Building a new Rasch-based self-report inventory of depression

What is a psychopathology dimension?

Coherence in the science and practice of mental health assessment depends upon a tight connection between psychopathology concepts that are used and the way those concepts are operationalized and defined. In contrast, the use of the same word to mean more than one thing contributes to incoherence, inefficiency, and confusion. In this paper, we review three possible meanings of the word "dimension" as it relates to the assessment of psychopathology and describe how the indiscriminate use of this word has caused confusion in the general context of the transition to a more evidence-based approach to mental health diagnosis. We attempt to disambiguate the term "dimension" by demarcating three concepts that can be distinguished based on different empirical standards: continuous variables, unidimensional dimensions, and distinct dimensions.

Measuring Depression in Young Adults: Preliminary Development of an English Version of the Teate Depression Inventory

Depression is a common and debilitating condition that impacts individuals with various cultural backgrounds, medical conditions, and life circumstances. Thus, assessment tools need to be useful among different cultural groups. The 21-item Teate Depression Inventory (TDI) was developed in Italy, is designed to assess major depression, and focuses on cognitive and affective rather than somatic symptoms. This study aims to examine the factor structure and concurrent validity of the TDI English version among a non-clinical population in the United States. Participants included 398 adults (mean age 19.89 years, SD = 2.72, range: 18 to 46 years old) who completed the TDI and The Center for Epidemiologic Studies Depression Scale-Revised (CESD-R). The results supported a three-factor bifactor structure of the TDI (Positive Affect, Negative Affect, and Daily Functioning), which largely corresponds to the Tripartite Model of affective disorders. These findings support the use of TDI scores as measures of depressive symptoms among U.S. young adults, offering researchers and practitioners a brief and useful tool.

The Role of Gender in the Association Among the Emotional Intelligence, Anxiety and Depression

Recent epidemiological data show an increase of depression and anxiety that cause a loss of about 3-4% of the gross domestic product in Europe, as a consequence of a reduced productivity and a premature death of people. Gender differences in both psychopathologies were found from mid-to-late adolescence until 55 years, and data indicate an increase of depression in women. Considering these data, new interventions focused on promoting psychological well-being were designed. A predictive factor of psychological disorders is Emotional Intelligence (EI), the ability to understand and regulate our own emotions, as well as those of others. EI is associated with psychological well-being, as well as with the treatment of mental illness, but gender differences in the association among EI, anxiety and depression remains unclear. The present study aims at analyzing the nomological associations among EI, anxiety and depression. Furthermore, the possible moderating role of gender in the relation between EI, depression and anxiety is investigated in a sample of 1725 healthy participants. Our results show that the ability to recognize and to control emotions in the social context helps us to reduce the risk to be affected by depression and anxiety. Moreover, our study shows that the association of EI with anxiety and depression wasn't gender moderated. In conclusion, the findings highlight that EI can help people to manage emotions linked to negative events and to successfully understand emotions in others. In addition, we found no moderation role of gender in the association between EI, anxiety and depression.

Development and Validation of Psychometric Properties of the 10 IB Learner Profile Instrument (10IBLP-I): A Combination of the Rasch and Classical Measurement Model

Background: The International Baccalaureate Middle Years Programme (IBMYP) aims to produce a holistic transformation with creative and critically minded students. However, very little attention has been paid to the development of an instrument to measure the IB learner profile with good psychometric properties. Purpose: This study aims to develop an instrument with good psychometric properties, based on the Rasch measurement model and confirmatory factor analysis. Methods: The study consists of two phases of pilot and field studies involving 597 year four students from IBWS MOE. Results: The findings from the Rasch measurement model analysis have shown that 54 items meet the criteria of the item fit, unidimensionality, and reliability index. Meanwhile, confirmatory factor analysis found that 44 items have shown a valid item fit index. Conclusions: The combination of both analyses has shown the strength of 10IBLP-I psychometric properties that cover the aspects of validity and reliability. The findings also provide an implication to the theory, with empirical evidence that the IB learner profile consists of 10 constructs. Besides, the evidenced 10IBLP-I comprises good psychometric properties, which can be used to measure the level of IB learner profile among IBWS MOE students to assess the effectiveness of the implementation of IBMYP in Malaysia.

Does Usage of Online Social Media Help Users With Depressed Symptoms Improve Their Mental Health? Empirical Evidence From an Online Depression Community

Online depression communities offer people with depressed symptoms new opportunities to obtain health information and provide social support for each other to fight against the depression. We sought to investigate whether usage of online community help improve depression outcomes and determine which types of usage behaviors have positive or negative effects on depression. We proposed that two dimensions of the sense of belonging (sense of identity and trust) and three dimensions of the sense of support (informational, emotional, and socializing) have significant effects on depression, and further considered gender difference and its effect on depression. We obtained a dataset consisting of 465,337 posts from 244 members from a popular online depression community to test all 10 proposed hypotheses. The results reveal that (i) the sense of shared identity, trust, informational support, and emotional support have positive effects on depression, while socializing support have negative effects on depression, and (ii) the sense of shared identity and trust have more positive effects on depression for female users than male users while socializing support has a more negative effect on depression for female users than for male users. The findings have important practical implications for designers and managers of online depression communities.

