Development and validation of the Geriatric Anxiety Inventory

BACKGROUND: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people. METHODS: We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale. RESULTS: Cronbach's alpha for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test-retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%. CONCLUSIONS: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.     

Therapeutic Agency Inventory: Development and psychometric validation of a patient self-report

Abstract

Objectives: Therapeutic agency is defined as a patient’s intentional influence over the process of psychotherapeutic change. However, there is a lack of conceptually sound self-report measures with adequate psychometric properties. The aim of this study was to develop and psychometrically evaluate the patient-rated Therapeutic Agency Inventory (TAI).

Method: Based on the literature, we developed items related to therapeutic agency and investigated their psychometric properties in a naturalistic study with a sample of 334 psychotherapy participants. We assessed changes in TAI scores in a subsample of 58 patients over the course of inpatient psychotherapy and related TAI scores to therapeutic improvement.

Results: The TAI consists of 15 items. We performed exploratory factor analyses, and the following three factors were extracted: In-session activity, therapy-related processing, and therapist-oriented passivity. Internal consistency was .84 for the total score and ranged between .73 and .80 for each of the factors. The TAI was significantly associated with other psychotherapy process factors, self-efficacy expectations, control beliefs, lower overall psychological distress, and lower depression scores. Changes in agency during psychotherapy predicted therapy outcome, even after controlling for baseline distress.

Conclusions: The TAI is a reliable, valid, and change-sensitive self-report instrument that can be used to assess agency in psychotherapy.     

Development and validation of the Asian Migraine Criteria (AMC)

Physicians often do not use the International Classification of Headache Disorders (ICHD-II) for diagnosis of migraine in their routine clinical practice. The diagnosis of headache subtypes in 453 patients was made by headache experts according to the ICHD-II and the likelihood ratios (LR) of clinical characteristics of migraine were calculated in Part I of the study. Asian headache specialists designed the Asian Migraine Criteria (AMC) based on these LR and their experience. In Part II of the study, another group of 500 patients with headache were evaluated by a family physician, based on the AMC. Thereafter the headache experts, who were blinded to the diagnosis of these patients based on the AMC, re-evaluated them according to the ICHD-II. The AMC consists of seven items: (i) unilateral location; (ii) throbbing quality; (iii) nausea and/or vomiting; (iv) photophobia and/or sonophobia; (v) osmophobia; (vi) family history of migraine; and (vii) aura. In the AMC the presence of at least three items in adults and at least two items in children is necessary for the detection of definite migraine. The AMC had a sensitivity 99.3%, specificity 84.5%, positive predictive value (PPV) 96.9%, negative predictive value (NPV) 96.1% and validity of 96.8% for diagnosis of adult migraine compared to the ICHD-II as the gold standard. The AMC had a sensitivity 93.5%, specificity 46.8%, PPV 69.9%, NPV 86.6% and a validity of 73.4% for detection of childhood migraine against the ICHD-II. The AMC was shown to be a highly valid and reliable tool for screening of adult migraine by non-neurologists. AMC was shown to be moderately valid for detection of pediatric migraine.     

Cultural translation and Tunisian validation of the Drug Attitude Inventory (DAI-30) in outpatients with schizophrenia

BackgroundNon-adherence to treatment in patients with schizophrenia is associated with increased hospitalization, higher health care costs, and poorer long-term outcomes in terms of relapse rates. It is established that a negative drug attitude was a risk factor for non-adherence in long-term schizophrenia. The scale “Drug Attitude Inventory" is one of the scales designed to assess this concept. It has been translated and validated in different languages. However, its psychometric properties have not yet been studied in our sociocultural context.ObjectivesThe aims of this study were to translate into Tunisian Arabic dialect the scale “Drug Attitude Inventory" with 30 dichotomous items (DAI-30) and validate it in Tunisian sociocultural context in patients with schizophrenia.Materials and methodsThis study was performed in 234 outpatients with schizophrenia, recruited through a random drawing. These patients are in remission and meet remission criteria proposed by “The Remission in schizophrenia Working Group". We recruited 30 patients for pretest and 204 patients for linguistic validation.Forward and backward translation of the DAI-30 was performed according to the protocol of the “MAPI Research Institute". This final version was submitted to 24 experts and followed by a pretest.Construct validity has been established by performing a principal component analysis factor on a sample of 204 patients. Internal consistency was assessed by Cronbach alpha coefficient and inter-rater reliability was assessed by the use of Intra-Class Correlation coefficient (ICC). For the test–retest reliability evaluation, the “r” Pearson's coefficient was used between the DAI scores obtained in the initial evaluation and those obtained at 15 days.ResultsRegarding construct validity, factor analysis revealed seven factors that were responsible for 59.9% of the variance. The study of internal consistency between the 30 items was rated good (α = 0.88). The test–retest reliability was satisfactory (r = 0.99, p < 10⁻³), as well as inter-rater reliability (ICC = 0.99).ConclusionIn the Tunisian cultural context, the DAI-30 presented seven factors with good consistency and an inter-rater reliability.     

