Family functioning perceived by patients and their family members in three Diagnostic and Statistical Manual-IV diagnostic groups

The aim of this study was to clarify the difference in the perception of family functioning measured on the Family Assessment Device (FAD) by Diagnostic and Statistical Manual-IV diagnoses (i.e. schizophrenia, major depressive disorder and bipolar disorder) and by raters (patients and family members). The subjects were 70 psychiatric outpatients paired with their family members (i.e. principal caretaker), divided into three groups based on the patient's diagnosis of schizophrenia (24 pairs), major depressive disorder (28 pairs) or bipolar disorder (18 pairs). They rated their perceived family functioning on the FAD. There was no significant difference in perceptions of family functioning between the three groups of family members, while there were differences between the patient groups in some FAD dimensions. Perceptions of family functioning were not significantly correlated between the schizophrenic patients and their family members. The perceptions of family functioning were correlated more strongly between patients and their family members in the bipolar group than between patients and family members in the other two diagnostic groups. As for the FAD Problem Solving dimension, the schizophrenia patients saw it more negatively than did their family members, whereas the depressive patients saw it more positively than did their family members. These results might reflect psychopathological characteristics of each disorder. When clinicians evaluate the family functioning of psychiatric patients, it is important to consider the diagnoses of patients as well as who assesses it.     

Brief report: Development of the family perceptions scale; a novel instrument for evaluating subjective functioning in the families of adolescents

A pool of 75 items relating to family functioning was created and piloted in a sample of 12-18 year olds (N = 673). The responses were subjected to an exploratory factor analysis which indicated the presence of three significant latent traits. The results were then used to inform the development of a rating instrument with five subscales labelled Nurture, Problem Solving, Expressed Emotion, Behavioural Boundaries and Responsibility. These demonstrated high levels of internal consistency (Cronbach’s alphas .70-.81), high test-retest reliability (rho = .70-.82), varying degrees of intercorrelation (rho = .18-.75) and significant associations with family functioning as defined by the McMaster Family Assessment Device (p < 0.0001 in all cases). This novel instrument is a promising tool for use in both clinical practice and research.     

A Spanish version of the Family Assessment Device

Introduction  

This paper presents the results of a study on the psychometric properties of an authorized Spanish version of the McMaster Family Assessment Device, a self-report measure of family functioning.     

The Brief Assessment of Family Functioning Scale (BAFFS): a three-item version of the General Functioning Scale of the Family Assessment Device

The purpose of the present study is to compare results from the 12-item General Functioning Scale (GF-FAD) of the Family Assessment Device (FAD) to a three-item version, the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important. We used principal components analysis of the GF-FAD, followed by multiple sample confirmatory factor analyses to test the robustness of the BAFFS in different samples. The BAFFS correlated highly with the GF-FAD, and demonstrated good concurrent validity with another measure of global marital functioning, the Dyadic Adjustment Scale-4 in a help-seeking sample. Like the 12-item version, the BAFFS moderately correlated with an objective, interview-based rating of family functioning, the McMaster Clinical Rating Scale. The BAFFS appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.     

The Questionnaire of Family Functioning: A Preliminary Validation of a Standardized Instrument to Evaluate Psychoeducational Family Treatments

The aim of the study was to develop and preliminarily validate a self-completed questionnaire that could help in the assessment of families before and during psycho-educational interventions. The questionnaire was developed according to the cognitive-behavioural psycho-educational model. From an initial 38-item version of the questionnaire, a final shorter 24-item version was derived. The validation study of the final version was conducted on relatives of schizophrenic and schizoaffective patients: 31 for the test–retest reliability study and 92 for the confirmation of the subscales and convergent validity study vs. SF-36 and the questionnaire on Family Problems, PF. The final questionnaire showed good psychometric properties. The three-core dimensions of Problem-Solving, Communication Skills, and Personal Goals were clearly outlined in the items correlation analysis. The association with family burden and health-related quality of life was as expected. The FF provides a promising assessment of the family functioning pattern that is the object of psychoeducational family interventions. Further studies are needed to confirm the validity of the instrument, that could be helpful both in planning and in monitoring psycho-educational interventions and in mental health promotion projects. Rita Roncone, Monica Mazza, Donatella Ussorio, Rocco Pollice, Ian R.H. Falloon, Pierluigi Morosini and Massimo Casacchia are affiliated with the Department of Experimental Medicine-Psychiatry, University of L'Aquila, Via Vetoio, Coppito2, I- 67100, L'Aquila, Italy Massimo Casacchia is also affiliated with National Health Institute, Surveillance, and Health Promotion, Viale Regina Elena 299, I - 00161, Roma, Italy Address correspondence to Rita Roncone, M.D., Department of Experimental Medicine-Psychiatry, University of L'Aquila, Via Vetoio, Coppito2 I- 67100, L'Aquila, Italy; e-mail: rita.roncone@cc.univaq.it Ian R.H. Falloon - Deceased author     

