Abstract
BackgroundDiagnosis and management of depression occurs frequently in the primary care setting. Current diagnostic and management of treatment practices across clinical populations focus on eliminating signs and symptoms of depression. However, there is debate that some interventions may pathologize normal, adaptive responses to stressors. Analytical rumination (AR) is an example of an adaptive response of depression that is characterized by enhanced cognitive function to help an individual focus on, analyze, and solve problems. To date, research on AR has been hampered by the lack of theoretically-derived and psychometrically sound instruments. This study developed and tested a clinically meaningful measure of AR.MethodsUsing expert panels and an extensive literature review, we developed a conceptual framework for AR and 22 candidate items. Items were field tested to 579 young adults; 140 of whom completed the items at a second time point. We used Rasch measurement methods to construct and test the item set; and traditional psychometric analyses to compare items to existing rating scales.ResultsData were high quality (<1% missing; high reliability: Cronbach's alpha = 0.92, test-retest intraclass correlations >0.81; evidence for divergent validity). Evidence of misfit for 2 items suggested that a 20-item scale with 4-point response categories best captured the concept of AR, fitting the Rasch model (χ2 = 95.26; df = 76, p = 0.07), with high reliability (rp = 0.86), ordered response scale structure, and no item bias (gender, age, time).ConclusionOur study provides evidence for a 20-item Analytical Rumination Questionnaire (ARQ) that can be used to quantify AR in adults who experience symptoms of depression. The ARQ is psychometrically robust and a clinically useful tool for the assessment and improvement of depression in the primary care setting. Future work is needed to establish the validity of this measure in people with major depression.
Highlights
Depression affects approximately 350 million people worldwide and is a leading cause of global disability [1,2]
The analytical rumination hypothesis states that individuals with depression engage in analysis to understand at least four different parts of their problems: (1) understanding the cause (e.g., ‘‘I tried to understand why I had these problems’’); (2) understanding the aspects of the problems that need to be solved (e.g., ‘‘I tried to understand what was wrong in my life’’; (3) generating possible solutions (e.g., ‘‘I thought about all my options for dealing with my problems’’); and (4) evaluating the advantages and disadvantages of possible solutions (e.g., ‘‘I thought about whether my options for dealing with one problem would make other problems worse’’)
Possible scores ranged from 22–110, with a higher score indicating a higher level of analytical rumination
Summary
Depression affects approximately 350 million people worldwide and is a leading cause of global disability [1,2]. Depression is associated with factors that increase mortality risk such as poor adherence to medical treatment and self-care for diabetes and cardiovascular disease [4] [5], health behaviors such as smoking and lack of physical activity [6], cognitive impairment [7] and disability [8]. It is a common consequence of changes in health status (i.e., cancer [9] & stroke [10]), and/or new life roles (i.e., caregiving [11], immigration [12], and loss of employment [13]). This study developed and tested a clinically meaningful measure of AR
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