A very short visual analog form of the Center for Epidemiologic Studies Depression Scale (CES-D) for the idiographic measurement of depression

Do State and Trait Affect Measures Retain Their Measurement Properties during a Disaster? An Investigation of Measurement Invariance during the COVID-19 Pandemic

Psychologists have begun to study the impact of the COVID-19 pandemic on emotionality, though such investigations assume that the measurement properties of affect scales have not changed as a function of the pandemic. To our knowledge, no prior study has tested measurement invariance (MI) of an affect scale during a disaster, and very few studies have explored MI of scales administered through ecological momentary assessment (EMA). The current study tested invariance of trait and state affect measures across homogenous groups of 18-year-olds assessed prior to and during the first acute phase of the COVID-19 pandemic in Long Island, New York. Trait affect was measured with a single administration of the Schedule for Nonadaptive and Adaptive Personality-Youth Version. State affect was assessed with items developed for the EMA portion of this study, which were administered 5 times daily for 14 consecutive days using a smartphone application. A baseline correlated 2-factor (positive and negative affect) model was fit for both measures. Invariances tests established up to strict MI across pre-/COVID-19 groups for both affect measures. These findings suggest that valid comparisons of observed score means and variances can be made between groups assessed before and during the COVID-19 pandemic.

Development of a Short Form Depression Screening Questionnaire for Korean Soldiers

BACKGROUND

The frequencies of South Korean soldiers' depression and resulting suicide are increasing every year. Thus, this study aimed to develop and confirm the reliability and validity of a simple short form depression screening scale for soldiers.

METHODS

This study was conducted as part of a 2013 research project named 'The Epidemiological Study on the Prevalence of Depression in Military Service and a Search for High Risk Group Management.' Clinical depression was diagnosed using the Korean version of the Mini International Neuropsychiatric Interview and suicide risk was assessed through the Korean version of the Composite International Diagnostic Interview. Furthermore, the Center for Epidemiological Studies for Depression Scale (CES-D), the Stress Response Inventory, and the Barret Impulsiveness Scale were employed. Of the 20 CES-D items, three of the most correlated items with clinical diagnosis were derived to form the short form scale. Analyses for internal consistency, concurrent validity, and factor analysis were implemented for its validation. We performed a receiver operating curve (ROC) analysis using a clinical diagnosis of depression as a gold standard to calculate the area under the curve (AUC) value, cut-off score, and corresponding sensitivity and specificity to that cut-off score.

RESULTS

According to the results of the correlation analysis, 7, 18, and 4 were selected to be on our scale. The three-item scale was reliable with a Cronbach's alpha value of 0.720, and a factor was derived from the factor analysis. The ROC analysis showed a high discriminant validity, with an AUC value of 0.891. The sensitivity and specificity were 84.8% and 78.2%, and 71.7% and 91.6%, respectively, for each when the selected cut-off scores were 2 and 3, respectively. Depression screened through the scale when the cut-off score was 2 or 3 was significantly associated with suicidality, stress, and social support.

CONCLUSION

The depression screening questionnaire for Korean soldiers developed through this study demonstrated high reliability and validity. Since it comprises only three items, it can be utilized easily and frequently. It is expected to be employed in a large-scale suicide prevention project targeting military soldiers in the future; it will be beneficial in selecting high-risk groups for depression.

The development of the visual screening tool for anxiety disorders and depression: Addressing barriers to screening for depression and anxiety disorders in hypertension and/or diabetes

Background

There is a lack of screening tools for common mental disorders that can be applied across cultures, languages and levels of education in people with diabetes and hypertension.

Aim

To develop a visual screening tool for depression and anxiety disorders that is applicable across cultures and levels of education.

Setting

Participants were purposively recruited from two not-for-profit organisations and two public health facilities – a maternal mental health unit and a primary health care centre.

Method

This was a qualitative cross-sectional study. Thirteen drawings based on the Hospital Anxiety and Depression Scale depicting symptoms of anxiety disorders and depression were drawn. Participants described emotions and thoughts depicted in the drawings. Data were analysed through content analysis.

