A Mokken scale analysis of the Kessler-6 screening measure among Chinese older population: findings from a national survey

Impact of self-stigma of loneliness on psychological distress in older adults: mediation effect of relative deprivation and moderation effect of positive solitude

BACKGROUND

Self-stigma of loneliness is a major predictor of psychological distress among older adults, but its mechanism has not been further discussed. Drawing on classical relative deprivation theory and conceptualizing stigma model, this study aimed to examine the relationship between self-stigma of loneliness and psychological distress among older people and analyzed the mediation effect of relative deprivation and the moderation effect of positive solitude.

METHODS

The study applied a cross-sectional study design to conduct questionnaire survey by administrating the Stigma of Loneliness Scale (SLS), 6-item Kessler Psychological Distress Scale (K6), Relative Deprivation Questionnaire, and Positive Solitude Scale (PS) among 1179 Chinese older adults. The Pearson correlation analysis explored the correlation between variables and Model 4 in PROCESS examined the mediating effect of relative deprivation. The moderating effect of positive solitude in the mediation model was tested through Model 59.

RESULTS

The correlation analysis shows a significant and positive correlation between the stigma of loneliness, relative deprivation, and psychological distress (r = 0.530 ~ 0.714); while positive solitude is significantly and negatively correlated with the stigma of loneliness, relative deprivation, and psychological distress (r = -0.128 ~ -0.179). Additionally, relative deprivation plays a mediating role in the relationship between self-stigma of loneliness and psychological distress. Meanwhile, it is invalid of the moderating effect of positive solitude in the direct path, first half of and second half of the path in the mediation model.

CONCLUSIONS

Self-stigma of loneliness could both directly affect psychological distress in older people and indirectly through the role of relative deprivation. Furthermore, positive solitude does not significantly buffer the impact of self-stigma of loneliness on relative deprivation and psychological distress. As research findings suggested, it is conducive to reducing psychological distress in older adults by adopting appropriate interventions to diminish self-stigma of loneliness and relative deprivation.

ICF-Based simple scale for children with cerebral palsy: Application of Mokken scale analysis and Rasch modeling

Children with cerebral palsy (CP) are faced with long-term dysfunction. The International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) has been proposed but the complicated procedure limits the feasibility of clinical application and the exploration of health degrees. This study was aimed to establish a Mokken scale based on the ICF-CY for CP, and then to estimate psychometric properties through the derived Rasch model. 150 children with CP were assessed by the categories of "b" and "d" components in the core set. The binarized data was screened by the Mokken scale analysis and utilized for generating a reliable Rasch model. The validity of the final model was checked by the correlation between person ability, Gross Motor Function Classification System (GMFCS) and total scores. Using the Mokken scale to guide Rasch modeling, we can parameterize the properties of ICF-CY and realize the simple assessment of person abilities for children with CP.

Factor structure and longitudinal measurement invariance of the K6 among a national representative elder sample of China

Background

As the number of older people is rapidly growing, prevention, screening, and treatment of mental health problems (including anxiety and depression) in this population increasingly become a heavy burden to individuals, families, and even the whole society. The Kessler-6 screening measure (K6) is an efficient and effective instrument for general mental health problems. However, few studies have examined its measurement invariance across time, which is particularly important in longitudinal studies, such as exploring developmental trajectories of non-specific psychological distress and evaluating the effects of certain interventions.

Methods

The current study investigated the factor structure and the longitudinal measurement invariance of the K6 among a national representative elder sample of China. Longitudinal data in two survey waves (the year 2010, and the year 2014) from the China Family Panel Studies were drawn for secondary data analysis. A total of 3845 participants aged 60 years old and above (52.2% male, mean age = 66.99 years, SD = 5.93 years) responded to both waves of the survey.

Results

A comparison of four existing models with confirmatory factor analysis supported a two-factor solution of the K6. A series of multi-group confirmatory factor analyses further indicated that the K6 held strict longitudinal measurement invariance across time. Additionally, the internal consistency indices across time and the stability coefficients over time were acceptable.

Conclusions

The findings further confirmed the psychometric defensibility of the K6 when used in the old Chinese population. The longitudinal measurement invariance justified comparisons of psychological distress scores among different measurement time points.

Development of a career questionnaire for medical undergraduates using Mokken scale analysis

BACKGROUND

Individual-centred career questionnaires are important for understanding the motivations of medical students. This study aimed to collect validity evidence of a questionnaire to measure the career choice of medical undergraduates.

METHODS

A cross-sectional survey was sent to third-year undergraduate students at a Chinese university-affiliated hospital. The questionnaire was formed using items that were selected after a systematic literature review. Item reduction was conducted using Mokken scale analysis, followed by reliability and validity testing, which described the validity evidence of the content, response process and internal structure.

RESULTS

The preliminary 20-item questionnaire was returned by 213 undergraduate students (response rate: 86.59%). To construct a monotone homogeneity model, 6 items were removed after testing for unidimensionality, local independence, and latent monotonicity according to the sequence. The final questionnaire included 14 items in two subscales: a 10-item 'career advantage' subscale and a 4-item 'career disadvantage' subscale. The questionnaire was judged to be acceptably reliable (Molenaar-Sijtsma method: 0.87 and 0.75, Cronbach's alpha: 0.87 and 0.74) and to have good construct validity (χ2/df: 1.748, normed fit index: > 0.9, comparative fit index: > 0.9, root mean square error of approximation: 0.05-0.08). Male and female undergraduates had different responses regarding their salary, subspecialty, career prospects, and ability to serve their relatives. Male undergraduates might be more willing to accept on-call positions and have subspecialties with greater likelihoods of patient-physician conflict.

CONCLUSION

We used Mokken scale analysis to develop and collect evidence of the validity of a 14-item questionnaire regarding career preferences among Chinese medical undergraduate students. This short and simple questionnaire may provide a suitable tool for exploring insights regarding the motivations of Chinese medical students.

Simplified Post-stroke Functioning Assessment Based on ICF via Dichotomous Mokken Scale Analysis and Rasch Modeling

Purpose

This study aims to accomplish two tasks for International Classification of Functioning, Disability and Health (ICF) application among persons with stroke: (1) to make an ICF tool for measuring personal abilities with simplified assessment operations; (2) to quantitatively evaluate ICF categories for being functioning rather than being disabled.

Methods

A total of 130 inpatients with stroke via convenience sampling were evaluated by the extended comprehensive ICF core set for stroke, modified Rankin scale, and modified Barthel index (MBI). This study investigated the responses to 118 stroke-related ICF items (59 items in b and d domains individually) using Mokken scale analysis followed with Rasch modeling.

Results

A Mokken scale with 47 items was extracted from the binary data (1 as no-impairment or mild-impairment and 0 as moderate to complete impairment). A Rasch model with 45 items was derived from the Mokken scale. The conversion chart was available involving the original ordinal scores to Rasch-transformed scores from 0 to 100 (interval scale). Total scores exhibited a high correlation with the personal abilities estimated by the Rasch model. The personal ability also demonstrated a significantly strong correlation with the score of the MBI. Thus, the 45 ICF items were suggested to rate potential functional ability as a single measurement.

Conclusion

Based on simple “functioning or disabled” judgment tasks, ICF assessment can be simplified to a questionnaire with answering “yes-or-no” questions for each category. Functioning level for each person and difficulty of being functioning for each category can be estimated by the Rasch model of this questionnaire.