Prescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose.

BACKGROUND: The opioid overdose crisis continues within the U.S., and the role of prescribed opioids and prescribing patterns in overdose deaths remains an important area of research. This study investigated patterns of prescription opioids dispensed in the 12 months prior to opioid-detected overdose death in Connecticut between May 8th, 2016 and January 2nd, 2018, considering differences by demographic characteristics. METHODS: The sample included decedents who had an opioid dispensed within 30 days preceding death. Using multilevel modeling, we estimated the slope of change in mean morphine equivalent (MME) daily dose over 12 months prior to death, considering linear and quadratic effects of time. We estimated the main effects of age, sex, race, and ethnicity and their interactions with time on MME. A sensitivity analysis examined how excluding decedents who did not receive long-term (≥90 days) opioid therapy affected mean MME slopes. Secondary analysis explored differences by toxicology results. RESULTS: Among 1,580 opioid-detected deaths, 179 decedents had prescribed opioids dispensed within 30 days preceding death. Decedents' mean age was 47.3 years (±11.5), 65.5% were male, 81% White non-Hispanic, 9.5% Black non-Hispanic, and 9.5% Hispanic. In the time-only model, linear (ß=6.25, p<0.01) and quadratic (ß=0.49, p=0.02) effects of time were positive, indicating exponentially increasing dose prior to death. Linear change in MME was significantly attenuated in men compared to women (ß=-4.87, p=0.03); however, men were more likely to have non-prescription opioids in their toxicology results (p=0.02). Sensitivity analysis results supported primary findings. CONCLUSION: Rapid dose increases in dispensed opioids may be associated with opioid-detected overdose deaths, especially among women.

Nursing students' personality (Temperament and Character), burnout symptoms, and health and well-being.

Background: About 9 million nurses will be needed by 2030. To face these unprecedented times, governments/institutions focus on educating as many nursing students as possible. This strategy is clouded by burnout and lack of both health and well-being among students and by the fact that personality is one of the major determinants of these health outcomes. Nevertheless, recent findings show that personality is a complex adaptive system (i,e., nonlinear) and that combinations of people's temperament and character traits (i.e., joint personality networks) might provide further information to understand its development, academic burnout, and lack of health and well-being. Aims: Our aims were to investigate the linear relationship between nursing students' personality, burnout, health, and well-being; investigate the linear mediational effects of personality and burnout on health and well-being; and investigate differences in these health outcomes between/within students with distinct joint personality networks (i.e., nonlinear relationships). Method: Swedish nursing students (189 women, 29 men) responded to the Temperament and Character Inventory, The Maslach Burnout Inventory-General Survey for Students, and the Public Health Surveillance Well-Being Scale. We conducted correlation analyses and Structural Equation Modeling and, for the nonlinear relationships, Latent Profile Analysis and Latent Class Analysis for clustering and then Analyses of Variance for differences in health outcomes between/within students with distinct personality networks. This study was not pre-registered. Results: High levels of health and well-being and low burnout symptoms (low Emotional Exhaustion, low Cynicism, and high Academic Efficacy) were associated with low Harm Avoidance and high Self-Directedness. Some personality traits were associated with specific health outcomes (e.g., high Self-Transcendence-high Emotional Exhaustion and high Persistence-high Academic Efficacy) and their effects on health and well-being were mediated by specific burnout symptoms. Cynicism and Emotional Exhaustion predicted low levels of health and well-being, Academic Efficacy predicted high levels, and Cynicism lead both directly and indirectly to low levels of health and well-being through Emotional Exhaustion. We found two joint personality networks: students with an Organized/Reliable combination who reported being less emotionally exhausted by their studies, less cynical towards education, higher self-efficacy regarding their academic work/skills, and better health and well-being compared to nursing students with an Emotional/Unreliable combination. Conclusions: The coherence of temperament-character, rather than single traits, seems to determine students' health outcomes. Thus, nursing education might need to focus on helping students to develop professional skills and health-related abilities (e.g., self-acceptance and spiritual-acceptance), by supporting self-awareness.

