Diagnostic Inventory Research Articles

Validity of a brief screening instrument—CRAFFT in a multiethnic Asian population

Aim To validate the CRAFFT screening test, against the DSM IV Axis 1-based diagnostic inventory in a population of adolescents and young adult males in Singapore. Methods The 23,248 participants belonged to a cohort of males who had undergone a medical examination prior to enlistment for military service. This study took place between August 2004 and August 2005. Subjects underwent a two-stage assessment and were administered the CRAFFT questionnaire and the Composite International Diagnostic Interview (CIDI). Results The mean age of the subjects was 19 years (range, 16 to 26 years). The CRAFFT showed moderately high levels of internal consistency (Cronbach's α = 0.73). The optimum cutoff point for drug-related disorder either abuse or dependence and alcohol-related disorder either abuse or dependence criterions were found at CRAFFT score of 1 or higher. Conclusion The CRAFFT test is a valid means of screening adolescents for substance-related disorders in a multiethnic population of adolescent and young adult males.

Psychologic Distress and Maladaptive Coping Styles in Patients With Severe vs Moderate Asthma

Though several biologic factors have been suggested to play a role in the development and persistence of severe asthma, those associated with psychologic factors remain poorly understood. This study assessed levels of psychologic distress and a range of disease-relevant emotional and behavioral coping styles in patients with severe vs moderate asthma. Eighty-four patients (50% women, mean [M] age 46 years) with severe (n = 42) and moderate (n = 42) asthma were recruited. Severe asthma was defined according to American Thoracic Society criteria. Patients underwent demographic and medical history interviews and pulmonary function and allergy testing. Patients also completed questionnaires measuring asthma symptoms and the Millon Behavioral Medicine Diagnostic Inventory, which assesses psychologic distress and emotional/behavioral coping factors that influence disease progression and treatment. After adjustment for covariates and applying a correction factor that reduced the significant P level to < .01, patients with severe vs moderate asthma reported experiencing more psychologic distress, including worse cognitive dysfunction (F = 6.72, P < .01) and marginally worse anxiety-tension (F = 4.02, P < .05). They also reported worse emotional coping (higher illness apprehension [F = 9.57, P < .01], pain sensitivity [F = 10.65, P < .01], future pessimism [F= 8.53, P < .01], and interventional fragility [F = 7.18, P < .01]), and marginally worse behavioral coping (more functional deficits [F = 5.48, P < .05] and problematic compliance [F = 4.32, P < .05]). Patients with severe asthma have more psychologic distress and difficulty coping with their disease, both emotionally and behaviorally, relative to patients with moderate asthma. Future treatment studies should focus on helping patients with severe asthma manage distress and cope more effectively with their illness, which may improve outcomes in these high-risk patients.

Sustained Improvement in Cognitive and Emotional Status of Apneic Patients After Prolonged Treatment with Positive Airway Pressure

Obstructive sleep apnea-hypopnea syndrome (OSAH) is associated with impairment of cognitive functions and disturbances in emotional status. The aim of this study was to objectively evaluate the benefits of prolonged and sustained treatment for OSAH at two sleep centers serving rural community hospitals. Fifty-six patients diagnosed with OSAH syndrome underwent Cognistat, Beck Depression Inventory (BDI) and Millon Behavioral Medicine Diagnostic Inventory (MBMD) testing before initiation of treatment. Repeated testing after six months of therapy with positive airway pressure (PAP) was performed. Significant improvements were noted in the BDI scale scores and a reduction in the MBMD scores reflected initial abnormal clinical personal symptoms that improved with treatment. MBMD analysis showed subjects with fewer symptoms of anxiety post baseline, which were sustained at 6 months post-treatment. Memory function improved as reflected by performance on the Cognistat. Women were observed to have a higher post-treatment BDI and younger patients appeared to have more shifts for improvement than older subjects in depressive symptomatology. These results indicate that prolonged and sustained PAP therapy is effective in restoring some of the deficiencies in patients with OSAH, particularly in terms of memory, depression, anxiety and increased psychological pathology.

