The role of emotion in PTSD: two preliminary studies.

BACKGROUND: Two studies are presented that highlight the role of emotion in PTSD in which we examine what emotions in addition to anxiety may be present. AIMS: The first aim was to assess the overall emotion profile across the five basic emotions of anxiety, sadness, anger, disgust, and happiness in clients attending a stress clinic. A small pilot study was also carried out to see how the emotion profiles impacted on outcome for CBT. METHOD: In Study 1, 75 consecutive attenders at a trauma service who were diagnosed with PTSD were assessed with a number of measures that included the Basic Emotions Scale. RESULTS: The results showed that less than 50% of PTSD cases presented with anxiety as the primary emotion, with the remainder showing primary emotions of sadness, anger, or disgust rather than anxiety. A second pilot study involved the follow-up across exposure-based CBT of 20 of the participants from Study 1. CONCLUSIONS: The results suggest that anxiety-based PTSD is more likely to benefit from exposure than is non-anxiety based PTSD. Implications both for the classification and the treatment of PTSD are considered.

The EUROHIS-QOL 8-item index: comparative psychometric properties to its parent WHOQOL-BREF.

OBJECTIVES: To test the psychometric properties of the EUROHIS-QOL 8-item index, a shortened version of the World Health Organization Quality of Life Instrument-Abbreviated Version (WHOQOL-BREF). METHODS: The sample consisted of 2359 subjects identified from primary care settings, with 1193 having a confirmed diagnosis of depression. Data came from six countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in a large international study, the Longitudinal Investigation of Depression Outcomes. The structure of the EUROHIS-QOL 8-item index follows that of the WHOQOL-BREF assessment. Internal consistency was measured by using Cronbach's alpha. Convergent validity was assessed by using correlations with different measures for mental health (Symptom Checklist 90), physical health (self-evaluation), and quality of life (WHOQOL-BREF and short form 36 health survey). Discriminant group validity was assessed between diagnosed depressed and nondepressed patients. Differential item functioning and unidimensionality were analyzed by using Rasch analysis. Factor structure was assessed with structural equation modeling analyses. RESULTS: Internal consistency was acceptable (ranged between 0.72 and 0.81 across countries), and the index discriminated well between depression (t = 6.31-20.33; P < 0.001) across all countries. Correlations between the EUROHIS-QOL 8-item index and different measures--Symptom Checklist 90 (r = -0.42), physical health (r = -0.42), WHOQOL-BREF domains (r = 0.61-0.77), and short form 36 health survey (r = 0.58)--were all significant (P < 0.001). The index is unidimensional with desired item fit statistics. Two items ("daily living activities" and "enough money to meet your needs") had residuals exceeding 4. Differential item functioning was observed with general quality of life, general health, relationships, and home items for age. A common one-factor structure with acceptable fit was identified in three out of six countries (comparative fit index = 0.85, root mean square error of approximation = 0.11). CONCLUSIONS: The EUROHIS-QOL 8-item index showed acceptable cross-cultural performance and a satisfactory discriminant validity and would be a useful measure to include in studies to assess treatment effectiveness.

What basic emotions are experienced in bipolar disorder?

AIMS: The aims of this study were to investigate the basic emotions experienced within and between episodes of bipolar disorder and, more specifically, to test the predictions made by the Schematic, Propositional, Analogical and Associative Representation Systems (SPAARS) model that mania is predominantly characterized by the coupling of happiness with anger whereas depression (unipolar and bipolar) primarily comprises a coupling between sadness and disgust. DESIGN: A cross-sectional design was employed to examine the differences within and between the bipolar, unipolar and control groups in the emotional profiles. Data were analysed using one-way ANOVAs. METHOD: Psychiatric diagnoses in the clinical groups were confirmed using the Structured Clinical Interview for DSM-IV (SCID). It was not administered in the control group. Current mood state was measured using the Beck Depression Inventory-II, the State-Trait Anxiety Inventory and the Bech-Rafaelsen Mania Scale. The Basic Emotions Scale was used to explore the emotional profiles. RESULTS: The results confirmed the predictions made by the SPAARS model about emotions in mania and depression. Outwith these episodes, individuals with bipolar disorder experienced elevated levels of disgust. DISCUSSION: Evidence was found in support of the proposal of SPAARS that there are five basic emotions, which form the basis for both normal emotional experience and emotional disorders. Disgust is an important feature of bipolar disorder. Strengths and limitations are discussed, and suggestions for future research are explored.

