Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

Background/ObjectiveThe aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients.MethodThe sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions.ResultsExcept for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender.ConclusionsThe HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression.     

Factorial structure of the perceived stress scale and implications for scoring

IntroductionThe 10-item Perceived Stress Scale (PSS-10) is a brief, widely-used measure of perceived stressful experiences that evaluates the degree to which people perceive their lives as unpredictable, uncontrollable or overloaded.ObjectiveThe present study examined the factor structure of the Greek version of the PSS-10.MethodUsing a representative sample of 320 adults from Cyprus, alternative confirmatory factor analytic models were compared to specifically assess bidimensional versus unidimensional specifications for the scale.ResultsA bifactor model with a general factor which loads on all items and a specific one which loads on positively-worded items that capture the notion of self-efficacy to deal with stressful situations, was found to fit well to the data, while providing evidence of a robust latent factor of general distress. Reliability and construct validity evidence with multiple criterion variables were also examined.ConclusionsAlthough a simple unidimensional specification has not been empirically supported in previous research, bifactor modeling exemplifies the extent of multidimensionality and implies that a single score may be reliably used for practical purposes.     

Measurement Invariance of the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) across Gender,Age and Treatment Context

The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) was designed to measure quality of life in clinical samples of Latino adolescents aged 12–18 years, but has also been used in community samples. The original measure included three factors: Emotional Regulation (ER), Self-Concept (SC) and Social Context (SoC). The goals of this study are to replicate the factor structure using confirmatory factor analysis (CFA), shorten the instrument and test the degree of measurement invariance across gender, age, and type of sample. Participants for the analyses (N?=?354) came from two populations in the San Juan Metropolitan Area: (1) adolescents from randomly selected households, using a multi-stage probability sampling design (n?=?295), and (2) adolescents receiving treatment at mental health clinics (n?=?59). We first carried out a conceptual item analysis for item reduction purposes and then assessed dimensional, configural, metric and scalar invariance for each factor using the Mplus software system. The original 3-factor structure was replicated with comparable model fit in each treatment context. Metric invariance was attained for all three scales across groups. Either full or partial scalar invariance was also observed with DIF in a total of 6 items. Invariance testing supports the use of the abridged 21 item version of the AQOL-MHS to compare diverse individuals with little bias using observed scores, but for refined estimates the ideal scoring will be from a latent variable model.     

The Communities That Care (CTC) Family Attachment Scale: Measurement Invariance Across Family Structures

Familial protective factors are an integral part of prevention approaches aimed at problematic behaviour in adolescents. However, there is scarce evidence on the role of familial protective factors in families deviating from the two-parent family configuration. For evaluating targeted (preventive) interventions, a reliable and valid measurement of familial protective factors is crucial. We investigated the factor structure of the Communities That Care (CTC) Family Attachment Scale and tested its measurement invariance in different family structures. Adolescents (n?=?2.459, grades 6–11) from Lower Saxony, Germany filled in the German version of the CTC Youth Survey. Our analyses focused on the CTC Family Attachment Scale measuring the adolescent’s attachment to the mother and the father with six items. We evaluated the postulated unidimensional structure of the scale by confirmatory factor analysis (CFA) and tested the measurement invariance using multigroup factor analyses across different family structures (two-parent family/single-parent family). We used SPSS V.23 and the R packages lavaan and semTools. The two-factor solution for the CTC Family Attachment Scale with one factor representing attachment to the mother and one indicating attachment to the father had an adequate model fit in the total sample (χ²(5)?=?29.938; p?<?.001; CFI?=?.996; TLI?=?.988; RMSEA?=?.050, SRMR?=?.019). This two-factor solution of the CTC Family Attachment Scale showed strong measurement invariance regarding adolescents living in a two-parent family vs. those living with a single parent. The two-factor CTC Family Attachment Scale appears to be a suitable measure to assess family attachment in both two-parent and single-parent families with German adolescents.     

