Response Category Functioning on the Health Care Engagement Measure Using the Nominal Response Model.

As part of a scale development project, we fit a nominal response item response theory model to responses to the Health Care Engagement Measure (HEM). When using the original 5-point response format, categories were not ordered as intended for six of the 23 items. For the remaining, the category boundary discrimination between Categories 0 (not at all true) and 1 (a little bit true) was only weakly discriminating, suggesting uninformative categories. When the lowest two categories were collapsed, psychometric properties improved greatly. Category boundary discriminations within items, however, varied significantly. Specifically, higher response category distinctions, such as responding 3 (very true) versus 2 (mostly true) were considerably more discriminating than lower response category distinctions. Implications for HEM scoring and for improving measurement precision at lower levels of the construct are presented as is the unique role of the nominal response model in category analysis.

Matching IRT Models to Patient-Reported Outcomes Constructs: The Graded Response and Log-Logistic Models for Scaling Depression.

Item response theory (IRT) model applications extend well beyond cognitive ability testing, and various patient-reported outcomes (PRO) measures are among the more prominent examples. PRO (and like) constructs differ from cognitive ability constructs in many ways, and these differences have model fitting implications. With a few notable exceptions, however, most IRT applications to PRO constructs rely on traditional IRT models, such as the graded response model. We review some notable differences between cognitive and PRO constructs and how these differences can present challenges for traditional IRT model applications. We then apply two models (the traditional graded response model and an alternative log-logistic model) to depression measure data drawn from the Patient-Reported Outcomes Measurement Information System project. We do not claim that one model is "a better fit" or more "valid" than the other; rather, we show that the log-logistic model may be more consistent with the construct of depression as a unipolar phenomenon. Clearly, the graded response and log-logistic models can lead to different conclusions about the psychometrics of an instrument and the scaling of individual differences. We underscore, too, that, in general, explorations of which model may be more appropriate cannot be decided only by fit index comparisons; these decisions may require the integration of psychometrics with theory and research findings on the construct of interest.

Comprehensive treatment for patients with chronic pain in a 12-step based substance use disorder program.

Patients with chronic pain (CP) and substance use disorder (SUD) are complex, not yet adequately described, and in need of comprehensive treatments that address both diseases concurrently. Our objectives were to (a) describe a cohort of CP patients who failed traditional treatment (mainly opioids) - then developed opioid use disorder (OUD) and other SUDs and (b) evaluate a comprehensive inpatient treatment program for these patients. Patients were enrolled in an inpatient CP program. Treatment consisted of medical detoxification, group process/education, external and internal qigong, osteopathic manual medicine, and qigong-based mindfulness. Patients also received 20 h per week of 12-step recovery-based SUD treatment. Patients were evaluated at the beginning of treatment (first assessment, day 1-5 range) and at days 30 and 45. Assessments were: Beck Depression Inventory-II, Brief Pain Inventory, West Haven-Yale Multidimensional Pain Inventory (patient section), and McGill Pain Questionnaire. The Global Impression of Change Scale was administered at day 45. A mixed model analysis was used to evaluate treatment progress. Demographic data revealed an older cohort with OUD, other SUDs, and multiple pain diagnoses who failed traditional treatment. Questionnaire evaluations were consistent and similar across all of the above measures: patients' scores showed marked, statistically significant improvements in depression, pain, and quality of life ratings. The most substantial improvements occurred between the first and second assessments. The findings are sufficiently encouraging to warrant further evaluation of the protocol and to plan comparative studies.

Multimodal compared to pharmacologic treatments for chronic tension-type headache in adolescents.

Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p < .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p < .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results.

Evaluating bifactor models: Calculating and interpreting statistical indices.

Bifactor measurement models are increasingly being applied to personality and psychopathology measures (Reise, 2012). In this work, authors generally have emphasized model fit, and their typical conclusion is that a bifactor model provides a superior fit relative to alternative subordinate models. Often unexplored, however, are important statistical indices that can substantially improve the psychometric analysis of a measure. We provide a review of the particularly valuable statistical indices one can derive from bifactor models. They include omega reliability coefficients, factor determinacy, construct reliability, explained common variance, and percentage of uncontaminated correlations. We describe how these indices can be calculated and used to inform: (a) the quality of unit-weighted total and subscale score composites, as well as factor score estimates, and (b) the specification and quality of a measurement model in structural equation modeling. (PsycINFO Database Record

Posttraumatic Stress Disorder-Related Hospitalizations in the United States (2002-2011): Rates, Co-Occurring Illnesses, Suicidal Ideation/Self-Harm, and Hospital Charges.