Is there a measurement overlap between depressive symptoms and quality of life?

BACKGROUND: Previous studies found that depression is associated with a broad impairment in quality of life (QOL). This finding might be associated to a measurement overlap. METHODS: The objective of this study was to verify whether the items of the World Health Organization Quality of Life Instrument-Abbreviated version (WHOQOL-BREF), a measure of generic QOL, are invariant among patients having a current major depressive episode who come from primary care services. We investigated data from primary care services from the 6 countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in the baseline sample of the Longitudinal Investigation of Depression Outcomes. The Rasch model was used to analyze items exhibiting differential item functioning (DIF) as a way of assessing invariance in relation to a depression factor defined by the diagnosis of depression using the Composite International Diagnostic Interview. In addition, the Center for Epidemiological Studies-Depression Scale (CES-D) score was correlated with the item and domain scores of the WHOQOL-BREF using the Pearson coefficient. RESULTS: The sample consisted of 2359 subjects, of which 1193 had a confirmed diagnosis of a current major depressive episode. Of the 26 items of the WHOQOL-BREF, 11 showed DIF due to the depression factor, and the physical domain presented more items displaying DIF. All Pearson coefficients between the WHOQOL-BREF item and domain scores and the CES-D score were weak and moderate (r = -0.13 to r = 0.43). CONCLUSIONS: Our findings indicate that most WHOQOL-BREF items do not exhibit DIF for a current major depressive episode and the variance associated with depression in this generic QOL measure is restricted to some facets of this construct. Thus, we recommend this restricted adjustment for depression in future analyses of this measure. Furthermore, our study indicates that researchers must measure QOL regardless of depression severity.

Development and validation of the Brazilian version of the Attitudes to Aging Questionnaire (AAQ): An example of merging classical psychometric theory and the Rasch measurement model.

BACKGROUND: Aging has determined a demographic shift in the world, which is considered a major societal achievement, and a challenge. Aging is primarily a subjective experience, shaped by factors such as gender and culture. There is a lack of instruments to assess attitudes to aging adequately. In addition, there is no instrument developed or validated in developing region contexts, so that the particularities of ageing in these areas are not included in the measures available. This paper aims to develop and validate a reliable attitude to aging instrument by combining classical psychometric approach and Rasch analysis. METHODS: Pilot study and field trial are described in details. Statistical analysis included classic psychometric theory (EFA and CFA) and Rasch measurement model. The latter was applied to examine unidimensionality, response scale and item fit. RESULTS: Sample was composed of 424 Brazilian old adults, which was compared to an international sample (n = 5238). The final instrument shows excellent psychometric performance (discriminant validity, confirmatory factor analysis and Rasch fit statistics). Rasch analysis indicated that modifications in the response scale and item deletions improved the initial solution derived from the classic approach. CONCLUSION: The combination of classic and modern psychometric theories in a complementary way is fruitful for development and validation of instruments. The construction of a reliable Brazilian Attitudes to Aging Questionnaire is important for assessing cultural specificities of aging in a transcultural perspective and can be applied in international cross-cultural investigations running less risk of cultural bias.

Counterfactual thinking and functional differences in depression.

The purpose of the studies reported in this paper was to evaluate the function of counterfactual thinking (CT) in depression. In Experiment 1, depressed and non-depressed participants were asked to imagine themselves as the protagonist of a hypothetical situation, and to think counterfactually about three different scenarios. The results showed that there was a similar CT style (in terms of direction, structure and focus of mutation) for the depressed and the non-depressed groups. It was also found that the perceived preparation for a future similar situation increased after CT and, contrary to our hypotheses, this effect was observed in both groups. In Experiment 2, a real-life situation was used (a course examination) in which participants experienced a negative outcome (a poor score on the test). Again, it was observed that depressed and non-depressed participants showed the same CT style, but non-depressed participants were more likely to use CT spontaneously. In addition, the second study showed further differences between the two groups: depressed participants not only showed a lack of cognitive benefits from thinking counterfactually (i.e., after CT they do not feel more prepared for future similar events, nor able to avoid a similar bad outcome, in contrast to the non-depressed participants), but also show a lack of behavioural changes (both intentions to change and actual changes over the subsequent week). In conclusion, these results provide evidence about the function of CT both in depressed and in non-depressed thinking, and highlight both the similarities and differences for these two groups.

