Measuring individual true change with PROMIS using IRT-based plausible values.

AIMS: A primary advantage of IRT-based patient-reported outcome measures such as PROMIS short forms and computer-adaptive tests is that each estimate of the latent trait comes with a standard error. Such measurement error needs to be acknowledged, in particular when monitoring individual patients over time. In this study, we use plausible values to account for measurement error and analyze the probability of true within-individual change. METHODS: We use a longitudinal, observational study of stable and exacerbated COPD patients (N = 185), providing PROMIS Physical Function and Fatigue T-scores over 3 months. At each measurement, we imputed 1000 plausible values from the scores' posterior distribution. These were then used to calculate probability of true change using a pre-specified threshold such as minimally important difference supported by the literature, or [Formula: see text] > 0. We demonstrate assessment of change in individuals and in groups, across different measures (Short Forms and CATs), and at various levels of confidence. RESULTS: Using plausible value imputation and with 95% certainty, 47.5% of participants in the exacerbated group reported less fatigue, compared with 26.5% of participants in the stable group. Comparison of Short Forms and CATs suggests that CATs have better ability to detect change compared to short forms. We also illustrate this method using an individual's probability of change at different time points. CONCLUSION: Plausible values offer a flexible way to include measurement error in analysis of individuals and on sample level. Assessment of probability of true change can complement existing distribution-based approaches and facilitates interpretation of improvement or decline.

How client death impacts home care aides' workforce outcomes: an exploratory analysis of return to work and job retention.

Home health aides face a range of stressors that may result in departing the workforce. One stressor that has emerged in multiple qualitative studies as potentially influencing retention is client death. Using 2019 data from a single agency in New York City employing approximately 1700 aides, we used logistic and linear regression to explore case and aide factors associated with workforce outcomes after client death. We found that longer case length (Beta = 0.01, p < .001) was associated with longer return to work for aides experiencing client death and longer job tenure (Beta = -0.002, p = .002) was associated with shorter return to work (n = 67). We found no difference in retention between aides who experienced client death and those who did not (n 216). This analysis suggests the importance of research on the period of time following client death and of offering support to aides after clients die, particularly after longer cases.

Individual factors and cisgender college students' attitudes and behaviors toward transgender individuals.

The present study is one of few to investigate both anti-trans discrimination and anti-trans prejudice. It examined four individual factors (religiosity; political beliefs; affiliation with LGBTQ [lesbian, gay, bisexual, transgender, and queer] people; gender role beliefs) through a lens of hetero-cis-normativity to understand their association with anti-trans attitudes and reported behaviors. Using a sample of 302 cisgender college students from across the United States, hierarchical multiple regressions on bootstrap samples were used to analyze how these factors are associated with anti-trans attitudes and behaviors. More liberal political beliefs, affiliation with more LGBTQ friends and family members, and less traditional gender role beliefs were related to more positive attitudes toward transgender people. Less traditional gender role beliefs and more positive attitudes were associated with more positive reported behaviors toward transgender individuals. Interventions designed to challenge traditional gender role beliefs and approximate affiliation with LGBTQ persons may be most effective to reduce pervasive hetero-cis-normative prejudice and discrimination within schools.

Measuring Trauma Exposure: Count Versus Variety of Potentially Traumatic Events in a Binational Sample.

Traumatic event checklists typically ask respondents to indicate whether they have experienced particular types of potentially traumatic events (PTEs) and then sum these endorsements to gauge cumulative trauma exposure. However, the sum of these endorsements indicates the variety of PTEs respondents have experienced rather than the count of exposure events. The main objective of the present study was to explore the association between PTE count and variety to examine assumptions regarding the use of traumatic event checklists to measure cumulative trauma exposure. The limited empirical research suggests that count and variety are strongly associated; however, there may be variation in magnitude concerning whether participants' environments confer an increased or decreased risk of exposure. We present Life Event Checklist data from a large sample of Mexican and U.S. participants (n = 1,820), which allowed us to compare reports of count and variety. Count and variety were strongly correlated, Kendall's tau-b = .74, such that count accounted for 54.6% of the variance in variety. A negative binomial regression analysis revealed that this association was moderated by county and municipio homicide rate, used as a proxy for violent crime, but not by natural disaster history. Variety was more strongly associated with scores on the Posttraumatic Stress Checklist for DSM-5, Kendall's tau-b = .26, than was PTE count, Kendall's tau-b = .22, Fisher's z = -8.04, p < .001. Although there are challenges in estimating PTE counts, the present findings suggest that PTE variety is not a good proxy for cumulative trauma exposure.

