Torbjørn Moum

How well can a few questionnaire items indicate anxiety and depression

There is a need for a short form questionnaire with known psychometric characteristics that may be used as an indicator of level of global mental distress. A weighted sum of 5 questions from the Symptom Check List (SCL) anxiety and depression subscales (SCL‐25) correlates at r= 0.92 with the global SCL‐25 score. The alpha reliability for the (5‐item) short form questionnaire was 0.85. Age differences seemed to be trivial, and sex differences were moderate. Descriptive statistics for short form scores in a large, representative sample are given.

Concordance between symptom screening and diagnostic procedure : the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview I

Abstract The definition of case is a core issue in psychiatric epidemiology. Psychiatric symptom screening scales have been extensively used in population studies for many decades. Structured diagnostic interviews have become available during recent years to give exact diagnoses through carefully undertaken procedures. The aim of this article was to assess how well the Hopkins Symptom Checklist-25 (HSCL-25) predicted cases by the Composite International Diagnostic Interview (CIDI), and find the optimal cut-offs on the HSCL-25 for each diagnosis and gender. Characteristics of concordant and discordant cases were explored. In a Norwegian two-stage survey mental health problems were measured by the HSCL-25 and the CIDI. Only 46% of the present CIDI diagnoses were predicted by the HSCL-25. Comorbidity between CIDI diagnoses was found more than four times as often in the concordant cases (cases agreed upon by both instruments) than in the discordant CIDI cases. Concordant cases had more depression and panic/generalized anxiety disorders. Neither the anxiety nor the depression subscales improved the prediction of anxiety or depression. The receiver operating characteristic (ROC) curves confirmed that the HSCL-25 gave best information about depression. Except for phobia it predicted best for men. Optimal HSCL-25 cut-off was 1.67 for men and 1.75 for women. Of the discordant HSCL-25 cases, one -third reported no symptoms in the CIDI, one-third reported symptoms in the CIDI anxiety module, and the rest had symptoms spread across the modules. With the exception of depression, the HSCL-25 was insufficient to select individuals for further investigation of diagnosis. The two instruments to a large extent identified different cases. Either the HSCL-25 is a very imperfect indicator of the chosen CIDI diagnoses, or the dimensions of mental illness measured by each of the instruments are different and clearly only partly overlapping.

Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale:

Objective: A study was undertaken to test the psychometric properties of the Fatigue Severity Scale (FSS), and to explore the relationship between fatigue and sociodemographic variables in the general population. Method: A national representative sample of 1893 respondents was randomly selected from a pool of 4,000 Norwegians aged 19—81 years. A mailed questionnaire that included the FSS was used to measure fatigue severity. Results: The FSS showed satisfactory internal consistency (Cronbachs alpha 0.88). The prevalence of high fatigue (FSS score>=5) was 23.1% in the total sample. More women (26.2%) than men (19.8%) experienced high fatigue (p=0.004). Respondents with chronic illness (more than six months) reported a higher mean (M=4.69, SD=1.35) than the rest of the sample (M=3.67, SD=1.17) (p<0.001). An inverse correlation was found between fatigue and level of formal education (r=0.20, p<0.001). Conclusion: The psychometric properties of the Norwegian version of FSS were satisfactory. To avoid over-diagnosing people for high level of fatigue, the threshold for high fatigue probably should be 5 on the FSS scale instead of 4 as had been suggested originally, but further validation of the cut-off point is needed.

The Groningen activity restriction scale for measuring disability: its utility in international comparisons

OBJECTIVES The Groningen Activity Restriction Scale (GARS) is a non-disease-specific instrument to measure disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). It was developed in studies of Dutch samples consisting of elderly or chronically ill people. The psychometric properties of the GARS demonstrated in these studies were highly satisfactory. This paper addresses the psychometric properties of the GARS across countries. METHODS Data of 623 patients with recently diagnosed rheumatoid arthritis from four European countries were analyzed by means of a principal components analysis and a Mokken scale analysis for polychotomous items. RESULTS The results of the analyses were highly satisfactory: there was one strong and reliable general factor representing one underlying dimension of disability in ADL and IADL, and there was a clear hierarchical ordering of the items included in the GARS. The validity of the GARS was strongly suggested by the pattern of associations of the GARS with age, sex, and other existing health status measures. CONCLUSIONS The psychometric characteristics of the GARS, which measures disability in ADL and IADL simultaneously, make this instrument very useful for comparative research across countries.

