On the Dimensionalities of the Dissociative Experiences Scale (DES) and the Dissociation Questionnaire (DIS-Q)

Abstract

The dimensionalities of the Dissociative Experiences Scale (DES) and the Dissociation Questionnaire (DIS-Q) have been explored by factor analysis by a number of investigators. The general claim is that both scales are multidimensional. However, we argue that, in both cases, this ap parent multidimensionality is a form of range restriction that arises because some symptoms are more common than other symptoms. As a result, the resulting subscales derived from the multifactor solutions are so highly intercorrelated as to be incapable of meaningful discriminant validity. The current findings support a more parsimonious single factor solution for both scales.     

简版社区心理体验评估测评大学生的效度和信度

目的:考察简版社区心理体验评估(CAPE-P8)的效度和信度。方法:对1451名大学生进行CAPE-P8施测,采用精神病前驱期问卷(PQ-16)作为效标工具,217名大学生在7～14天后完成CAPE-P8重测,90名大学生在一个月内完成电话访谈。结果:CAPE-P8内部一致性(α=0.82～0.84)、重测信度(α=0.80～0.83)、自评-访谈一致性(α=0.64～0.78)均良好;验证性因子分析显示CAPE-P8的妄想体验和幻觉体验的双因子模型拟合良好;CAPE-P8频率维度与痛苦维度呈正相关(r=0.72～0.89,P<0.001),且CAPE-P8各维度与PQ-16呈正相关(r=0.50～0.67,P<0.001);大学生精神病样体验终身检出率、现患检出率分别为83.5%和58.6%,终身痛苦率、现患痛苦率分别为15.9%和9.9%。结论:本研究显示简版社区心理体验评估(CAPE-P8)测评大学生的精神病样体验效度信度良好。     

A web-based computerized adaptive testing (CAT) to assess patient perception in hospitalization

Background

Many hospitals have adopted mobile nursing carts that can be easily rolled up to a patient’s bedside to access charts and help nurses perform their rounds. However, few papers have reported data regarding the use of wireless computers on wheels (COW) at patients’ bedsides to collect questionnaire-based information of their perception of hospitalization on discharge from the hospital.

Objective

The purpose of this study was to evaluate the relative efficiency of computerized adaptive testing (CAT) and the precision of CAT-based measures of perceptions of hospitalized patients, as compared with those of nonadaptive testing (NAT). An Excel module of our CAT multicategory assessment is provided as an example.

Method

A total of 200 patients who were discharged from the hospital responded to the CAT-based 18-item inpatient perception questionnaire on COW. The numbers of question administrated were recorded and the responses were calibrated using the Rasch model. They were compared with those from NAT to show the advantage of CAT over NAT.

Results

Patient measures derived from CAT and NAT were highly correlated (r = 0.98) and their measurement precisions were not statistically different (P = .14). CAT required fewer questions than NAT (an efficiency gain of 42%), suggesting a reduced burden for patients. There were no significant differences between groups in terms of gender and other demographic characteristics.

Conclusions

CAT-based administration of surveys of patient perception substantially reduced patient burden without compromising the precision of measuring patients’ perceptions of hospitalization. The Excel module of animation-CAT on the wireless COW that we developed is recommended for use in hospitals.     

Differential Diagnosis between Anomalous Experiences and Dissociation Disorder Using the Dissociative Disorders Interview Schedule (DDIS)

Background. It is important to understand the most diverse cultural aspects related to religiosity. Scientifically, it is important to understand religious manifestations and their relation to health, and to differentiate them from psychopathological manifestations. Objective. To evaluate the mental health of a group of mediums and compare it with that of a control group from the same religious context who do not manifest mediumship, using the Dissociative Disorders Interview Schedule (DDIS). Methods. This was a cross-sectional study, evaluating 47 mediums (Group 1) and comparing them with 22 non-medium volunteers from the same religious context (Group 2) using the DDIS questionnaire. All results were matched with historical data from patients with dissociative identity disorder (DID) who answered the DDIS. Results. Scores obtained from the DDIS were similar in both groups. The number of positive symptoms was comparable in a wide range of analyzed areas, involving but not being restricted to somatization disorder, major depressive episode, borderline personality disorder, extrasensory/paranormal experiences, physical/sexual abuse and five dissociative disorders. There were considerable differences when we compared these results with historical data from patients with DID. Conclusion. In agreement with the extant literature, these results showed that mediumship can be considered a non-pathological form of dissociative phenomena.     

