Trajectories of mental health in children and adolescents during the COVID-19 pandemic: findings from the longitudinal COPSY study.

BACKGROUND: Mental health and health-related quality of life (HRQoL) in children and adolescents deteriorated during the COVID-19 pandemic. The aim of this population-based longitudinal study was to explore whether distinct mental health trajectories in youths can be identified over the course of the pandemic. METHODS: Mental health problems (MHP), psychosomatic symptoms and HRQoL were assessed at five time points between May 2020 and October 2022 in 744 children and adolescents aged 7 to 20 years using established instruments. We used generalized mixture modeling to identify distinct mental health trajectories and fixed-effects regressions to analyse covariates of the identified profiles of change. RESULTS: We found five distinct linear latent trajectory classes each for externalising MHP and psychosomatic symptoms and four trajectory classes for internalising MHP. For HRQoL, a single-class solution that indicates a common development process proved to be optimal. The largest groups remained almost stable at a low internalising and externalising symptom level (64 to 74%) and consistently showed moderate psychosomatic symptoms (79%), while 2 to 18% showed improvements across the pandemic. About 10% of the youths had consistently high internalising problems, while externalising problems deteriorated in 18% of youths. Class membership was significantly associated with initial HRQoL, parental and child burden, personal resources, family climate and social support. CONCLUSIONS: The mental health of most children and adolescents remained resilient throughout the pandemic. However, a sizeable number of youths had consistently poor or deteriorating mental health. Those children and adolescents need special attention in schools and mental health care.

Interpersonal neural synchrony and mental disorders: unlocking potential pathways for clinical interventions.

Introduction: Interpersonal synchronization involves the alignment of behavioral, affective, physiological, and brain states during social interactions. It facilitates empathy, emotion regulation, and prosocial commitment. Mental disorders characterized by social interaction dysfunction, such as Autism Spectrum Disorder (ASD), Reactive Attachment Disorder (RAD), and Social Anxiety Disorder (SAD), often exhibit atypical synchronization with others across multiple levels. With the introduction of the "second-person" neuroscience perspective, our understanding of interpersonal neural synchronization (INS) has improved, however, so far, it has hardly impacted the development of novel therapeutic interventions. Methods: To evaluate the potential of INS-based treatments for mental disorders, we performed two systematic literature searches identifying studies that directly target INS through neurofeedback (12 publications; 9 independent studies) or brain stimulation techniques (7 studies), following PRISMA guidelines. In addition, we narratively review indirect INS manipulations through behavioral, biofeedback, or hormonal interventions. We discuss the potential of such treatments for ASD, RAD, and SAD and using a systematic database search assess the acceptability of neurofeedback (4 studies) and neurostimulation (4 studies) in patients with social dysfunction. Results: Although behavioral approaches, such as engaging in eye contact or cooperative actions, have been shown to be associated with increased INS, little is known about potential long-term consequences of such interventions. Few proof-of-concept studies have utilized brain stimulation techniques, like transcranial direct current stimulation or INS-based neurofeedback, showing feasibility and preliminary evidence that such interventions can boost behavioral synchrony and social connectedness. Yet, optimal brain stimulation protocols and neurofeedback parameters are still undefined. For ASD, RAD, or SAD, so far no randomized controlled trial has proven the efficacy of direct INS-based intervention techniques, although in general brain stimulation and neurofeedback methods seem to be well accepted in these patient groups. Discussion: Significant work remains to translate INS-based manipulations into effective treatments for social interaction disorders. Future research should focus on mechanistic insights into INS, technological advancements, and rigorous design standards. Furthermore, it will be key to compare interventions directly targeting INS to those targeting other modalities of synchrony as well as to define optimal target dyads and target synchrony states in clinical interventions.

Using photographs for rating severity degrees of clinical appearance in research mice enables valid discrimination of extreme but not mild and moderate conditions: A pilot study.

