Clinician-rated Measures Research Articles

A Psychometric Evaluation of the Parenting Anxious Kids Rating Scale (PAKRS-PR) in a Sample of Families with Clinically Anxious Children.

The Parenting Anxious Kids Rating Scale-Parent Report (PAKRS-PR) measures five types of anxiogenic parenting. The present study aimed to extend the previous psychometric evaluation of the PAKRS-PR to a treatment-seeking sample and examine sensitivity to change over 15 sessions of cognitive behavioral therapy. The sample included 383 parent-child dyads presenting to treatment at a specialty outpatient clinic. Cronbach's α was acceptable for the PAKRS-PR Total scale and several subscales, although the Accommodation/Beliefs and Warmth/Support subscales were in the unacceptable/questionable range. Convergent validity was found to be mixed with the closest relationship between anxiety severity and the Accommodation/Beliefs, Warmth/Support, and Conflict PAKRS-PR subscales. Additionally, the PAKRS-PR Total score and subscales changed significantly throughout treatment, but were not associated with treatment response or child- or clinician-rated treatment outcome measures. Overall, the current findings demonstrate some support for the psychometric properties of the PAKRS-PR; however, further refinement of the PAKRS-PR at the item-level is recommended to further strengthen the measure.

Examining interrelations among trajectories of mindful awareness, acceptance, and values-consistent actions in acceptance-based behavioral therapy for generalized anxiety disorder

ABSTRACT The goal of this study was to understand how mindful awareness, acceptance, and values-consistent action change across acceptance-based behavioral therapy (ABBT) for generalized anxiety disorder (GAD) and determine their effect on symptoms. We examined weekly data from 31 individuals who received ABBT as part of a randomized control trial for individuals with GAD (Hayes-Skelton, Roemer, & Orsillo, 2013). Participants answered questions weekly about three components of ABBT, including the percentages of time they spent over their past week: 1) aware of the present moment, 2) accepting of their internal experiences, and 3) engaging in values. GAD symptoms were examined using two self-report measures (DASS-21 Stress subscale and PSWQ) and two clinician-rated interview measures (CSR and SIGH-A) at pre- and post-treatment. 1 Mindful awareness, acceptance, and values-consistent action increased linearly across ABBT. All three change trajectories were positively correlated (Z’s 2.99 to 8.74, p’s < .001). Mindful awareness, acceptance, and values-consistent action across treatment predicted decreases in GAD symptoms above and beyond baseline for most outcome measures (Z’s −1.95 to −3.03, p’s < .05), with the exception that mindfulness did not predict DASS-stress (Z = −1.39, p = .17). These findings are consistent with the structure and model of ABBT.

A Psychometric Evaluation of the Body Image Questionnaire Child and Adolescent Version.

Body dysmorphic disorder (BDD) typically develops during adolescence, but there has been little research evaluating assessment tools for BDD in youth. This study sought to provide a comprehensive psychometric evaluation of a brief self-report questionnaire of BDD symptoms, the Body Image Questionnaire Child and Adolescent version (BIQ-C), in both clinical and non-clinical adolescent samples. Properties of the BIQ-C were examined in 479 adolescents recruited through schools and 118 young people with BDD attending a specialist clinic. Sensitivity to change was additionally examined in a subgroup of the clinical sample who received treatment (n = 35). Exploratory factor analysis indicated that a two-factor structure provided the best fit for the data in the non-clinical sample. The two-factor solution was corroborated through confirmatory factor analysis as the best solution in the clinical sample, although it did not fulfil predefined fit thresholds The first factor encompassed preoccupation and repetitive behaviours, while the second included items assessing functional impairment. The BIQ-C showed good internal consistency across both samples, and convergent validity with other measures of BDD. Among those in the clinical sample who received treatment, BIQ-C scores decreased significantly, and BIQ-C change scores were highly correlated with change scores on the gold-standard clinician-rated measure of BDD symptom severity. These findings indicate that the BIQ-C is a suitable tool for assessing BDD symptoms in young people and measuring change during treatment.

Measuring clinical outcomes in adult ADHD clinics: psychometrics of a new scale, the adult ADHD Clinical Outcome Scale.

Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate. To present the psychometrics of a short outcome measure of key clinical areas including symptoms. The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered. The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = -0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships. The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.

Talking About Things Important to Me: Mental Health Consumers' Experiences of Consumer-Rated Measures.

