Measurement Invariance of the WHODAS 2.0 in a Population-Based Sample of Youth

A mixed-methods study to evaluate the feasibility and preliminary efficacy of delivering the optimal health program (OHP) for youth at clinical high risk (CHR) for psychosis: A study protocol

Individuals with clinical high risk (CHR) for psychosis experience significant distress, impaired general functioning and a high lifetime risk of self-harm and attempted suicide. The CHR period is an important phase in an individual's mental health where appropriate interventions may reduce the risk of progression to several negative outcomes, including the development of schizophrenia. Given that up to 80% of individuals with CHR have another diagnosable mental illness and almost half experience poor psychosocial functioning, developing interventions that address psychosocial functioning in young people with CHR is of great importance. This mixed-methods study aims to employ qualitative and quantitative methods to adapt an evidence-based comprehensive psychosocial and mental health self-efficacy program, the Optimal Health Program (OHP), and evaluate the feasibility, acceptability and preliminary clinical efficacy in young people with CHR. We aim to recruit 30 CHR participants (age 16-29 years) in a single-arm 12-week exploratory clinical trial. Feasibility metrics will include recruitment, retention, and data completion rates. Acceptability will be informed by the Client Satisfaction Questionnaire. Clinical assessments (psychosis spectrum symptoms, depression, and anxiety), functional measures, and cognitive outcomes will be completed at study entry and repeated post-intervention at 12-weeks. We will run pre-post test data analysis to examine changes following engagement in the OHP intervention. Qualitative interviews will be conducted post-intervention to further evaluate the acceptability of the intervention and the trial design, and will be analyzed using thematic analysis. OHP may enhance the long-term mental health, well-being and functioning of CHR youth. However, the intervention must first be adapted to a CHR population; then, the feasibility and preliminary efficacy of delivering an intervention tailored around the varied needs of the CHR group must be established before a larger-scale appropriately powered study is pursued. Trial registration: The trial is registered with ClinicalTrials.gov NCT05757128.

Impact of mental and developmental disorders on disability in Japanese university students: A cross-sectional study

OBJECTIVE

This study utilized the World Health Organization Disability Assessment Schedule version 2 (WHODAS 2.0) to identify vulnerable students and explore the impact of mental and developmental disorders on disability.

PARTICIPANTS

A total of 156 undergraduates who visited support service offices at large-scale universities in Japan between April 2018 and March 2020 were included.

METHODS

The 36-item WHODAS 2.0 was administered, and data were gathered regarding mental and developmental disabilities. Mann-Whitney and Kruskal-Wallis tests were conducted.

RESULTS

Parents/guardians typically initiated consultation with student support services. Students whose parents had initiated consultation did not have higher scores in any WHODAS domain except "Life Activities." In every WHODAS domain except "Cognition," the "Mental Disorder" group scored significantly higher than the "No Disorder" group. The addition of "Developmental Disorders" significantly increased WHODAS scores, except in "Mobility."

CONCLUSIONS

The WHODAS is a useful tool for identifying vulnerable students.

The Toronto Adolescent and Youth Cohort Study: Study Design and Early Data Related to Psychosis Spectrum Symptoms, Functioning, and Suicidality

BACKGROUND

Psychosis spectrum symptoms (PSSs) occur in a sizable percentage of youth and are associated with poorer cognitive performance, poorer functioning, and suicidality (i.e., suicidal thoughts and behaviors). PSSs may occur more frequently in youths already experiencing another mental illness, but the antecedents are not well known. The Toronto Adolescent and Youth (TAY) Cohort Study aims to characterize developmental trajectories in youths with mental illness and understand associations with PSSs, functioning, and suicidality.

METHODS

The TAY Cohort Study is a longitudinal cohort study that aims to assess 1500 youths (age 11-24 years) presenting to tertiary care. In this article, we describe the extensive diagnostic and clinical characterization of psychopathology, substance use, functioning, suicidality, and health service utilization in these youths, with follow-up every 6 months over 5 years, including early baseline data.

RESULTS

A total of 417 participants were enrolled between May 4, 2021, and February 2, 2023. Participants met diagnostic criteria for an average of 3.5 psychiatric diagnoses, most frequently anxiety and depressive disorders. Forty-nine percent of participants met a pre-established threshold for PSSs and exhibited higher rates of functional impairment, internalizing and externalizing symptoms, and suicidality than participants without PSSs.

CONCLUSIONS

Initial findings from the TAY Cohort Study demonstrate the feasibility of extensive clinical phenotyping in youths who are seeking help for mental health problems. PSS prevalence is much higher than in community-based studies. Our early data support the critical need to better understand longitudinal trajectories of clinical youth cohorts in relation to psychosis risk, functioning, and suicidality.

Validation of the 12-item World Health Organization Disability Assessment Schedule 2.0 in individuals with schizophrenia, depression, anxiety, and diabetes in Singapore

BACKGROUND

There is limited evidence on the reliability and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an Asian patient population with mental and physical disorders. The current study aimed to examine the psychometric properties of the WHODAS 2.0 among patients with schizophrenia, depression, anxiety, and diabetes.

METHODS

A total of 1076 patients (M  =  40.9 years, SD  =  14.7) were recruited from the outpatient clinics of a tertiary psychiatric hospital and a primary care clinic. Internal consistency and test-retest reliability, structural validity, convergent validity, agreement, and floor and ceiling effects were examined.

RESULTS

Our confirmatory factor analysis (CFA) showed that the 1-factor model fits our data. Multigroup CFA demonstrated metric and scalar invariance, indicating the scores can be compared across the four conditions. The WHODAS 2.0 scale had excellent reliability in the overall sample and good to excellent reliability across conditions. The test-retest reliability and agreement between self-administered and interviewer-administered modes were good. The WHODAS 2.0 scores had moderate to strong correlations with the Social and Occupational Functioning Scale and the Sheehan Disability Scale scores in the overall sample and across four conditions.

CONCLUSION

Findings suggest that the WHODAS 2.0 is a valid tool to measure functioning and disability in those with schizophrenia, anxiety, depression, and diabetes in an Asian patient population.

Measurement invariance of the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 across early and late adolescents in Canada

PURPOSE

This study examined whether the 12-item self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 demonstrated measurement invariance between young adolescents aged 10-16 years with a physical illness and older adolescents aged 15-19 years from the general population.

MATERIALS AND METHODS

Young adolescent data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117) and older adolescent data come from the Canadian Community Health Survey-Mental Health (n = 1851). Multiple-group confirmatory factor analysis was used to test measurement invariance. WHODAS 2.0 scores were compared across morbidity subgroups using multiple regression.

RESULTS

Measurement invariance of the WHODAS 2.0 was demonstrated: (χ2=635.2(144), p<.001; RMSEA = 0.059 (0.054, 0.064); CFI = 0.967; TLI = 0.970; and, SRMR = 0.068). Adjusting for data source, sex, race, immigrant status, and household income, WHODAS 2.0 scores were associated with morbidity status in a dose-response manner: physical illness only (B = 1.50, p<.001), mental illness only (B = 2.92, p<.001), and physical-mental comorbidity (B = 4.44, p<.001).