To ensure good animal welfare in laboratory research and in stockbreeding severity ratings of the animals´ wellbeing are essential. The current study investigated how valid raters can evaluate different severity degrees of clinical appearance and how ratings might be influenced by factors other than the severity itself. Ninety-seven people rated the severity degree (none, mild, moderate, or severe) of the clinical appearance of mice seen in eight different images. The images also differed in the perspective in which they had been taken (entire mouse or head only). The raters differed with regard to their experience of working with laboratory animals and were subsequently divided into three groups-beginners, advanced, professionals. Generalisability theory was applied to examine the contribution of the different rater (raters themselves and experience) and image facets (actual degree of severity and perspective) to the overall data variability. The images showing the extreme severity degrees were rated more homogenously and more precisely than were the images showing the intermediate degrees, as compared to the reference scores. The largest source of variance was the actual degree of severity, accounting for 56.6% of the total variance. Considering only the images showing the extreme severity degrees, this percentage rose to 91.6%, accounting almost exclusively for the found variance. In considering only the intermediate severity degrees, the actual degree of severity did not contribute to variance at all. The remaining variance was due to the raters and the interactions between raters, the actual degree of severity and the perspective. The experience of the raters did not account for any variance. Training in the assessment of severity degrees seems necessary to enhance detection of the intermediate degrees of severity, especially when images are used. In addition, good training material should be developed and evaluated to optimise teaching and to minimise wrong assessments.

Gender and Age Differences in ADHD Symptoms and Co-occurring Depression and Anxiety Symptoms Among Children and Adolescents in the BELLA Study.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed neurodevelopmental disorders of childhood. Current studies addressing gender and age differences in ADHD are lacking. The present study aims to fill this research gap by dimensionally evaluating gender and age differences in ADHD symptoms, as measured by a DSM-5-based parent rating scale, in children and adolescents who participated in the two-year follow-up of the community-based BELLA study (n = 1326). Associations between ADHD symptoms and depression symptoms and anxiety symptoms were also examined. Multiple linear regressions revealed significant associations between gender and all ADHD symptoms. Age was significantly associated with hyperactive/impulsive symptoms. Additional multiple linear regressions demonstrated significant positive associations between depression and anxiety symptoms and ADHD symptoms. Further, female gender was found to be positively associated with both depression and anxiety symptoms. These findings may suggest a need for more gender-specific approaches to ADHD diagnosis and treatment, as well as more research into the intersections of ADHD and depression and anxiety symptoms in children and adolescents.

The Development and Validation of the First German Open Scale of Social Information Processing.

INTRODUCTION: This study introduces the first German Open Scale of Social Information Processing (GOSSIP) and evaluates its psychometric properties. Even though social information processing (SIP) and its important role in developmental psychopathology is a rising field of interest, model-based standardized assessment tools are still scarce. METHODS: GOSSIP was developed to assess SI processes in boys and girls aged eight to 21 years. First, 61 vignettes (combinations of pictures and short written descriptions of the situation depicted) were evaluated by an expert group and piloted with 48 healthy participants (aged 8-21). The best-rated vignettes were then implemented in a Web-based application. 191 participants completed GOSSIP. Of those, 76 answered additional questionnaires to assess their social skills and psychopathology. Internal consistencies for the emotional and cognitive GOSSIP scales were determined. Latent profile analysis (LPA) was used to identify subgroups of children and adolescents characterized by specific SIP profiles (i.e., patterns of emotional, cognitive, and behavioral responses to the GOSSIP). Furthermore, the external validity of the participants' attribution tendencies in GOSSIP was evaluated in real life by smartphone-based Ecological Momentary Assessments (EMA). RESULTS: The internal consistencies for the emotional and cognitive scales (angry, ashamed, physical aggression, pro-social response, revenge, and outcome expectancy) were good to excellent. The scales of hostile interpretation, relation aggression, sadness, and exclusion showed borderline/acceptable internal consistency. Correlation analysis confirmed convergent validity with self-reported social skills and external validity with ratings of aggressive and pro-social behaviors. The LPA revealed three profiles as the best fit of the data. The first group is named "aggressors," the second "social-emotional group," and a third named "ashamed-internalizing group." However, no significant association was found between the attribution tendencies derived from GOSSIP and EMA data. DISCUSSION/CONCLUSION: GOSSIP is the first model-based German Web-based assessment for several SIP mechanisms that showed overall adequate psychometric properties. GOSSIP can be used to classify individuals into SIP profiles that differ in terms of their cognitive and emotional response tendencies and therefore could contribute to the development of targeted interventions. Integrating assessments of emotional responses into GOSSIP revealed an important role of "shame" in SIP and the development of psychopathology. Furthermore, the lack of external validity between GOSSIP and EMA calls into question how attribution tendencies are best assessed in future studies.

Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies.

Background: The COVID-19 pandemic has significantly impacted the mental health of children and families, i.e., due to measures like social distancing and remote schooling. While previous research has shown negative effects on mental health and health-related quality of life (HRQoL), most studies have focused on pre-post comparisons in the early pandemic stages. This systematic review aims to examine longitudinal studies to understand the long-term impacts of the pandemic on children and adolescents. Methods: This systematic review adhered to the PRISMA guidelines and was preregistered in the international prospective register of systematic reviews (Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies published up to August 30, 2022. Based on pre-defined eligibility criteria, longitudinal and prospective studies that assessed the mental health or quality of life of children or adolescents (0-19 years) in the general population over a longer time span (at two or more measurement points) during the COVID-19 pandemic were included in the review. The methodological quality of the included studies was assessed using an adapted version of the Effective Public Health Practice Project (EPHPP) checklist. Narrative data synthesis was used to summarize the findings. Results: A total of 5,099 results were obtained from literature searches, with 4,935 excluded during title/abstract screening. After reviewing 163 full-text articles, 24 publications were included in the review. Sample sizes ranged between n = 86 and n = 34,038. The length of the investigated time periods and the number of assessment points, as well as outcomes, varied. The majority of studies were of moderate methodological quality. Mental health outcomes were more frequently studied compared to measures of HRQoL. The findings from these studies mostly suggest that children and adolescents experienced heightened mental health problems, specifically internalizing symptoms like anxiety and depression. Further, there was a decline in their overall HRQoL over the course of the COVID-19 pandemic that did not necessarily subside when lockdowns ended. Conclusion: It is crucial to continue monitoring the mental health and well-being of children and adolescents following the pandemic to identify groups at risks and plan interventions. This should ideally be conducted by large systematic studies, using validated instruments, and encompassing representative samples to obtain reliable and comprehensive insights with the aim of improving youth mental health care.

Psychometric evaluation of the Positive Mental Health (PMH) scale using item response theory.

BACKGROUND: The investigation of patient-reported outcomes and psycho-oncological interventions mainly focuses on psychological distress or psychopathology. However, the recognition of the equal importance of positive mental health (PMH) has increased lately. The PMH-scale is a brief questionnaire allowing to assess well-being in individuals in the general population and in patients. Previous studies evaluated the psychometric properties of the PMH-scale using classical test theory (CTT). This study is the first to investigate the PMH-scale in patients with cancer using item analysis according to the Rasch model. METHODS: In total, N = 357 cancer patients participated in the study. A Rasch analysis of the PMH-scale was conducted including testing of unidimensionality, local independence, homogeneity and differential item functioning (DIF) with regard to age, gender, type of cancer, the presence of metastases, psycho-oncological support, and duration of disease. Additionally, the ordering of the item thresholds as well as the targeting of the scale were investigated. RESULTS: After excluding one misfitting item and accounting for local dependence by forming superitems, a satisfactory overall fit to the Rasch model was established (χ2 = 30.34, p = 0.21). The new PMH-8 scale proved to be unidimensional, and homogeneity of the scale could be inferred. All items showed ordered thresholds, there was no further item misfit. DIF was found for age, but as the impact of DIF was not substantial, no adjustment related to the age-DIF had to be made. The Person Separation Index (PSI = 0.89) was excellent, indicating excellent discriminatory power between different levels of positive mental health. Overall, the targeting of the PMH-8 was good for the majority of the present sample. However, at both ends of the scale item thresholds are missing as indicated by a slight floor effect (1.4%) and a considerable ceiling effect (9.8%). CONCLUSIONS: Overall, the results of the analysis according to the Rasch model support the use of the revised PMH-scale in a psycho-oncological context.

Development of the German social attitude barriers and facilitators to participation-scales: an analysis according to the Rasch model.

