Michela Balsamo

Building a new Rasch-based self-report inventory of depression

This paper illustrates a sequential item development process to create a new self-report instrument of depression refined with Rasch analysis from a larger pool of potential diagnostic items elicited through a consensus approach by clinical experts according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders criteria for major depression. A 51-item pool was administered to a sample of 529 subjects (300 healthy community-dwelling adults and 229 psychiatric outpatients). Item selection resulted in a 21-item set, named the Teate Depression Inventory, with an excellent Person Separation Index and no evidence of bias due to an item–trait interaction (χ2=147.71; df =168; P=0.48). Additional support for the unidimensionality, local independence, appropriateness of the response format, and discrimination ability between clinical and nonclinical subjects was provided. No substantial differential item functioning by sex was observed. The Teate Depression Inventory shows considerable promise as a unidimensional tool for the screening of depression. Finally, advantages and disadvantages of this methodology will be discussed in terms of subsequent possible mathematical analyses, statistical tests, and implications for clinical investigations.

Food Cravings Questionnaire–Trait (FCQ–T) Discriminates Between Obese and Overweight Patients With and Without Binge Eating Tendencies: The Italian Version of the FCQ–T

Food craving (FC) might play an important role in the course of eating disorders and obesity. The question of its measurement has particular importance in relation to the dramatic growth in obesity rates and its relevance for public health. The aim of this study was to investigate the psychometric properties of the Italian version of the Food Cravings Questionnaire–Trait (FCQ–T) in overweight and obese patients who were attending weight loss programs, and its efficiency in discriminating patients with binge eating. Participants were 497 (411 women, 86 men) overweight and obese patients in treatment with low-energy diet therapy. We used structural equation modeling to compare 3 factor models tested in previous studies (a 6-factor model, an 8-factor model, and a 9-factor model), which indicated that the 9-factor model has a better fit over the competing models. The FCQ–T had good internal consistency (Cronbachs α of.96 for the total score, and between.76 and.92 for subfactors), and was able to discriminate patients with clinical-level binge eating from those with probable and without binge eating with an efficiency of.74 (sensitivity =.64, specificity =.78). FCQ–T scores were sensitive to changes associated with treatment only for patients who started dietary restriction between the baseline and the follow-up assessment, but not for patients who were already observing dietary restrictions at the time of the baseline assessment. These results suggest that the FCQ–T could be a potentially useful measure for the screening of binge eating problems in overweight and obese patients while in treatment.

Anger and Depression: Evidence of a Possible Mediating Role for Rumination:

Tendency to ruminate may mediate the relationship between anger and depression. In this preliminary study, 353 Italian community participants completed the State-Trait Anger Expression Inventory–2, the Padua Inventorys Tendency to Doubt and to Ruminate subscale, and the Beck Depression Inventory–II. Trait anger and depression were expected to have a positive relationship, and separate relationships with the tendency to ruminate. Theoretically, a new hypothesis was that the tendency to ruminate would mediate the relationship between depression and anger. Zero-order and partial correlations and a path analysis based on Baron and Kennys method for calculating multiple regression analyses were calculated. Consistent with the hypotheses, anger and depression were strongly associated; the tendency to ruminate was significantly associated with both anger and depression; and the mediation model fit the data. Behaviors related to the tendency to ruminate could help to explain how depression is related to anger.

Psychometric Properties of the Attitudes toward Self-Revised in Italian Young Adults

Objectives and Methods. Several researchers have provided support for the critical role of cognitive vulnerabilities in the development of depression. The Attitudes toward Self-Revised (ATS-R) was designed to assess three potential self-regulatory vulnerabilities to depression: High Standards (HS), Self-Criticism (SC), and Negative Generalization (NG). The aim of the study was to assess the psychometric properties of the ATS-R in the Italian young adult population. The ATS-R, the Beck Depression Inventory-II (BDI-II), the Beck Hopelessness Scale (BHS), and the Teate Depression Inventory (TDI) were administered to 857 (320 men and 537 women) young adults. Results. The best-fitting solution for the ATS-R was a 2-factor model, which obtained satisfactory homogeneity of content (HS/SC: Cronbach α = 0.81; mean interitem correlation = 0.46. NG: Cronbach α = 0.75; mean interitem correlation = 0.43) and significant correlation with the BDI-II (NG: Pearson r = 0.29, P < 0.01), the TDI (HS/SC: Pearson r = −0.26, P < 0.01), and the BHS (HS/SC: Pearson r = −0.29, P < 0.01; NG: Pearson r = 0.22, P < 0.01). Conclusions. The Italian version of the ATS-R seems to be a valid instrument for the study of the role of cognitive tendencies as potential vulnerability for depression.

Cognitive Vulnerabilities and Depression in Young Adults: An ROC Curves Analysis

Objectives and Methods. The aim of the present study was to evaluate, by means of receiver operating characteristic (ROC) curves, whether cognitive vulnerabilities (CV), as measured by three well-known instruments (the Beck Hopelessness Scale, BHS; the Life Orientation Test-Revised, LOT-R; and the Attitudes Toward Self-Revised, ATS-R), independently discriminate between subjects with different severities of depression. Participants were 467 young adults (336 females and 131 males), recruited from the general population. The subjects were also administered the Beck Depression Inventory-II (BDI-II). Results. Four first-order (BHS Optimism/Low Standard; BHS Pessimism; Generalized Self-Criticism; and LOT Optimism) and two higher-order factors (Pessimism/Negative Attitudes Toward Self, Optimism) were extracted using Principal Axis Factoring analysis. Although all first-order and second-order factors were able to discriminate individuals with different depression severities, the Pessimism factor had the best performance in discriminating individuals with moderate to severe depression from those with lower depression severity. Conclusion. In the screening of young adults at risk of depression, clinicians have to pay particular attention to the expression of pessimism about the future.

