Generalized Anxiety Disorder-7 (GAD-7) is a widely used self-report that assesses generalized anxiety disorder symptomatology. Whilst previous studies have reported good-to-excellent psychometric ...properties across different languages, it remains unclear whether GAD-7 measures the same construct across Western and non-Western countries. Here, we tested the hypothesis that the GAD-7 is measurement invariant across Western and non-Western countries and the hypothesis that a less severe GAD symptomatology can be found in non-Western countries.
The present study employed an online survey to examine the GAD-7's measurement invariance (MI) across community samples from Indonesia, Germany, and the USA (N = 2350). MI was computed using multiple-group confirmatory factor analyses with a general factor model of the GAD-7.
The general factor of the GAD-7 had good model fit and configural, metric, scalar, and residual MI across the three countries. No significant differences were found in mean scores (Indonesia, M = 1.78, SD = 0.64, Germany, M = 1.84, SD = 0.69, USA, M = 1.87, SD = 0.79; F (2, 1514) = 3.079, p = 0.046; Games-Howell post-hoc analysis, tGermany-Indonesia = 1.720, p = 0.199; tGermany-USA = 0.750, p = 0.734; tIndonesia-USA = 2.330, p = 0.053).
This study's online nature may have inflated cross-country similarities and reduced data generalizability.
The full MI demonstrates the GAD-7 captures the same GAD construct across Western and non-Western countries. Inconsistent with the previous findings GAD severity levels were similar across countries. Despite some possible reservations, the GAD-7 appears to be a culturally fair GAD measure.
•The unidimensional factorial structure of GAD-7 has residual measurement invariance across Germany, Indonesia, and the USA.•Individuals in Germany, Indonesia, and the USA may experience similar generalized anxiety symptomatology.•No difference in anxiety levels between our samples from Germany, Indonesia, and the USA.•Our finding is inconsistent with the notion that people from non-Western countries have lower anxiety than Western countries.
Social adversity is a risk factor for psychosis, but the translating mechanisms are not well understood. This study tests whether the relationship between social adversity and psychosis is mediated ...by cognitive vulnerability in the form of low perceived social rank, negative schemas related to self and other, and loneliness and whether the putative mediations are specific to psychosis or are largely explained by depression.
The study was a survey in a community sample (N = 2350) from Germany (n = 786), Indonesia (n = 844), and the United States (n = 720). Mediation path analysis with structural equation modeling was used to test for the specificity of the hypothesized paths to psychosis controlling for depression.
Social adversity had a significant medium to large effect on positive (R2 = .20) and negative symptoms (R2 = .38). Social rank, negative schemas, and loneliness significantly mediated the relationship between social adversity and negative symptoms and the models explained a large amount of the variance (R2 = .43-.44). For positive symptoms, only negative schemas were a significant mediator (R2 = .27).
The results emphasize the role of social adversity in psychosis and support the assumption that cognitive vulnerability is a relevant translating mechanism as postulated by the social defeat hypothesis and cognitive models of psychosis. This underlines the relevance of the clinical practice of targeting beliefs in cognitive interventions for psychosis. It also indicates that targeting cognitive vulnerability in people experiencing social adversity could be a promising approach to prevention.
Psychological models of the consequences of ostracism (i.e. being socially excluded and ignored) and negative symptoms in schizophrenia suggest that repeatedly experiencing ostracism can lead to ...elevated levels of amotivation, anhedonia, and asociality (i.e. negative symptoms).
We tested this assumption in a prospective study, following up a large multi-national community sample from Germany, Indonesia, and the United States (N = 962) every four months over one year. At each of the four assessment points (T0 – T3), participants rated their recent ostracism experiences and negative symptoms.
Using cross-lagged panel analyses we found a) that negative symptoms and experiences of ostracism were significantly associated in each of the four assessment points, b) that ostracism predicted negative symptoms over time (T2 to T3), and c) that negative symptoms increased ostracism (T0 to T1).
The results are in line with the social defeat model of negative symptoms and suggest a bi-directional longitudinal relationship between ostracism and negative symptoms. Moving forward, it will therefore be important to gain an understanding of potential moderators involved in the mechanism.
•Negative symptoms and ostracism were significantly associated consistently in each assessment points.•Ostracism predicted negative symptoms (T2 to T3).•Negative symptoms predicted ostracism (T0 to T1).•The relationship between ostracism and negative symptoms may be bi-directional.
