Objective:Approximately 20%–35% of individuals 12–35 years old who meet criteria for a prodromal risk syndrome convert to psychosis within 2 years. However, this estimate ignores the fact that ...clinical high-risk cases vary considerably in risk. The authors sought to create a risk calculator, based on profiles of risk indicators, that can ascertain the probability of conversion to psychosis in individual patients.Method:The study subjects were 596 clinical high-risk participants from the second phase of the North American Prodrome Longitudinal Study who were followed up to the time of conversion to psychosis or last contact (up to 2 years). The predictors examined were limited to those that are supported by previous studies and are readily obtainable in general clinical settings. Time-to-event regression was used to build a multivariate model predicting conversion, with internal validation using 1,000 bootstrap resamples.Results:The 2-year probability of conversion to psychosis was 16%. Higher levels of unusual thought content and suspiciousness, greater decline in social functioning, lower verbal learning and memory performance, slower speed of processing, and younger age at baseline each contributed to individual risk for psychosis. Stressful life events, trauma, and family history of schizophrenia were not significant predictors. The multivariate model achieved a concordance index of 0.71 and, as reported in an article by Carrión et al., published concurrently with this one, was validated in an independent external data set. The results are instantiated in a web-based risk prediction tool envisioned to be most useful in research protocols involving the psychosis prodrome.Conclusions:A risk calculator comparable in accuracy to those for cardiovascular disease and cancer is available to predict individualized conversion risks in newly ascertained clinical high-risk cases. Given that the risk calculator can be validly applied only for patients who screen positive on the Structured Clinical Interview for Psychosis Risk Syndromes, which requires training to administer, its most immediate uses will be in research on psychosis risk factors and in research-driven clinical (prevention) trials.
Rating scale development in the field of language assessment is often considered in dichotomous ways: It is assumed to be guided either by expert intuition or by drawing on performance data. Even ...though quite a few authors have argued
that rating scale development is rarely so easily classifiable, this dyadic view has dominated language testing research for over a decade. In this paper we refine the dominant model of rating scale development by drawing on a corpus of
36 studies identified in a systematic review. We present a model showing the different sources of scale construct in the corpus. In the discussion, we argue that rating scale designers, just like test developers more broadly, need to
start by determining the purpose of the test, the relevant policies that guide test development and score use, and the intended score use when considering the design choices available to them. These include considering the impact of such
sources on the generalizability of the scores, the precision of the post-test predictions that can be made about test takers' future performances and scoring reliability. The most important contributions of the model are that it gives
rating scale developers a framework to consider prior to starting scale development and validation activities. Author abstract
Abstract Objective To systematically review the accuracy of the GAD-7 and GAD-2 questionnaires for identifying anxiety disorders. Methods A systematic review of the literature was conducted to ...identify studies that validated the GAD-7 or GAD-2 against a recognized gold standard diagnosis. Pooled estimates of diagnostic test accuracy were produced using random-effects bivariate metaanalysis. Heterogeneity was explored using the I2 statistic. Results A total of 12 samples were identified involving 5223 participants; 11 samples provided data on the accuracy of the GAD-7 for identifying generalized anxiety disorder (GAD). Pooled sensitivity and specificity values appeared acceptable at a cutoff point of 8 sensitivity: 0.83 (95% CI 0.71–0.91), specificity: 0.84 (95% CI 0.70–0.92) although cutoff scores 7–10 also had similar pooled estimates of sensitivity/specificity. Six samples provided data on the accuracy of the GAD-2 for identifying GAD. Pooled sensitivity and specificity values appeared acceptable at a cutoff of 3 sensitivity: 0.76 (95% CI 0.55–0.89), specificity: 0.81 (95% CI 0.60–0.92). Four studies looked at the accuracy of the questionnaires for identifying any anxiety disorder. Conclusions The GAD-7 had acceptable properties for identifying GAD at cutoff scores 7–10. The GAD-2 had acceptable properties for identifying GAD at a cutoff score of 3. Further validation studies are needed.
Abstract Background The depression module of the Patient Health Questionnaire-9 (PHQ-9) is a widely used depression screening instrument in nonpsychiatric settings. The PHQ-9 can be scored using ...different methods, including an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and a cut-off based on summed-item scores. The algorithm was the originally proposed scoring method to screen for depression. We summarized the diagnostic test accuracy of the PHQ-9 using the algorithm scoring method across a range of validation studies and compared the diagnostic properties of the PHQ-9 using the algorithm and summed scoring method at the proposed cut-off point of 10. Methods We performed a systematic review of diagnostic accuracy studies of the PHQ-9 using the algorithm scoring method to detect major depressive disorder (MDD). We used meta-analytic methods to calculate summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios for diagnosing MDD of the PHQ-9 using algorithm scoring method. In studies that reported both scoring methods (algorithm and summed-item scoring at proposed cut-off point of ≥ 10), we compared the diagnostic properties of the PHQ-9 using these methods. Results We found 27 validation studies that validated the algorithm scoring method of the PHQ-9 in various settings. There was substantial heterogeneity across studies, which makes the pooled results difficult to interpret. In general, sensitivity was low whereas specificity was good. Thirteen studies reported the diagnostic properties of the PHQ-9 for both scoring methods. Pooled sensitivity for algorithm scoring method was lower while specificities were good for both scoring methods. Heterogeneity was consistently high; therefore, caution should be used when interpreting these results. Interpretation This review shows that, if the algorithm scoring method is used, the PHQ-9 has a low sensitivity for detecting MDD. This could be due to the rating scale categories of the measure, higher specificity or other factors that warrant further research. The summed-item score method at proposed cut-off point of ≥ 10 has better diagnostic performance for screening purposes or where a high sensitivity is needed.
