Item response analysis of the Positive and Negative Syndrome Scale

<p>Abstract</p> <p>Background</p> <p>Statistical models based on item response theory were used to examine (a) the performance of individual Positive and Negative Syndrome Scale (PANSS) items and their options, (b) the effectiveness of various subscales to discriminate among individual differences in symptom severity, and (c) the appropriateness of cutoff scores recently recommended by Andreasen and her colleagues (2005) to establish symptom remission.</p> <p>Methods</p> <p>Option characteristic curves were estimated using a nonparametric item response model to examine the probability of endorsing each of 7 options within each of 30 PANSS items as a function of standardized, overall symptom severity. Our data were baseline PANSS scores from 9205 patients with schizophrenia or schizoaffective disorder who were enrolled between 1995 and 2003 in either a large, naturalistic, observational study or else in 1 of 12 randomized, double-blind, clinical trials comparing olanzapine to other antipsychotic drugs.</p> <p>Results</p> <p>Our analyses show that the majority of items forming the Positive and Negative subscales of the PANSS perform very well. We also identified key areas for improvement or revision in items and options within the General Psychopathology subscale. The Positive and Negative subscale scores are not only more discriminating of individual differences in symptom severity than the General Psychopathology subscale score, but are also more efficient on average than the 30-item total score. Of the 8 items recently recommended to establish symptom remission, 1 performed markedly different from the 7 others and should either be deleted or rescored requiring that patients achieve a lower score of 2 (rather than 3) to signal remission.</p> <p>Conclusion</p> <p>This first item response analysis of the PANSS supports its sound psychometric properties; most PANSS items were either very good or good at assessing overall severity of illness. These analyses did identify some items which might be further improved for measuring individual severity differences or for defining remission thresholds. Findings also suggest that the Positive and Negative subscales are more sensitive to change than the PANSS total score and, thus, may constitute a "mini PANSS" that may be more reliable, require shorter administration and training time, and possibly reduce sample sizes needed for future research.</p

The 12-item World Health Organization Disability Assessment Schedule II (WHO-DAS II): a nonparametric item response analysis

<p>Abstract</p> <p>Background</p> <p>Previous studies have analyzed the psychometric properties of the World Health Organization Disability Assessment Schedule II (WHO-DAS II) using classical omnibus measures of scale quality. These analyses are sample dependent and do not model item responses as a function of the underlying trait level. The main objective of this study was to examine the effectiveness of the WHO-DAS II items and their options in discriminating between changes in the underlying disability level by means of item response analyses. We also explored differential item functioning (DIF) in men and women.</p> <p>Methods</p> <p>The participants were 3615 adult general practice patients from 17 regions of Spain, with a first diagnosed major depressive episode. The 12-item WHO-DAS II was administered by the general practitioners during the consultation. We used a non-parametric item response method (Kernel-Smoothing) implemented with the TestGraf software to examine the effectiveness of each item (item characteristic curves) and their options (option characteristic curves) in discriminating between changes in the underliying disability level. We examined composite DIF to know whether women had a higher probability than men of endorsing each item.</p> <p>Results</p> <p>Item response analyses indicated that the twelve items forming the WHO-DAS II perform very well. All items were determined to provide good discrimination across varying standardized levels of the trait. The items also had option characteristic curves that showed good discrimination, given that each increasing option became more likely than the previous as a function of increasing trait level. No gender-related DIF was found on any of the items.</p> <p>Conclusions</p> <p>All WHO-DAS II items were very good at assessing overall disability. Our results supported the appropriateness of the weights assigned to response option categories and showed an absence of gender differences in item functioning.</p

