Brief Symptom Inventory Research Articles

Problematic WhatsApp Use Among Adolescents: Linking Fear of Missing Out and Psychiatric Symptoms

Abstract Objective: WhatsApp (WA) is the most popular instant message application all over the world. Although communication has become easier and enjoyable with the help of this application, the overuse, and addiction of WA has become an important problem among adolescents. WhatsApp addiction is a part of problematic smartphone use (PSU). When we examined previous studies, we found that the samples were generally composed of young adults, but studies on adolescents who are at high risk for problematic Whatsapp use (PWU) were insufficient, and almost no studies were conducted in the clinical adolescent sample. In this study, we aimed to increase our knowledge about problematic Whatsapp use (PWU) and possible risk factors including fear of missing out (FoMO), PSU, and psychiatric symptoms among adolescents who applied to outpatient psychiatry clinics. Method: 197 adolescents (136 boys, 61 girls, age: 12-18 years) recruited the study. Problematic Mobile Phone Usage Scale (PMPUS), Bergen Whatsapp Addiction Scale, Brief Symptom Inventory, and Fear of Missing Out (FoMO) Scale were used. Results: We grouped the sample as PWU (Problematic WhatsApp use) and Normal Use group due to Bergen WA Addiction scale. PWU group’s adolescents were significantly older than others (p=0.03), and had higher scores in all subscales of Brief Symptom Inventory (BSI), FoMO and PMPUS (for all scale scores p

Excessive smartphone use symptoms associated with psychological distress as consequence of early phase COVID-19 restrictions

Coronavirus disease (COVID-19) has been associated to various mental health problems and its consequences such as lock-down and social distancing were linked to various adaptations forms including increased smartphone usage. The purpose of the present study was to determine the prevalence of symptoms related to smartphone excessive use and to detect smartphone addiction symptoms related to general psychological distress. Participants were (N=260) surveyed during the first two weeks of lockdown measure. Online measures were introduced including sociodemographic background, Smartphone Addiction Scale Short Version (SAS-SV), and the Brief Symptoms Inventory (BSI). Among 260 Moroccan adults, the prevalence of excessive smartphone use was 48.4% (women: 59.6% / men: 40.4%). Withdrawal, preoccupation, simultaneous presence of withdrawal and tolerance, with or without preoccupation, were significantly more observed among female users (p=.019, p=.042, p=.023 and p=.003; respectively). Comparing excessive smartphone users to non-excessive users, GSI and all BSI dimensions, showed higher significant difference in mean scores (r ranging from .15 to .31). SAS-SV total score was positively correlated with general distress (rho=.19, p<.05), depression (rho=.27, p<.01), and paranoid ideation (rho=.20, p<.05) in excessive smartphone users. Smartphone excessive use appears strongly associated with general distress, regardless of the circumstances. The results of this work provide sufficient evidence for the implementation of psychological interventions in general population during possible lock down measures or potential quarantine for potential next pandemic waves.

Psychometric Properties of the Persian Version of Millon Clinical Multiaxial Inventory-IV (MCMI-IV).

Objective: Millon Clinical Multiaxial Inventory (MCMI) is one of the most widely used clinical tools in research studies and clinical settings. MCMI was revised 4 times and its last version was published in 2015. All previous versions of MCMI have been translated to Persian and validated and have been frequently used by Iranian clinicians or researchers. Thus, this study provides the Persian version of the last version of this popular inventory for clinical or research purposes. Method: The participants of this psychometric study were selected by combining purposeful and convenience sampling methods among inpatients and outpatients who referred to Roozbeh hospital from 2018 to 2019. After data screening by statistical methods and Validity Scales based on MCMI-IV profile, 400 participants’ profiles were analyzed to estimate the psychometric properties of the Persian Version of MCMI-IV. MCMI-IV, the Structured Clinical Interview for DSM-5 (SCID-5), and the Brief Symptoms Inventory (BSI) were used for clinical data gathering. Content Validity Ratio (CVR), Correlational Coefficients, Kappa Agreement, Spearman Brown Coefficient, and Cronbach Alpha were performed for data analysis. Results: According to the results of data analysis, the psychometric properties for MCMI-IV were estimated as follows: the content validity index (CVI, 0.29 to 0.99), criterion validity (0.13 to 0.40), convergent validity (-0.35 to 0.72), The Cronbach’s alpha for the personality scales was 0.48 to 0.90, the Spearman-Brown coefficient was from 0.49 to 0.90, and test-retest reliability was from 0.51 to 0.86. Conclusion: The psychometric properties of the Persian version of MCMI-IV, including validity and reliability indexes, are appropriate and in line with the findings of its original version.

Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT): treatment protocol description and a case study

ABSTRACT Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as ‘the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.’ These events can provoke emotions such as remorse, guilt and shame, and affects someone’s self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion: The case of Dusan has shown it is worthwhile to address moral trauma and BEP- MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT.

The mediating effect of difficulties in emotion regulation on the association between childhood maltreatment and borderline personality disorder

ABSTRACT Background: Childhood maltreatment and difficulties in emotion regulation are common in patients with Borderline Personality Disorder (BPD) and Depressive Disorders (DD). Objective: This study examines differences between patients with BPD and patients with DD, regarding childhood maltreatment and difficulties in emotion regulation as well as the mediating effect of different aspects of emotion regulation deficits on the association between childhood maltreatment and BPD-symptoms. Method: A total of 305 participants, 177 with BPD and 128 with DD completed an assessment including the Childhood Trauma Questionnaire (CTQ), the Emotion Regulation Scale (DERS), the Brief Symptom Inventory (BSI), and the Structured Clinical Interview for DSM-IV (SCID). Data was analyzed using multiple analyses of variances and mediation analyses. Results: Patients with BPD reported more childhood maltreatment and more difficulties in emotion regulation than patients with DD. When general symptom severity, age, and gender were included in the analysis as covariates only group differences regarding ‘impulse control difficulties’ (F(1,299) = 38.97, p < .001, ηp 2 = .115), ‘limited access to emotion regulation strategies’ (F(1,299) = 4.66, p = .032, ηp 2 = .015), and ‘lack of emotional clarity’ (F(1,299) = 9.38, p = .002, ηp 2 = .030) remained statistically significant. A mediation analysis, including above-mentioned covariates, indicated an association between emotional abuse and BPD-symptoms, which was mediated by difficulties in emotion regulation (indirect effect B = .012, 95% CI [.001; .031], R2 = .429). Subscale analyses revealed ‘impulse control difficulties’ as the aspect of difficulties in emotion regulation that has the greatest impact on this association (B = .021, 95% CI [.003; .045]). Conclusions: Patients with BPD display more childhood maltreatment and difficulties in emotion regulation than patients with DD. Difficulties in emotion regulation, especially difficulties in impulse control, seem to play an important role in the association between childhood emotional abuse and BPD-symptoms.

THE PREDICTORS OF TIME PERSPECTIVES: A COMPARATIVE STUDY FROM CYPRUS

Traumatic events may have long lasting consequences on physical and psychological well-being. Moreover, exposure to traumatic events might have adverse intergenerational consequences. The aim of the present study was to explore individuals’ time perspectives (i.e. how individuals link their behavior to their past, present, and future), and their correlates with vulnerability to Post Traumatic Stress Disorder (PTSD) and psychological difficulties on two samples; first a theoretically traumatic group whom their parent had gone missing during the war of Cyprus (N= 50; age range = 49-70) and their first born offspring (N= 50; age range = 26-40); second a theoretically non-traumatic group with no missing parent (N= 50; age range = 46-69) and their first born offspring (N= 50; age range = 20-39). Purposeful sampling technique was used to recruit the participants. Brief Symptom Inventory (BSI), Impact of Event Scale-Revised and Zimbardo’s Time Perspective Inventory were used as measurement tools. Results of the study revealed that parents’ PTSD symptoms and time perspectives (TP) were associated with their offsprings’. Past-Negative and Present Fatalistic TP significantly predicted PTSD and experienced psychological difficulties. Participants whom had a relative gone missing during the war scored higher on PTSD compared to the participants whom had no missing relative. Keywords Time perspectives, PTSD, psychological difficulties, war trauma, Cyprus

Mental Health Determinants Among a Psychiatric Outpatient Sample of Vietnamese Migrants in Germany

