Cross-cultural confirmation of bi-factor models of a symptom distress measure: Symptom Checklist-90-Revised in clinical samples

A detailed hierarchical model of psychopathology in Chinese clinical sample: Based on the SCL-90-R measure

OBJECTIVE

The Hierarchical Taxonomy of Psychopathology (HiTOP)model is an impressive effort to overcome shortcomings of traditional diagnostic systems. However, almost all of the quantitative empirical evidence used to structure the model comes from Western cultures and is built upon traditional diagnostic categories. This study aims to provide a detailed Chinese version of the HiTOP structure, ranging from symptoms based on The Symptom Checklist 90-R (SCL-90-R) up to the general factor.

METHODS

We explored the detailed hierarchical structure of the SCL-90-R scale in adult (N = 34,222) and adolescent (N = 1973) clinical sample from Shanghai Mental Health Center, using extended bass-ackwards approach to draw the HiTOP model.

RESULTS

The Chinese HiTOP structure had a general factor at the top, 4 higher-order spectra (Internalizing, Externalizing, Broad Thought Disorder and Somatization and Somatic Anxiety) and 6 subfactors (Distress, Somatoform, Hostility, Fear, Psychosis and OCD) across both adult and adolescent samples. In addition, the adult sample contained 2 other subfactors: a) Sleep, and b) Suicide and Guilt. At the symptom level, some items were posited to components diverged from the original SCL-90-R subscales.

CONCLUSIONS

These findings offer the first description of the HiTOP structure in two Chinese samples and demonstrate that the SCL-90-R can be used to examine the HiTOP structure. The Somatization spectrum first emerged as a higher-order dimension, suggesting structural differences between Western and Eastern cultures. The results also suggest that transdiagnostic research should (1) further examine the positioning of somatoform symptoms using measures in other Eastern samples, and (2) place more emphasis on interpreting SCL-90-R results across different cultures.

Assessment and Evaluation of Alcohol Use Disorder in Liver Transplant

Alcohol-related liver disease is the most common indication for liver transplantation. It is essential for providers in transplantation to be informed of the state of the science in evaluation of alcohol use disorder (AUD). This review examines the broad range of approaches to the evaluation of AUD ranging from traditional interview approaches to recent literature on artificial intelligence models. The empirical support for methods of evaluation is examined. The authors discuss the use of each method in the context of patients seeking a liver transplant for alcohol-related liver disease. This review emphasizes the importance of using objective assessments so that transplant centers make evidence-based decisions and reduce cognitive bias. The review concludes with a proposed assessment battery for evaluation and bridges to future directions in the field of AUD assessment in liver transplantation.

The structure of the Symptom Checklist-90-Revised: Global distress, Somatization, Hostility, and Phobic Anxiety scales are reliable and robust across community and clinical samples from four European countries

While the reliability of SCL-90-R subscales is often questioned, five relatively recent European studies have examined the factor structure of SCL-90-R using a bifactor model and concluded that most of these subscales are reliable. However, examination of their results shows that three subscales, Somatization, Hostility, and Phobic Anxiety, consistently had significantly higher reliability than the other six across clinical and community samples recruited in three very different European countries, Greece, Hungary, and the Netherlands. The objective of this study was to examine whether this "top-3″ would be found in a sample from a fourth European country, France. To do this, we had 696 university students (387 women, 56 %) complete the SCL-90-R and we examined the reliability of the scales of this questionnaire by testing a bifactor model using Exploratory Structural Equation Modeling (ESEM). Our results confirmed that, in our sample, the three scales presented a higher reliability than the other six scales. It therefore seems that there exists, at least in the European cultural area, a stable structure of the SCL-90-R comprising a global distress factor and three reliable and robust specific factors: Somatization, Hostility, and Phobic Anxiety.