Since 2002, National Outcomes and Casemix Collection of clinician-rated and consumer-rated outcome measures has become part of routine care within Australian clinical mental health services, aiming to ensure that services understand, improve and are accountable for effectiveness of treatment and care provision. Consumer-rated outcome measures, implemented well, support basic human rights of consumers to be asked, heard and included equally in their own care. However, their use has lagged due to clinician inertia, uncertainty about their value to clinical care, assumptions about consumers' capacity to complete the measures and organisational cultural issues that have hampered more holistic assessment, consumer inclusion and care collaboration. Much is known about negative, largely tokenistic use of such measures, poor uptake and dominance of clinical approaches to measurement that privilege clinical expertise; however, little is known about consumers' positive experiences of using consumer-rated measures, Therefore, our aims were as follows: to seek the views and experiences of mental health consumers of using consumer-rated measures in their encounters with clinicians; to understand better whether there were benefits (and if so what) of consumer-rated measures being used in routine mental health practice; to understand how feedback on the use of consumer-rated measures can inform training for mental health staff; and to promote their wider use within mental health services. In-depth interviews conducted with 10 Australian mental health consumers used interview questions co-designed with lived experience and clinical advocates. Descriptive thematic analyses produced four themes emphasising consumers' preferences for completing the measures, the importance of explaining their purpose, how the process validated their feelings and was an opportunity for self-reflection, sense-making, trust-building, and transparency in the encounter and empowerment. This research offers recommendations about the value of effective implementation of consumer-rated measures.

Measuring successful conversations in couples with and without aphasia: A scoping review.

Aphasia impacts communication and relationships. While counselling is increasingly recognised as a component of the speech-language therapy role, the success of conversation partner training is typically measured in terms of communication alone. This scoping review aimed to describe how successful conversation is currently measured with couples-with and without aphasia, to inform the development of an ecologically valid measure for couples with aphasia. The scoping review was reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extensions for Scoping Reviews (PRISMA-SCR). MEDLINE, EMBASE, CINAHL and PsycINFO databases were searched for conversation treatment studies for couples with and without aphasia. Patient-reported outcome measures (PROMs) were extracted from included studies and screened against the three-tier model of situated language to shortlist those that measure everyday communication. Items within shortlisted PROMs were further described using the refined International Classification of Functioning, Disability and Health linking rules. Following screening and full-text review, 46 studies were included, consisting of 24 studies conducted with couples with aphasia and 22 studies conducted with couples without aphasia. For couples with aphasia, 13 PROMs were identified that measured everyday communication. Of these, 23% were dyadic (i.e., measured from the perspectives of both members of the couple); however, they usually only appraised the communication behaviours of the person with aphasia. For couples without aphasia, eight PROMs were identified that measured everyday communication; all were dyadic and measured both attitudes and communication behaviours of both partners. Conversation relies on the interaction of two people, and success in conversation is best rated by those having the conversation. The use of PROMs is recommended as part of person and relationship-centred practice; however, there is currently no validated PROM for conversation in aphasia that considers the perspectives and behaviours of both the person with aphasia and their communication partner. The PROM items identified in this study will form the basis of future research to develop a PROM for couples' conversations in aphasia. What is already known on the subject Communication partner training (CPT) for couples, where one person has aphasia, can improve conversation skills and enhance relationships. Clinician-rated measures, such as conversation analysis, have been used to measure the outcomes of CPT. However, there is a lack of person-centred or self-rated outcome measurement instruments. that is, patient-reported outcome measures (PROMs) for couples' conversations in aphasia. What this paper adds to existing knowledge We have identified outcome measurement instruments used in conversation treatment studies for couples with and without aphasia. We found that most PROMs used in aphasia treatment studies were not dyadic, that is, they did not include the self-report of both communication partners. In contrast, the PROMs used with couples without aphasia were dyadic and contained items that measured a more complex range of both partners' emotions, behaviours and attitudes. What are the potential or actual clinical implications of this work? This study provides insights into the content and characteristics of PROMs for couples' conversation therapy and may assist clinicians in selecting outcome measurement instruments in their practice.

The BigMove Intervention for People With Physical and Mental Health Conditions: A First Evaluation of Self-Perceived Health, Quality of Life, Coping and Mental and Social Functioning.