CONCLUSIONS

Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents - a group that previously demonstrated measurement invariance with an adult sample. The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course. IMPLICATIONS FOR REHABILITATIONThe 12-item self-administered WHODAS 2.0 is one of the most widely used measures of disability and functioning.Measurement invariance of the WHODAS 2.0 suggests that young adolescents interpret the items and disability construct similarly to older adolescents and adults in Canada.Researchers and health professionals can be confident that differences in 12-item self-administered WHODAS 2.0 scores are real and meaningful.The 12-item self-administered WHODAS 2.0 may be used to measure disability across the life-course.

Validating the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada

PURPOSE

This study investigated the psychometric properties of the 12-item proxy-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in young children with chronic physical illness in Canada.

MATERIALS AND METHODS

Data come from the Multimorbidity in Youth across the Life-course, a longitudinal study of Canadian youth with physical illnesses (n = 263). Baseline parent-reported data from children (2-9 years, n = 143) and adolescents (10-16 years, n = 117) were analyzed. Wilcoxon's tests examined differences in WHODAS 2.0 scores between subgroups. Internal consistency was estimated, and confirmatory factor analysis modeled the WHODAS 2.0 factor structure. Regression modeling examined if the WHODAS 2.0 could discriminate between children with vs. without mental comorbidity.

RESULTS

Differences were found between children and adolescents regarding self-care and getting along, and for the item on emotional affect. Inter-item correlations were similar between subgroups and internal consistency was strong for children (α = 0.90) and adolescents (α = 0.93). The factor structure of the WHODAS 2.0 was confirmed; parameter estimates were similar between subgroups. The association between mental comorbidity and disability did not differ by age - comorbidity was associated with greater disability (β = 5.87, p < 0.01).

CONCLUSIONS

The 12-item proxy-administered WHODAS 2.0 appears valid and reliable in young children with physical illness and can be used in this population.Implications for rehabilitationThe 12-item proxy-administered WHODAS 2.0 has acceptable inter-item correlations and internal consistency in young Canadian children with chronic physical illness, and its factor structure is consistent with previous reportsExpansion of its use in measuring disability in young children provides the opportunity to use the WHODAS 2.0 across the life-course, facilitating the interpretation of changes in disability over time or in response to treatmentAdditional research is needed to determine responsiveness to change and the minimal clinically important difference of the WHODAS 2.0 in this population.

Agreement of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in parents and youth with physical illness living in Canada

PURPOSE

This study modelled the factor structure and tested for measurement invariance between youth and parent reports on the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0; estimated agreement between informants; and, examined moderators of youth-parent discrepancies.

MATERIALS AND METHODS

Data come from the baseline wave of the Multimorbidity in Youth across the Life-course study (n = 117). Multiple-group confirmatory factor analysis was used to test for measurement invariance and Wilcoxon signed-rank tests compared informant scores. Intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement plots were used to examine the youth-parent agreement.

RESULTS

The WHODAS 2.0 demonstrated measurement invariance [χ2 = 221.8(136), p < 0.01; RMSEA = 0.073 (0.055, 0.091); CFI = 0.962; and, SRMR = 0.078]. Youth typically reported more disability compared to parent proxies, with the exception of item Q5 (emotional). The agreement was low (ICC = 0.08-0.53). Youth sex moderated informant agreement such that more consistent agreement was seen for female youth (β = 0.54, p < .01) compared to male youth (β = 0.11, p = .29).

CONCLUSIONS

Youth and their parents interpret the construct of disability, as measured by the 12-item WHODAS 2.0, similarly. Thus, informant differences represent real differences that are not a consequence of error. Low parent-youth agreement reinforces the need for collecting multiple perspectives in the pediatric setting, especially for male youth.Implications for rehabilitationThe WHODAS 2.0 is one of the most widely used measures of disability and functioning.Measurement invariance of the WHODAS 2.0 suggests that youth and parents interpret the construct of disability similarly.Parent-youth agreement was low and youth typically report more disability compared to parent proxies.More consistent agreement with parents was found for female youth compared to male youth.

Longitudinal Association Between Youth Multimorbidity and Psychological Distress: Impact of the COVID-19 Pandemic

This research examined longitudinal associations between youth physical-mental multimorbidity and psychological distress before and during the COVID-19 pandemic; assessed the contextual impact of the pandemic on these associations; and, investigated potential moderating factors. The Multimorbidity in Youth across the Life-course, an ongoing study of youth aged 2-16 years (mean 9.4; 46.9% female) with physical illness, was used as the sampling frame for this COVID-19 sub-study, in which 147 parent-youth dyads participated. Psychological distress was measured using the Kessler-6 (K6). Multimorbidity was associated with higher pre-pandemic, but not with intra-pandemic distress. Disability moderated pre-pandemic distress-multimorbidity was associated with higher K6 among youth with high disability, but not among youth with low disability. Age moderated intra-pandemic distress-multimorbidity was associated with higher K6 in older youth, but not among younger youth.

Validation and Psychometric Properties of the Italian Version of the Unconditional Self-Kindness Scale (USKS)

Western psychology and social sciences have long emphasized the value of a positive attitude toward oneself. Previous research had developed psychometric tools assessing self-compassion, defined as being open to and moved by one's own suffering. However, self-compassion did not describe whether people actually applied such protective factors when acutely faced with threats. The Unconditional Self-Kindness Scale (USKS) was developed as a tool to measure the behavioral response of self-kindness during an acute presence of threat to the self and not just as a general attitude when threat is absent. Since it can be experienced even in the most challenging situations and may promote resilience, this kindness may be defined as unconditional. We validated the Italian version of the USKS and found that the scale retained a one-factor structure. The USKS showed sound psychometric properties and good convergent validity since it was found to show very strong correlations with the Self-Compassion Scale-Short-Form and the Reassure Self subscale of the Forms of Self-criticizing/Attacking and Self-Reassuring Scale (FSCRS). In addition, the USKS showed good discriminant validity since it was found to show a negative moderate correlation and a negative strong correlation with the HS subscale and with the IS subscale of the FSCRS, respectively. Finally, the USKS showed good test-retest reliability and its use is encouraged in clinical and research settings in which the assessment of a positive attitude toward oneself during an acute presence of threat to the self is of interest.

Psychometric properties and informant agreement of the WHODAS 2.0 in youth with mental disorder

Objective

This study examined psychometric properties, parent-youth agreement, and factors associated with agreement on the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0.

Methods

Data come from a clinical sample of 56 youth, aged 14-17 years, receiving mental health care at a pediatric hospital. Correlations between the WHODAS 2.0, KIDSCREEN-27, and demographic variables were used to assess validity. Internal consistency was measured using ordinal alpha. The Bland-Altman method and intraclass correlation coefficients (ICC) were used to assess parent-youth agreement. Logistic regression examined factors associated with disagreement > 0.5 standard deviation.

Results

For both parent and youth, correlations were low to moderate in exploring convergent (τ= -0.42 to 0.01) and divergent validity (τ/r = -0.12 to 0.32). Internal consistency was adequate (α > 0.7). Parent WHODAS 2.0 scores were significantly lower than youth scores and Bland-Altman plots revealed poor parent-youth agreement (ICC = -0.04 to 0.33). Lower household income was associated with lower odds of disagreement on the 35-item WHODAS 2.0 (OR= 0.28, 95% CI= 0.08-0.99), and older youth age was associated with lower odds of disagreement on the 12-item WHODAS 2.0 (OR= 0.40, 95% CI= 0.19-0.84).