A five-sample confirmatory factor analytic study of burnout-depression overlap.

OBJECTIVE: It has been asserted that burnout-a condition ascribed to unresolvable job stress-should not be mistaken for a depressive syndrome. In this confirmatory factor analytic study, the validity of this assertion was examined. METHODS: Five samples of employed individuals, recruited in Switzerland and France, were mobilized for this study (N = 3,113). Burnout symptoms were assessed with the Shirom-Melamed Burnout Measure, the Maslach Burnout Inventory (MBI)-General Survey, and the MBI for Educators. Depressive symptoms were measured with the PHQ-9. RESULTS: In all five samples, the latent factors pertaining to burnout's components correlated on average more highly with the latent Depression factor than with each other, even with fatigue-related items removed from the PHQ-9. Second-order factor analyses indicated that the latent Depression factor and the latent factors pertaining to burnout's components were reflective of the same overarching factor. CONCLUSIONS: This study suggests that the burnout-depression distinction is artificial.

Network models can help focus research on the role of culture and context in psychopathology, but don't discount latent variable models.

Borsboom et al. correctly note that the use of latent variable models in cross-cultural research has resulted in a futile search for universal, biological causes of psychopathology; however, this is not an inevitable outcome of such models. While network analytic approaches require further development, network models have the potential to better elucidate the role of cultural and contextual variables related to psychopathology.

Measurement invariance of the Pandemic Anxiety Inventory in different demographic groups.

BACKGROUND: The Pandemic Anxiety Inventory (PAI) was developed in the context of the COVID-19 pandemic. Its content allows it to assess anxiety in connection to any pandemic. Previous research has demonstrated the instrument's reliability and validity. An important question for clinicians and researchers, however, remains open: Does the PAI have similar meaning for members of different demographic groups? The finding of measurement invariance would allow clinicians and researchers to comparatively assess pandemic-related anxiety across demographic groups, including favored and disfavored groups. METHODS: We conducted a multi-group confirmatory factor analysis to assess the measurement invariance of the PAI using data obtained from a sample of 379 residents of the United Kingdom. RESULTS: The PAI demonstrated invariance across genders, age groups, individuals who are married or in a relationship and those who are not, as well as individuals with higher and lower incomes. In an ancillary analysis, we found invariance across subsamples of Whites and Nonwhites, although we note that the Nonwhite group was small (n = 60) and heterogeneous. The findings of a supplemental MIMIC analysis were consistent with the above. CONCLUSIONS: The PAI shows measurement invariance across a variety of demographic groups. Our findings suggest that the instrument can be meaningfully employed to compare pandemic-related anxiety across these groups.

TBscore II: refining and validating a simple clinical score for treatment monitoring of patients with pulmonary tuberculosis.