BACKGROUND: Social attitudes experienced by people with disabilities can strongly impact upon their health and quality of life. The extent to which social attitude measurement transcends specific cultures is unknown. Thus, the aim of the study was to develop German item banks to assess social attitude barriers and facilitators to participation and compare the construct definition with that developed in the United States. METHODS: The American version of the two item banks assessing social attitudes that act as barriers and facilitators in persons with disabilities was translated into German and culturally adapted. The sample consisted of 410 in- and outpatients treated for spinal diseases at a German University Hospital. The psychometric properties of the resulting 53 items-item pool were evaluated using Rasch analysis. A special focus was placed on the investigation of unidimensionality, local independence, differential item functioning (DIF) and targeting. To evaluate convergent and divergent validity correlations with perceived social support, depression and pain interference were calculated. RESULTS: Unlike the American version, both the barriers and facilitators item banks had to be divided into two subscales assessing attitudes that individuals with disabilities experience as being directed towards them (individual perception) or attitudes that respondents experience as being directed towards people with disabilities as a social group (societal perception). Four unidimensional scales were constructed. Fit to the Rasch model required item deletion and forming testlets to account for extensive local dependence. There was no evidence of DIF with regard to gender or age. Targeting of the subscales was moderate to good. CONCLUSIONS: Results support a distinction between social attitudes at the individual and societal level, allowing a more specific assessment than is possible when this distinction is ignored.

Psychometric evaluation of the Patient Assessment of Chronic Illness Care instrument using Item analysis according to the Rasch model.

RATIONALE, AIMS AND OBJECTIVES: The Patient Assessment of Chronic Illness Care (PACIC) instrument assesses patient care in alignment with the chronic care model. The aim of the study was to comprehensively validate the PACIC using the Rasch model. A special focus was placed on the investigation of local dependence (LD), differential item functioning (DIF) and targeting. METHOD: This secondary analysis utilized data of 760 patients with a diagnosis of diabetes who had participated in the Swiss CoDiab-VD cohort study. The psychometric properties of the French PACIC-version were evaluated using the Rasch model. DIF was investigated in relation to age, gender, education, year of recruitment into the CoDiab-VD cohort study, type of diabetes and whether patients got an injectable antidiabetic drug or not. RESULTS: The initial analysis of the PACIC revealed poor fit to the Rasch model (χ2 -p < 0.001) with response dependency being the most prominent problem. After combining the items into two testlets (testlet 1: Items 1-11; testlet 2: Items 12-20), good overall model fit was found (χ2 -p = 0.77) as well as good reliability (Person Separation Index = 0.85) and targeting. DIF with regard to whether patients got an injectable antidiabetic drug or not was found for testlet 2. However, the size of this DIF was regarded as not being substantial. CONCLUSION: The PACIC is a well-targeted, reliable unidimensional instrument to assess patient care in alignment with the chronic care model in patients with diabetes. It is free of substantial DIF. The PACIC-20 sum score can hence be used in clinical practice for individual diagnostic. For evaluation purposes like assessment of change or group evaluations, the usage of the interval-scale level person parameters is recommended as it permits using parametric statistical analyses and provides a more accurate picture about the actual amount of change.

An Evaluation of Forced Distance Learning and Teaching Under Pandemic Conditions Using the Technology Acceptance Model.