Conclusion

The psychometric properties of both WHODAS 2.0 versions were similar, so the abbreviated version may be sufficient to measure functional impairment in a clinical context. Additional research is needed to better understand the factors that influence discrepancies between informants and the implications for care. However, reports from both youth and parents appear valuable in understanding functional impairment.

Self-concept in Adolescents with Physical-Mental Comorbidity

Objective

Little is known about self-concept in adolescents with physical-mental comorbidity. This study investigated whether physical-mental comorbidity was associated with self-concept in adolescents and examined if adolescent age or sex moderated the association between physical-mental comorbidity and self-concept.

Methods

Study data were obtained from the Multimorbidity in Youth across the Life-course (MY LIFE), an ongoing Canadian study of adolescents with chronic physical illness who were recruited from outpatient clinics at a pediatric hospital. A total of 116 adolescents aged ≥ 10 years provided self-reports on key measures.

Results

Adolescents with comorbidity (n = 48) had lower self-concept scores on the Self-Determination Questionnaire (SDQ; d = 0.62) and Self-Perception Profile for Children (SPPC; d = 0.53) vs. adolescents without comorbidity (n = 68). An age × comorbidity status interaction was found and age-stratified models were computed to investigate this moderating effect of age. Amongst older adolescents, comorbidity was associated with lower SDQ (B = -2.55, p < .001), but this association was not found among younger adolescents (B = -0.29, p = .680). A similar effect was found for SPPC among older (B = -0.48, p = .001) and younger adolescents (B = 0.03, p = .842). Adolescent sex was not found to be a moderator.

Conclusions

Physical-mental comorbidity in adolescence was associated with lower self-concept and this association was moderated by age-differences between adolescents with vs. without comorbidity were greater for older adolescents and were clinically relevant. Opportunities to support positive self-perceptions for adolescents with comorbidity are warranted, especially when planning the transition from pediatric to adult health services.

Internalizing-Externalizing Comorbidity and Impaired Functioning in Children

BACKGROUND

The comorbidity of mental illnesses is common in child and adolescent psychiatry. Children with internalizing-externalizing comorbidity often experience worse health outcomes compared to children with a single diagnosis. Greater knowledge of functioning among children with internalizing-externalizing comorbidity can help improve mental health care.

OBJECTIVE

The objective of this exploratory study was to examine whether internalizing-externalizing comorbidity was associated with impaired functioning in children currently receiving mental health services.

METHODS

The data came from a cross-sectional clinical sample of 100 children aged 4-17 with mental illness and their parents recruited from an academic pediatric hospital. The current mental illnesses in children were measured using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and the level of functioning was measured using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. Linear regression was used to estimate the association between internalizing-externalizing comorbidity and level of functioning, adjusting for demographic, psychosocial, and geographic covariates.

RESULTS

Internalizing-externalizing comorbidity in children was associated with worse functioning compared to children with strictly internalizing comorbidities, β = 0.32 (p = 0.041). Among covariates, parent's psychological distress, β = 0.01 (p = 0.004), and distance to the pediatric hospital, β = 0.38 (p = 0.049) were associated with worse functioning in children.

CONCLUSIONS

Health professionals should be mindful that children with internalizing-externalizing comorbidity may experience worsening functioning that is disruptive to daily activities and should use this information when making decisions about care. Given the exploratory nature of this study, additional research with larger and more diverse samples of children is warranted.

Prevalence and Correlates of Physical-mental Multimorbidity in Outpatient Children From a Pediatric Hospital in Canada

OBJECTIVE

The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity.

METHOD

The sample included 263 children aged 2-16 years with a physician-diagnosed chronic physical illness recruited from the outpatient clinics at a pediatric hospital. Children were categorized by physical illness according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10. Parent and child-reported six-month mental illness was based on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).

RESULTS

Overall, 101 (38%) of children had a parent-reported mental illness; 29 (25%) children self-reported mental illness. There were no differences in prevalence across ICD-10 classifications. Parent-child agreement on the MINI-KID was low (κ = 0.18), ranging from κ = 0.24 for specific phobia to κ = 0.03 for attention-deficit hyperactivity. From logistic regression modeling (odds ratio [OR] and 95% confidence interval), factors associated with multimorbidity were: child age (OR = 1.16 [1.04, 1.31]), male (OR = 3.76 [1.54, 9.22]), ≥$90,000 household income (OR = 2.57 [1.08, 6.22]), parental symptoms of depression (OR = 1.09 [1.03, 1.14]), and child disability (OR = 1.21 [1.13, 1.30]). Similar results were obtained when modeling number of mental illnesses.

CONCLUSIONS

Findings suggest that six-month multimorbidity is common and similar across different physical illnesses. Level of disability is a robust, potentially modifiable correlate of multimorbidity that can be assessed routinely by health professionals in the pediatric setting to initiate early mental health intervention to reduce the incidence of multimorbidity in children.

Correlates of Moderate-to-Vigorous Physical Activity in Children With Physical Illness and Physical-Mental Multimorbidity

This study measured physical activity (PA) and explored its correlates among children with multimorbidity (co-occurring chronic physical and mental illness; MM) versus those with chronic physical illness only (PI). This study used baseline data from the Multimorbidity in Children and Youth Across the Life Course (MY LIFE) study, an on-going cohort study following 263 children with a PI 2 to 16 years of age (mean age: 9.8 years, SD = 4.0; 47.7% female). PA was measured using accelerometry, and demographic and psychosocial variables were collected using questionnaires. Of the 55 children with MM and the 85 with PI with valid accelerometer data, 38.1% and 41.2%, respectively, met average daily PA guidelines. Correlates of moderate-to-physical PA (MVPA) among children with MM were age, ρ(53) = -0.45, p = .001, body mass index (BMI), ρ(48) = -0.28, p = .04, self-perceived behavioral conduct, ρ(24) = -0.45, p = .02, physical health-related quality of life, ρ(51) = 0.56, p < .001, and peer support, ρ(52) = 0.27, p = .04. Correlates of MVPA among children with PI were age, ρ(83) = -0.40, p < .001, sex, ρ(83) = -0.26, p = .01, self-perceived social competence, ρ(31) = 0.42, p = .02, self-perceived athletic competence, ρ(31) = 0.48, p = .005, physical health-related quality of life, ρ(83) = 0.34, p = .001, participation in community sport, ρ(31) = 0.41, p = .02, and family functioning, ρ(83) = 0.26, p = .02. These results demonstrate that children with PI and MM are insufficiently active and their PA is correlated with demographic and psychosocial factors.

Factorial validity and measurement invariance of the psychological need satisfaction in exercise scale across gender

BACKGROUND

Based on the self-determination theory, the psychological requirements for competence, autonomy, and relatedness boost beneficial exercise behaviour for healthy living. However, there is no valid, reliable Malay version scale to investigate the extent to which these psychological needs are met. The main purpose of this study was to examine the psychometric properties of a Malay version of the Psychological Need Satisfaction in Exercise (PNSE-M) scale. In addition, the purpose of this study was to confirm the measurement and structural invariance of the PNSE-M across gender.

METHODS

The study participants included 919 students (male: 49.6%, female: 50.4%), with a mean age of 20.4 years (standard deviation = 1.5). The participants were selected through convenience sampling. The 18-item PNSE-M was used to measure psychological need satisfaction in exercise. The English version of the PNSE was translated into Malay using standard forward-backward translation. Confirmatory factor analysis (CFA) and invariance tests were performed on the three domains of the PNSE-M model. Composite reliability (CR), average variance extracted (AVE), internal consistency based on Cronbach's alpha, and test-retest reliabilities using intraclass correlation coefficient (ICC) were also computed.

