 19.69 years). The full 60-item NEO-FFI data fit the expected five-factor structure for both groups using exploratory structural equation modeling, and achieved configural invariance. Only 37 items significantly loaded onto the FFM-theorized factors for both groups and demonstrated metric invariance. Threshold invariance was not supported with this reduced item set. Groups differed the most in the item–factor relationships for Extraversion and Agreeableness, as well as in response styles. Asian internationals were more likely to use midpoint responses than Euro Americans. While the FFM can characterize broad nomothetic patterns of personality traits, metric invariance with only the subset of NEO-FFI items identified limits direct group comparisons of correlation coefficients among personality domains and with other constructs, and of mean differences on personality domains.

AMP!: A Cross-site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness, Attitudes, and Knowledge about HIV

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N = 159) and a suburban county in North Carolina (N = 317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p = 0.05), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p = 0.001), HIV awareness (p = 0.001), and HIV attitudes (p = 0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p = 0.01), HIV awareness (p = 0.01), and HIV attitudes (p = 0.05)). Thus, AMP!'s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.

Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease

AIM: To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD).

METHODS: This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn’s disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky’s SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL.

RESULTS: Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL.

CONCLUSION: Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.

An Adapted Measure of Teacher Self-Efficacy for Preservice Teachers: Exploring its Validity Across two Countries

Teacher self-efficacy (TSE) is an important construct in the prediction of positive student and teacher outcomes. However, problems with its measurement have persisted, often through confounding TSE with other constructs. This research introduces an adapted TSE instrument for preservice teachers, which is closely aligned with self-efficacy experts' recommendations for measuring self-efficacy, and based on a widely used measure of TSE. We provide first evidence of construct validity for this instrument. Participants were 851 preservice teachers in three samples from Germany and New Zealand. Results of the multiple-group confirmatory factor analyses showed a uniform 3-factor solution for all samples, metric measurement invariance, and a consistent and moderate correlation between TSE and a measure of general self-efficacy across all samples. Despite limitations to this study, there is some first evidence that this measure allows for a valid 3-dimensional assessment of TSE in preservice teachers.

The short form of the revised almost perfect scale

We created a shorter and more refined item set from the Almost Perfect Scale-Revised (APS-R; Slaney, Mobley, Trippi, Ashby, & Johnson, 1996; Slaney, Rice, Mobley, Trippi, & Ashby, 2001) to measure 2 major dimensions of perfectionism: standards (high performance expectations) and discrepancy (self-critical performance evaluations). In Study 1, after testing the internal structure of the measure (N = 749), a subset of the current APS-R items was derived (Short Almost Perfect Scale [SAPS]) that possessed good psychometric features, such as strong item-factor loadings, score reliability, measurement invariance between women and men, and criterion-related validity through associations with neuroticism, conscientiousness, academic performance, and depression. Controlling for neuroticism and conscientiousness, factor mixture modeling supported a 2-factor, 3-class model of perfectionism, and results were consistent with labeling the classes as nonperfectionists and adaptive and maladaptive perfectionists. Measurement results were cross-validated in a separate sample (N = 335). Study 2 also provided substantial evidence for the convergent, discriminant, and criterion-related validity of SAPS scores. Both studies supported the SAPS as a brief and psychometrically strong measure of major perfectionism factors and classes of perfectionists.

Measure of internalized sexual stigma for lesbians and gay men: a new scale

The goal of this study is to propose a new Measure of Internalized Sexual Stigma for Lesbians and Gay Men (MISS-LG) that assesses three dimensions of internalized homonegativity: identity, social discomfort, and sexuality. A convenience sample of 735 Italian lesbians and gay male participants was used to demonstrate the psychometric validity of the scale. Results of confirmatory factor analysis supported three identifiable factors reflecting theoretically based constructs of the MISS-LG. The correlations with other instruments demonstrate the convergent validity: lesbian and gay participants with high internalized sexual stigma describe lower levels of self-disclosure and wellbeing. Implications for research and practice are discussed.

