Tanya Covic

Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

BackgroundWhile it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.MethodsPatients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.ResultsA total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the possible+probable cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both possible+probable anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.ConclusionsThis study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.

A longitudinal evaluation of the Center for Epidemiologic Studies-Depression scale (CES-D) in a Rheumatoid Arthritis Population using Rasch Analysis

BackgroundThe aim of this study was to test the internal validity of the total Center for Epidemiologic Studies-Depression (CES-D) scale using Rasch analysis in a rheumatoid arthritis (RA) population.MethodsCES-D was administered to 157 patients with RA over three time points within a 12 month period. Rasch analysis was applied using RUMM2020 software to assess the overall fit of the model, the response scale used, individual item fit, differential item functioning (DIF) and person separation.ResultsPooled data across three time points was shown to fit the Rasch model with removal of seven items from the original 20-item CES-D scale. It was necessary to rescore the response format from four to three categories in order to improve the scales fit. Two items demonstrated some DIF for age and gender but were retained within the 13-item CES-D scale. A new cut point for depression score of 9 was found to correspond to the original cut point score of 16 in the full CES-D scale.ConclusionThis Rasch analysis of the CES-D in a longstanding RA cohort resulted in the construction of a modified 13-item scale with good internal validity. Further validation of the modified scale is recommended particularly in relation to the new cut point for depression.

Is the essay resubmission option a formative or a summative assessment and does it matter as long as the grades improve

Typically, essays are used as summative rather than formative assessments and students experience them as tasks rather than learning opportunities. Thus, the aim of this study was to see whether providing students with detailed formative feedback and an opportunity to resubmit their essay would improve their essays writing skills. Twenty‐six out of 54 third‐year psychology students resubmitted their essay. Of those 26 resubmitted essays, 18 were awarded higher grades. Although the students observed that their skills had improved, they mainly perceived the resubmission option as a ‘safety net’ and were motivated to use it as a way of improving their grades. Lack of time was the most common reason given for not resubmitting. Therefore, lecturers may be faced with a challenge of finding ways of not only providing formative feedback but also encouraging students to use it as such.

Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales

BackgroundDepression is common in rheumatoid arthritis (RA), however reported prevalence varies considerably. Two frequently used instruments to identify depression are the Center for Epidemiological Studies Depression (CES-D) scale, and the Hospital Anxiety and Depression Scale (HADS). The objectives of this study were to test if the CES-D and HADS-D (a) satisfy current modern psychometric standards for unidimensional measurement in an early RA sample; (b) measure the same construct (i.e. depression); and (c) identify similar levels of depression.MethodsData from the two scales completed by patients with early RA were fitted to the Rasch measurement model to show that (a) each scale satisfies the criteria of fit to the model, including strict unidimensionality; (b) that the scales can be co-calibrated onto a single underlying continuum of depression and to (c) examine the location of the cut points on the underlying continuum as indication of the prevalence of depression.ResultsNinety-two patients with early RA (62% female; mean age = 56.3, SD = 13.7) gave 141 sets of paired CES-D and HAD-D data. Fit of the data from the CES-D was found to be poor, and the scale had to be reduced to 13 items to satisfy Rasch measurement criteria whereas the HADS-D met model expectations from the outset. The 20 items combined (CES-D13 and HADS-D) satisfied Rasch model expectations. The CES-D gave a much higher prevalence of depression than the HADS-D.ConclusionThe CES-D in its present form is unsuitable for use in patients with early RA, and needs to be reduced to a 13-item scale. The HADS-D is valid for early RA and the two scales measure the same underlying construct but their cut points lead to different estimates of the level of depression. Revised cut points on the CES-D13 provide comparative prevalence rates.

Does the Örebro Musculoskeletal Pain Questionnaire, predict outcomes following a work-related compensable injury?

The objective of this prospective study was to investigate the usefulness of the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) to predict return to work outcomes following a compensable musculoskeletal injury. Participants (n=196 injured workers, 66% male, 36% with back pain) were screened at 4–12 weeks, and followed up at 6 months, post-injury. Total scores on the ÖMPQ were able to differentiate between work status on both occasions, indicating the potential predictive validity of this instrument. This is the first study to evaluate the ÖMPQ in a compensable injury population, and although replication with a larger sample is required, the findings have significant relevance to the recommendation of routine screening for the early identification of injured workers at risk of long-term disability.

Psychometric analysis of the Self-Harm Inventory using Rasch modelling

BackgroundDeliberate Self-Harm (DSH) is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI) is a widely used measure of DSH in clinical populations (mental and physical health) and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts). The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD) using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples.MethodsThe SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30). External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21) to a sub-sample (n = 221). Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score.ResultsThe SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related.ConclusionThe recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.