An AI-based Decision Support System for Predicting Mental Health Disorders

Approximately one billion individuals suffer from mental health disorders, such as depression, bipolar disorder, schizophrenia, and anxiety. Mental health professionals use various assessment tools to detect and diagnose these disorders. However, these tools are complex, contain an excessive number of questions, and require a significant amount of time to administer, leading to low participation and completion rates. Additionally, the results obtained from these tools must be analyzed and interpreted manually by mental health professionals, which may yield inaccurate diagnoses. To this extent, this research utilizes advanced analytics and artificial intelligence to develop a decision support system (DSS) that can efficiently detect and diagnose various mental disorders. As part of the DSS development process, the Network Pattern Recognition (NEPAR) algorithm is first utilized to build the assessment tool and identify the questions that participants need to answer. Then, various machine learning models are trained using participants' answers to these questions and other historical data as inputs to predict the existence and the type of their mental disorder. The results show that the proposed DSS can automatically diagnose mental disorders using only 28 questions without any human input, to an accuracy level of 89%. Furthermore, the proposed mental disorder diagnostic tool has significantly fewer questions than its counterparts; hence, it provides higher participation and completion rates. Therefore, mental health professionals can use this proposed DSS and its accompanying assessment tool for improved clinical decision-making and diagnostic accuracy.

Quantile regression analysis of the association between parental rearing and interpersonal sensitivity in Chinese adolescents

BACKGROUND

Parental rearing is well documented as an important influencing factor of interpersonal sensitivity (IS). However, little research has focused on the extent by which various aspects of parental rearing in fluence IS. This study aimed to analyze the effects of parental rearing on IS, using quantile regression. We analyzed the extent of the influence of parental rearing on IS by quantile regression to provide definitive evidence on the family education of adolescents with IS problems.

METHODS

The multiple cross-sectional studies were conducted among 3345 adolescents from Harbin, China, in 1999, 2006, 2009 and 2016. Furthermore, a multistage sampling method (stratified random cluster) was used to select participants. IS was assessed using a subscale of the Symptom Checklist-90-Revision. Perceived parental rearing was assessed using the Egna Minnen av. Barndoms Uppfostran. The ordinary least squares (OLS) linear regression was used to determine the average effect of parental rearing on IS. The quantile regression was conducted to examine the established associations and to further explain the association.

RESULTS

Paternal emotional warmth was found to be associated with IS across the quantile, especially after the 0.6 quantiles; however, this association was not found for maternal emotional warmth. Paternal punishment was associated with IS at the 0.22-0.27 and 0.60 quantile; however, maternal punishment had no significant effect on IS. QR method found that paternal overinvolvement was associated with IS at the 0.48-0.65 quantiles, but paternal overprotection was associated with IS across the quantile; however, maternal overinvolvement and overprotection was positively correlated with IS at the 0.07-0.95 quantiles. The correlation between paternal rejection and IS was found at the 0.40-0.75 and > 0.90 quantiles; maternal rejection was associated with IS within the 0.05-0.92 quantiles.

CONCLUSIONS

Parental rearing practices predict different magnitudes of IS at varying levels. This study provides suggestions for parents to assess purposefully and systematically, intervene, and ameliorate adolescent IS problems. We also highlight the role of paternal rearing in children's IS problems, providing new ideas for family education.

The Inventory of Personality Organization: A valid instrument to detect the severity of personality dysfunction

BACKGROUND AND AIMS

In the eleventh revision of the International Classification of Diseases (ICD-11), the severity of personality dysfunction became the central dimension of personality disorder's (PDs) definition, besides the trait domain qualifiers. Personality functioning, also known as personality organization (PO), is becoming an increasingly important concept in administering, predicting, and measuring severity and nature of personality disturbance. Otto Kernberg and his team developed several tools to measure personality impairment. The Inventory of Personality Organization (IPO) is a self-report rating scale for the measurement of PO. Aim of this study was to identify severity groups according to the level of PO and to explore their validity.

