Norm O’Rourke

Reliability Generalization of Responses by Care Providers to the Center for Epidemiologic Studies-Depression Scale:

The Center for Epidemiologic Studies-Depression (CES-D) Scale is among the most commonly used measures of depressive symptomatology. Despite this, a paucity of research has been undertaken to examine the psychometric properties of responses to this scale. This meta-analytic study examined previously published studies of caregiving to identify factors that predict variance in reliability estimates (i.e., reliability generalization). The results suggest that the type of care recipient, the relationship to the care recipient, and CES-D Scale length each statistically affect reliability estimates. Only the number of items, however, appears to have a substantive effect. It is thus recommended that the original 20-item scale be used. Overall, it appears that responses to the CES-D Scale by care providers are largely reliable across these populations. The findings of an informal survey of authors suggest an incomplete awareness and appreciation for issues regarding reliability induction.

Psychological resilience predicts depressive symptoms among spouses of persons with Alzheimer disease over time

This study examines the three facets of psychological resilience (i.e., perceived control, commitment to living, challenge versus stability) as predictors of depressive symptoms over time among spousal caregivers of persons with Alzheimer disease; these resilience factors were considered over and above dementia-related and socio-demographic control variables. A sample of 105 cohabiting spouses of persons diagnosed with probable or possible Alzheimer disease was recruited for this study. Multilevel modeling enabled us to examine baseline resilience, and the direction and magnitude of change in resilience over time, as distinct predictors of depressive symptoms one year later, and change in depressive symptoms between points of measurement. Both Time 1 control and challenge predicted lower levels of depressive symptoms one year later; furthermore, an increase in challenge over this interval predicted lower Time 2 depressive symptoms. In contrast, commitment did not emerge as a statistically significant predictor of caregiver depression. Findings of this study provide general support for the stress process model of caregiving; in particular, the central role of intra-psychic factors as significant predictors of depressive symptoms over time.

Personality traits and marital satisfaction within enduring relationships: An intra-couple discrepancy approach

In this study of 125 heterosexual long-wed couples, we examined both spouses’ personality traits and relative differences in partner perceptions of personality as predictors of marital satisfaction, simultaneously for both husbands and wives. As hypothesized, each of the Big Five personality traits emerged as significantly associated with marital satisfaction though significant between-trait and between-sex differences were observed. Most notably, trait levels predicted marital satisfaction less consistently than positive reporting discrepancies (i.e., comparatively greater extraversion, openness to experience, agreeableness, conscientiousness, and lower neuroticism reported by spouses vis-à-vis their partners’ self-descriptions). While previous research points to a central role of neuroticism, our findings suggest that conscientiousness is the trait most broadly associated with marital satisfaction in this sample of long-wed couples. These differences between study findings may reflect change over the course of married life, the degree to which neuroticism determines divorce, overreliance on younger samples in previous marital research, or some combination of these three.

Personality trait levels within older couples and between-spouse trait differences as predictors of marital satisfaction

In this study of 125 older couples married for an average of 34 years, multilevel models were computed to simultaneously examine intra-couple personality trait averages and between-spouse trait similarity as predictors of marital satisfaction. Our findings suggest that higher intra-couple levels of extraversion predict marital satisfaction, both husbands and wives. In addition, between-spouse similarity in openness to experience appears associated with higher levels of marital satisfaction as reported by husbands; concomitantly, between-spouse similarity in agreeableness predicts wives’ marital satisfaction. With respect to openness (husbands) and agreeableness (wives), it did not matter which spouse within couples reported higher or lower trait levels. The most notable finding to emerge from this study is that neuroticism is not associated with marital satisfaction, neither husbands nor wives. This result stands in contrast to previously reported findings – the vast majority of prior research conducted with dating and newlywed couples. Conflicting results may reflect the degree to which neuroticism determines divorce within the first years of married life, adaptation to the foibles of ones spouse over time, overreliance on younger samples in marriage and family research, or some combination of these alternate explanations.

Development and initial validation of the Therapeutic Misunderstanding Scale for use with clinical trials research participants.

Therapeutic misconception is evident when clinical trials participants conflate research and treatment, erroneously believing that every aspect of the research is intended to be for their direct benefit. We developed the 20-item Therapeutic Misunderstanding Scale (TMU) based on responses from 464 community-dwelling adults 50+ years of age (Study 1). A three-factor solution based on Horng and Gradys (2003) three-facets definition was identified using both exploratory and confirmatory factor analyses (EFA and CFA; these analyses were performed on separate samples). CFA results point to a second-order solution where each of Horng and Gradys three facets contribute significantly to the measurement of a higher-order therapeutic misunderstanding latent construct. Internal consistency of TMU responses (full scale) as well as the therapeutic misconception, misestimation, and optimism subscales were calculated as α = 0.88, α = 0.83, α = 0.79, and α = 0.75, respectively. These results were subsequently supported with responses from former clinical trials participants (Study 2). This TMU provides applied researchers a brief measure for use in future studies as well as a screening instrument for clinicians to more fully assess informed consent for participation in clinical trials research.

