Danielle N. Shapiro

Using Mechanical Turk to Study Clinical Populations

Although participants with psychiatric symptoms, specific risk factors, or rare demographic characteristics can be difficult to identify and recruit for participation in research, participants with these characteristics are crucial for research in the social, behavioral, and clinical sciences. Online research in general and crowdsourcing software in particular may offer a solution. However, no research to date has examined the utility of crowdsourcing software for conducting research on psychopathology. In the current study, we examined the prevalence of several psychiatric disorders and related problems, as well as the reliability and validity of participant reports on these domains, among users of Amazon’s Mechanical Turk. Findings suggest that crowdsourcing software offers several advantages for clinical research while providing insight into potential problems, such as misrepresentation, that researchers should address when collecting data online.

Conducting Clinical Research Using Crowdsourced Convenience Samples

Crowdsourcing has had a dramatic impact on the speed and scale at which scientific research can be conducted. Clinical scientists have particularly benefited from readily available research study participants and streamlined recruiting and payment systems afforded by Amazon Mechanical Turk (MTurk), a popular labor market for crowdsourcing workers. MTurk has been used in this capacity for more than five years. The popularity and novelty of the platform have spurred numerous methodological investigations, making it the most studied nonprobability sample available to researchers. This article summarizes what is known about MTurk sample composition and data quality with an emphasis on findings relevant to clinical psychological research. It then addresses methodological issues with using MTurk--many of which are common to other nonprobability samples but unfamiliar to clinical science researchers--and suggests concrete steps to avoid these issues or minimize their impact.

Legal and social contexts and mental health among lesbian and heterosexual mothers.

This study examines the role of legal and social context (the level of legal and social support offered by ones country of residence) and sexual orientation in the mental health of lesbian and heterosexual mothers. Participants were sampled from the United States and Canada because the two countries have many similarities (North American location, reliance on English language, and democratic structures) but provide different legal and social rights to their lesbian citizens. The study included 52 lesbian mothers and 153 heterosexual mothers in the United States and 35 lesbian mothers and 42 heterosexual mothers in Canada. Although there were no differences between heterosexual mothers as a function of legal and social context, lesbian mothers from the United States reported more family worries about legal status and discrimination (but not more general family worries) and more depressive symptoms than did lesbian mothers in Canada. Results indicate that legal and social context moderates the role of sexual orientation in maternal mental health.

Conceptualizing lesbian sexual identity development: Narrative accounts of socializing structures and individual decisions and actions

Many theories have aimed to chart lesbian, gay and bisexual identity development. These include traditional developmental models as well as newer approaches designed to capture a more fluid, multidimensional trajectory, both of which have tended to neglect the role of intersectional identities, context and individual variation in lesbian identity development. This study used inductive research methods, informed by grounded theory, to examine lesbian identity development in life narrative interviews with four lesbian scholar-activists from different national and racial backgrounds. The women’s narratives suggest that a dynamic, non-linear, and contextualized representation of sexual identity development may more accurately describe lesbian identity development in terms of intersecting identities, national and local contexts, and personal and professional relationships.

Stepparents and parenting stress: The roles of gender, marital quality, and views about gender roles

Previous research suggests that stepparenting can be stressful, although the mechanisms that contribute to the experience of parenting stress in stepfamilies are less clear. This study examines gender, marital quality, and views about gendered family roles as correlates of parenting stress among 310 stepmothers, stepfathers, and biological mothers and fathers. Findings suggest that stepparents, and especially stepmothers, experience higher levels of parenting stress than biological parents. Findings also suggest that less traditional views about gendered family roles and higher dyadic adjustment are associated with lower parenting stress for stepparents, particularly in combination. Stepparents reporting both of these protective factors were indistinguishable in terms of parenting stress from biological parents. These findings indicate potential pathways to mitigate the stress associated with stepparenting.

Behavioral markers of coping and psychiatric symptoms among sexually abused children

The current study examined coping and psychiatric symptoms in a longitudinal sample of sexually abused children. Coping was behaviorally coded from childrens forensic interviews in the aftermath of sexual abuse. Using principal components analysis, coping behaviors were found to cluster into 3 categories: avoidant, expressive, and positive affective coping. Avoidant coping had predictive utility for a range of psychiatric symptoms, including depressive, posttraumatic stress, anxiety, and dissociative symptoms as well as aggression and attention problems measured 8-36 months following the forensic interview. Specific behaviors, namely fidgetiness and distractibility, were also found to be associated with future symptoms. These findings suggest the predictive utility of avoidant behaviors in general, and fidgetiness and distractibility in particular, among sexually abused children.

Individual and Psychosocial Mechanisms of Adaptive Functioning in Parentally Bereaved Children

ABSTRACT The authors examined factors theorized to contribute to adaptive functioning in 56 parentally bereaved children (age 7–13) who had lost their caregiver within the previous 6 months. Adaptive functioning, defined as falling below clinical threshold levels on all measures of depression, posttraumatic stress, anxiety, and internalizing/externalizing symptoms, characterized 57% of the sample. Linear mixed modeling revealed that children in the adaptive functioning group had lower mean scores on avoidant coping and higher mean scores on coping efficacy, religiosity, parental positive reinforcement, and parental empathy. Findings suggest that adaptive functioning following parental loss is related to both child-intrinsic factors and child-extrinsic factors.