The mediating role of pain in substance use and depressive symptoms among Multicenter AIDS Cohort Study (MACS) participants

Pain in human immunodeficiency virus (HIV) frequently co-occurs with substance use and depression. The complex associations among patient characteristics, pain, depression, and drug use in HIV suggests a role for testing models that can account for relationships simultaneously, control for HIV status, and also test for mediation. Using structural equation modeling, the current study examined associations among pain, sociodemographics, illicit drug use, and depressive symptoms in 921 HIV-seropositive and 1019 HIV-seronegative men from the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural history of HIV infection among gay/bisexual men. Longitudinal repeated measures data collected over a 6-year period were analyzed using predictive path models in which sociodemographics, HIV status, and CD4+ cell counts predicted pain, which, in turn, predicted depressive symptoms and illicit drug use. The path models did not differ substantially between HIV-seropositive and -seronegative men. Analyses using the total sample indicated that pain served both as a mediator and as a predictor of more use of cannabis, cocaine, and heroin, as well as more depressive symptoms. HIV-seropositive status predicted more use of inhaled nitrites. In this cohort, having lower CD4+ cell counts (predicted by HIV status), being African American, less educated, and older were all associated with more pain, which, in turn, was associated with more illicit drug use and more depressive symptoms. The results underscore the need for adequate pain management, particularly among vulnerable subgroups of HIV-seropositive and HIV-seronegative men to reduce the risk of drug use and depression.

Clarifying and measuring filial concepts across five cultural groups

Literature on responsibility of adult children for aging parents reflects lack of conceptual clarity. We examined filial concepts across five cultural groups: African-, Asian-, Euro-, Latino-, and Native Americans. Data were randomly divided for scale development (n = 285) and cross-validation (n = 284). Exploratory factor analysis on 59 items identified three filial concepts: Responsibility, Respect, and Care. Confirmatory factor analysis on a 12-item final scale showed data fit the three-factor model better than a single factor solution despite substantial correlations between the factors (.82, .82 for Care with Responsibility and Respect, and .74 for Responsibility with Respect). The scale can be used in cross-cultural research to test hypotheses that predict associations among filial values, filial caregiving, and caregiver health outcomes.

Gender differences in the relative impact of physical and relational bullying on adolescent injury and weapon carrying

Using structural equation modeling, concurrent associations were assessed among physical bullying, relational bullying, physical victimization, relational victimization, injury and weapon carrying using data from the population of 1300 adolescent girls and 1362 adolescent boys in grades 7-12 in a Colorado school district. For both genders, being a relational bully was a significantly stronger predictor of weapon carrying than being a physical bully, and both bullying types were significant predictors of more weapon carrying. For both genders, being a victim of physical bullying, a victim of relational bullying, or being a relational bully significantly predicted more injury. In latent means comparisons, adolescent girls reported more relational victimization and adolescent boys reported more physical bullying and victimization, more weapon carrying, and more injury. The relative strength of relational bullying on weapon carrying, and the health-related consequences of bullying on interpersonal violence and injury support concerted efforts in schools to mitigate these behaviors. Attention to differences related to age and gender also is indicated in the design of bullying mitigation programs.

Revision, criterion validity, and multigroup assessment of the reactions to homosexuality scale

Internalized homonegativity encompasses negative attitudes toward one's own sexual orientation and is associated with negative mental and physical health outcomes. The Reactions to Homosexuality Scale (Ross & Rosser, 1996), an instrument used to measure internalized homonegativity, has been criticized for including content irrelevant to the construct of internalized homonegativity. We revised the scale using exploratory and confirmatory factor analyses and identified a 7-item, 3-factor reduced version that demonstrated measurement invariance across racial/ethnic categorizations and between English and Spanish versions. We also investigated criterion validity by estimating correlations with hypothesized outcomes associated with outness, relationship status, sexual orientation, and gay community affiliation. The evidence of measurement invariance suggests that this scale is appropriate for pluralistic treatment or study groups.

Protective factors associated with fewer multiple problem behaviors among homeless/runaway youth

Although homeless youth exhibit numerous problem behaviors, protective factors that can be targeted and modified by prevention programs to decrease the likelihood of involvement in risky behaviors are less apparent. The current study tested a model of protective factors for multiple problem behavior in a sample of 474 homeless youth (42% girls; 83% minority) ages 12 to 24 years. Higher levels of problem solving and planning skills were strongly related to lower levels of multiple problem behaviors in homeless youth, suggesting both the positive impact of preexisting personal assets of these youth and important programmatic targets for further building their resilience and decreasing problem behaviors. Indirect relationships between the background factors of self-esteem and social support and multiple problem behaviors were significantly mediated through protective skills. The model suggests that helping youth enhance their skills in goal setting, decision making, and self-reliant coping could lessen a variety of problem behaviors commonly found among homeless youth.