BACKGROUND: The TBscore, based on simple signs and symptoms, was introduced to predict unsuccessful outcome in tuberculosis patients on treatment. A recent inter-observer variation study showed profound variation in some variables. Further, some variables depend on a physician assessing them, making the score less applicable. The aim of the present study was to simplify the TBscore. METHODS: Inter-observer variation assessment and exploratory factor analysis were combined to develop a simplified score, the TBscore II. To validate TBscore II we assessed the association between start score and failure (i.e. death or treatment failure), responsiveness using Cohen's effect size, and the relationship between severity class at treatment start and a decrease < 25% in score from the start until the end of the second treatment month and subsequent mortality. RESULTS: We analyzed data from 1070 Guinean (2003-2012) and 432 Ethiopian (2007-2012) pulmonary tuberculosis patients. For the refined score, items with less than substantial agreement (κ ≤ 0.6) and/or not associated with the underlying constructs were excluded. Items kept were: cough, dyspnea, chest pain, anemia, body mass index (BMI) < 18 kg/m(2), BMI < 16 kg/m(2), mid upper arm circumference (MUAC) < 220 mm, and MUAC < 200 mm. The effect sizes for the change between the start of treatment and the 2-month follow-up were 0.51 in Guinea-Bissau and 0.68 in Ethiopia, and for the change between the start of treatment and the end of treatment were 0.68 in Guinea-Bissau and 0.74 in Ethiopia. Severity class placement at treatment start predicted failure (p < 0.001 Guinea-Bissau, p = 0.208 Ethiopia). Inability to decrease at least 25% in score was associated with a higher failure rate during the remaining 4 months of treatment (p = 0.063 Guinea-Bissau, p = 0.008 Ethiopia). CONCLUSION: The TBscore II could be a useful monitoring tool, aiding triage at the beginning of treatment and during treatment.

Developing a personal health record self-efficacy tool.

The purpose of this preliminary work was to develop a new short tool to assess personal health records (PHRs) self-efficacy. Prior work had found 4 distinct skills related to creating, updating, tracking symptoms, and sharing information with health care providers using PHR. Although PHRs have great promise, their uptake has been rather limited, especially in economically limited populations. A convenience sample of community-living persons with HIV/AIDS (N = 100) was asked to complete the new tool along with other self-efficacy measures. Preliminary work indicated more confidence about paper-based PHRs compared with computer-based PHRs. The paper-based subscale was significantly correlated to chronic illness and HIV treatment self-efficacy scales as expected, but there were no relationships for the computer-based subscale. This simple screening tool could identify interested clients and their preference either for a paper-based or computer-based PHR. Further research is needed with larger sample sizes and different chronically ill populations to further explore the psychometrics of the instrument.

Towards a new approach to job-related distress: A three-sample study of the Occupational Depression Inventory.

The Occupational Depression Inventory (ODI) was recently developed to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to respond to limitations of current assessments of job-related distress, most notably, assessments relying on the burnout construct. In this study, we conducted a thorough examination of the psychometric and structural properties of the ODI using exploratory structural equation modelling bifactor analysis and Mokken scale analysis. The study involved three samples of employed individuals, recruited in France (N = 3454), Switzerland (N = 1971), and Australia (N = 1485). Results were consistent across the three samples. The ODI exhibited essential unidimensionality and excellent total-score reliability-as indexed by McDonald's omega, Cronbach's alpha, Guttman's lambda-2, and the Molenaar-Sijtsma statistic. We found evidence for measurement invariance across sexes, age groups, and samples. Mokken scale analysis revealed that the ODI's scalability was strong. No monotonicity violation was detected. Invariant item ordering showed sufficient accuracy. In all three samples, suicidal ideation was the least commonly endorsed item-thus acting as a sentinel item-and fatigue/loss of energy was the most commonly endorsed item. The ODI exhibits excellent psychometric and structural properties, suggesting that occupational health specialists can effectively employ the instrument.

Validation of the Occupational Depression Inventory in Brazil: A study of 1612 civil servants.

OBJECTIVE: The Occupational Depression Inventory (ODI) assesses work-attributed depressive symptoms. The ODI has demonstrated robust psychometric and structural properties. To date, the instrument has been validated in English, French, and Spanish. This study examined the psychometric and structural properties of the ODI's Brazilian-Portuguese version. METHODS: The study involved 1612 civil servants employed in Brazil (MAGE = 44, SDAGE = 9; 60% female). The study was conducted online across all Brazilian states. RESULTS: Exploratory structural equation modeling (ESEM) bifactor analysis indicated that the ODI meets the requirements for essential unidimensionality. The general factor accounted for 91% of the common variance extracted. We found measurement invariance to hold across sexes and age groups. Consistent with these findings, the ODI showed strong scalability (H = 0.67). The instrument's total score accurately ranked respondents on the latent dimension underlying the measure. Furthermore, the ODI exhibited excellent total-score reliability (e.g., McDonald's ω = 0.93). Occupational depression correlated negatively with work engagement and each of its components (vigor, dedication, and absorption), speaking to the ODI's criterion validity. Finally, the ODI helped clarify the issue of burnout-depression overlap. Relying on ESEM confirmatory factor analysis (CFA), we found burnout's components to correlate more strongly with occupational depression than with each other. Using a higher-order ESEM-within-CFA framework, we found a correlation of 0.95 between burnout and occupational depression. CONCLUSION: The ODI displays robust psychometric and structural properties within the Brazilian context. The ODI constitutes a valuable resource for occupational health specialists and may help advance research on job-related distress.