The purpose of the present study was to evaluate posttraumatic stress disorder (PTSD)-related hospitalizations in the United States (2002-2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most commonly co-occurring psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

Applying Bifactor Statistical Indices in the Evaluation of Psychological Measures.

The purpose of this study was to apply a set of rarely reported psychometric indices that, nevertheless, are important to consider when evaluating psychological measures. All can be derived from a standardized loading matrix in a confirmatory bifactor model: omega reliability coefficients, factor determinacy, construct replicability, explained common variance, and percentage of uncontaminated correlations. We calculated these indices and extended the findings of 50 recent bifactor model estimation studies published in psychopathology, personality, and assessment journals. These bifactor derived indices (most not presented in the articles) provided a clearer and more complete picture of the psychometric properties of the assessment instruments. We reached 2 firm conclusions. First, although all measures had been tagged "multidimensional," unit-weighted total scores overwhelmingly reflected variance due to a single latent variable. Second, unit-weighted subscale scores often have ambiguous interpretations because their variance mostly reflects the general, not the specific, trait. Finally, we review the implications of our evaluations and consider the limits of inferences drawn from a bifactor modeling approach.

Iteration of Partially Specified Target Matrices: Applications in Exploratory and Bayesian Confirmatory Factor Analysis.

We describe and evaluate a factor rotation algorithm, iterated target rotation (ITR). Whereas target rotation (Browne, 2001) requires a user to specify a target matrix a priori based on theory or prior research, ITR begins with a standard analytic factor rotation (i.e., an empirically informed target) followed by an iterative search procedure to update the target matrix. In Study 1, Monte Carlo simulations were conducted to evaluate the performance of ITR relative to analytic rotations from the Crawford-Ferguson family with population factor structures varying in complexity. Simulation results: (a) suggested that ITR analyses will be particularly useful when evaluating data with complex structures (i.e., multiple cross-loadings) and (b) showed that the rotation method used to define an initial target matrix did not materially affect the accuracy of the various ITRs. In Study 2, we: (a) demonstrated the application of ITR as a way to determine empirically informed priors in a Bayesian confirmatory factor analysis (BCFA; Muthén & Asparouhov, 2012) of a rater-report alexithymia measure (Haviland, Warren, & Riggs, 2000) and (b) highlighted some of the challenges when specifying empirically based priors and assessing item and overall model fit.

Prevalence and correlates of pain interference in older adults: why treating the whole body and mind is necessary.

Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults.

Binge drinking by gender and race/ethnicity among California adults, 2007/2009.

BACKGROUND: This study provides binge drinking population estimates for California adults by gender and detailed race/ethnicity categories. This information may be helpful for planning targeted initiatives to decrease binge drinking. METHOD: Data were from the 2007 and 2009 California Health Interview Surveys. The 98 662 respondents represent an annual estimated population of 27.2 million adults. Survey adjusted binary logistic regression was used to calculate gender-specific binge drinking population rates and multinomial logit regression to estimate binge drinking frequency. RESULTS: Adjusting for socio-demographics, any binge drinking during the past year was reported by 31.0% (95% Confidence Interval = 30.5-31.4%) of men and 18.0% (17.7-18.3%) of women. Rates among White men and women were 30.5% and 19.6%, respectively. Binge drinking rates ranged from 11.9% among Chinese to 42.9% among Mexican men and from 4.8% among Vietnamese to 25.7% among "Other Latino" women. Five race/ethnicity categories of men and seven categories of women were significantly less likely to binge drink compared to Whites. Although Whites had the highest overall binge drinking rates, an estimated 12.5% of White men binge drank less than monthly, significantly exceeded by Mexican and Central American men, 19.9 and 19.6%, respectively. An estimated 9.6% of White women binge drank less than monthly, exceeded only by "Other Latino" women, 13.6%. CONCLUSION: These findings underscore the importance of detailed gender and race/ethnicity breakdowns when examining any binge drinking. Furthermore, there is variability across Asian and Latino subgroups in the frequency of binge drinking episodes, which is not evident in broad-group population studies.