Research: Due to the sudden outbreak of COVID-19 and the resulting pandemic situation, universities were forced to rapidly change their traditional pedagogical and didactical approach by shifting from mostly face-to-face teaching to entirely virtual and online teaching methods. Through this, a "forced" distance learning and teaching situation emerged. This study aimed at investigating the effect of these innovations on the implementation, acceptance, and use of the virtual teaching offer within the framework of the technology acceptance model (TAM). Methods: A total of 218 students and 69 lecturers of a German Medical Faculty completed online questionnaires on the acceptance, satisfaction, and usefulness of the forced distance learning (FDL) and teaching (FDT), respectively. An extended version of the TAM was used to assess the acceptance of the students and lecturers of FDL and FDT. In order to estimate the multivariate dependencies, path analysis was employed using structural equation modeling (SEM). Results: In general, students and lecturers reported being satisfied with the implementation of the FDL and FDT. Regarding the TAM model, the fit indices suggested an acceptable model fit for both groups. The model of the students revealed that the perceived usefulness had a strong predictive power on the attitude toward using and the perceived ease of use also predicted the attitude. The existing technical infrastructure as well as the general media affinity and pandemic-related worries proved to be positively associated with the perceived usefulness while data security worries and organization of online teaching predicted the perceived ease of use in students. The strong positive predictive power of the perceived usefulness for the attitude toward using was also evident in the model for the lecturers and the technical infrastructure predicted the perceived ease of use in the lecturers. Conclusion: The TAM is a suitable framework to represent the implementation, acceptance, and use of the virtual teaching offer during the special pandemic situation at the university. However, personal and structural context factors were important predictors for the perceived usefulness and the perceived ease of use in the student group. The forced situation for learning and teaching makes it more difficult to predict the actual use of virtual teaching offers solely based on attitude.

Improving the measurement of oral health-related quality of life: Rasch model of the oral health impact profile-14.

OBJECTIVES: The 14-item Oral Health Impact Profile (OHIP-14) is the most frequently used instrument to measure oral health-related quality-of-life (OHRQoL) in adults. Despite its popularity, its psychometric properties have been predominantly investigated based on the classical test theory while the fundamental principles of measurement have not been fully assessed. Therefore, our aim was to investigate to what extent the OHIP-14 meets the fundamental requirments of measurements. METHODS: We used the Rasch model to explore person-item-targeting, unidimensionality, local independence of items, invariance (differential-item-functioning, DIF), and the order of thresholds between response-options in the German version OHIP-14. We used data from osteoarthritis patients because hand disabilities and joint pain might influence oral hygiene. Furthermore, osteoarthritis in the temporomandibular-joint directly affects oral functioning. RESULTS: Five-hundred sixteen patients were included (mean age 66.5 years [±10.2; ranging from 34 to 89]; 71.3% [368] females). The OHIP-14 median total score was 0 (interquartile-range from 0 to 4), indicating a right-skewed distribution because many patients reported good OHRQoL. The instrument was found unidimensional. However, there was strong evidence of local dependency, disordered thresholds between response-options, and age-related DIF for item 5. A revised scoring scheme with three instead of five answer-options in all items and eliminating two items resolving local dependency, the newly adapted OHIP-12, showed better reliability and item-fit to the Rasch model than the original OHIP-14. CONCLUSIONS: This study assesses, for the first time, the OHIP-14 in terms of fundamental principles of measurement and proposes an item-reduced OHIP-12 as a psychometrically more accurate version of the instrument. CLINICAL SIGNIFICANCE: The Rasch model is essential to ensure instruments' precision and clinical meaningfulness when measuring OHRQoL in clinical practice and research. The OHIP-12, derived from the OHIP-14 by deleting two items due to local dependency, with a revised scoring scheme for all items distinguishing three answer-options instead of five, represents a psychometrically improved version of the instrument.

An item analysis according to the Rasch model of the German 12-item WHO Disability Assessment Schedule (WHODAS 2.0).

PURPOSE: The World Health Organization Disability Assessent Schedule 2.0 (WHODAS 2.0) assesses disability in individuals irrespective of their health condition. Previous studies validated the usefulness of the WHODAS 2.0 using classical test theory. This study is the first investigating the psychometric properties of the 12-items WHODAS 2.0 in patients with cancer using item analysis according to the Rasch model. METHODS: In total, 350 cancer patients participated in the study. Rasch analysis of the 12-items version of the WHODAS 2.0 was conducted and included testing unidimensionality, local independence, and testing for differential item functioning (DIF) with regard to age, gender, type of cancer, presence of metastases, psycho-oncological support, and duration of disease. RESULTS: After accounting for local dependence, which was mainly found across items of the same WHODAS domain, satisfactory overall fit to the Rasch model was established (χ2 = 36.14, p = 0.07) with good reliability (PSI = 0.82) and unidimensionality of the scale. DIF was found for gender (testlet 'Life activities') and age (testlet 'Getting around/Self-care'), but the size of DIF was not substantial. CONCLUSION: Overall, the analysis results according to the Rasch model support the use of the WHODAS 2.0 12-item version as a measure of disability in cancer patients.

