Factor structure of the brief symptom inventory--18 in adult survivors of childhood cancer: results from the childhood cancer survivor study

The factor structure of the Brief Symptom Inventory--18 (BSI-18; L. R. Derogatis, 2000) was investigated in a sample of adult survivors of childhood cancer enrolled in the Childhood Cancer Survivor Study (CCSS; N = 8,945). An exploratory factor analysis with a randomly chosen subsample supported a 3-factor structure closely corresponding to the 3 BSI-18 subscales: Depression, Anxiety, and Somatization. Confirmatory factor analysis with structural equation modeling validated this 3-dimensional structure in a separate subsample, though an alternative 4-factor model also fit the data. Analysis of the 3-factor model showed consistent fit in male and female participants. Compared with available community-based norms, survivors reported fewer symptoms of psychological distress. Together, results support the hypothesized 3-dimensional structure of the BSI-18 and indicate the measure may be useful in assessing psychological distress in this growing population of cancer survivors.     

Assessing Psychosocial Distress in Cystic Fibrosis: Validation of the ‘Distress in Cystic Fibrosis Scale’

Experiences of anxiety and depression are common in adults with Cystic Fibrosis (AwCF) (e.g. Quittner in Thorax 69:1090-1097, 2014) and may impact on a wide range of important health-related behaviours, such as adherence to medication and timely attendance for medical review when experiencing pulmonary exacerbation. Common screening measures used in CF such as the PHQ-9 and GAD-7 may reflect an absence of anxiety or depression when clinically significant emotional difficulties are apparent on further assessment. This study preliminarily validated the previously developed Distress in Cystic Fibrosis Scale (DCFS) (Patel in Journal of Cystic Fibrosis 15:S26, 2016); a 23-item questionnaire to assess psychosocial distress in AwCF. Inpatient and outpatient participants with CF (N?=?119) completed a battery of questionnaires, including the DCFS. PCA results supported a single component model. The DCFS showed high internal consistency and correlated significantly with measures of mood and quality of life. The DCFS shows promise as a screening tool to assess clinically significant psychosocial distress in an adult CF population.

     

Relations Between PTSD and Distress Dimensions in an Indian Child/Adolescent Sample Following the 2008 Mumbai Terrorist Attacks

Posttraumatic stress disorder’s (PTSD) four-factor dysphoria model has substantial empirical support (reviewed in Elhai & Palmieri, Journal of Anxiety Disorders, 25, 849–854, 2011; Yufik & Simms, Journal of Abnormal Psychology, 119, 764–776, 2010). However, debatable is whether the model’s dysphoria factor adequately captures all of PTSD’s emotional distress (e.g., Marshall et al., Journal of Abnormal Psychology, 119(1), 126–135, 2010), which is relevant to understanding the assessment and psychopathology of PTSD. Thus, the present study assessed the factor-level relationship between PTSD and emotional distress in 818 children/adolescents attending school in the vicinity of the 2008 Mumbai terrorist attacks. The effective sample had a mean age of 12.85 years (SD?=?1.33), with the majority being male (n?=?435, 53.8 %). PTSD and emotional distress were measured by the UCLA PTSD Reaction Index (PTSD-RI) and Brief Symptom Inventory-18 (BSI-18) respectively. Confirmatory factor analyses (CFA) assessed the PTSD and BSI-18 model fit; Wald tests assessed hypothesized PTSD-distress latent-level relations; and invariance testing examined PTSD-distress parameter differences using age, gender and direct exposure as moderators. There were no moderating effects for the PTSD-distress structural parameters. BSI-18’s depression and somatization factors related more to PTSD’s dysphoria than PTSD’s avoidance factor. The results emphasize assessing for specificity and distress variance of PTSD factors on a continuum, rather than assuming dysphoria factor’s complete accountability for PTSD’s inherent distress. Additionally, PTSD’s dysphoria factor related more to BSI-18’s depression than BSI-18’s anxiety/somatization factors; this may explain PTSD’s comorbidity mechanism with depressive disorders.     