Gender and Satisfaction with Appearance in Children with Craniofacial Anomalies.

Background: Although children with craniofacial anomalies appear to have relatively high self-esteem, research has identified gender differences in psychosocial outcomes, including self-concept, suggesting that girls with craniofacial anomalies may be at an increased risk. In addition, though parents make important medical and aesthetic decisions for their children, it is unclear whether they are attuned to their childrens perceptions of their appearance. Methods: The current study assessed self-ratings and parent proxy ratings of child satisfaction with the appearance of both the face and the body among 74 children with craniofacial anomalies (50 percent boys). Data were collected in a multidisciplinary clinic setting. Results: The authors identified that ratings provided by parents and children, and particularly parents and daughters, were uncorrelated. Furthermore, whereas girls’ dissatisfaction with the appearance of their faces was associated with negative psychosocial outcomes, these associations were not significant among boys. Finally, results obtained for satisfaction with the appearance of the face were largely replicated for satisfaction with appearance of the body, suggesting that children with craniofacial anomalies and their parents may apply more holistic criteria to evaluating their appearance. Conclusion: Considered together, the findings of this study highlight the importance of engaging both parents and children in discussions about craniofacial anomalies and possible reconstruction and suggest the need for future research on the intersection of gender and craniofacial anomalies in child psychosocial functioning.

Using the Patient Reported Outcomes Measurement Information System to Evaluate Psychosocial Functioning among Children with Craniofacial Anomalies.

Background: Children with craniofacial anomalies are at risk for social exclusion, bullying, and psychological symptoms, all of which are associated with poor developmental and health outcomes. The National Institutes of Health–developed Patient Reported Outcomes Measurement Information System instruments may be useful tools for monitoring psychosocial functioning in clinical settings and for integrating patient and parent perspectives. Methods: The current study included 74 children (50 percent male) with craniofacial anomalies recruited through a multidisciplinary clinic. The authors obtained child self-report and parent-proxy ratings of depression, anxiety, and peer relationship quality using National Institutes of Health Patient Reported Outcomes Measurement Information System instruments. The authors compared sample means to Patient Reported Outcomes Measurement Information System instruments norms and analyzed the reliability of parents’ and children’s reporting of psychosocial variables. Results: All reliability statistics were satisfactory (&agr; values ranging from 0.74 to 0.96) and sample standard deviations were similar to those obtained in a general population, suggesting that Patient Reported Outcomes Measurement Information System instruments are reliable among children with craniofacial anomalies. In general, children and parents did not report unusual levels of psychological distress; however, they did report poorer peer relationship quality relative to normed data, a trend that was particularly pronounced among boys. Conclusions: National Institutes of Health Patient Reported Outcomes Measurement Information System instruments are efficient and accurate tools for monitoring psychosocial adjustment among children with craniofacial anomalies. It may be especially important to monitor social functioning, particularly among boys.

The Feasibility and Validity of PROMIS: A Novel Measure of Quality of Life among Children with Cleft Lip and Palate.

Background: Health-related quality of life is inconsistently captured among children with cleft lip and palate. The Patient-Reported Outcomes Measurement Information System (PROMIS) captures health-related quality of life, with the added benefit of comparability across clinical conditions. In this study, the authors define the validity and feasibility of PROMIS among children with clefts. Methods: Children with cleft lip and palate who were at least 5 years old and able to complete instruments independently were eligible for inclusion (n = 93). Children completed PROMIS anxiety, depression, and peer relationship item banks as short forms or computerized adaptive tests. Participants also completed the Pediatric Quality of Life Inventory. Construct validity was measured by Spearman correlations between PROMIS and the Pediatric Quality of Life Inventory controlling for race, sex, age, and income. Feasibility was measured using instrument completion time, reading level, and floor/ceiling effects. Results: PROMIS computerized adaptive tests (peer relationship, r = 0.49; depression, r = −0.56; and anxiety, r = −0.36) and short forms (peer relationship, r = 0.65; depression, r = −0.54; and anxiety, r = −0.56) demonstrated moderate correlation with the Pediatric Quality of Life Inventory. Computerized adaptive tests had fewer floor (0 percent versus 0 percent) and ceiling (8.6 to 19.3 percent versus 21.8 to 41.9 percent) effects than short forms, and demonstrated better readability. Computerized adaptive tests required more time than short forms (peer relationship, 0.84 ± 0.67 versus 1.3 ± 0.92; depression, 0.52 ± 0.38 versus 1.1 ± 0.73; and anxiety, 0.53 ± 0.23 versus 1.1 ± 0.62; p = 0.001), as each computerized adaptive test included on average four more questions. Conclusions: PROMIS correlates well with the Pediatric Quality of Life Inventory and demonstrates similar accuracy, with better readability and efficiency. Use of PROMIS will improve our ability to compare children with cleft lip and palate to diverse populations and clinical conditions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.