Italians on the Age of COVID-19: The Self-Reported Depressive Symptoms Through Web-Based Survey

The pandemic of coronavirus disease 2019 (COVID-19) has affected the Italian community. The widespread use of quarantine had the desired impact of controlling the epidemic, although it caused many psychological consequences. To date, compliance of the Italian public with voluntary home quarantine has been very high, but little is known about the impact of psychological health on sociodemographic categories during the quarantine. The purpose of this study was to assess the prevalence of depressive symptoms in specific sociodemographic categories during the COVID-19 quarantine lockdown and the potential factors that contribute to, or mitigate, these effects. In the very early stage of the nationwide lockdown, 3,672 quarantined Italian adult residents (65% females, ranging from 18 to 85 years) participated in a web-based cross-sectional survey, including measures of depressive symptoms, which were measured by the Teate depression inventory, and state anxiety levels. The overall prevalence was 27.8% for moderate and 9.3% for severe levels of depressive symptoms. A generalized logistic model was used to identify the factors associated with mental health problems. Among these factors, sociodemographic variables (e.g., sex, age, employment status) and adherence to quarantine guidelines were analyzed. Females, younger people, students, singles, residents in northern Italy, people who were reluctant to adhere to quarantine guidelines, and people less worried about being infected with COVID-19 were at high risk of developing depressive symptoms during the COVID-19 epidemic, also after controlling for state anxiety. These findings showed that public levels of depressive symptoms did not increase the greater likelihood of being infected. Our study suggested that the monitoring of psychological outcomes for outbreaks could identify groups at higher risk of psychological morbidities due to the current pandemic in order to target future psychological interventions for implementation.

Dysregulated brain salience within a triple network model in high trait anxiety individuals: A pilot EEG functional connectivity study

Although previous studies have reported the association between large-scale brain networks alterations and pathological anxiety, abnormalities in the dynamic interaction among the triple network model in anxiety disorders and, especially, in trait anxiety is still poorly explored. Thus, the main aim of the current study was to investigate triple network functional dynamics in subjects with high trait anxiety during resting state (RS) through electroencephalography (EEG) connectivity. Twenty-three individuals with high-trait-anxiety (HTA) and forty-five participants with low-trait-anxiety (LTA) were enrolled. EEG analyses were conducted by means of the exact Low-Resolution Electromagnetic Tomography software (eLORETA). Compared to LTA participants, HTA subjects showed a decrease of alpha connectivity within the salience network (SN), between the dorsal anterior cingulate cortex (dACC) and both left and right anterior insula (AI). Furthermore, SN functional connectivity strength was negatively correlated with higher trait anxiety, even when controlling for potential confounding variables (e.g., depressive and obsessive-compulsive symptoms). Taken together, our results point out a specific functional connectivity pattern in HTA individuals, which consists in a dysfunctional communication within the SN, specifically in the AI-dACC pathway. This functional pattern could underline, at rest, saliency detection and brain correlates of altereted emotion regulation and cognitive control processes typically involved in anxiety.

Understanding the severity of depression: do nondepressive symptoms influence global ratings of depression severity?

OBJECTIVE

Almost all depression measures have been developed without discussing how to best conceptualize and assess the severity of depression. It is therefore not surprising that measures differ in both how items are rated and item content. The question that we address in the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project is whether a measure of depression severity should include symptoms that are frequent in depressed patients but are defining features of other disorders (eg, anxiety, irritability).

METHODS

Patients were evaluated with a semi-structured interview and severity ratings were made of each symptom of major depressive disorder (MDD) as well as anxiety, irritability, and somatization. Patients were also rated on the Clinical Global Index of severity (CGI).

RESULTS

Three of the 5 nondepressive symptoms (psychic anxiety, somatic anxiety, and subjective anger) were significantly correlated with the CGI. The correlation between the sum of all 5 nondepressive symptoms and the CGI was significantly lower than the correlation between the sum of the depressive symptom severity ratings (0.12 vs 0.52, z = 11.0, p < .001). The partial correlation between the CGI and the nondepressive symptom severity ratings (after controlling for the total depressive symptom ratings) was nonsignificant.

DISCUSSION

After accounting for the severity of depressive symptoms, the severity of the nondepressive symptoms was not associated with global ratings of depressive severity. These findings raise questions regarding the appropriateness of including ratings of anxiety, irritability, and somatization on a measure that purportedly assesses the severity of depression.

