A hierarchy of distress and invariant item ordering in the General Health Questionnaire-12

Psychometric Properties of Parent Outcome Measures Used in RCTs of Antenatal and Early Years Parent Programs: A Systematic Review

Parenting programs are effective in the early intervention and treatment of children’s social, emotional and behavioural difficulties. However, inconsistency in the use of outcome measures limits the comparability of programs and creates challenges for practitioners seeking to monitor progress of families in their care. A systematic review was conducted to identify measures, appraise their psychometric properties and ease of implementation, with the overall objective of recommending a small battery of measures for use by researchers and practitioners. This article provides an overview of the most commonly used measures in experimental evaluations of parenting programs delivered to parents of children up to, and including, the age of 5 years (including antenatal programs). An in-depth appraisal of the psychometric properties and ease of implementation of parent outcome measures is also presented (findings in relation to child and dyadic outcome measures are presented elsewhere). Following a systematic search, 64 measures were identified as being used in three or more of 279 included evaluation studies. Data on the psychometric properties of 18 parent outcome measures were synthesised from 87 development and validation studies. Whilst it was not possible to identify a definitive battery of recommended measures, we are able to recommend specific measures that could be prioritised in further research and development and hold promise for those seeking to monitor the outcomes of parents and children in receipt of parenting programs.

Evaluating hierarchical items of the geriatric depression scale through factor analysis and item response theory

Background

Geriatric depression scale (GDS) is a common screening tool for measuring depression among older adults. It employs a multi-factor structure and some differential item functioning (DIF) allowing different versions of GDS across cultures. The present study aimed to identify the short version of the hierarchical scale of GDS in which all items comprised the invariant item ordering, and items without DIF.

Methods

Participants and Measurement: A total of 803 participants, 70% female, with a mean age of 69.24 years (SD = 6.88) were enrolled from three geriatric units of tertiary care hospitals. All completed the 15-item GDS. Three methods of confirmatory factor analysis (CFA) with multiple indicators, multiple cause model, Mokken analysis and Rasch analysis were applied.

Results

Item 9 (prefer to stay at home) showed poor discriminatory power among all three methods. After removing DIF items due to sex and age, nine items remained suitable for the shortened version by CFA. When Mokken and Rasch analysis were applied, only six items remained for the hierarchical scale. Compared with other related shortened version of GDS, the new GDS-6 proved to have a comparable ability to detect depression as did the original 15-item GDS.

Limitation

The new GDS-6 needs to be investigated for test-retest reliability to ensure temporal stability of the scale. This cross-sectional analysis needs replication.

Conclusion

The GDS-6 derived from IRT had measurement properties and met criteria related to unidimensionality and ability to separate levels of depression. It was shown to be equal to or better in predicting performance compared with the original 15-item GDS.

Factor Structures of General Health Questionnaire-12 Within the Number of Kins Among the Rural Residents in China

The 12-item general health questionnaire (GHQ-12) has been extensively used with Chinese population. Yet, it has not been used from a national representative survey in rural China. The aim of this study was to examine how number of kins associated with the factor structures of the CHQ-12 among the rural residents in China. Data were obtained from the 2009 rural-to-urban migrants survey (RUMiC). Exploratory factor analysis (EFA) (principal component analysis with varimax rotation) was performed to identify factor structures of GHQ-12 regarding number of siblings, age ranking, and number of children. To investigate the reliability of the questionnaire, Cronbach’s alpha was used. Internal consistency was assessed by confirmatory factor analysis (CFA). In all, 32171 rural residents in China from 2009 RUMiC participated in the study. The mean age of the respondents was 37.03 (SD = 19.21) years. The psychometric properties and factor structures of the GHQ-12 used were described. All of the fit indices in CFA models were satisfactory. The two-factor and three-factor structures gathered the satisfactory fit indexes in the part of 2009 subsamples. The rural version of the GHQ-12 was reliable measures of psychological distress among the rural residents in China with respect to number of kins. The two-and three-factor structures derived from the present sample, with good model fit in the CFA analysis, which suggested that two-and three-factor solution could be used to assess mental health of rural residents in rural China.

Dimensionality of the Chinese hospital anxiety depression scale in psychiatric outpatients: Mokken scale and factor analyses

OBJECTIVE

The hospital anxiety and depression scale (HADS) is a widely used scale of anxiety and depression. However, recent studies have challenged the bi-dimensional scoring of the HADS. The present study was to examine the dimensionality of the Chinese HADS.

METHODS

We recruited a convenience sample of 214 adult psychiatric outpatients at a medical centre in Taiwan, and they completed the Chinese HADS. We used Mokken scale analysis (MSA), exploratory factor analysis (EFA), exploratory bifactor analysis (EBA) and confirmatory factor analysis (CFA) to examine the dimensionality of the Chinese HADS.

RESULTS

The Chinese HADS was a moderate Mokken scale (H_s = 0.44), and had a two-factor structure. EBA showed that one general factor, emotional distress, explained 68% of the common variance of the Chinese HADS. CFA confirmed that the bifactor model had the best fit statistics. The items 5 and 7 of the Chinese HADS contributed to structural ambiguity in the Chinese HADS subscales.

CONCLUSIONS

The sum scores of the Chinese HADS were a reliable and valid unidimensional measure of emotional distress. The Chinese HADS subscales were incapable of differentiating between anxiety and depression. Clinicians and researchers should choose other scales that are specifically designed for measuring anxiety and depression.

Construct validity of the Depression and Somatic Symptoms Scale: evaluation by Mokken scale analysis

OBJECTIVE

Previous studies of the Depression and Somatic Symptoms Scale (DSSS), a free scale, have been based on the classical test theory, and the construct validity and dimensionality of the DSSS are as yet uncertain. The aim of this study was to use Mokken scale analysis (MSA) to assess the dimensionality of the DSSS.