Development and initial validation of the Performance Skills Questionnaire (PSQ)

The objectives of this study was to develop and test the psychometric properties of the Performance Skills Questionnaire (PSQ), addressed to measure performance skills of preschoolers, as reported by their parents. Participants included 231 children ranging in age from 4 to 6 years old, with mild to moderate developmental disabilities and 240 children without disabilities at same age range. Internal consistency, test–retest, construct validity, and divergent and convergent validity were assessed. The PSQ has shown good internal reliability, and temporal stability. Construct validity was supported by factor analysis which yielded 3 factors that explained almost 52% of the total variance. Significant differences were found between known groups. Convergent and divergent validity were supported by significant correlations with Visual-Motor Integration (VMI) test, and the Children Participation Questionnaire (CPQ). The PSQ is a unique tool that measures performance skills based on preschool children's everyday function. Results provide evidence in support of the PSQ as a reliable and psychometrically sound instrument.     

Development and validation of the Diagnostic Interview Adjustment Disorder (DIAD)

Adjustment disorders (ADs) are under‐researched due to the absence of a reliable and valid diagnostic tool. This paper describes the development and content/construct validation of a fully structured interview for the diagnosis of AD, the Diagnostic Interview Adjustment Disorder (DIAD). We developed the DIAD by partly adjusting and operationalizing DSM‐IV criteria. Eleven experts were consulted on the content of the DIAD. In addition, the DIAD was administered by trained lay interviewers to a representative sample of disability claimants (n = 323). To assess construct validity of the DIAD, we explored the associations between the AD classification by the DIAD and summary scores of the Kessler Psychological Distress 10‐item Scale (K10) and the World Health Organization Disability Assessment Schedule (WHODAS) by linear regression. Expert agreement on content of the DIAD was moderate to good. The prevalence of AD using the DIAD with revised criteria for the diagnosis AD was 7.4%. The associations of AD by the DIAD with average sum scores on the K10 and the WHODAS supported construct validity of the DIAD. The results provide a first indication that the DIAD is a valid instrument to diagnose AD. Further studies on reliability and on other aspects of validity are needed. Copyright © 2014 John Wiley & Sons, Ltd.     

Development and validation of the Heidelberg Neurological Triage System (HEINTS)

Journal of Neurology - Neurological syndromes are underrepresented in existing triage systems which are not validated for neurological patients; therefore, we developed and validated the new...     

Development and validation of the Experiential Avoidance in Caregiving Questionnaire (EACQ)

Objective: Providing care to a relative with dementia is associated with negative health consequences. Experiential avoidance has been found to be related to caregivers’ distress. However, no specific measure of experiential avoidance in the caregiving context is available. The aim of this study is to develop and present the psychometric properties of the Experiential Avoidance in Caregiving Questionnaire (EACQ).Method: Face-to-face interviews were conducted with 263 dementia family caregivers (mean age = 61.37; SD = 14.84; 78.3% female). In addition to the EACQ, the Action and Acceptance Questionnaire (AAQ) was used. Depression, anxiety, alexithymia, cognitive fusion, dysfunctional thoughts about caregiving, and mean arterial pressure were also measured.Results: Using principal component analysis, three factors were retained that explained 44.75% of the variance. These factors were labeled: (1) Active Avoidant Behaviors; (2) Intolerance of Negative Thoughts and Emotions Towards the Relative; and (3) Apprehension Concerning Negative Internal Experiences Related to Caregiving. Acceptable reliability indexes (Cronbach's alpha) were found for each factor (.63 for factor 1; .71 for factor 2; and .60 for factor 3) and the total scale (α = .70). Significant positive associations were found between the global scale and anxiety, dysfunctional thoughts, alexithymia and the AAQ.Conclusion: The EACQ shows acceptable psychometric properties and may be a useful tool for clinical assessment and therapeutic work with caregivers.     

Development and initial validation of the Preschool Imitation and Praxis Scale (PIPS)

The goal of this study was to develop and subsequently evaluate the internal construct and criterion-related validity of the Preschool Imitation and Praxis Scale (PIPS). Different task characteristics were selected considered to be important as unravelled in research in apraxic adults to tap a broad range of possible imitation mechanisms. Participants included 498 children without disabilities (1–4.9 years) and 47 children with autism spectrum disorders (ASD) (1.9–4.5 years). Exploratory factor analysis disclosed 4 dimensions in the scale, labelled: goal directed versus non-goal directed procedural imitation and single versus sequential bodily imitation. Internal consistency for the PIPS scale (α = .97) and subscales was high (α ranged from .79 to .96). In both samples, the PIPS scale score was strongly related to age (r = .78, respectively r = .56). Significant relationships between the PIPS score and mental, language, motor ages in the ASD sample supported criterion-related validity (r ranged from .59 to .74). The PIPS appears to have fundamentally sound psychometric characteristics, although more research is needed.     