Corrigendum: The 18-item Swedish version of Ryff's psychological wellbeing scale: psychometric properties based on classical test theory and item response theory.

[This corrects the article DOI: 10.3389/fpsyg.2023.1208300.].

Epidemiology of substance use and mental health disorders among forced migrants displaced from the MENAT region: A systematic review and meta-analysis protocol.

BACKGROUND: Understanding the epidemiology of substance use disorders (SUDs) and mental health disorders (MHDs) among forced migrants from the Middle East and North Africa and Türkiye (MENAT) region is of utmost importance given their distinct challenges and vulnerabilities. Existing research on the topic is substantial; however, comprehensive systematic reviews are limited. We aim to conduct a systematic literature review to bridge this gap, providing a thorough understanding of SUDs and MHDs epidemiology among this population. METHODS: The systematic review will include original, peer-reviewed research articles published in English or Arabic between 2013 and 2023. It will encompass qualitative, quantitative, and mixed-methods studies focusing on SUDs and/or MHDs among forced migrants from the MENAT region. A Medline (via Ovid) search strategy was developed and will be translated into databases of EMBASE (via Ovid), Web of Science Core Collection (as licensed at Yale), and CINAHL. Risk of Bias in the included studies will be assessed using the Joanna Briggs Institute (JBI) checklist for observational studies and the Cochrane Risk of Bias (ROB) 2 tool for intervention studies. Meta-analysis using random-effects models will be conducted and subgroup analyses based on studies' data will be performed. The systematic review will be conducted based on the framework introduced by the Joanna Briggs Institute. Additionally, the PRISMA-P extension for systematic reviews was used to report the present protocol. The present systematic review protocol has been registered with PROSPERO, an international prospective register of systematic reviews. The review's registration ID is CRD42021286882. DISCUSSION: The systematic review aims to explore, identify and synthesize the evidence to reveal the epidemiology of SU and/or MH of forced migrants of the MENAT region as described in this protocol. In sum, the review will provide evidence to fill the gap in the literature and help the stakeholders, policymakers, and health providers to expand current knowledge of the prevalence and risk factors of SU and/or MH in humanitarian settings.

The 18-item Swedish version of Ryff's psychological wellbeing scale: psychometric properties based on classical test theory and item response theory.

Background: Psychological wellbeing is conceptualized as the full engagement and optimal performance in existential challenges of life. Our understanding of psychological wellbeing is important for us humans to survive, adapt, and thrive during the challenges of the 21st century. Hence, the measurement of psychological wellbeing is one cornerstone for the identification and treatment of both mental illness and health promotion. In this context, Ryff operationalized psychological wellbeing as a six-dimensional model of human characteristics: self-acceptance, positive relations with others, environmental mastery, personal growth, autonomy, and purpose in life. Ryff's Psychological Wellbeing Scale has been developed and translated into different versions. Here, we examine and describe the psychometric properties of the 18-item Swedish version of Ryff's Psychological Wellbeing Scale using both Classical Test Theory (CTT) and Item Response Theory (IRT). Methods: The data used in the present study was earlier published elsewhere and consists of 768 participants (279 women and 489 men). In addition to the 18-item version of the scale, participants answered the Temporal Satisfaction with Life Scale, the Positive Affect Negative Affect Schedule, and the Background and Health Questionnaire. We examined, the 18-item version's factor structure using different models and its relationship with subjective wellbeing, sociodemographic factors (e.g., education level, gender, age), lifestyle habits (i.e., smoking, frequency of doing exercise, and exercise intensity), and health issues (i.e., pain and sleeping problems). We also analyzed measurement invariance with regard to gender. Moreover, as an addition to the existing literature, we analyzed the properties of the 18 items using Graded Response Model (GRM). Results: Although the original six-factor structure showed a good fit, both CTT and IRT indicated that a five-factor model, without the purpose in life subscale, provided a better fit. The results supported the internal consistency and concurrent validity of the 18-item Swedish version. Moreover, invariance testing showed similar measurement precision by the scale across gender. Finally, we found several items, especially the purpose in life's item "I live life one day at a time and do not really think about the future," that might need revision or modification in order to improve measurement. Conclusion: A five-factor solution is a valid and reliable measure for the assessment of psychological wellbeing in the general Swedish population. With some modifications, the scale might achieve enough accuracy to measure the more appropriate and correct six-dimensional theoretical framework as detailed by Ryff. Fortunately, Ryff's original version contains 20 items per subscale and should therefore act as a perfect pool of items in this endeavor.