New Perspectives in Computing the Point of Subjective Equality Using Rasch Models

In psychophysics, the point of subject equality (PSE) is any of the points along a stimulus dimension at which a variable stimulus (visual, tactile, auditory, and so on) is judged by an observer to be equal to a standard stimulus. Rasch models have been found to offer a valid solution for computing the PSE when the method of constant stimuli is applied in the version of the method of transitions. The present work provides an overview of the procedures for computing the PSE using Rasch models and proposes some new developments. An adaptive procedure is described that allows for estimating the PSE of an observer without presenting him/her with all stimuli pairs. This procedure can be particularly useful in those situations in which psychophysical conditions of the individuals require that the number of trials is limited. Moreover, it allows for saving time that can be used to scrutinize the results of the experiment or to run other experiments. Also, the possibility of using Rasch-based fit statistics for identifying observers who gave unexpected judgments is explored. They could be individuals who, instead of carefully evaluating the presented stimuli pairs, gave random, inattentive, or careless responses, or gave the same response to many consecutive stimuli pairs. Otherwise, they could be atypical and clinically relevant individuals who deserve further investigation. The aforementioned developments are implemented using procedures and statistics that are well established in the framework of Rasch models. In particular, computerized adaptive testing procedures are used for efficiently estimating the PSE of the observers, whereas infit and outfit mean-squares statistics are used for detecting observers who gave unexpected judgments. Results of the analyses carried out on simulated data sets suggest that the proposed developments can be used in psychophysical experiments.

Tailored Screening for Late-Life Depression: A Short Version of the Teate Depression Inventory (TDI-E)

A number of assessment instruments have been developed as efficacy measures of geriatric depression in clinical trials but most showed several weaknesses, such as time-consuming administration, development and validation in younger populations, and lack of discrimination between anxiety and depression. Among the extant self-report measures of depression, the 21-item Teate Depression Inventory (TDI; Balsamo and Saggino, 2013), developed via Rasch analysis, showed a satisfactory level of diagnostic accuracy, and allowed the reduction of false positives in test scoring in adult population. The present study explored the potential improvement in the psychometric performance of the TDI in the elderly by item refinement through Rasch analysis in a sample of 836 elderly people (49.5% males; mean age = 73.28; SD = 6.56). A resulting shorter version was composed of the best-fitting and discriminative nine items from the full form. The Teate Depression Inventory (TDI-E) (E for elderly) presented good internal construct validity, with unidimensional structure, local dependency, good reliability (person separation index and Cronbach's alpha), and no signs of differential item functioning or measurement bias due to gender and age (65 vs. 75+ years). Cut-off points and normative data provided could enhance the clinical usefulness of the TDI-E, which seems to be a promising valid and reliable tool for the screening of geriatric depression, with less risk of finding false positives due to overlapping of depression in elderly with other comorbid conditions.

A Comparison of Classical and Modern Measures of Internal Consistency

Three measures of internal consistency – Kuder-Richardson Formula 20 (KR20), Cronbach’s alpha (α), and person separation reliability (R) – are considered. KR20 and α are common measures in classical test theory, whereas R is developed in modern test theory and, more precisely, in Rasch measurement. These three measures specify the observed variance as the sum of true variance and error variance. However, they differ for the way in which these quantities are obtained. KR20 uses the error variance of an “average” respondent from the sample, which overestimates the error variance of respondents with high or low scores. Conversely, R uses the actual average error variance of the sample. KR20 and α use respondents’ test scores in calculating the observed variance. This is potentially misleading because test scores are not linear representations of the underlying variable, whereas calculation of variance requires linearity. Contrariwise, if the data fit the Rasch model, the measures estimated for each respondent are on a linear scale, thus being numerically suitable for calculating the observed variance. Given these differences, R is expected to be a better index of internal consistency than KR20 and α. The present work compares the three measures on simulated data sets with dichotomous and polytomous items. It is shown that all the estimates of internal consistency decrease with the increasing of the skewness of the score distribution, with R decreasing to a larger extent. Thus, R is more conservative than KR20 and α, and prevents test users from believing a test has better measurement characteristics than it actually has. In addition, it is shown that Rasch-based infit and outfit person statistics can be used for handling data sets with random responses. Two options are described. The first one implies computing a more conservative estimate of internal consistency. The second one implies detecting individuals with random responses. When there are a few individuals with a consistent number of random responses, infit and outfit allow for correctly detecting almost all of them. Once these individuals are removed, a “cleaned” data set is obtained that can be used for computing a less biased estimate of internal consistency.

A Cross-Cultural Investigation of Co-Rumination Via Cellphone Among Emerging Adults

Introduction: This study investigated cellphone-mediated co-rumination and its association with emerging adults' anxiety, depression, and social functioning. Comparisons on the basis of gender and nation of residence (United States vs. Italy) were made, and the co-rumination subcomponent of co-brooding was explored.

Method: Participants included 216 undergraduate students recruited in the southeastern United States and 375 students recruited in southern Italy.

