Structural Validation of the Hamilton Depression Rating Scale

Despite the prolific use of the Hamilton Depression Rating Scale (HDRS), there have been no prior studies using confirmatory factor analysis (CFA) to compare competing HDRS latent structures. The current study undertakes this task, examining CFAs on 397 older adults on the most stable latent models previously posited and a new rationally derived model by Cole and Motivala. CFAs were evaluated in their original first-order structure and in hierarchically related counterparts. All hierarchical models performed significantly better than their first-order counterparts. Moreover, the hierarchical Cole and Motivala model was significantly better on all comparative criteria than any of the other models. However, none of the tested models obtained sufficient fit with the data suggesting psychometric, scoring, or content limitations of the scale.     

Relationships between the Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression in depressed outpatients

The Beck Depression Inventory (BDI) and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were used with 300 outpatients diagnosed with DSM-III major depression disorders. A principal-components analysis was performed on the intercorrelations among the 21 BDI and 24 HRSD symptoms. Three orthogonal components were found and interpreted as reflecting differences in self-report and clinical rating methods for measuring the severity of depression. The importance of using both self-reports and clinical ratings for evaluating depression in psychiatric outpatients was discussed.     

Effectiveness of the Hamilton Anxiety Rating Scale with Older Generalized Anxiety Disorder Patients

To expand the collection of instruments available for assessment of anxiety in the elderly, this report examined the original and revised Hamilton anxiety scales in a sample of 50 older adults diagnosed with Generalized Anxiety Disorder (GAD) and 93 normal community participants (ages 55–82). Although the revised anxiety scale had better discriminant validity (lower correlation with the revised Hamilton depression scale) than the original anxiety and depression scales, a considerable amount of shared variance still existed (41% shared variance, GAD sample alone; 17% control sample alone; 74% shared variance, both samples combined). Near-perfect group classification was possible using 7 items from the original anxiety scale and 10 items from the revised anxiety scale. Results are discussed in light of their implications for use of the Hamilton anxiety rating scale with older anxiety-disordered patients.     

A comparison between a visual analogue scale and a four point scale as measures of conscious experience of motion

Can participants make use of the large number of response alternatives of visual analogue scales (VAS) when reporting their subjective experience of motion? In a new paradigm, participants adjusted a comparison according to random dot kinematograms with the direction of motion varying between 0° and 360°. After each discrimination response, they reported how clearly they experienced the global motion either using a VAS or a discrete scale with four scale steps. We observed that both scales were internally consistent and were used gradually. The visual analogue scale was more efficient in predicting discrimination error but this effect was mediated by longer report times and was no longer observed when the VAS was discretized into four bins. These observations are consistent with the interpretation that VAS and discrete scales are associated with a comparable degree of metacognitive sensitivity, although the VAS provides a greater amount of information.     

National Norms and Life-Event Frequencies for the Revised Social Readjustment Rating Scale

The revised 51-event Social Readjustment Rating Scale (SRRS) was administered to a representative national sample of 5,000 in order to construct and interpret norms for overall scale scores and life-event frequencies. Directions asked for the frequency of each life-event during the previous 12 months. Life-event frequencies for each subject were multiplied by previously determined stressfulness ratings to produce an overall scale score. Norms for overall scale scores and life-event frequencies were calculated. A total of 3,399 completed surveys were returned (68%). The distribution of overall scale scores had a mean of 278, standard deviation of 422, and marked positive skewness of 4.12. Five of the top 10 most frequently occurring life-events were directly related to work. The normative information concerning overall scores on the revised Social Readjustment Rating Scale can be invaluable in understanding and interpreting individual scores, as well as diagnosing or identifying at-risk individuals with high scores who would likely benefit from stress management interventions.     