The Mediating Role of Early Maladaptive Schemas in the Relation between Co-Rumination and Depression in Young Adults.

Research on co-rumination has investigated its relationship with internalizing symptoms, but few studies have addressed underlying maladaptive cognitive-affective processes that may play an important role in the maintenance of this relation. This study examines if Young’s schema domains mediate the relation between co-rumination and depression in a community sample of non-clinical young adults. Participants completed the Co-Rumination Questionnaire, Young Schema Questionnaire-L3, and Teate Depression Inventory. Correlations and path analysis were calculated for the full sample and separately by gender. The schema domains of Overvigilance/Inhibition and Other-Directedness fully mediated the relation between co-rumination and depression. When analyses were performed separately for males and females, mediation persisted only for females. Findings suggest that among young women, co-rumination with a friend may be associated with depressive symptoms because of its activation of specific maladaptive cognitive schemas. Better understanding of the content and processes underpinning co-rumination may have important implications for the prevention and treatment of depression.

Measurement of External Shame: An Inside View

The aims of this study were to investigate the construct validity of the Other as Shamer scale (OAS) using confirmatory factor analysis (CFA) and to examine the psychometric properties of its Italian version in a sample of 687 nonclinical individuals. The CFA results indicated that the hypothesized hierarchical model (with 1 higher order factor and 3 first-order factors) was the best fitting solution. Cronbachs alpha indexes, as well as test–retest stability, provided satisfactory results. Correlations of the OAS total score and its subscales with the Beck Depression Inventory–II (rs = .30–.48) and the Teate Depression Inventory (rs = .32–.45) were both substantial and significant (p < .01). Receiver operating characteristic curves were constructed to indicate sensitivity and specificity of the OAS and its subscales when determining those nonclinical subjects who met clinical thresholds for depression symptoms. A series of cutoff scores for the OAS scale and its subscales was developed, with sensitivity values between .70 and .62, and specificity values between .71 and .62, indicating good to fair discrimination between the 2 groups (depressed vs. nondepressed). The theoretical and practical implications of these results were discussed.

Measuring anxiety in the elderly: psychometric properties of the state trait inventory of cognitive and somatic anxiety (STICSA) in an elderly Italian sample

BACKGROUND Despite its increasing personal and societal impact, assessment of late-life anxiety has received relatively little attention in psychiatric research. Differential symptom presentation and physical comorbidities among the elderly, relative to younger cohorts creates a need for anxiety measures that are psychometrically validated in the elderly. METHODS The present study examined the factor structure and discriminant validity of the state-trait inventory for cognitive and somatic anxiety (STICSA) in a sample of Italian middle-aged and older adults. Participants were 396 community-dwelling middle-aged (50-64 years) and older (≥65 years) adults. In addition to the STICSA, participants completed two depression measures and a general well-being survey with physical and mental health subscales. RESULTS Factor analysis supported the validity of both state-trait and cognitive-somatic distinctions underlying the STICSA, all dimensions exhibited excellent internal consistency (Cronbachs α coefficients ≥ 0.86), and correlations with depression measures provided limited evidence for differentiation of anxious and depressive symptoms. The STICSA also showed evidence of discriminating anxious symptoms from physical health symptoms, a particularly relevant feature of a valid anxiety measure in elderly samples. CONCLUSIONS The STICSA appears to be a valid measure of cognitive and somatic anxiety in the elderly.

Determining a diagnostic cut-off on the Teate Depression Inventory

A small but growing body of literature suggests that the Teate Depression Inventory (TDI) may be an “objective” measure of depression compared with other commonly used scales. Furthermore, the TDI has strong psychometric properties in both clinical and nonclinical samples. The present study aimed to extend the use of TDI by identifying cut-off scores that could differentiate varying levels of depression severity in a group of clinically diagnosed depression disorder patients (N=125). Three receiver operating characteristic curve analyses indicated cut-off scores of 21 (sensitivity =0.86, specificity =0.94, and classification accuracy =0.90); 36 (sensitivity =0.84, specificity =0.96, and classification accuracy =0.92); and 50 (sensitivity =0.81, specificity =0.93, and classification accuracy =0.90), for minimal, mild, moderate, and severe depression, respectively. Results suggest that the TDI measures depression severity across a broad range with high test accuracy and may be appropriately used to screen for depression.

Personality and depression: evidence of a possible mediating role for anger trait in the relationship between cooperativeness and depression.

BACKGROUND An increasingly growing area of empirical research has found consistent links between anger, depression, and temperament and character domains of personality, separately. However, precise nature of these relationships remains still unclear, and little is known about its underlying processes. OBJECTIVES The aim of our explorative research was to conduct a more detailed investigation into the relationships among depression, anger trait, and personality characteristics based on Cloningers 7-factor personality theory in healthy individuals. METHOD In this preliminary study, 230 Italian undergraduates were investigated by using the Temperament and Character Inventory-Revised, the State-Trait Anger Expression Inventory-2, and the Beck Depression Inventory-II. Depression and cooperativeness were expected to have a negative and significant relationship and separate relationships with the trait-anger. Theoretically, a new hypothesis was that the trait-anger would mediate the relationship between depression and cooperativeness. RESULTS Zero-order and partial correlations and a path analysis based on Baron and Kennys method (J Pers Soc Psychol.1986;51:1173-1182) for calculating multiple regression analyses were calculated. Consistent with the hypotheses, cooperativeness and depression were strongly associated; the trait-anger was significantly associated with both cooperativeness and depression, and the mediation model fit the data. CONCLUSIONS Behaviors related to the trait-anger could help to explain how depression and reduced cooperativeness are related each other.