Results: Co-rumination via cellphone was associated with higher levels of anxiety and depression and lower levels of social self-efficacy in the U.S. sample. Analyses of the co-brooding element of co-rumination via cellphone revealed its robust association with anxiety and depression in the U.S. sample. In contrast, among Italian emerging adults co-rumination via cellphone was not associated with anxiety or depression and it was positively associated with social well-being. Co-brooding via cellphone was not associated with anxiety or depression in the Italy sample.

Discussion: Cross-cultural and gender differences in co-rumination via cellphone and psychosocial functioning are discussed.

Pragmatic abilities in children with neurodevelopmental disorders: development of Pragmatic Abilities Questionnaire based on the Rasch rating scale model

Background

Pragmatic abilities includes a set of skills that could vary by culture and which are absolutely essential for social communication. These abilities can be impaired in many children with neurodevelopmental disorders and may lead to educational and psychological difficulties. Assessing pragmatic abilities requires valid and reliable instruments that should be developed with cultural differences in mind.

Purpose

This paper reports on the development of a new instrument for measuring and evaluating pragmatic abilities in children with neurodevelopmental disorders.

Methods and participants

The questionnaire items were generated based on a literature review on the theoretical basis of pragmatic abilities, the available pragmatic assessment instruments, interviews with experts and the mothers of children with neurodevelopmental disorders and the observation of their interaction with children based on the pragmatic protocol. Item selection and reliability and validity assessment for the instrument were carried out based on the Rasch rating scale model analysis. The Pragmatic Abilities Questionnaire (PAQ) was completed by the mothers of 185 normally-developing children and the mothers of 120 children with neurodevelopmental disorders, including Autism Spectrum Disorder (ASD), Specific Language Impairment (SLI), Attention-Deficit/Hyperactivity Disorder (ADHD) and Social (Pragmatic) Communication Disorder (SPCD).

Results

The initial pool of 119 items, reflecting the characteristics of pragmatic abilities, was first reduced to 80 after a review by ten experts, and then further reduced to 40 using the Rasch analysis for removing the misfitting items. The final PAQ had a person measure reliability of 0.97 with a separation of 6.03 and an item measure reliability of 0.99. The remaining items formed the questionnaire and measured a single construct, which explained 63.8% of the variance.

Conclusion

The 40 items of the PAQ appear to construe a psychometrically-sound measure of pragmatic abilities.

A bidimensional measure of empathy: Empathic Experience Scale

Empathy is a key notion in the study of sociality. A phenomenological perspective on empathy as intersubjective understanding offers a common ground for multiple dimensions. Corresponding to the dichotomy between perceptual and cognitive levels, two constructs can be distinguished: vicariously experiencing and intuitively understanding others’ emotions. We developed and validated a new questionnaire for the assessment of individual differences in empathy. In a first study (N = 921), we created a questionnaire measuring empathy consisting of a pool of 75 items. Exploratory factor analysis suggested to retain two factors (“Intuitive Understanding” and “Vicarious Experience”), whereas a 30-item version of the questionnaire had satisfactory psychometric properties. In a second study (N = 504), we administered the 30-items questionnaire and several concurrent/divergent measures. Confirmatory factor analysis indicated that a two-factor structure best represented its latent factor structure. The results show that our questionnaire could be considered a reliable and valid measure of empathy with internal consistencies of 0.93 and 0.95 for Vicarious Experience and Intuitive Intuitive Understanding, respectively. Whereas our questionnaire mostly showed the expected convergence with existing scales of empathy, the correlations also suggest that it adds valuable new information to the assessment of empathy. The two-factor structure suggests that the perceptual (vicarious) experience and the basic (non-effortful) cognitive awareness of others’ emotions can be assessed as distinct constructs. This bidimensional structure that distinguishes between the perceptual experience and the basic cognitive awareness of others’ emotional states connects theoretical, empirical, and clinical data from psychology and neuroscience.

[Regional differences in the incidence of affective disorders]

AIM

To analyze the dynamics of the primary indicator of morbidity of affective psychotic and non-psychotic disorders.

MATERIAL AND METHODS

The article uses the data of State statistical observations for the period from 2005 to 2015 years. Regional (eight federal districts) primary indicators of diagnosis of mental disorders were subjected to epidemiological analysis in general, schizophrenia and mood disorders were analyzed in more detail.

RESULTS AND CONCLUSION

The rate of reduction in the incidence of primary psychiatric disorders in this period varied as in Russia in whole as well as in federal districts. It was 22.5% for all mental disorders, 36.0%, for schizophrenia, 50.3% for psychotic forms of mood disorders and 29.6% for non-psychotic disorders, which demonstrated the relatively greater stability of the latter indicator. An analysis of world literature of the last decade shows the convergence of views of foreign and russian researchers on the need for careful clinical assessment of mood disorders in order to form a more differentiated approach to their prevention, diagnosis, treatment and prognostic evaluation.

