Abstract
ObjectivesEcological momentary sampling in BD research requires brief symptom measures with low cognitive demands to maximize data collection across the range of BD symptomatology. We developed the BD Sx cognizant of the challenges inherent in scale development with low prevalence populations and the limitations of existing measures (e.g., over-reliance on patients in acute states recruited from psychiatric settings). In order to be generalizable across the full spectrum of the illness, we also included those currently euthymic and those who avoid clinical contact.MethodsWe recruited a global sample of 1010 adults with BD over 19 days using socio-demographically targeted, social media advertising and online data collection. At follow-up, 428 participants provided responses 67 days later on average. This enabled us to develop the BD Sx and replicate initial findings across multiple samples over time.ResultsBoth exploratory and confirmatory factor analyses support a 4-factor BD Sx model. Goodness of fit indices indicate good model fit across samples and over time. We labeled these factors: elation/loss of insight, affrontive symptoms of mania, cognitive/depressive, and somatic/depressive symptoms. Affrontive symptoms correlate positively with cognitive and somatic depression factors, which may suggest mixed-state symptom clusters in accord with DSM 5.ConclusionsResponses to the BD Sx reliably measure both depressive and hypo/manic symptoms. Temporal invariance analyses indicate that the 4-factor structure is consistent over time. Future research should compare BD Sx responses to clinical diagnoses of hypo/mania and major depressive episodes.
Highlights
Bipolar disorder (BD) is a chronic mental health condition defined by extremes of mood and mood variability (DSM-5 American Psychiatric Association 2013)
A fundamental challenge in scale development with low prevalence populations such as BD is recruitment of samples of sufficient size given that psychometric research generally requires 200–300 participants (Clark and Watson 1995)
Bipolar affective and older adults (BADAS) study For our BADAS Study, we developed and validated BD Sx to enable ecological momentary sampling [EMS (Wenze and Miller 2010)] of hypo/manic and depressive symptoms using the iOS app we developed for iPad and iPhone (King et al 2016)
Summary
Bipolar disorder (BD) is a chronic mental health condition defined by extremes of mood and mood variability (DSM-5 American Psychiatric Association 2013). A fundamental challenge in scale development with low prevalence populations such as BD is recruitment of samples of sufficient size given that psychometric research generally requires 200–300 participants (Clark and Watson 1995). O’Rourke et al Int J Bipolar Disord (2016) 4:8 produces invalid or unstable factor structures unlikely to be replicated with other samples or generalize to the population. Scale development with clinical populations commonly relies on refractory patients or those in acute states in psychiatric settings (e.g., Michalak and Murray 2010). Valid and reliable test construction requires large samples recruited across multiple sites and settings (ideally multiple countries), reflecting the full range of BD symptomatology, including those who are currently euthymic. We developed the BD Sx cognizant of these challenges and the psychometric limitations of existing scales
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