METHODS

A sample of 214 psychiatric outpatients with mood and anxiety disorders were enrolled at a medical center in Taiwan (age: mean [SD] =38.3 [10.5] years; 63.1% female) and asked to complete the DSSS. MSA was used to assess the dimensionality of the DSSS.

RESULTS

All 22 items of the DSSS formed a moderate unidimensional scale (H_s =0.403), supporting its construct validity. The DSSS was divided into 4 subscales (H_s ranged from 0.35 to 0.67), including a general somatic scale (GSS), melancholic scale (MS), muscular pain scale (MPS), and chest symptom scale (CSS). The GSS is a weak reliable Mokken scale; the other 3 scales are strong reliable Mokken scales.

CONCLUSION

The DSSS is a psychometrically sound measure of depression and somatic symptoms in adult psychiatric outpatients with depression or anxiety. The summed score of the DSSS and its 4 subscales are valid statistics. Further research is required for replication of the 4 subscales of the DSSS.

The Chinese Version of the Gotland Male Depression Scale (GMDS): Mokken scaling

OBJECTIVE

Invariant item ordering (IIO) is defined as the extent to which items have the same order for each respondent who completes a scale. IIO is crucial for establishing a scale hierarchy that is replicable across samples; however, no research has demonstrated IIO in the Gotland Male Depression Scale (GMDS). The aim of this study was to determine if an IIO hierarchy of depressive symptoms existed in a clinical sample of men who completed the GMDS.

METHODS

A convenience sample of 231 men (age: mean (SD) = 46.1 (11.0) yrs) who visited a men's health polyclinic in Taiwan and completed the GMDS. Mokken scale analysis was conducted to evaluate the psychometric properties of the GMDS.

RESULTS

All items on the GMDS formed a strong uni-dimensional scale (H=0.592). Except for item #9 (alcohol/drug abuse, or hyperactivity), IIO was found for the remaining 12 items (H(T)=0.366). These symptoms reflected the following hierarchy: positive family history (#13), complaining (#12), anxiety (#8), loss of vitality (#10), depressed mood (#11), indecisiveness (#6), aggression (#2), irritability (#5), stress (#1), burn-out (#3), fatigue (#4), and sleep problems (#7).

CONCLUSION

The GMDS is a psychometrically sound measure of depressive symptoms in Taiwanese male outpatients. The GMDS has both cumulative and hierarchical properties.

Factor structure of the Iranian version of 12-item general health questionnaire

BACKGROUND

The 12-Item General Health (GHQ-12) questionnaire is one of the most commonly used instruments in screening studies on mental health.

OBJECTIVES

The current study aimed to examine the factor structure of the GHQ-12 questionnaire among the students in Iran.

MATERIALS AND METHODS

It was a cross-sectional study in which 428 university students were recruited and completed the GHQ-12. Reliability of the GHQ-12 was evaluated using the Cronbach's alpha and the split-half method by applying the Spearman-Brown coefficient. Factor structure of the questionnaire was extracted by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was conducted to assess how well the EFA extracted model fitted the observed data.

RESULTS

The mean age of the participants was 22.83 years (SD = 3.09). Most of them were female (56.1%) and 81% were unemployed. The Cronbach's alpha coefficient for the Iranian version of GHQ-12 was 0.85. Using the split-half method, the alpha for the social dysfunction was found to be 0.77; it was 0.76 for the psychological distress. The principal component analysis revealed a two-factor structure for the questionnaire including social dysfunction and psychological distress that explained 48% of the observed variances. The confirmatory factor analysis was showed fit for the data.

CONCLUSIONS

The current study findings confirm that the Iranian version of GHQ-12 has a good factor structure and is a reliable and valid instrument to measure psychological distress and social dysfunction.

Differential predictive value of depressive versus anxiety symptoms in the prediction of 8-year mortality after acute coronary syndrome

OBJECTIVE

Both depression and anxiety have been associated with poor prognosis in patients with acute coronary syndrome (ACS). However, certain symptoms and how they are measured may be more important than others. We investigated three different scales to determine their predictive validity.

METHODS

Patients with ACS (N = 598) completed either the Hospital Anxiety and Depression Scales (HADS-A, HADS-D; n = 316) or the Beck Depression Inventory-Fast Screen (n = 282). Their all-cause mortality status was assessed at 8 years.

RESULTS

During follow-up, 20% (121/598) of participants died. Cox proportional hazards modeling showed that the HADS-D was predictive of mortality (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.04-1.19), and this association remained significant after adjustment for major clinical/demographic factors, whereas the HADS-A (HR = 0.96, 95% CI = 0.85-1.09) and the Beck Depression Inventory-Fast Screen (HR = 0.99, 95% CI = 0.91-1.08) were not. The following depression items from the HADS-D predicted mortality: "I still enjoy the things I used to enjoy" (HR = 1.38, 95% CI = 1.05-1.82), "I can laugh and see the funny side of things" (HR = 1.48, 95% CI = 1.11-1.96), "I feel as if I am slowed down" (HR = 1.66, 95% CI = 1.24-2.22), and "I look forward with enjoyment to things" (HR = 1.36, 95% CI = 1.08-1.72).

CONCLUSIONS

Depressive symptoms related to lack of enjoyment or pleasure and physical or cognitive slowing, as measured by the HADS-D, predicted all-cause mortality at 8 years ACS patients, whereas other depressive and anxiety symptoms did not. Whether symptoms of distress predict prognosis in ACS seems to be dependent on the measures and items used.