Ryan T. Williams

Prevalence of Depression After Spinal Cord Injury: A Meta-Analysis

OBJECTIVES To use meta-analysis to synthesize point prevalence estimates of depressive disorder diagnoses for persons who have sustained a spinal cord injury (SCI). DATA SOURCES We searched PsycINFO, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Dissertation Abstracts International (DAI) for studies examining depression after SCI through 2013. We also conducted a manual search of the reference sections of included studies. STUDY SELECTION Included studies contained persons with SCI; used a diagnostic measure of depression (ie, an unstructured, semi-structured, or structured clinical interview, and/or a clinician diagnosis); and provided a diagnosis of major or minor depressive episodes for the subjects in the study. Diagnostic criteria were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, or the Diagnostic and Statistical Manual of Mental Disorders-Third Edition (including Research Diagnostic Criteria) criteria. DATA EXTRACTION The 2 authors of this study screened the titles and abstracts of 1053 unique studies for inclusion in this meta-analysis. Nineteen studies, containing 35,676 subjects and 21 effect size estimates, were included. DATA SYNTHESIS The mean prevalence estimate of depression diagnosis after SCI was 22.2%, with a lower-bound estimate of 18.7% and an upper bound estimate of 26.3%. Random effects and mixed effects models were used in this work. A small number of study moderators were explored, including sample sex composition, Diagnostic and Statistical Manual of Mental Disorders version used, data collection method (primary vs secondary), sample traumatic etiology composition, sample injury level and completeness composition, and sample diagnostic composition. Data collection method, Diagnostic and Statistical Manual of Mental Disorders version, and diagnostic composition significantly predicted variation in observed effect size estimates, with primary data collection studies having lower estimates compared with secondary data analysis studies, studies using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria having higher estimates compared with studies using Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria, and samples comprising individuals diagnosed only with major depression having lower prevalence estimates. CONCLUSIONS The existing data on depression after SCI indicate that the prevalence of depression after SCI is substantially greater than that in the general medical population. These results underscore the importance of continued research on measuring depression in persons with SCI and on treatments for depression after SCI.

Outcome-Reporting Bias in Education Research

Outcome-reporting bias occurs when primary studies do not include information about all outcomes measured in a study. When studies omit findings on important measures, efforts to synthesize the research using systematic review techniques will be biased and interpretations of individual studies will be incomplete. Outcome-reporting bias has been well documented in medicine and has been shown to lead to inaccurate assessments of the effects of medical treatments and, in some cases, to omission of reports of harms. This study examines outcome-reporting bias in educational research by comparing the reports of educational interventions from dissertations to their published versions. We find that nonsignificant outcomes were 30% more likely to be omitted from a published study than statistically significant ones.

Identifying depression severity risk factors in persons with traumatic spinal cord injury

PURPOSE/OBJECTIVE Examine the relationship between demographic characteristics, health-, and injury-related characteristics, and substance misuse across multiple levels of depression severity. RESEARCH METHOD/DESIGN 204 persons with traumatic spinal cord injury (SCI) volunteered as part of screening efforts for a randomized controlled trial of venlafaxine extended release for major depressive disorder (MDD). Instruments included the Patient Health Questionnaire-9 (PHQ-9) depression scale, the Alcohol Use Disorders Identification Test (AUDIT), and the Substance Abuse in Vocational Rehabilitation-Screener (SAVR-S), which contains 3 subscales: drug misuse, alcohol misuse, and a subtle items scale. Each of the SAVR-S subscales contributes to an overall substance use disorder (SUD) outcome. Three proportional odds models were specified, varying the substance misuse measure included in each model. RESULTS 44% individuals had no depression symptoms, 31% had mild symptoms, 16% had moderate symptoms, 6% had moderately severe symptoms, and 3% had severe depression symptoms. Alcohol misuse, as indicated by the AUDIT and the SAVR-S drug misuse subscale scores were significant predictors of depression symptom severity. The SAVR-S substance use disorder (SUD) screening outcome was the most predictive variable. Level of education was only significantly predictive of depression severity in the model using the AUDIT alcohol misuse indicator. CONCLUSIONS/IMPLICATIONS Likely SUD as measured by the SAVR-S was most predictive of depression symptom severity in this sample of persons with traumatic SCI. Drug and alcohol screening are important for identifying individuals at risk for depression, but screening for both may be optimal. Further research is needed on risk and protective factors for depression, including psychosocial characteristics.