A IMPORTÂNCIA DA COMUNICAÇÃO INTERNA EM UMA INDÚSTRIA DE NUTRIÇÃO ANIMAL

This research aims to identify how the process can be organized to facilitate scheduling and compliance with daily schedules based on the smooth running of the internal communication process in the Logistics, Production and Commercial sectors of a nutrition industry. animal. The study is characterized as a bibliographic research, with a qualitative approach, with an exploratory character and a case study. data, the Failure Mode and Effect Analysis tool (FMEA), Action Plan and SWOT Analysis was used to understand, analyze and suggest improvements in the internal communication process. It was possible to identify strengths, weaknesses, opportunities and threats, thus enabling the improvement of internal communication and achievement of organizational objectives.Esta investigación tiene como objetivo identificar cómo se puede organizar el proceso para facilitar la programación y el cumplimiento de los horarios diarios a partir del buen avance del proceso de comunicación interna en los sectores logístico, productivo y comercial de una industria de nutrición animal. El estudio se caracteriza por ser una investigación bibliográfica, con un enfoque cualitativo, exploratorio y un caso de estudio.  los datos se utilizaron la Herramienta de Análisis del Modo y Efecto de Falla (FMEA), el Plan de Acción y el Análisis SWOT para la comprensión, el análisis y las sugerencias de mejoras en el proceso de comunicación interna. Fue posible identificar fortalezas, debilidades, oportunidades y amenazas, permitiendo así la mejora de la comunicación interna y el logro de los objetivos organizativos.A presente pesquisa tem o objetivo de identificar de que forma o processo pode ser organizado para facilitar o agendamento e o cumprimento das programações diárias a partir do bom andamento do processo de comunicação interna nos setores de Logística, Produção e Comercial, de uma indústria de nutrição animal. O estudo se caracteriza como uma pesquisa bibliográfica, com abordagem qualitativa, de caráter exploratório e um estudo de caso.&nbsp; dados foi utilizada a ferramenta de Análise do Modo e Efeito de Falha (FMEA), Plano de Ação e Análise SWOT para compreensão, análise e sugestões de melhorias no processo de comunicação interna. Foi possível identificar pontos fortes, pontos fracos, oportunidades e ameaças, desta forma, possibilitando a melhoria da comunicação interna e atingimento dos objetivos organizacionais

Use of NON-PARAMETRIC Item Response Theory to develop a shortened version of the Positive and Negative Syndrome Scale (PANSS)

<p>Abstract</p> <p>Background</p> <p>Nonparametric item response theory (IRT) was used to examine (a) the performance of the 30 Positive and Negative Syndrome Scale (PANSS) items and their options ((levels of severity), (b) the effectiveness of various subscales to discriminate among differences in symptom severity, and (c) the development of an abbreviated PANSS (Mini-PANSS) based on IRT and a method to link scores to the original PANSS.</p> <p>Methods</p> <p>Baseline PANSS scores from 7,187 patients with Schizophrenia or Schizoaffective disorder who were enrolled between 1995 and 2005 in psychopharmacology trials were obtained. Option characteristic curves (OCCs) and Item Characteristic Curves (ICCs) were constructed to examine the probability of rating each of seven options within each of 30 PANSS items as a function of subscale severity, and summed-score linking was applied to items selected for the Mini-PANSS.</p> <p>Results</p> <p>The majority of items forming the Positive and Negative subscales (i.e. 19 items) performed very well and discriminate better along symptom severity compared to the General Psychopathology subscale. Six of the seven Positive Symptom items, six of the seven Negative Symptom items, and seven out of the 16 General Psychopathology items were retained for inclusion in the Mini-PANSS. Summed score linking and linear interpolation was able to produce a translation table for comparing total subscale scores of the Mini-PANSS to total subscale scores on the original PANSS. Results show scores on the subscales of the Mini-PANSS can be linked to scores on the original PANSS subscales, with very little bias.</p> <p>Conclusions</p> <p>The study demonstrated the utility of non-parametric IRT in examining the item properties of the PANSS and to allow selection of items for an abbreviated PANSS scale. The comparisons between the 30-item PANSS and the Mini-PANSS revealed that the shorter version is comparable to the 30-item PANSS, but when applying IRT, the Mini-PANSS is also a good indicator of illness severity.</p

Association between substance use and psychosocial characteristics among adolescents of the Seychelles

BACKGROUND: We examined the associations between substance use (cigarette smoking, alcohol drinking, and cannabis use) and psychosocial characteristics at the individual and family levels among adolescents of the Seychelles, a rapidly developing small island state in the African region. METHODS: A school survey was conducted in a representative sample of 1432 students aged 11-17 years from all secondary schools. Data came from a self-administered anonymous questionnaire conducted along a standard methodology (Global School-based Health Survey, GSHS). Risk behaviors and psychosocial characteristics were dichotomized. Association analyses were adjusted for a possible classroom effect. RESULTS: The prevalence of cigarette smoking, alcohol drinking and cannabis use was higher in boys than in girls and increased with age. Age-adjusted and multivariate analyses showed that several individual level characteristics (e.g. suicidal ideation and truancy) and family level characteristics (e.g. poor parental monitoring) were associated with substance use among students. CONCLUSIONS: Our results suggest that health promotion programs should simultaneously address multiple risk behaviors and take into account a wide range of psychosocial characteristics of the students at the individual and family levels

Mixed Emotional Experience Is Associated with and Precedes Improvements in Psychological Well-Being

