Steve Balsis

An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample.

Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and mens different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.

A unifying perspective on personality pathology across the life span: Developmental considerations for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders

Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.

The Alzheimer's Disease Knowledge Scale: Development and Psychometric Properties

PURPOSE This study provides preliminary evidence for the acceptability, reliability, and validity of the new Alzheimers Disease Knowledge Scale (ADKS), a content and psychometric update to the Alzheimers Disease Knowledge Test. DESIGN AND METHODS Traditional scale development methods were used to generate items and evaluate their psychometric properties in a variety of subsamples. RESULTS The final 30-item, true/false scale takes approximately 5-10 min to complete and covers risk factors, assessment and diagnosis, symptoms, course, life impact, caregiving, and treatment and management. Preliminary results suggest that the ADKS has adequate reliability (test-retest and internal consistency) and validity (content, predictive, concurrent, and convergent). IMPLICATIONS The ADKS is designed for use in both applied and research contexts, capable of assessing knowledge about Alzheimers disease among laypeople, patients, caregivers, and professionals.

An item response theory analysis of DSM-IV personality disorder criteria across younger and older age groups.

Many of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994) personality disorder (PD) diagnostic criteria focus on a younger social and occupational context. The absence of age-appropriate criteria for older adults forces researchers and clinicians to draw conclusions based on existing criteria, which are likely inadequate. To explore which DSM-IV PD criteria contain age group measurement bias, the authors report 2 analyses of data on nearly 37,000 participants, ages 18-98 years, taken from a public data set that includes 7 of the 10 PDs (antisocial, avoidant, dependent, histrionic, obsessive-compulsive, paranoid, and schizoid). The 1st analysis revealed that older age groups tend to endorse fewer PD criteria than younger age groups. The 2nd analysis revealed that 29% of the criteria contain measurement bias. Although the latent variable structure for each PD was quite similar across younger and older age groups, some individual criteria were differentially endorsed by younger and older adults with equivalent PD pathology. The presence of measurement bias for these criteria raises questions concerning the assessment of PDs in older adults and the interpretation of existing data.

Personality Disorders in Later Life: Questions About the Measurement, Course, and Impact of Disorders

Lifespan perspectives have played a crucial role in shaping our understanding of many forms of psychopathology. Unfortunately, little attention has been given to personality disorders in middle adulthood and later life. Several issues are responsible for this deficiency, including difficulty applying the diagnostic criteria for personality disorders to older people and challenges in identifying appropriate samples of older participants. The goal of this review is to explore the benefits of considering older adults in the study of personality disorders. Later life offers a unique opportunity for investigators to consider links between personality pathology and consequential outcomes in peoples lives. Many domains are relevant, including health, longevity, social adjustment, marital relationships, and the experience of major life events. We review each domain and consider ways in which the study of middle-aged and older adults challenges researchers to evaluate how personality disorders in general are defined and measured.

Cross-ethnic measurement equivalence of measures of depression, social anxiety and worry.

Although study of clinical phenomena in individuals from different ethnic backgrounds has improved over the years, African American and Asian American individuals continue to be underrepresented in research samples. Without adequate psychometric data about how questionnaires perform in individuals from different ethnic samples, findings from both within and across groups are arguably uninterpretable. Analyses based on item response theory (IRT) allow us to make fine-grained comparisons of the ways individuals from different ethnic groups respond to clinical measures. This study compared response patterns of African American and Asian American undergraduates to White undergraduates on measures of depression, social anxiety, and worry. On the Beck Depression Inventory—II, response patterns for African American participants were roughly equivalent to the response patterns of White participants. On measures of worry and social anxiety, there were substantial differences, suggesting that the use of these measures in African American and Asian American populations may lead to biased conclusions.