AbstractAimThis study examined the factorial and criterion validity of the Community Assessment of Psychic Experiences (CAPE). We compared the validity of the original three-dimensional model and a ...recently proposed multidimensional model, in which positive symptoms are subdivided into the subfactors hallucinations, bizarre experiences, paranoia, grandiosity and magical thinking and negative symptoms are subdivided into social withdrawal, affective flattening and avolition. MethodsEleven community ( n= 934) and three patient samples ( n= 112) were combined and the proposed models were tested using confirmatory factor analysis. Criterion validity was calculated based on self-report measures for depression and paranoia as well as observer-based ratings for positive and negative symptoms. ResultsThe multidimensional model showed better relative quality (AIC, BIC) than the original three-dimensional model of the CAPE, but both models showed acceptable absolute model-fit (RMSEA, SRMR). The criterion validity was good for the positive symptom scales and negative symptom subfactors social withdrawal and affective flattening. ConclusionFactorial validity was found for the three-dimensional and multidimensional model for the CAPE. The multidimensional model, however, shows better comparative fit and promising results in regard to criterion validity. Thus, we recommend a hierarchical multidimensional structure of positive and negative symptoms for future use of the CAPE.
Targeting the antecedents of paranoia may be one potential method to reduce or prevent paranoia. For instance, targeting a potential antecedent of paranoia – loneliness – may reduce paranoia. Our ...first research question was whether loneliness heightens subclinical paranoia and whether negative affect may mediate this effect. Second, we wondered whether this potential effect could be targeted via two interventionist pathways in line with an interventionist-causal model approach: (1) decreasing loneliness, and (2) intervening on the potential mediator – negative affect. In Study 1 (N = 222), recollecting an experience of companionship reduced paranoia in participants high in pre-manipulation paranoia but not in participants low in pre-manipulation paranoia. Participants recollecting an experience of loneliness, on the other hand, exhibited increased paranoia, and this effect was mediated by negative affect. In Study 2 (N = 196), participants who utilized an emotion-regulation strategy, cognitive reappraisal, to regulate the negative affect associated with loneliness successfully attenuated the effect of loneliness on paranoia. Targeting the effect of loneliness on paranoia by identifying interventionist pathways may be one promising route for reducing and preventing subclinical paranoia.
•Inducing loneliness by recalling a lonely experience heightened subclinical paranoia.•We intervened on the observed link between loneliness and subclinical paranoia.•Reducing loneliness led to reduced subclinical paranoia in individuals high in paranoia.•Cognitive reappraisal can be used to attenuate the effect of loneliness on paranoia.•Intervening on loneliness can attenuate subclinical paranoia.
Although a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) is known to be linked to psychotic experiences and psychotic disorders in later life, the developmental trajectories ...that could explain this association are unknown. Using a sample from the prospective population-based Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 8247), we hypothesized that the previously reported association of ADHD combined subtype in childhood and psychotic experiences in early adolescence is mediated by traumatic events and by involvement in bullying. Moreover, we expected this mediation to be specific to ADHD and tested this by comparison with specific phobia. Children with ADHD combined subtype at age 7 were more often involved in bullying at age 10 (OR 3.635, 95% CI 1.973-6.697) and had more psychotic experiences at age 12 (OR 3.362, 95% CI 1.781-6.348). Moreover, children who were involved in bullying had more psychotic experiences (2.005, 95% CI 1.684-2.388). Bullying was a significant mediator between ADHD and psychotic experiences accounting for 41%-50% of the effect. Traumatic events from birth to age 11 were also significantly associated with ADHD combined subtype and psychotic experiences; however, there was no evidence of mediation. Specific phobia was significantly associated with psychotic experiences, but not with bullying. To conclude, bullying is a relevant translating mechanism from ADHD in childhood to psychotic experiences in early adolescence. Interventions that eliminate bullying in children with ADHD could potentially reduce the risk of having psychotic experiences in later life by up to 50%. Clinicians should thus screen for bullying in routine assessments of children with ADHD.