The BigMove intervention aims to improve the functioning and quality of life of people with physical and mental health conditions via an integrated care approach. This pilot study evaluates the impact of the intervention on self-perceived health (SPH), quality of life (QoL), active coping behaviour, and mental and social functioning. Data were analysed from N = 457 participants who had been referred to the intervention by their general practitioner (mean age 48.98 years; 76% female). Three patient-reported and one clinician-rated measures were used: SPH, QoL (MANSA), active coping behaviour (UPCC-ACT), mental and social functioning (HoNOS). Pre- and post-intervention measurements (from 2011 to 2018) were compared using paired-samples t-tests. Due to missing data, analyses were conducted with 205-257 participants per completed outcome. Associations with age and sex were assessed using repeated-measures ANOVA. Clinically relevant change was evaluated with the Edwards-Nunnally index and standard error of measurement (SEM) scores. Post-intervention, there were statistically significant improvements for all outcomes (p < 0.0001) with moderate to large effect sizes (d = 0.41 to 1.02). The observed changes in outcomes can be considered as clinically relevant improvements. This pilot study provides preliminary evidence that the intervention has positive effects on SPH, QoL, active coping behaviour, and mental and social functioning.

Treatment-emergent symptoms during short-term ketamine administration in treatment-resistant bipolar depression: A retrospective cross-sectional descriptive study

Symptoms that emerge during pharmacological treatment of bipolar depression are frequently observed, underscoring the necessity for comprehensive treatment monitoring. This observational study sought to observe the correlation of eight intravenous ketamine infusions with treatment-emergent depressive symptoms in treatment-resistant bipolar depression patients who maintained their baseline psychotropic and chronic somatic treatments. Depressive symptoms were evaluated using the Inventory of Depressive Symptomatology Self-Report 30 (IDS-SR30). Treatment-emergent symptoms TES were defined as symptoms absent at baseline but present at the conclusion of the study. The most common TES included decreased appetite, increased weight, hypersomnia, and diurnal mood variation. Conversely, feelings of sadness, altered perceptions of the future, decreased interest in sex, and physical discomfort were absent in all patients. Notably, 13.6 % of patients reported thoughts of death or suicide. Larger-scale studies, integrating clinician-rated and patient-reported outcome measures, are essential to deepen our understanding of treatment-emergent symptoms. Establishing regulatory or professional definitions for treatment-emergent symptoms is warranted to improve the robustness of future research endeavors.

Video-Based Kinematic Analysis of Movement Quality in a Phase 3 Clinical Trial of Troriluzole in Adults with Spinocerebellar Ataxia: A Post Hoc Analysis.

Traditional methods for assessing movement quality rely on subjective standardized scales and clinical expertise. This limitation creates challenges for assessing patients with spinocerebellar ataxia (SCA), in whom changes in mobility can be subtle and varied. We hypothesized that a machine learning analytic system might complement traditional clinician-rated measures of gait. Our objective was to use a video-based assessment of gait dispersion to compare the effects of troriluzole with placebo on gait quality in adults with SCA. Participants with SCA underwent gait assessment in a phase 3, double-blind, placebo-controlled trial of troriluzole (NCT03701399). Videos were processed through a deep learning pose extraction algorithm, followed by the estimation of a novel gait stability measure, the Pose Dispersion Index, quantifying the frame-by-frame symmetry, balance, and stability during natural and tandem walk tasks. The effects of troriluzole treatment were assessed in mixed linear models, participant-level grouping, and treatment group-by-visit week interaction adjusted for age, sex, baseline modified Functional Scale for the Assessment and Rating of Ataxia (f-SARA), and time since diagnosis. From 218 randomized participants, 67 and 56 participants had interpretable videos of a tandem and natural walk attempt, respectively. At Week 48, individuals assigned to troriluzole exhibited significant (p=0.010) improvement in tandem walk Pose Dispersion Index versus placebo {adjusted interaction coefficient: 0.584 [95% confidence interval (CI) 0.137 to 1.031]}. A similar, nonsignificant trend was observed in the natural walk assessment [coefficient: 1.198 (95% CI-1.067 to 3.462)]. Further, lower baseline Pose Dispersion Index during the natural walk was significantly (p=0.041) associated with a higher risk of subsequent falls [adjusted Poisson coefficient:-0.356 [95% CI-0.697 to-0.014)]. Using this novel approach, troriluzole-treated subjects demonstrated improvement in gait as compared to placebo for the tandem walk. Machine learning applied to video-captured gait parameters can complement clinician-reported motor assessment in adults with SCA. The Pose Dispersion Index may enhance assessment in future research. TRIAL REGISTRATION-CLINICALTRIALS. NCT03701399.