Psychometric properties of responses by clinicians and older adults to a 6-item Hebrew version of the Hamilton Depression Rating Scale (HAM-D6)

BackgroundThe Hamilton Depression Rating Scale (HAM-D) is commonly used as a screening instrument, as a continuous measure of change in depressive symptoms over time, and as a means to compare the relative efficacy of treatments. Among several abridged versions, the 6-item HAM-D6 is used most widely in large degree because of its good psychometric properties. The current study compares both self-report and clinician-rated versions of the Hebrew version of this scale.MethodsA total of 153 Israelis 75 years of age on average participated in this study. The HAM-D6 was examined using confirmatory factor analytic (CFA) models separately for both patient and clinician responses.ResultsReponses to the HAM-D6 suggest that this instrument measures a unidimensional construct with each of the scales’ six items contributing significantly to the measurement. Comparisons between self-report and clinician versions indicate that responses do not significantly differ for 4 of the 6 items. Moreover, 100% sensitivity (and 91% specificity) was found between patient HAM-D6 responses and clinician diagnoses of depression.ConclusionThese results indicate that the Hebrew HAM-D6 can be used to measure and screen for depressive symptoms among elderly patients.

Cognitive status and the psychological well-being of long-term care residents over time

The majority of research within long-term care (LTC) has emphasized the physical health of residents, has been cross-sectional in design and has focused almost exclusively on residents with dementia. Few longitudinal studies have followed participants over intervals longer than 1 year. In contrast, the current study set out to examine the experience of LTC residents with and without significant cognitive loss over a 2-year period comparing the psychological well-being of groups over time. Significant Group × Time interaction effects were observed between residents with and without significant cognitive loss in life satisfaction and depressive symptomatology. Results of this study underscore the need for longitudinal measurement in LTC research, the use of multivariate statistical procedures and the need to identify and meet the distinct needs of residents with and without significant cognitive loss.

'Til Divorce Do Us Part: Marriage Dissolution in Later Life

Late-life divorce—commonly referred to as gray divorce—is a rising trend that parallels the growth of the older adult population. We sought to gain an in-depth understanding of the experience of marriage dissolution, the divorce process, and life following divorce in a sample of older adults who divorced after more than 20 years of marriage. Qualitative data were collected from 10 divorcees (7 women and 3 men; M age = 63.5) and analyzed to understand the gray divorce experience; that is, factors that determined or delayed the decision to divorce and divorcees’ coping during and after divorce. Participants’ stories demonstrate that marriages endure despite problems because relationships are complex, and good experiences mix with bad ones. Outcomes of late-life divorce have significant health and financial implications for both individuals and society.

Measurement and analysis of behavioural disturbance among community-dwelling and institutionalized persons with dementia

Census data suggest that persons over 84 years of age represent the fastest growing segment of populations in most western nations. As advancing age remains the single strongest risk factor for dementia, prevalence rates are expected to increase substantially in coming years. This awareness underscores the need to more fully understand the clinical presentation of Alzheimer disease and other neurodegenerative disorders. The present study examines responses to the 28-item Dementia Behaviour Disturbance Scale (DBD; Baumgarten, Becker, & Gauthier, 1990) among a national sample of persons with dementia (PWD) in Canada. A 3-factor solution appears to best reflect DBD responses for both institutionalized and community-dwelling PWD. This finding is notable given that the former was significantly more impaired and presented with significantly greater levels of behavioural disturbance. Support for the factorial validity of these constructs is provided relative to caregiver burden and depressive symptomatology. Of note, only 14 of 28 DBD items were retained in our analyses; on this basis, we propose the use of an abridged version of the scale. These findings can be generalized with greater confidence given the random and representative nature of the PWD and caregiver samples.

Age Differences in Cognitive and Affective Theory of Mind: Concurrent Contributions of Neurocognitive Performance, Sex, and Pulse Pressure

Objectives Theory of mind (ToM) allows us to detect and make inferences about cognitive and affective mental states. Mixed findings exist regarding (a) age differences in cognitive and affective ToM and (b) what mechanisms may underlie changes in the two components. We addressed these questions by examining the unique and joint contributions of neurocognitive performance, pulse pressure (PP), and biological sex to age differences in cognitive and affective ToM. Method We tested 86 young and 85 older adults on standardized measures of neurocognitive performance and ToM. Predictors were derived from demographics (sex), in-office PP, and measures of executive functions, semantic memory, and episodic memory. We used path analysis to identify concurrent predictors of cognitive and affective ToM between groups and invariance analyses to assess age differences in the relative strength of identified predictors. Results We demonstrated robust age differences in cognitive and affective ToM. Certain neurocognitive predictors of ToM were more salient among older individuals; most predictors were shared across age groups and equivalent in magnitude. Discussion To our knowledge, this study represents the most comprehensive investigation to date of predictors of ToM in aging. Findings highlight the need for continued investigation of ToM within a multidimensional framework.