Factor structure and measurement invariance of the Brief Symptom Inventory (BSI-18) in cancer patients

Background/Objective: The purpose of this study was to assess psychometric properties of the Brief Symptom Inventory (BSI-18), evaluate the measurement invariance with respect to sex, age, and tumor location, and to analyze associations between social support and sociodemographic and clinical variables among individuals with resected, non-advanced cancer. Method: A confirmatory factor analysis was conducted to explore the dimensionality of the scale and test invariance across sex, age, and tumor localization in a prospective, multicenter cohort of 877 patients who completed the BSI-18 and Multidimensional Scale of Perceived Social Support (MSPSS). Results: The results show that 3-factor and 1-factor measurement models provided a good fit to the data; however, a three-factor, second-order model was deemed more appropriate and parsimonious in this population. Alpha coefficients ranged between .75 and .88. Test of measurement invariance showed strong invariance results for sex, age, and tumor location; strong invariance over time was likewise assumed. Less perceived social support appears to correlate with all BSI factors. Conclusions: The study confirmed the tridimensional structure of the BSI-18 and invariance across age, sex, and tumor localization. We recommend using this instrument to measure anxiety, depression, and somatization in epidemiological research and clinical practice.     

The Experience in Personal Social Systems Questionnaire (EXIS.pers): Development and Psychometric Properties

This study presents the theoretical background, development, and psychometric properties of the German and English versions of the Experience in Personal Social Systems Questionnaire (EXIS.pers). It assesses how the members of a personal social system experience their situation within that system. It is designed as a research tool for interventions in which only one member of the system participates (e.g., Family Constellation Seminars). The EXIS.pers was created to measure change on the individual level relating to one's own important personal social system. In Study 1, we used exploratory factor analysis (EFA) for latent variable identification of the original German EXIS.pers (n = 179). In Studies 2 and 3, we used confirmatory factor analysis (CFA) to examine the dimensionality of the German (n = 634) and English (n = 310) EXIS.pers. Internal consistencies and cross‐cultural structural equivalence were assessed. EFA indicated that a four‐factor model provided best fit for the German EXIS.pers. For both the German and English EXIS.pers, CFA provided the best fit for a five‐factor bi‐level model that included a general factor (Experience In Personal Social Systems) and four dimensions (Belonging, Autonomy, Accord, Confidence). Good internal consistencies, external associations, and cross‐cultural structural equivalence were demonstrated. This study provides first evidence for the German and English EXIS.pers as an economical and reliable measure of an individual's experience within his or her personal social systems.     

Psychometric properties and measurement invariance of Depression,Anxiety and Stress Scales (DASS-21) across cultures

Cross-culturally measurement invariant instruments are useful for the assessment of mental symptoms across cultures. The current study aimed to investigate the psychometric properties and measurement invariance of the Depression, Anxiety and Stress Scales (DASS-21) (DASS) across Pakistan and Germany. German participants were recruited through an online survey (N = 1323), while Pakistani participants were recruited through online survey or paper-and-pencil survey (N = 1841). The DASS-21 showed good reliability, construct and structure validity in both countries. The DASS-21 indicated partial weak (stress subscale) and partial strong measurement invariance (depression and anxiety subscales) between both countries. Latent mean comparison of depression and anxiety symptoms between Pakistani and German students indicated that Pakistani university students experience more symptoms of depression and anxiety. Results suggest that the DASS-21 could be used in Pakistan and Germany, but caution should be taken when making direct comparisons between the two countries.     

Clinical Validation of the Swedish Version of the Quality of Life Inventory in Crime Victims with Posttraumatic Stress Disorder and a Nonclinical Sample

The Swedish version of the Quality of Life Inventory (QOLI) was cross-culturally validated with a crime victim sample (N = 53) with posttraumatic stress disorder (PTSD) and a nonclinical group (N = 100) with no lifetime and current psychiatric disorder from the general population in the Stockholm county of Sweden. The QOLI showed excellent internal consistencies in the clinical and the nonclinical sample. In addition, PTSD participants displayed a significantly lower self-perceived quality of life in 13 out of 16 domains of life than the nonclinical individuals. Furthermore, the QOLI was inversely correlated with interview and self-report measures of PTSD symptoms, depression, and anxiety. Overall, the results support the utility of the Swedish QOLI version as a potentially useful measure of self-perceived quality of life in Swedish clinical and nonclinical samples. The results are discussed in relation to the Swedish cross-cultural validation of the QOLI, methodological limitations and future directions.     

