Vivre avec un proche malade : évaluation des dimensions positive et négative de l’expérience des aidants naturels

The growing prevalence of chronic diseases and the greater reliance on outpatient care have shifted the demands from professional caregivers towards natural caregivers. Patients and their family members are based in their homes with complicated therapies to administer. Since a natural caregiver is a key to home care, if the burden becomes too great, the home care support may be threatened. Subjective burden aims to refer to the embarrassment or role overload that may be experienced when giving care at home. Caregivers can experience an alteration in their psychological and physical health due to the new situation. Health care professionals need to be aware of these problems, and they need instruments to assess the impact on the natural caregivers. There has been a growing interest on the part of researchers over the past 30 years in exploring and in developing methodologically sound instruments to measure the caregiving experience. Researchers and clinicians involved in these projects have come from a wide spectrum of medical and psychological domains, including psychiatry, gerontology, psycho-oncology, and somatic medicine. A number of instruments may be appropriate, but while many of these instruments have individual strengths and weaknesses two instruments deserve to be recommended. More specifically, one of these is Given and Given's Caregiver Reaction Assessment (CRA) which was correctly developed and tested, and contains the most areas of interest. The authors are experts in the field, and their instrument has been used satisfactorily by other researchers. The CRA was developed and tested in a study conducted among caregivers of patients with various disorders and this study revealed excellent psychometric properties. The original English version of the CRA was translated into French by six researchers. Each made his own translation. These translations were compared and a consensus was reached for each of the 24 items. A professional translator retranslated the French version into English and a discussion on minor differences led to the final version of the French CRA. The translated CRA is expected to have the same structure as that found for the original instrument or other translated forms (Nijboer et al., 1999). This article addresses the construct validity of the CRA in a multicenter study among partners of chronic disease patients suffering from depression, anxiety disorder, type 2 diabetes, multiple sclerosis, Alzheimer disease, polyarthritis, alcohol dependence, hemiplegia, muscular distrophy (n = 174). The partner was defined as a relative or person identified by the patient as a partner, and who resided in the patient's household. The construct validity was thus confirmed. More specifically the CRA aims to assess the caregiver experience with respect to five domains of the caregiver's lives. The CRA contained five meaningful factors explaining 64% of the total variance. The five dimensions of caregiver reactions were identified through exploratory factor analysis: impact on disrupted schedule, financial problems, lack of family support, health problems and the impact on self-esteem. The strongest correlations between CRA scales were found for the subscales of disrupted schedule and health problems. To assess the construct validity of the CRA subscales, a measure of subjective burden among informal caregivers (Zarit et al., 1984) was included in the study. The correlations between the CRA subscales and the Zarit scale vary (−0.11 < r < 0.67). The strongest correlations with the Zarit scale were found for the subscales of health problems and disrupted schedule. The lowest correlations were found for the subscales of impact on self-esteem (r = −11) and financial problems (r = 0.14). These two negative subscales of the CRA were unrelated or only slightly related to subjective burden as measured with a unidimensional instrument. Reliability analyses showed that Cronbach's alpha's varied between 0.75 and 0.85 for the subscales, indicating sufficient internal consistencies. The French form of the CRA proves to be a reliable and valid instrument for assessing both negative and positive reactions to caregiving among partners of patients with chronic diseases. In conclusion, the CRA seems to be a good option for studying the subjective, multidimensional, negative and positive experiences of caregiving among caregivers of chronically ill patients.     