Children on the autism spectrum: grandmother involvement and family functioning.

BACKGROUND: This study investigated associations between the presence of a child with autism or Asperger's disorder in the family, family functioning and grandmother experiences with the goal of better understanding grandparent involvement in the lives of grandchildren on the autism spectrum and their families. METHODS: Mothers and grandmothers of children who were either typically developing or on the autism spectrum completed parallel forms of a grandparent involvement measure. Mothers reported on the functioning of the immediate family. Data were analysed via multilevel modelling with mother-grandmother dyads as the unit of observation. RESULTS: Autism spectrum disorders in children were associated with more flexible family functioning, lower levels of family satisfaction, greater grandmother difficulties and more grandmother information needs. CONCLUSIONS: Participation of grandparents in diagnostic and treatment meetings and increased communication among family members may facilitate grandparent support and involvement in families with a child on the autism spectrum.

The Fisher information function and scoring in binary ideal point item response models: a cautionary tale.

This article examines the Fisher information functions, I(θ) , and explores implications for scoring of binary ideal point item response models. These models typically appear to have I(θ) that are bimodal and identically equal to 0 at the ideal point. The article shows that this is an inherent property of ideal point IRT models, which either have this property or are indeterminate and thus violate the likelihood regularity conditions. For some models, the indeterminacy can be resolved, generating an effectively unimodal I(θ) , albeit with violated regularity conditions. In other cases, I(θ) diverges. All reasonable ideal point IRT models exhibit this behaviour. Users should exercise caution when relying on asymptotics, particularly for shorter assessments. Use of simulated plausible values or prediction from a fully Bayesian estimation is recommended for scoring.

Is the PHQ-9 a unidimensional measure of depression? A 58,272-participant study.

The PHQ-9 has become a measure of reference in depression research and clinical practice. However, the issue of the PHQ-9's unidimensionality has not been fully elucidated, and the usability of the PHQ-9's total score requires clarification. In this study, we examined the dimensionality, scalability, and monotonicity properties of the PHQ-9 as well as the scale's total-score reliability. We did so based on exploratory structural equation modeling (ESEM) bifactor analysis and Mokken scale analysis (MSA). We relied on a total of 58,272 participants (63% female; Mage = 43, SDage = 13) from 29 samples involving seven different countries (e.g., Germany, the U.S.) and five different languages (e.g., German, English). We found no concerning deviations from measurement invariance for our ESEM bifactor model, neither across samples nor across sexes, age groups, and languages. The PHQ-9 met the requirements for essential unidimensionality in the pooled sample and across sex-, age-, and language-based subsamples. In each case, the general factor was strong (e.g., factor loadings ranged from 0.725 to 0.893 in the pooled sample) and Omega Hierarchical values exceeded 0.900. The correlations between the general factor and the observed total scores were large (≥ 0.952). Our MSA, including multilevel MSA, revealed that the PHQ-9's scalability is satisfactory. No monotonicity violation was detected, suggesting that the scale's total score accurately orders respondents on the latent Depression variable. Total-score reliability was good. This study provides robust evidence that the PHQ-9 can be used as a unidimensional measure of depressive symptoms by researchers and practitioners. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The contribution of set switching and working memory to sentence processing in older adults.