RESULTS

After some model re-specification, the CFA findings based on the hypothesised measurement model of three factors and 18 items indicated acceptable factor structure (CFI = .936, TLI = .923, SRMR = .054, RMSEA = .059). The CR and AVE values were .864-.902 and .573-.617, respectively. Cronbach's alpha was .891-.908, and the ICC was .980-.985. The findings supported the full measurement and structural invariance of the PNSE-M for both male and female participants. The CFA model matched the data well for both male (CFI = .926, SRMR = .057, RMSEA = .066) and female (CFI = .926, SRMR = .060, RMSEA = .065) participants.

CONCLUSION

The PNSE-M with three factors and 18 items is considered to be a valid, reliable instrument for university students in Malaysia. It is valid for use to make meaningful comparisons across gender.

Measuring health-related quality of life in young children with physical illness: psychometric properties of the parent-reported KIDSCREEN-27

PURPOSE

This study examined whether the KIDSCREEN-27 was reliable and valid in young children 2-7 years with chronic physical illnesses which included estimating inter-domain correlations and internal consistency; measurement invariance testing; and, discriminant and convergent validity assessments.

METHODS

Data come from the Multimorbidity in Children and Youth across the Life-course; a longitudinal study of individuals aged 2-16 years with physical illness. The parent-reported KIDSCREEN-27 was administered. Children (2-7 years; n = 106) were compared to adolescents (8-16 years; n = 157). Reliability was estimated using Cronbach α for internal consistency. Multiple group confirmatory factor analysis tested for measurement invariance. Cohen's d and Pearson coefficient were used to assess discriminant validity by sex and age. Convergent validity was tested using Pearson coefficients with the WHODAS 2.0 (child functioning/impairment). Multiple regression examined associations between multimorbidity (co-occurring physical and mental illness) and HRQL.

RESULTS

Internal consistency reliabilities were α = 0.74-0.88 (children) and α = 0.77-0.88 (adolescents). Inter-domain correlations were relatively low (children: r = 0.18-0.59; adolescents: r = 0.30-0.62) indicating that each KIDSCREEN-27 domain was measuring a unique aspect of health-related quality of life. Measurement invariance was demonstrated (scalar level). Parameter estimates of the invariant models were similar for children and adolescents. Small, non-significant correlations were found for sex and age for children and adolescents. Medium, significant correlations were found for both groups between the KIDSCREEN-27 and WHODAS 2.0. Children and adolescents with multimorbidity had significantly lower physical well-being, psychological well-being, and school environment scores compare to those without multimorbidity. Regression coefficients were similar between groups.

CONCLUSION

Findings provide evidence of adequate psychometrics for the KIDSCREEN-27 in young children with chronic physical illness.

THE POSSIBILITIES OF DISABILITY LEVEL DETERMINATION BASED ON THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING WITH THE WHO DISABILITY ASSESSMENT SCHEDULE (WHODAS 2.0)

OBJECTIVE

The aim: To explore the possibilities of using the WHODAS 2.0 questionnaire in the field of medical and social expertise in Ukraine as an additional tool for the determination of the levels of human functioning in the main spheres of life.

PATIENTS AND METHODS

Materials and methods: A check-up of 125 disabled people was conducted, their scores were determined using the WHODAS as well as their degree of disability according to generally accepted criteria in Ukraine. The study object was the disability level. The study subject - levels of functioning and disability assessment with the WHODAS 2.0.

RESULTS

Results: It is shown that most disabilities occur in the spheres of participation, life activity, and mobility, which is the biggest obstacle to the functioning of such people. An interval gradation of disability level determination is proposed based on the scores obtained by the respondent according to the WHODAS 2.0 with the selection of criteria for mild, moderate, severe, and very severe functional limitations.

CONCLUSION

Conclusions: Correlation analysis of indicators in different sections of the WHODAS 2.0 questionnaire with the disability criteria used in the practice of medical and social examination proves that the disability level assessment according to the WHODAS 2.0 meets the generally accepted criteria, therefore, this disability scale can be an objective tool for functional level assessment and disability group determination.

An International Multicenter Comparison of IBD-Related Disability and Validation of the IBDDI

BACKGROUND

The IBD disability index (IBDDI) has been shown to be valid and reliable. We compared the distributional and predictive properties of the IBDDI, when collected from five populations of people living with IBD- from Winnipeg, Chicago, Toronto, Hong Kong, and Jerusalem.

METHODS

People with IBD from five jurisdictions were invited to complete a survey including the IBDDI, the World Health Organization Disability Assessment Scale, the Work and Social Adjustment Scale, the IBDQ, the Kessler-6 distress scale, and the Stanford presenteeism scale. Between sites, we compared the correlation between IBDDI and the other 4 measures of disability/quality of life/distress, and the association between IBDDI and presenteeism and having been hospitalized in the past year.

RESULTS

There were 1121 participants from Winnipeg, 511 from Chicago, 147 from Toronto, 97 from Hong Kong, and 96 from Jerusalem. The majority had Crohn's disease. Although the mean IBDDI score varied by site, the correlation between IBDDI and each of the other 4 measures of disability/QOL/distress was nearly identical. Similarly, the regression coefficient showing the association between IBDDI and presenteeism was nearly identical in all sites, and the risk ratios showing the association between hospitalization and high IBDDI was similar in all sites.

CONCLUSION

The correlation between IBDDI and different measures of disability/QOL/distress was similar across all sites. There is strong evidence of the association between IBD-related disability and presenteeism, and between hospitalization and high IBD-related disability, and that the associations are the same across different populations. The severity of disability that an individual with a given IBDDI score has is directly comparable across populations.

Parent-Child Agreement on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)

OBJECTIVE

Multiple informants are often used in the assessment of child psychopathology; however, parent-child agreement is low in child psychiatry. The objective of this exploratory study was to assess informant agreement on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in a clinical sample of children with mental disorders and their parents, and to examine health and demographic factors associated with agreement.

METHOD

MINI-KID results were analyzed for 88 parent-child dyads. Children were between 8-17 years old and were receiving in- or outpatient services for at least one mental disorder at a pediatric hospital. Kappas were calculated to assess parent-child agreement and logistic regression models were used to identify factors associated with agreement.

RESULTS

Agreement was low to moderate (κ=0.19-0.41) across the MINI-KID modules. Household income was associated with agreement for major depression, generalized anxiety, and attention-deficit hyperactivity disorder. Recruitment setting and parent psychological distress were associated with agreement for generalized anxiety and separation anxiety, respectively. Age, sex, and child disability/impairment were not associated with agreement.

CONCLUSIONS

Parent-child agreement on the MINI-KID was low to moderate, and few factors were associated with agreement. These initial findings reaffirm the need for multiple informants when assessing psychopathology in children and can be used by health professionals to facilitate parent-child discussions in clinical settings in child psychiatry.