Extending the Common Sense Model to Explore the Impact of the Fear of COVID-19 on Quality of Life in an International Inflammatory Bowel Disease Cohort

The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ² (9)?=?17.06, p?=?.05, χ²/N?=?1.90, RMSEA?=?0.05, SRMR?=?0.04, CFI?=?.99, TLI?=?.97, GFI?=?0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual’s perceptions will likely enhance QoL during the pandemic.

     

Identifying the Source of Misfit in Item Response Theory Models

When an item response theory model fails to fit adequately, the items for which the model provides a good fit and those for which it does not must be determined. To this end, we compare the performance of several fit statistics for item pairs with known asymptotic distributions under maximum likelihood estimation of the item parameters: (a) a mean and variance adjustment to bivariate Pearson's X², (b) a bivariate subtable analog to Reiser's (1996) overall goodness-of-fit test, (c) a z statistic for the bivariate residual cross product, and (d) Maydeu-Olivares and Joe's (2006) M₂ statistic applied to bivariate subtables. The unadjusted Pearson's X² with heuristically determined degrees of freedom is also included in the comparison. For binary and ordinal data, our simulation results suggest that the z statistic has the best Type I error and power behavior among all the statistics under investigation when the observed information matrix is used in its computation. However, if one has to use the cross-product information, the mean and variance adjusted X² is recommended. We illustrate the use of pairwise fit statistics in 2 real-data examples and discuss possible extensions of the current research in various directions.     

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.     

Validation of the Patient Health Questionnaire-2 with Iranian students

ABSTRACT

Depression is a serious public health problem in community settings and primary care. The Patient Health Questionnaire-2 (PHQ-2) is a brief screen for depression. The PHQ-2 has not had its validity examined in academic settings in Iran. A cross-sectional study was conducted to investigate the reliability, validity, and factorial structure of the PHQ-2 in a convenience sample of 157 Iranian volunteer college students selected from the Iran University of Medical Sciences. Participants completed the PHQ-2, and the Loneliness Scale (LS). The mean score of the PHQ-2 was 2.26 (SD?=?1.64). The Cronbach's α coefficient was .74, indicating high internal consistency. The PHQ-2 correlated .68 with the LS, demonstrating good construct validity. The results of the factor analysis of the PHQ-2 identified one factor labeled: General depression (79.87% of the variance). The PHQ-2 has a unidimensional structure, acceptable validity and reliability, and it can be used in the non-clinical settings in Iran.     

Screening for Depression in Cardiovascular Patients in Albania: Findings from the Country Check-Up Program

This is a retrospective study conducted in Vlora from January 2016 to April 2017 and the aim was to report the prevalence of depression in cardiovascular (CVD) patients. Depression assessment was done using the Patient Health Questionnaire (PHQ)-9 (PHQ-9). Data were derived from the patient records and the standard recommended cut-off point of PHQ-9 ≥ 10 was used. In total, data of 300 patients were analyzed. Depressive symptoms (PHQ-9 ≥ 10) were observed at 6% of the participants. Trouble falling asleep or staying asleep or sleeping too much, feeling tired or having little energy and having little interest or pleasure in doing things were the most common symptoms reported. In multivariate analysis, only family status showed statistical significance. Unmarried (mean rank?=?207.22) are more likely to have moderate or severe depression level (OR?3.529; C.I. 95% 1.017–12.238). Future research should focus on the needed actions after depression screening (i.e. referral, treatment etc.).

     

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.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

A practice-based exploration of therapeutic change in a charitable,community-based person-centred counselling service using routine outcome measures of anxiety and depression. I: Statistical and clinically significant change

Background

Establishing the value of differing treatments for depression and anxiety is crucial in a climate of delimited spending and increased demand. Drawing from a well-founded, diverse evidence base is salient to constructive evaluation and any subsequent recommendations being fit for purpose.

Design

This study employed a practice-based quantitative design to explore therapeutic gains in adult counselling clients attending person-centred therapy (n = 301), delivered in a charitable, community-based UK service.

