ABSTRACT
In this study, we assessed the psychometric properties of the Spanish Patient-Reported Outcomes Measurement Information System (PROMIS) Depression in an adult population-representative sample from Spain (n = 1,503). We tested unidimensionality and local independence item response theory (IRT) assumptions with confirmatory factor and bifactor models under the exploratory structural equations modeling framework. We evaluated item monotonicity assumption with Mokken scaling analysis. We calibrated the items with an IRT-graded response model and assessed score reliability and test information, and evidence of validity with regard to scores on external measures. To examine differential item functioning by age, sex, education, and country (United States vs. Spain, N = 2,271), we used ordinal logistic regression. Results support compliance with IRT assumptions. We found few signs of differential item functioning: Only one item showed country differential functioning between the United States (n = 768) and Spain, with minimal impact on the overall score. Information values were equivalent to reliabilities over 0.90 from -1 (low depression) to +4 SD (high depression) around the population score mean. Evidence of validity in relation to concurrent measures was supported by the expected correlation pattern with external variables of depression, but higher than expected correlations with anxiety were found. Results indicate that the Spanish version of PROMIS Depression is adequate for assessing and monitoring depression levels in the general population and that PROMIS Depression is especially suitable for cross-national comparisons. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Subject(s)
Cross-Cultural Comparison , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Patient Reported Outcome Measures , Adolescent , Adult , Age Distribution , Aged , Cross-Sectional Studies , Female , Humans , Logistic Models , Male , Middle Aged , Psychometrics , Reproducibility of Results , Sex Distribution , Spain/epidemiology , United States/epidemiology , Young AdultABSTRACT
BACKGROUND: Concurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce. METHODS: The study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months. RESULTS: The baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables - the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits - improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups. CONCLUSION: Specialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.
ABSTRACT
Introducción. En los últimos 25 años varios estudios han mostrado la eficacia de diversas intervenciones psicológicas para los trastornos graves de la personalidad. Sin embargo, la generalización de estos resultados positivos desde entornos con larga tradición investigadora a condiciones de práctica habitual ha sido cuestionada, reclamándose la replicación en estudios pragmáticos. Métodos. Este estudio pragmático compara las hospitalizaciones y las visitas a Urgencias antes y durante un programa terapéutico de 6 meses para trastornos graves de la personalidad y 36 meses después del inicio. El programa terapéutico, que integra varias intervenciones específicas en un encuadre coherente, se realizó en un entorno de práctica habitual. Se incluyeron 51 pacientes evaluados de acuerdo con criterios DSM-IV por medio de la versión española de la Entrevista Clínica Estructurada para Trastornos de la Personalidad (SCID-II). Resultados. Las características clínicas evidenciaron un grupo de pacientes muy graves, de los que el 78,4% cumplía criterios de trastorno límite de la personalidad. El porcentaje de pacientes hospitalizados y que visitaron Urgencias, así como el número de días de hospitalización y de visitas a Urgencias, se redujo significativamente durante el tratamiento, y esta mejoría se mantuvo en el tiempo. Conclusiones. Un tratamiento integrado para trastornos graves de la personalidad puede ser efectivo para reducir las readmisiones o las estancias hospitalarias prolongadas cuando es implementado por clínicos en condiciones de práctica habitual (AU)
Introduction. Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies. Methods. This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included. Results. The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout. Conclusions. An integrated treatment for severe personality disorders could be effective in preventing reliance on readmissions, or prolonged hospital stays, when it is implemented by clinicians in ordinary clinical settings (AU)
Subject(s)
Humans , Male , Female , Adult , Personality Disorders/therapy , Borderline Personality Disorder/therapy , Psychotherapy , Health Programs and Plans , EffectivenessABSTRACT
INTRODUCTION: Over the past 25 years, several studies have shown the efficacy of a number of psychological interventions for severe personality disorders. However, the generalizability of these positive results from long traditional research settings to more ordinary ones has been questioned, requiring a need for replication in pragmatic studies. METHODS: This pragmatic study compares hospitalizations and Emergency Room visits before and during a 6-month therapeutic program for severe personality disorders, and at 36 months after starting it. The therapeutic program, which integrates several specific interventions within a coherent framework, was carried out in an ordinary clinical setting. Fifty-one patients, evaluated according DSM-IV criteria by using the Spanish version of the Structured Clinical Interview for Personality Disorders (SCID-II), were included. RESULTS: The clinical characteristics showed a group of severely disturbed patients, of which 78.4% met criteria for borderline personality disorder. The percentage of patients hospitalized and visiting the Emergency Room, as well as the number of days of hospitalization and Emergency Room visits was significantly reduced during the treatment, and this improvement was maintained throughout. CONCLUSIONS: An integrated treatment for severe personality disorders could be effective in preventing reliance on readmissions, or prolonged hospital stays, when it is implemented by clinicians in ordinary clinical settings.