The hypothesis implicit in the rating scale design is that the categories reflect increasing levels of the latent variable. Rasch models for ordered polytomous items include parameters, called ...thresholds, that allow for empirically testing this hypothesis. Failure of the thresholds to advance monotonically with the categories (a condition that is referred to as "threshold disordering") provides evidence that the rating scale is not functioning as intended. This work focuses on scales consisting of rather large numbers of categories, whose use is often recommended in the literature. Threshold disordering is observed in both an extended 8-point scale specially developed for the Patient Health Questionnaire-9 and the original 10-point scale of the Behavioral Religiosity Scale. The results of this work prompt practitioners not to take the functioning of the rating scale for granted, but to verify it empirically.
In pediatric patients with anxiety disorders, existing symptom inventories are either not freely available or require extensive time and effort to administer. We sought to evaluate a brief ...self-report scale-the Generalized Anxiety Disorder 7-item scale (GAD-7)-in adolescents with generalized anxiety disorder (GAD).
The Pediatric Anxiety Rating Scale (PARS) and the GAD-7 were administered to youth with GAD (confirmed by structured interview). Relationships between the measures were assessed, and sensitivity and specificity was determined with regard to a global symptom severity measure (Clinical Global Impression-Severity).
In adolescents with GAD (N = 40; mean age, 14.8 ± 2.8), PARS and GAD-7 scores strongly correlated (R = 0.65, P ≤ .001) and a main effect for symptom severity was observed (P ≤ .001). GAD-7 scores ≥11 and ≥17 represented the optimum specificity and sensitivity for detecting moderate and severe anxiety, respectively.
The PARS and GAD-7 similarly reflect symptom severity. The GAD-7 is associated with acceptable specificity and sensitivity for detecting clinically significant anxiety symptoms. GAD-7 scores may be used to assess anxiety symptoms and to differentiate between mild and moderate GAD in adolescents, and may be more efficient than the PARS.
This prospective study characterized parents' concerns about infants at high risk for developing autism spectrum disorder (ASD; each with an older sibling with ASD) at multiple time points in the ...first 2 years, and assessed their relation to diagnostic outcome at 3 years.
Parents of low-risk controls (LR) and high-risk infant siblings (HR) reported any concerns that they had regarding their children's development between 6 and 24 months of age regarding sleep, diet, sensory behavior, gross/fine motor skills, repetitive movements, communication, communication regression, social skills, play, and behavioral problems, using a parent concern form designed for this study. At 3 years of age, an independent, gold-standard diagnostic assessment for ASD was conducted for all participants.
As predicted, parents of HR children who received an ASD diagnosis reported more concerns than parents of LR and HR children who did not have ASD. The total number of concerns predicted a subsequent diagnosis of ASD as early as 12 months within the HR group. Concerns regarding sensory behavior and motor development predicted a subsequent diagnosis of ASD as early as 6 months, whereas concerns about social communication and repetitive behaviors did not predict diagnosis of ASD until after 12 months.
Parent-reported concerns can improve earlier recognition of ASD in HR children.
Orthorexia nervosa is characterized by a preoccupation to eat healthily. However, reliability and validity of some of the existing measures of orthorexic symptomatology are questionable. Therefore, ...the aim of the current study was to examine internal reliability of and intercorrelations between four of the most popular self-report scales for measuring orthorexia nervosa: Bratman's Orthorexia Test (BOT), the ORTO–15, the Eating Habits Questionnaire (EHQ), and the Düsseldorf Orthorexia Scale (DOS). Five-hundred and eleven adults (63% female) completed all four instruments. Model fit of the originally proposed factor structures of the BOT, DOS, and EHQ was good but was unacceptable for the ORTO–15. Similarly, internal reliability was good for the BOT, EHQ, and DOS, but was unacceptable for the ORTO–15. The BOT, EHQ, and DOS were highly correlated with each other while correlations with the ORTO–15 were of medium size. A subsequent exploratory item analysis suggested that the poor psychometric properties of the ORTO–15 are largely due to the originally proposed scoring procedure. In conclusion, the BOT, EHQ, and DOS are internally reliable instruments that seem to measure the same construct—orthorexic eating behavior. In line with previous suggestions, we conclude that the ORTO–15 cannot be recommended for the measurement of orthorexia nervosa, at least not when the originally proposed scoring procedure is used.
Background and purpose
Depression is the most common psychiatric disorder in multiple sclerosis (MS). Self‐report depression scales are frequently used as screening, diagnostic and grading ...instruments. This study investigated the psychometric properties of the Beck Depression Inventory second edition (BDI‐II) for assessing depressive disorders in a sample of Italian MS patients.
Methods
The sample included 141 consecutive non‐demented MS patients who completed the BDI‐II and the Chicago Multiscale Depression Inventory (CMDI). MS patients also completed a clinical interview, a neurological/neuropsychological examination and a Fatigue Severity Score (FSS) questionnaire in order to assess divergent validity.
Results
The BDI‐II showed good internal consistency (Cronbach's alpha 0.89) and good convergent and divergent validity. With respect to CMDI serving as the ‘gold standard’, the receiver operating characteristic curve revealed that BDI‐II is an adequate diagnostic measure and that the optimum total cut‐off score was 18.5. Such score identified clinically relevant depressive symptoms in 25.5% of our MS sample.
Conclusions
The BDI‐II is a simple, reliable and valid tool for detecting and grading depressive symptoms in Italian MS patients.
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