Measures

Outcome measures PHQ-9 and GAD-7 were used from three time points: initial assessment (IA), first ongoing session and last or 6th ongoing appointment (whichever occurred first; T1, T2 and T3).

Analysis

Repeated measures ANOVA, CSI, RI and RCSI calculations were used to consider significant change in clients.

Findings

Reductions in PHQ-9 and GAD-7 outcome measures were observed over time (between T2 & T3 and T1 & T3) and were all statistically significant (p = <0.001). By T3: CSI was achieved by 48.1% of clients on PHQ-9 and 50.8% of clients on GAD-7, RI was achieved by 47.8% of clients on PHQ-9 and 60.5% of clients on GAD-7, and RCSI was achieved by 32.6% of clients on PHQ-9 and 41.2% of clients on GAD-7.

Conclusions

The treatment observed resulted in effective outcomes equivalent to other therapies reviewed in the literature for clients' symptoms of anxiety and depression as measured by GAD-7 and PHQ-9.     

Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.

Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).

Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.

Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.     

Response to an abnormal ovarian cancer-screening test result: Test of the social cognitive processing and cognitive social health information processing models

All cancer screening tests produce a proportion of abnormal results requiring follow up. Consequently, the cancer-screening setting is a natural laboratory for examining psychological and behavioural response to a threatening health-related event. This study tested hypotheses derived from the social cognitive processing and cognitive–social health information processing models in trying to understand response to an abnormal ovarian cancer (OC) screening test result. Women (n = 278) receiving an abnormal screening test result a mean of 7 weeks earlier were assessed prior to a repeat screening test intended to clarify their previous abnormal result. Measures of disposition (optimism, informational coping style), social environment (social support and constraint), emotional processing, distress, and benefit finding were obtained. Regression analyses indicated greater distress was associated with greater social constraint and emotional processing and a monitoring coping style in women with a family history of OC. Distress was unrelated to social support. Greater benefit finding was associated with both greater social constraint and support and greater distress. The primacy of social constraint in accounting for both benefit finding and distress was noteworthy and warrants further research on the role of social constraint in adaptation to stressful events.     

The PHQ-9 assesses depression similarly in men and women from the general population

Gender-based differential item functioning occurs when men and women respond differently to an item despite being similar on the trait assessed by that item. The Patient Health Questionnaire-9 (PHQ-9) is a prominent screening tool for depression. Researchers exploring whether the PHQ-9 exhibits gender-based differential item functioning have used only specialized samples (e.g., individuals with cancer or vision loss). We explored gender bias in the PHQ-9 by means of differential item functioning analyses in a population-based sample.We made use of the National Health and Nutrition Examination Surveys (NHANES, 2008), a population-based sample of the USA including 5995 participants. Differential item functioning was assessed using the Mantel-Haenszel chi-square test and by comparing item characteristic curves between men and women.All items exhibited negligible differential item functioning as demonstrated by the Mantel-Haenszel test, with absolute standardized mean differences ranging from 0.00 to 0.06. Item characteristic curves were similar between genders for all but one item. Item 5 (i.e., changes in appetite) exhibited very minor non-uniform differential item functioning, wherein extremely depressed women endorsed higher response options on this item compared to equally depressed men.Researchers can use the PHQ-9 without concern of gender biases, particularly in epidemiological research.     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

Assessing Approximate Fit in Categorical Data Analysis

A family of Root Mean Square Error of Approximation (RMSEA) statistics is proposed for assessing the goodness of approximation in discrete multivariate analysis with applications to item response theory (IRT) models. The family includes RMSEAs to assess the approximation up to any level of association of the discrete variables. Two members of this family are RMSEA₂, which uses up to bivariate moments, and the full information RMSEA_n. The RMSEA₂ is estimated using the M₂ statistic of Maydeu-Olivares and Joe (2005, 2006), whereas for maximum likelihood estimation, RMSEA_n is estimated using Pearson's X² statistic. Using IRT models, we provide cutoff criteria of adequate, good, and excellent fit using the RMSEA₂. When the data are ordinal, we find a strong linear relationship between the RMSEA₂ and the Standardized Root Mean Squared Residual goodness-of-fit index. We are unable to offer cutoff criteria for the RMSEA_n as its population values decrease as the number of variables and categories increase.     