Psychometric properties of the World Health Organization Disability Assessment Schedule used in the European Study of the Epidemiology of Mental Disorders

This study assessed the factor structure, internal consistency, and discriminatory validity of the World Health Organization Disability Assessment Schedule (WHODAS) version used in the European Study of the Epidemiology of Mental Disorders (ESEMeD). In total 8796 adults were assessed using the ESEMeD WHODAS (22 severity and 8 frequency items). An Exploratory Factor Analysis (EFA) with promax rotation was done with a random 50%. The other half was used for confirmatory factor analysis (CFA) comparing models (a) suggested by EFA; (b) hypothesized a priori; and (c) reduced with four items. A CFA model with covariates was conducted in the whole sample to assess invariance across Mediterranean (Spain, France and Italy) and non-Mediterranean (Belgium, Germany and the Netherlands) countries. Cronbach's alphas and discriminatory validity were also examined. EFA identified seven factors (explained variance: 80%). The reduced model (six factors, four frequency items excluded) presented the best fit [Confirmatory Fit Index (CFI) = 0.992, Tucker-Lewis Index (TLI) = 0.996, Root Mean Square Error of Approximation (RMSEA) = 0.024]. The second-order factor structure also fitted well (CFI = 0.987, TLI = 0.991, RMSEA = 0.036). Measurement non-invariance was found for Embarrassment. Cronbach's alphas ranged from 0.84 for Participation to 0.93 for Mobility. Preliminary data suggest acceptable discriminatory validity. Thus, the ESEMeD WHODAS may well be a valuable shortened version of the WHODAS-II, but future users should reconsider the filter questions.     

Factor structure of the CES-D scale among older adults in Chennai,India

To examine the psychometric properties of the 20-item Centre for Epidemiological Studies – Depression scale (CES-D). Data were collected from 400 community-dwelling older adults aged 65 years and above, residing in Chennai, India. The instruments including the CES-D scale were translated into Tamil language. The sample was randomly split for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. EFA on a subsample (n?=?200) yielded two factors, depressed affect and positive affect. CFA with another subsample (n?=?200) indicated a good fit for the two-factor structure. In addition, the two-factor model evinced a superior fit to one-, three- and four-factor models. The internal consistency was high for the total scale and its subscales. The convergent validity of the scale was supported by significant correlations with theoretically related measures. The results indicate acceptable measurement properties of the CES-D scale. However, some items appear to be problematic for Indian older adults. Therefore, there is a need for further studies among Indian older adults.     

Grouping and trajectories of the neuropsychiatric symptoms in patients with Alzheimer's disease, part I: symptom clusters

Behavioral and psychological symptoms of dementia (BPSD) are frequently observed in Alzheimer's disease (AD) and affect more than 80% of patients over the course of AD. The goal of this study was to establish a model for grouping the symptoms of BPSD into clinical syndromes. Over a 24-month period, an observational study was conducted using a population of ambulatory patients with AD of mild to moderate severity. The Neuropsychiatric Inventory (NPI) was administered to the patients' caregivers every 6 months. BPSD were grouped using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of the NPI scores of each assessment. The sample population consisted of 491 patients (70.9% women) with an average age of 75.2 years (SD=6.6). The five EFA suggested that there was a stable three-factor structure. According to the results of the EFA, three models of symptom grouping were adjusted using CFA methodology. The CFA model that satisfactorily grouped the NPI scores into three factors included a psychotic syndrome (hallucinations, delusions), an affective syndrome (depression, anxiety, irritability, agitation) and a behavior syndrome (euphoria, disinhibition, apathy, aberrant motor behavior). Based on our findings, we propose a model for grouping the BDSD in which there are core nuclear syndromes (psychotic and affective) as well as an unspecified behavior syndrome comprising satellite symptoms that may be related to the presence of the nuclear syndromes.     

The five-factor model of the Positive and Negative Syndrome Scale I: confirmatory factor analysis fails to confirm 25 published five-factor solutions

OBJECTIVE: The aim of this study was to test the goodness-of-fit of all previously published five-factor models of the Positive and Negative Syndrome Scale (PANSS). METHODS: We used confirmatory factor analysis (CFA) with a large data set (N = 5769). RESULTS: The different subsamples were tested for heterogeneity and were found to be homogeneous. This indicates that despite variability in age, sex, duration of illness, admission status, etc., in the different subsamples, the structure of symptoms is the same for all patients with schizophrenia. Although previous research has shown that a five-factor model fits the data better than models with three or four factors, no satisfactory fit for any of the 25 published five-factor models was found with CFA. CONCLUSIONS: Variability in age, sex, admission status and duration of illness has no substantial effect on the structure of symptoms in schizophrenia. The lack of fit can be caused by ill-defined items that aim to measure several properties in a single rating. Another explanation is that well-defined symptoms can have two or more causes. Then a double or triple loading item should not be discarded, but included because the complexity of symptoms in schizophrenia is represented by these multiple loadings. Such a complex model not only needs confirmation by CFA, but also has to be proven stable. A 10-fold cross-validation is suggested to develop a complex and stable model.     