MATERIALS AND METHODS

A clinical sample of 118 patients was recruited from a 4-weeks in-patient cognitive psychotherapy program. Beside the IPO, Structured Clinical Interview for the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV.) Axis I and II, Symptom Check List-90 (SCL-90), State-Trait Anger Expression Inventory and Dissociative Experience scale (DES). Two types of analyses were conducted: a person-centered (latent profile) analysis and various variable-centered tests to confirm the factor structure of IPO and calculate group differences.

RESULTS

The three-factor (CFI = 0.990, TLI = 0.990, RMSEA = 0.022, SRMR = 0.089) and the five-factor (CFI = 0.995, TLI = 0.995, RMSEA = 0.014, SRMR = 0.090) models of the IPO was supported. Latent class analysis identified three subgroups of PO: "Well-integrated," "Moderately integrated," and "Disintegrated" classes. There were no significant differences between the three classes in the number of Axis 1 diagnoses (p = 0.354; η² = 0.01). Group differences in the number of PDs, the number of PD symptoms as well as in the presence of borderline and depressive PD were significant (all p < 0.001; V = 0.35-0.42; η² = 0.15-0.26). Persons with more severe PO problem level had higher rates of psychopathological symptoms, state and trait anger, and dissociative characteristics (all p < 0.001; η² = 0.13-0.36).

CONCLUSION

The IPO can be an appropriate instrument to measure the severity of personality disorganization and to classify participants along a continuum of severity in this regard. Our results present further evidence that the severity of personality dysfunction, the central dimension of the ICD-11 and the Alternative Model for PDs is detectable with an instrument, the IPO, that was initially developed to detect the disturbances in PO.

Symptom Checklist-90-Revised: A structural examination in relation to family functioning

The accurate assessment of psychopathological behaviours of adolescents and young adults is imperative. Symptom Checklist-90-Revised (SCL-90-R) is one of the most comprehensive and widely used scales addressing this purpose internationally. Interestingly, associations between the different SCL-90 symptoms and family functioning have been highlighted. Nevertheless, the scale’s factorial structure has often been challenged. To contribute in this area, this study scrutinizes the psychopathological dimensions of the Symptom Checklist-90-Revised (SCL-90-R) in a large cohort of high school students (Mean age = 16.16; SD = .911) from Greece. It addresses this aim by: a) using first order and bi-factor confirmatory factor analysis, and exploratory structural equation models and; b) investigating the factors’ associations with family functioning. A total of 2090 public Greek High School students completed the SCL-90-R and the Family Adaptability and Cohesion Scale IV (FACES-IV) covering family functioning, satisfaction and communication. Six different solutions, yielded by separate permutations of CFA, ESEM, and bifactor models, were evaluated. Based on global fit, the clarity, reliabilities and the family functioning links of the dimensions in the models, the ESEM oblique model with the theorized nine factors emerged as the optimum. This model had adequate fit, and symptom dimensions were well defined. Also six of the nine factors demonstrated external associations with family functioning, satisfaction and communication. The clinical assessment benefits of these results are discussed.

The use of the Symptom Checklist 90-R in exploring the factor structure of mental disorders and the neglected fact of comorbidity

The Symptom Checklist 90-R (SCL-90-R) is a popular instrument, accessing nine different symptom clusters of psychopathology, although its original factor structure is widely questioned. However, most validation studies seem to ignore the possible effect of comorbidity. We aimed at validating the factor structure of the SCL-90-R and to draw additional information about the role of comorbidity in the factor structure of mental disorders. We thus introduced a comorbidity index within the SCL-90-R and validated the Greek version of the SCL-90-R in a sample of 914 participants, consisting of 688 individuals from the general population and 226 psychiatric outpatients. We showed that the original 9-factor model was superior to the second order factor and the bi-factor model. This may reflect lower comorbidity traits in our sample, rather than the accuracy of the original 9-factor structure of the SCL-90-R, which has to be further assessed by concurrent validity for each individual scale on selected samples. In this regard, we showed that the depression subscale was an excellent screening tool in a subgroup of patients with a confirmed major depressive episode.

