Cross‐cultural measurement invariance of the General Health Questionnaire‐12 in a German and a Colombian population sample

While the General Health Questionnaire, 12‐item version (GHQ‐12) has been widely used in cross‐cultural comparisons, rigorous tests of the measurement equivalence of different language versions are still lacking. Thus, our study aims at investigating configural, metric and scalar invariance across the German and the Spanish version of the GHQ‐12 in two population samples. The GHQ‐12 was applied in two large‐scale population‐based samples in Germany (N = 1,977) and Colombia (N = 1,500). To investigate measurement equivalence, confirmatory factor analyses were conducted in both samples. In the German sample mean GHQ‐12 total scores were higher than in the Colombian sample. A one‐factor model including response bias on the negatively worded items showed superior fit in the German and the Colombian sample; thus both versions of the GHQ‐12 showed configural invariance. Factor loadings and intercepts were not equal across both samples; thus GHQ‐12 showed no metric and scalar invariance. As both versions of the GHQ‐12 did not show measurement equivalence, it is not recommendable to compare both measures and to conclude that mental distress is higher in the German sample, although we do not know if the differences are attributable to measurement problems or represent a real difference in mental distress. The study underlines the importance of measurement equivalence in cross‐cultural comparisons.     

Social Anxiety Scale for Adolescents: Factorial invariance and latent mean differences across gender and age in Spanish adolescents

Little is known about the factorial invariance across gender and age for self-report measures of social anxiety in adolescence. This study examined the factorial invariance and latent mean differences of the Social Anxiety Scale for Adolescents (SAS-A) across gender and age groups in 1570 Spanish adolescents (54% girls), ranging in age from 14 to 17 years. Equality of factor structures was compared using multi-group confirmatory factor analyses. Measurement invariance for the correlated three-factor model of the SAS-A was found across gender and age samples. Analyses of latent mean differences revealed that girls exhibited higher means than boys on two SAS-A subscales, Fear of Negative Evaluation and Social Avoidance and Distress-New (SAD-New). In addition, on the SAD-New subscale, the structured means significantly diminished from 14-year olds to 16- and 17-year olds and from 15-year olds to 17-year olds. Findings are discussed in terms of the use of the SAS-A with Spanish adolescents.     

Validation of the Resilience Scale for Adolescents (READ) in Ireland: a multi‐group analysis

Resilience is a process reflecting positive adaptation in the face of adversity. The Resilience Scale for Adolescence (READ) incorporates intrapersonal and interpersonal protective factors mapping onto the three salient domains of resilience, including individual, family and external environment. This study investigated the validity and reliability of the READ by means of factor analysis, multi‐group analysis, inter‐correlations and internal consistency measures. Participants were 6085 young people in Ireland aged 12–18 years. Participants completed the My World Survey – Second Level (MWS‐SL), assessing risk and protective factors of mental health. Confirmatory factor analysis validated the original five‐factor structure of the READ including Personal Competence, Social Competence, Structured Style, Family Cohesion, and Social Resources, χ²(340) = 6146.02, p < 0.001, RMSEA = 0.056 (90% CI = 0.054–0.057), CFI = 0.97; GFI = 0.93. Measurement invariance indicated that the five‐factor structure was similar across gender, school cycle and distress levels. Construct validity was evident, by correlating the five factors of the READ with various social, psychological and behavioural variables. The findings suggest that the READ is a valid measure to assess resilience factors among adolescents in Ireland, demonstrating its applicability in a different cultural context and with a wider age range of adolescents. Copyright © 2016 John Wiley & Sons, Ltd.     

Does the Revised Child Anxiety and Depression Scale (RCADS) measure anxiety symptoms consistently across adolescence? The TRAILS study

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n = 2226) at three time points (age range 10–17 years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive‐compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10–12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence. Copyright © 2013 John Wiley & Sons, Ltd.     