This study evaluates the involvement of switching skills and working-memory capacity in auditory sentence processing in older adults. The authors examined 241 healthy participants, aged 55 to 88 years, who completed four neuropsychological tasks and two sentence-processing tasks. In addition to age and the expected contribution of working memory, switching ability, as measured by the number of perseverative errors on the Wisconsin Card Sorting Test, emerged as a strong predictor of performance on both sentence-processing tasks. Individuals with both low working-memory spans and more perseverative errors achieved the lowest accuracy scores. These findings are consistent with compensatory accounts of successful performance in older age.

Burnout-Depression Overlap: Exploratory Structural Equation Modeling Bifactor Analysis and Network Analysis.

Burnout has been viewed as a work-induced condition combining exhaustion, cynicism, and professional inefficacy. Using correlational analyses, an exploratory structural equation modeling bifactor analysis, structural regression analyses, and a network analysis, we examined the claim that burnout should not be mistaken for a depressive syndrome. The study involved 1,258 educational staff members. Burnout was assessed with the Maslach Burnout Inventory-General Survey and depression with the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale. Illegitimate work tasks and work-nonwork interferences were additionally measured. We notably found that (a) on average, exhaustion, cynicism, and professional inefficacy correlated less strongly with each other than with depression; (b) exhaustion-burnout's core-was more strongly associated with depression than with either cynicism or professional inefficacy; (c) the Patient Health Questionnaire-9 did not correlate more strongly with the Hospital Anxiety and Depression Scale than with exhaustion; (d) exhaustion and depression loaded primarily on a general distress/dysphoria factor in the exploratory structural equation modeling bifactor analysis; (e) on average, burnout and depression were related to job stressors in a similar manner; (f) work-nonwork interferences were strongly linked to distress/dysphoria. Overall, burnout showed no syndromal unity and lacked discriminant validity. Clinicians should systematically assess depressive symptoms in individuals presenting with a complaint of "burnout."

An exploratory structural equation modeling bi-factor analytic approach to uncovering what burnout, depression, and anxiety scales measure.

In this study, we addressed the ongoing debate about what burnout and depression scales measure by conducting an exploratory structural equation modeling (ESEM) bifactor analysis. A sample of 734 U.S. teachers completed a survey that included the Center for Epidemiologic Studies Depression scale (CES-D-10), the depression module of the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), and the Maslach Burnout Inventory (MBI), which contains emotional exhaustion (EE), depersonalization (DP), and (diminished) personal accomplishment (PA) subscales. Job adversity and workplace support were additionally measured for the purpose of a nomological network analysis. EE, burnout's core, was more highly correlated with the depression and anxiety scales than it was with DP and PA, even with controls for item content overlap. The CES-D-10, PHQ-9, GAD-7, and EE subscale of the MBI were similarly related to job adversity and workplace support. ESEM bifactor analysis revealed that the CES-D-10, PHQ-9, GAD-7, and EE items loaded highly on a general factor, which we labeled nonspecific psychological distress (NSPD). We conclude that depression, anxiety, and EE scales reflect NSPD. DP items largely reflect two factors, NSPD and depersonalization, about equally. PA items were found to be less related to NSPD. With respect to the debate surrounding burnout-depression overlap, our findings do not support the view that the burnout construct represents a syndrome that consists of EE, DP, and diminished PA and excludes (or does not primarily include) depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Inquiry into the correlation between burnout and depression.