Dimensions of Anxiety, Age, and Gender: Assessing Dimensionality and Measurement Invariance of the State-Trait for Cognitive and Somatic Anxiety (STICSA) in an Italian Sample

The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) is a widely used measure of state and trait anxiety that permits a specific assessment of cognitive and somatic anxiety. Previous research provided inconsistent findings about its factor structure in non-clinical samples (e.g., hierarchical or bi-factor structure). To date, no psychometric validation of the Italian version of the STICSA has been conducted. Our study aimed to determine the psychometric functioning of the Italian version of the STICSA, including its dimensionality, gender and age measurement equivalence, and convergent/divergent validity in a large sample of community-dwelling participants (N = 2,938; 55.9% female). Through confirmatory factor analysis, the multidimensional structure of both State and Trait STICSA scales, with each including Cognitive and Somatic dimensions, was supported. Factor structure invariance was tested and established at configural, metric, and scalar levels for males and females. Additionally, full factorial measurement invariance was supported for the State scale across young, middle age, and old adult groups whereas the Trait scale was partially invariant across age groups. The STICSA also showed good convergent validity with concurrent anxiety measures (State-Trait Anxiety Inventory and Beck Anxiety Inventory), and satisfactory internal discriminant validity with two depression measures (Teate Depression Inventory and Beck Depression Inventory-II). Results provided support for the multidimensionality of the STICSA, as well as the generalizability of the State and Trait scales as independent measures of Cognitive and Somatic symptomatology across gender in the general population. Implications for research and personality and clinical assessment are discussed.

Using Item Response Theory for the Development of a New Short Form of the Eysenck Personality Questionnaire-Revised

The present work aims at developing a new version of the short form of the Eysenck Personality Questionnaire-Revised, which includes Psychoticism, Extraversion, Neuroticism, and Lie scales (48 items, 12 per scale). The work consists of two studies. In the first one, an item response theory model was estimated on the responses of 590 individuals to the full-length version of the questionnaire (100 items). The analyses allowed the selection of 48 items well discriminating and distributed along the latent continuum of each trait, and without misfit and differential item functioning. In the second study, the functioning of the new form of the questionnaire was evaluated in a different sample of 300 individuals. Results of the two studies show that reliability of the four scales is better than, or equal to that of the original forms. The new version outperforms the original one in approximating scores of the full-length questionnaire. Moreover, convergent validity coefficients and relations with clinical constructs were consistent with literature.

The severity of psychiatric disorders

The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM-5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom-defined disorders depends on factors extrinsic to those disorders, such as self-efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.

Measuring Intimate Partner Violence and Traumatic Affect: Development of VITA, an Italian Scale

In a global context where the percentage of women who are victim of violence is still high (World Health Organization, 2013), intimate partner violence (IPV) can be considered the most widespread form of violence against women: in such cases violent attacks are perpetuated or threatened by a partner or ex-partner within an intimate relationship, which makes its recognition more difficult. IPV requires specific tools and, although the literature has highlighted the specific role played by some emotions (such as shame, guilt, and fear) that keep women experiencing this violence in a state of passivity and confusion, to date too little attention has been given to the construction of sound instruments able to detect post-traumatic affectivity. Such instruments could facilitate women who have suffered from IPV in recognizing it and in making the responses of women's health services more sensitive and structured. This study illustrates a sequential item development process to elaborate a new self-report instrument (VITA Scale: Intimate Violence and Traumatic Affects Scale) for assessing the intensity of post-traumatic affect derived from IPV. Within a psychodynamic perspective, the scale is characterized by four affects: fear, as a state of alarm elicited by the avoidance of the danger; terror, as a paralyzing state that hinders an active process of reaction; shame as a strong exposure to the other that disarms the individual and the guilt as a defensive dimension aiming at the restoring of the link with the abusive partner. Trough specific methodological steps, a 28-item set was selected and administered to a sample of 302 Italian women who declared themselves as having suffered from IPV. Explorative and confirmatory factor analysis, as well as correlations with well-established concurrent tools were computed in order to investigate its psychometric property. A factorial structure composed of four factors, consistent with theoretical scales and a good internal consistency (Cronbach's alphas from 0.80 to 0.90) emerged. The VITA Scale could be a useful tool for clinicians and researchers to investigate the intensity of the affective state of the woman suffered from IPV. It could be useful to better address the clinical practice and therapeutic intervention planning.

New Perspectives in the Adaptive Assessment of Depression: The ATS-PD Version of the QuEDS

Measurement is a crucial issue in psychological assessment. In this paper a contribution to this task is provided by means of the implementation of an adaptive algorithm for the assessment of depression. More specifically, the Adaptive Testing System for Psychological Disorders (ATS-PD) version of the Qualitative-Quantitative Evaluation of Depressive Symptomatology questionnaire (QuEDS) is introduced. Such implementation refers to the theoretical background of Formal Psychological Assessment (FPA) with respect to both its deterministic and probabilistic issues. Three models (one for each sub-scale of the QuEDS) are fitted on a sample of 383 individuals. The obtained estimates are then used to calibrate the adaptive procedure whose performance is tested in terms of both efficiency and accuracy by means of a simulation study. Results indicate that the ATS-PD version of the QuEDS allows for both obtaining an accurate description of the patient in terms of symptomatology, and reducing the number of items asked by 40%. Further developments of the adaptive procedure are then discussed.

