Psychometric Comparability of Self-Report by Children Aged 9–10 versus 11 Years on the Strengths and Difficulties Questionnaire (SDQ)
The 25-item Strengths and Difficulties Questionnaire (SDQ) is a popular screening instrument that assesses childhood psychopathology and prosocial behaviour. While the value of acquiring multi-informant perspectives in the assessment of childhood psychopathology is recognised, the use of the self-report version of the questionnaire is recommended only for children aged 11 years and older. This study aimed to evaluate the psychometric comparability of self-report on the SDQ by children aged 9–10 years relative to children aged 11 years using item response modelling. Item response models were used in a community sample of 7959 children to investigate the structure, item characteristics, and age differences related to self-report by children aged 9–10 years (n=6004), relative to children aged 11 years (n=1955), on the SDQ. Internalizing, externalizing, and prosocial factors explained the covariance of the questionnaire items. There were statistically significant age-related differences on only two items (the “worries” and “distractible” items), but these differences were small in magnitude and did not affect the precision of measurement of the SDQ. Self-report by children aged 9 and 10 years on the SDQ is psychometrically comparable to reports by children aged 11 years after controlling for differences in latent severity. This work expands the utility of the self-report SDQ to children aged as young as 9 years.
A randomized controlled trial of 'MUMentum Pregnancy': Internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression
Background: Anxiety and depression are common during pregnancy and associated with adverse outcomes for the mother and infant if left untreated. Despite the need to improve treatment accessibility and uptake in this population, no studies have investigated internet-delivered cognitive behavioural therapy (iCBT) for antenatal anxiety and depression. In a randomised controlled trial, we examined the efficacy and acceptability of a brief, unguided iCBT intervention – the MUMentum Pregnancy program – in pregnant women with anxiety and/or depression. Methods: Participants meeting clinical threshold on validated self-report measures of generalised anxiety and/or depression were recruited online and randomised to iCBT (n=43) or a treatment as usual (TAU) control (n=44). Outcomes were assessed at baseline, post-treatment and four-week follow-up; and included anxiety, depression, psychological distress, antenatal bonding, quality of life, and treatment acceptability. Results: Of the 36 women who started iCBT, 26 completed all three lessons of treatment (76% adherence rate). iCBT produced moderate to large effect size reductions for anxiety on the GAD-7 (Hedges’ g=0.76) and psychological distress on the Kessler-10 (g=0.88) that were superior to TAU. Only small nonsignificant differences were found for depression outcomes (g=<0.35). Participants reported that iCBT was an acceptable treatment for antenatal anxiety and/or depression. Limitations: Lack of an active control condition and long-term postpartum follow-up. Conclusions: This is the first study to evaluate brief unguided iCBT for antenatal anxiety and depression. While our findings are promising, particularly for anxiety reduction, additional RCTs are required to establish treatment efficacy.
Integrating iCBT for generalized anxiety disorder into routine clinical care: Treatment effects across the adult lifespan
The burden attributable to late-life Generalized Anxiety Disorder (GAD) is set to increase alongside the ageing population. Yet, the psychogeriatric workforce is limited in size and few studies have focused on the treatment of GAD among older patients. Internet-delivered cognitive behavioral therapy (iCBT) could be integrated into existing infrastructure and scale the psychogeriatric workforce, if shown to be effective across the adult lifespan. This study examined age-related differences in presentation, adherence and effects of iCBT for GAD among patients in routine clinical care (N = 942; 18–29 years (n = 267); 30–39 years (n = 260); 40–49 years (n = 180); 50–59 years (n = 124); and 60+ years (n = 111)). Compared to younger patients, older patients were less likely to present with probable GAD and MDD diagnoses (<60 years vs. 60+ years) and more likely to complete treatment (<50 years vs. 50+ years). iCBT produced moderate to large effect size reductions in symptom severity, distress and impairment independent of age. iCBT is therefore an effective treatment for GAD across the adult lifespan, which can be delivered in routine clinical care. Continuing to integrate iCBT into existing services has the potential to improve the capacity of the existing workforce to manage those seeking help for GAD particularly as the population ages.
