Clinical Utility of the Inventory of Depression and Anxiety Symptoms (IDAS).

Depressive and anxiety disorders are severe and disabling conditions that result in substantial cost and global societal burden. Accurate and efficient identification is thus vital to proper diagnosis and treatment of these disorders. The Inventory of Depression and Anxiety Symptoms (IDAS) is a reliable and well-validated measure that provides dimensional assessment of both mood and anxiety disorder symptoms. The current study examined the clinical utility of the IDAS by establishing diagnostic cutoff scores and severity ranges using a large mixed sample (N = 5,750). Results indicated that the IDAS scales are good to excellent predictors of their associated Structured Clinical Interview for DSM-IV diagnoses. These findings were replicated using Diagnostic and Statistical Manual of Mental Disorders-Fifth edition(DSM-5) criteria assessed via the Mini-International Neuropsychiatric Interview. We provide three cutoff scores for each scale that can be used differentially depending on the goal of their use: screening, efficiency, or diagnosis confirmation. The identified severity ranges allow users to characterize individuals as mild, moderate, or severe, providing clinical information beyond diagnostic status. Finally, the 10-item IDAS Dysphoria scale and 20-item General Depression scale demonstrate strong ability to predict internalizing diagnoses and may represent an efficient way to screen for the presence of internalizing psychopathology.

Development and Validation of the Dissociative Symptoms Scale.

The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe levels of depersonalization, derealization, gaps in awareness or memory, and dissociative reexperiencing that would be relevant to a wide range of clinical populations. Structural analyses of data from four clinical and five nonclinical samples ( N = 1,600) yielded four factors that reflected the domains of interest and showed good fit with the data. Sample scores were consistent with expectations and showed very good internal consistency and temporal stability. Analyses showed consistent evidence of convergent and divergent validity, and posttrauma elevations in scores and in patients with posttraumatic stress disorder provided additional evidence of construct validity. Item response theory analyses indicated that the items assessed moderately severe dissociative experiences. Overall, the results provide support for the reliability and validity of DSS total and subscale scores in the populations studied. Further work is needed to evaluate the performance of the DSS relative to structured interview measures and in samples of patients with other psychological disorders.

The role of active assortment in spousal similarity.

Previous research has established the existence of active assortment, that is, a preference for similarity in a potential mate. Few studies, however, have directly related mate preferences to dyadic similarity by examining them in the same participants. We collected both similarity and mate preference data in two studies: undergraduate students (N = 519) and newlyweds (N = 335). In both studies, women placed a higher value on desirable personality characteristics (e.g., higher Conscientiousness and Agreeableness, lower Neuroticism) than did men. Nevertheless, our data also provided strong evidence of consensual mate preferences: Men and women both desired partners who were agreeable, conscientious, emotionally stable, intelligent, and physically attractive; furthermore, participants desired partners who were better (e.g., more agreeable and attractive) than they were. In contrast, attitudinal variables such as religiousness and political orientation displayed much weaker consensus but showed significant dyadic similarity in both samples; similarity coefficients for personality tended to be positive, but lower. Finally, analyses revealed a direct link between actual and desired similarity: Couples displayed the strongest similarity on those variables for which participants expressed the strongest preference for similarity. Our findings strongly suggest that active assortment is partly responsible for dyadic similarity.

Self-other agreement and assumed similarity in neuroticism, extraversion, and trait affect: distinguishing the effects of form and content.

Trait Negative Affect (NA) and Positive Affect (PA) are strongly associated with Neuroticism and Extraversion, respectively. Nevertheless, measures of the former tend to show substantially weaker self-other agreement-and stronger assumed similarity correlations-than scales assessing the latter. The current study separated the effects of item content versus format on agreement and assumed similarity using two different sets of Neuroticism and Extraversion measures and two different indicators of NA and PA (N = 381 newlyweds). Neuroticism and Extraversion consistently showed stronger agreement than NA and PA; in addition, however, scales with more elaborated items yielded significantly higher agreement correlations than those based on single adjectives. Conversely, the trait affect scales yielded stronger assumed similarity correlations than the personality scales; these coefficients were strongest for the adjectival measures of trait affect. Thus, our data establish a significant role for both content and format in assumed similarity and self-other agreement.

Positive affect, childhood adversity, and psychopathology in psychiatric inpatients.