Depression Anxiety Stress Scales-21: Factor Structure and Test-Retest Invariance,and Temporal Stability and Uniqueness of Latent Factors in Older Adults

This study examined the factor structure and test-retest invariance, and temporal stability and uniqueness of the latent factors (depression, anxiety, and stress) of the Depression Anxiety Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995) in group a of 269 older adults (age ranging from 60 to 85 years) from the general community. Participants completed the DASS-21 twice, 3 months apart. Confirmatory factor analysis (CFA) of their ratings at Time 1 indicated support for the original 3-factor oblique model (factors for depression, anxiety, and stress). Additional analyses showed support for test-retest invariance for both the measurement (configural, metric and thresholds) and structural (variances and covariances) components of this model. Results also indicated temporal stability and uniqueness of the latent factors. The practical, theoretical, research and clinical implications of the findings are discussed.     

The Factor Structure and Measurement Invariance of the Daily Spiritual Experiences Scale

The current study has two main goals: (a) to identify a factor structure of the Daily Spiritual Experiences Scale (DSES) on a large archival data, collected from 1,325 adults in the United States (709 women, 616 men) by the U.S. General Social Survey in 2004 and (b) to examine the measurement invariance of the 16 DSES items between women and men in the same data to see whether any of the items are favoring or biased toward either women or men. The one-factor confirmatory factor analysis (CFA) model fit our data better than the two-factor CFA models because of high correlations between the two factors (r > .90). The fit of the one-factor CFA to our sample data was improved when we specified seven correlated residuals suggested by overlapping item content and large modification indices. The ensuing measurement invariance testing of the one-factor CFA model with seven correlated residuals supported full measurement invariance of factor loadings, thresholds, and residual variances, as well as factor variances between the women and the men. Yet the factor mean for the women was .841 units (Cohen’s d = .496) higher than it was for the men, indicating that higher levels of daily spiritual experiences for women reported in gender comparison studies in the United States are not likely to be an artifact of bias in the questionnaire.     

The Perceived Stress Scale: Evaluating Configural, Metric and Scalar Invariance across Mental Health Status and Gender

The Perceived Stress Scale (PSS; Cohen, Kamarck, & Mermelstein, Journal of Health and Social Behavior, 24: 385–396, 1983) and its derivatives are among the most commonly used self-report measures of subjective global stress. Several factorial models of the PSS have been proposed; however, which of these structures reliably measures individuals with mental illness remains unclear. Moreover, despite the detection of gender differences in perceived stress, factorial invariance between genders has not yet been tested with the PSS. Confirmatory factor analysis evaluating six prevailing factorial models of the PSS among a large sample of psychiatric patients and a matched community sample supported a two-factor model. Multiple group analysis established configural, metric and scalar invariance of this model across gender, but only configural invariance across samples differing by mental health status. Implications are that gender differences can be cautiously interpreted as true mean differences rather than artifacts of measurement bias; however, mean perceived stress factor scores should not be compared directly across psychiatric and non-psychiatric samples.     

Stress assessment during adolescence: Psychometric properties and measurement invariance of the Student Stress Inventory-Stress Manifestations across gender and age

The main purpose of this study was to analyze the psychometric properties and measurement invariance across gender and age of the Student Stress Inventory-Stress Manifestations (SSI-SM) scores in a large sample of adolescents. The sample was comprised by a total of 1108 students (482 were male), with a mean age of 14.61 years (SD = 1.71). The results indicated that the SSI-SM scores presented adequate psychometric properties from both classical test theory and Item Response Theory (IRT). Confirmatory factorial analysis (CFA), showed that both the bifactor model and a three-factor model (emotional, physiological, and behavioural) were adequate. Multi-group CFA showed that the three-factor model had strong measurement invariance across gender and age. Statistically significant differences in gender were found between latent means as well as raw scores of SSI-SM. Ordinal alpha was .78 for Physiological, .90 for the Emotional, and .79 for the Behavioural subscales. Using IRT, the SSI-SM provides more accuracy information at the medium level of the latent trait. SSI-SM subscales were associated with emotional and behavioural problems. These results provided new sources of validity evidence of the SSI-SM scores in adolescents from general population. The SSI-SM appears to be a useful, brief, and easy to administrate self-report instrument for the screening of stress manifestations at school and educational settings.     