General practitioners’ perspectives on the management of refugee health: a qualitative study
Objective To explore general practitioners’ (GPs) perceptions of the challenges and facilitators to managing refugee healthcare needs in regional Australia.
Setting A regional community in Australia involved in the resettlement of refugees.
Participants Nine GPs from five practices in the region.
Design A qualitative study based on semistructured interviews conducted between September and November 2020.
Results The main challenges identified surrounded language and communication difficulties, cultural differences and health literacy and regional workforce shortages. The main facilitators were clinical and community supports, including refugee health nurses and trauma counselling services. Personal benefits experienced by GPs such as positive relationships, satisfaction and broadening scope of practice further facilitated ongoing healthcare provision.
Conclusions Overall, GPs were generally positive about providing care to refugees. However, significant challenges were expressed, particularly surrounding language, culture and resources. These barriers were compounded by the regional location. This highlights the need for preplanning and consultation with healthcare providers in the community both prior to and during the settlement of refugees as well as ongoing support proportional to the increase in settlement numbers.
Symptom screening scales for detecting major depressive disorder in children and adolescents: A systematic review and meta-analysis of reliability, validity and diagnostic utility
Background: Depression symptom screening scales are often used to determine a clinical diagnosis of major depressive disorder (MDD) in prevention research. The aim of this review is to systematically examine the reliability, validity and diagnostic utility of commonly used screening scales in depression prevention research among children and adolescents. Methods: We conducted a systematic review of the electronic databases PsycINFO, PsycEXTRA and Medline examining the reliability, validity and diagnostic utility of four commonly used depression symptom rating scales among children and adolescents: the Children׳s Depression Inventory (CDI), Beck Depression Inventory (BDI), Center for Epidemiologic Studies – Depression Scale (CES-D) and the Reynolds Adolescent Depression Scale (RADS). We used univariate and bivariate random effects models to pool data and conducted metaregression to identify and explain causes of heterogeneity. Results: We identified 54 studies (66 data points, 34,542 participants). Across the four scales, internal reliability was ‘good’ (pooled estimate: 0.89, 95% Confidence Interval (CI): 0.86–0.92). Sensitivity and specificity were ‘moderate’ (sensitivity: 0.80, 95% CI: 0.76–0.84; specificity: 0.78, 95% CI: 0.74–0.83). For studies that used a diagnostic interview to determine a diagnosis of MDD, positive predictive power for identifying true cases was mostly poor. Psychometric properties did not differ on the basis of study quality, sample type (clinical vs. nonclinical) or sample age (child vs. adolescent). Limitations: Some analyses may have been underpowered to identify conditions in which test performance may vary, due to low numbers of studies with adequate data. Conclusions: Commonly used depression symptom rating scales are reliable measures of depressive symptoms among adolescents; however, using cutoff scores to indicate clinical levels of depression may result in many false positives.
DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11)
Background: Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11–13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being. Method: Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit. Results: In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life. Conclusions: This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.
EEG abnormalities in adolescent males with AD/HD
Objective: This study investigated EEG abnormalities in adolescents with attention-deficit/hyperactivity disorder (AD/HD). Methods: Fifteen AD/HD subjects and 15 control subjects participated in this study. All subjects were between 14 and 17 years of age. The EEG was recorded from 19 electrode sites and was analysed to provide estimates of both absolute and relative power in the delta, theta, alpha and beta bands. Theta/alpha and theta/beta ratio coefficients were also calculated. Results: Across the scalp, AD/HD subjects were characterised by greater absolute delta and theta activity, and an increased theta/beta ratio compared to controls. No group differences were found for either absolute or relative alpha, or absolute beta. However, AD/HD subjects demonstrated a reduction in relative beta activity in the posterior regions. Conclusions: The AD/HD group showed significant deviations from normal CNS development, in particular in posterior regions. This supports previous suggestions that individuals with an EEG profile that is not indicative of a maturational lag are more likely to have AD/HD during adolescence. Significance: This is the first study to investigate EEG abnormalities in adolescents with AD/HD during an eyes-closed resting condition.