BACKGROUND: Low positive affect is closely related to common pathological responses to childhood adversity, including posttraumatic stress disorder (PTSD) and depression, but little is known about how the characteristics of early adversity experiences might be related to positive affect in adulthood. OBJECTIVE: This study aimed to explore whether low positive affect is related to specific childhood adversities, including abuse, neglect, caretaker dysfunction, and low childhood social support. METHOD: Using structured interviews and self-report measure data collected from 173 adult psychiatric inpatients, this study examined the relationship between positive affect and symptoms of psychopathology, as well as how the number of types of abuse experienced, severity of adversity types (physical abuse and sexual abuse), childhood environment (childhood social support, neglect, and caretaker dysfunction), and number of non-abuse traumas related to positive affect. RESULTS: Positive affect was significantly negatively related to several symptoms of psychopathology, including depression, dissociation, self-destructive behavior, PTSD, and global psychopathology. Individuals who experienced both physical and sexual abuse reported significantly less positive affect than those with only physical or no abuse experiences. Lower positive affect was predicted by lower childhood social support and greater severity of sexual abuse, with both factors accounting for unique variance in positive affect. CONCLUSION: These results suggest that individuals who experience multiple types of early adversity, more severe sexual abuse experiences, and less social support are at risk of psychological difficulties. Given the relatively strong association between positive affect and childhood social support, interventions to foster social support may be a means of increasing positive affect among individuals exposed to childhood adversity.

Similarity, agreement, and assumed similarity in proxy end-of-life decision making.

Medical decisions near the end of life are often made by proxies who can be inaccurate in their judgments of patient preferences. Given that accuracy in surrogate decision making is an important goal in end-of-life decision making, and in light of that previously seen levels of accuracy reflect substantial disagreement, error, or both, this study examined both relationship and individual factors that potentially affect surrogate accuracy. Specifically, this study examined similarity, agreement, and assumed similarity-a process whereby raters use their own traits and preferences to rate another person-in spousal ratings of end-of-life treatment. This study expands on previous research by examining the potential influence of relationship factors and assumed similarity on end-of-life decision making among a sample of newlyweds. Newly married couples (n = 197) completed self and spouse measures of hypothetical end-of-life preferences and scales assessing marital satisfaction, personality, and attitudes. Results indicate a moderate level of similarity on husband and wife self-rated end-of-life treatment preferences (rs = .18-.29) and a moderate level of agreement between self and proxy ratings (rs = .17-.41). The largest correlations were seen between self ratings and proxy ratings (e.g., husband self ratings and husband proxy ratings of wife preferences, rs = .46-.69), reflecting strong assumed similarity in proxy ratings. For wives, similarity with husbands on a few attitudinal variables (i.e., spirituality, moral strictness, and conservatism) influenced proxy accuracy. Recognizing the potential impact of personal preferences on proxy ratings, as well as the potential influence of relationship factors, may help improve proxy accuracy and end-of-life care for patients and families.

Development and initial validation of the Structured Interview for Self-Destructive Behaviors.

This article describes the initial validation of the Structured Interview for Self-Destructive Behaviors (SI-SDB), a brief interview assessing suicidality, self-injury, substance abuse, disordered eating, and risky sexual behaviors. Self-destructive behaviors present clinical and practical challenges for mental health treatment providers. Participants were 217 psychiatric inpatients with a wide variety of diagnoses who completed the SI-SDB and other measures of psychiatric symptoms, trauma exposure, and other childhood experiences. Internal validity analyses revealed an internally consistent measure with 2 major factors. External validity analyses indicated that the Substance Abuse and Disordered Eating scales were predictive of related psychiatric diagnoses. All scales except Substance Abuse were significantly correlated with psychiatric symptoms and childhood abuse. These findings indicate that the SI-SDB is a valid means of assessing 5 significant domains of dangerous behaviors in clinical and research settings. Further research on the reliability of reports over time, interrater consistency, and convergent validity with longer measures of the SI-SDB domains is needed.

Examining the potential influence of diabetes on depression and anxiety symptoms via multiple sample confirmatory factor analysis.

BACKGROUND: Assessing and diagnosing depression and anxiety in the presence of diabetes is complicated by overlapping symptoms that, therefore, are etiologically ambiguous (e.g., fatigue, appetite disturbance, autonomic arousal). PURPOSE: The goal of the current study is to test whether overlapping symptoms are affected by the presence of diabetes by comparing structural models of symptoms in adults with and without diabetes. METHODS: Participants include 226 adults with diabetes and 380 healthy adults who completed questionnaires assessing symptoms of depression, anxiety, and health status. The most recent hemoglobin A1c lab result was obtained for diabetes patients. RESULTS: Multiple sample confirmatory factor analyses indicated that overlapping symptoms were strongly related to mood disturbance for adults with and without diabetes, suggesting that symptoms were not substantially influenced by diabetes. CONCLUSIONS: It is recommended that when overlapping symptoms are present in diabetes patients, depression and anxiety should be considered as possible contributors to their presence.