Results

Thirty-one women (66%) and 16 men (34%) participated in the development of the visual screening tool. The mean age was 34 (standard deviation [SD] 12.46). There were 32 (68%) black participants, 11 (23%) mixed race participants and 4 (9%) white participants. Two participants (4%) had no schooling, 14 (31%) primary schooling, 8 (18%) senior schooling, 13 (29%) matric qualification and 8 (18%) had post-matric qualification. Participants correctly described 10 out of the 13 visual depiction of symptoms as associated with depression and anxiety disorders, with no differences between levels of education and cultural groups.

Conclusion

Ten drawings were appropriate for inclusion in the visual screening tool for anxiety disorders and depression (VISTAD). The VISTAD will be validated against the mini international neuropsychiatric interview (MINI) in a primary care population with hypertension and/or diabetes.

Prenatal maternal mood patterns predict child temperament and adolescent mental health

BACKGROUND

This study quantifies the dynamics of maternal mood focusing on unpredictability, and to assess if greater unpredictability of prenatal maternal mood predicts child temperament and internalizing symptoms through early adolescence.

METHODS

The association between prenatal mood predictability and child internalizing symptoms were assessed in two longitudinal cohorts (N's = 227 and 180). Maternal mood was assessed repeatedly during pregnancy as early as 15 weeks' gestation. Predictability of maternal mood was calculated by applying Shannon's entropy to the distribution of responses on mood questionnaires. Maternal reports of child negative affectivity (a predictor of later internalizing) were collected at 6, 12, 24 months and 7 years of age. Child self-reports of anxiety symptoms were collected at 10 years and reports of depression symptoms at 13 years.

RESULTS

Fetal exposure to more elevated maternal mood entropy predicted higher levels of child negative affectivity at 12 months (r = .36; p < 01), 24 months (r = .31; p < 01) and 7 years (r = .32; p < 01) of age. In addition, children exposed to higher prenatal maternal mood entropy, reported higher levels of anxiety symptoms at 10 years (r = .24; p < 01) and elevated depressive symptoms at 13 years (r = .29; p < .01). These associations persisted after adjusting for maternal pre and postnatal mood valence (e.g. depression levels) and for other relevant demographic characteristics.

CONCLUSIONS

Our findings provide strong support for the notion that patterns of maternal mood influence the developing brain. More specifically, they suggest that prenatal maternal mood predictability may be a critical predictor of developmental mental health trajectories and should be considered when assessing early life influences on lifespan mental health.

The Center for Epidemiologic Studies Depression Scale is an adequate screening instrument for depression and anxiety disorder in adults with congential heart disease

BACKGROUND

The Center for Epidemiological Studies Depression Scale (CES-D) is an instrument that is commonly used to screen for depression in patients with chronic disease, but the characteristics of the CES-D in adults with congenital heart disease (CHD) have not yet been studied. The aim of this study was to investigate the criterion validities and the predictive powers of the CES-D for depression and anxiety disorders in adults with CHD.

METHODS

Two hundred patients were screened with the CES-D and secondarily interviewed with a diagnostic instrument, i.e., the Mini International Neuropsychiatric Instrument. The sensitivity and specificity values of the CES-D were calculated by cross-tabulation at different cutoff scores. Receiver operating characteristic (ROC) curves were used to assess the optimal cutoff point for each disorder and to assess the predictive power of the instrument.

RESULTS

The CES-D exhibited satisfactory criterion validities for depression and for all combinations of depression and/or anxiety. With a desired sensitivity of at least 80%, the optimal cutoff scores were 18. The predictive power of the CES-D in the patients was best for major depression and dysthymia (area under the ROC curve: 0.92) followed by the score for any combination of depression and/or anxiety (0.88).

CONCLUSION

The use of CES-D to simultaneously screen for both depression and anxiety disorders may be useful in adults with CHD.

TRIAL REGISTRATION

CESDEP 212. Registered 2 March 2014 (retrospectively registered).

Insomnia and Multimorbidity in the Community Elderly in China

STUDY OBJECTIVES

To examine the comorbidity between insomnia and medical conditions.