Psychometric evaluation of the Interpersonal Needs Questionnaire (INQ) using item analysis according to the Rasch model.

The Interpersonal Needs Questionnaire (INQ) assesses Thwarted Belongingness (TB) and Perceived Burdensomeness (PB), two predictors of suicidal thoughts. Up to now, the use of item response theory (IRT) for the evaluation of the INQ has been restricted to a single study with clinically depressed and suicidal youth. Therefore, the psychometric properties of the two INQ-15-subscales TB and PB were now evaluated in a general population sample (N = 2508) and a clinical adult population sample (N = 185) using IRT, specifically the Rasch model (RM) and the graphical log-linear Rasch model (GLLRM). Of special interest was whether the INQ-subscales displayed differential item functioning (DIF) across the two different samples and how well the subscales were targeted to the two sample populations. For the clinical sample, fit to a GLLRM could be established for the PB-subscale and fit to a RM was established for a five-item version of the TB-subscale. In contrast, for the general population sample fit to a GLLRM could only be achieved for the PB-subscale. Overall, there was strong evidence of local dependence (LD) across items and of some age- and gender-related DIF. Both subscales exhibited massive DIF related to the sample, indicating that they don't work the same across the general population and clinical sample. As expected, targeting of both INQ-subscales was much better for the clinical population. Further investigations of the INQ-15 under the Rasch approach in a large clinical population are recommended to determine and optimize the scale performance.

Development of Rasch-based short screenings for the assessment of treatment motivation in patients with cardiovascular diseases.

Purpose: The aim of the study was to develop unidimensional test-fair and economic short screenings to assess treatment motivation in patients with cardiovascular diseases using the Rasch analysis.Materials and methods: After pretesting for relevance and comprehension, a pool of 132 items on treatment motivation was completed by a sample consisting of 1168 patients with cardiovascular diseases recruited in two German cardiological rehabilitation centers. Confirmatory factor analyses and the Rasch analyses were conducted.Results: The confirmatory factor analyses confirmed a three-factor structure of the treatment motivation construct with task self-efficacy, outcome expectancies and intention as factors. Using the Rasch analysis for each of the three factors and removing items with misfit, differential item functioning and local response dependency reduced the initial item pool to the three short screenings. The short screenings fit to the Rasch model with a root mean square error of approximation (RMSEA = 0.021 (task self-efficacy; seven items); RMSEA = 0.024 (outcome expectancies; 12 items), RMSEA = 0.027 (intention; nine items). Person-separation reliability was 0.81, 0.82, and 0.73. Unidimensionality could be verified.Conclusions: The calibrated, unidimensional short screenings provide a psychometrically sound option for an initial- and follow-up assessment of treatment motivation in rehabilitation patients with cardiovascular diseases. Further testing in other cardiovascular diseases populations is needed to increase generalizability.Implications for rehabilitationNew short screenings for the assessment of treatment motivation: task self-efficacy, outcome expectancies, intention in rehabilitation patients with cardiovascular diseases are available.Treatment motivation short screeningsself-efficacy/outcome expectancies/intention consist of seven items (treatment motivation short screeningself-efficacy), 12 items (treatment motivation short screeningoutcome expectancies), nine items (treatment motivation short screeningintention) and are therefore especially timesaving.The short screenings demonstrate good psychometric properties, cover a wide spectrum of task self-efficacy, outcome expectancies and intention, and are free of local dependencies and of differential item functioning regarding to gender, age and cardiovascular diagnoses.Using a Rasch based unidimensional short screening is a test-fair and economic method to assess patients' treatment motivation, which might help to improve rehabilitation health care tailored to patients' needs.

Elated or sad mood induction affects the attention of patients with a bipolar disorder less than that of patients with a depressive disorder.