Development and initial validation of the disinhibition inventory: a multifaceted measure of disinhibition.

The broad personality trait of disinhibition reflects the tendency to behave in an underconstrained versus overconstrained manner and is associated with externalizing psychopathology and risk-taking behaviors. This article describes the development and initial validation of the Disinhibition Inventory (DIS-I), a multifaceted measure of disinhibition that helps explicate the nature of this important higher-order dimension more fully. Factor analyses of an initial item pool resulted in five content-distinct, yet correlated scales measuring both high (Manipulativeness, Distractibility, Risk Taking) and low (Prosociality, Orderliness) levels of disinhibition that cross-validated in an independent sample. Evidence for the construct validity of the DIS-I is presented, including convergent and discriminant relations with Big-Three and Big-Five/five-factor model measures of personality. Results indicate that the DIS-I scales are associated most strongly with other measures of disinhibition, but that the DIS-I additionally contains content absent in extant adult measures of disinhibition that may prove useful in the assessment of externalizing psychopathology.

Further validation of the IDAS: evidence of convergent, discriminant, criterion, and incremental validity.

The authors explicated the validity of the Inventory of Depression and Anxiety Symptoms (IDAS; D. Watson et al., 2007) in 2 samples (306 college students and 605 psychiatric patients). The IDAS scales showed strong convergent validity in relation to parallel interview-based scores on the Clinician Rating version of the IDAS; the mean convergent correlations were .51 and .62 in the student and patient samples, respectively. With the exception of the Well-Being Scale, the scales also consistently demonstrated significant discriminant validity. Furthermore, the scales displayed substantial criterion validity in relation to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) mood and anxiety disorder diagnoses in the patient sample. The authors identified particularly clear and strong associations between (a) major depression and the IDAS General Depression, Dysphoria and Well-Being scales, (b) panic disorder and IDAS Panic, (c) posttraumatic stress disorder and IDAS Traumatic Intrusions, and (d) social phobia and IDAS Social Anxiety. Finally, in logistic regression analyses, the IDAS scales showed significant incremental validity in predicting several DSM-IV diagnoses when compared against the Beck Depression Inventory-II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996) and the Beck Anxiety Inventory (A. T. Beck & R. A. Steer, 1990).

The effect of symptom visibility on informant reporting.

Informant reporting is important in the assessment of depression and anxiety among individuals with cognitive impairment. The authors examined the influence of the visibility effect on the ease of rating depression and anxiety symptoms. Fifty-three family members of dementia patients and 65 staff members working with cognitively impaired adults judged the ratability of the Inventory of Depression and Anxiety Symptoms item pool. Results indicated that Appetite Loss, Lassitude, and Insomnia scales were easiest to rate; Suicidality and Traumatic Intrusions scales were most difficult to rate. Findings support the visibility effect and emphasize the importance of selecting easy to rate items for informants.

Development and validation of the Inventory of Depression and Anxiety Symptoms (IDAS).

The authors describe a new self-report instrument, the Inventory of Depression and Anxiety Symptoms (IDAS), which was designed to assess specific symptom dimensions of major depression and related anxiety disorders. They created the IDAS by conducting principal factor analyses in 3 large samples (college students, psychiatric patients, community adults); the authors also examined the robustness of its psychometric properties in 5 additional samples (high school students, college students, young adults, postpartum women, psychiatric patients) who were not involved in the scale development process. The IDAS contains 10 specific symptom scales: Suicidality, Lassitude, Insomnia, Appetite Loss, Appetite Gain, Ill Temper, Well-Being, Panic, Social Anxiety, and Traumatic Intrusions. It also includes 2 broader scales: General Depression (which contains items overlapping with several other IDAS scales) and Dysphoria (which does not). The scales (a) are internally consistent, (b) capture the target dimensions well, and (c) define a single underlying factor. They show strong short-term stability and display excellent convergent validity and good discriminant validity in relation to other self-report and interview-based measures of depression and anxiety.

The role of depression symptoms in dialysis withdrawal.

Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study's objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment. Of these, 18% withdrew from dialysis. Using multivariate survival analysis and after controlling for the effects of age (p < .001) and clinical variables, the authors found that level of depression symptoms was a unique and significant predictive risk factor for the subsequent decision to withdraw from dialysis (p < .05). The potential impact that depression may have on the decision to withdraw from hemodialysis should be considered by health care providers, patient families, and patients.