Impaired inhibitory control is associated with higher-order repetitive behaviors in autism spectrum disorders

Impairments in executive cognitive control, including a reduced ability to inhibit prepotent responses, have been reported in autism spectrum disorders (ASD). These deficits may underlie patterns of repetitive behaviors associated with the disorder. Eighteen individuals with ASD and 15 age- and IQ-matched healthy individuals performed an antisaccade task and a visually guided saccade control task, each with gap and overlap conditions. Measures of repetitive behaviors were obtained using the Autism Diagnostic Inventory-Revised (ADI-R) and examined in relation to neurocognitive task performance. Individuals with an ASD showed increased rates of prosaccade errors (failures to inhibit prepotent responses) on the antisaccade task regardless of task condition (gap/overlap). Prosaccade error rates were associated with the level of higher-order (e.g. compulsions, preoccupations) but not sensorimotor repetitive behaviors in ASD. Neurocognitive disturbances in voluntary behavioral control suggest that alterations in frontostriatal systems contribute to higher-order repetitive behaviors in ASD.

The psychological competitive ability of Japanese national synchronized swimmers

The purpose of this study was to investigate the psychological trait of Japanese national synchronized swimmers at different levels of performance. We analyzed the scales of psychological competitive ability for synchronized swimmers of national A team (22.3 ± 2.2 yrs, n = 12), national B team (18.0 ± 2.2 yrs, n = 8), junior national team (15.8 ± 0.4 yrs, n = 8) and junior elite team (12.7 ± 0.7 yrs, n = 14), by using the Diagnostic Inventory Psychological Competitive Ability test (DIPCA.3.). Results revealed that synchronized swimmers were significantly high in cooperation, patience and volition for self-realization, and significantly low in their ability to relax, self-confidence and decision-making ability as compared to Olympic female athletes. It is suggested that the psychological competitive ability of synchronized swimmers were reflected by specific factors of synchronized swimming, which is judged as a closed-skill, synchronized sport and a large repetitive drill. Although world class synchronized swimmers had a low ability to relax, it is suggested they can perform better under high pressure and tension. The national A team was higher in patience and aggressiveness than the lower level groups. Therefore, patience and aggressiveness are important abilities that are required to be a world top-level athlete. In addition, younger swimmers need to gain experience by participating in international competitions and national team training camps at a young age in order to improve their psychological competitive ability.

Students' perceptions of learning environment in an Indian medical school

BackgroundLearning environment in any medical school is found to be important in determining students' academic success. This study was undertaken to compare the perceptions of first year and clinical phase students regarding the learning environment at Melaka Manipal Medical College (MMMC) (Manipal Campus) and also to identify the gender wise differences in their perceptions.MethodsIn the present study, the Dundee Ready Education Environment Measure (DREEM) inventory was used. DREEM was originally developed at Dundee and has been validated as a universal diagnostic inventory for assessing the quality of educational environment. In the present study, DREEM was administered to undergraduate medical students of first year (n = 118) and clinical phase (n = 108) and the scores were compared using a nonparametric test.ResultsAmong the two batches, first year students were found to be more satisfied with the learning environment at MMMC (as indicated by their higher DREEM score) compared to the clinical batch students. Gender wise, there was not much difference in the students' perceptions.ConclusionThe present study revealed that both groups of students perceived the learning environment positively. Nevertheless, the study also revealed problematic areas of learning environment in our medical school which enabled us to adopt some remedial measures.

Analysis of HIV Medication Adherence in Relation to Person and Treatment Characteristics Using Hierarchical Linear Modeling

The purpose of this investigation was to consider person characteristics, treatment level variables, and illicit drug use to help explain the HIV antiviral adherence patterns of a community-based, non-drug-treatment-seeking sample of men who have sex with men (MSM). Adherence data were gathered for 300 MSM eight times over the course of 1 year using electronic monitoring. Treatment and person level characteristics were assessed at baseline assessment using computer-administered surveys, and drug usage was established via a diagnostic inventory. These longitudinal data were analyzed via Hierarchical Linear Modeling. The sample was diverse in terms of age and race/ethnicity. Across the span of the year in which the participants were assessed, adherence rates were relatively stable and high (means: 82% to 90%) at each time point and remained relatively stable across the yearlong investigation. Lower adherence rates were evident among those who were drug users, black identified (in terms of race), older, and by pill burden. Individuals on HIV antiretroviral therapy demonstrated consistent although not optimal adherence rates when assessed during the course of a year. The significance of numerous person level factors such as age, race, and drug use suggest that adherence to treatment may in part be impacted by the circumstances that the individual brings to the treatment behavior, and suggests interventions that delve beyond the behavioral to consider and address life social and intrapersonal circumstances that may interfere with adherence behaviors.