Measuring disability across cultures — the psychometric properties of the WHODAS II in older people from seven low‐ and middle‐income countries. The 10/66 Dementia Research Group population‐based survey

We evaluated the psychometric properties of the 12‐item interviewer‐administered screener version of the World Health Organization Disability Assessment Schedule – version II (WHODAS II) among older people living in seven low‐ and middle‐income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites. PCA generated a one‐factor solution in most sites. In CFA, the two‐factor solution generated in Dominican Republic fitted better for all sites other than rural China. The two factors were not easily interpretable, and may have been an artefact of differing item difficulties. Strong internal consistency and high factor loadings for the one‐factor solution supported unidimensionality. Furthermore, the WHODAS II was found to be a ‘strong’ Mokken scale. Measurement invariance was supported by the similarity of factor loadings across sites, and by the high between‐site correlations in item difficulties. The Mokken results strongly support that the WHODAS II 12‐item screener is a unidimensional and hierarchical scale confirming to item response theory (IRT) principles, at least at the monotone homogeneity model level. More work is needed to assess the generalizability of our findings to different populations. Copyright © 2010 John Wiley & Sons, Ltd.     

The structure of the Montgomery–Åsberg depression rating scale over the course of treatment for depression

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a widely used clinician‐rated measure of depressive severity. Empirical support for the factor structure of the MADRS is mixed; further, the comparison of MADRS scores within and between patients requires the demonstration of consistent instrument properties. The objective of the current investigation was to evaluate MADRS factor structure as well as MADRS factorial invariance across time and gender. The MADRS was administered to 821 depressed outpatients participating in a large‐scale effectiveness study of combined pharmacotherapy and psychotherapy for depression. Treatment outcome did not differ across treatment groups. Factor structure and invariance was evaluated via confirmatory factor analysis. A four‐factor model consisting of Sadness, Negative Thoughts, Detachment and Neurovegetative symptoms demonstrated a good fit to the data. This four‐factor structure was invariant across time and gender. A hierarchical model, in which these four factors served as indicators of a general depression factor, was also supported. A limitation of the current study is the lack of comprehensive characterization of patient clinical features; results need to be replicated in more severely depressed or treatment refractory patients. Overall, evidence supported the use of the MADRS total score as well as subscales focused on affective, cognitive, social and somatic aspects of depression in male and female outpatients. Copyright © 2013 John Wiley & Sons, Ltd.     

Measurement non‐invariance of DSM‐IV narcissistic personality disorder criteria across age and sex in a population‐based sample of Norwegian twins

We investigated measurement non‐invariance of DSM‐IV narcissistic personality disorder (NPD) criteria across age and sex in a population‐based cohort sample of 2794 Norwegian twins. Age had a statistically significant effect on the factor mean for NPD. Sex had a statistically significant effect on the factor mean and variance. Controlling for these factor level effects, item‐level analysis indicated that the criteria were functioning differently across age and sex. After correcting for measurement differences at the item level, the latent factor mean effect for age was no longer statistically significant. The mean difference for sex remained statistically significant after correcting for item threshold effects. The results indicate that DSM‐IV NPD criteria perform differently in males and females and across age. Differences in diagnostic rates across groups may not be valid without correcting for measurement non‐invariance.     

The Peer Aggressive and Reactive Behavior Questionnaire (Parb-Q): Measurement Invariance Across Italian and Brazilian Children, Gender and Age

This study examines measurement invariance, reliability and scores differences of the Peer Aggressive and Reactive Behaviors Questionnaire (PARB-Q) across Italian and Brazilian children, gender and age. Participants were 587 Italian and 727 Brazilian children, aged 7–13 years from 12 elementary schools. The PARB-Q is a brief self-report instrument composed by two scales that assess aggressive behavior and reactions to peer aggression. Multigroup confirmatory factor analyses indicated full measurement invariance of the PARB-Q across groups based on country, gender and age, providing support for the unidimensionality of the first scale (direct peer aggression, PA) and a 3-factor model of the second scale (reactive aggression, RA; seeking teacher support, STS; internalizing reaction, IR). Reliability indices were good for all factors. Italian children reported a higher frequency of PA and a lower frequency of IR than the Brazilian children. Boys scored higher than girls on PA and RA, while girls scored higher than boys on STS and IR. Younger children reported a lower frequency of PA and a higher frequency of STS than older children. Results provide support for structure validity and reliability of the PARB-Q in two countries and information on differences related to gender, age and culture in peer relationships in elementary school.     

