Chung-Ying Lin

Child-rated versus parent-rated quality of life of community-based obese children across gender and grade

BackgroundQuality of life (QoL), which can be examined using self-reports or parental reports, might help healthcare providers understand obese children’s subjective well-being in several domains of life. Community-based obese children report their QoL lower than their parents do. However, the differences between child- and parent-reported QoL have neither been tested across gender and grade nor analyzed by item. This study probed the relationship between obesity and QoL item scores in children, and compared child-reported with parent-reported QoL stratified by gender and grade.MethodsOne hundred eighty-seven dyads of 8- to 12-year-old children (60 obese, 127 normal-weight) and their parents were recruited. QoL was assessed using both child- and parent-reported Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaires.ResultsRegression analyses showed specific difficulties with physical and emotional QoL in third- and fourth-grade obese boys (β = 0.278-0.620), and specific problems with social functioning in fifth- and sixth-grade obese girls (β = 0.337-0.411). Moreover, parents seemed unaware of the specific difficulties that their children faced (β = 0.274-0.435).ConclusionsObese children seemed to have their difficulties from third to fifth grade, respectively, and their parents seemed unaware of them. Thus, parents need to be more aware of specific difficulties related to childhood obesity.

Further Psychometric Evaluation of the Self- Stigma Scale-Short: Measurement Invariance across Mental Illness and Gender

Background This study cross-validated the factor structure of the Self-Stigma Scale-Short (SSS-S) in a cohort of patients with mental illness in southern Taiwan. The measurement invariance of the SSS-S factor structure across mental illness and gender was also examined. Methods The sample consisted of 161 patients with schizophrenia (51.6% males; mean age ± SD = 40.53 ± 10.38 years) and 189 patients with other mental illnesses (34.9% males; mean age = 46.52 ± 11.29 years). Results The internal reliability (total score: α = 0.948) and concurrent validity (r = 0.335 to 0.457 with Depression and Somatic Symptoms Scale; r = −0.447 to −0.556 with WHOQOL-BREF) of the SSS-S were both satisfactory, and the results verified that the factor structure in our Taiwan sample (RMSEA = 0.0796, CFA = 0.992) was the same as that of the Hong Kong population. In addition, the results supported the measurement invariance of the SSS-S across mental illness (ΔRMSEAs = −0.0082 to −0.0037, ΔCFAs = 0.000) and gender (ΔRMSEAs = −0.0054 to −0.0008, ΔCFAs = −0.001 to 0.000). Conclusion Future studies can use the SSS-S to compare self-stigma between genders and between patients with different kinds of mental illnesses.

Psychometric evaluation of the internalized stigma of mental illness scale for patients with mental illnesses: measurement invariance across time.

Background The current investigation examined the psychometric properties of the Internalized Stigma of Mental Illness (ISMI) scale in a sample of patients with mental illness. In addition to the internal consistency, test-retest reliability, and concurrent validity that previous studies have tested for the ISMI, we extended the evaluation to its construct validity and measurement invariance using confirmatory factor analysis (CFA). Methods Three hundred forty-seven participants completed two questionnaires (i.e., the ISMI and the Depression and Somatic Symptoms Scale [DSSS]), and 162 filled out the ISMI again after 50.23±31.18 days. Results The results of this study confirmed the frame structure of the ISMI; however, the Stigma Resistance subscale in the ISMI seemed weak. In addition, internal consistency, test-retest reliability, and concurrent validity were all satisfactory for all subscales and the total score of the ISMI, except for Stigma Resistance (α = 0.66; ICC = 0.52, and r = 0.02 to 0.06 with DSSS). Therefore, we hypothesize that Stigma Resistance is a new concept rather than a concept in internalized stigma. The acceptable fit indices supported the measurement invariance of the ISMI across time, and suggested that people with mental illness interpret the ISMI items the same at different times. Conclusion The clinical implication of our finding is that clinicians, when they design interventions, may want to use the valid and reliable ISMI without the Stigma Resistance subscale to evaluate the internalized stigma of people with mental illness.