COVID-19-Related Psychological and Psychosocial Distress Among Parents and Youth With Physical Illness: A Longitudinal Study

Despite the initial thrust of research aimed at understanding the impact of the COVID-19 pandemic on youth with physical illness and their parents, knowledge gaps in the literature remain, providing the impetus for additional investigation. This study described changes in psychological distress from prior to during the COVID-19 pandemic for parents and youth with physical illness, compared parent-proxy and youth self-reported perceptions of COVID-19-related psychosocial health, and modeled factors associated with psychological and psychosocial distress. There were 147 parent-youth dyads (2-16 years) from MY LIFE-a longitudinal study of youth with physical illness. The Kessler-6 (K6) measured psychological distress for the time before the COVID-19 lockdown (December 19 to March 20) and during the pandemic (December 20 to March 21) among parents and youth. COVID-19-related psychosocial health was measured using the CRISIS. Parents and youth reported increases in K6 scores (d = 0.62 and 0.38). Parent-proxy reports on the K6 were lower vs. youth self-reports prior to and during the pandemic (d = 0.63 for both). In contrast, parents reported lower proxy CRISIS scores for worries (d = 0.38) and effects of social restrictions (d = 0.52). Pandemic parent K6 scores were associated with age, combined in-person and online schooling for youth, COVID-19-related worries, and effects of social restrictions. For youth, only COVID-19-related worries and effects of social restrictions were associated with K6 scores. Parent worries were associated with youth sex, parental stress, family functioning, online and combination learning, and social restrictions. Parental depression and worries were associated with effects of social restrictions. Youth worries were associated with online and combination learning, and social restrictions. Youth disability, online learning, and worries were associated with effects of social restrictions. Few clinical factors are associated with COVID-19-related psychological and psychosocial distress. Instead, parent/family factors and youth learning environment have prominent roles in predicting outcomes and have implications for the health, education, and social services systems.

Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees

Background

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees.

Aims

The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention.

Method

A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0.

Results

The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution.

Conclusions

The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.

Cross-cultural validation of the decisional balance scale in exercise across countries

BACKGROUND

This study examined the psychometric properties of the Korean and Malay version of the decisional balance (DB) for exercise (i.e. perceived benefits and perceived barriers) using a cross-sectional design. Also, this study assessed the measurement and structural invariance of the DB scale across countries.

METHODS

A cross sectional study was conducted in Malaysia and Korea. The study sample consisted of 574 Korean participants and 562 Malaysian participants. The mean age of the participants was 19.8 (SD = 1.29) for the Korean sample and 19.8 (SD = 1.22) for the Malaysian sample. Participants were invited to complete the DB scale with the 10-item and two factors (i.e., perceived benefit and perceived barriers). Confirmatory factor analysis (CFA) and invariance test were conducted on the data by using Mplus 8.3.

RESULTS

The CFA results based on the hypothesised measurement model of two factors and ten items showed sufficient construct validity after adding residual covariance between items within the same factor: CFI = 0.979, TLI = 0.970, SRMR = 0.036, RMSEA = 0.036 for the Korea sample, and CFI = 0.964, TLI = 0.949, SRMR = 0.055, RMSEA = 0.066 for the Malay sample. For the Korea sample, the construct reliability was 0.62 and 0.74 for perceived benefits and perceived barriers respectively. For the Malay sample, the construct reliability was 0.75 and 0.77 for perceived benefits and perceived barriers respectively. The findings presented evidence for measurement and structural invariance of the DB scale for the Korea and Malaysia samples.

CONCLUSION

The DB scale was a valid and reliable measure for assessing exercise behaviour and for making comparisons between Korean and Malaysian samples.

Challenges in Documenting Non-Fatal Drowning Disability in Bangladesh: A Community-Based Survey

Limited access to health care and the lack of robust data systems means non-fatal drownings are largely missed in low-and middle-income countries. We report morbidity among individuals who experienced non-fatal drowning in the Barishal Division, Bangladesh. A representative household survey was conducted in the Barishal Division in southern Bangladesh between September 2016 and February 2017, covering a population of 386,016. The burden of non-fatal drowning was assessed using the WHODAS 2.0 disability assessment tool, a generic assessment instrument for health and disability. A total of 5164 non-fatal drowning events occurred in the one year preceding the survey. Among these 18% were multiple events. From these, 4235 people were administered the WHODAS 2.0 questionnaire. Non-fatal drowning incidence rates were highest in children aged 1–4 years at 5810 per 100,000 population, and among males. Non-fatal drowning was associated with lower socio-economic status and larger family sizes. Few respondents (6.5%; 95% CI: 4.5–8.4%) reported some level of disability (WHODAS-12 score > 8). Incidence of non-fatal drowning is high in the population, however limited impact on morbidity was found. There is a need to develop tools and methodologies for reliable and comparable data for non-fatal drowning, especially to capture post-event disability in children.

Health-related quality of life in children with and without physical-mental multimorbidity

PURPOSE

This study examined health-related quality of life (HRQL) in children across different physical illnesses; estimated parent-child agreement on HRQL reports; compared HRQL between children with and without physical-mental multimorbidity; and tested if multimorbidity was associated with HRQL.

METHODS

Children aged 6-16 years (mean = 11.1; n = 198) with one physical illness and their parents were recruited from a pediatric hospital. Physical illnesses were classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10, mental illnesses were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, and HRQL was measured using the KIDSCREEN-27. Children who screened positive for ≥ 1 mental illness were classified as having physical-mental multimorbidity. χ²/t tests compared sample characteristics of children with vs. without multimorbidity; Kruskal-Wallis tests compared KIDSCREEN-27 scores across ICD-10 categories; interclass correlation coefficients estimated parent-child agreement; and multiple regression examined effects of the number of mental illnesses on HRQL.

RESULTS

HRQL was similar across ICD-10 categories. Parent-child agreement was fair to good for all HRQL domains, regardless of multimorbidity status. Parent-reported HRQL was significantly lower for children with multimorbidity compared to norms across all domains, whereas child-reported HRQL was significantly lower for physical well-being, psychological well-being, and school environment. Number of mental illnesses was negatively associated with psychological well-being and school environment in a dose-response manner.

CONCLUSION

Children with physical-mental multimorbidity are vulnerable to experiencing lower HRQL, particularly for psychological well-being and school environment. Longitudinal studies documenting trajectories of HRQL and school-based interventions that target these domains of HRQL for children with multimorbidity are warranted.

The development of burn scar contractures and impact on joint function, disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up

OBJECTIVE

The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country.

METHODS

Patients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury.

RESULTS

Thirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns.

CONCLUSION

The prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.

Cohort Profile: Multimorbidity in Children and Youth Across the Life-course (MY LIFE) Study

OBJECTIVE

This manuscript serves to provide an overview of the methods of the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study, profile sample characteristics of the cohort, and provide baseline estimates of multimorbidity to foster collaboration with clinical and research colleagues across Canada.

METHOD

MY LIFE is comprised of 263 children (2-16 years) with a physical illness recruited from McMaster Children's Hospital, their primary caregiving parent, and their closest-aged sibling. Participants are followed with data collection at recruitment, 6, 12, and 24 months which includes structured interviews, self-reported measures, and biological samples and occur in a private research office or at participants' homes. Post-COVID-19, data collection transitioned to mail and telephone surveys.

RESULTS

At recruitment, children were 9.4 (4.2) years of age and 52.7% were male. The mean duration of their physical illness was 4.5 (4.1) years; 25% represent incident cases (duration <1 year). Most (69.7%) had healthy body weight and intelligence in the average range (73.5%). Overall, 38.2% of children screened positive for ≥1 mental illness according to parent report (24.8% screened positive based on child self-report). Compared to 2016 Census data, the MY LIFE cohort overrepresents families of higher socioeconomic status.