Psychometric investigation of the specific phobia of vomiting inventory: A new factor model

Well‐validated, standardized measures are lacking for the assessment of emetophobia, the specific phobia of vomiting. The Specific Phobia of Vomiting Inventory (SPOVI) was recently developed and shows promise as a useful measure of emetophobia. The goal of the present study was to further examine and investigate the psychometric properties of the SPOVI in a large student sample (n = 1626), specifically focusing on its factor structure, measurement invariance across gender, and convergent/divergent validity. Confirmatory factor analysis results provide support for a one‐factor model of the SPOVI, in contrast to the previously proposed two‐factor model. Internal consistency of the SPOVI was good (α = 0.89) and measurement invariance across gender invariance was supported. The SPOVI also demonstrated good psychometric properties with respect to convergent and divergent validity. The present study's demonstration of the reliability and validity of the SPOVI suggests that the instrument may be a valuable tool for assessing emetophobia symptoms based on its one‐factor structure.     

Subjective distress in first‐episode psychosis: role of symptoms and self‐esteem

Background: Patients with psychotic disorders are assumed to experience significant distress, especially during their first episode. It is unclear whether such distress is associated with the level of psychotic or other symptoms and/or to other characteristics such as level of self‐esteem. Methods: One hundred and five patients who presented with first episode psychosis (FEP) (54% male; mean age 22.74 years; 79.4% schizophrenia; 20.6% affective psychosis) were administered the Symptom Checklist 90‐Revised (SCL‐90‐R) at first presentation for treatment. Four indices derived from the SCL‐90‐R were used as measures of distress. Psychopathology was assessed with the Calgary Depression Scale, the Hamilton Anxiety Scale, the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms and self‐esteem with the Self‐esteem Rating Scale.Spearman's Correlation coefficients were calculated, followed by a regression analysis. Results: Measures of distress were highly correlated with depression (rho = 0.44–0.56), and anxiety (rho = 0.38–0.48), modestly with lack of judgement and insight (rho = ?0.28 to ?0.37) and not with positive or negative symptoms of psychosis. In a smaller sample (n = 68) distress measures were also highly correlated with self‐esteem (rho = ?0.55 to ?0.73). Logistic regression confirmed that self‐esteem explained 53% of the total variance explained (57%) by any combination of the independent variables. Conclusion: Distress experienced by individuals suffering from FEP is associated with levels of self‐esteem, depression and anxiety and not with the level of psychotic or negative symptoms. Self‐esteem may play a significant role in the magnitude of distress experienced by patients presenting with a FEP.     

Motion‐related artifacts in structural brain images revealed with independent estimates of in‐scanner head motion

Motion‐contaminated T1‐weighted (T1w) magnetic resonance imaging (MRI) results in misestimates of brain structure. Because conventional T1w scans are not collected with direct measures of head motion, a practical alternative is needed to identify potential motion‐induced bias in measures of brain anatomy. Head movements during functional MRI (fMRI) scanning of 266 healthy adults (20–89 years) were analyzed to reveal stable features of in‐scanner head motion. The magnitude of head motion increased with age and exhibited within‐participant stability across different fMRI scans. fMRI head motion was then related to measurements of both quality control (QC) and brain anatomy derived from a T1w structural image from the same scan session. A procedure was adopted to “flag” individuals exhibiting excessive head movement during fMRI or poor T1w quality rating. The flagging procedure reliably reduced the influence of head motion on estimates of gray matter thickness across the cortical surface. Moreover, T1w images from flagged participants exhibited reduced estimates of gray matter thickness and volume in comparison to age‐ and gender‐matched samples, resulting in inflated effect sizes in the relationships between regional anatomical measures and age. Gray matter thickness differences were noted in numerous regions previously reported to undergo prominent atrophy with age. Recommendations are provided for mitigating this potential confound, and highlight how the procedure may lead to more accurate measurement and comparison of anatomical features. Hum Brain Mapp 38:472–492, 2017. © 2016 Wiley Periodicals, Inc.     

