Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults.

OBJECTIVE: The authors sought to determine the impact of selected social determinants of health (SDoH) on psychological health and well-being (defined as depression, cognition, and self-rated health) among Black and Hispanic/Latinx adults relative to White adults 51-89 years of age. METHODS: Disparities in depressive symptomatology, cognition, and self-rated health were measured among 2,306 non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 non-Hispanic/Latinx White adults who participated in the Health and Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected SDoH explained a larger share of the disparities than age, sex, measures of health, health behaviors, and health care utilization. Selected SDoH included education, parental education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage. RESULTS: Black and Hispanic/Latinx adults reported worse depressive symptomatology, cognition, and self-rated health than White adults. Selected SDoH were associated with a larger proportion of the Black-White disparities in depressive symptomatology (51%), cognition (39%), and self-rated health (37%) than were age, sex, measures of health, health behaviors, and health care utilization. SDoH were associated with a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and physical health correlated with the disparity in depressive symptomatology (28%). Education, parental education, years worked, income, and insurance parity were SDoH associated with these disparities. CONCLUSIONS: Differences in SDoH underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key SDoH.

Advances in applications of item response theory to clinical assessment.

Item response theory (IRT) is moving to the forefront of methodologies used to develop, evaluate, and score clinical measures. Funding agencies and test developers are routinely supporting IRT work, and the theory has become closely tied to technological advances within the field. As a result, familiarity with IRT has grown increasingly relevant to mental health research and practice. But to what end? This article reviews advances in applications of IRT to clinical measurement in an effort to identify tangible improvements that can be attributed to the methodology. Although IRT shares similarities with classical test theory and factor analysis, the approach has certain practical benefits, but also limitations, when applied to measurement challenges. Major opportunities include the use of computerized adaptive tests to prevent conditional measurement error, multidimensional models to prevent misinterpretation of scores, and analyses of differential item functioning to prevent bias. Whereas these methods and technologies were once only discussed as future possibilities, they are now accessible because of recent support of IRT-focused clinical research. Despite this, much work still remains in widely disseminating methods and technologies from IRT into mental health research and practice. Clinicians have been reluctant to fully embrace the approach, especially in terms or prospective test development and adaptive item administration. Widespread use of IRT technologies will require continued cooperation among psychometricians, clinicians, and other stakeholders. There are also many opportunities to expand the methodology, especially with respect to integrating modern measurement theory with models from personality and cognitive psychology as well as neuroscience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

External locus of control contributes to racial disparities in memory and reasoning training gains in ACTIVE.

Racial disparities in cognitive outcomes may be partly explained by differences in locus of control. African Americans report more external locus of control than non-Hispanic Whites, and external locus of control is associated with poorer health and cognition. The aims of this study were to compare cognitive training gains between African American and non-Hispanic White participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study and determine whether racial differences in training gains are mediated by locus of control. The sample comprised 2,062 (26% African American) adults aged 65 and older who participated in memory, reasoning, or speed training. Latent growth curve models evaluated predictors of 10-year cognitive trajectories separately by training group. Multiple group modeling examined associations between training gains and locus of control across racial groups. Compared to non-Hispanic Whites, African Americans evidenced less improvement in memory and reasoning performance after training. These effects were partially mediated by locus of control, controlling for age, sex, education, health, depression, testing site, and initial cognitive ability. African Americans reported more external locus of control, which was associated with smaller training gains. External locus of control also had a stronger negative association with reasoning training gain for African Americans than for Whites. No racial difference in training gain was identified for speed training. Future intervention research with African Americans should test whether explicitly targeting external locus of control leads to greater cognitive improvement following cognitive training.

Disentangling working memory processes during spatial span assessment: a modeling analysis of preferred eye movement strategies.

The neurocognitive processes involved during classic spatial working memory (SWM) assessment were investigated by examining naturally preferred eye movement strategies. Cognitively healthy adult volunteers were tested in a computerized version of the Corsi Block-Tapping Task--a spatial span task requiring the short term maintenance of a series of locations presented in a specific order--coupled with eye tracking. Modeling analysis was developed to characterize eye-tracking patterns across all task phases, including encoding, retention, and recall. Results revealed a natural preference for local gaze maintenance during both encoding and retention, with fewer than 40% fixated targets. These findings contrasted with the stimulus retracing pattern expected during recall as a result of task demands, with 80% fixated targets. Along with participants' self-reported strategies of mentally "making shapes," these results suggest the involvement of covert attention shifts and higher order cognitive Gestalt processes during spatial span tasks, challenging instrument validity as a single measure of SWM storage capacity.

Assessment of global psychiatric categories: the PSI/PSI-2 and the MMPI-2-RF.

The 3 Higher Order (HO) scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form and the 3 core clinical scales of the Psychological Screening Inventory/Psychological Screening Inventory-2 were developed to broadly represent the 3 traditional psychiatric categories of mental disorder: major psychiatric disorder ("psychotic"), general psychological distress ("neurotic"), and significant antisocial characteristics ("character disorder"). The present article reports 2 studies that assessed the validity of test scores from each scale for their intended purpose. Participants included 2 groups of forensic clients (n=138 and 78), college undergraduates (n=100), and previously reported data on larger groups of participants. Validity was supported in 2 ways: high loadings in confirmatory factor models based on the 3 psychiatric categories and medium to large effect sizes in discriminating between relevant disordered groups and normative groups. The tests showed comparable results. Limitations included co-morbidity in some participant groups and the relatively narrow range of psychopathology in undergraduate participants.

The value of item response theory in clinical assessment: a review.

Item response theory (IRT) and related latent variable models represent modern psychometric theory, the successor to classical test theory in psychological assessment. Although IRT has become prevalent in the measurement of ability and achievement, its contributions to clinical domains have been less extensive. Applications of IRT to clinical assessment are reviewed to appraise its current and potential value. Benefits of IRT include comprehensive analyses and reduction of measurement error, creation of computer adaptive tests, meaningful scaling of latent variables, objective calibration and equating, evaluation of test and item bias, greater accuracy in the assessment of change due to therapeutic intervention, and evaluation of model and person fit. The theory may soon reinvent the manner in which tests are selected, developed, and scored. Although challenges remain to the widespread implementation of IRT, its application to clinical assessment holds great promise. Recommendations for research, test development, and clinical practice are provided.