A Test of the Measurement Validity of the Resistance to Change Scale in Russia and Ukraine

The authors developed a Russian-language version of Oreg’s (2003) Resistance to Change (RTC) Scale, a multidimensional dispositional measure of an individual’s tendency to avoid or resist change, and tested its generalizability to the post-Soviet context with data from Russia and Ukraine. Confirmatory factor analysis results indicated a lack of configural consistency for the cognitive rigidity subscale, and post hoc examination suggested an unintended frame of reference for the cognitive rigidity items. The other three subdimensions of the scale—routine seeking, emotional reaction, and short-term thinking—were measurement-invariant in the two countries, providing a psychometrically acceptable measure of individual resistance to change. As a result, this respecification of the RTC Scale should be useful for much needed research devoted to individual resistors to change in the post-Soviet context, an effort essential for understanding obstacles to organizational change, and for generating prescriptive guidelines in a situation where most organizations are pressed by transition-induced need for systemic change and development.

Confirming the Three-Factor Structure of the Disgust Scale—Revised in Eight Countries

The current study evaluates the factor structure of the Disgust Scale—Revised (DS-R) in eight countries: Australia, Brazil, Germany, Italy, Japan, the Netherlands, Sweden, and the United States ( N = 2,606). Confirmatory factor analysis is used to compare two different models of the DS-R and to investigate the invariance of the factor structure of the DS-R across countries and gender. A three-factor solution consisting of three different but interrelated disgust factors (a 12-item core disgust factor, an 8-item animal-reminder disgust factor, and a 5-item contamination disgust factor) best accounted for the data in all countries except the Netherlands. Relative to the United States, the three-factor solution is invariant in Australia, Brazil, and Japan but not in Germany, Italy, the Netherlands, and Sweden. The three-factor solution is also invariant across gender in most countries. The implications of these cross-cultural findings for promoting a more valid and reliable assessment of disgust dimensions, as assessed by the DS-R, are discussed.

Structural differences within negative and depressive syndrome dimensions in schizophrenia, organic brain disease, and major depression: A confirmatory factor analysis of the positive and negative syndrome scale

OBJECTIVE

The emerging dimensional approach to classification and treatment of psychiatric disorders calls for better understanding of diagnosis-related variations in psychiatric syndromes and for proper validation of psychometric scales used for the evaluation of those syndromes. This study tested the hypothesis that negative and depressive syndromes as measured by the Positive and Negative Syndrome Scale (PANSS) are consistent across different diagnoses.

METHOD

We administered the PANSS to subjects with schizophrenia (n = 305), organic brain disease (OBD, n = 66) and major depressive disorder (MDD, n = 75). Confirmatory factor analysis (CFA) was used to establish if the PANSS items for negative symptoms and for depression fit the hypothesized factor structure and if the item factor loadings were similar among the diagnostic groups.

RESULTS

The negative and depressive symptom subscales fit well according to a variety of fit indexes for all groups individually after some modest model modification. However, multisample modeling procedures indicated that the pattern of factor loadings was significantly different among the groups in most cases.

CONCLUSION

The results of this study indicate diagnosis-related variations in the negative and depressive syndrome dimensions in schizophrenia, OBD and MDD. These results also validate limited use of the PANSS for evaluation of negative and depressive syndromes in disorders other than schizophrenia. Larger studies are warranted to further evaluate clinical and nosologic significance of diagnostic categories, dimensions and structures of psychiatric syndromes.

Paternal and maternal influences on problem behaviors among homeless and runaway youth

Using an Attachment Theory conceptual framework, associations were investigated among positive paternal and maternal relationships, and recent problem behaviors among 501 currently homeless and runaway adolescents (253 males, 248 females). Homeless and runaway youth commonly exhibit problem behaviors such as substance use, various forms of delinquency and risky sex behaviors, and report more emotional distress than typical adolescents. Furthermore, attachments to their families are often strained. In structural equation models, positive paternal relationships significantly predicted less substance use and less criminal behavior, whereas maternal relationships did not have a significant effect on or association with either behavior. Positive maternal relationships predicted less survival sex behavior. Separate gender analyses indicated that among the females, a longer time away from home was significantly associated with a poorer paternal relationship, and more substance use and criminal behavior. Paternal relations, a neglected area of research and often not addressed in attachment theory, should be investigated further. Attachments, particularly to fathers, were protective against many deleterious behaviors. Building on relatively positive relations and attachments may foster family reunifications and beneficial outcomes for at-risk youth.