Inequalities in care for Iranian women suffering from the comorbidity of substance use and mental illness: The need for integrated treatment.

This paper addresses the comorbidity of substance use and mental illness among women in Iran and the barriers they encounter in accessing treatment. Research has demonstrated a higher prevalence of comorbidity of substance use disorders and mental illness among women than men. It has been suggested that women in Iran may face numerous barriers to appropriate care, such as stigma and discrimination associated with substance use. Integrated treatment for co-occurring disorders (CODs) has been highly beneficial and effective; however, personal and structural limitations impede this treatment approach, which explains the need to develop a situation- and culture-specific program. Needs assessment is necessary to achieve an integrated treatment, and the Iranian government should take the lead in this endeavor. However, if this seems unlikely, non-governmental organizations could be called upon to promote it.

Does auditory attentional bias determine craving for methamphetamine? A pilot study using a word recognition dichotic listening task.

Background: Obtaining reliable data under explicit evaluations is one of the most complicated challenges in assessing drug users' status. Respondents are likely to give answers that are to their advantage or deliberately deceitful. Regarding drug use, intense and inevitable drug craving is known as one of the main causes of relapse and treatment failure. As a matter of fact, drug craving is directly correlated to attentional bias toward drug-related stimuli, while drug-related stimuli capture drug users' attention as a result of craving. Most methods for studying selective attention and attentional bias have been developed for visual modality. However, stimuli that capture drug users' attention are not always visual, they could be auditory. Aims: We examined if a modified word recognition dichotic listening task discriminated between methamphetamine users and non-users. Moreover, we investigated further the reliability and validity of this new paradigm. Methods: A total of 30 adult males participated in the study (15 methamphetamine users and 15 non-users). The word recognition dichotic listening task included two stimuli narratives/sequences (one neutral and one methamphetamine-related) that were presented simultaneously via headphones, one stimuli sequence to each ear. The participants were instructed to only pay attention to the neutral stimuli and to ignore the drug-related stimuli. Afterward, participants were asked to indicate in a list which words they recognized from the listening task and responded to the Desire for Drug Questionnaire, which was modified to address methamphetamine craving. In addition, a month after the experiment, we assessed therapy adherence among participants who were methamphetamine users. Results: Methamphetamine users had a significantly lower performance in the word recognition dichotic task compared to non-users (t = 4.30, p < .001; Cohen's d = 6.13). Importantly, the average performance on the task was significantly higher among methamphetamine users who continued their treatment one month later compared to those who quitted (t = -2.56, p < .05; Hedges' g = 1.28). Moreover, the intraclass correlation coefficient with 95% interval confidence for the word recognition dichotic listening task scores was excellent (ICC = 0.90) and the scores were significantly correlated with self-reported methamphetamine craving (r = -.47, p < .001). Conclusions: The modified word recognition dichotic listening task successfully discriminated between individuals who craved methamphetamine from those who did not. This new paradigm demonstrated high reliability and validity in the present pilot study. Due to the importance of preventing unreliable responses when assessing drug cravings, the current method can be, after further validation, utilized in both research and clinical practices.

The A(ffect) B(ehavior) C(ognition) D(ecision) of parasocial relationships: A pilot study on the psychometric properties of the Multidimensional Measure of Parasocial Relationships (MMPR).