[Correction Notice: An Erratum for this article was reported online in Journal of Occupational Health Psychology on Sep 9 2019 (see record 2019-54511-001). In the article, there were wording errors in the Results section. Specifically, we referred to imposing "constraints" when we meant the opposite, namely, relaxing constraints, such as allowing residuals to correlate. We corrected the wording errors, added chi-square statistics, and corrected four small typographic errors bearing on fit statistics (three changes of .001 and one change of .003). The results remain fundamentally the same. All versions of this article have been corrected.] The extent to which burnout refers to anything other than a depressive condition remains an object of controversy among occupational health specialists. In three studies conducted in two different countries and two different languages, we investigated the discriminant validity of burnout scales by evaluating the magnitude of the correlation between (latent) burnout and (latent) depression. In Study 1 (N = 911), burnout was assessed with the Maslach Burnout Inventory-General Survey's Exhaustion subscale and depression with the depression module of the Patient Health Questionnaire (PHQ). In Study 2 (N = 1,386), the Shirom-Melamed Burnout Measure was used to assess burnout and the PHQ, depression. In Study 3 (N = 734), burnout was assessed with the Maslach Burnout Inventory-Educators Survey and depression, with the PHQ and the Center for Epidemiological Studies Depression scale; additionally, anxiety was measured with the Generalized Anxiety Disorder scale. In each study, we examined the burnout-depression association based on confirmatory factor analysis (CFA), controlling for item-level content overlap. In the three studies, latent exhaustion, the core of burnout, and latent depression were highly correlated (correlations ranging from .83 to .88). In Studies 2 and 3, second-order CFAs indicated that depressive (and anxiety) symptoms and the exhaustion and depersonalization components of burnout are reflective of the same second-order distress/dysphoria factor. Our findings, with their replication across samples, languages, and measures, together with meta-analytic findings, cast serious doubt on the discriminant validity of the burnout construct. The implications of burnout's problematic discriminant validity are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Retrieval practice and spacing effects in multi-session treatment of naming impairment in aphasia.

Retrieval practice and spacing are two factors shown to enhance learning in basic psychological research. The present study investigated the clinical applicability of these factors to naming treatment in aphasia. Prior studies have shown that naming treatment that provides retrieval practice (i.e., practice retrieving names for objects from semantic memory) improves later naming performance in people with aphasia (PWA) more so than repetition training. Repetition training is a common form of naming treatment that can support errorless production of names for objects, but it does not provide retrieval practice. Prior work has also demonstrated enhanced naming treatment benefit in PWA when an item's training trials are separated by multiple intervening trials (i.e., spacing) compared to only one intervening trial (i.e., massing). However, in those studies, items were only trained in one session. Also, the effects of the learning factors were probed after one day and one week. The goal of the present study was to examine the effects of retrieval practice and spacing in a more clinically-inspired schedule of delivery and to assess the effects of the learning factors at retention intervals of greater functional significance. Matched sets of errorful items for each of four PWA were presented for multiple trials of retrieval practice or repetition in a spaced or massed schedule in each of multiple training sessions. Mixed regression analyses revealed that retrieval practice outperformed repetition, and spacing outperformed massing, at an initial post-treatment test administered after one week. Furthermore, the advantage for retrieval practice over repetition persisted at a follow-up test administered after one month. The potential clinical relevance of retrieval practice and spacing for multi-session interventions in speech-language treatment is discussed.

Meta-analyses of the relation of goal consensus and collaboration to psychotherapy outcome.

This article provides meta-analyses of the relation between goal consensus and collaboration and individual psychotherapy outcome using studies published in English between 1978 and June 2017. Inclusion criteria involved (a) a measure of psychotherapy outcome, (b) a measure of goal consensus and/or collaboration, (c) a group design, (d) adult patients (aged 18 years or older), and (e) a reported effect or statistic that could be converted to an effect size. For the 54 studies (N = 7,278) of goal consensus and outcome, the result was r = .24 (95% confidence interval [CI] [.19, .28]) or d = .49, representing a medium effect. For the 53 studies (N = 5,286) of patient-therapist collaboration and outcome, the result was r = .29 (95% CI [.24, .34]) or d = .61, another medium effect. In all, 21 studies (N = 2,081) of therapist collaboration and outcome yielded an omnibus effect of .26 (95% CI [.18, .35]) or d = .54. Results suggest patient-therapist goal consensus and collaboration enhance psychotherapy outcome. The article concludes with research limitations, diversity considerations, and therapeutic practices. Limitations of the studies included a dearth of diverse samples, assessment of goal consensus and/or collaboration at a single time during treatment, failure to relate measures to outcome, and analyses that do not permit causal conclusions. Research suggests that therapists seek input from patients to form and effect treatment goals and plans, provide patients with regular feedback, and seek their involvement throughout therapy. (PsycINFO Database Record (c) 2018 APA, all rights reserved).