METHODS

This cross-sectional study was conducted in community adults, aged ≥ 60 years, who resided in one of four major cities in northern China. Sociodemographic and clinical data were collected simultaneously. A total of 3,176 elderly adults (1,292 male, mean ± standard deviation age 70.2 ± 6.8 years; 1,884 female, 68.8 ± 6.7 years) were interviewed.

RESULTS

The prevalence of specific medical conditions in both people with insomnia and people without insomnia was detected. Significantly higher proportions of arrhythmia, hypertension, cerebral hemorrhage, migraine, and hyperlipidemia were observed in people with insomnia than in people without insomnia. Moreover, a significantly higher proportion of insomnia was seen in elderly people with arrhythmia and migraine. We also found that elderly people with insomnia who took sleep medications reported a higher prevalence of coexisting arrhythmia, hypertension, and migraine, even after adjusting for age, sex, and depression.

CONCLUSIONS

Our results indicate associations between insomnia and medical conditions in the community elderly in China. People who complained of insomnia had poorer physical health conditions. Sleep medication may not be a covariate that influences the comorbidity of some specific physical conditions.

CLINICAL TRIAL REGISTRATION

Trial name: The study of diagnosis and treatment of senile dementia in Hebei Province; URL: http://www.chictr.org.cn/showproj.aspx?proj=8194; Registration number: ChiCTR-RRC-11001345.

Repeated self-evaluations may involve familiarization: An exploratory study related to Ecological Momentary Assessment designs in patients with major depressive disorder

A growing body of research in clinical psychology is now relying on Ecological Momentary Assessment (EMA). EMA is fitted to investigate fluctuating processes and as such, it is of particular interest in a clinical context in which patients are often characterized by fluctuating behaviors and affective states or symptoms. EMA typically involves frequent self-evaluations over long periods, which may influence patient response. The present study aimed to determine whether EMA follow-ups could influence the participants' self-evaluations over time. The sample comprised 24 outpatients suffering from a Major Depressive Disorder (15 women, age = 51.4 ± 9.6). This study relied on an EMA protocol involving self-evaluations of seven depressive symptoms twice a day over 5 months. Patients did not show any clinical improvement following the clinical screening and the level of depressive symptoms during the follow-up. As a novel finding, significant moderate to large effects were observed for decreased variability and instability of psychological states over time. The main difference in temporal properties of psychological states was found after the first two weeks of the follow-up. This study characterized early changes in patients' self-evaluations, suggesting the idea of a valuable familiarization period during the first two weeks of an EMA follow-up.

Diurnal Variations in Psychological Distress in Chronic Obstructive Pulmonary Disease

PURPOSE

The aim of this study was to investigate the association between depressive symptoms severity and amplitude of diurnal variations in depression symptoms in patients with chronic obstructive pulmonary disease (COPD).

DESIGN

Prospective, observational proof-of-concept study.

METHODS

Fourteen participants with moderate/severe COPD completed a 20-item Center for Epidemiologic Studies Depression Scale (CES-D) estimating depressive symptoms severity. Throughout one week, the four-item very short version of the CES-D was completed every day in the morning, afternoon, and evening.

FINDINGS

Strong positive correlations were observed between depressive severity and the mean range of diurnal variations in positive (r = .61) and depressed affects (r = .67), somatic complaints (r = .82), and disturbed interpersonal relationships (r = .71).

CONCLUSION

In COPD patients, a greater diurnal variation in depression symptoms was associated with greater depression severity. This relationship seems independent of COPD severity.

CLINICAL RELEVANCE

Diurnal variation in the symptoms of depression is a new method of identifying depression severity in COPD.

Development and validity of a very short form of the Eating Disorder Inventory

INTRODUCTION

The main objective of the present series of studies was to develop and validate a 16-item very short form of the Eating Disorder Inventory (EDI-VS) for use as a short assessment tool in large-scale comprehensive or longitudinal studies, as well as in-depth idiographic studies.