Development and validation of the Physical Appearance State and Trait Anxiety Scale (PASTAS)

The current paper reports on the development and validation of trait and state versions of the Physical Appearance State and Trait Anxiety Scale (PASTAS) on a sample of 205 college females. The single trait and three state versions have excellent internal consistencies and test-retest reliabilities. Principal components analysis revealed two clear-cut components that were labeled the Weight (W) and Non-Weight (NW) scales. The PASTAS-W correlated highly with available measures of body dissatisfaction, appearance evaluation, and eating disturbance, whereas the PASTAS-NW was not associated with these variables. Eating-disturbed individuals has significantly higher PASTAS-W scores than subjects with little evidence of eating disturbance, across all three anxiety situations (high, medium, low). There was no effect of eating disturbance for PASTAS-NW scores; however, the situational effect held. The PASTAS-W also added to other measures' ability to explain variance associated with level of eating disturbance. It was concluded that the trait and state versions of the PASTAS may prove to be useful tools for research in the areas of body image and eating disturbance.     

Development and validation of the Observation List for early signs of Dementia (OLD)

OBJECTIVE: Development and validation of a short Observation List of possible early signs of Dementia (OLD) for use in general practice. DESIGN: Stepwise development using reviews of publications and expert consensus. Field study for evaluation of reliability. Validation study (interviews, family forms) using existing valid and reliable measures. Use of data reduction techniques to construct a short version. Setting of field study Twenty-two GPs in 19 Dutch practices. PARTICIPANTS: The first two patients seen on 15 working days (n = 470) were observed. Inclusion: age > 75, without a known diagnosis of dementia. Exclusion: psychiatric treatment, severe depression, acute illness with confusion. Division of patients into three groups with no, intermediate, and the most signs (total of interviewed patients, n = 60; family forms, n = 39). Outcome measures Reliability (Cronbach's alpha and factor-analysis). Convergent validity using the Cognitive Screening Test (CST), the Word Learning Test (WLT, total and retention), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Groningen Activities Restriction Scale (GARS), and an IADL scale. Discriminant validity using the geriatric depression scale (GDS). Construct validity using a Principal Component Analysis (PRINCALS). Incremental validity using the intuitive opinion of the GP (McNemar test). RESULTS: Reliability in the total group 0.88, first factor explained variance 42.5%. Convergent validity (two-way ANOVA) results: CST (p = 0.00), WLT-total (p = 0.001), WLT retention (p = 0.00), IQCODE (p = 0.09). No statistically significant differences for GARS and IADL. GDS (p = 0.30) not different. PRINCALS first factor explained 48% of variance. The OLD added to the GP opinion (McNemar p = 0.00). Reliability short version 0.89 (interviewed group), 0.86 (total group). CONCLUSIONS: The OLD is a valid and reliable method to detect early signs of dementia in general practice that can indicate when it may be useful to employ existing screening instruments.     

A comparison of the Major Depression Inventory (MDI) and the Beck Depression Inventory (BDI) in severely depressed patients

Abstract

Background. We set out to examine the psychometric properties of the MDI in comparison to the BDI in a mixed group of patients with primary depression. Methods. At the Department of Biological Psychiatry in Vienna currently depressed inpatients with either a depressive or a schizo-affective disorder filled out both MDI and BDI on day of admission and at a time-point two weeks later during their treatment. Furthermore the Hamilton Depression Scale (HAM-D) was administered by the treating clinician at both time-points. Results. In total, 51 patients were included in the study. The non-parametric item response analysis was preferred to the classical Cronbach coefficient α as the latter is influenced by the number of items in a questionnaire. MDI obtained a Mokken analysis coefficient above 0.40, indicating unidimensionality. To determine external validity severely depressed patients with psychotic symptoms (N = 10) were compared to the remaining non-psychotic depressed patients (N = 41). Although BDI and MDI showed a lower score for psychotic than for non-psychotic inpatients, the standard deviations for both were greater for psychotic inpatients. On the intercorrelations between the different scales, MDI showed for all coefficients values above 0.70. On the other hand BDI and MDI both showed the same degree of linear relationship as the usual versions of HAM-D. Conclusion. Our results demonstrate that the MDI had the highest coefficients values and was sufficient as a measure for depressive disorders in psychiatric patients.