This study aimed to assess the diagnostic accuracy of the Patient Health Questionnaire (PHQ) for identifying common mental disorders in an outpatient clinical psychologist office setting in ...Indonesia. A total of 661 outpatients from a clinical psychology office in Jakarta, Indonesia, participated in the study. The complete PHQ was administered, and its results were compared with diagnoses made by clinical psychologists based on ICD-11 criteria, including somatoform disorder (n = 6), depression (n = 117), Generalized Anxiety Disorder (GAD, n = 50), panic disorder (n = 42), bulimia nervosa (n = 2), binge eating disorder (n = 2), and other diagnoses such as OCD and BPD (n = 442). Receiver operating characteristics were computed to examine cut-off points, and optimal cut-off points based on the Youden Index were identified for somatoform disorder (PHQ-15 ≥ 13), depression (PHQ-9 ≥ 13), GAD (GAD- 7 ≥ 10), and panic disorder (PHQ-PD ≥ 7). Cut-off points for the alcohol abuse and eating disorder modules of the PHQ could not be determined due to a lack of sample, and AUC was suboptimal for PHQ-9, GAD-7, and PHQ-ED. The Indonesian PHQ demonstrated good sensitivity but low specificity in identifying somatoform disorder, depression, GAD, and panic disorders based on ICD-11 criteria among Indonesian clinical psychologist office outpatients. In the Indonesian outpatient psychiatric context, the utility of the Indonesian PHQ appeared to be most effective in ruling out diagnoses.
•Optimal cut-offs in Indonesian outpatients: somatoform (PHQ-15 ≥ 13), depression (PHQ-9 ≥ 13), GAD (GAD-7 ≥ 10), panic (PHQ-PD ≥ 7).•The Indonesian PHQ shows good sensitivity for ruling out diagnoses, but limited specificity requires caution for confirming diagnoses.•The Indonesian PHQ's limited specificity may result from the psychiatric outpatient sample, with similar studies in specialist contexts showing lower accuracy than in primary care.
The UCLA Loneliness Scale (ULS-20) and its short version (ULS-8) are widely used to measure loneliness. However, the question remains whether or not previous studies using the scale to measure ...loneliness are measuring the construct equally across countries. The present study examined the measurement invariance (MI) of both scales in Germany, Indonesia, and the United States (N = 2350). The one-, two-, and three-factor structure of the ULS-20 did not meet the model fit cut-off criteria in the total sample. The ULS-8 met the model fit cut-off criteria and has configural, but not metric invariance because two items unrelated to social isolation were not MI. The final six items (ULS-6) exclusively related to social isolation had complete MI. Participants from the United States scored highest in the ULS-6, followed by participants from Germany and then Indonesia. We conclude that the ULS-6 is an appropriate measure for cross-cultural studies on loneliness.
Prodromal symptoms of psychosis are associated with an increased risk of transition, functional impairment, poor mental health, and unfavorable developmental prospects. Existing interventions ...targeting the prodrome are non-satisfactory. It may thus be more promising to attempt to identify risk factors in the premorbid phase preceding the prodrome to increase the chances of successful preventive approaches. Here, we investigate whether childhood mental disorders in general and attention-deficit/hyperactivity disorder (ADHD) specifically indicate a risk for subsequent psychotic experiences and disorders. We used a sample from the prospective Avon Longitudinal Study of Parents and Children (
N
= 5528). When the participants were 7 years old, mental disorders were assigned according to the DSM-IV. In standardized interviews, psychotic experiences were assessed at age 12 and psychotic disorders at age 18. We examined the associations of each of the childhood mental disorders alone and in combination with psychotic experiences at age 12 and psychotic disorders at age 18 using logistic regression. Compared to participants without a disorder, participants with a mental disorder had a higher risk of psychotic experiences at age 12 (OR 1.70, 95 % CI 1.28–2.27) and of psychotic disorders at age 18 (OR 2.31, 95 % CI 1.03–5.15). Particularly, the ADHD combined subtype at age 7 was strongly associated with psychotic experiences at age 12 (OR 3.26, 95 % CI 1.74–6.10). As expected, childhood mental disorders are risk indicators of psychotic experiences and disorders. To improve prevention, health care professionals need to screen for psychotic experiences in children with non-psychotic disorders.
Abstract Based on the social defeat (SD) hypothesis, this study examines the postulate that various social adversities converge into one common factor, and whether this factor has an effect on ...psychotic symptoms while controlling for its effect on depression and anxiety. Competing hypotheses arguing for the reverse effect were also tested. The study was a cross-sectional survey in a community sample (N = 2350) from Germany ( n = 786), Indonesia ( n = 844), and the United States ( n = 720). Confirmatory factor analysis (CFA) and path analysis with structural equation modeling were used to test the hypotheses. In the CFA two factors reflecting current and past experiences of SD could be identified with acceptable fit. Path analysis indicated acceptable fit for both SD and reverse models, and both the path from current SD to psychotic symptoms and the reverse one were significant, although the former was stronger than the latter. Interestingly, the current but not the past SD factor was significantly associated with psychotic symptoms. Overall, the results indicate that postulates derived from the SD hypothesis fit the data. However, longitudinal research is needed to further confirm the postulated directionality of the associations.
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