Psychometric evaluation, using Rasch analysis, of the WHOQOL-BREF in heroin-dependent people undergoing methadone maintenance treatment: further item validation

BackgroundThe brief version of World Health Organization Quality of Life assessment (WHOQOL-BREF), a useful outcome measure for clinical decision making, has been evaluated using classical test theory (CTT) for psychometric properties on heroin-dependent patients. However, CTT has a major disadvantage of invalid summated score, and using Rasch models can overcome the shortcoming. The purpose of this study was using Rasch models to evaluate the psychometric properties of the WHOQOL-BREF for heroin-dependent patients, and the hypothesis was that each WHOQOL-BREF domain is unidimensional.MethodsTwo hundred thirty six participants (24 females, mean [SD] age = 38.07 [7.44] years, first used heroin age = 26.13 [6.32] years), with a diagnosis of opioid dependence, were recruited from a methadone maintenance treatment program. Each participant filled out the WHOQOL-BREF. Parallel analysis (PA) and Rasch rating scale models were used for statistical analyses.ResultsBased on the PA analyses, four domains of the WHOQOL-BREF were unidimensional. The Rasch analyses showed three negatively worded items (2 in Physical and 1 in Psychological) reported as misfits that may not contribute to the Physical and Psychological domains; one positively worded item in the Physical domain may be redundant. All values for the separation indices were above 2 except for the person separation index in the Physical domain (1.93). Category functioning and item independency of four WHOQOL-BREF domains were supported by the Rasch analyses, and there were 5 items showing the differential item function (DIF) for positive versus negative HIV (human immunodeficiency virus) infection.ConclusionsThe WHOQOL-BREF is a valid outcome measure for assessing general quality of life for substance abusers in terms of physical, psychological, social, and environmental factors. It can also be used as a treatment outcome measure to evaluate the effect of treatments for substance abusers. However, the three misfit negatively worded items should be used with caution because the substance abuser may not fully understand their meaning. Future research may apply cognitive interviews to determine the cognitive functioning of substance abusers and their interpretation of negatively worded items.

Physical Activity Patterns and Quality of Life of Overweight Boys: A Preliminary Study

Objective We compared the physical activity (PA) patterns and the quality of life (QoL) between overweight and normal-weight boys, and examined the relationship between PA and QoL of overweight boys. Methods Eighteen overweight boys (age range: 8–10 years, mean ± standard deviation: 9.36 ± 0.82 years) and 18 age-matched, normal-weight counterparts (age range: 8–10 years, mean ± standard deviation: 9.01 ± 0.65 years) participated in this study. All participants were in the 3rd or 4th grade. Each boy completed a QoL questionnaire and wore an accelerometer on his waist for a week to measure his PA during that period. Independent t tests were used to examine the differences in QoL and PA between the overweight and normal-weight boys. Paired t tests were used to test the differences in PA between weekdays and weekend days for each group. Finally, Pearson correlations were used to analyze the relationships between PA and QoL in overweight boys. Results Overweight boys reported a significantly lower QoL, and participated in significantly less PA on weekends than did normal-weight boys. A moderate and marginally significant correlation was found between PA on weekends and QoL in overweight boys. Conclusion Our findings suggest the importance of increasing weekend PA for overweight boys. Occupational therapists should encourage overweight boys to engage in PA that the boys are interested in on weekends, and conduct a PA program for overweight boys.

Comparing Self-stigma Between People With Different Mental Disorders in Taiwan.

Abstract Internalized stigma (or self-stigma), one of the most painful effects of stigma, causes people with mental health problems profound negative consequences, for example, psychological adversity, demoralization, and feelings of hopelessness. However, knowledge about self-stigma in people with different mental disorders is insufficient. We hypothesized that people with different psychiatric diagnoses have different levels of self-stigma. Through convenience sampling, we used the Internalized Stigma of Mental Illness Scale to compare people diagnosed with schizophrenia (n = 161), depressive disorder (n = 98), bipolar disorder (n = 43), and anxiety disorder (n = 45) in southern Taiwan. We found that people with schizophrenia (mean, 2.09–2.30) and those with bipolar disorder (mean, 2.16–2.38) had significantly higher levels of self-stigma, except for the Stigma Resistance, than did those with anxiety disorder (mean, 1.74–1.87). Our results suggest that clinicians should use different interventions to reduce self-stigma for populations with different psychiatric diagnoses.

