Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients.

The Depression Anxiety Stress Scale (DASS) was designed to efficiently measure the core symptoms of anxiety and depression and has demonstrated positive psychometric properties in adult samples of anxiety and depression patients and student samples. Despite these findings, the psychometric properties of the DASS remain untested in older adults, for whom the identification of efficient measures of these constructs is especially important. To determine the psychometric properties of the DASS 21-item version in older adults, we analyzed data from 222 medical patients seeking treatment to manage worry. Consistent with younger samples, a three-factor structure best fit the data. Results also indicated good internal consistency, excellent convergent validity, and good discriminative validity, especially for the Depression scale. Receiver operating curve analyses indicated that the DASS-21 predicted the diagnostic presence of generalized anxiety disorder and depression as well as other commonly used measures. These data suggest that the DASS may be used with older adults in lieu of multiple scales designed to measure similar constructs, thereby reducing participant burden and facilitating assessment in settings with limited assessment resources.

Cognitive errors, symptom severity, and response to cognitive behavior therapy in older adults with generalized anxiety disorder.

OBJECTIVE: Recent research by Wetherell et al. investigating the differential response to group-administered cognitive behavior therapy (CBT) for generalized anxiety disorder (GAD) in older adults found that GAD severity, homework adherence, and psychiatric comorbidity predicted statistically significant improvement. The current study investigated whether the presence/absence of cognitive errors on separate domains of the Mini-Mental State Exam (MMSE) predicted baseline differences in symptom severity and improvement following CBT, above and beyond already established predictors. METHODS: Baseline characteristics were investigated in a sample of 208 older patients diagnosed with GAD. Predictors of treatment response were examined in a subsample of 65 patients who completed CBT and were included in a prior study by Wetherell et al. of response predictors. RESULTS: Results from the baseline sample indicated that only subjects who committed an error on the MMSE Working Memory domain exhibited increased severity in anxiety and depressive symptoms. Results from the treatment sample indicated that an error on the MMSE Orientation domain was a significant predictor of outcome at 6-month follow-up, while controlling for previously established predictors. Patients who committed at least one error in this domain showed decreased response relative to patients who committed no errors. CONCLUSION: In this sample of older adults diagnosed with GAD, poor performance on the MMSE Working Memory domain was associated with increased baseline anxiety and depression, while baseline performance differences on the MMSE Orientation domain predicted outcome six months after CBT intervention.

Utility of telephone assessments in an older adult population.

Telephone assessments are commonly used in mental health research and may be especially beneficial in older populations. The current study assessed the psychometric properties of the Penn State Worry Questionnaire (T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990) and the Beck Depression Inventory--II (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), when administered over the telephone in an older adult population. Results indicate no differences in mean symptom level or internal consistency across two modes of administration. Correlations between the in-person and telephone-administered measures and diagnostic categories suggest adequate validity of the telephone-administered measures. With this demonstrated evidence, the telephone assessment method can be applied in a variety of research and clinical settings.

Applying the transtheoretical model to female and male perpetrators of intimate partner violence: gender differences in stages and processes of change.

The Transtheoretical Model has been recently applied to men seeking services at battering intervention and prevention programs (Eckhardt, Babcock, & Homack, 2004; Murphy & Baxter, 1997). This study considers whether women arrested for intimate partner violence differ from male perpetrators in terms of stages of change and processes of change. No gender differences were found regarding stage of change. In general, all individuals presenting for treatment were in the early stages of change. The use of various processes of change was strongly related to stage of change, with individuals in the more advanced stages of change using more behavioral and experiential strategies to become nonviolent. However, except for the use of social liberation strategies, there were no gender differences in the use of the various processes. These findings suggest that the Transtheoretical Model may apply to female perpetrators equally as well as to male perpetrators. Intervention programs designed for male batterers using the Transtheoretical Model may also be helpful in the treatment of women arrested for domestic violence.