One‐year test–retest reliability of a Japanese web‐based version of the WHO Composite International Diagnostic Interview (CIDI) for major depression in a working population

The purpose of this study was to investigate the one‐year test–retest reliability and the demographic correlates of a self‐administered web‐based depression section of the World Health Organization‐Composite International Diagnostic Interview (WHO‐CIDI) in a working population. Overall, 1060 out of all employees (N = 1279) from a manufacturing company in Japan responded to two web‐based surveys of depression of the WHO‐CIDI within a one‐year interval in 2009 and 2010. The concordance between lifetime diagnoses of major depressive disorder on two occasions was calculated as percent agreement (%), Gwet's AC₁, and Yule's Q indicators were compared by gender, age, education, and marital status. For the total sample, percent agreement was 94%, AC₁ was 0.93, and Yule's Q was 0.82. The concordance rate was low (0.15) among those who were diagnosed at either time or both times. The concordance differed significantly across education and marital status. While the agreement indicators were relatively high, consistent with previous reports based on face‐to‐face interviews conducted within a shorter interval, the low stability of positive cases may challenge the accuracy of lifetime diagnosis of major depressive disorder using a web version of the WHO‐CIDI. Education and marital status might affect the test–retest reliability. Copyright © 2014 John Wiley & Sons, Ltd.     

The Penn State Worry Questionnaire for Children: Age,Gender and Clinical Invariance

The Penn State Worry Questionnaire for Children (PSWQ-C) is one of the most frequently used instruments to assess worry in children. The current study examines the measurement invariance of the PSWQ-C in a Romanian sample. Participants (n = 759) were recruited from both community and clinical populations. Our findings have replicated the good psychometric properties of the PSWQ-C and of the short PSWQ-C (the original scale with the negative items deleted). Multigroup confirmatory factor analysis has supported measurement invariance (configural, metric, scalar) across gender, age and clinical diagnosis. Convergent validity with other assessment measures has also been established. Finally, the implications of the use of the PSWQ-C in the assessment of anxiety in children and adolescents are discussed.     

Patient experiences with care across various types of mental health care: Questionnaire development,measurement invariance,and patients' reports

To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty‐five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after‐care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168). Exploratory structural equation modelling was conducted on a random split‐half sample to examine dimensionality. Confirmatory factor analysis and multiple group confirmatory factor analyses were conducted on the holdout sample to confirm dimensionality and assess measurement invariance across type of service and patient characteristics. Multilevel logistic regression models linking subscale top box scores to overall rating items were used to assess criterion validity. The hypothesized dimensionality was partly confirmed, and configural and scalar invariance were demonstrated across types of organizations and patient characteristics. Subscale scores were significantly associated with overall ratings. Process evaluation showed that participating organizations strongly support continued use of this questionnaire. This validated patient experience questionnaire supports comparison across organizations from different types of services to improve the quality of mental health care.     

Screening symptoms of reactive attachment disorder: evidence for measurement invariance and convergent validity