Reliability and sensitivity to change of the Family Life Questionnaire in a clinical population

Background: The Family Life Questionnaire (FLQ) is a new measure of family functioning, which acknowledges that the experience of the family unit may vary between different children. This study examined the reliability and sensitivity to change of the FLQ in a clinical population. Method: The FLQ was administered to 91 parents attending the first session of the Incredible Years parenting programmes in Devon during 2009, 71 of them completed it on a second occasion a week later and 55 on a third occasion at the end of the programme. Internal consistency, test–retest reliability and sensitivity to change were calculated. Results: Internal consistency and test–retest reliability of the scales varied between moderate and very good, except for the discipline and special allowances items which had poor internal consistency when grouped as a scale. The measures showed promising evidence of sensitivity to change. Conclusions: The FLQ is a reliable measure of family function that seems sensitive to change. There is some evidence of validity but a lack of suitable comparators limited this part of the study. The study sample was too small to explore the scale structure.     

Threshold 2: the reliability,validity and sensitivity to change of the Threshold Assessment Grid (TAG)

OBJECTIVE: This study investigated the psychometric properties of the Threshold Assessment Grid (TAG), a new assessment of the severity of mental health problems. METHOD: A total of 605 patients were recruited from 10 mental health adult and elderly services in London, UK. TAG ratings and other standardized definitions of severe mental illness were completed by referrers. TAG, Global Assessment of Functioning (GAF), Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and Health of the Nation Outcome Scale (HoNOS) ratings were completed by mental health service staff. Construct validation on extreme groups was investigated. RESULTS: Construct and concurrent validity were good. Referrer TAG scores predicted mental health team view of referral suitability, but not whether assessments were offered. Test-retest reliability was good, interrater reliability ranged from good to poor in different domains (but adequate for total TAG score), internal consistency was appropriate. Sensitivity to change requires further investigation. CONCLUSION: The TAG can be recommended for use by all agencies when making referrals to mental health services.     

A confirmatory factor analysis of the 12-item General Health Questionnaire among older people

BACKGROUND: the 12-item General Health Questionnaire (GHQ) is useful in measuring psychiatric morbidity in older people. Previous studies of its factor structure were often based on samples of young persons and on exploratory factor analysis techniques. The results varied from suggesting one to three factors. METHODS: this study involved 2123 participants aged over 60 and 7490 younger adults in a population-based survey in Britain. It compared the relative plausibility of several factor structures proposed by previous researchers, as indicated by the Akaike's Information Criterion and the Non-Normed Fit Index. Correlation between factors and internal consistency were examined. Mean subscale scores by demographic characteristics were analysed by ANOVA for the best-fit model. RESULTS: the 3-factor structure proposed by Graetz gave the best fit in both older and younger people. The properties of this model in older people were examined in details. The patterns of internal consistency and between-factor correlation were found satisfactory. Differences and similarities in subscale scores between demographic groups e.g. marital status, were presented. CONCLUSION: the 12-item General Health Questionnaire may measure three aspects of mental health, namely Anxiety and Depression, Social Dysfunction, and Loss of Confidence.     