Five-factor model of schizophrenic psychopathology: how valid is it?

Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients' scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach's alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing--in a decreasing order of relative importance--the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.     

Developing an African youth psychosocial assessment: an application of item response theory

This study aimed to refine a dimensional scale for measuring psychosocial adjustment in African youth using item response theory (IRT). A 60‐item scale derived from qualitative data was administered to 667 war‐affected adolescents (55% female). Exploratory factor analysis (EFA) determined the dimensionality of items based on goodness‐of‐fit indices. Items with loadings less than 0.4 were dropped. Confirmatory factor analysis (CFA) was used to confirm the scale's dimensionality found under the EFA. Item discrimination and difficulty were estimated using a graded response model for each subscale using weighted least squares means and variances. Predictive validity was examined through correlations between IRT scores (θ) for each subscale and ratings of functional impairment. All models were assessed using goodness‐of‐fit and comparative fit indices. Fisher's Information curves examined item precision at different underlying ranges of each trait. Original scale items were optimized and reconfigured into an empirically‐robust 41‐item scale, the African Youth Psychosocial Assessment (AYPA). Refined subscales assess internalizing and externalizing problems, prosocial attitudes/behaviors and somatic complaints without medical cause. The AYPA is a refined dimensional assessment of emotional and behavioral problems in African youth with good psychometric properties. Validation studies in other cultures are recommended. Copyright © 2014 John Wiley & Sons, Ltd.     

Exploratory and Confirmatory Factor Analysis of the Autism Diagnostic Interview-Revised

The factor structure of the Autism Diagnostic Interview-Revised (ADI-R) algorithm items was examined using exploratory (EFA) and confirmatory factor analyses (CFA) factor methods. The ADI-R was completed for 1,170 youths and adults (ages 2-46). Results of EFAs indicated strong support for two-factor structure, with social communication and stereotyped behavior factors. CFAs computed in a holdout sub-sample indicated roughly equal support for the above described two-factor model and a three factor model separating peer relationships and play from other social and communicative behaviors. Multi-group CFAs suggested that both two and three factor models showed good stability across age, with only slight changes in factor relationships. These findings indicate that the current ADI-R structure be revised to more accurately reflect the relationships between sub-scales.     

Validating the cross-cultural factor structure and invariance property of the Insomnia Severity Index: evidence based on ordinal EFA and CFA

ObjectiveThe purpose of this study is to examine the factor structure of the Insomnia Severity Index (ISI) across samples recruited from different countries. We tried to identify the most appropriate factor model for the ISI and further examined the measurement invariance property of the ISI across samples from different countries.MethodsOur analyses included one data set collected from a Taiwanese sample and two data sets obtained from samples in Hong Kong and Canada. The data set collected in Taiwan was analyzed with ordinal exploratory factor analysis (EFA) to obtain the appropriate factor model for the ISI. After that, we conducted a series of confirmatory factor analyses (CFAs), which is a special case of the structural equation model (SEM) that concerns the parameters in the measurement model, to the statistics collected in Canada and Hong Kong. The purposes of these CFA were to cross-validate the result obtained from EFA and further examine the cross-cultural measurement invariance of the ISI.ResultsThe three-factor model outperforms other models in terms of global fit indices in Taiwan's population. Its external validity is also supported by confirmatory factor analyses. Furthermore, the measurement invariance analyses show that the strong invariance property between the samples from different cultures holds, providing evidence that the ISI results obtained in different cultures are comparable.ConclusionsThe factorial validity of the ISI is stable in different populations. More importantly, its invariance property across cultures suggests that the ISI is a valid measure of the insomnia severity construct across countries.     