Testing Factor Structure and Measurement Invariance Across Gender With Italian Geriatric Anxiety Scale

Late-life anxiety is an increasingly relevant psychiatric condition that often goes unnoticed and/or untreated compared to anxiety in younger populations. Consequently, assessing the presence and severity of clinical anxiety in older adults an important challenge for researchers and clinicians alike. The Geriatric Anxiety Scale is a 30-item geriatric-specific measure of anxiety severity, grouped in three subscales (Somatic, Affective, and Cognitive), with solid evidence for the reliability and validity of its scores in clinical and community samples. Translated into several languages, it has been proven to have strong psychometric properties. In Italy only one recent preliminarily investigative study has appeared on its psychometric properties. However, sample data was largely collected from one specific Italian region (Lombardy) alone. Here, our aim in testing the items of the GAS in a sample of 346 healthy subjects (50% females; 52% from Southern Italy), with mean age of 71.74 years, was 2-fold. First, we aimed to determine factor structure in a wider sample of Italian participants. Confirmatory factor analysis showed that the GAS fits an originally postulated three-factor structure reasonably well. Second, results support gender invariance, entirely supported at the factorial structure, and at the intercept level. Latent means can be meaningfully compared across gender groups. Whereas the means of F1 (Somatic) and F3 (Affective) for males were significantly different from those for females, the means for F2 (Cognitive) were not. More specifically, in light of the negative signs associated with these statistically significant values, the finding showed that F1 and F3 for males appeared to be less positive on average than females. Overall, the GAS displayed acceptable convergent validity with matching subscales highly correlated, and satisfactory internal discriminant validity with lower correlations between non-matching subscales. Implications for clinical practice and research are discussed.

Assessment of anxiety in older adults: a review of self-report measures

With increasing numbers of older adults in the general population, anxiety will become a widespread problem in late life and one of the major causes of health care access contributing to high societal and individual costs. Unfortunately, the detection of anxiety disorders in late life is complicated by a series of factors that make it different from assessment in younger cohorts, such as differential symptom presentation, high comorbidity with medical and mental disorders, the aging process, and newly emergent changes in life circumstances. This review covers commonly and currently used self-report inventories for assessing anxiety in older adults. For each tool, psychometric data is investigated in depth. In particular, information about reliability, validity evidence based on data from clinical and nonclinical samples of older adults, and availability of age-appropriate norms are provided. Finally, guidance for clinical evaluation and future research are proposed in an effort to highlight the importance of clinical assessment in the promotion of clinically relevant therapeutic choices.

Assessment of Affect Lability: Psychometric Properties of the ALS-18

Affect lability, an important aspect of emotion dysregulation, characterizes several psychiatric conditions. The short Affective Lability Scales (ALS-18) measures three aspects of changeability between euthymia and affect states (Anxiety/Depression, AD; Depression/Elation, DE; and Anger, Ang). The aim of our study was to investigate the psychometric characteristics of an Italian version of the ALS-18 in a sample of adults recruited from the general population. The sample was composed of 494 adults (343 women and 151 men) aged 18 and higher (mean age = 31.73 years, SD = 12.6). All participants were administered a checklist assessing socio-demographic variables, the ALS-18 and measures of depression and difficulties in emotion regulation. Confirmatory factor analyses indicated adequate fit of the three-factor model (RMSEA = 0.061, 95% CI = 0.054/0.069; CFI = 0.99; SRMR = 0.055), and the presence of a higher-order general factor. Internal consistency was satisfactory for all the lower-order dimensions and the general factor (ordinal α > 0.70). The ALS-18 was significantly associated with concurrent measures of depression and difficulties in emotion regulation. These findings indicate that the ALS-18 is a valid and reliable instrument for measuring affect lability, although discriminant validity of subdimensions scores could be problematic.

Psychometric Properties of the Italian Version of the Young Schema Questionnaire L-3: Preliminary Results

Schema Therapy (ST) is a well-known approach for the treatment of personality disorders. This therapy integrates different theories and techniques into an original and systematic treatment model. The Young Schema Questionnaire L-3 (YSQ-L3) is a self-report instrument, based on the ST model, designed to assess 18 Early Maladaptive Schemas (EMSs). During the last decade, it has been translated and validated in different countries and languages. This study aims to establish the psychometric properties of the Italian Version of the YSQ-L3. We enrolled two groups: a clinical (n = 148) and a non-clinical one (n = 918). We investigated the factor structure, reliability and convergent validity with anxiety and depression between clinical and non-clinical groups. The results highlighted a few relevant findings. Cronbach's alpha showed significant values for all the schemas. All of the factor models do not seem highly adequate, even if the hierarchical model has proven to be the most significant one. Furthermore, the questionnaire confirms the ability to discriminate between clinical and non-clinical groups and could represent a useful tool in the clinical practice. Limitations and future directions are discussed.

eMindLog: Self-Measurement of Anxiety and Depression Using Mobile Technology

Background

Quantifying anxiety and depressive experiences permits individuals to calibrate where they are and monitor intervention-associated changes. eMindLog is a novel self-report measure for anxiety and depression that is grounded in psychology with an organizing structure based on neuroscience.