The aim of this pilot study was to preliminary test the psychometric properties of the Multidimensional Measure of Parasocial Relationships (MMPR), a self-report that assess people's attitude (affect, cognition, and behavior) towards social media figures and to what extent people perceive that media figures influence their daily life decisions (e.g., consumption, exercise, nutrition). In short, the MMPR measures how and to what extent people are committed to such one-sided relationships and interactions through social media platforms. Besides factor structural analyses (four different models) and internal consistency, we also tested the MMPR's concurrent validity by investigating if, as hypothesized, the association between commitment to parasocial relationships and self-esteem is mediated by its positive association to social comparison. Participants (N = 259) answered to the MMPR, the Iowa-Netherlands Comparison Orientation Measure, and the Rosenberg Self-Esteem Scale. As expected, the MMPR loaded in four dimensions and had good internal consistency (e.g., Cronbach's Alphas were between .66-.75 for the four dimensions and .85 for the whole measure). The bifactor model with correlated factors had the best fit indexes (CFI = .95, RMSEA = .07). Moreover, the direct effect of MMPR was positive on social comparison (ß = .18, p < .01), the direct effect of social comparison on self-esteem was negative (ß = -.51, p < .001), and the indirect effect of MMPR on self-esteem was negative (ß = -.09, p < .01). In sum, our results suggest that parasocial relationships through social media platforms consist of four necessary and correlated dimensions (A: Affective; B: Behavioral; C: Cognitive; and D: Decisional). Moreover, the MMPR successfully assessed that high level of commitment with parasocial relationships are positively associated with the tendency to compare oneself to others, which in turn leads to low levels of self-esteem. Hence, the MMPR has sound psychometric properties and is a good candidate for further analyses.

Differences in subjective well-being between individuals with distinct Joint Personality (temperament-character) networks in a Bulgarian sample.

Background: Personality is the major predictor of people's subjective well-being (i.e., positive affect, negative affect, and life satisfaction). Recent research in countries with high-income and strong self-transcendent values shows that well-being depends on multidimensional configurations of temperament and character traits (i.e., Joint Personality Networks) that regulate the way people learn to adapt their habits to be in accord with their goals and values, rather than individual traits. To evaluate the prevalence and the associations of different Joint Personality (temperament-character) Networks with well-being in a low-income country with weak self-transcendent values, we tested their association in Bulgarian adults, a population known to have strong secular-rationalist values but weak self-transcendent values. Method: The sample consisted of 443 individuals from Bulgaria (68.70% females) with a mean age of 34 years (SD = 15.05). Participants self-reported personality (Temperament and Character Inventory), affect (Positive Affect Negative Affect Schedule), and life satisfaction (Satisfaction with Life Scale). The personality scores were used for profiling through latent profile analysis and latent class analysis based on temperament configurations (i.e., Temperament Profiles) of high/low scores of Novelty Seeking (N/n), Harm Avoidance (H/h), Reward Dependence (R/r), and Persistence (P/s); and character configurations (i.e., Character Profiles) of high/low scores of Self-Directedness (S/s), Cooperativeness (C/c), and Self-Transcendence (T/t). Results: We found two Temperament Profiles and two Character Profiles that clustered into two distinctive Joint Personality Networks. All individuals in Joint Personality Network 1 had a Reliable (nhRP) Temperament Profile in combination with an Organized (SCt) Character Profile (i.e., a stable temperament and a healthy character configuration). About 71.9% in Joint Personality Network 2 had an Apathetic (sct) Character Profile in combination with Methodical (nHrp) or Reliable (nhRP) Temperament Profiles, while 28.1% had a Methodical (nHrp) Temperament Profile in combination with an Organized (SCt) Character Profile. Few people with high self-expressive values (i.e., high in all three character traits; SCT) were found. Individuals with a Joint Personality Network 1 with strong secular-rationalist values reported higher levels of positive affect and life satisfaction (p < .001), while individuals with a Joint Personality Network 2 reported higher levels of negative affect (p < .001). Conclusions: Although a stable temperament and a healthy character were separately important for well-being, it was clear that it was the interaction between such temperament and character configuration that yielded greater levels of subjective well-being. Nevertheless, future research needs to investigate this interaction further to evaluate other cultures with variable configurations of personality traits and values.