The Relationship Problems Questionnaire (RPQ) was developed to screen symptoms of the inhibited and disinhibited subtype of reactive attachment disorder (RAD). This study further examines the psychometric properties of the RPQ in children with severe emotional and behavioural problems by testing its measurement invariance across informants and its convergent validity. Parents and teachers of 152 children [mean age (M_age) = 7.92] from 20 schools for special education filled out the RPQ and the Strengths and Difficulties Questionnaire (SDQ). During a home visit in a subsample of 77 children the Disturbances of Attachment Interview (DAI) was administered to the caregiver and the child was observed using an observational schedule for RAD. Exploratory and confirmatory factor analyses revealed the expected two‐factor structure for both parent and teacher RPQ. Configural and metric invariance, but no scalar invariance, were obtained across informants. Both RPQ‐subscales had acceptable to good internal consistencies and correlated as expected with similar DAI‐subscales. Furthermore, the disinhibited RPQ‐scale related with observations of the child's approach to a stranger. Finally, significant associations were found between the RPQ and the SDQ. Overall, the RPQ has good psychometric qualities as a multi‐informant instrument for RAD‐symptoms in children with severe emotional and behavioural problems. Copyright © 2013 John Wiley & Sons, Ltd.     

Surgical therapy for multiple sclerosis tremor: a 12‐year follow‐up study

Background and purpose: Severe multiple sclerosis (MS) tremor causes disability poorly responsive to medication. Deep brain stimulation (DBS) or thalamotomy can suppress tremor, but long‐term outcomes are unclear. Methods: Nine patients with MS tremor underwent disability measures at baseline and 12 months post‐surgery (six thalamotomy, three DBS) in 1997–1998 (previously reported, Matsumoto et al., Neurology 2001;57:1876–82). We report the prospective 12‐year follow‐up of this cohort for tremor, disability, and death. Results: Surgery was initially successful in all. Tremor recurred in all patients within median 3 months, although two DBS patients were tremor‐free for 5 years. Median tremor‐free survival (tremor‐free time/survival time) was 4.3%. At 12‐year follow‐up, four survivors (two thalamotomy, two DBS) (Expanded Disability Status Scale scores 8–8.5) were severely disabled. Five patients were dead (four thalamotomy, one DBS) median 5.8 years post‐operative. Conclusions: Surgery benefit for severe tremor was overall short‐lived (median 3 months), with long‐term poor prognosis. Although two DBS patients had sustained 5‐year tremor‐suppression, the observed progressive disability and death in this cohort bear importance for long‐term success in future MS tremor surgery trials.     

Assessment and characterization of phenotypic heterogeneity of anxiety disorders across five large cohorts

To achieve sample sizes necessary for effectively conducting genome‐wide association studies (GWASs), researchers often combine data from samples possessing multiple potential sources of heterogeneity. This is particularly relevant for psychiatric disorders, where symptom self‐report, differing assessment instruments, and diagnostic comorbidity complicates the phenotypes and contribute to difficulties with detecting and replicating genetic association signals. We investigated sources of heterogeneity of anxiety disorders (ADs) across five large cohorts used in a GWAS meta‐analysis project using a dimensional structural modeling approach including confirmatory factor analyses (CFAs) and measurement invariance (MI) testing. CFA indicated a single‐factor model provided the best fit in each sample with the same pattern of factor loadings. MI testing indicated degrees of failure of metric and scalar invariance which depended on the inclusion of the effects of sex and age in the model. This is the first study to examine the phenotypic structure of psychiatric disorder phenotypes simultaneously across multiple, large cohorts used for GWAS. The analyses provide evidence for higher order invariance but possible break‐down at more detailed levels that can be subtly influenced by included covariates, suggesting caution when combining such data. These methods have significance for large‐scale collaborative studies that draw on multiple, potentially heterogeneous datasets. Copyright © 2016 John Wiley & Sons, Ltd.     

Is adjustment disorder unidimensional or multidimensional? Implications for ICD‐11