Development and validation of the Cancer Knowledge Scale for the general population: An item response theory approach

ObjectiveTo develop and validate a new measure of cancer knowledge for members of the general population who have never been diagnosed with cancer.MethodsInitially, 20 items were generated to measure cancer knowledge. After expert refinement and cognitive interviews, 11 items remained and were completed by 1,076 adults with no history of cancer. Responses were assessed using an item response theory (IRT) approach and differential item functioning.ResultsItems were analyzed using a two-parameter logistic IRT model. Two items with tetrachoric correlation coefficients>0.8 and one item with a discrimination parameter>2.0 were excluded. The final eight items demonstrated a good range of discrimination (1.13 to 1.86) and difficulty (?1.11 to 0.85). No meaningful differential item functioning by participant attributes was detected for these eight items.ConclusionThe Cancer Knowledge Scale appears to be a reliable and valid measure for the general population.Practice ImplicationsThe eight-item scale could be used to assess the effects of psychoeducational programs, including those on cancer knowledge, for members of the general population with no cancer history     

Assessment of complex mental activity across the lifespan: development of the Lifetime of Experiences Questionnaire (LEQ)

BACKGROUND: Brain reserve is a property of the central nervous system related to complex mental activity which may mediate the course and clinical expression of brain injury. Since there is no instrument that comprehensively assesses complex mental activity through the lifespan, we developed and tested the Lifetime of Experiences Questionnaire (LEQ) in a prospective study of healthy ageing. METHOD: The LEQ assesses educational, occupational and cognitive lifestyle activities at different stages through life. Test-retest, item analysis and Item Response Theory (IRT) were used to determine reliability. Dimensionality was evaluated using factor analysis. Validity was established through IRT analysis of test performance, correlation with an extant contemporaneous instrument (Cognitive Activities Scale; CAS) and prediction of global cognitive change over 18 months controlling for age, baseline cognition and hypertension. RESULTS: In a sample of healthy older individuals (n=79) the LEQ was found to be consistent, coherent and discriminate between individuals with high and low mental activity levels. Factor analysis revealed a dominant factor which loaded heavily on education, occupation and leisure activity. Total LEQ was significantly correlated with the CAS. Furthermore, individuals with higher LEQ scores showed less cognitive decline over 18 months, independent of covariates (r=0.37, p=0.003). CONCLUSIONS: The LEQ is a reliable and valid instrument for assessing complex lifespan mental activity which is protective against cognitive decline. The LEQ is therefore proposed as a useful tool for estimating brain reserve in older individuals and further development is anticipated.     

The value of an improved scoring system (CGHQ) for the General Health Questionnaire in a representative community sample

The value of a new method of scoring the General Health Questionnaire (CGHQ) has been assessed in a representative sample of 6317 British community residents aged 18+. The CGHQ, which takes account of the chronicity of psychiatric symptoms, is found to be superior to the conventional scoring method in yielding a wider range of scores, a more normal distribution and in its close association to a well validated measure of neurotic illness. On the other hand, the conventional GHQ and the CGHQ score appear equally sensitive to a number of socio-demographic variables, including social class, marital status and employment. An important finding is that the two methods identify different individuals as cases. Compared with the GHQ, the CGHQ identifies a higher proportion of the middle-aged. The implications of these findings with respect to the optimal method of scoring the GHQ are discussed.     

Development of a measure of genome sequencing knowledge for young people: The kids-KOGS

Genome sequencing (GS) is increasingly being used to diagnose rare diseases in paediatric patients; however, no measures exist to evaluate their knowledge of this technology. We aimed to develop a robust measure of knowledge of GS (the kids-KOGS') suitable for use in the paediatric setting as well as for general public education. The target age was 11 to 15 year olds. An iterative process involving six sequential stages was conducted to develop a set of draft true/false items. These were then administered to 539 target-age school pupils (mean 12.8; SD ± 1.3), from the United Kingdom. Item-response theory was used to confirm the psychometric suitability of the candidate items. None of the Items was identified as misfits. All 10 items performed well under the two-parameter logistic model. The internal consistency of the test was 0.84 (Cronbach alpha value) indicating excellent reliability. The mean kids-KOGS score in the sample overall was 4.24 (SD; 2.49), where 0 = low knowledge and 10 = high knowledge. Age was positively associated with score in a multivariate linear regression. The kids-KOGS is a short and reliable tool that can be used by researchers and healthcare professionals offering GS to paediatric patients. Further validation in a clinical setting is required.     

Use of an online community to develop patient-reported outcome instruments: the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ)

Background

Patients with multiple sclerosis (MS) may face barriers, such as treatment fatigue, memory problems, or side effects, that may influence their adherence to medication.

Objective

The objective of our study was to use an online community to develop a self-report questionnaire to quantify adherence and barriers to achieving adherence, that is specific to MS disease-modifying treatments (DMTs) and predictive of missed doses.