Introduction: The role of acute mood states as mediating factors in cognitive impairment in patients with mania or depression is not sufficiently clear. Similarly, the extent to which cognitive impairment is trait or state-specific remains an open question. Therefore, the aim of this study was to investigate the effect of a mood-induction on attention in patients with an affective disorder.Methods: Twenty-two depressed bipolar patients, 10 manic bipolar patients, 17 with a depressive episode (MDE), and 24 healthy controls performed the Attention-Network-Test (ANT). In a within-participants design, elated and sad moods were induced by an autobiographic recall and measured on a self-report scale. Subsequently, participants performed the ANT again.Results: The modulating effect of the elated mood induction on attention was small. Only the MDE group displayed moderate improvements in selective attention and tonic alertness. Surprisingly, after the sad mood induction, patients with MDE improved moderately on phasic and tonic alertness. Phasic alertness was also enhanced in patients with mania. Finally, after the mood induction, patients with MDE showed the largest variability in attentional performance.Conclusions: Results showed only small effects of mood induction on attention. This supports the view that attention deficits reflect trait variables.

Calibration of an item bank in 474 orthopedic patients using Rasch analysis for computer-adaptive assessment of anxiety.

OBJECTIVE: To calibrate an item bank of anxiety-related questions for use in orthopedic patients within a computer-adaptive test. DESIGN: This is a psychometric study. SETTING: The sample of orthopedic patients was recruited in two orthopedic rehabilitation clinics in Germany. SUBJECTS: A total of 474 orthopedic rehabilitation patients were recruited for this study. INTERVENTIONS: Not applicable. MAIN MEASURES: The main measure is an adapted version of an existing anxiety item pool for cardiovascular rehabilitation patients. RESULTS: The results of the confirmatory factor analysis and Mokken analysis confirmed a one-factor structure and double monotonicity. An anxiety item bank (48 items) could be developed and calibrated using Rasch analysis. It fitted to the Rasch model with a non-significant item-trait interaction (χ2(203) = 172.59; P = .94) and was free of differential item functioning. Unidimensionality could be verified and the person separation reliability was .96. The category threshold parameters varied between 4.72 and 3.16 (7.88 logits). CONCLUSION: The unidimensional anxiety item bank provides the basis for a computer-adaptive test to assess a wide range of anxiety in rehabilitation patients with orthopedic diseases with very good psychometric characteristics.

Strategies of selective changing: Preparatory neural processes seem to be responsible for differences in complex inhibition.

Selective inhibition describes the stopping of an action while other actions are further executed. It can be differentiated between two strategies to stop selectively: the fast but global stop all, then discriminate strategy and the slower but more selective first discriminate, then stop strategy. It is assumed that the first discriminate, then stop strategy is especially used when information regarding which action might have to be stopped is already available beforehand. Moreover, it is supposed that both strategies differ in matters of basal ganglia pathways used for their execution. Aim of the present study was to investigate the use of the two strategies in situations requiring selective changing of an action. Eighteen healthy male participants performed a selective stop-change task with informative and uninformative cues during fMRI. Behavioral results show that informative cues led to a benefit in both inhibition times and selectivity. FMRI data revealed that the same cortico-subcortical pathway was used with informative and uninformative cues. Behavioral and neuronal results indicate that participants used the first discriminate, then stop strategy for selective inhibition irrespective of the amount of previously available information. Moreover, the neural activity data indicate that the benefit in the informed condition was produced by an efficient preparation for the concrete change process. Possible factors that might affect which strategy is used for selective stopping are the level of previously available information (foreknowledge) and the experimental set-up, as e.g. task complexity.

Stopping Speed in the Stop-Change Task: Experimental Design Matters!

Previous research comparing the speed of inhibiting a motor response in no-foreknowledge vs. foreknowledge conditions revealed inconsistent findings. While some studies found stopping to be faster in the no-foreknowledge condition, others reported that it was faster in the foreknowledge condition. One possible explanation for the heterogeneous results might be differences in experimental design between those studies. Given this, we wanted to scrutinize whether it makes any difference if foreknowledge and no-foreknowledge are investigated in a context in which both conditions are presented separated from each other (block design) vs. in a context in which both conditions occur intermingled (event-related design). To address this question a modified stop-change task was used. In Experiment 1 no-foreknowledge and foreknowledge trials were imbedded in a block design, while Experiment 2 made use of an event-related design. We found that inhibition speed as measured with the stop signal reaction time (SSRT) was faster in the foreknowledge as compared to the no-foreknowledge condition of the event-related study, whereas no differences in SSRT between both conditions were revealed in the block design study. Analyses of reaction times to the go stimulus reflect that participants tended to slow down their go responses in both experimental contexts. However, in the foreknowledge condition of the event-related study, this strategic slowing was especially pronounced, a finding we refer to as strategic delay effect (SDE), and significantly correlated with SSRT. In sum our results suggest that inhibition speed is susceptible to strategic bias resulting from differences in experimental setup.