Sex Differences Between Female and Male Individuals in Antipsychotic Efficacy and Adverse Effects in the Treatment of Schizophrenia.

Antipsychotics are core treatments for people living with psychotic disorders. Understanding individualised factors that influence both efficacy and adverse responses will improve outcomes. The objective of this study was to examine sex differences in antipsychotic-related efficacy and tolerability. This was a secondary analysis of data from phase 1 and 1a of Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE); participants with schizophrenia were randomly assigned to double-blinded treatment with oral olanzapine, quetiapine, risperidone, ziprasidone or perphenazine. Measures included Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions (CGI) scale and Calgary Depression Rating Scale, as well as self-reported side effects, medication compliance, dosage, weight measurements and various blood parameters. There were 1460 participants including 380 female and 1080 male individuals. Very few differences existed between male and female participants in response, adverse reactions, compliance or antipsychotic dosage. However, significantly more female participants than male participants reported constipation (28% vs 16%), dry mouth (50% vs 38%), gynecomastia/galactorrhea (11% vs 3%), incontinence/nocturia (16% vs 8%) and self reportedweight gain (37% vs 24%) [all p < 0.001]. Within the risperidone treatment group, there was a significantly greater increase in prolactin levels (p < 0.001) among female participants (n = 61) than male participants (n = 159). No overall differences in clinician-rated measures, weight gain or otherlaboratory indicators were found. While overall sex differences were limited across efficacy and tolerability for antipsychotic treatment, there were some specific findings with risperidone. Further examination of sex differences within antipsychotic trials will be important to improve efficacy and reduce adverse responses across as well as individualising care for people with schizophrenia.

Validity of the DSM-5 Mixed Features Specifier Interview.

To examine the reliability and validity of a semi-structured interview assessing the features of the DSM-5 mixed features specifier. Our goal was to develop an instrument that could be used for both diagnostic and severity measurement purposes. Four hundred fifty-nine psychiatric patients in a depressive episode were interviewed by a trained diagnostic rater who administered semi-structured interviews including the DSM-5 Mixed Features Specifier Interview (DMSI). We examined the inter-rater reliability and psychometric properties of the DMSI. The patients were rated on clinician rating scales of depression, anxiety, and irritability, and measures of psychosocial functioning, suicidality, and family history of bipolar disorder. The DMSI had excellent joint-interview interrater reliability. More than twice as many patients met the DSM-5 mixed features specifier criteria during the week before the assessment than for the majority of the episode (9.4% vs. 3.9%). DMSI total scores were more highly correlated with a clinician-rated measure of manic symptoms than with measures of depression and anxiety. More patients with bipolar depression met the mixed features specifier than patients with MDD. Amongst patients with MDD, those with mixed features more frequently had a family history of bipolar disorder, were more frequently diagnosed with anxiety disorders, attention deficit disorder, and borderline personality disorder, more frequently had attempted suicide, and were more severely depressed, anxious, and irritable. The DMSI is a reliable and valid measure of the presence of the DSM-5 mixed features specifier in depressed patients as well as the severity of the features of the specifier.

Validation of the rating scales for negative symptoms: new strategies

AbstractNegative symptoms of schizophrenia are linked with poor functioning and quality of life. Therefore, appropriate measurement tools to assess negative symptoms are needed. The NIMH-MATRICS Consensus defined five domains for negative symptoms. We used the COSMIN guidelines for systematic reviews to evaluate the quality of psychometric data of negative symptom scales as Clinician-Rated Outcome Measure (ClinROM). COSMIN assesses risk of bias, so called updated criteria of measurement properties, a modified GRADE approach and a final judgement on the rating scale. In the lecture the process will be described using the Brief Negative Symptom Scale and the Clinical Assessment Interview for Negative Symptoms (CAINS) as examples.Disclosure of InterestNone Declared

Digital assessment of speech in Huntington disease.