Race/ethnicity, parent-identified emotional difficulties, and mental health visits among California children.

Variability in mental health services utilization by race/ethnicity was evaluated with a Behavioral Model approach. Subjects were 17,705 children 5 to 11 years of age in the 2005, 2007, and 2009 California Health Interview Surveys. Parents identified minor emotional difficulties in 18.7% of these children (ranging from 14.8% in Asians to 24.4% in African Americans) and definite or severe difficulties in 7.4% (5.5% in Asians to 9.7% in "other race"). Overall, 7.6% of children had at least one mental health visit in the prior year (2.3% in Asians to 11.2% in African Americans). Parent-identified need was the most salient predictor of mental health visits for all racial/ethnic groups. Beyond need, no consistent patterns could be determined across racial/ethnic groups with regard to the relationship between contextual, predisposing, and enabling measures and mental health service utilization. Different factors operated for each racial/ethnic group, suggesting the need for studies to examine mental health need, mental health service use, and determinants by racial/ethnic subgroup. These findings suggest that a "one-size-fits-all approach" with regard to policies and practices aimed at reducing mental health disparities will not be effective for all racial/ethnic groups.

Scoring and modeling psychological measures in the presence of multidimensionality.

Confirmatory factor analytic studies of psychological measures showing item responses to be multidimensional do not provide sufficient guidance for applied work. Demonstrating that item response data are multifactorial in this way does not necessarily (a) mean that a total scale score is an inadequate indicator of the intended construct, (b) demand creating and scoring subscales, or (c) require specifying a multidimensional measurement model in research using structural equation modeling (SEM). To better inform these important decisions, more fine-grained psychometric analyses are necessary. We describe 3 established, but seldom used, psychometric approaches that address 4 distinct questions: (a) To what degree do total scale scores reflect reliable variation on a single construct? (b) Is the scoring and reporting of subscale scores justified? (c) If justified, how much reliable variance do subscale scores provide after controlling for a general factor? and (d) Can multidimensional item response data be represented by a unidimensional measurement model in SEM, or are multidimensional measurement models (e.g., second-order, bifactor) necessary to achieve unbiased structural coefficients? In the discussion, we provide guidance for applied researchers on how best to interpret the results from applying these methods and review their limitations.

Hospitalisation charges for fibromyalgia in the United States, 1999-2007.

OBJECTIVES: To estimate fibromyalgia (FM) hospitalisation costs (i.e. charges) for patients in the United States from 1999 to 2007; to determine factors associated with variation in costs of FM and non-FM hospitalisations; and to investigate hospital procedures associated with FM hospitalisations. METHODS: Data were from the Nationwide Inpatient Sample, a large database of hospitalisations in the U.S. Over the study period, an estimated 63,772 patients - two-thirds women, one-third men - had been hospitalised for FM (FM criterion was the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code 729.1, Myositis and Myalgia, unspecified). Demographics and hospital characteristics were described with frequencies and mean inflation-adjusted charges. Two multivariable linear regressions (one for FM and a second for non-FM patients), with Consumer Price Index (CPI)-adjusted charges (hospital and related services category) in thousands of dollars as the dependent variable, were performed, excluding cases with masked or missing data. Procedures were categorised with a standard classification scheme. RESULTS: Survey-adjusted total CPI-adjusted charges over the study period were estimated to be approximately $1.0 billion. Hospital procedures and Charlson-Deyo Index (co-morbidity severity) scores were the strongest predictors of charges in bivariate and multivariate analyses (for both FM and non-FM patients). The majority of procedures for FM patients were related to musculoskeletal, gastrointestinal, or cardiovascular systems. Most FM patients, however, did not have any procedure or a life-threatening co-morbid illness. CONCLUSIONS: Over the nine-year period, hospital charges for FM were substantial. Studies of how to reduce or avoid these costs in the treatment of FM need to be undertaken.

Self-reported physical health, mental health, and comorbid diseases among women with irritable bowel syndrome, fibromyalgia, or both compared with healthy control respondents.