Effects of a 10-Week Physical Activity Intervention on Asylum Seekers' Physiological Health.

INTRODUCTION: The rise in armed conflicts has contributed to an increase in the number of asylum seekers. Prolonged asylum processes may negatively affect asylum seekers' health and lead to inactivity. Studies show that physical activity interventions are associated with improvements in health outcomes. However, there are a limited number of studies investigating the associations of physical activity on asylum seekers' health. METHODS: Participants (263 males and 204 females), mostly from Syria, were assessed before and after a 10-week intervention for VO2 max, body mass index (BMI), skeletal muscle mass (SMM), body fat, and visceral fat. Linear mixed models were used to test differences within groups, and a linear regression model analysis was performed to test whether physiological variables predicted adherence. RESULTS: Participants' VO2 max increased: males by 2.96 mL/min/kg and females 2.57 mL/min/kg. Increased SMM percentages were seen in both genders: females by 0.38% and males 0.23%. Visceral fat area decreased: males by 0.73 cm2 and females 5.44 cm2. CONCLUSIONS: Participants showed significant increases in VO2 max and SMM and decreased visceral fat. This study provides an insight into asylum seekers' health and serves as a starting point to new interventions in which physical activity is used as a tool to promote and improve vulnerable populations' health.

Medication for opioid use disorder in the Arab World: A systematic review.

BACKGROUND: Opioid use disorder (OUD) is a global public health concern. The standard of care for OUD involves treatment using medications such as buprenorphine, methadone, or naltrexone. No known review exists to assess the contextual factors associated with medication for opioid use disorder (MOUD) in the Arab World. This systematic review serves as an implementation science study to address this research gap and improve the uptake of MOUD in the Arab World. METHODS: Systematic searches of Medline, PsycINFO, and EMBASE, and a citation analysis, were used to identify peer-reviewed articles with original data on MOUD in the Arab World. Quality assessment was conducted using the CASP appraisal tools, and main findings were extracted and coded according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS: 652 research articles were identified, and 10 met inclusion criteria for final review. Four studies considered health-systems aspects of MOUD administration, such as cost-effectiveness, the motivations for and impact of national MOUD policies, the types of social, political, and scientific advocacy that led to the adoption of MOUD in Arab countries, and the challenges limiting its wide-scale adoption in the Arab World. Six papers considered MOUD at individual and group patient levels by evaluating patient quality of life, addiction severity, patient satisfaction, and patient perspectives on opioid agonist therapy. CONCLUSION: Despite financial and geographic barriers that limit access to MOUD in the Arab World, this review found MOUD to be cost-effective and associated with positive health outcomes for OUD patients in the Arab World. MOUD can be successfully established and scaled to the national level in the Arab context, and strong coalitions of health practitioners can lobby to establish MOUD programs in Arab countries. Still, the relative novelty of MOUD in this context precludes an abundance of research to address its long-term delivery in the Arab World.

Translation and psychometric validation of the Persian version of the Questionnaire on Smoking Urges for assessment of craving to smoke among university students.