Rasch models suggested the satisfactory psychometric properties of the World Health Organization Quality of Life-Brief among lung cancer patients.

The study examined whether the items of the World Health Organization Quality of Life—Brief questionnaire can assess its four underlying domains (Physical, Psychological, Social, and Environment) in a sample of lung cancer patients. All patients (n = 1150) were recruited from a medical center in Tainan, and each participant completed the World Health Organization Quality of Life—Brief. Several Rasch rating scale models were used to examine the data-model fit, and Rasch analyses corroborated that each domain of the World Health Organization Quality of Life—Brief could be unidimensional. Although three items were found to have a poor fit, all the other items fit the unidimensionality with ordered thresholds.

Effects of Music Intervention on State Anxiety and Physiological Indices in Patients Undergoing Mechanical Ventilation in the Intensive Care Unit: A Randomized Controlled Trial

Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention (n = 41) or control group (n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures (p < .02) and pre–post differences (p < .03) except for diastolic blood pressure. Because of music intervention’s low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient’s mood should be monitored after the music intervention.

Psychometric validation of the Persian nine-item Internet Gaming Disorder Scale – Short Form: Does gender and hours spent online gaming affect the interpretations of item descriptions?

Background and aims The nine-item Internet Gaming Disorder Scale – Short Form (IGDS-SF9) is brief and effective to evaluate Internet Gaming Disorder (IGD) severity. Although its scores show promising psychometric properties, less is known about whether different groups of gamers interpret the items similarly. This study aimed to verify the construct validity of the Persian IGDS-SF9 and examine the scores in relation to gender and hours spent online gaming among 2,363 Iranian adolescents. Methods Confirmatory factor analysis (CFA) and Rasch analysis were used to examine the construct validity of the IGDS-SF9. The effects of gender and time spent online gaming per week were investigated by multigroup CFA and Rasch differential item functioning (DIF). Results The unidimensionality of the IGDS-SF9 was supported in both CFA and Rasch. However, Item 4 (fail to control or cease gaming activities) displayed DIF (DIF contrast = 0.55) slightly over the recommended cutoff in Rasch but was invariant in multigroup CFA across gender. Items 4 (DIF contrast = −0.67) and 9 (jeopardize or lose an important thing because of gaming activity; DIF contrast = 0.61) displayed DIF in Rasch and were non-invariant in multigroup CFA across time spent online gaming. Conclusions Given the Persian IGDS-SF9 was unidimensional, it is concluded that the instrument can be used to assess IGD severity. However, users of the instrument are cautioned concerning the comparisons of the sum scores of the IGDS-SF9 across gender and across adolescents spending different amounts of time online gaming.

Cross-Validation of Two Commonly Used Self-Stigma Measures, Taiwan Versions of the Internalized Stigma Mental Illness Scale and Self-Stigma Scale – Short, for People With Mental Illness

Self-stigma instruments investigate how people with mental illness internalize public stigma. However, information is limited for the psychometric properties of their scores, especially cross-validating scores from different instruments. Thus, we used confirmatory factor analyses (CFAs) and item-response theory (IRT) models to examine the Internalized Stigma Mental Illness (ISMI) scale and the Self-Stigma Scale–Short (SSS-S). Participants with mental illness (n = 347) completed both instruments. The CFAs that simultaneously accounted for both the instrument (ISMI and SSS-S) and the trait (Affect, Cognitive, and Behavior concepts) effects outperformed those that accounted only for the instrument effect or only the trait effect. All item scores fit the IRT model and were fit with ordered, progressing hierarchies in their step difficulties. We conclude that both instruments are feasible for measuring the self-stigma and that future research can combine the items of both.