Psychometric Properties and Factorial Structure of the State Trait Anxiety Inventory-Trait Version (STAI-T) in Caribbean University Students

The study investigated the psychometric properties of the State Trait Anxiety Inventory—Trait Scale (STAI-T: Spielberger, 1983) in a Caribbean university student sample. Participants were 415 undergraduate students (75% female) who completed the State-Trait Anxiety Inventory-Trait Version (STAI-T; Spielberger, 1983), Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996), the Zung Self-Rating Depression Scale (SDS; Zung, 1965), the Ego Resiliecy-89 (ER-89; Block, 1989), and the Perceived Stress Scale-Ten Item Version (PSS-10; Cohen et al., 1983). Confirmatory factor analysis (CFA) was conducted to examine the construct validity of the trait anxiety scale in terms of factor structure, convergent, discriminant, and nomological validities. CFA results revealed that a two-factor solution (trait anxiety absent and trait anxiety present) provided significantly better fit than the one-factor model of trait anxiety. There was clear evidence of convergent validity, discriminant validity, and nomological validity of the scale. Results support the psychometric adequacy of the STAI-T for use with Caribbean university students.     

Invariance of a two-factor model of Social Dominance Orientation across gender

This research examined the measurement and structural invariance of the 16-item Social Dominance Orientation (SDO) scale across gender. The Social Dominance Theory (SDT) invariance hypothesis proposes that men are higher than women in SDO. Tests of this hypothesis have compared summary scores with t-tests, but there is no psychometric work of measurement invariance across gender, which makes interpretation of t-test comparisons problematic. Some research suggests the scale captures two distinct factors: support for group-based dominance (GBD) and general opposition to equality (OEQ). However, gender differences in GBD and OEQ have mixed findings. Results replicated the two-factor structure. Multiple-group CFA indicated that loadings, intercepts, factor variances, and factor covariance are equivalent across gender. Males demonstrated higher latent means of GBD and OEQ, supporting the SDT invariance hypothesis.     

Determinants of Perceived Stress in Adolescence: The Role of Personality Traits,Emotional Abilities,Trait Emotional Intelligence,Self-Efficacy,and Self-Esteem

The aim of the current study was to examine the explanatory power of personality traits, emotional abilities, trait emotional intelligence, self-efficacy, and self-esteem in predicting perceived stress in adolescents. The data were collected from 406 high school students, aged 18-22 years (M_age = 18.47, SD = 0.64). Perceived stress was assessed with the 10-item Perceived Stress Scale (PSS-10). Personality traits were measured with the Eysenck Personality Short Scale (EPQ-R-S), emotional abilities were assessed with two performance tests, the Emotional Intelligence Scale – Faces (SIE-T), and the Emotion Understanding Test (TRE), and trait emotional intelligence was measured with a selfreport questionnaire (the Schutte Emotional Intelligence Scale, SEIS). The Generalized Self-Efficacy Scale (GSES) and the Rosenberg Self-Esteem Scale (RSES) were also used. Results indicate that the strongest determinant of perceived stress in adolescents was high neuroticism. Perceived stress was also determined by low self-efficacy and self-esteem, as well as high extraversion and psychoticism. Women reported higher perceived stress than men. There also were differences in the determinants of perceived stress between graduate and nongraduate students. The obtained results suggest that the development of high self-esteem and high self-efficacy may contribute to perceptions of lower stress in adolescents and may be especially valuable for neurotic individuals and for women, who are more exposed to stress.     

Salutogenic constructs across Pakistan and Germany: A cross sectional study

Background/ObjectiveProtective factors are relevant for mental health in general, however, universality of the instruments has been rarely tested. Therefore, the current study aimed to examine psychometric properties and cross-cultural measurement invariance of salutogenic constructs.MethodData was collected from university students of Pakistan (n = 1,841) and Germany (n = 7,890). Single-group confirmatory analysis (CFA) and multiple-group CFA was tested to examine the proposed factor structure and measurement invariance of Positive Mental Health Scale, Resilience Scale, Perceived Social Support Questionnaire, and Life Satisfaction Scale across student samples from Pakistan and Germany respectively.ResultsWe found strong measurement invariance for the Positive Mental Health Scale, Life Satisfaction Scale, and partial strong measurement for the Resilience Scale, and Perceived Social Support Questionnaire.ConclusionsThe results indicate that these scales could be recommended for the meaningful comparison of latent means across cultures. Understanding these differences would further advance our knowledge about the mechanism underlying positive mental health.     