BACKGROUND: Even though tobacco is one of the most preventable causes of death worldwide, it endangers more than 8 million people yearly. In this context, meta-analyses suggest that a significant part of the general Iranian population over 15 years of age smoke and that there is a need for good screening tools for smoking cravings and urges in Iran. The present study reported the translation and investigated the psychometric properties (i.e., factor structure, validity, and reliability) of the Persian version of the Questionnaire on Smoking Urges (QSU) with 12 items in the Iranian context. METHOD: The translation process and content validity of the items were examined entirely in an expert panel using the Content Validity Index. The total sample of participants in which the translated version was tested consisted of 392 (172 female, 220 male, Mage = 22.31 years, SD = 2.90) university students who answered the QSU 12-item at the start of their participation in smoking cessation interventions. The QSU 12-item was firstly translated, then piloted using a subsample of 150 university students and finally validity and reliability of the instrument were investigated using a subsample of 242 participants. We tested the proposed models in the literature, that is, a 1-factor solution and a 2-factor solution with six items on each factor (Factor 1: desire/intention to smoke; Factor 2: relief of negative affect or withdrawal symptoms and anticipation of positive outcome). At last, we tested differences across differences in QSU-scores across different subgroups of individuals based on their demographics. RESULTS: The results suggested that, in contrast to past studies, a modified 2-factor model, using five items for Factor 1 and 7 items for Factor 2, was the best fitting model (CFI = .95, RMSEA = .09, CI = 90%). Additionally, the QSU 12-item Persian version showed good convergent and divergent validity, internal consistency (Factor 1 = .94, Factor 2 = .97), ICC (average measure ICC = .95, CI = 95%, F(391, 4301) = 20.54, p < .001), concurrent validity (r = .71, p < .01), and discriminant validity (r = -.04, p > .05). Finally, subgroups based on gender, marital status, (un)employment, and educational level did not differed in their responses to the QSU 12-item. CONCLUSION: The Persian version of the QSU 12-item has satisfactory psychometric properties and, with a slight modification, it can be considered as a reliable and valid method to estimate smoking urges in the Iranian population. Moreover, the QSU 12-item seems appropriate to measure urge for smoking among groups of individuals with different sociodemographic backgrounds. Importantly, the QSU 12-item differentiates individuals' desire and intention to smoke from their anticipated relief of negative affect or withdrawal symptoms, which can be important for personalizing interventions targeting individuals who want to quit smoking.

Psychometric properties of the Swedish version of the satisfaction with life scale in a sample of individuals with mental illness.

BACKGROUND: Health assessment among individuals with mental health problems often involves measures of ill-being (e.g., anxiety, depression). Health is, however, defined as a state of physical, mental and social well-being and not merely the absence of disease (WHO, 1948, 2001). Hence, in order to address mental illness during the 21st century, we need to develop methods for the prevention, identification and treatment of mental illness; but also, for the promotion, identification, and maintenance of well-being. In this context, over three decades of subjective well-being research have resulted in the development of measures of positive aspects of human life, such as the Satisfaction with Life Scale (Diener et al., 1985). Our aim was to investigate the psychometric properties of the Satisfaction with Life Scale in a Swedish population of individuals with mental illness using both Classical Test Theory (CTT) and Item Response Theory (IRT). METHOD: A total of 264 participants (age mean = 43.46, SD = 13.31) diagnosed with different types of mental illness answered to the Swedish version of the Satisfaction with Life Scale (five items, 7-point scale: 1 = strongly disagree, 7 = strongly agree). RESULTS: We found positive and significant relationships between the five items of the scale (r ranging from 0.37 to 0.75), good reliability (Cronbach's alpha = 0.86), and that the one-factor solution had best goodness of fit (loadings between 0.52-0.88, p < 0.001). Additionally, there were no significant differences in comparative fit indexes regarding gender and occupation status. All items had high discrimination values (between 1.95-3.81), but item 5 ("If I could live my life over, I would change almost nothing"); which had a moderate discrimination value (1.17) and the highest estimated difficulty on response 7 (3.06). Moreover, item 2 ("The conditions of my life are excellent") had less discrimination and redundant difficulty with both item 1 ("In most ways my life is close to my ideal"; 2.03) on response 7 and with item 3 ("I am satisfied with my life"; -1.21) on response 1. The five items together provided good information, with especial good reliability and small standard error within -1.00 up to about 2.00 and the highest amount of test information at 0.00 of the level of life satisfaction within this population. CONCLUSIONS: Consistent with previous research, the scale had good reliability and provided good information across most of the latent trait range. In addition, within this population, sociodemographic factors such as gender and occupation status do not influence how individuals respond to the items in the scale. However, the items couldn't measure extreme levels of low/high life satisfaction. We suggest replication of these findings, the test of additional items, and the modification of items 2 and 5 in order to use the scale among individuals with mental illness.