Patterns of anxiety symptoms in toddlers and preschool-age children: evidence of early differentiation

The degree to which young children's anxiety symptoms differentiate according to diagnostic groupings is under-studied, especially in children below the age of 4 years. Theoretical (confirmatory factor analysis, CFA) and statistical (exploratory factor analysis, EFA) analytical methods were employed to test the hypothesis that anxiety symptoms among 2-3-year-old children from a non-clinical, representative sample would differentiate in a manner consistent with current diagnostic nosology. Anxiety symptom items were selected from two norm-referenced parent-report scales of child behavior. CFA and EFA results suggested that anxiety symptoms aggregate in a manner consistent with generalized anxiety, obsessive-compulsive symptoms, separation anxiety, and social phobia. Multi-dimensional models achieved good model fit and fit the data significantly better than undifferentiated models. Results from EFA and CFA methods were predominantly consistent and supported the grouping of early childhood anxiety symptoms into differentiated, diagnostic-specific categories.     

A factor analytic study of the Autism Behavior Checklist

The factor structure of the Autism Behavior Checklist (ABC) (Krug, Arick, & Almond, 1980a, 1980b), a 57-item screening instrument for autism, was examined on a sample of 383 individuals with autism spectrum disorders (i.e., autistic disorder, Asperger syndrome, and other autism-like conditions) aged 5-22 years. A five-factor model accounted for 80% of the total variance in the checklist. Thirty-nine of the 57 items had factor loadings of 0.4 or more, with 13 items loading on Factor 1, 11 items on Factor 2, 6 items on Factor 3, 5 items on Factor 4, and 4 items on Factor 5. No support was found for classifying the 57 items into the five subscales proposed by Krug et al. (1980a, 1980b) or for the three-factor solution suggested by Wadden, Bryson, and Rodger (1991).     

Reliability,Validity, and Unidimensionality of the Korean Version of the Pornography Craving Questionnaire Based on the Classical Test Theory and Item Response Theory

ObjectiveThis study aimed to evaluate the reliability and validity of the Korean version of the Pornography Craving Questionnaire (K-PCQ) using classical test theory and item response theory. MethodsThe goodness of fit test and differential item functioning (DIF) analysis based on the Rasch model, confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and correlation analysis were used to test its reliability and validity. ResultsResponse data from 226 students were analyzed. According to the goodness of fit test, the outfit mean square value of only one item, Item 11, was greater than 2. The CFA results revealed that all items of the K-PCQ measured a single construct. The EFA results revealed that the K-PCQ had excellent internal reliability. The DIF analysis results showed that the measurement of pornography craving using the K-PCQ did not differ based on gender. The result of Poly-DIMTEST supported the unidimensionality of the K-PCQ. The cut-off value of pornography craving was suggested as a measure of -0.0908 which corresponds to 46 (54.8%) out of a maximum score of 84. ConclusionThe items of the K-PCQ are unidimensional and have good reliability and validity. The K-PCQ will be useful in clinical practice and research as a screening tool for pornography craving.     

Psychometric properties of the self-reporting questionnaire (SRQ-20): Measurement invariance across women from Brazilian community settings

BackgroundSRQ-20 is a validated screening tool for common psychiatric disorders in several countries. Exploration of the latent structure of this instrument resulted in conflicting evidence. This study aimed to explore the latent structure of SRQ-20 among Brazilian women from community settings. We also tested the model invariance across different sociodemographic conditions.MethodsExploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on a sample of 1668 women from four different geographical regions of Brazil. Invariance of the model was tested through multi-group CFA according to sociodemographic variables.ResultsEFA has shown two potential solutions with two and three factors. CFA resulted in indices of the two-factor solution slightly worse than the three-factor solution. Invariance testing has shown this model was not invariant across cities, but was invariant across different social classes. The structure was also invariant for the two lower educated groups. The respecified model (i.e., excluding item 16) was not invariant across groups with different educational levels.ConclusionThe three-factor solution seems to be the most suitable model of SRQ-20 for Brazilian women in community settings. Furthermore, sociodemographic variables seem to reflect on the latent structure of this instrument. Validation of screening tools should consider sociodemographic variables.     