Implicit and explicit memory biases in mixed anxiety-depression.

BACKGROUND: This study investigated and compared implicit and explicit memory biases in anxiety, depression and mixed anxiety-depression. METHOD: Outpatients who were either depressed only (n=18), anxious only (n=18) or mixed (anxious and depressed) (n=18) were compared to normal controls (n=18) on self-report measures and typical experimental tasks assessing memory biases. The implicit memory test was a word identification task and the explicit memory test was an incidental free recall with depression relevant, anxiety relevant, emotional positive and neutral words. RESULTS: The depressed group showed a positive implicit memory bias and a mood-congruent bias at free recall. The anxious group presented an overall higher priming effect in the implicit memory test, whilst the mixed group exhibited no difference in the quantity of priming effect compared to normal controls and recalled more anxious relevant words than other word types. LIMITATIONS: Because of the dimensional perspective adopted in the present study, the mixed group was composed of both DSM-IV sub-threshold (n=5) and supra-threshold (n=13) patients. CONCLUSIONS: These results show a specific pattern for the mixed group and suggest that mixed anxiety-depression represents a distinct clinical group.

Cross-cultural evaluation of the WHOQOL-BREF domains in primary care depressed patients using Rasch analysis.

BACKGROUND: The Rasch model prescribes procedures to ensure that a scale constructed from multiple items conforms to fundamental requirements of interval scales of measurement. OBJECTIVE: To test the Rasch properties of the domains of the World Health Organization Quality of Life Instrument-abbreviated version (WHOQOL-BREF) in depressed patients from primary care settings. DESIGN: Cross-sectional, cross-national study. SETTING: Primary care. PATIENTS: The sample consisted of 1193 patients having a confirmed diagnosis of depression from 6 countries (Australia, Brazil, Israel, Russia, Spain, and the United States) involved in the Longitudinal Investigation of Depression Outcomes (LIDO) study. MEASUREMENTS: The Composite International Diagnostic Interview (CIDI) diagnosed depression, whereas the Center for Epidemiological Studies Depression Scale (CES-D) assessed severity of depression. The WHOQOL-BREF measured generic quality of life (QOL). RESULTS: Three of the 4 WHOQOL-BREF domains (physical, psychological, and environment) conform to the Rasch model expectations, following adjustments required mainly because of individual item misfit or differential item functioning (DIF) due to age or country. The social domain showed relatively poor psychometric properties, as observed in previous studies. CONCLUSIONS: The Rasch analysis demonstrated that, with some modifications, all domains of the WHOQOL-BREF, except for the social domain, provide an interval scale measure of generic subjective QOL in the context of depressed primary care patients in 6 countries worldwide.

The effect of fear on attentional processing in a sample of healthy females.

The present experiment examines the effect of fear on efficiency of three attention networks: executive attention, orienting and alerting, in a healthy female sample. International Affective Picture System (IAPS) images were used to elicit both a fear response and a non-emotional response in 100 participants. During the emotion manipulation, participants performed a modified version of the Attention Network Test (ANT). Results showed enhanced executive attention in the fear condition compared to the control condition. Specifically, during a fear experience participants were better able to inhibit irrelevant information resulting in faster response times to a target. There was no effect of fear on orienting while the effect of fear on alerting was inconclusive. It is suggested that enhanced executive attention in fear-eliciting situations may function to focus attention on a potentially threat-related target, thus facilitating subsequent rapid responding.

The effect of happiness and sadness on alerting, orienting, and executive attention.

OBJECTIVE: According to the attention network approach, attention is best understood in terms of three functionally and neuroanatomically distinct networks-alerting, orienting, and executive attention. An important question is whether the experience of emotion differentially influences the efficiency of these networks. METHOD: This study examines 180 participants were randomly assigned to a happy, sad, or control condition and undertook a modified version of the Attention Network Test. RESULTS: The results showed no effect of happiness or sadness on alerting, orienting, or executive attention. However, sad participants showed reduced intrinsic alertness. CONCLUSION: This suggests that sadness reduces general alertness rather than impairing the efficiency of specific attention networks.