Occupation and life satisfaction among individuals with mental illness: the mediation role of self-reported psychophysiological health.

BACKGROUND: Unemployment can diminish physical, psychological and social health. In this context, research shows that people with mental illness have even more difficulties finding occupation. Thus, some countries, such as Sweden, strive after creating job opportunities for this specific group. We investigated the effect of having an occupation on life satisfaction among individuals with mental illness and whether self-reported physical and psychological health mediated the relationship between being (un)employed and life satisfaction. METHOD: Two-hundred eighty-seven individuals (148 males, 134 females, and 5 missing information) with mental illness, who received support and services from Swedish Municipalities in Blekinge, self-reported occupation, life satisfaction, and physical and psychological health. RESULTS: Participants who reported having an occupation reported also significantly higher levels of life satisfaction, physical health, and psychological health compared to those without occupation. Nevertheless, these differences were rather small (Eta2 < 0.06). Moreover, the indirect effect of having an occupation on life satisfaction through physical and psychological health was significant. Finally, the total indirect effect of physical and psychological health (i.e., psychophysiological health) accounted for 53% of the total effect of having an occupation on life satisfaction. CONCLUSION: For individuals with mental illness there seems to be an almost equal importance of indirect and direct effects of having an occupation on their levels of life satisfaction. More specifically, while there are differences in life satisfaction within this population in relation to having an occupation, having an occupation leads to the sense of good psychophysiological health, which in turn helps individuals with mental illness to feel satisfied with their lives.

Development and primary validation of the School Health Assessment Tool for Primary Schools (SHAT-PS).

BACKGROUND: School health programs need to target all aspects of physical, psychological, and social well-being. Using a slightly modified version of the COSMIN Risk of Bias checklist, we developed and conducted the first validation of the School Health Assessment Tool for Primary Schools (SHAT-PS). METHOD: The exploratory sequential mixed method was used in this study. In the first phase, scientific databases were systematically searched to find school health models and instruments and 65 interviews were conducted with school stakeholders. The Colaizzi's method was used to code the qualitative data into themes. Then, a pool of items was created for each theme, rechecked by psychometric experts and then validated for content (i.e., relevance, clarity, and comprehensiveness) by psychometric experts and individuals of the target population (i.e., school personnel). In the second phase, classical test theory was utilized to analyze the validity and reliability of the resulting items from phase 1 among 400 individuals working at primary schools. RESULTS: The coding of the interviews resulted in ten themes that we labeled based on the theoretical literature: school health policies, community connections, health education, physical activity, health services, nutrition, psychological services, physical environment, equipment and facilities, and school staff's health. The items created for each theme ended up in an initial pool of 76 items. In the final stage of phase 1, 69 items remained after the content validity assessment by experts and school personnel. In phase 2, the SHAT-PS items were tested using maximum likelihood exploratory factor analysis and confirmatory factor analysis. Of the 69 items from phase 1, 22 items were removed due to low factor loadings. The results showed that the 8-factor model was the best solution (chi-square/df = 2.41, CFI = .98, TLI = .97, RMSEA = .06). The discriminant and convergent validity of the SHAT-PS were evaluated as satisfactory and the scale had high internal consistency (Cronbach's alpha for all subscales > .93). The test-retest reliability was satisfactory-the intraclass correlation coefficient pooled was .95 (99% CI [.91-.98]). Moreover, the standard error of measurement resulted in an SEM pooled equal to 4.4. No discrepancy was found between subgroups of gender and subgroups of staffs' positions at schools. CONCLUSION: The SHAT-PS is a valid and reliable tool that may facilitate school staff, stakeholders and researchers to evaluate the presence of the factors that promote health at primary schools. Nevertheless, in the process of validation, many of the items related to staff's health were eliminated due to poor factor loadings. Obviously, staff health is an important factor in the measurement of school health. Hence, we recommend that the validity and reliability of the SHAT-PS in other cultures should be done using the original 76-item version.