CONCLUSIONS

Multimorbidity is common among children and these baseline data will serve to measure relative changes in the mental health of children with physical illness over time. MY LIFE will provide new information for understanding multimorbidity among children, though underrepresentation of lower socioeconomic families may have implications for the generalizability of findings.

The 12 items Amharic version WHODAS-2 showed cultural adaptation and used to measure disability among road traffic trauma victims in Ethiopia

BACKGROUND

Adapting and translating already developed tools to different cultures is a complex process, but once done, it increases the validity of the construct to be measured. This study aimed to assess the 12 items WHODAS-2 and test its psychometric properties among road traffic injury victims in Ethiopia. This study aimed to translate the 12 items WHODAS- 2 interview-based tools into Amharic and examine the psychometric properties of the new version among road traffic injury victims.

METHODS

The 12 items WHODAS 2 was first translated into Amharic by two experts. Back translation was done by two English experts. A group of experts reviewed the forward and backward translation. A total of 240 patients with road traffic injury completed the questionnaires at three selected Hospitals in Amhara Regional State. Internal consistency was; assessed using Chronbach's alpha, convergent, and divergent validity, which were; tested via factor analysis. Confirmatory factor analysis (CFA); was computed, and the model fit; was examined.

RESULTS

The translated Amharic version 12 -items WHODAS-2 showed that good cross-cultural adaptation and internal consistency (Chronbach's α =0.88). The six factor structure best fits data (model fitness indices; CFI = 0.962, RMSEA = 0.042, RMR = 0.072, GFI = 0.961, chi-square value/degree of freedom = 1.42, TLI = 0.935 and PCLOSE = 0.68). Our analysis showed that from the six domains, mobility is the dominant factor explaining 95% of variability in disability.

CONCLUSION

The 12 items interview-based Amharic version WHODAS-2; showed good cultural adaptation at three different settings of Amhara Regional State and can be used to measure dis-ability following a road traffic injury.

Tansey T. Psychometric Validation of a Measure Assessing Functional Limitations of Students With Disabilities: An Adaptation of the World Health Organization Disability Assessment Schedule 2.0

The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) has been used to assess functional impairments in various disability populations and has been shown to be applicable to the youth population. The purpose of the study was to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule II–Youth Version (WHODAS-Y). Results of the study revealed a two-factor solution, including the socio-cognitive index and self-care index. The WHODAS-Y measurement appears to be a reliable and valid measure of function impairment in transition-age youth with disabilities in a community setting. This assessment tool can be integrated in vocational rehabilitation practices and guide rehabilitation counselors in identifying needs and facilitators related to education and employment-related services, as well as understanding health care needs in youth with disabilities.

A randomised double-blind trial of cognitive training for the prevention of psychopathology in at-risk youth

BACKGROUND

The aim of this study was to evaluate the effectiveness of online cognitive training as a means of reducing psychopathology in at-risk youth.

METHODS

In a double-blind randomised controlled trial, 228 youths (mean age = 18.6, 74.6% female) were randomly allocated to either an intervention group (n = 114; online cognitive training focused on executive functioning) and a control group (n = 114; online cognitive training focused on other cognitive abilities). Participants were assessed online at baseline, post-training, 3-, 6- and 12-month follow-up. The primary outcome of the study was overall psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes were executive functioning ability (assessed using the n-back, trail-making and Stroop tasks), day-to-day functioning and risky drinking.

RESULTS

Mixed model intention-to-treat analyses indicated that psychopathology increased and day-to-day functioning decreased, regardless of intervention group. Those in the intervention group improved more than those in the control group in terms of the n-back task, but this was not statistically significant after adjusting for multiple comparisons. There were no statistically significant effects on risky drinking, or the trail-making and Stroop tasks.

CONCLUSION

This study failed to provide evidence for the efficacy of cognitive training as a stand-alone intervention for psychopathology.

Factorial validity, measurement and structure invariance of the Malay language decisional balance scale in exercise across gender

Background

This study examined the psychometric properties of the Malay version of the decisional balance (DB-M) for exercise (i.e. perceived benefits and perceived barriers) using a cross-sectional design. Also, this study assessed the measurement and structural invariance of the DB-M across gender.

Methods

The study sample consisted of 750 students (female: 51.7%, male: 48.3%), with a mean age of 20.2 years (SD = 1.2). Decision balance (DB) scale was assessed with the 10-item DB-M. Standard forward-backward translation was performed to translate the English version of the DB into Malay version (DB-M).

Results

The confirmatory factor analysis (CFA) results based on the hypothesised measurement model of two factors and ten items demonstrated adequate factor structure after the addition of some correlated item residuals (comparative fit index (CFI) = .979, Tucker and Lewis index (TLI) = .969, standardised root mean square residual (SRMR) = .037, root mean square error of approximation (RMSEA) = .047). The construct reliability and average variance extracted values were .850 and .839, and .542 and .538, for perceived benefits and perceived barriers, respectively. Meanwhile, the Cronbach’s alpha was .857 and .859, and the intraclass correlation coefficient for test-retest reliability was .979 and .960 for perceived benefits and perceived barriers respectively. The findings provided evidence for measurement invariance of DB-M for the male and female samples. The final CFA model fit the data well for both male sample (CFI = .975, TLI = .964, SRMR = .040, RMSEA = .052) and female sample (CFI = .965, TLI = .949, SRMR = .044, RMSEA = .058).

Conclusions

The translated version of the DB-M was valid and reliable for assessing the level of perceived benefits and perceived barriers in exercise among university students in Malaysia.

Psychometric properties of 12-item self-administered World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) among general population and people with non-acute physical causes of disability - systematic review

OBJECTIVE

WHODAS 2.0 is a unified scale to measuring disability across diseases, countries, and cultures. The objective was to explore the available evidence on the psychometric properties of 12-item self-administered WHODAS 2.0 among a general population and people with non-acute physical causes of disability.

METHODS

Five databases Medline, Embase, Web of Science, Scopus, and PsycINFO were searched for papers related to the validity, reliability, responsiveness, minimal clinically important difference or minimal detectable change of 12-item self-administered WHODAS 2.0. In order to avoid missing any potentially relevant studies, the search clauses were left as generic as possible and the refining search was conducted manually. As the review was focusing on chronic physical disorders and general adult population, major psychiatric diagnoses, acute traumas, other acute conditions (e.g., postpartum or pregnancy), hearing loss, progressive neurological disorders, and age <19 years were excluded. The relevancy of the studies was assessed by two independent reviewers.

RESULTS

The 14 out of 191 observational studies were considered relevant. The sample sizes varied from 80 up to 31,251 participants. Great diversity was observed in the participants' health problems. The Cronbach's alpha was high - up to 0.96. The correlations between WHODAS 2.0 and other disability scales were high. Substantial floor without ceiling effect was reported by two studies. Exploratory factor analysis resulted in a multidimensional structure - up to five factors. The discriminative ability and test-retest reliability of the scale was good.

CONCLUSIONS

It seems, that the 12-item self-administered WHODAS 2.0 is internally consistent and a reliable scale demonstrating overall good correlation with other measures of disability. However, it appears that it is a multidimensional scale and its total score may represent different combinations of several contributing factors. Thus, the 12-item WHODAS 2.0 can be more reliable when creating a person's functional profile formed by the 12 individual item scores instead of a single total sum.IMPLICATIONS FOR REHABILITATIONThe 12-item self-administered WHODAS 2.0 is internally consistent and a reliable scale demonstrating overall good correlation with other measures of disability.It appears that it is a multidimensional scale and its total score may represent different combinations of several contributing factors.The 12-item WHODAS 2.0 can be more reliable when creating a person's functional profile formed by the 12 individual item scores instead of a single total sum.