The Relationship Between CBT-Mindedness and iCBT Outcomes Amongst a Large Adult Sample
Background Predicting response to cognitive behavior therapy (CBT) assists efforts to enhance treatment outcome when predictive factors are modifiable prior to, or during, treatment. The extent to which clients hold beliefs and attitudes consistent with CBT (termed CBT-mindedness) is a relatively new concept with research suggesting it predicts response to CBT amongst small samples of adults with anxiety. This study aimed to investigate CBT-mindedness amongst a larger clinical population receiving internet-delivered CBT (iCBT).
Method 1132 adults with anxiety, depression or mixed anxiety and depression who accessed iCBT with or without therapist support via the THIS WAY UP clinic completed a brief self-report measure of CBT-mindedness along with measures of distress, anxiety, and depression. Measures were completed pre- and post-treatment.
Results The 3-factor structure of the CBT Suitability Scale (CBT-SUITS) was confirmed and scores were unrelated or very weakly related to symptoms/distress. CBT-mindedness increased amongst treatment completers. CBT-mindedness predicted post-treatment distress (but not symptoms), and change in CBT-mindedness predicted lower post-treatment symptoms and distress.
Conclusions The CBT-SUITS represents a psychometrically sound measure of CBT-mindedness. Results amongst this large sample of adults accessing iCBT in a community service indicate that CBT-mindedness (or CBT-mindedness change) is an important predictor of therapy response.
Psychological distress across the lifespan: examining age-related item bias in the Kessler 6 Psychological Distress Scale
Background: Old age respondents may differ systemically in their responses to measures of psychological distress over and above their actual latent distress levels when compared to younger respondents. The current study aimed to investigate the potential for age-related bias(es) in the Kessler 6 Psychological Distress Scale (K6) items. Methods: Data from the 2007 Australian National Survey of Mental Health and Wellbeing were analyzed using Item Response Theory to detect the presence of item bias in each of the K6 items. The potential for item bias was assessed by systematically comparing respondents classed as young (16–34 years), middle aged (35–64 years), and old aged (65–85 years). The significance and magnitude of the item bias between the age groups was assessed using the log-likelihood ratio method of differential item functioning. Results: After statistical adjustment, there were no biases of significant magnitude influencing the endorsement of K6 items between young and middle-aged respondents or between middle-aged and old age respondents. There was a bias of significant magnitude present in the endorsement of the K6 item addressing levels of fatigue between young and old age respondents. Conclusions: Despite the identification of significant item bias in the endorsement of K6 items between the age groups, the magnitude and influence of the bias on total K6 scores is likely to have little influence on the overall interpretation of group data when comparing psychological distress across the lifespan. Researchers should be cautious, however, when examining individual levels of fatigue related to psychological distress in older individuals.
The effectiveness of unguided internet cognitive behavioural therapy for mixed anxiety and depression
Clinician-guided internet-delivered cognitive behavioral therapy (iCBT) is an effective treatment for depression and anxiety disorders. However, few studies have examined the effectiveness of completely unguided iCBT. The current research investigated adherence to, and the effects of two brief unguided iCBT programs on depression and anxiety symptom severity, and psychological distress. Study 1 evaluated a four-lesson transdiagnostic iCBT program for anxiety and depression (N = 927). Study 2 then evaluated a three-lesson version of the same program (N = 5107) in order to determine whether reducing the duration of treatment would influence adherence and treatment effects. Cross-tabulations and independent t-tests were used to examine the extent to which users adhered and remitted with treatment. Linear mixed models were used to evaluate the effects of treatment in the entire sample, and stratified by gender and completer-type (e.g., users who completed some but not all lessons vs. those who completed all lessons of treatment). Among those who began treatment, 13.83% completed all four lessons in Study 1. Shortening the course to three lessons did not improve adherence (e.g., 13.11% in Study 2). In both studies, users, on average, experienced moderate to large effect size reductions in anxiety and depressive symptom severity, as well as psychological distress. This pattern of results was robust across gender and for those who did and did not complete treatment. Approximately two-thirds of those who completed treatment experienced remission. These data show that unguided iCBT programs, which have the capacity to attract large numbers of individuals with clinically significant symptoms of depression and anxiety, and psychological distress, can produce significant improvements in wellbeing.
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