Background: Mental health risk-factors for Asian migrants have been studied almost exclusively in the US, Canada, and Australia but not in European countries. Therefore, we aimed to identify sociodemographic, clinical, and migration-surrounding factors associated with experienced mental distress among Vietnamese migrants in Germany.Method: 305 Vietnamese migrants utilizing Germany's first Vietnamese psychiatric outpatient clinic filled out at admission the Brief-Symptom-Inventory 18 (BSI-18) as well as a questionnaire on 22 potential mental health determinants. Using a multiple linear regression model, we identified those sociodemographic, clinical, and migration-surrounding factors that were significantly related to the Global Severity Index (GSI) of the BSI-18.Results: The factors unemployment (B = −6.32, p = 0.014), financial problems (B = −10.71, p < 0.001), no or only little religious involvement (B = −3.23, p = 0.002), no psychiatric precontact (B = −7.35, p = 0.004), previous migration experiences (B = 8.76, p = 0.002), and perceived discrimination (B = 6.58, p = 0.011) were found to significantly increase the level of mental distress according to the BSI-GSI.Conclusion: Based on these results, we were able to construct a mental health risk-profile for Vietnamese migrants in Germany, which aims to detect candidates for psychiatric problems earlier and supply them with customized prevention and therapy options.

Psychological Distress and Somatization in Immigrants in Primary Health Care Practices.

The process of international migration causes a situation of vulnerability in people’s health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from four communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the primary care centers of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the Sub-Saharan community. Psychological distress showed a mean value of 0.66, with the Sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the Sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.

Enhanced cognitive behavior therapy for severe and extreme anorexia nervosa: An outpatient case series.

The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting. Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers. Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups. CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.

Assessment of health-related quality-of-life in patients with chronic Rhinosinusitis – Validation of the German Sino-Nasal Outcome Test-22 (German-SNOT-22)

PurposeThe Sino-Nasal-Outcome-Test-22 (SNOT-22) represents the reference questionnaire to assess symptoms, health-related quality-of-life (HRQOL) and treatment-response in patients with chronic rhinosinusitis (CRS). The SNOT-22 has been validated for various languages, yet no validation is available for the German version. Thus, we provide a validation of the SNOT-22 for German. MethodsIn this prospective observational study 139 CRS-patients and 36 control-participants were included. CRS-patients completed the German-SNOT-22 before treatment (T0) and four (T1), twelve (T2) and 48 weeks after inclusion (T3). At T0, Mackay-Naclerio-, Lund-Mackay- and Brief-Symptom-Inventory-18 (BSI-18) scores were collected as external reference for the German-SNOT-22 and its subscales. At T1, T2, and T3 health-transition-items (HTIs) were raised to explore responsivity. Control-participants completed the German-SNOT-22 at T0. Reliability (internal consistency, item-total correlation), validity (concurrent validity, discriminatory validity) and responsiveness (distribution- and anchor-based) were explored for the German-SNOT-22. ResultsAt T0, the mean German-SNOT-22 total-score for CRS patients was 38.0 (± 20.9) and responded to treatment (T1 = 26.3 ± 19.1; T2 = 25.8 ± 20.6; T3 = 20.5 ± 16.3). For control-participants, the mean total-score at T0 was 15.1 (±10.9). The German-SNOT-22 was reliable (excellent internal consistency α = 0.93; good overall item-total correlations r = 0.39–0.85), valid (significant correlations between Mackay-Naclerio-, Lund-Mackay- and BSI-18 scores, all r > 0.39, p < 0.01) and responsive (significant correlations between HTIs and mean change in German-SNOT-22 total-score F = 9.57, p < 0.001). ConclusionThe German-SNOT-22 validated here matches the original SNOT-22. It is a reliable, valid and responsive questionnaire to assess symptoms, HRQOL and treatment-response in CRS-patients. Good psychometric properties were observed.

The Intergenerational Transmission of Chronic Pain from Parents to Survivors of Childhood Cancer.