Mental-Physical Multimorbidity in Youth: Associations with Individual, Family, and Health Service Use Outcomes

Prevalence, correlates, and outcomes of youth with comorbid mental and physical conditions (i.e., multimorbidity) were examined in this cross-sectional study. Participants were 92 youth (14.5 years [SD 2.7]; 69.6% female) and their parents. Mental disorder was assessed using structured interviews and physical health using a standardized questionnaire. Twenty-five percent of youth had multimorbidity and no child or parent demographic or health characteristics were correlated with multimorbidity. Youth with multimorbidity reported similar quality of life and better family functioning [B = - 4.80 (- 8.77, - 0.83)] compared to youth with mental disorder only (i.e., non-multimorbid). Youth with multimorbidity had lower odds of receiving inpatient services [OR = 0.20 (0.05, 0.85)] and shorter stays in hospital for their mental health [OR = 0.74 (0.57, 0.91)] over the past year. Family functioning was found to mediate the association between youth multimorbidity and length of stay [αβ = 0.14 (0.01, 0.27)]. Findings reinforce the need for family-centered youth mental health care.

Association Between IBD Disability and Reduced Work Productivity (Presenteeism): A Population-Based Study in Manitoba, Canada

BACKGROUND

One effect of IBD disability is reduced productivity when at work (presenteeism). We explored potential predictors of work presenteeism and compared the predictive ability of the recently developed IBD Disability Index (IBDDI) with 4 other scales in predicting presenteeism.

METHODS

Participants (aged 18-65 years) were recruited from the University of Manitoba IBD Research Registry. We calculated a presenteeism score (range, 0-24) from the Stanford Presenteeism Scale (SPS), with higher scores representing greater degrees of presenteeism. Using receiver operating characteristic curves and linear regression, we explored associations between presenteeism and the IBDDI, the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Work and Social Adjustment Scale (WSAS), the Inflammatory Bowel Disease Questionnaire (IBDQ), and the Kessler-6 (K6) distress scale.

RESULTS

Out of 744 respondents working at least half-time (20+ hours/wk), 472 (63%) reported no reduced productivity in the previous 14 days. Reduced productivity was reported for 1-2 days by 131 (18%), for 3-9 days by 119 (16%), and on most days by 22 (3%). When predicting the SPS, similar model fits were found for the IBDDI, WHODAS, WSAS, IBDQ, and K6. Each increase of 10 on the IBDDI score was associated with an increase of 2.19 (95% confidence interval, 2.00-2.37) on the SPS. Each additional year of disease duration was associated with a reduction in SPS score of 0.08 (P < 0.01).

CONCLUSIONS

More than one-third of persons with IBD report presenteeism. We found strong associations between presenteeism and disability, lower quality of life, and emotional distress. The IBDDI performs equally as well as the more established scales in predicting presenteeism.

Measurement equivalence of the short-form Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16)

OBJECTIVE

The aim of this study was to assess measurement equivalence in the 16-item short-form Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16) across age, sex, and time in a sample of children with newly diagnosed epilepsy.

METHODS

Data came from 373 children participating in the Health-related Quality of Life in Children with Epilepsy Study (HERQULES), a multicenter prospective cohort study. Measurement equivalence was assessed using multigroup confirmatory factor analysis methods. Comparison groups were stratified by age (4-7 years vs. 8-12 years), sex (male vs. female), and time (at diagnosis vs. 24 months postdiagnosis).

RESULTS

The QOLCE-16 demonstrated measurement equivalence at the level of strict invariance for each comparison group tested - age: χ² (3, 274) = 429.6, p < 0.001; comparative fit index (CFI) = 0.985; root mean square error of approximation (RMSEA) = 0.056 (0.046, 0.066); sex: χ² (3, 271) = 430.5, p < 0.001; CFI = 0.984; RMSEA = 0.057 (0.047, 0.067); and time: χ² (3, 269) = 566.4, p < 0.001; CFI = 0.985; RMSEA = 0.059 (0.052, 0.066).

SIGNIFICANCE

The findings provide support for the robust psychometric profile of the QOLCE-16 as a reliable and valid measure of health-related quality of life for children with epilepsy. Demonstrating good properties and a multidimensional structure, the QOLCE-16 is an appropriate short measure for both clinicians and researchers wanting to obtain health-related quality of life information on children with epilepsy.

Measurement Invariance of the WHODAS 2.0 Across Youth With and Without Physical or Mental Conditions

Initial evidence suggests that the WHO Disability Assessment Schedule (WHODAS 2.0) is valid and reliable in general youth populations; however, its psychometric properties in specific subgroups are less established. The primary objective was to test for measurement invariance of the 12-item WHODAS 2.0 in an epidemiological sample of youth aged 15 to 19 years with and without physical or mental conditions. Using data from 1,851 youth in the Canadian Community Health Survey-Mental Health, invariance was tested using multiple-group confirmatory factor analysis. Within-domain item correlations were significant and ordinal coefficient alphas were .91, .94, .93, and .92 for the healthy control, physical, mental, and comorbid groups, respectively. Partial measurement invariance was demonstrated for the WHODAS 2.0, with evidence of noninvariance for item residuals and factor variances related to cognition and participation. While these domain-specific comparisons may be biased, valid comparisons of overall disability across subgroups of youth can be made with confidence.

Testing Measurement and Factor Structure Invariance of the Physical Activity and Leisure Motivation Scale for Youth Across Gender

Measurement equivalence is often assumed across comparison groups, a pervasive problem related to many self-report instruments. Measurement equivalence, also known as measurement invariance, implies that a measure has the same meaning across different groups of people. In this study, we aimed to examine the measurement and structural invariance among gender of the Malay version of the Physical Activity and Leisure Motivation Scale for Youth (PALMS-Y-M). Seven-hundred-and-eighty-three secondary school students (female = 57.3%, male = 42.7%) with mean age 14.5 years (standard deviation = 1.25) from Kota Bharu, Malaysia, volunteered to participate in this study and completed the PALMS-Y-M, consisting of 28 items with seven subscales. We conducted the confirmatory factor analysis (CFA) and invariance tests on the seven motives of the PALMS-Y-M model. The hypothesized model consisted of 28 observed items and seven latent variables. We used estimator robust to maximum likelihood, MLR to examine the hypothesized measurement and structural invariance. Measurement invariance was tested for three different levels. We first established the configural invariance model, then we compared the metric invariance model and the scalar invariance model with the less restrictive model. Then structural invariance was tested for factor variance, covariance, and means. Findings provided evidence for full measurement and structural invariance of the PALMS-Y-M in males and females. The final CFA model fit the data well for males [comparative fit index (CFI) = 0.922, root mean square error of approximation (RMSEA) = 0.048, standardized root mean residual (SRMR) = 0.050] and females (CFI = 0.922, RMSEA = 0.047, SRMR = 0.053). When invariance of both factor loadings and item intercepts holds in PALMS-Y-M, underlying factors consisting of different motives for participating in PA can be meaningfully compared across gender. Accurate and valid measurement of PALMS-Y-M across comparison groups is crucial for future research that involves examining motives to physical activity in different genders and other socio-cultural variables.