School health assessment tools: a systematic review of measurement in primary schools.

BACKGROUND: This systematic review aimed to investigate the psychometric properties of the school health's assessment tools in primary schools through COSMIN Risk of Bias checklist. We examined the studies that have addressed the measurement properties of school-health instruments to give a clear overview of the quality of all available tools measuring school health in primary schools. This systematic review was registered in PROPERO with the Registration ID: CRD42020158158. METHOD: Databases of EBSCOhost, PubMed, ProQuest, Wily, PROSPERO, and OpenGrey were systematically searched without any time limitation to find all full-text English journal articles studied at least one of the COSMIN checklist measurement properties of a school-health assessment tool in primary schools. The instruments should be constructed based on a school health model. The eligible studies were assessed by COSMIN Risk of Bias checklist to report their quality of methodology for each measurement property and for the whole study by rating high, moderate or low quality. RESULTS: At the final screening just seven studies remained for review. Four studies were tool development, three of them were rated as "adequate" and the other study as "very good"; five studies examined the content validity, three of them were appraised as "very good", and the two remaining as "inadequate". All seven studies measured structural validity, three of them were evaluated as "very good", three other were scored as "adequate", and the last study as "inadequate". All the seven studies investigated the internal consistency, five of them were assessed as "very good", one was rated as "doubtful", and the last one as "inadequate". Just one study examined the cross-cultural validity and was rated as "adequate". Finally, all seven studies measured reliability, two of them were rated as "very good" and the rest five studies were appraised as "doubtful". All rating was based on COSMIN checklist criteria for quality of measurement properties assessment. CONCLUSION: The number of studies addressing school health assessment tools was very low and therefore not sufficient. Hence, there is a serious need to investigate the psychometric properties of the available instruments measuring school health at primary schools. Moreover, the studies included in the present systematic review did not fulfill all the criteria of the COSMIN checklist for assessing measurement properties. We suggest that future studies consider these criteria for measuring psychometric properties and developing school health assessment tools.

Inpatients with major depressive disorder: Psychometric properties of the new Multidimensional Depression Scale.

The New Multi-dimensional Depression Scale (NMDS) is one of the most comprehensive scales that measures depression symptoms in four domains, including emotional, cognitive, somatic, and interpersonal. This study aimed to evaluate the factor structure and psychometric properties of the NMDS in a group of Iranian inpatients with Major Depressive Disorder (MDD). At first, the scale was translated into Persian and used as part of a battery consisting of the Beck Depression Inventory-II (BDI-II), Oxford Happiness Inventory (OHI), Beck Anxiety Inventory (BAI), and Short Form Health Survey (SF-36). The battery was administered to 271 inpatients with MDD (90 men and 181 women) aged from 18 to 60 who had been referred to psychiatric hospitals in Tehran, Iran. Confirmatory factor analysis of the Persian version of the NMDS upheld its original four-factor structure. Moreover, the results showed its good internal consistency (Cronbach's alpha coefficient ranging from 0.70 for the emotional subscale to 0.83 for the interpersonal subscale). In addition, the NMDS scores were correlated with other constructs in empirically and theoretically expected ways, which provides evidence for the convergent (positive significant relationships with anxiety and cognitive and somatic-affective symptoms of depression) and divergent (negative significant relationships with happiness and mental health and physical health) validity of the scale. These findings supported the Persian version of the NMDS as a reliable and valid measure for the assessment of depression symptoms in patients with MDD.