Measuring Instructional Differentiation in a Large-Scale Experiment

This study operationalizes four measures of instructional differentiation: one for Grade 2 English language arts (ELA), one for Grade 2 mathematics, one for Grade 5 ELA, and one for Grade 5 mathematics. Our study evaluates their measurement properties of each measure in a large field experiment: the Indiana Diagnostic Assessment Tools Study, which included two consecutive cluster randomized trials (CRTs) of the effects of interim assessments on student achievement. Each log was designed to measure instructional practices as they were implemented for eight randomly selected students in the participating teachers’ classrooms. A total of 592 teachers from 127 schools took part in this study. Logs were administered 16 times in each experiment. Item responses to the logs were scaled using the Rasch model and reliability estimates for the differentiation measures were evaluated at the log level (observations within teachers), the teacher level, and the school level. Estimated reliability was above .70 for each of the log- and teacher-level measures. At the school level, reliability estimates were lower for Grade 5 ELA and mathematics. The variance between teachers and schools on the scaled differentiation measures was substantially less than within-teacher variation. These results provide preliminary evidence that teacher instructional logs may provide useful measures of instructional differentiation in elementary grades at multiple levels of aggregation.

Overcoming obstacles in obtaining individual participant data for meta‐analysis

Individual participant data (IPD) is the backbone of scientific inquiry and important to a meta-analysis for a variety of reasons. It is therefore important to be able to access IPD, and yet, obstacles persist that make it difficult for meta-analysts, as well as interested primary study analysts, to obtain it. In this paper, we discuss the barriers to obtaining IPD via online repositories or contacting primary study authors and provide an example data sharing agreement that can be used to ameliorate a few of these issues. We also discuss the ethics of data sharing. The goal of this paper is to help meta-analysts anticipate these potential barriers at the outset of their studies and hopefully increase the likelihood of producing thorough IPD syntheses and foster collaborative partnerships with primary study researchers. Copyright

The Question of School Resources and Student Achievement: A History and Reconsideration

One question posed continually over the past century of education research is to what extent school resources affect student outcomes. From the turn of the century to the present, a diverse set of actors, including politicians, physicians, and researchers from a number of disciplines, have studied whether and how money that is provided for schools translates into increased student achievement. The authors discuss the historical origins of the question of whether school resources relate to student achievement, and report the results of a meta-analysis of studies examining that relationship. They find that policymakers, researchers, and other stakeholders have addressed this question using diverse strategies. The way the question is asked, and the methods used to answer it, is shaped by history, as well by the scholarly, social, and political concerns of any given time. The diversity of methods has resulted in a body of literature too diverse and too inconsistent to yield reliable inferences through meta-analysis. The authors suggest that a collaborative approach addressing the question from a variety of disciplinary and practice perspectives may lead to more effective interventions to meet the needs of all students.

Evaluating the Psychometric Properties and Responsiveness to Change of 3 Depression Measures in a Sample of Persons With Traumatic Spinal Cord Injury and Major Depressive Disorder.

OBJECTIVES To compare the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD). DESIGN Secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as part of a randomized controlled trial of venlafaxine XR for MDD in persons with SCI. SETTING Outpatient and community settings. PARTICIPANTS Individuals (N=133) consented and completed the drug trial. Eligibility criteria were age at least 18 years, traumatic SCI, and diagnosis of MDD. INTERVENTIONS Venlafaxine XR. MAIN OUTCOME MEASURES Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators completed the HAM-D and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Dissociative Disorders, which was used as a diagnostic criterion measure. RESULTS All 3 instruments were improved with rating scale analysis. The HSCL-20 and the HAM-D contained items that misfit the underlying construct and that correlated weakly with the total scores. Removing these items improved the internal consistency, with floor effects increasing slightly. The HAM-D correlated most strongly with Structured Clinical Interview for DSM-IV Dissociative Disorders diagnoses. Improvement in depression was similar on all outcome measures in both treatment and control groups. CONCLUSIONS The psychometric properties of the revised depression instruments are more than adequate for routine use in adults with SCI and are responsive to clinical improvement. The PHQ-9 is the simplest instrument with measurement properties as good as or better than those of the other instruments and required the fewest modifications.

Comparative Efficacy Between Self-Report and Clinician-Administered Assessments of Posttraumatic Stress Disorder Symptoms Across Seven Studies

A meta-analysis of seven studies using self-report and clinician-administered assessments to evaluate the effectiveness of a cognitive processing therapy (CPT) intervention among 684 participants. A secondary moderation analysis was completed to investigate the effect of assessment type, type of comparison group, and Publication date with effect size reporting in seven studies evaluating the effectiveness of CPT for treating posttraumatic stress disorder. Results indicated no significant differences and modest effect sizes for assessment format (self-report vs. clinician administered) and Publication date. A medium effect size was detected for type of comparison group implemented within individual studies. Implications for counseling practice and future research are discussed.