Assessing Mental Health for China's Police: Psychometric Features of the Self-Rating Depression Scale and Symptom Checklist 90-Revised

Police mental health is important because police officers usually encounter stressors that cause high levels of stress. In order to better understand mental health for Chinese police, the Zung Self-Rating Depression Scale (SDS) and Symptom Checklist 90-Revised (SCL-90-R) are commonly used in mainland China. Unfortunately, both the SDS and SCL-90-R lack detailed information on their psychometric properties. More specifically, factor structures of the SDS and SCL-90-R have yet to be confirmed among the police population in mainland China. Therefore, the present study compared several factor structures of the SDS and SCL-90-R proposed by prior research and to determine an appropriate structure for the police population. Utilizing cluster sampling, 1151 traffic police officers (1047 males; mean age = 36.6 years [SD = 6.10]) from 49 traffic police units in Jiangxi Province (China) participated in this study. Confirmatory factor analysis (CFA) with Akaike information criterion (AIC) was used to decide the best fit structure. In the SDS, the three-factor model (first posited by Kitamura et al.) had the smallest AIC and outperformed other models. In the SCL-90-R, the eight-factor model had the smallest AIC and outperformed the one-factor and nine-factor models. CFA fit indices also showed that both the three-factor model in the SDS and the eight-factor model in the SCL-90-R had satisfactory fit. The present study’s results support the use of both SDS and SCL-90-R for police officers in mainland China.

Different aspects of impulsivity in chronic alcohol use disorder with and without comorbid problem gambling

BACKGROUND AND AIMS

Alcohol use disorder (AUD) and problem gambling are highly comorbid disorders. This study aims to explore the role of four aspects of impulsivity (trait concept of impulsivity, choice impulsivity, impulsive aggression and response inhibition/decision-making) in long-term chronic AUD patients with and without problem or pathological gambling symptoms.

METHODS

Cognitively intact chronic AUD patients were enrolled with (n = 32) and without (n = 71) problem gambling symptoms in an inpatient clinic for chronic alcohol users. Multiple facets of impulsivity, cognitive ability, psychopathological symptoms, alcohol and gambling severity were measured.

RESULTS

Chronic AUD patients with gambling disorder symptoms showed longer lifetime alcohol consumption, more severe alcohol use and higher psychopathological symptom severity than AUD patients without gambling symptoms. Gambling severity correlated with overall trait impulsivity, but not with choice impulsivity, impulsive aggression or cognitive impulsivity with controlling for lifetime alcohol consumption, lifetime alcohol use and psychopathological symptom severity. High trait impulsivity and non-planning was associated with comorbid gambling symptoms in AUD patients, which was independent of the level of intelligence, age and psychopathological symptoms.

CONCLUSION

Comorbid gambling disorder symptoms in chronic AUD was connected to more severe alcohol-related variables. Higher trait impulsivity was also linked with gambling disorder symptoms in patients with chronic AUD. This accents the need of special focus on comorbid GD symptoms in AUD, since prognosis and treatment for them may vary.

Factor structure models of the SCL-90-R: Replicability across community samples of adolescents

Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological distress in both the clinical and the research settings, although its factor structure is still debated. In this study, the factor structure of the SCL-90-R has been investigated in two independent samples of Italian adolescents. Two samples of 817 (urban sample) and 507 (rural sample) adolescents attending high schools were involved. Confirmatory factorial analysis (CFA) was used alongside hierarchical nested, progressively constrained models to assess configural, metric and scalar invariance of the best models fitted by CFA. The standard nine-factor structure of the SCL-90-R resulted reproducible and invariant between the two samples, in both its correlated and hierarchical second-order implementations. Estimated reliability of the nine scales of the SCL-90-R was optimal. This study also confirmed the reproducibility of the bifactor models of the SCL-90-R with nine orthogonally independent factors and with nine correlated primary factors, which have been tested in some recent studies. Overall, the SCL-90-R measures both common and unique features of psychological distress in community samples. The measurement invariance across different levels of psychological distress in the factor structure of the SCL-90-R is an issue deserving further testing and investigation.