Self- and Informant-Reported Perspectives on Symptoms of Narcissistic Personality Disorder

Because narcissistic individuals tend to have an inflated view of themselves and their abilities, the reliance on self-reported information in the assessment and diagnosis of narcissistic personality disorder (NPD) is problematic. Hence, the use of informants in the assessment of NPD may be necessary. In the current study we examined self- and informant-reported features of NPD using agreement, frequency, and discrepancy analyses. The results indicated that informants tended to report more NPD features than selves, and that there were either low or nonsignificant levels of self-informant agreement among the 9 NPD diagnostic criteria and its categorical diagnosis. Informants were increasingly more likely to report higher raw scores relative to selves, indicating that the discrepancy between self- and informant reports increases with the NPD scale. Informants also reported NPD features that selves often did not, suggesting that current prevalence estimates of NPD, which use only self-reported information, are most likely underestimates. These results highlight the importance of gathering informant-reported data in addition to self-reported data when assessing NPD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Demographic and Contextual Factors Related to Knowledge About Alzheimer's Disease

Accurate knowledge about Alzheimer’s disease (AD) is essential to address the public health impact of dementia. This study examined AD knowledge in 794 people who completed the Alzheimer’s Disease Knowledge Scale and questions about their background and experience with AD. Whereas overall knowledge was fair, there was significant variability across groups. Knowledge was highest among professionals working in the dementia field, lower for dementia caregivers and older adults, and lowest for senior center staff and undergraduate students. Across groups, respondents knew the most about assessment, treatment, and management of AD and knew the least about risk factors and prevention. Greater knowledge was associated with working in the dementia field, having family members with AD, attending a related class or support group, and exposure to dementia-related information from multiple sources. Understanding where gaps in dementia knowledge exist can guide education initiatives to increase disease awareness and improve supportive services.

How Well Do the ADAS-cog and its Subscales Measure Cognitive Dysfunction in Alzheimer’s Disease?

Background/Aims: The Alzheimer’s Disease Assessment Scale-cognitive (ADAS-cog) is regularly used to assess cognitive dysfunction in Alzheimer’s disease (AD) clinical trials. Yet, little is known about how the instrument and its subscales measure cognition across the spectrum of AD. The current investigation used item response theory (IRT) analyses to assess the measurement properties of the ADAS-cog across the range of cognitive dysfunction in AD. Methods: We used IRT-based analyses to establish the relationship between cognitive dysfunction and the probability of obtaining observed scores on each subscale and the test as a whole. Data were obtained from 1,087 patients with AD and amnestic mild cognitive impairment. Results: Results showed that the ADAS-cog and its subscales provide maximum information at moderate levels of cognitive dysfunction. Raw score differences toward the lower and higher ends of the scale corresponded to large differences in cognitive dysfunction, whereas raw score differences toward the middle of the scale corresponded to smaller differences. Conclusions: The utility of the ADAS-cog and its subscales is optimal in the moderate range of cognitive dysfunction, but raw score differences in that region correspond to relatively small differences in cognitive dysfunction. Implications for tracking and staging dementia and for clinical trials are discussed.

Comparing depression diagnostic symptoms across younger and older adults

Objectives: Depression in later life has potential grave implications and contributes to heavy emotional, medical, and economic burdens. Therefore, it is not surprising that identifying depression and its symptoms in later life has remained a sustained concern for professionals who treat older patients. Despite this concern, the current diagnostic gold standard may not identify depression symptoms equally well in older and younger adults. The objective of this analysis is to determine whether older and younger adults with equivalent levels of latent depression are equally likely to endorse particular DSM diagnostic symptoms. Method: We analyzed DSM depression data using Item Response Theory (IRT)-based differential item functioning analyses. The data came from 1808 older adults (age 65–98 years) and 3734 younger adults (age 18–34 years) who participated in the National Epidemiological Survey on Alcoholism and Related Conditions. Results: The analyses confirmed our hypothesis. The DSM items identify depression differently in younger and older adults. Specifically, results showed that older adults were more likely to endorse somatic items and less likely to endorse cognitive and suicide items than their younger counterparts with equivalent levels of depression. Conclusion: These findings provide evidence that the DSM depression items work differently across age groups when controlling for latent depression. It is important to consider, however, that these findings are limited by the sampling methodology and the particular protocol implemented.