Independent Validation of a Self-Report Version of the IBD Disability Index (IBDDI) in a Population-Based Cohort of IBD Patients

INTRODUCTION

A new clinician-administered inflammatory bowel disease (IBD) Disability Index (IBDDI) was recently developed and validated among a population in France. We aimed to validate the IBDDI in a North American setting and adapt for use as a self-report tool.

METHODS

Persons 18-65 years old from the population-based University of Manitoba IBD Research Registry were mailed a self-administered survey. This survey included the IBDDI and several scales that should correlate with a disability measure- the World Health Organization (WHO) Disability Assessment Scale (WHODAS) 2.0, Work and Social Adjustment Scale (WSAS), the Inflammatory Bowel Disease Questionnaire (IBDQ), and the K6-Kessler Emotional Distress Scale. We used Pearson correlation coefficients to assess construct validity, Cronbach's alpha to assess internal consistency, and Factor analysis to assess which of the IBDDI items likely belonged to a single IBD-related disability factor.

RESULTS

In response to the survey request,1143 (46% of those contacted) participated (61% female, mean age 51, 52% with Crohn's disease). On an index scale from 0-100, 14% had a score ≥50 (extreme disability, 18% of those with Crohn's disease; 10% of those with ulcerative colitis). There were strong correlations between IBDDI and WSAS (0.76), WHODAS (0.76), K6 (0.73), and an inverse correlation with IBDQ (-0.86). The Cronbach's alpha was high (0.88). All but 2 items (number of liquid stools in the past week and arthritis/arthralgia) of the 14 identified for IBDDI loaded highly onto a single factor (factor loading > 0.40).

CONCLUSIONS

The findings support the validity of this new self-report version of the IBDDI as a sound measure of disability in IBD.

The Brain Games study: protocol for a randomised controlled trial of computerised cognitive training for preventing mental illness in adolescents with high-risk personality styles

INTRODUCTION

A broad range of mental disorders are now understood as aberrations of normal adolescent brain development. In both adolescents and adults, executive dysfunction has been implicated across a range of mental illnesses, and enhancing executive functioning may prove to be a useful prevention strategy for adolescents at risk for a range of psychopathology.

METHODS AND ANALYSIS

This study will consist of a double-blind, randomised controlled trial with a 12-month follow-up period. Participants will consist of 200 people aged 16-24 years who are at risk for a range of mental disorders based on personality risk factors, but have not experienced a lifetime mental illness as determined by a structured diagnostic interview. Participants will be randomly allocated to either an intervention group who complete an online cognitive training programme specifically targeting executive functioning ability or a control group who complete an online cognitive training programme that has limited executive functioning training potential. Superiority of the executive functioning training programme compared with the control training programme will be assessed at baseline, post-training and at 3-month, 6-month and 12-month follow-up. All assessments will be conducted online. The primary outcome of the study will be general psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes will include executive functioning ability, day-to-day functioning and alcohol consumption. All analyses will be undertaken using mixed-model repeated measures analysis of variance with planned contrasts.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the University of New South Wales Human Research Ethics Committee (HC15094). Results of the trial immediately post-treatment and at 12 months follow-up will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12616000127404; Pre-results.

Validating the shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) in a sample of children with drug-resistant epilepsy

OBJECTIVE

The aim of this study was to validate the newly developed shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) in a sample of children with drug-resistant epilepsy.

METHODS

Data came from 136 children enrolled in the Impact of Pediatric Epilepsy Surgery on Health-Related Quality of Life Study (PEPSQOL), a multicenter prospective cohort study. Confirmatory factor analysis was used to assess the higher-order factor structure of the QOLCE-55. Convergent and divergent validity was assessed by correlating subscales of the KIDSCREEN-27 with the QOLCE-55. Measurement equivalence of the QOLCE-55 was evaluated using multiple-group confirmatory factor analysis of children with drug-resistant epilepsy from PEPSQOL versus children with new-onset epilepsy from HERQULES (Health-Related Quality of Life in Children with Epilepsy Study).

RESULTS

The higher-order factor structure of the QOLCE-55 demonstrated adequate fit: Comparative Fit Index (CFI) = 0.948; Tucker-Lewis Index (TLI) = 0.946; Root Mean Square of Approximation (RMSEA) = 0.060 (90% confidence interval [CI] 0.054-0.065); Weighted Root Mean Square Residuals (WRMR) = 1.247. Higher-order factor loadings were strong, ranging from λ = 0.74 to 0.81. Internal consistency reliability was excellent (α = 0.97, subscales α > 0.82). QOLCE-55 subscales demonstrated moderate to strong correlations with similar subscales of the KIDSCREEN-27 (ρ = 0.43-0.75) and weak to moderate correlations with dissimilar subscales (ρ = 0.25-0.42). The QOLCE-55 demonstrated partial measurement equivalence at the level of strict invariance - χ² (2,823) = 3,727.9, CFI = 0.961, TLI = 0.962, RMSEA = 0.049 (0.044, 0.053), WRMR = 1.834.

SIGNIFICANCE

The findings provide support for the factor structure of the QOLCE-55 and contribute to its robust psychometric profile as a reliable and valid measure. Researchers and health practitioners should consider the QOLCE-55 as a viable option for reducing respondent burden when assessing health-related quality of life in children with epilepsy.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Major depressive disorder, suicidal behaviour, bipolar disorder, and generalised anxiety disorder among emerging adults with and without chronic health conditions

BACKGROUND

Despite the considerable physical, emotional and social change that occurs during emerging adulthood, there is little research that examines the association between having a chronic health condition and mental disorder during this developmental period. The aims of this study were to examine the sex-specific prevalence of lifetime mental disorder in an epidemiological sample of emerging adults aged 15-30 years with and without chronic health conditions; quantify the association between chronic health conditions and mental disorder, adjusting for sociodemographic and health factors; and, examine potential moderating and mediating effects of sex, level of disability and pain.

METHOD

Data come from the Canadian Community Health Survey-Mental Health. Respondents were 15-30 years of age (n = 5947) and self-reported whether they had a chronic health condition. Chronic health conditions were classified as: respiratory, musculoskeletal/connective tissue, cardiovascular, neurological and endocrine/digestive. The World Health Organization Composite International Diagnostic Interview 3.0 was used to assess the presence of mental disorder (major depressive disorder, suicidal behaviour, bipolar disorder and generalised anxiety disorder).

RESULTS

Lifetime prevalence of mental disorder was significantly higher for individuals with chronic health conditions compared with healthy controls. Substantial heterogeneity in the prevalence of mental disorder was found in males, but not in females. Logistic regression models adjusting for several sociodemographic and health factors showed that the individuals with chronic health conditions were at elevated risk for mental disorder. There was no evidence that the level of disability or pain moderated the associations between chronic health conditions and mental disorder. Sex was found to moderate the association between musculoskeletal/connective tissue conditions and bipolar disorder (β = 1.71, p = 0.002). Exploratory analyses suggest that the levels of disability and pain mediate the association between chronic health conditions and mental disorder.

CONCLUSIONS

Physical and mental comorbidity is prevalent among emerging adults and this relationship is not augmented, but may be mediated, by the level of disability or pain. Findings point to the integration and coordination of public sectors - health, education and social services - to facilitate the prevention and reduction of mental disorder among emerging adults with chronic health conditions.