Methods

A review of the scientific literature and analysis of discussions between MS patients on PatientsLikeMe.com were used to generate survey items salient to patients. Cognitive debriefing was used to refine the items. The Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) contains 30 questions in three subscales: Barriers, Side Effects, and Coping Strategies.

Results

MS patients completed an online survey (response rate: 431 of 1209 invited, 35.7%). Between 16% (14/86) and 51% (51/100) of MS patients missed at least 1 dose of their DMT in the previous 28 days, with significant between-treatment differences. The MS-TAQ Barriers scale was positively correlated with the proportion of doses missed (r = .5), demonstrating a stronger relationship between adherence and perceived barriers than was found with clinical or demographic variables (r ≈ .3). The Coping Strategies subscale was negatively correlated with missed doses (r = -.3), suggesting that use of more coping strategies is associated with higher adherence.

Conclusions

Online communities can provide domains of interest and psychometric data to more rapidly develop and prototype patient-reported outcome instruments. The MS-TAQ offers patients and clinicians a simple method for identifying barriers to adherence, which may then be targeted through interventions.     

Testing the psychometric properties of the Ways of Coping Questionnaire (WCQ) in Turkish university students and community samples

Ways of Coping Questionnaire (WCQ) has been extensively used to assess coping styles in the clinical or non‐clinical context. The present study investigates the psychometric properties of WCQ in Turkish culture and attempts to get its shorter version by using three separate and independent samples (two groups of university students and one community sample). The constructive study was conducted with a sample of full‐time university students (N = 472) and it indicated that the most relevant factor structure was seven‐factor model. The factors were planful problem‐solving, seeking refuge in supernatural forces, keep to self, seeking social support, seeking refuge in fate, escape/avoidance and accepting responsibility. After that, confirmatory factor analysis was performed to test the adequacy of these factors with two different samples. Study 1 was conducted with a sample of university students (N = 485) and Study 2 was conducted with a sample of community (N = 416). Results demonstrated that seven‐factor solution revealed better results in both samples in terms of goodness of fit indexes in confirmatory factor analysis. The results of reliability and validity analysis revealed that psychometric properties of WCQ were acceptable. In addition to getting shorter version of WCQ, the present study enhances cross‐cultural information that increases awareness about the coping styles in a non‐western culture. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioners Message: ? Ways of Coping Questionnaire (WCQ) is a feasible measure especially for non‐native clinicians to understand the client's coping styles by exploring and being sensitive to his/her cultural values in order to establish therapeutic alliance throughout the therapy assess. ? Turkish version of WCQ includes specifi c dimensions of seeking refuge in fate and supernatural forces. ? Clinicians can assess behavioural as well as cognitive responses of coping behaviours by WCQ. ? WCQ can be used to identify focal point of the therapy when dealing with depression, negative affect and self esteem problems of Turkish clients.     

Applying Computerized Adaptive Testing to the Negative Acts Questionnaire-Revised: Rasch Analysis of Workplace Bullying

Background

Workplace bullying is a prevalent problem in contemporary work places that has adverse effects on both the victims of bullying and organizations. With the rapid development of computer technology in recent years, there is an urgent need to prove whether item response theory–based computerized adaptive testing (CAT) can be applied to measure exposure to workplace bullying.

Objective

The purpose of this study was to evaluate the relative efficiency and measurement precision of a CAT-based test for hospital nurses compared to traditional nonadaptive testing (NAT). Under the preliminary conditions of a single domain derived from the scale, a CAT module bullying scale model with polytomously scored items is provided as an example for evaluation purposes.

Methods

A total of 300 nurses were recruited and responded to the 22-item Negative Acts Questionnaire-Revised (NAQ-R). All NAT (or CAT-selected) items were calibrated with the Rasch rating scale model and all respondents were randomly selected for a comparison of the advantages of CAT and NAT in efficiency and precision by paired t tests and the area under the receiver operating characteristic curve (AUROC).

Results

The NAQ-R is a unidimensional construct that can be applied to measure exposure to workplace bullying through CAT-based administration. Nursing measures derived from both tests (CAT and NAT) were highly correlated (r=.97) and their measurement precisions were not statistically different (P=.49) as expected. CAT required fewer items than NAT (an efficiency gain of 32%), suggesting a reduced burden for respondents. There were significant differences in work tenure between the 2 groups (bullied and nonbullied) at a cutoff point of 6 years at 1 worksite. An AUROC of 0.75 (95% CI 0.68-0.79) with logits greater than –4.2 (or >30 in summation) was defined as being highly likely bullied in a workplace.