Speech changes are an early symptom of Huntington disease (HD) and may occur prior to other motor and cognitive symptoms. Assessment of HD commonly uses clinician-rated outcome measures, which can be limited by observer variability and episodic administration. Speech symptoms are well suited for evaluation by digital measures which can enable sensitive, frequent, passive, and remote administration. We collected audio recordings using an external microphone of 36 (18 HD, 7 prodromal HD, and 11 control) participants completing passage reading, counting forward, and counting backwards speech tasks. Motor and cognitive assessments were also administered. Features including pausing, pitch, and accuracy were automatically extracted from recordings using the BioDigit Speech software and compared between the three groups. Speech features were also analyzed by the Unified Huntington Disease Rating Scale (UHDRS) dysarthria score. Random forest machine learning models were implemented to predict clinical status and clinical scores from speech features. Significant differences in pausing, intelligibility, and accuracy features were observed between HD, prodromal HD, and control groups for the passage reading task (e.g., p < 0.001 with Cohen'd = -2 between HD and control groups for pause ratio). A few parameters were significantly different between the HD and control groups for the counting forward and backwards speech tasks. A random forest classifier predicted clinical status from speech tasks with a balanced accuracy of 73% and an AUC of 0.92. Random forest regressors predicted clinical outcomes from speech features with mean absolute error ranging from 2.43-9.64 for UHDRS total functional capacity, motor and dysarthria scores, and explained variance ranging from 14 to 65%. Montreal Cognitive Assessment scores were predicted with mean absolute error of 2.3 and explained variance of 30%. Speech data have the potential to be a valuable digital measure of HD progression, and can also enable remote, frequent disease assessment in prodromal HD and HD. Clinical status and disease severity were predicted from extracted speech features using random forest machine learning models. Speech measurements could be leveraged as sensitive marker of clinical onset and disease progression in future clinical trials.

Decisional Conflict Regarding Disease-Modifying Treatment Choices Among Patients with Mid-Stage Relapsing-Remitting Multiple Sclerosis.

Shared decision-making is critical in multiple sclerosis (MS) due to the uncertainty of the disease trajectory over time and the large number of treatment options with differing efficacy, safety and administration characteristics. The aim of this study was to assess patients' decisional conflict regarding the choice of a disease-modifying therapy and its associated factors in patients with mid-stage relapsing-remitting multiple sclerosis (RRMS). A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS (2017 revised McDonald criteria) and disease duration of 3 to 8 years were included. The level of uncertainty experienced by a patient when faced with making a treatment choice was assessed using the 4-item Decisional Conflict Scale. A battery of patient-reported and clinician-rated measures was administered to obtain information on symptom severity, illness perception, illness-related uncertainty, regret, MS knowledge, risk taking behavior, preferred role in the decision-making process, cognition, and self-management. Patients were recruited during routine follow-up visits and completed all questionnaires online using electronic tablets at the hospital. A multivariate logistic regression analysis was conducted. A total of 201 patients were studied. Mean age (Standard deviation) was 38.7 (8.4) years and 74.1% were female. Median disease duration (Interquartile range) was 6.0 (4.0-7.0) years. Median EDSS score was 1.0 (0-2.0). Sixty-seven (33.3%) patients reported a decisional conflict. These patients had lower MS knowledge and more illness uncertainty, anxiety, depressive symptoms, fatigue, subjective symptom severity, a threatening illness perception, and poorer quality of life than their counterparts. Lack of decisional conflict was associated with MS knowledge (Odds ratio [OR]=1.195, 95% CI 1.045, 1.383, p=0.013), self-management (OR=1.049, 95% CI 1.013, 1.093, p=0.018), and regret after a healthcare decision (OR=0.860, 95% CI 0.756, 0.973, p=0.018) in the multivariate analysis. Decisional conflict regarding the selection of a disease-modifying therapy was a common phenomenon in patients with mid-stage RRMS. Identifying factors associated with decisional conflict may be useful to implement preventive strategies that help patients better understand their condition and strengthen their self-management resources.

Link between post-stroke psychopathology and scope-of-action awareness.

