Lynne A. Hall

PSYCHOMETRICS FOR TWO SHORT FORMS OF THE CENTER FOR EPIDEMIOLOGIC STUDIES± DEPRESSION SCALE

The Center for Epidemiologic Studies-Depression Scale (CES-D; L. S. Radloff, 1977) assesses the presence and severity of depressive symptoms occurring over the past week. Although it contains only 20 items, its length may preclude its use in a variety of clinical populations. This study evaluated psychometric properties of 2 shorter forms of the CES-D developed by F. J. Kohout, L. F. Berkman, D. A. Evans, and J. Cornoni-Huntley (1993): the Iowa form and the Boston form. Data were pooled from 832 women representing 6 populations. Internal consistency estimates, correlations with the original version of the CES-D, and omitted-included item correlations supported use of the Iowa form over the Boston form when a shortened version of the scale is desired. Regression statistics are provided for use in estimating scores on the original CES-D when either shortened form is used. Factor analytic results from two populations support a single-factor structure for the original CES-D as well as the short forms.

The Relationship among Young Adult College Students’ Depression, Anxiety, Stress, Demographics, Life Satisfaction, and Coping Styles

Recent research indicates that young adult college students experience increased levels of depression, anxiety, and stress. It is less clear what strategies college health care providers might use to assist students in decreasing these mental health concerns. In this paper, we examine the relative importance of coping style, life satisfaction, and selected demographics in predicting undergraduates’ depression, anxiety, and stress. A total of 508 full-time undergraduate students aged 18–24 years completed the study measures and a short demographics information questionnaire. Coping strategies and life satisfaction were assessed using the Brief COPE Inventory and an adapted version of the Brief Students’ Multidimensional Life Satisfaction Scale. Depression, anxiety, and stress were measured using the Depression Anxiety and Stress Scale-21 (DASS-21). Multiple regression analyses were used to examine the relative influence of each of the independent variables on depression, anxiety, and stress. Maladaptive coping was the main predictor of depression, anxiety, and stress. Adaptive coping was not a significant predictor of any of the three outcome variables. Reducing maladaptive coping behaviors may have the most positive impact on reducing depression, anxiety, and stress in this population.

Testing the Psychometric Properties of the Minnesota Living With Heart Failure Questionnaire

BackgroundHealth-related quality of life (HRQOL) is an important outcome in patients with heart failure. One of the most commonly used instruments to measure HRQOL in this population is the Minnesota Living With Heart Failure Questionnaire (LHFQ). Although the psychometric properties of the LHFQ have been tested, the results do not definitively support the psychometric soundness of the instrument. ObjectiveTo examine the psychometric properties of the LHFQ. MethodData from 638 patients with heart failure were used to assess the reliability, homogeneity, representativeness, discriminative ability, and construct validity of the LHFQ before and after deletion of 5 items that showed lack of representativeness and contributed to inadequate factor structure. ResultsCronbachs alphas for the LHFQ Total and subscales were greater than .80. Interitem correlation coefficients in 17 of the 21 items, item–total correlation coefficients in 20 items, and discriminative ability in all items were acceptable. The total and both subscales of the LHFQ differentiated New York Heart Association functional groups. The Physical subscale was moderately related to the physical measures (the Specific Activity Scale and symptom status), whereas the emotional subscale was weakly related to the measures. The results of item p level testing and factor analysis demonstrated that 7 items were consistently problematic and 5 items were recommended to be deleted. The results of the reliability, homogeneity, and construct validity after deletion of these items demonstrated that the psychometric properties of the LHFQ were improved as a result. DiscussionThe initial results provided additional support for the reliability and substantial evidence for the validity of the LHFQ. However, the results of item and factor analyses did not fully support the psychometric soundness of several items. The psychometric properties of the LHFQ after deleting these items were improved. These results could provide researchers and clinicians a more useful measure of HRQOL.

Preventing Depression in High-Risk College Women: A Report of an 18-month Follow-up

Abstract The authors tested the long-term effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in 92 college women aged 18 to 24 years who ere at risk for clinical depression. The women were randomly assigned to either an experimental or a no-treatment control group. The experimental group participated in a 6-week cognitive-behavioral intervention that targeted identification and reduction of negative thinking, using such techniques as thought stopping and affirmations. Data on depressive symptoms, self-esteem, and negative thinking were collected before the intervention and at intervals of 1, 6, and 18 months postintervention. The women in the intervention group experienced a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem than those in the control group. The beneficial effects continued over an 18-month follow-up period. These findings support the importance of thought stopping and affirmations as prevention interventions with at-risk college women.