Background: Among youth with chronic non-cancer pain, 50% have parents with chronic pain. These youth report significantly more pain interference and posttraumatic stress symptoms (PTSS), and worse health-related quality of life (HRQL) than youth whose parents do not have chronic pain. Additionally, parent chronic pain is linked to increased child anxiety and depressive symptoms. Survivors of childhood cancer (SCCs) are at risk of pain and negative psychosocial outcomes and therefore may be especially vulnerable if their parents have chronic pain. Thus, the aims of the current study were to (1) identify rates of chronic pain among parents of SCCs, (2) test group differences in psychological symptoms in parents with chronic pain versus without, and (3) test group differences in pain interference, HRQL, anxiety, depression, and PTSS in SCCs with parents with chronic pain versus without. Methods: 122 SCCs (Mean age = 15.8, SD = 4.8, 45.7% male, Mean age at diagnosis = 5.9, SD = 4.7) and their parents were recruited from across Canada to complete online questionnaires. Parents were asked if they have had pain for at least three consecutive months and completed the brief symptom inventory (BSI) as a measure of psychological symptomatology. Survivors completed the pain questionnaire, patient reported outcomes measurement information system (PROMIS)—pain interference, anxiety, and depression measures, child posttraumatic stress scale, posttraumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, and the pediatric quality of life inventory. Results: Forty-three (39%) parents of SCCs reported having chronic pain. Of the 29 survivors who had chronic pain, 14 (48%) also had parents with chronic pain. Parents with chronic pain reported significantly higher scores on the BSI than parents without chronic pain, F(1, 116) = 5.07, p = 0.026. SCCs with parents with versus without chronic pain reported significantly higher PTSS F(1, 105) = 10.53, p = 0.002 and depressive symptoms F(1, 102) = 6.68, p = 0.011. No significant differences were found across the other variables tested. Conclusions: Findings suggest that survivors’ parents’ own pain is prevalent and is related to survivors’ increased depressive symptoms and PTSS, but not anxiety, pain interference, or HRQL. Future research should explore whether parents may benefit from psychological intervention after their child has been diagnosed with cancer and how this could improve outcomes for their child.

Age of First Exposure to Collision Sports Does Not Affect Quality of Life Outcomes in Community Rugby Players

To determine the relationship between exposure to repetitive head impacts (RHI) through collision sports prior to the age of 12 and quality of life measures in community rugby players. It is suggested that RHI incurred before age 12 may be associated with later life neurologic impairments. However, research on age of first exposure (AFE) to collision sports and psychological outcomes has not be explored in rugby, a sport which participants often continue in community settings beyond college. Individuals over 18 years old who currently or previously played contact rugby completed an online questionnaire. To assess quality of life and psychological status, participants completed the Brief-Symptoms Inventory 18 (BSI-18), Short Form 12 (SF-12), and Satisfaction with Life Survey (SWLS). Participants were dichotomized into AFE to collision sports (12); AFE to rugby was not used since most participated in other collision sports prior to rugby. Data were not normally distributed; therefore, a Mann-Whitney U test was performed to compare outcomes between AFE groups. 1,037 rugby players (31.6 + 11.3 years, 59.1% male) participated in this study. There were no significant differences between AFE 12 groups on all outcomes: BSI-18 Somatization (U = 97,286, p = 0.307), BSI-18 Depression (U = 100,267, p = 0.778), BSI-18 Anxiety (U = 98,851, p = 0.531), SF-12 Physical (U = 94,413, p = 0.241), SF-12 Mental (U = 96,517, p = 0.512), SWLS (U = 98,866, p = 0.537). Mean scores for all outcomes were: BSI-18 Somatization (2.33 + 2.99), BSI-18 Depression (4.20 + 4.91), BSI-18 Anxiety (3.32 + 3.75), SF-12 Physical (52.40 + 7.25), SF-12 Mental (46.20 + 11.45), SWLS (24.86 + 6.31). Consistent with recent cohort studies, there was no observed difference on three common measures of psychological well-being and quality of life in rugby players based upon AFE to collision sports. However, later life potential consequences of RHI in rugby players remains to be elucidated.

Post-Concussion Psychological Distress at Return to Play Does Not Predict Subsequent Musculoskeletal Injury

To assess the association between the Brief Symptom Inventory 18 (BSI-18) response at post-concussion return to play (RTP) and subsequent lower extremity musculoskeletal injury (LE-MSI). Concussion evaluation includes a multifaceted neurologic assessment at baseline and post-injury. Despite emotional sequelae after concussion, psychological assessments have received limited attention thus athletes may RTP despite persistent psychological distress post-concussion. Recent evidence has suggested an ∼2x elevated rate of post-concussion LE-MSI in collegiate athletes; however there is limited understanding of potential mechanisms. As psychological distress has been associated with MSI, the purpose of this study was to assess BSI-18 as a potential predictor of subsequent MSI. This analysis utilized a cross-sectional design of 67 NCAA intercollegiate students-athletes with a diagnosed concussion (59.7% female, age: 19.7 ± 1.4 years). Participants completed the BSI-18, an 18-item questionnaire based on a 5-point Likert scale (0-4) used to measure psychological distress at the RTP clinical time-point. Outcome measures were the Global Severity Index (GSI) which is the total score of symptoms (0-72) with higher scores representing greater psychological distress and subsequent MSI (yes or no) collected retrospectively through an electronic medical record in the year following diagnosed concussion. Binary logistic regression was used to assess the predictive capabilities of BSI-18 GSI and subsequent LE-MSI. The BSI-18 GSI did not significantly predict subsequent LE-MSI (p = 0.095, Exp(B) = 2.436, Nagelkerke R2 = 0.181). The BSI-18 GSI at RTP did not predict post-concussion subsequent LE-MSI. While the underlying mechanism for post-concussion MSI remains to be fully elucidated, results suggest that psychological health, as measured by the BSI-18 GSI, at RTP is not associated with subsequent LE-MSI. If MSI risk can be predicted then targeted, established, and clinically feasible injury prevention programs can be implemented to reduce injury risk.