Objective

Our aim was to explore the psychometric properties of eMindLog in a nonclinical sample of subjects.

Methods

In a cross-sectional study of eMindLog, a convenience sample of 198 adults provided informed consent and completed eMindLog and the Hospital Anxiety and Depression Scale (HADS) as a reference. Brain systems (eg, negative and positive valence systems, cognitive systems) and their functional states that drive behavior are measured daily as emotions, thoughts, and behaviors. Associated symptoms, quality of life, and functioning are assessed weekly. eMindLog offers ease of use and expediency, using mobile technology across multiple platforms, with dashboard reporting of scores. It enhances precision by providing distinct, nonoverlapping description of terms, and accuracy through guidance for scoring severity.

Results

eMindLog daily total score had a Cronbach alpha of .94. Pearson correlation coefficient for eMindLog indexes for anxiety and sadness/anhedonia were r=.66 (P<.001) and r=.62 (P<.001) contrasted with the HADS anxiety and depression subscales respectively. Of 195 subjects, 23 (11.8%) had cross-sectional symptoms above the threshold for Generalized Anxiety Disorder and 29 (29/195, 14.9%) for Major Depressive Disorder. Factor analysis supported the theoretically derived index derivatives for anxiety, anger, sadness, and anhedonia.

Conclusions

eMindLog is a novel self-measurement tool to measure anxiety and depression, demonstrating excellent reliability and strong validity in a nonclinical population. Further studies in clinical populations are necessary for fuller validation of its psychometric properties. Self-measurement of anxiety and depressive symptoms with precision and accuracy has several potential benefits, including case detection, tracking change over time, efficacy assessment of interventions, and exploration of potential biomarkers.

The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

OBJECTIVES

Melancholic features of depression (MFD) seem to be a unidimensional group of signs and symptoms. However, little importance has been given to the evaluation of what features are related to a more severe disorder. That is, what are the MFD that appear only in the most depressed patients. We aim to demonstrate how each MFD is related to the severity of the major depressive disorder.

METHODS

We evaluated both the Hamilton depression rating scale (HDRS-17) and its 6-item melancholic subscale (HAM-D6) in 291 depressed inpatients using Rasch analysis, which computes the severity of each MFD. Overall measures of model fit were mean (±SD) of items and persons residual = 0 (±1); low χ2 value; p>0.01.

RESULTS

For the HDRS-17 model fit, mean (±SD) of item residuals = 0.35 (±1.4); mean (±SD) of person residuals = -0.15 (±1.09); χ2 = 309.74; p<0.00001. For the HAM-D6 model fit, mean (±SD) of item residuals = 0.5 (±0.86); mean (±SD) of person residuals = 0.15 (±0.91); χ2 = 56.13; p = 0.196. MFD ordered by crescent severity were depressed mood, work and activities, somatic symptoms, psychic anxiety, guilt feelings, and psychomotor retardation.

CONCLUSIONS

Depressed mood is less severe, while guilt feelings and psychomotor retardation are more severe MFD in a psychiatric hospitalization. Understanding depression as a continuum of symptoms can improve the understanding of the disorder and may improve its perspective of treatment.

Outcomes Assessment in Clinical Trials of Alzheimer's Disease and its Precursors: Readying for Short-term and Long-term Clinical Trial Needs

An evolving paradigm shift in the diagnostic conceptualization of Alzheimer's disease is reflected in its recently updated diagnostic criteria from the National Institute on Aging-Alzheimer's Association and the International Working Group. Additionally, it is reflected in the increased focus in this field on conducting prevention trials in addition to improving cognition and function in people with dementia. These developments are making key contributions towards defining new regulatory thinking around Alzheimer's disease treatment earlier in the disease continuum. As a result, the field as a whole is now concentrated on exploring the next-generation of cognitive and functional outcome measures that will support clinical trials focused on treating the slow slide into cognitive and functional impairment. With this backdrop, the International Society for CNS Clinical Trials and Methodology convened semi-annual working group meetings which began in spring of 2012 to address methodological issues in this area. This report presents the most critical issues around primary outcome assessments in Alzheimer's disease clinical trials, and summarizes the presentations, discussions, and recommendations of those meetings, within the context of the evolving landscape of Alzheimer's disease clinical trials.