THE EFFECTS OF MATERNAL PSYCHOSOCIAL FACTORS ON PARENTING ATTITUDES OF LOW-INCOME, SINGLE MOTHERS WITH YOUNG CHILDREN

BACKGROUND Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, history of childhood abuse, and parenting attitudes, the evidence does not clearly elucidate the relationships among these variables. OBJECTIVES To investigate the relationships among maternal psychosocial factors (history of childhood abuse, everyday stressors, self-esteem, and depressive symptoms) and parenting attitudes of low-income, single mothers who have young children. METHODS Secondary analyses of data from in-home interviews with 206 low-income, single mothers from a southeastern United States urban area were conducted. A variety of scales, including the Adult-Adolescent Parenting Inventory (AAPI), were used to measure maternal psychosocial factors. RESULTS Using the AAPI, a Modified Parenting Attitudes Measure (MPAM), and subscales, a three-stage regression procedure was used to test the model. For stages 1 and 2, everyday stressors were the strongest predictor of self-esteem. Childhood sexual abuse, everyday stressors, low self-esteem, and control variables accounted for 58% of variance in depressive symptoms. In the third stage for the AAPI, only control variables were retained except in the Lack of Empathy subscale, where depressive symptoms and control variables accounted for 16% of the variance. The third stage for the MPAM yielded, by subscale: Only control variables predicted Corporal Punishment Beliefs; depressive symptoms were the strongest predictor for the total MPAM (19% of variance) and of the Inappropriate Emotional Expectations subscale (17%); and childhood physical abuse was the only predictor of Role Reversal. CONCLUSIONS Depressive symptoms mediated the effects of childhood abuse, everyday stressors, and self-esteem and provided the linkage between these variables and at-risk parenting attitudes. Self-esteem decreased as everyday stressors increased but did not directly affect parenting attitudes. A relationship was not found between childhood abuse and low self-esteem. This study highlights the complexity of parenting and the need to identify other factors of at-risk parenting not accounted for in this study.

Psychometrics of the PHQ-9 as a measure of depressive symptoms in patients with heart failure

Background Depression in patients with heart failure commonly goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) is a simple, valid measure of depressive symptoms that may facilitate clinical assessment. It has not been validated in patients with heart failure. Aims To test the reliability, and concurrent and construct validity of the PHQ-9 in patients with heart failure. Methods A total of 322 heart failure patients (32% female, 61 ± 12 years, 56% New York Heart Association class III/IV) completed the PHQ-9, the Beck Depression Inventory-II (BDI-II), and the Control Attitudes Scale (CAS). Results Cronbach’s alpha of .83 supported the internal consistency reliability of the PHQ-9 in this sample. Inter-item correlations (range .22–.66) and item-total correlation (except item 9) supported homogeneity of the PHQ-9. Spearman’s rho of .80, (p < .001) between the PHQ-9 and the BDI-II supported the concurrent validity as did the agreement between the PHQ-9 and the BDI-II (Kappa = 0.64, p < .001). At cut-off score of 10, the PHQ-9 was 70% sensitive and 92% specific in identifying depressive symptoms, using the BDI-II scores as the criterion for comparison. Differences in PHQ-9 scores by level of perceived control measured by CAS (t318 = −5.05, p < .001) supported construct validity. Conclusion The PHQ-9 is a reliable, valid measure of depressive symptoms in patients with heart failure.

Negative thinking mediates the effect of self-esteem on depressive symptoms in college women.

BACKGROUND One of every three women between 18 and 24 years of age may be significantly depressed. Younger women have shown increasing rates of unipolar depression since the 1950s, and the average age of onset continues to decline. OBJECTIVES To examine the prevalence and correlates of high depressive symptoms in single college women 18 to 24 years of age. Negative thinking was posited to mediate the relationship between self-esteem and depressive symptoms. METHODS A sample of 246 women was recruited from a university student body. Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-esteem Scale, the Crandell Cognitions Inventory, and the Automatic Thoughts Questionnaire. RESULTS Of the women, 35% had high depressive symptoms. Negative thinking mediated the relationship between self-esteem and depressive symptoms. However, self-esteem also showed a weak direct effect on depressive symptoms. CONCLUSION The findings suggest that negative thinking may play an important role in the development of depressive symptoms in college women.

PARENTAL BONDING: A KEY FACTOR FOR MENTAL HEALTH OF COLLEGE WOMEN

The purpose of this study was to investigate the relationship of parental bonding to the mental health of college women aged 18 to 24 years. A cross-sectional study of a volunteer sample of 246 college women was conducted. Data on depressive symptoms, negative thinking, self-esteem, and parental bonding were collected via self-report. Maternal care was the strongest predictor of all four mental health indices. Paternal overprotection predicted scores of three of the four mental health measures. Women with optimal maternal and paternal bonding profiles (high care/low overprotection) had fewer depressive symptoms, less negative thinking, and higher self-esteem than women with other bonding profiles. The findings have implications for prevention, screening, and intervention to enhance the mental health of college women.

The Effects of Prenatal Secondhand Smoke Exposure on Preterm Birth and Neonatal Outcomes

OBJECTIVE To examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine. DESIGN Cross-sectional, observational design. SETTING A metropolitan Kentucky birthing center. PARTICIPANTS Two hundred and ten (210) mother-baby couplets. METHODS Nicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis. RESULTS Smoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200-300 g), and deliver shorter infants (decrease of 1.1-1.7 cm). CONCLUSIONS Prenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.

Testing the psychometric properties of the Medication Adherence Scale in patients with heart failure

OBJECTIVE Many factors may contribute to medication nonadherence in heart failure (HF), but no standard measure exists to evaluate factors associated with nonadherence. To fill this gap, we developed the Medication Adherence Scale (MAS) and tested its reliability and validity in patients with HF. METHOD Questionnaire data were collected from 100 patients with HF at baseline using the MAS, and objective adherence data were collected for 3 consecutive months using the Medication Event Monitoring System. RESULTS Principal component analysis yielded three factors that explained 63% of the variance in medication adherence: knowledge, attitudes, and barriers to medication adherence. Cronbachs alphas for these subscales ranged from .75 to .94, which supported their internal consistency. The Spearman rho correlation coefficients between the Medication Event Monitoring System and Knowledge, Attitudes, and Barriers scores were .25 to .31 (P < .05), demonstrating support for construct validity. CONCLUSION These results support the reliability and validity of the MAS as a measure of knowledge, attitudes, and barriers of medication adherence.