Conclusions

With CAT-based administration of the NAQ-R for nurses, their burden was substantially reduced without compromising measurement precision.     

The organizational trauma-informed practices tool (O-TIPs): Development and preliminary validation

The goal of the study was to develop and validate a simple, short, easy to self-administer, and cost-effective tool to assess organizational trauma-informed practices (O-TIPs), by building on existing tools. The tool was developed through a series of steps involving detailed examination, selection, and modification of existing trauma-informed (TI) frameworks and tools, which resulted in a 31-item questionnaire with three domains and eight subscales. The O-TIPs was evaluated for known-group construct validity to determine the degree to which it could discriminate between groups of organizations that were higher and lower on the extent to which they were implementing TIPs, by administering it online to staff at seven federally qualified health centers at two-time points. The domains, subscales, and the overall measure showed high internal consistency and discriminated significantly between known groups of centers at baseline and follow-up. In addition, the tool captured change over time in the extent to which the organizations were implementing TIPs. These findings provide preliminary support for the future use of the O-TIPs tool by service-delivery organizations.     

The structure of the General Health Questionnaire (GHQ-12): two meta-analytic factor analyses

The General Health Questionnaire (GHQ-12) is a popular measure of psychological distress. Despite its widespread use, an ongoing controversy pertains to its internal structure. Although the GHQ-12 was originally constructed to capture a unitary construct, empirical studies identified different factor structures. Therefore, this study examined the dimensionality of the GHQ-12 in two independent meta-analyses. The first meta-analysis used summary data published in 38 primary studies (total N?=?76,473). Meta-analytic exploratory factor analyses identified two factors formed by negatively and positively worded items. The second meta-analysis included individual responses of 410,640 participants from 84 independent samples. Meta-analytic confirmatory factor analyses corroborated the two-dimensional structure of the GHQ-12. However, bifactor modelling showed that most of the variance was explained by a general factor. Therefore, subscale scores reflected rather limited unique variance. Overall, the two meta-analyses demonstrated that the GHQ-12 is essentially unidimensional. It is not recommended to use and interpret subscale scores because they primarily reflect general mental health rather than distinct constructs.     

Measuring life event stress in the lives of college students: The Undergraduate Stress Questionnaire (USQ)

We describe the development of the Undergraduate Stress Questionnaire (USQ), a life events checklist designed to measure stress among undergraduates. Several studies demonstrate the USQ's validity. The USQ correlates positively with physical symptoms and negatively with mood. Students rated the USQ as the most complete and accurate of four different life events questionnaires. In a panel study, the USQ closely tracked subjective reports of stress, both during the term and finals week. The USQ predicted symptoms more reliably than three other stress measures, controlling for negative affect. Students waiting in the college infirmary score higher on the USQ than students socializing on campus. Finally, we compare the checklist format to subjective scaling, and show the superiority of the checklist version. We discuss the usefulness of the USQ in terms of validity, representativeness, adaptability, brevity, and low confounding with negative affect.     

The Pregnancy Related Beliefs Questionnaire (PRBQ): An examination of the psychometric properties in perinatal samples

Background

Identifying vulnerability to perinatal depression is an important public health issue. Risk factors include general and maternal‐specific dysfunctional attitudes. Scales of maternal attitudes have a number of shortcomings. Further, it is not known whether antenatal maternal attitudes predict post‐natal depression, independently of general dysfunctional attitudes (GDA). The aim of the current study was to examine the psychometric properties of the Pregnancy Related Beliefs Questionnaire (PRBQ) and to establish, prospectively, the utility of the revised PRBQ in predicting the symptoms of post‐natal depression.

Method

In Study 1, a cross‐sectional sample of 344 participants, who were either pregnant or in the post‐natal period, completed a battery of questionnaires assessing background factors, GDA, attitudes specific to motherhood (PRBQ), and depression. In Study 2, a sample of 210 women completed a battery of questionnaires, including a measure of GDA, the PRBQ‐8, and depression, on two occasions: early in the second trimester of pregnancy and post‐natally.

Results

Exploratory and confirmatory factor analyses supported a one‐factor, eight‐item measure of maladaptive attitudes specific to motherhood (PRBQ‐8). The PRBQ‐8 was found to have good convergent, concurrent, and predictive validity and high internal and test–retest reliability. A hierarchical regression analysis revealed that antenatal PRBQ‐8 scores predict the severity of post‐natal depression symptoms, after controlling for background factors, antenatal depression, and GDA.

Conclusions

The PRBQ‐8 is a psychometrically sound measure of maternal attitudes that can be used antenatally to identify women at risk of post‐natal depression.