CONTEXT: Physicians often encounter patients with functional pain disorders such as irritable bowel syndrome (IBS), fibromyalgia (FM), and their co-occurrence. Although these diseases are diagnosed exclusively by patients' report of symptoms, there are few comparative studies about patients' perceptions of these diseases. OBJECTIVE: To compare perceptions of these conditions among 4 groups-3 clinical groups of older women with IBS, FM, or both disorders (IBS plus FM) and 1 similarly aged control group of women with no IBS or FM-using their responses to survey questions about stressful life events, general physical and mental health, and general medical, pain, and psychiatric comorbidities. METHOD: Using data from the Biopsychosocial Religion and Health Study survey, responses from women were compared regarding a number of variables. To compare stress-related and physical-mental health profiles across the 4 groups, 1-way analyses of variance and χ(2) tests (with Tukey-Kramer and Tukey post hoc tests, respectively) were used, with α set to .05. RESULTS: The present study comprised 3811 women. Participants in the control group, the IBS group, the FM group, and the IBS plus FM group numbered 3213 (84.3%), 366 (9.6%), 161 (4.2%), and 71 (1.9%), respectively, with a mean (standard deviation) age of 62.4 (13.6), 64.9 (13.7), 63.2 (10.8), and 61.1 (10.9) years, respectively. In general, participants in the control group reported fewer lifetime traumatic and major life stressors, better physical and mental health, and fewer comorbidities than respondents in the 3 clinical groups, and these differences were both statistically significant and substantial. Respondents with IBS reported fewer traumatic and major life stressors and better health (ratings and comorbidity data) than respondents with FM or respondents with IBS plus FM. Overall, respondents with both diseases reported the worst stressors and physical-mental health profiles and reported more diagnosed medical, pain, and psychiatric comorbidities. CONCLUSION: The results revealed statistically significant, relatively large differences in perceptions of quality of life measures and health profiles among the respondents in the control group and the 3 clinical groups.

Child maltreatment, alexithymia, and problematic internet use in young adulthood.

The goals of this study were to (a) examine the phenomenology and developmental correlates of problematic Internet use (PIU) in a large and diverse college student sample; (b) evaluate a developmental process model of PIU in which the expected association between child maltreatment and PIU would be explained by alexithymia; and (c) explore these relations as a function of gender and race. PIU was assessed in a sample of 1,470 college students (62.9 percent female, 37.1 percent male; M(age)=19.13 years [SD=1.49]; 46.1 percent Asian, 28.2 percent Hispanic, 16.3 percent White, 5.9 percent Black, and 3.5 percent Multiracial/Other) who participated in a larger study of young adult adaptation, which included measures of child maltreatment, alexithymia, self-concept, social support, and psychopathology. Males and Asian students endorsed higher levels of PIU than females and other ethnoracial groups, respectively. PIU was related to contemporaneous maladaptation in the form of decreased self-concept, lower social support, and increased psychopathology across groups. Experiences of child maltreatment were related to increased PIU, and mediation analyses showed that this relation was partially explained by alexithymia. These relations were comparable across males and females and between Asian and non-Asian respondents. The analyses provide evidence for the significant role of child maltreatment and the cognitive-affective deficits it precipitates in understanding pathways toward PIU in young adulthood. Our findings suggest that maltreated youth are at disproportionate risk for PIU, and their capacities to regulate and process emotion are important targets for prevention and therapeutic intervention.

Religious Engagement in a Risky Family Model Predicting Health in Older Black and White Seventh-day Adventists.

In a structural equation model, associations among latent variables - Child Poverty, Risky Family exposure, Religious Engagement, Negative Social Interactions, Negative Emotionality, and Perceived Physical Health - were evaluated in 6,753 Black and White adults aged 35-106 years (M = 60.5, SD = 13.0). All participants were members of the Seventh-day Adventist church surveyed in the Biopsychosocial Religion and Health Study (BRHS). Child Poverty was positively associated with both Risky Family exposure (conflict, neglect, abuse) and Religious Engagement (intrinsic religiosity, religious coping, religiousness). Risky Family was negatively associated with Religious Engagement and positively associated with both Negative Social Interactions (intrusive, failed to help, insensitive, rejecting) and Negative Emotionality (depression, negative affect, neuroticism). Religious Engagement was negatively associated with Negative Emotionality and Negative Social Interactions at a given level of risky family. Negative Social Interactions was positively associated with Negative Emotionality, which had a direct, negative effect on Perceived Physical Health. All constructs had indirect effects on Perceived Physical Health through Negative Emotionality. The effects of a risky family environment appear to be enduring, negatively affecting one's adult religious life, emotionality, social interactions, and perceived health. Religious engagement, however, may counteract the damaging effects of early life stress.

