Psychometric evaluation of the Chicago Multiscale Depression Inventory in multiple sclerosis patients.

OBJECTIVE: The Chicago Multiscale Depression Inventory (CMDI), a comprehensive self-report measure of depression, has proven useful in the assessment of patients with chronic medical conditions. The objective of this study was to determine the validity of the CMDI in multiple sclerosis (MS) patients and explore the nature of depressive symptoms reported by people with MS. METHOD: Using a combined classical and modern psychometric approach, the factor structure of responses in MS patients was compared with that of a normative sample to confirm meaningful subtypes of depression in MS (mood, depressive cognition, and vegetative symptoms). Patient groups also were compared by disease severity to evaluate differences in depression associated with differences in disease severity. RESULTS: The results supported the factor structures of the measure, which was internally consistent, reliable, and factorially valid. Some items function differently in MS patients when compared with depressed patients and normals, offering a further opportunity to understand the unique clinical aspects of depression in people with MS compared with those without a concurrent physical illness. CONCLUSIONS: Use of the CMDI to assess separate dimensions of depression may help to clarify the complex interrelationships among aspects of depression and health-related behavior.

Validation of the functional assessment of multiple sclerosis quality of life instrument.

Based on scientific literature and interviews with clinicians and patients, we developed a quality of life instrument for use with people with MS called the Functional Assessment of Multiple Sclerosis (FAMS). The initial item pool consisted of 88 questions: 28 from the general version of the Functional Assessment of Cancer Therapy quality of life instrument, plus 60 generated by patients, providers, and literature review. The validation samples comprised a mail survey cohort (N = 377) and a clinical cohort (N = 56). Both cohorts provides evidence for internal consistency of the derived subscales, test-retest reliability, content validity, concurrent validity, and construct validity. Principal components and Rasch measurement model analyses were applied sequentially to survey sample data, reducing test length to 44 questions, divided into six subscales: mobility, symptoms, emotional well-being (depression), general contentment, thinking/fatigue, and family/social well-being. Fifteen initially rejected questions were added back as miscellaneous (unscored) questions for their potential clinical and empirical value. The mobility subscale was strongly predictive of the Kurtzke Extended Disability Status Scale and the Scripps Neurologic Rating Scales. The other five subscales were not, indicating they measure aspects of patient quality of life not captured by the neurologic exam. The final 59-item English language instrument (FAMS version 2) is available for inclusion in clinical trials and clinical practice.

Antepartum home-care services for high-risk women.

OBJECTIVE: To determine the scope of home-care services for pregnant women by addressing types of agencies, nursing personnel, and problems encountered. DESIGN: Descriptive study with survey questionnaire. SETTING: A sample of urban and rural settings throughout Minnesota. PARTICIPANTS: Nine private and 38 public agencies providing antepartum home-care services. MAIN OUTCOME: Data described clients, agencies, personnel, and services. RESULTS: Differences were reflected in the nursing skills and interventions used with high-risk pregnant women. Public agencies identified teenage pregnancy as the most frequent antepartum problem, while private agencies identified preterm labor. CONCLUSION: Results suggest a need to examine the scope of antepartum home-care services.