Institutional Violence Against Users of the Family Law Courts and the Legal Harassment Scale

The term harassment is often used to refer two contexts, the workplace and school, but not the legal system itself. Long drawn-out litigation in the Family Law Courts often produces a surreptitious phenomenon of violence toward one of the litigating parties, who become victims of the legal system itself. The aim of this study was to determine whether legal harassment could be detected and measured in the Spanish Justice System using an innovative Legal Harassment Scale (LHS). This hypothesis was substantiated by the data obtained using a new 32-item psychometric instrument with a global index: the LHS, consisting of four factors: Direct Aggression, Procedural Harassment, Personal Contempt, and Manipulation of Reality. The estimated reliability and validity of the LHS was satisfactory, both in terms of the global score, and for each of the four factors distributed along the normal curve. The results of this study are discussed in terms of the limitations of the study and in relation to future lines of research aimed at ensuring that the legal system respects and safeguards the rights of the parties involved in litigation, and that no party falls victim to legal harassment.

Factorial validity and invariance of the Patient Health Questionnaire (PHQ)-9 among clinical and non-clinical populations

The Patient Health Questionnaire-9 (PHQ-9) is commonly used to screen for depressive disorder and for monitoring depressive symptoms. However, there are mixed findings regarding its factor structure (i.e., whether it has a unidimensional, two-dimensional, or bi-factor structure). Furthermore, its measurement invariance between non-clinical and clinical populations and that between patients with major depressive disorder (MDD) and MDD with comorbid anxiety disorder (AD) is unknown. Japanese adults with MDD (n = 406), MDD with AD (n = 636), and no psychiatric disorders (non-clinical population; n = 1,163) answered this questionnaire on the Internet. Confirmatory factor analyses showed that the bi-factor model had a better fit than the unidimensional and two-dimensional factor models did. The results of a multi-group confirmatory factor analysis indicated scalar invariance between the non-clinical and only MDD groups, and that between the only MDD and MDD with AD groups. In conclusion, the bi-factor model with two specific factors was supported among the non-clinical, only MDD, and MDD with AD groups. The scalar measurement invariance model was supported between the groups, which indicated the total or sub-scale scores were comparable between groups.

Substance Use and Psychological Disorders Among Art and Non-art University Students: an Empirical Self-Report Survey

Media stories often suggest that those working in the creative arts appear to use and abuse psychoactive substances. The aim of the present study was to analyze the relationship between the use of psychoactive substances and the presence of psychological disorders among art and non-art students. Questionnaires related to these two areas were completed by 182 art students in higher education and a control group of 704 non-art university students. To assess psychoactive substance use, a structured questionnaire including the Cannabis Abuse Screening Test (CAST) and the Alcohol Use Disorders Identification Test (AUDIT) was administered to participants. Psychological disorders were assessed using the Hungarian version of the Brief Symptom Inventory (BSI) and the Global Severity Index (GSI). After analyzing the data, significant differences were found between the two groups regarding their first use of psychoactive substances. Art students' current substance use was found to be significantly more frequent compared to the control group. In relation to psychological disorders, art students scored significantly higher on three scales of the BSI (i.e., psychoticism, hostility, and phobic anxiety). Overall, a significantly higher proportion of artists were labeled as "problematic" using the GSI. The results suggest that artists have a higher risk of both substance use and experiencing psychological disorders.