Factor Structure and Psychometric Properties of the Young Schema Questionnaire (Short Form) in Chinese Undergraduate Students

This study investigated cross-cultural differences in the factor structure and psychometric properties of the Young Schema Questionnaire (short form; YSQ-SF). The participants were 712 Chinese undergraduate students. The total sample was randomly divided into two sub-samples. Exploratory Factor Analysis (EFA) was conducted on questionnaire results for Group A, and Confirmatory Factor Analysis (CFA) was conducted on Group B. Multiple regression analyses were conducted to investigate the predictive validity of the schemas in predicting depression and anxiety. EFA revealed a 14-factor solution in Sample A. This factor solution was confirmed using CFA on the data from Sample B. The overall scale of the YSQ-SF demonstrated a high level of internal consistency, as did all of the subscales. Predictive validity of the schema domains in predicting depression and anxiety scores was confirmed via two multiple regression analyses.     

Dimensionality of the Chinese hospital anxiety depression scale in psychiatric outpatients: Mokken scale and factor analyses

Objective: The hospital anxiety and depression scale (HADS) is a widely used scale of anxiety and depression. However, recent studies have challenged the bi-dimensional scoring of the HADS. The present study was to examine the dimensionality of the Chinese HADS.

Methods: We recruited a convenience sample of 214 adult psychiatric outpatients at a medical centre in Taiwan, and they completed the Chinese HADS. We used Mokken scale analysis (MSA), exploratory factor analysis (EFA), exploratory bifactor analysis (EBA) and confirmatory factor analysis (CFA) to examine the dimensionality of the Chinese HADS.

Results: The Chinese HADS was a moderate Mokken scale (H_s?=?0.44), and had a two-factor structure. EBA showed that one general factor, emotional distress, explained 68% of the common variance of the Chinese HADS. CFA confirmed that the bifactor model had the best fit statistics. The items 5 and 7 of the Chinese HADS contributed to structural ambiguity in the Chinese HADS subscales.

Conclusions: The sum scores of the Chinese HADS were a reliable and valid unidimensional measure of emotional distress. The Chinese HADS subscales were incapable of differentiating between anxiety and depression. Clinicians and researchers should choose other scales that are specifically designed for measuring anxiety and depression.     

Factor structure of the Behavior Flexibility Rating Scale (BFRS)

The Behavior Flexibility Rating Scale (BFRS) is designed to assess insistence on sameness or lack of behavioral flexibility, which is often associated with autism and other developmental disabilities. This study was designed to assess the factor structure of this scale for a sample of 968 individuals with autism, Asperger's syndrome, and Down syndrome. To establish factorial validity, an exploratory factor analysis (EFA) was conducted with half of the sample, with a confirmatory factor analysis (CFA) conducted with the remaining cases to cross-validate the model obtained with the EFA. The factor analyses supported the presence of two factors—Interruption/Disruption and Position/Location. However, further analysis suggested the presence of a third factor, Interpersonal Mishaps, for the Asperger's syndrome group.     

Exploratory factor analysis and confirmatory factor analysis of the korean version of hypomania checklist-32

Objective

The Hypomania Checklist - 32 (HCL-32) is a self-assessment instrument developed by Angst et al. (2005) to identify bipolarity in the general population, as well as patients with unipolar depression. The principal objective of this study was to assess the factor structure of the Korean version of the HCL-32 for mood disorder patients, via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Methods

The Korean version of HCL-32 were evaluated in a sample of 608 mood disorder patients, including 210 bipolar disorder patients and 398 unipolar disorder patients, all of whom were diagnosed in accordance with either the Structured Clinical Interview of DSM-IV or Mini International Neuropsychiatric Interview They were divided randomly into two groups, and then the EFA was administered to group 1 and the CFA was administered to group 2.