The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study

BackgroundMiscarriage and induced abortion are life events that can potentially cause mental distress. The objective of this study was to determine whether there are differences in the patterns of normalization of mental health scores after these two pregnancy termination events.MethodsForty women who experienced miscarriages and 80 women who underwent abortions at the main hospital of Buskerud County in Norway were interviewed. All subjects completed the following questionnaires 10 days (T1), six months (T2), two years (T3) and five years (T4) after the pregnancy termination: Impact of Event Scale (IES), Quality of Life, Hospital Anxiety and Depression Scale (HADS), and another addressing their feelings about the pregnancy termination. Differential changes in mean scores were determined by analysis of covariance (ANCOVA) and inter-group differences were assessed by ordinary least squares methods.ResultsWomen who had experienced a miscarriage had more mental distress at 10 days and six months after the pregnancy termination than women who had undergone an abortion. However, women who had had a miscarriage exhibited significantly quicker improvement on IES scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group at two and five years after the pregnancy termination (IES avoidance means: 3.2 vs 9.3 at T3, respectively, p < 0.001; 1.5 vs 8.3 at T4, respectively, p < 0.001). Compared with the general population, women who had undergone induced abortion had significantly higher HADS anxiety scores at all four interviews (p < 0.01 to p < 0.001), while women who had had a miscarriage had significantly higher anxiety scores only at T1 (p < 0.01).ConclusionThe course of psychological responses to miscarriage and abortion differed during the five-year period after the event. Women who had undergone an abortion exhibited higher scores during the follow-up period for some outcomes. The difference in the courses of responses may partly result from the different characteristics of the two pregnancy termination events.

The meaning and significance of caseness : the Hopkins Symptom Checklist-25 and the Composite International Diagnostic Interview II

Abstract In previous analyses of data from the present general population study we found that screening of anxiety and depression symptoms by the Hopkins Symptom Checklist-25 (HSCL-25) and diagnostic classification by the Composite International Diagnostic Interview (CIDI) identified the same amount of cases, but agreed in only half of them. In this paper we compared and validated the screening cases with the classificatory cases by the use of medication, loss of functioning and help seeking (illness indicators). We thought that the CIDI cases would have more illness indicators, because they reflected diagnoses, “true illness”, in contrast to the HSCL-25, which was a more unspecific measure of distress. The HSCL-25 and the illness indicators data were collected in a stage I random individual population sample above 18 years during 1989–1991 (N = 1879, response rate 74%), the CIDI data were collected in a selected stage II, (N = 606, response rate 77%). The stage II data were weighted to represent the population sample. Screening cases by the HSCL-25 had significantly more illness indicators than diagnostic cases by the CIDI. Cases agreed upon with both instruments had the most illness indicators, cases agreed upon only by the CIDI had the least. Diagnoses give information about help eventually needed, the HSCL-25 distress measure expresses more the urgency with which it is needed. The choice between the HSCL-25 and the CIDI would depend on the aim and the resources of the study. If evaluation of needs is involved, using an instrument picking up both classification and distress would be the best choice. Given our positive experience with interviewing with the CIDI, a CIDI improved to be more sensitive to how much distress a certain diagnosis exerts on the individual would be a good choice.

An international study on measuring social support: Interactions and satisfaction

Recently, a new instrument was developed to measure social support. It consists of two parts; the Social Support Questionnaire for Transactions (SSQT) and the Social Support Questionnaire for Satisfaction with the supportive transactions (SSQS). The SSQT measures the number of supportive interactions and has proved to have good psychometric properties. From the taxonomy that was used for the present study, it results that social support in general consists of two aspects. There are, on the one hand, actual supportive transactions and, on the other hand, the perception of being supported or the satisfaction with the social support provided. In the present study, two research questions were addressed. The first concerned the psychometric properties of the SSQS, measuring the individuals satisfaction with the supportive interactions provided. Secondly, the relative contribution of both supportive interactions (the SSQT) and the satisfaction with the support provided (the SSQS) were assessed, in explaining the level of health related quality of life outcome. The data of 744 rheumatoid arthritis (RA) patients from four different countries (116 French, 238 Norwegian, 98 Swedish and 292 Dutch patients) were used in the present study. At the entry of the study, all patients fulfilled four out of seven American Rheumatism Association (ARA) criteria and had a disease duration of 4 years or less. The results of the study indicate that the SSQS has good psychometric properties across countries. Cronbachs alpha for the emotional support scales was 0.80 or more, and for the instrumental support subscales around 0.60. The standardized regression coefficients demonstrated that, compared to supportive interactions, support satisfaction was more relevant in explaining health related quality of life measures, although it is recommended that the SSQT and SSQS be used to complement each other.