Epidemiological research has failed to confirm laterality of lesion site as a neurobiological source of post-stroke psychopathology. However, acquired communication disorders have proved to be a key risk factor for depression, apart from established parameters such as pre-stroke psychopathology and physical immobility. The present work examines a new predictor of post-stroke psychopathology: psychological flexibility. This concept describes an accepting attitude toward irreversible loss following stroke while using remaining agency. Overall, 70 individuals engaged in a cross-sectional study conducted in the subacute stage after an ischemic or hemorrhagic event, a period with elevated prevalence of mental-health problems (2 weeks to 6 months after stroke). Outcomes included standardized self-report and clinician-rated measures of depression, anxiety disorders, and general psychopathology (Beck Depression Inventory; Hospital Anxiety and Depression Scale; ICD-10 Symptom Rating; Hamilton Depression Rating Scale) alongside lack of psychological flexibility (Acceptance and Action Questionnaire II). The study design controlled for pre-stroke psychopathology and physical immobility (Barthel Index). Partial correlation analyses revealed a significant medium-to-large association between the entire set of clinical outcomes and lack of psychological flexibility (r ⩽ 0.62, p < 0.001). In moderator analyses, the magnitude of this association did not vary significantly with diagnosis of acquired communication disorders (i.e., aphasia, apraxia of speech or dysarthria; separately or combined). The current results demonstrate a substantial link between post-stroke psychopathology and psychological flexibility. This finding opens new avenues for research on depression and other mental-health problems in stroke survivors with and without acquired communication disorders. www.drks.de; identifier: DRKS00031204.

Patient-reported outcome measures in early psychosis: Evaluating the psychometric properties of the single-item self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada.

Patient-reported outcome measures (PROMs) provide valuable information and promote shared decision-making but are infrequently used in psychosis. Self-rated Health (SRH) and Self-rated Mental Health (SRMH) are single-item PROMs in which respondents rate their health and mental health from 'poor' to 'excellent'. We examined the psychometric properties of the SRH and SRMH in early psychosis services in Chennai, India and Montreal, Canada. Assessments were completed in Tamil/English in Chennai and French/English in Montreal. Test-retest reliability included data from 59 patients in Chennai and Montreal. Criterion validity was examined against clinician-rated measures of depression, anxiety, positive and negative symptoms, and a quality-of-life PROM for 261 patients in Chennai and Montreal. SRH and SRMH had good to excellent test-retest reliability (ICC >0.63) at both sites and in English and Tamil (but not French). Results for criterion validity were mixed. In Montreal, low SRH was associated with not being in positive symptom remission, and poorer functioning and quality of life. SRH was associated only with functioning in Chennai. No associations were found for SRMH in Montreal. In Chennai, low SRMH was associated with not being in positive symptom remission and poorer functioning. Patient-reported outcome measures may perform differently across contexts as a potential function of variations in sociodemographics, illness characteristics/course, understandings of health/mental health, and so forth. More work is needed to understand if discrepancies between PROMs and CROMs indicate poor validity of PROMs or 'valid' differences between patient and clinician perceptions. Our work suggests that single-item PROMs can be feasibly integrated into clinical settings.

Do latent profiles of self-reported anxiety, depression, and PTSD map onto clinician ratings? An examination with intimate partner violence survivors

ObjectiveStudies exploring latent profiles of mental health in trauma survivors have largely relied on self-report, making it unclear whether these patterns correspond with clinician-assessed psychopathology. The purpose of the current study was to examine latent profiles of self-reported PTSD, depression, and anxiety in a sample of 387 women who had experienced intimate partner violence (IPV) and investigate whether profiles mapped onto clinician-rated measures of the same outcomes. MethodParticipants completed a series of semi-structured interviews and self-report measures assessing PTSD, depression, and anxiety. ResultsLatent profile analyses revealed a 3-profile solution characterized by Low (22.48 %), Moderate (37.98 %), and High (39.53 %) self-reported symptomology. Clinician ratings were significant predictors of membership in the low vs. moderate vs. high symptomology profiles. However, normalized means showed discrepancies between self-report and clinician assessment regarding which issue was rated most severe. ConclusionsResults suggest that while latent modeling approaches relying on self-report may adequately approximate common underlying patterns of psychopathology, they have limitations in identifying which disorders are most salient for clinical intervention.

Depression and anxiety have distinct and overlapping language patterns: Results from a clinical interview.