Results

A 3-factor structure for the HCL-32 was generated, which explained 44% of the total variance from EFA. Factor 1, comprising 18 items, was designated as ''elated mood/increased energy''; factor 2, comprising 8 items, was designated as ''risk-taking behavior/irritability''; and factor 3, comprising 2 items, was designated as ''increased sexual activity''. Researchers confirmed the 3-factor solution derived from group 1 by the CFA.

Conclusion

The primary findings of this study were the replication and confirmation of the 3-factor structure in Korean mood disorder patients; our results were consistent with previous EFAs.     

Cognition and the five-factor model of the Positive and Negative Syndrome Scale in schizophrenia

Different exploratory and confirmatory factorial analyses of the Positive and Negative Syndrome Scale (PANSS) have found a number of factors other than the original positive, negative, and general psychopathology. Based on a review of previous studies and using confirmatory factor analyses (CFA), Wallwork et al. (Schizophr Res 2012; 137: 246–250) have recently proposed a consensus five-factor structure of the PANSS. This solution includes a cognitive factor which could be a useful measure of cognition in schizophrenia. Our objectives were 1) to study the psychometric properties (factorial structure and reliability) of this consensus five-factor model of the PANSS, and 2) to study the relationship between executive performance assessed using the Wisconsin Card Sorting Test (WCST) and the proposed PANSS consensus cognitive factor (composed by items P2-N5-G11). This cross-sectional study included a final sample of 201 Spanish outpatients diagnosed with schizophrenia. For our first objective, CFA was performed and Cronbach's alphas of the five factors were calculated; for the second objective, sequential linear regression analyses were used. The results of the CFA showed acceptable fit indices (NNFI = 0.94, CFI = 0.95, RMSEA = 0.08). Cronbach's alphas of the five factors were adequate. Regression analyses showed that this five-factor model of the PANSS explained more of the WCST variance than the classical three-factor model. Moreover, higher cognitive factor scores were associated with worse WCST performance. These results supporting its factorial structure and reliability provide robustness to this consensus PANSS five-factor model, and indicate some usefulness of the cognitive factor in the clinical assessment of schizophrenic patients.     

Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia

Although the developers of the Positive and Negative Syndrome Scale (PANSS) grouped items into three subscales, factor analyses indicate that a five-factor model better characterizes PANSS data. However, lack of consensus on which model to use limits the comparability of PANSS variables across studies. We counted "votes" from published factor analyses to derive consensus models. One of these combined superior fit in our Caucasian sample (n=458, CFI=.970), and in distinct Japanese sample (n=164, CFI=.964), relative to the original three-subscale model, with a sorting of items into factors that was highly consistent across the studies reviewed.     

A cross-national factor analytic comparison of three models of PANSS symptoms in schizophrenia

The 30-item Positive and Negative Syndrome Scale (PANSS) is used worldwide in the assessment of symptom severity in schizophrenia. The present study uses confirmatory factor analysis (CFA) to compare three different factorial models and to evaluate the best-fitting representation of schizophrenia symptom structure on the PANSS across four samples of patients diagnosed with schizophrenia from the US (the CATIE schizophrenia trial), São Paulo, Brazil, and from Beijing and Changsha, China. We examine the goodness of fit of several previously proposed models. The traditional trifactorial model for the PANSS and two five-factor models were evaluated using absolute and incremental indices. Single group CFA found that the five-factor model proposed by NIMH researchers based on an extensive literature review demonstrates the best fit in each of the four samples. This model used 20 of the 30 PANSS items grouped into five factors: positive, negative, disorganized, excited, and depressed symptoms. Subgroups defined by age, gender, nationality, hospitalization status, and severity of illness also did not differ in overall symptom structure as assessed by several standard indices. Our findings suggest that the five factor NIMH model showed the best representation among all four samples from different countries and potentially contrasting cultures.