What leads to the expectation to return to work? Insights from a Theory of Planned Behavior (TPB) model of future work outcomes

OBJECTIVEnThis study used a Theory of Planned Behavior (TPB) model to identify the factors influencing the future work expectations and outcomes of employees with a musculoskeletal injury.nnnPARTICIPANTSnAustralians with a compensable work injury (N=174), mean age=43.7 years, 53.2% male, 48.3% back injury , and 34.2% unskilled.nnnMETHODSnA TPB model of the target behavior working, or continuing to work … three months from now was constructed. A questionnaire measuring the models components was completed at baseline and three-months follow-up.nnnRESULTSnThe model met standard psychometric requirements. Attitude, Subjective Norm and Perceived Behavioral Control explained 76% of the variance in Behavioral Intention (R^{2}= 0.76, p< 0.001). Behavioral Intention (the expectation to return to work) explained 51% of the variance in work participation at follow-up (Nagelkerke R^{2}=0.51, p< 0.001; sensitivity=86.4%, specificity=71.2%). The strength of key influences on expectations varied according to employment status, but included the availability of modified duties, social aspects of work, the opinion of the treating doctor, co-worker support, pain, and functional limitations.nnnCONCLUSIONnThe TPG is a useful model and conceptual framework for integrating the biopsychosocial determinantsof return to work (RTW) and identifying the influences on future work expectations and outcomes.

Teaching Time and Organizational Management Skills to First Year Health Science Students: Does Training Make a Difference?.

The present study reports on new research conducted to determine whether teaching time and organizational skills using a training package can improve these skills. The Abbreviated Time Management Indicator (ATMI) developed by Roberts et al. was used to assess time and organizational management skills. This scale consists of six dimensions, namely sense of purpose, meeting deadlines, mechanics of time management, propensity to plan, coping with temporal flow and effective organization. Participants in this study comprised first year health science students studying at the University of Sydney in their first semester. Four hundred and seventy‐eight students participated in a pre‐test (baseline) session after which they received information on their individual scores on each of the six dimensions of the scale together with average scores on each dimension for the total group (feedback). Of the original participants 122 completed the post‐test session, 5 weeks later. During the intervening period students were given a self‐directed training package which provided practical information on how to improve their skills on each of the dimensions contained in the scale. The results of the study indicated no significant improvement in time and organizational management skills. Possible reasons for the lack of improvement are discussed in terms of recent developments in teaching and learning contexts, together with suggestions for future research.

Health science students' time organization and management skills: a cross-disciplinary investigation

One hundred and fifty-four final year health science undergraduates from the disciplines of Medical Radiation Sciences, Speech Pathology and Physiotherapy in the Faculty of Health Sciences, the University of Sydney completed the Australian Time Organisation and Management Scale (ATOMS). Findings identified the strengths and weaknesses of students on the four dimensions included in this analysis.Whilst the results indicated strengths in the area of students sense of purpose, level of focus and goalsetting ability, areas of weakness were noted, particularly with regard to the use of basic time-management devices (e.g. use of a diary and making lists). How these skills and competences are related to age, gender and discipline is explored. In addition, the degree to which these time-management behaviours can be enhanced (eg with time management intervention programs), the generalizability of the findings to other settings (non-academic), and the development of these skills over time are major issues discussed in the paper.

Co-calibration of deliberate self harm (DSH) behaviours: Towards a common measurement metric

The purpose of this study was to co-calibrate items from different deliberate self-harm (DSH) behavioural scales on the same measurement metric and compare cut points and item hierarchy across those scales. Participants included 568 young Australians aged 18-30 years (62% university students, 21% mental health patients, and 17% community volunteers). Six DSH scales (containing 82 items) were administered, namely, Self-Injury Questionnaire Treatment Related (SIQTR), Self-Injurious Thoughts and Behaviours Interview (SITBI), Deliberate Self-Harm Inventory (DSHI), Inventory of Statements About Self-Injury (ISAS), Self-Harm Information Form (SHIF) and Self-Harm Inventory (SHI). Data were co-calibrated onto an underlying metric using the Rasch measurement model. The resulting calibration shows that the different scales occupy different ranges on the hierarchy of DSH methods with prevalence estimates ranging from 47.7 to 77.1%. A raw score conversion table is provided to adjust prevalence rates and to equate cut points on the six scales. A Rasch-validated hierarchy of DSH behaviours is also provided to inform the development of DSH nomenclatures and assist clinical practice.