METHOD

The EDI-VS was developed, and validated, through a series of five studies based on independent community samples including a total of 1372 French adolescents.

RESULTS

The results supported the reliability, content validity, factor validity, convergent validity, and criterion-related validity of the EDI-VS.

CONCLUSIONS

The EDI-VS comprises 16 items assessing the eight original dimensions of the conceptual model for the EDI. Recommendations for future practice and research on the EDI-VS are outlined.

Pilot randomised controlled trial of Help4Mood, an embodied virtual agent-based system to support treatment of depression

INTRODUCTION

Help4Mood is an interactive system with an embodied virtual agent (avatar) to assist in self-monitoring of patients receiving treatment for depression. Help4Mood supports self-report and biometric monitoring and includes elements of cognitive behavioural therapy. We aimed to evaluate system use and acceptability, to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future randomised controlled trial (RCT).

METHODS

We conducted a pilot RCT of Help4Mood in three centres, in Romania, Spain and Scotland, UK. Patients with diagnosed depression (major depressive disorder) and current mild/moderate depressive symptoms were randomised to use the system for four weeks in addition to treatment as usual (TAU) or to TAU alone.

RESULTS

Twenty-seven individuals were randomised and follow-up data were obtained from 21 participants (12/13 Help4Mood, 9/14 TAU). Half of participants randomised to Help4Mood used it regularly (more than 10 times); none used it every day. Acceptability varied between users. Some valued the emotional responsiveness of the system, while others found it too repetitive. Intention to treat analysis showed a small difference in change of Beck Depression Inventory II (BDI-2) scores (Help4Mood -5.7 points, TAU -4.2). Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of -8 points.

CONCLUSION

Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended. Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels.

Trait self-control, identified-introjected religiosity and health-related-feelings in healthy muslims: a structural equation model analysis

Aim

The present study attempted to test McCullough and Willoughby’s hypothesis that self-control mediates the relationships between religiosity and psychosocial outcomes. Specifically, this study examined whether trait self-control (TSC) mediates the relationship of identified-introjected religiosity with positive and negative health-related-feelings (HRF) in healthy Muslims.

Methods

Two hundred eleven French-speaking participants (116 females, 95 males; M_age = 28.15, SD_age = 6.90) answered questionnaires. One hundred ninety participants were retained for the analyses because they reported to be healthy (105 females, 85 males; M_age = 27.72, SD_age = 6.80). To examine the relationships between religiosity, TSC and HRF, two competing mediation models were tested using structural equation model analysis: While a starting model used TSC as mediator of the religiosity-HRF relationship, an alternative model used religiosity as mediator of the TSC-HRF relationship.

Results

The findings revealed that TSC mediated the relationship between identified religiosity and positive HRF, and that identified religiosity mediated the relationship between TSC and positive and negative HRF, thereby validating both models. Moreover, the comparison of both models showed that the starting model explained 13.211% of the variance (goodness of fit = 1.000), whereas the alternative model explained 6.877% of the variance (goodness of fit = 0.987).

Conclusion

These results show that the starting model is the most effective model to account for the relationships between religiosity, TSC, and HRF. Therefore, this study provides initial insights into how religiosity influences psychological health through TSC. Important practical implications for the religious education are suggested.

The Center for Epidemiologic Studies Depression Scale: factor validity and reliability in a French sample of adolescents with Intellectual Disability

The purpose of this study was to test the factor validity and reliability of the Center for Epidemiologic Studies Depression Scale (CES-D) within a sample of adolescents with mild to moderate Intellectual Disability (ID). A total sample of 189 adolescents (121 boys and 68 girls), aged between 12 and 18 years old, with mild to moderate ID were involved in two studies. In study 1, the content, phrasing and answering format of the CES-D were adapted for adolescents with ID. This instrument was renamed CES-D for ID (CES-D-ID) and two different versions based on two alternative answer scales (Likert and Likert-graphical) were developed and their psychometric properties were verified in study 2. The results provided support for the factor validity, reliability and invariance across gender and age of a 14-item version of the CES-D-ID based on a Likert-graphical answer scale.