Psychometric properties of the Trauma Assessment for Adults

Background: The Trauma Assessment for Adults (TAA) was developed to facilitate the assessment of exposure to traumatic events that could result in posttraumatic stress disorder (PTSD). The TAA inquires about numerous potentially traumatic events that an individual may have experienced. Although the TAA has been used extensively for clinical and research purposes, its psychometric properties have never been formally evaluated. The objective of the present investigation was to evaluate the psychometric properties of this frequently used measure. Methods: The studies reported here describe the performance of the TAA in two samples—college undergraduates (N=142) and community mental health center clients (N=67). Among undergraduates, 1‐week temporal stability was evaluated and, in both samples, item‐ and scale‐level convergence of the TAA with an established trauma exposure measure was assessed. Convergence of the TAA with clinically related constructs was also evaluated. Results: The TAA exhibited adequate temporal stability (r=.80) and satisfactory item‐level convergence with existing measures of trauma history among college students. In the clinical sample, the TAA again converged well with an established measure of trauma exposure (r=.65). It was not as strongly predictive, in either sample, of trauma‐related distress relative to an alternate trauma exposure measure. Conclusion: Although it performs satisfactorily, the TAA does not appear to be superior to other existing measures of trauma exposure. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

A latent class analysis of psychosis-like experiences in the New Zealand Mental Health Survey

Gale CK, Wells JE, McGee MA, Oakley Browne MA. A latent class analysis of psychosis‐like experiences in the New Zealand Mental Health Survey. Objective: To describe the underlying structure of psychosis‐like experiences in the New Zealand Mental Health Survey. Method: A nationwide survey of household residents aged 16+ years was undertaken (n = 7435), using the Composite International Diagnostic Interview (3.0), including a six question lifetime screener for psychosis. Participants were grouped in three ways: by the number of ‘symptoms’ (occurring when not dreaming, half‐asleep or under the influences of drugs) and by latent classes derived from binary responses (no/yes) or ordinal responses (never/sub‐threshold/few times/many times). Results: Psychosis‐like events were not uncommon (7.3%; 95% CIs 6.5–8.1), particularly experiences of visual (5.3%; 95% CIs 4.7–6.0) or auditory hallucinations (2.8%; 95% CIs 2.3–3.3). Both latent class analyses indicated a ‘normal’ class, a ‘hallucinatory class’ and a ‘psychotic’ class. The lifetime probability of anxiety, mood or substance disorders and the lifetime probability of seeking help for mental health problems increased from ‘normal’ to ‘hallucinatory’ to ‘psychotic’ classes and with the ‘symptom’ count. Conclusion: The presence of sub‐threshold events and variation in the number of times a ‘symptom’ is experienced suggest a psychosis continuum. However, the latent classes labelled ‘hallucinatory’ and ‘psychotic’ differ markedly in symptomatology, which suggests some form of discrete clustering.     

Expressed emotion: a Swedish version of the Camberwell Family Interview.

A Swedish version of the Camberwell Family Interview (CFI), a psychiatric, semistructured interview schedule for assessing a family's emotional atmosphere, is described. Thirty-two relatives of patients with schizophrenic disorders, according to DSM-III criteria, were interviewed. Eighteen relatives were interviewed twice, before and after one part of a psychoeducational programme. The total number of interviews analysed was 50. Two independent investigators rated the audiotape-recorded interviews to test the interrater reliability of 5 different measures of expressed emotion (critical remarks, hostility, emotional overinvolvement, warmth and positive remarks). High interrater reliabilities were found for the frequency scales, i.e. critical remarks and positive remarks. For the global scales the interrater reliabilities were lower. The use of only one interviewer, the interviewer being one of the raters and shortage of co-training probably influence the reliability. The CFI schedule could probably gain in clarity, structure and shortness in a revised form, although the interview time cannot be reduced to less than 1.5 h. The ratings of measures of expressed emotion are quite complicated and require extensive and specific training of the raters. The total procedure is complex, time-consuming and not easily learned. In its present form, the CFI probably discourages clinicians and researchers from using it.     

Reliability and validity of the Chinese version of the Caregiver Reaction Assessment

Aims: The aim of this study was to examine the reliability and validity of the Chinese version of the Caregiver Reaction Assessment, as part of a psychosocial study among family caregivers of cancer patients. Methods: Participants were derived from the Second Affiliated Hospital of China Medical University in Shenyang, China. The research established the internal consistent reliability, test–retest reliability and construct validity. Results: The research comprised 400 family caregivers. The Chinese version of the Caregiver Reaction Assessment showed adequate internal consistency reliability, test–retest reliability and appropriate construct validity. After adjusting items 4, 8, 15 and 18, confirmatory factor analysis confirmed the five new factors of the Chinese version of the Caregiver Reaction Assessment had goodness of fit. Conclusions: These findings suggest that the Chinese version of the Caregiver Reaction Assessment is a reliable and valid instrument for measuring specific aspects of the caregiving experience in the Chinese population.