The relationship between smartphone using style and sleep quality and psychiatric symptoms among a foundation university students

Objectives: We aimed to measure problematic smartphone use frequency and it’s association with sleep problems and psychiatric symptoms in a sample of university students. Methods: The data in the study was collected by using a sociodemographic data form, the Smartphone Addiction Scale (SAS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Brief Symptom Inventory (BSI). Results: Based on the SAS median score, the participants were divided into two groups as the low-level smartphone use (SAS score &amp;lt; 79) and the high-level smartphone use (SAS score &amp;gt; 79) groups. In the high-level smartphone use group, general sleep quality was lower, sleep latency was longer, scores of sleep disorder and daytime dysfunction were higher as measured by PSQI and the BSI scores were higher (p &amp;lt; 0.001). As a result of the study, it was observed that, as smartphone use increased and became problematic, sleep quality decreased, and daytime dysfunction and psychiatric symptoms increased. SAS scores were positively correlated with both PSQI and ESS scores. SAS score was found as a predictor of PSQI scores in the regression analysis. Conclusions: This study shows that the relationship between problematic smartphone use and decreased sleep quality and increased psychiatric symptomatology in university students is still an important public health issue. Responsible and mindfull use of smartphones by the students throughout the day may provide a positive effect on their sleep.

Factor structure of the Albanian version of the Clinical Assessment Interview for Negative Symptoms (CAINS): Associations with the Brief Symptoms Inventory (BSI)

Objectives: The measurement and assessment of the emergent symptoms in various psychotic disorders is essential to the delivery of efficacious, patient centred mental health care. Despite the existence of several instruments that can measure these factors, their applicability within a global context remains undetermined. This paper aims to provide evidence for a factor structure in Clinical Assessment Interview for Negative Symptoms (CAINS), tailored for use in the Albanian language. Methods: We recruited 106 patients with psychosis (68% male), who were aged 16 to 40 years old (M = 22, SD = 1.75), and treated in community services in Kosovo. We adapted, translated, and back-translated CAINS and the Brief Symptom Inventory (BSI) before these measures were administered in interviews with the participants. According to Kaiser-Guttman’s criterion (i.e., eigen-value >1), four components were extracted from the original measure of CAINS. Results: Using Principal Component Analysis, CAINS was found to be a valid means of measurement of motivation and pleasure in various life domains (social, recreational, and work/school). Intercorrelation existed not only between the BSI scale and the CAINS scales, but within the CAINS scales themselves. Conclusions: In contrast to the previous studies that found Expression and Motivation and Pleasure as two major factors, our results revealed four components. Thus, it may be that the culture plays a substantial role in the factor structure of CAINS, and it might be related to different appraisal of emotional situations, which are influenced by different socio-cultural practices. These results have global implications for clinical practice and future research.

Negligible Effects of the Survey Modes for Patient-Reported Outcomes: A Report From the Childhood Cancer Survivor Study.