BACKGROUND: The relationships between positive and negative emotional experience and physical and psychological well-being have been well-documented. The present study examines the prospective positive relationship between concurrent positive and negative emotional experience and psychological well-being in the context of psychotherapy. METHODS: 47 adults undergoing psychotherapy completed measures of psychological well-being and wrote private narratives that were coded by trained raters for emotional content. RESULTS: The specific concurrent experience of happiness and sadness was associated with improvements in psychological well-being above and beyond the impact of the passage of time, personality traits, or the independent effects of happiness and sadness. Changes in mixed emotional experience preceded improvements in well-being. CONCLUSIONS: Experiencing happiness alongside sadness in psychotherapy may be a harbinger of improvement in psychological well-being

A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender

<p>Abstract</p> <p>Background</p> <p>Psychological distress is a widespread indicator of mental health and mental illness in research and clinical settings. A recurrent finding from epidemiological studies and population surveys is that women report a higher mean level and a higher prevalence of psychological distress than men. These differences may reflect, to some extent, cultural norms associated with the expression of distress in women and men. Assuming that these norms differ across age groups and that they evolve over time, one would expect gender differences in psychological distress to vary over the life-course and over time. The objective of this study was to investigate the construct validity of a psychological distress scale, the K6, across gender in different age groups and over a twelve-year period.</p> <p>Methods</p> <p>This study is based on data from the Canadian National Population Health Survey (C-NPHS). Psychological distress was assessed with the K6, a scale developed by Kessler and his colleagues. Data were examined through multi-group confirmatory factor analyses. Increasing levels of measurement and structural invariance across gender were assessed cross-sectionally with data from cycle 1 (n = 13019) of the C-NPHS and longitudinally with cycles 1 (1994-1995), 4 (2000-2001) and 7 (2006-2007).</p> <p>Results</p> <p>Higher levels of measurement and structural invariance across gender were reached only after the constraint of equivalence was relaxed for various parameters of a few items of the K6. Some items had a different pattern of gender non invariance across age groups and over the course of the study. Gender differences in the expression of psychological distress may vary over the lifespan and over a 12-year period without markedly affecting the construct validity of the K6.</p> <p>Conclusions</p> <p>This study confirms the cross-gender construct validity of psychological distress as assessed with the K6 despite differences in the expression of some symptoms in women and in men over the life-course and over time. Findings suggest that the higher mean level of psychological distress observed in women reflects a true difference in distress and is unlikely to be gender-biased. Gender differences in psychological distress are an important public health and clinical issue and further researches are needed to decipher the factors underlying these differences.</p

Supporting adolescent emotional health in schools: a mixed methods study of student and staff views in England

<p>Abstract</p> <p>Background</p> <p>Schools have been identified as an important place in which to support adolescent emotional health, although evidence as to which interventions are effective remains limited. Relatively little is known about student and staff views regarding current school-based emotional health provision and what they would like to see in the future, and this is what this study explored.</p> <p>Methods</p> <p>A random sample of 296 English secondary schools were surveyed to quantify current level of emotional health provision. Qualitative student focus groups (27 groups, 154 students aged 12-14) and staff interviews (12 interviews, 15 individuals) were conducted in eight schools, purposively sampled from the survey respondents to ensure a range of emotional health activity, free school meal eligibility and location. Data were analysed thematically, following a constant comparison approach.</p> <p>Results</p> <p>Emergent themes were grouped into three areas in which participants felt schools did or could intervene: emotional health in the curriculum, support for those in distress, and the physical and psychosocial environment. Little time was spent teaching about emotional health in the curriculum, and most staff and students wanted more. Opportunities to explore emotions in other curriculum subjects were valued. All schools provided some support for students experiencing emotional distress, but the type and quality varied a great deal. Students wanted an increase in school-based help sources that were confidential, available to all and sympathetic, and were concerned that accessing support should not lead to stigma. Finally, staff and students emphasised the need to consider the whole school environment in order to address sources of distress such as bullying and teacher-student relationships, but also to increase activities that enhanced emotional health.</p> <p>Conclusion</p> <p>Staff and students identified several ways in which schools can improve their support of adolescent emotional health, both within and outside the curriculum. However, such changes should be introduced as part of a wider consideration of how the whole school environment can be more supportive of students' emotional health. Clearer guidance at policy level, more rigorous evaluation of current interventions, and greater dissemination of good practice is necessary to ensure adolescents' emotional health needs are addressed effectively within schools.</p

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

Abstract Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. Trial Registration ClinicalTrials.gov: NCT0140792