To see in a mirror dimly. The looking glass self is self-shaming in borderline personality disorder

Symptoms of borderline personality disorder (BPD) can be conceptualized as the expression of and defenses against or response to the painful emotion of chronic shame, which may relate to early maladaptive schemas (EMS). The goal of this research is to examine levels of early maladaptive schemas, self-reported shame, and anxious or angry reactions to social put-downs as well as their associations. We also looked to assess the association of shame with BPD symptoms. Fifty-six patients with BPD completed self-report measures of EMSs, chronic shame, and reactions to put-downs. Comparison groups consisted of 24 patients without personality disorder (non-PD) and 80 healthy controls (HC). Those with BPD reported higher levels of EMSs, characterological, behavioral and bodily shame, and were more prone to react with anxiety and anger than non-PD patients and HC subjects. EMSs domains had specific associations with chronic shame and reaction types to social put-downs. Identity disturbances were associated with characterological, behavioral and bodily shame. Stormy relationships were associated with bodily shame. Chronic shame and anxious and angry reactions to social put-downs are prominent in patients with borderline personality disorder and are associated with specific EMS domains and with the symptoms of identity disturbance and stormy relationships.

Relationship between borderline personality symptoms and Internet addiction: The mediating effects of mental health problems

Aim To examine the relationship between borderline personality symptoms and Internet addiction as well as the mediating role of mental health problems between them. Methods A total of 500 college students from Taiwan were recruited and assessed for symptoms of Internet addiction using the Chen Internet Addiction Scale, borderline personality symptoms using the Taiwanese version of the Borderline Symptom List and mental health problems using four subscales from the Symptom Checklist-90-Revised Scale (interpersonal sensitivity, depression, anxiety, and hostility). Structural equation modeling (SEM) was used to test our hypothesis that borderline personality symptoms are associated with the severity of Internet addiction directly and also through the mediation of mental health problems. Results SEM analysis revealed that all paths in the hypothesized model were significant, indicating that borderline personality symptoms were directly related to the severity of Internet addiction as well as indirectly related to the severity of Internet addiction by increasing the severity of mental health problems. Conclusion Borderline personality symptoms and mental health problems should be taken into consideration when designing intervention programs for Internet addiction.

SCL-90-R emotional distress ratings in substance use and impulse control disorders: One-factor, oblique first-order, higher-order, and bi-factor models compared

To fully understand the dimensionality of an instrument in a certain population, rival bi-factor models should be routinely examined and tested against oblique first-order and higher-order structures. The present study is among the very few studies that have carried out such a comparison in relation to the Symptom Checklist-90-R. In doing so, it utilized a sample comprising 2593 patients with substance use and impulse control disorders. The study also included a test of a one-dimensional model of general psychological distress. Oblique first-order factors were based on the original a priori 9-dimensional model advanced by Derogatis (1977); and on an 8-dimensional model proposed by Arrindell and Ettema (2003)-Agoraphobia, Anxiety, Depression, Somatization, Cognitive-performance deficits, Interpersonal sensitivity and mistrust, Acting-out hostility, and Sleep difficulties. Taking individual symptoms as input, three higher-order models were tested with at the second-order levels either (1) General psychological distress; (2) 'Panic with agoraphobia', 'Depression' and 'Extra-punitive behavior'; or (3) 'Irritable-hostile depression' and 'Panic with agoraphobia'. In line with previous studies, no support was found for the one-factor model. Bi-factor models were found to fit the dataset best relative to the oblique first-order and higher-order models. However, oblique first-order and higher-order factor models also fit the data fairly well in absolute terms. Higher-order solution (2) provided support for R.F. Krueger's empirical model of psychopathology which distinguishes between fear, distress, and externalizing factors (Krueger, 1999). The higher-order model (3), which combines externalizing and distress factors (Irritable-hostile depression), fit the data numerically equally well. Overall, findings were interpreted as supporting the hypothesis that the prevalent forms of symptomatology addressed have both important common and unique features. Proposals were made to improve the Depression subscale as its scores represent more of a very common construct as is measured with the severity (total) scale than of a specific measure that purports to measure what it should assess-symptoms of depression.