Depression has been associated with heightened first-person singular pronoun use (I-usage; e.g., "I," "my") and negative emotion words. However, past research has relied on nonclinical samples and nonspecific depression measures, raising the question of whether these features are unique to depression vis-à-vis frequently co-occurring conditions, especially anxiety. Using structured questions about recent life changes or difficulties, we interviewed a sample of individuals with varying levels of depression and anxiety (N = 486), including individuals in a major depressive episode (n = 228) and/or diagnosed with generalized anxiety disorder (n = 273). Interviews were transcribed to provide a natural language sample. Analyses isolated language features associated with gold standard, clinician-rated measures of depression and anxiety. Many language features associated with depression were in fact shared between depression and anxiety. Language markers with relative specificity to depression included I-usage, sadness, and decreased positive emotion, while negations (e.g., "not," "no"), negative emotion, and several emotional language markers (e.g., anxiety, stress, depression) were relatively specific to anxiety. Several of these results were replicated using a self-report measure designed to disentangle components of depression and anxiety. We next built machine learning models to detect severity of common and specific depression and anxiety using only interview language. Individuals' speech characteristics during this brief interview predicted their depression and anxiety severity, beyond other clinical and demographic variables. Depression and anxiety have partially distinct patterns of expression in spoken language. Monitoring of depression and anxiety severity via language can augment traditional assessment modalities and aid in early detection. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Exposure-Based Cognitive–Behavioral Therapy for Youth with Severe Irritability: Feasibility and Preliminary Efficacy

ABSTRACT Objective Clinically impairing irritability and temper outbursts are among the most common psychiatric problems in youth and present transdiagnostically; however, few mechanistically informed treatments have been developed. Here, we test the acceptability, feasibility, and preliminary efficacy of a novel exposure-based treatment with integrated parent management skills for youth with severe irritability using a randomized between-subjects multiple baseline design. Method N = 41 patients (Age, Mean (SD) = 11.23 years (1.85), 62.5% male, 77.5% white) characterized by severe and impairing temper outbursts and irritability were randomized to different baseline observation durations (2, 4, or 6 weeks) prior to active treatment; 40 participants completed the 12 session treatment of exposure-based cognitive–behavioral therapy for irritability with integrated parent management skills. Masked clinician ratings were acquired throughout baseline and treatment phases, as well as 3- and 6-months post-treatment. To examine acceptability and feasibility, drop-out rates and adverse events were examined. Primary clinical outcome measures included clinician-administered measures of irritability severity and improvement. Secondary clinical outcome measures included multi-informant measures of irritability, depression, anxiety, and attention-deficit/hyperactivity disorder symptoms. Results No patients dropped out once treatment began, and no adverse events were reported. Irritability symptoms improved during the active phase of treatment across all measurements (all βs > –0.04, ps < .011, Cohen’s d range: –0.33 to –0.98). Treatment gains were maintained at follow-up (all βs (39) < –0.001, ps > .400). Sixty-five percent of patients were considered significantly improved or recovered post-treatment based on the primary clinician-rated outcome measure. Conclusions Results support acceptability, feasibility, and preliminary efficacy of this novel treatment for youth with severe irritability. Limitations and future directions are also discussed.

Association and interaction between clinician-rated measures of depression and anxiety with heart rate variability in elderly patients with psychiatric disorders

BackgroundOlder adults are vulnerable to comorbid depression and anxiety symptoms; however, these conditions are widely underrecognized and often untreated. Understanding their combined manifestation using objective measurements, such as clinician-rated scales and heart rate variability (HRV), can help refine the diagnosis and select a treatment strategy for geriatric patients. MethodsThis study included patients over 65 years who were mainly diagnosed with either category of depressive or anxiety disorders from the psychiatric outpatient clinic in a university hospital. A total of 114 patients met eligibility with a completed collection of electrocardiograms, the Hamilton Depression Rating Scale (HDRS; clinician-rated depression), and the Hamilton Anxiety Scale (HAS; clinician-rated anxiety) to assess the severity of symptoms. Both main and interaction effects between HDRS and HAS on HRV parameters were examined. ResultsSignificant interaction effects between clinician-rated depression and anxiety (HDRS × HAS) on HRV reduction in frequency parameters (i.e., nuLF, nuHF, LF/HF ratio) were found, which consistently indicated autonomic nervous system dysregulation. Findings imply that HRV could reflect synergistic effects of comorbid depressive and anxiety symptoms, perhaps due to the amplification of individual symptoms in geriatric patients. ConclusionsThe results imply that using objective measurements can improve diagnostic accuracy, particularly in geriatric patients with comorbid status, and the normalization of the autonomic nervous system might be a candidate target for prevention and treatment.