In preparation for ICD‐11, the adjustment disorder (AjD) diagnosis has undergone considerable revisions; however, the latent structure of AjD remains uncertain. It is unclear whether AjD is best represented as a unidimensional or multidimensional construct. This study performed a comprehensive assessment of the latent structure of AjD symptomatology and assessed its concurrent and discriminant validity. Individuals who experienced involuntary job loss (N = 333) completed a self‐report measure of AjD symptoms. Seven alternative models of AjD were tested using confirmatory factor analysis. General psychological distress, impairment in social functioning, occupational self‐efficacy, and sense of coherence were used as criterion variables for construct validity. In the confirmatory factor analysis, a bifactor solution with one dominant general AjD factor and 5 correlated group factors (preoccupation, failure‐to‐adapt, avoidance, affective reaction, and impulsivity) provided optimal fit. As expected, the AjD factor showed strong positive associations with general psychological distress and impairments in social functioning and moderately negative associations with occupational self‐efficacy and sense of coherence. With regard to unidimensionality or multidimensionality of AjD symptoms, the current results indicate the plausibility of a unidimensional conceptualization. Future research should focus on essential key characteristics and a reduction of symptoms for the AjD definition.     

Psychosis risk screening: Validation of the youth psychosis at‐risk questionnaire – brief in a community‐derived sample of adolescents

There have been several attempts to identify individuals potentially at high risk for psychotic‐spectrum disorders using brief screening measures. However, relatively few studies have tested the psychometric properties of the psychosis screening measures in representative samples of adolescents. The main purpose of the present study was to analyse the prevalence, factorial structure, measurement invariance across gender, and reliability of the Youth Psychosis At‐Risk Questionnaire – Brief (YPARQ‐B) in a community‐derived sample of adolescents. Additionally, the relationship between YPARQ‐B, depressive symptoms, psychopathology, stress manifestations, and prosocial skills was analysed. One thousand and twenty students from high schools participated in a cross‐sectional survey. The YPARQ‐B, the Reynolds Adolescent Depression Scale, the Strengths and Difficulties Questionnaire, and the Student Stress Inventory – Stress Manifestations were used. A total of 85.1% of the total sample self‐reported at least one subclinical psychotic experience. We observed a total of 10.9% of adolescents with a cutoff score of ≥11 or 6.8% with a cutoff score of ≥13. The analysis of internal structure of the YPARQ‐B yielded an essentially unidimensional structure. The YPARQ‐B scores showed measurement invariance across gender. The internal consistency of the YPARQ‐B total score was 0.94. Furthermore, self‐reported subclinical psychotic experiences were associated with depressive symptoms, emotional and behavioural problems, poor prosocial skills, and stress manifestations. These results would appear to indicate that YPARQ‐B is a brief and easy tool to assess self‐reported subclinical psychotic experiences in adolescents from the general population. The assessment of these experiences in community settings, and its associations with psychopathology, may help us to enhance the possibility of an early identification of adolescents potentially at risk for psychosis and mental health problems.     

Age‐dependent increase in Kalirin‐9 and Kalirin‐12 transcripts in human orbitofrontal cortex

KALRN (KAL) is a Rho GEF that is highly involved in regulation of the actin cytoskeleton within dendrites. There are several isoforms of the protein that arise from differential splicing of KALRN's 66 exons. KAL isoforms have different functions in development. For example, overexpression of the KAL9 and KAL12 isoforms induce dendritic elongation in early development. However, in mature neurons KAL9 overexpression reduces dendritic length, a phenotype also observed in normal human ageing. We therefore hypothesized that KAL9 would have increased expression with age, and undertook to evaluate the expression of individual KALRN exons throughout the adult lifespan. Postmortem human brain grey matter from Brodmann's area (BA) 11 and BA47 derived from a cohort of 209 individuals without psychiatric or neurodegenerative disease, ranging in age from 16 to 91 years, were analysed for KALRN expression by Affymetrix exon array. Analysis of the exon array data in an isoform‐specific manner, as well as confirmatory isoform‐specific qPCR studies, indicated that the longer KAL9 and KAL12 isoforms demonstrated a statistically significant, but modest, increase with age. The small magnitude of the age effect suggests that inter‐individual factors other than age likely contribute to a higher degree to KAL9 and KAL12 expression. In contrast to KAL9 and KAL12, global KALRN expression did not increase with age. Our work suggests that global measures of KALRN gene expression may be misleading and future studies should focus on isoform‐specific quantification.