This study compared the measurement properties for multiple modes of survey administration, including postal mail, telephone interview, and Web-based completion of patient-reported outcomes (PROs) among survivors of childhood cancer. The population included 6,974 adult survivors of childhood cancer in the Childhood Cancer Survivor Study who completed the Brief Symptom Inventory-18 (BSI-18), which measured anxiety, depression, and somatization symptoms. Scale reliability, construct validity, and known-groups validity related to health status were tested for each mode of completion. The multiple indicators and multiple causes technique was used to identify differential item functioning (DIF) for the BSI-18 items that responded through a specific survey mode. The impact of the administration mode was tested by comparing differences in BSI-18 scores between the modes accounting for DIF effects. Of the respondents, 58%, 27%, and 15% completed postal mail, Web-based, and telephone surveys, respectively. Survivors who were male; had lower education, lower household income, or poorer health status; or were treated with cranial radiotherapy were more likely to complete a telephone-based survey compared with either a postal mail or Web-based survey (all P < .05). Scale reliability and validity were equivalent across the 3 survey options. One, 2, and 5 items from the anxiety, depression, and somatization domains, respectively, were identified as having significant DIF among survivors who responded by telephone (P < .05). However, estimated BSI-18 domain scores, especially depression and anxiety, between modes did not differ after accounting for DIF effects. Certain survivor characteristics were associated with choosing a specific mode for PRO survey completion. However, measurement properties among these modes were equivalent, and the impact of using a specific mode on scores was minimal.

Factorial Structure of the Serbian Version of the Clinical Assessment Interview for Negative Symptoms - Evidence for Three Factors of Negative Symptoms.

Introduction: Negative symptoms are a common occurrence in patients with psychosis spectrum disorders. Previous analysis of the latent structure of the Clinical Assessment Interview for Negative Symptoms (CAINS) – which was developed to advance the assessment of negative symptomatology – showed two underlying sub-domains (Motivation and Pleasure; Expression). Recent findings indicate that a more complex structure might be more applicable. Aim: To evaluate the psychometric properties of the Serbian version of the CAINS in a sample of outpatients (N = 67) with psychosis spectrum disorders. Materials and Methods: Negative symptoms and general level of psychopathology were assessed with Serbian translations of the CAINS, the 53-item version of the Brief Symptom Inventory (BSI), and the 24-item version of the Brief Psychiatric Rating Scale (BPRS). Principal component analysis (PCA) was carried out on the CAINS items, and correlation analyses were done to assess its convergent and discriminant validity. Results: Our results showed an excellent internal consistency (Cronbach’s alpha = 0.92). PCA revealed a three-component solution consisting of Expressiveness and Motivation for Social and Family Relationships (Factor 1), Motivation for Vocational Activities (Factor 2), and Motivation for Recreation (Factor 3). Convergent validity was supported by significant correlations with the Negative symptoms domain of the BPRS (Factor 1, 0.695, p < 0.01; Factor 2, 0.352, p < 0.05; Factor 3, 0.452, p < 0.01). When assessing discriminant validity, weak correlations were found with BPRS and BSI scores. Conclusion: The Serbian version of CAINS is a valid, reliable and useful tool for the assessment of negative symptomatology. Our findings support a three-factor structure of CAINS, which indicates that the construct is more complex than envisaged by the original conceptualization of two distinct factors.

Longitudinal study of PTSD and depression in a war-exposed sample – comorbidity increases distress and suicide risk

Background Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life. Subjects and methods The sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline. Results In the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone. Conclusion PTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.

Salivary markers of stress system activation and social withdrawal in humans

Social withdrawal is an early and common feature of psychiatric disorders. Hypothalamic-pituitary-adrenal (HPA)-axis activation through increased salivary cortisol (sC) and sympathetic activation through increased salivary alpha-amylase (sAA) may play a role. We aimed to study whether the link between increased sC and sAA on the one hand and depression on the other hand is mediated by social withdrawal. In this cross-sectional, observational study, sC and sAA measures were measured in seven saliva samples in 843 participants (231 psychiatric patients and 612 healthy controls). Social withdrawal was assessed through the Brief Symptom Inventory (BSI)-, the Short Form 36-, and the Dutch Dimensional Assessment of Personality Pathology social withdrawal subscales, and analyzed using linear regression and mediation analyses. On average, participants were 44.0 years old (SD = 12.8; 64.1% female). Basal and diurnal sAA were unrelated to any social withdrawal scale and depression. Certain sC measures were positively associated with the BSI social withdrawal subscale (i.e., area under the curve with respect to the increase, beta = 0.082, p = 0.02; evening sC value: beta = 0.110, p = 0.003; and mean sC value: beta = 0.097; p = 0.01). We found limited support for statistical mediation by social withdrawal (measured using a composite social withdrawal score) on the relationship between evening sC and depression. Thus, although we found no support for a role of basal and diurnal sAA in social withdrawal, HPA-axis activation may partly aggravate social withdrawal in depressive disorders.

Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)

Objectives Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes. Methods This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families. Trial registration: ISRCTN 11913964