Stressful Life Events: A Revision and Update of the Social Readjustment Rating Scale

The widely used and cited Social Readjustment Rating Scale developed by Holmes and Rahe (1967) was comprehensively revised and updated. The new instrument, containing 51 major life events, was administered to a national sample of 5000. Respondents were asked to rate the stressfulness of each life event on a 1–100 scale. Completed surveys were returned by 3122 individuals (62.4%). Responses were analyzed using repeated measures MANOVA and profile analysis. Major results included: (a) statistically and practically significant differences in mean ratings for the 51 life events; (b) five overlapping themes in the top 20 rated life events—death and dying, healthcare, crime and the criminal justice system, financial/economic issues, and family-related issues; and (c) an amazing level of agreement concerning perceived life event stressfulness, regardless of gender, age, or income level.     

Clinical cutoffs for the beck Depression inventory and the Geriatric Depression scale with older adult psychiatric outpatients

The present study developed new clinical cutoffs for the Beck Depression Inventory (BDI) and the Geriatric Depression Scale (GDS) with 59 older adult psychiatric outpatients. Maximum discrimination of a current major depressive episode resulted, with cutoff scores of 22 for the BDI and 16 for the GDS. Specifically, the following validity scores emerged for the BDI: sensitivity, 64%; specificity, 73%; positive predictive power, 75%; negative predictive power, 61%; and hit rate 68%. For the GDS the validity scores were as follows: sensitivity, 79%; specificity, 69%; positive predictive power, 77%; negative predictive power, 72%; and hit rate, 75%. Combined BDI and GDS scores did not result in improved prediction of a current major depressive episode as compared to the GDS alone. These results support the notion that the BDI and GDS are valid quick screening instruments in discriminating a current major depressive episode for older adult psychiatric outpatients.     

The structure of the Hospital Anxiety and Depression Scale: Theoretical and methodological considerations

The Hospital Anxiety and Depression Scale (HADS; Zigmond - Snaith, 1983) is widely used; however, its factor structure is unclear, with studies reporting differing unidimensional, two-factor and three-factor models. We aimed to address some key theoretical and methodological issues contributing to inconsistencies in HADS structures across samples. We reviewed existing HADS models and compared their fit using confirmatory factor analysis (CFA). We also investigated methodological effects by comparing factor structures derived from Rasch and Principal Components Analysis (PCA) methods, as well as effects of a negative wording factor. An Australian community-dwelling sample consisting of 189 females and 158 males aged 17–86 (M = 35.73, SD = 17.41) completed the 14-item HADS. The Rasch Analysis, PCA and CFA all supported the original two-factor structure. Although some three-factor models had good fit, they had unacceptable reliability. In the CFA, a hierarchical bifactor model with a general distress factor and uncorrelated depression and anxiety subscales produced the best fit, but the general factor was not unidimensional. The addition of a negative wording factor improved model fit. These findings highlight the effects of differing methodologies in producing inconsistent HADS factor structures across studies. Further replication of model fit across samples and refinement of the HADS items is warranted.     

Psychometric Properties and Factor Structure of the French Version of the Behavioral Activation for Depression Scale (BADS) in Non-Clinical Adults

Behavioral activation (BA) is a well-established empirical treatment for depression that aims to improve depressive mood by increasing activation and reducing avoidance. Therefore, it is essential to evaluate activation and avoidance when a BA treatment is applied. The Behavioral Activation for Depression Scale (BADS) was developed to measure the changes in activation and avoidance over the course of BA treatment of depression. This study aims to validate the French version of this scale. In a first study, 131 bilingual adults were recruited to explored internal consistency, test-retest reliability and construct validity of the final French version. In a second study, 409 non-clinical adults completed an online survey assessing concurrent measures. Results of the first study suggested good internal consistency, test-retest reliability and construct validity. The second study revealed a confirmatory factor analysis supporting the original four-factor structure, with Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment subscales. Results also revealed that a 5-factor model distinguishing Behavioral Avoidance and Rumination had a better fit than the original four-factor structure. All subscales showed adequate internal consistency and good construct validity with evidence of convergent validity with depressive symptoms, brooding, psychological flexibility, negative automatic thought, behavioral inhibition and activation system. Furthermore, the French BADS total scale and subscales showed a good ability to predict depressive symptoms. The French version of the BADS appears to be a reliable tool for clinician and researchers to assess mechanisms of change in BA interventions.     