Student mistreatment in medical school and planning a career in academic medicine.

BACKGROUND: Student mistreatment in medical school is a persistent problem with both known and unexplored consequences [corrected]. PURPOSE: The purpose of this study was to determine whether a perception of having been mistreated in medical school had an association with planning a full-time career in academic medicine. METHOD: Using Association of American Medical Colleges' 2000-2004 Medical School Graduation Questionnaire data, we evaluated the relationship between students' mistreatment experience and their career choice, academic versus nonacademic setting. Meta-analysis and regression were used to evaluate this relationship. RESULTS: At medical schools where relatively high percentages of graduating seniors were planning academic careers, students reporting mistreatment experiences were less likely at graduation to be planning careers in academic medicine. CONCLUSION: A perception of having been mistreated in medical school is related to students' career choices, a finding that may be useful to medical school administrators/faculty and students as mistreatment is addressed in program planning, counseling, and faculty recruitment.

Serious psychological distress and diabetes care among California adults.

OBJECTIVE: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin A 1 C checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). METHOD: Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. RESULTS: Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin A 1 C checks. CONCLUSIONS: The findings highlight a specific area--foot complication evaluation and prevention--for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.

Correlates of perceived pain-related restrictions among women with fibromyalgia.

OBJECTIVE: To identify correlates of perceived pain-related restrictions in a community sample of women with fibromyalgia. METHOD: The fibromyalgia group was composed of white women with a self-reported, physician-given fibromyalgia diagnosis (N = 238) from the Biopsychosocial Religion and Health Study (BRHS). BRHS respondents had participated in the larger Adventist Health Study-2. To identify associations with pain-related restrictions, we used hierarchical linear regression. The outcome measure was subjects' pain-related restrictions (one SF-12 version 2 item). Predictors included age, education, body mass index (BMI), sleep apnea, and fibromyalgia treatment in the last year, as well as standardized measures for trauma, major life stress, depression, and hostility. To better interpret the findings, pain-related restrictions also were predicted in women with osteoarthritis and no fibromyalgia. RESULTS: Women with fibromyalgia reporting the more severe pain-related restrictions were those who had experienced trauma accompanied by physical pain, were older, less educated, more depressed, more hostile, had high BMI scores, and had been treated for fibromyalgia in the last 12 months (adjusted R(2) = 0.308). Predictors in women with osteoarthritis were age, BMI, treatment in the last 12 months, experience of a major life stressor, and greater depression symptom severity (adjusted R(2) = 0.192). CONCLUSIONS: In both groups, age, BMI, treatment in the last 12 months, and depression predicted pain-related restrictions. Experience of a traumatic event with physical pain was the strongest predictor in the fibromyalgia group. These findings may be useful in constructing novel treatments and prevention strategies for pain-related morbidity in fibromyalgia patients.

Bifactor models and rotations: exploring the extent to which multidimensional data yield univocal scale scores.

The application of psychological measures often results in item response data that arguably are consistent with both unidimensional (a single common factor) and multidimensional latent structures (typically caused by parcels of items that tap similar content domains). As such, structural ambiguity leads to seemingly endless "confirmatory" factor analytic studies in which the research question is whether scale scores can be interpreted as reflecting variation on a single trait. An alternative to the more commonly observed unidimensional, correlated traits, or second-order representations of a measure's latent structure is a bifactor model. Bifactor structures, however, are not well understood in the personality assessment community and thus rarely are applied. To address this, herein we (a) describe issues that arise in conceptualizing and modeling multidimensionality, (b) describe exploratory (including Schmid-Leiman [Schmid & Leiman, 1957] and target bifactor rotations) and confirmatory bifactor modeling, (c) differentiate between bifactor and second-order models, and (d) suggest contexts where bifactor analysis is particularly valuable (e.g., for evaluating the plausibility of subscales, determining the extent to which scores reflect a single variable even when the data are multidimensional, and evaluating the feasibility of applying a unidimensional item response theory (IRT) measurement model). We emphasize that the determination of dimensionality is a related but distinct question from either determining the extent to which scores reflect a single individual difference variable or determining the effect of multidimensionality on IRT item parameter estimates. Indeed, we suggest that in many contexts, multidimensional data can yield interpretable scale scores and be appropriately fitted to unidimensional IRT models.