The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample

The present study sought to examine the factor structure and psychometric properties of the Perceived Stress Scale (PSS) when administered to psychiatric patients. We also examined predictive validity of the PSS by assessing the association between the Perceived Stress Scale and the Beck Depression Inventory. A heterogeneous sample of 96 psychiatric patients (48 men, 48 women) completed the Perceived Stress Scale (PSS) and the Beck Depression Inventory. Factor analysis of the PSS established that the scale consisted of two factors. The first factor was comprised primarily of items reflecting adaptational symptoms. In contrast, the second factor consisted of items reflecting coping ability. Both factors had an adequate degree of internal consistency. Finally, a series of regression analyses predicting depression found that both factors accounted for unique variance in depression scores in women, but only the first factor accounted for unique variance in men. It is concluded that the PSS is a multidimensional and internally consistent measure of perceived stress.This research was supported by Grant 410-91-1690 from the social sciences and Humanities Research Council of Canada as well as by grants from the Research and Program Evaluation Committee Brockville Psychiatric Hospital.     

Evidence for a Higher-Order ESEM Structure of ADHD in a Sample of Chinese Children

Exploratory structural equation modeling (ESEM) solutions have been proposed to represent the factor structures of attention-deficit/hyperactivity disorder (ADHD) in recent literature, yet no studies have assessed those structures in Chinese children. The primary aim of this study was to comprehensively examine the factor structures of the Chinese version of the ADHD Rating Scale-IV (ADHD RS-IV): Home Version. Data on 458 Chinese children aged 3–8 years (boys: 246; 54%) were used to test and compare eleven factor models: confirmatory factor analysis (CFA) models (one-factor, two-factor and three-factor), second-order CFA model, bifactor CFA models (two and three specific factors), ESEM models (two-factor and three-factor), second-order ESEM model, and bifactor ESEM models (two and three specific factors). The results showed that, overall, ESEM models displayed better fit than CFA models. Specifically, the second-order ESEM model with three first-order factors best represented of the ADHD factor structure in our sample. In addition, measurement invariance testing results showed that scalar invariance was established across gender, age and informant groups. Implications for future research are discussed.

     

Measurement invariance of the Emotion Regulation Questionnaire (ERQ). A cross-national validity study

The goal of this research was to examine the measurement invariance of the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003) across two European nations. Participants were Italian and German undergraduate students. First, confirmatory factor analysis was used to test for the two-factor structure of the ERQ; subsequently, measurement invariance was analysed. The results showed acceptable fit indices for the German and Italian sample; however, results with regard to the Italian sample showed lower fit indices than results regarding the German one. Measurement invariance of the ERQ across Italy and Germany was confirmed. Despite the fact that we assumed measurement invariance of the ERQ, future research is needed to deal with the lower fit regarding the Italian version.     

Effectiveness of an MP3 Christian mindfulness intervention on mindfulness and perceived stress

ABSTRACT

Mindfulness is enfolded in therapies addressing mental health conditions and is informed by secular and Buddhist models. However, mindfulness interventions can be rooted in other theoretical and spiritual frameworks including Christianity, which parallels Buddhist-based mindfulness practices. This study evaluates a mindfulness–based intervention drawing from Christian spiritual practices and discusses its practical implications. The researcher explored whether a Moving Picture Experts Group-3 (MP3)-based Christian mindfulness intervention would improve mindfulness states and decrease stress, measured by the Mindful Attention and Awareness Scale (MAAS) and Perceived Stress Scale (PSS), respectively. An analysis of covariance (ANCOVA) resulted in significant differences between pre- and post-test scores in experimental versus control groups on the MAAS and PSS after a 6–8-week intervention of a student sample (n?=?80) from two private, religiously-affiliated universities. Higher MAAS scores reflected improved mindfulness states, F(1,80)?=?11.947, p?=?.01 with a partial η^2?=?.134. Lower PSS scores reflect lowered perceived stress, F(1,80)?=?3.849, p?=?.053 with a partial η^2?=?.047.