Measuring HIV-related stigma among Chinese service providers: confirmatory factor analysis of a multidimensional scale

An HIV-related stigma scale for health care workers needs to be multidimensional in that it should encompass attitudes that might be experienced by the general public about people living with HIV/AIDS (PLWHA) (e.g., fear, shame, blame) and, further, specifically capture perceptions of appropriate professional care and medical responsibilities regarding PLWHA. A 17-item, 5-factor multidimensional HIV-related stigma scale was developed and validated using both exploratory and confirmatory factor analysis among 1,101 service providers in China. The sample was divided into a development sample (N = 551) and a validation sample (N = 550). The fit of the final confirmatory factor model with five hypothesized subscales was excellent in both samples. The final stigma subscales included: Discrimination Intent at Work, Opinion about Health Care for HIV/AIDS Patients, Prejudiced Attitudes, Internalized Shame, and Fear of PLWHA.

Factorial invariance of child self-report across age subgroups: a confirmatory factor analysis of ages 5 to 16 years utilizing the PedsQL 4.0 Generic Core Scales

BACKGROUND

The utilization of health-related quality of life (HRQOL) measurement in an effort to improve pediatric health and well-being and determine the value of health care services has grown dramatically over the past decade. The paradigm shift toward patient-reported outcomes (PROs) in clinical trials has provided the opportunity to emphasize the value and essential need for pediatric patient self-report. In order for HRQOL/PRO comparisons to be meaningful for subgroup analyses, it is essential to demonstrate factorial invariance. This study examined age subgroup factorial invariance of child self-report for ages 5 to 16 years on more than 8,500 children utilizing the PedsQL 4.0 Generic Core Scales.

METHOD

Multigroup Confirmatory Factor Analysis (MGCFA) was performed specifying a five-factor model. Two multigroup structural equation models, one with constrained parameters and the other with unconstrained parameters, were proposed to compare the factor loadings across the age subgroups.

RESULTS

Metric invariance (i.e., equal factor loadings) across the age subgroups was demonstrated based on stability of the Comparative Fit Index between the two models, and several additional indices of practical fit including the Root Mean Squared Error of Approximation, the Non-Normed Fit Index, and the Parsimony Normed Fit Index.

CONCLUSION

The findings support an equivalent five-factor structure across the age subgroups. Based on these data, it can be concluded that children across the age subgroups in this study interpreted items on the PedsQL 4.0 Generic Core Scales in a similar manner regardless of their age.

Pain, problem drug use history, and aberrant analgesic use behaviors in persons living with HIV

Little is known about the relationship between pain and aberrant use of prescription analgesics in persons living with HIV. We examined the predictive and concurrent associations among pain, aberrant use of opioids, and problem drug use history in a nationally representative longitudinal sample of 2267 HIV+ persons. Covariance structure analyses tested a conceptual model wherein HIV+ patients with a history of problematic drug use (n=870), compared to those without such history (n=1397), were hypothesized to report more pain and aberrant opioid use, as well as use of opioids specifically for pain at baseline and 6- and 12-month follow-ups, after controlling for key sociodemographic characteristics. In support of the hypothesized model, patients with a history of problematic drug use reported more pain, and were more likely to report aberrant use of prescription analgesics, as well as use of such medications specifically for pain, compared to patients without such history. We also found a trend toward greater stability of aberrant opioid use over time in problem drug users compared with non-problem users suggesting a persistent pattern of inappropriate medication use in the former group. Our findings suggest that even though HIV+ persons with a history of problematic drug use report on-going patterns of using prescription analgesics specifically for pain, these patients continued to experience persistently higher levels of pain, relative to non-problem users. Among non-problem users, pain was not linked to aberrant use of opioids, but was linked to the use of such medications specifically for pain.