Factor structure of the Brief Psychiatric Rating Scale for Children (BPRS-C) among Hospital Patients and Community Clients

The factor structure, reliability and concurrent validity of the Brief Psychiatric Rating Scale for Children (BPRS-C) was examined. The BPRS-C was designed to measure child psychopathology with seven scales consisting of three items each. Two large samples of intake assessments at admission to the public mental health system of state psychiatric hospitals (n = 6712) and community mental health centers (n = 21,459) for children aged 3–17 were examined. In both samples exploratory and confirmatory factor analysis found seven factors that generally supported the BPRS-C seven scale structure. Reliability as measured by internal consistency was acceptable with an average alpha of .72 (SD = .09). Mean scale scores across diagnoses and concurrent correlations with the Child Behavior Checklist (CBCL) were consistent with expectations.     

A self-esteem measure for patients with cancer

Abstract

In assessing the quality of life of patients with cancer. :in important. though largely ignored. variable is self-esteem. The development of an instrument to measure self-esteem, using visual analogue scales, is described. This instrument was administered to 170 patients with newly diagnosed early breast cancer. Hodgkin's disease and non-Hodgkin's lymphoma three months and one year alter diagnosis. The instrument was acceptable to patients; internal consistency and test-retest reliability data are reported. Self-esteem scores were inversely correlated with depression and trait anxiety scores, and positively correlated with internal locus of control. Self-esteem was not significantly affected by tumour grade or stage. or by the extent to which patients felt disabled by the symptoms and side effects of their disease and treatment. The implications of these findings are discussed.     

Validation of the Behavioral Activation for Depression Scale (BADS) in a Community Sample with Elevated Depressive Symptoms

The Behavioral Activation for Depression Scale (BADS) was previously developed to measure changes in avoidance and activation over the course of Behavioral Activation for depression. Initial scale development, definition of the factor structure and confirmation of the factor structure was performed with a non-depressed undergraduate sample. These prior results revealed four factors (Activation, Avoidance/Rumination, Work/School Impairment, and Social Impairment) with good factor structure, internal consistency, and test–retest reliability. The purpose of the current study was to evaluate the psychometric properties, factor structure and construct validity of the BADS with a community sample with elevated depressive symptoms (N = 193). Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Normative data are also provided separately for depressed men and women, and for Caucasians and African Americans.     

A Measure for the Reliability of a Rating Scale Based on Longitudinal Clinical Trial Data

A new measure for reliability of a rating scale is introduced, based on the classical definition of reliability, as the ratio of the true score variance and the total variance. Clinical trial data can be employed to estimate the reliability of the scale in use, whenever repeated measurements are taken. The reliability is estimated from the covariance parameters obtained from a linear mixed model. The method provides a single number to express the reliability of the scale, but allows for the study of the reliability’s time evolution. The method is illustrated using a case study in schizophrenia. The authors are grateful to J&J PRD for kind permission to use their data. We gratefully acknowledge support from the Belgian IUAP/PAI network “Statistical Techniques and Modeling for Complex Substantive Questions with Complex Data.”     

A comparison of masking by visual and transcranial magnetic stimulation: implications for the study of conscious and unconscious visual processing

Visual stimuli as well as transcranial magnetic stimulation (TMS) can be used: (1) to suppress the visibility of a target and (2) to recover the visibility of a target that has been suppressed by another mask. Both types of stimulation thus provide useful methods for studying the microgenesis of object perception. We first review evidence of similarities between the processes by which a TMS mask and a visual mask can either suppress the visibility of targets or recover such suppressed visibility. However, we then also point out a significant difference that has important implications for the study of the time course of unconscious and conscious visual information processing and for theoretical accounts of the processes involved. We present evidence and arguments showing: (a) that visual masking techniques, by revealing more detailed aspects of target masking and target recovery, support a theoretical approach to visual masking and visual perception that must take into account activities in two separate neural channels or processing streams and, as a corollary, (b) that at the current stage of methodological sophistication visual masks, by acting in more highly specifiable ways on these pathways, provide information about the microgenesis of form perception not available with TMS masks.