A cross-cultural analysis of the Brief Symptom Inventory-18

The Brief Symptom Inventory-18 (BSI-18: Derogatis, 2000) is an abbreviated version of the nine dimension, 53-item BSI (Derogatis, 1993) which is a shortened form of the 90-item Symptom Checklist-90-Revised (SCL-90-R: Derogatis, 1994). Criticism focused on factor structure (cf. Boulet & Boss, 1991; Ruipérez, Ibá?ez, Lorente, Moro, & Ortet, 2001) and the two older versions' poor discriminant validity suggest the scales' usefulness is limited to global scores only. Using principal component analysis, the authors explore the three-dimension factor structure of the BSI - 18 with the understudied population of Central American immigrants to the U.S. (N = 100). Results suggest one underlying factor best used in aggregate as a general screening for overall levels of psychological distress. Cultural differences are discussed.     

THE TOTALITARIAN STATE OF MIND

The paper describes the development of Dynamic Interpersonal Therapy for use with complex depression (DITCC), and a pilot study testing DITCC’s effectiveness. The pilot found large pre-post improvements in well-being and distress; moderate rates of reliable improvement and clinically significant change; and curvilinear declines in depression and anxiety. Treatment completers and near-completers (N= 19) showed a significant curvilinear decline in symptoms of depression (PHQ-9) and anxiety (GAD-7). The results provide preliminary evidence that DITCC can be used as an effective treatment approach for complex depression. However, further research is needed to test its effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions to further elaborate the short-term and long-term effects.     

The psychometric properties of the Greek version of the State-Trait Anxiety Inventory in cancer patients receiving palliative care

Objectives: To validate the Greek version of the State-Trait Anxiety Inventory (STAI) in a sample of cancer patients. Design: The scale was administered twice, with a 3-day interval, to 99 eligible patients with cancer. Together with the Greek version of STAI scale, the patients also completed the anxiety subscale from the Hospital Anxiety and Depression scale (HAD). Observations: Factor analysis yielded a three-factor solution, explaining 47.143% of the variance. Cronbach α for three scales was between 0.729 and 0.852. Inter-scale correlations were moderate-to-high and ranged from 0.282 to 0.563 (p < 0.0005, p < 0.005). The assessment of the relationships among the Greek STAI scales and HAD-Anxiety showed statistically significant correlations between them (r ranged between 0.428 and 0.596, p < 0.0005). The test/retest reliability of scale (Pearson's ‘r’), showed that the coefficient agreement ranged between 0.85 and 0.90 (p < 0.0005). Univariate analysis revealed significant correlations between female gender, metastasis, performance status, chemotherapy, mild opioids and low education level with increased anxiety. Conclusions: These results support that the Greek version of STAI is an instrument with satisfactory psychometric properties, and is a valid research tool for Greek cancer patients.     

Comparing score tests and other local dependence diagnostics for the graded response model

Score tests for identifying locally dependent item pairs have been proposed for binary item response models. In this article, both the bifactor and the threshold shift score tests are generalized to the graded response model. For the bifactor test, the generalization is straightforward; it adds one secondary dimension associated only with one pair of items. For the threshold shift test, however, multiple generalizations are possible: in particular, conditional, uniform, and linear shift tests are discussed in this article. Simulation studies show that all of the score tests have accurate Type I error rates given large enough samples, although their small‐sample behaviour is not as good as that of Pearson's Χ² and M₂ as proposed in other studies for the purpose of local dependence (LD) detection. All score tests have the highest power to detect the LD which is consistent with their parametric form, and in this case they are uniformly more powerful than Χ² and M₂; even wrongly specified score tests are more powerful than Χ² and M₂ in most conditions. An example using empirical data is provided for illustration.