Mode of administration and interviewer effects in self-reported symptoms of anxiety and depression

This study investigates whether mode of administration and the interviewers age and sex affect results obtained with a commonly used rating scale for symptoms anxiety and depression (HSCL-25). Identical versions of the scale was administered orally by experienced interviewers, either face-to-face or by phone. Another sample received self-administered questionnaires that were completed at home and returned by mail. Subjects were a total of 13,850 Norwegian adults participating in two broad population surveys. Results seem to confirm the standing presumption that in-person interviews are more vulnerable to socially desirable responding (SDR) than self-administered modes: Two to three times as many “probable cases” of psychological distress are identified with the self-administered mode compared to the interview modes. However, the SDR generated by mode of administration apparently occurs in subgroups of respondents not identified by extant measures of social desirability (the Crowne-Marlowe scale, etc.) as being high on SDR: In the present study the young and well-educated respondents appear particularly prone to under-report symptoms with the interview modes. The impact of sex and age of interviewer on symptom reports generally appears weak. However, young male interviewers receive very few symptom reports compared to other interviewers.

Fatigue and its association with sociodemographic variables among multiple sclerosis patients

Objective: To explore the relationship between fatigue, sociodemographic and clinical variables in a population of patients with multiple sclerosis (MS). Rationale: There is a need to identify empirical relationships with possible antecedents of fatigue among patients with MS. Methods: A mailed questionnaire designed to survey sociodemographic variables and the Fatigue Severity Scale (FSS) was mailed to 502 individuals from the population of patients with definite MS in the city of O slo. A total of 368 (73%) responded. C linical data were collected from the O slo C ity MS-Registry. Results: The prevalence of fatigue in this population was 60.1%. The FSS score showed a negative correlation with education (r =-0.15, P <0.01) and a positive correlation with age (r =0.20, P B-0.001) and time since disease onset (r =0.11, P B-0.05). When controlled for gender, level of education and time since disease onset, the data showed a positive relationship between fatigue and age (P B-0.001) among patients with primary progressive (PP) disease. This relationship between age and fatigue was not found among patients with relapsing-remitting/secondary progressive (RR/SP) disease. Conclusion: The negative relationship between level of formal educatio n (FE) and fatigue among individuals with RR/SP disease suggests that behavioral factors may be among the antecedents of fatigue in this patient group. In contrast to normative data from the general population, our findings revealed no differences in fatigue related to gender. Thus, this study supports the hypothesis that there are disease-specific antecedents of fatigue among patients with MS.

Psychological impact on women of miscarriage versus induced abortion: A 2-year follow-up study

Objective To compare the psychological trauma reactions of women who had either a miscarriage or an induced abortion, in the 2 years after the event. Further, to identify important predictors of Impact of Event Scale (IES) scores. Method A consecutive sample of women who experienced miscarriage (N = 40) or induced abortion (N = 80) were interviewed 3 times: 10 days (T1), 6 months (T2), and 2 years (T3) after the event. Results At T1, 47.5% of the women who had a miscarriage were cases (IES score 19 points on 1 or both of the IES subscales), compared with 30% for women who had an induced abortion (p = .60). The corresponding values at T3 were 2.6% and 18.1%, respectively (p = .019). At all measurement time points, the group who had induced abortion scored higher on IES avoidance. Women who had a miscarriage were more likely to experience feelings of loss and grief, whereas women who had induced abortion were more likely to experience feelings of relief, guilt, and shame. At T3, IES intrusion was predicted by feelings of loss and grief at T1, whereas avoidance at T3 was predicted by guilt and shame at T1. Conclusion The short-term emotional reactions to miscarriage appear to be larger and more powerful than those to induced abortion. In the long term, however, women who had induced abortion reported significantly more avoidance of thoughts and feelings related to the event than women who had a miscarriage.