The Mediating Role of Early Maladaptive Schemas in the Relation between Co-Rumination and Depression in Young Adults

Research on co-rumination has investigated its relationship with internalizing symptoms, but few studies have addressed underlying maladaptive cognitive-affective processes that may play an important role in the maintenance of this relation. This study examines if Young’s schema domains mediate the relation between co-rumination and depression in a community sample of non-clinical young adults. Participants completed the Co-Rumination Questionnaire, Young Schema Questionnaire-L3, and Teate Depression Inventory. Correlations and path analysis were calculated for the full sample and separately by gender. The schema domains of Overvigilance/Inhibition and Other-Directedness fully mediated the relation between co-rumination and depression. When analyses were performed separately for males and females, mediation persisted only for females. Findings suggest that among young women, co-rumination with a friend may be associated with depressive symptoms because of its activation of specific maladaptive cognitive schemas. Better understanding of the content and processes underpinning co-rumination may have important implications for the prevention and treatment of depression.

Development and psychometric analysis of the student-teacher relationship scale - short form

The purpose of this study is the construction and validation of an Italian Short Form version of the Student-Teacher Relationship Scale (STRS; Fraire et al., 2013). The analyses were conducted on 1256 students and 210 teachers. The STRS is a self-report measure assessing teachers' perception of the quality of their relationship with students ranging from preschool to third grade. The items were selected from the original Italian adaptation of the regular STRS (Pianta, 2001) through Rasch (1960/1980) analysis, which allowed us to identify a subset of items with proven psychometric properties. The STRS-SF consists of two subscales: Conflict (eight items) and Closeness (six items). Results indicate that the 14-item instrument shows good internal consistency (α>0.80), high correlations with the scales from the regular STRS (r > 0.90) and equivalence across gender.

Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample

BACKGROUND

Despite its increasing personal and societal impact, assessment of late-life anxiety has received relatively little attention in psychiatric research. Differential symptom presentation and physical comorbidities among the elderly, relative to younger cohorts creates a need for anxiety measures that are psychometrically validated in the elderly.

METHODS

The present study examined the factor structure and discriminant validity of the state-trait inventory for cognitive and somatic anxiety (STICSA) in a sample of Italian middle-aged and older adults. Participants were 396 community-dwelling middle-aged (50-64 years) and older (≥65 years) adults. In addition to the STICSA, participants completed two depression measures and a general well-being survey with physical and mental health subscales.

RESULTS

Factor analysis supported the validity of both state-trait and cognitive-somatic distinctions underlying the STICSA, all dimensions exhibited excellent internal consistency (Cronbach's α coefficients ≥ 0.86), and correlations with depression measures provided limited evidence for differentiation of anxious and depressive symptoms. The STICSA also showed evidence of discriminating anxious symptoms from physical health symptoms, a particularly relevant feature of a valid anxiety measure in elderly samples.

CONCLUSIONS

The STICSA appears to be a valid measure of cognitive and somatic anxiety in the elderly.

Measurement of external shame: an inside view

The aims of this study were to investigate the construct validity of the Other as Shamer scale (OAS) using confirmatory factor analysis (CFA) and to examine the psychometric properties of its Italian version in a sample of 687 nonclinical individuals. The CFA results indicated that the hypothesized hierarchical model (with 1 higher order factor and 3 first-order factors) was the best fitting solution. Cronbach's alpha indexes, as well as test-retest stability, provided satisfactory results. Correlations of the OAS total score and its subscales with the Beck Depression Inventory-II (rs = .30-.48) and the Teate Depression Inventory (rs = .32-.45) were both substantial and significant (p < .01). Receiver operating characteristic curves were constructed to indicate sensitivity and specificity of the OAS and its subscales when determining those nonclinical subjects who met clinical thresholds for depression symptoms. A series of cutoff scores for the OAS scale and its subscales was developed, with sensitivity values between .70 and .62, and specificity values between .71 and .62, indicating good to fair discrimination between the 2 groups (depressed vs. nondepressed). The theoretical and practical implications of these results were discussed.

Determining a diagnostic cut-off on the Teate Depression Inventory

A small but growing body of literature suggests that the Teate Depression Inventory (TDI) may be an "objective" measure of depression compared with other commonly used scales. Furthermore, the TDI has strong psychometric properties in both clinical and nonclinical samples. The present study aimed to extend the use of TDI by identifying cut-off scores that could differentiate varying levels of depression severity in a group of clinically diagnosed depression disorder patients (N=125). Three receiver operating characteristic curve analyses indicated cut-off scores of 21 (sensitivity =0.86, specificity =0.94, and classification accuracy =0.90); 36 (sensitivity =0.84, specificity =0.96, and classification accuracy =0.92); and 50 (sensitivity =0.81, specificity =0.93, and classification accuracy =0.90), for minimal, mild, moderate, and severe depression, respectively. Results suggest that the TDI measures depression severity across a broad range with high test accuracy and may be appropriately used to screen for depression.