Rasch model of the Child Perceptions Questionnaire for oral health-related quality of life: A step forward toward accurate outcome measures.

BACKGROUND: Oral health is related to major chronic diseases and contributes to general health. Oral health-related quality of life (OHRQoL) is, therefore, an essential part of well-being. Measurement of OHRQoL over the lifetime requires accurate and comparable outcome measures that are suitable for different age groups. The most frequently used instrument for children aged 11 through 14 years is the Child Perceptions Questionnaire (CPQ-11-14). The authors aimed to examine the psychometric properties of the CPQ-11-14 using modern statistical approaches. METHODS: The authors carried out a psychometric analysis of 2 population-representative data sets from Germany (N = 2,658) and a randomly selected smaller sample (n = 300) on the basis of the Rasch model. RESULTS: The authors detected a right-skewed distribution of the CPQ-11-14 total scores. The instrument items did not match the level of OHRQoL of the study participants. Moreover, a large number of questionnaire items (range, 51.4%-94.3%) had so-called disordered thresholds, meaning that the answer categories did not work as intended. Unidimensionality was achieved via splitting the CPQ-11-14 into 2 subscales, namely socioemotional and oral symptoms and functioning. CONCLUSIONS: Despite its classic validation, the CPQ-11-14 needs adaptions for meaningful clinical use. More items on the better end of the scale are needed to better differentiate between children with higher and lower OHRQoL. PRACTICAL IMPLICATIONS: The Rasch model addresses psychometric properties of questionnaires on an item-based level, which were not detected via classic approaches. The results reported by the authors are needed to generate a well-calibrated outcome measure for accurate clinical and public health assessment of OHRQoL.

Parallel short forms for the assessment of activities of daily living in cardiovascular rehabilitation patients (PADL-cardio): development and validation.

PURPOSE: To develop and validate parallel short forms for the assessment of activities of daily living in cardiac rehabilitation patients (PADL-cardio I & II). METHOD: PADL-cardio I & II were developed based on a sample of 106 patients [mean age = 57.6; standard deviation (SD) = 11.1; 72.6% males] using Rasch analysis and validated with a sample of 81 patients (mean age = 59.1; SD = 11.1; 88.9% males). All patients answered PADL-cardio and the Short Form 12 Health Survey. RESULTS: Both versions of PADL-cardio are composed of 10 items. The fit to the Rasch model was given documented by a non-significant Item-trait interaction score (PADL-cardio I: χ2 = 31.08, df = 30, p = 0.41; PADL-cardio II: χ2 = 45.6, df = 40, p = 0.25). The two versions were free of differential item functioning. Person-separation reliability was 0.72/0.78 and unidimensionality was given. The two versions correlated with r = 0.98 and the correlation between PADL-cardio and the underlying item bank was 0.99 for both versions. Concurrent validity is indicated through correlations with the Short Form 12 Health Survey (r = -0.37 to -0.40). CONCLUSION: PADL-cardio provides a short and psychometrically sound option for the assessment of activities of daily living in cardiovascular rehabilitation patients. The two versions of PADL-cardio are equivalent. Hence, they can be used to reduce practice and retest effects in repeated measurement, facilitating the longitudinal assessment of activities of daily living. Implications for Rehabilitation New parallel test forms for the assessment of activities of daily living in cardiac rehabilitation (PADL-cardio I & PADL-cardio II) are available. PADL-cardio I & II consist of 10 items and are therefore especially timesaving. Concurrent validity is given through correlations with the Short Form Health Survey 12. Therapeutic success could be determined more precisely by the parallel forms reducing practice and retest effects.