Screening for Depressive Symptoms

OBJECTIVE—We determined the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) against the DSM-IV–based diagnostic inventory, Schedule for Clinical Assessment in Neuropsychiatry (SCAN), in a multiethnic sample of adult subjects with diabetes attending a diabetes center in Singapore. RESEARCH DESIGN AND METHODS—A total of 522 subjects (74.7% Chinese, 11.1% Malay, and 14.2% Indian) completed culturally adapted versions of the CES-D; 291 subjects were administered the SCAN inventory. RESULTS—The CES-D (cutoff score 16) showed high negative predictive values of more than 90% in all three ethnic groups. The prevalence of depressive symptoms (CES-D) and depression (SCAN) was significantly different between the Chinese and Indian subjects (CES-D 27.4 vs. 43.2%, P = 0.006); (SCAN 15.0 vs. 31.1%, P = 0.01). CONCLUSIONS—The CES-D proved to be a reliable instrument for identifying patients with depressive symptoms in the multiethnic setting of this study.

行動科学に基づく体育プログラムが大学新入生の健康度・生活習慣に及ぼす効果：Project FYPE

The purpose of this study was to investigate the effects of a physical education program based on behavioral science, which includes homework (project First-Year Physical Education: FYPE) on the health level and lifestyle of first-year college students. The study participants comprised 1,090 male college freshmen from an institute of technology in the Kinki area of Japan (intervention group, N=515; non-intervention group, N=575). The programs that were common to all the classes were as follows (the numbers correspond to the sequence of activities of the program). 1: guidance, 2–4: sports activity, 5: lecture (health science), 6–8: sports activity, 9: lecture (health science), 10–12: sports activity, and 13: summary of the class. Health behavior promotion programs were intended only for the intervention group. The programs comprised (1) education on behavioral change skills (self-monitoring, goal setting, self-reinforcement, and so on), and (2) out-of-class practical assignments such as physical education homework. We evaluated the health level and life habits of the students by using the Diagnostic Inventory of Health and Life Habit (DIHAL; Tokunaga, 2003) and evaluated their physical activity level using the Physical Activity Assessment Scale (PAAS; Wakui & Suzuki, 1997). As a result, significant intervention effects were observed with regard to the DIHAL scales for “Eating,” “Resting,” and the “Sum of lifestyle,” and with regard to the subscales of “Level of physical health,” “Eating regularly,” “Relaxing,” “Sleeping regularly,” and the “Fulfillment level of sleep.” The PAAS revealed a significant intervention effect with regard to “Daily activity,” which indicates the relatively light physical activities in daily life; however, this was not observed with regard to the DIHAL scale of “Exercise.” These results clearly indicate that physical education programs based on behavioral science and including homework can improve the overall lifestyle (namely, physical activity, eating, and resting) of first-year college students.

Screening for Parental Substance Abuse in Pediatric Primary Care

Parental alcohol and drug abuse may have significant deleterious effects on children. Although screening in the pediatric office is recommended, few screening measures have been evaluated for use in this setting. We sought to validate a 2-question screening tool for parental substance abuse. A total of 216 caregivers bringing children to a primary care clinic completed a brief screening for psychosocial problems that contained 2 substance abuse questions. To assess reliability and validity of the questionnaire, recruited caregivers returned within 2 months to complete a computerized study protocol that contained the brief screening questions and the substance abuse sections of the Composite International Diagnostic Inventory (CIDI). Sixteen percent of caregivers acknowledged a problem with drugs or alcohol on the CIDI. A "yes" response to either screening question had a sensitivity of 29%, specificity of 95%, positive predictive value of 17%, and negative predictive value of 98% for drug abuse. Values were 13%, 96%, 33%, and 87%, respectively for predicting alcohol abuse. Brief screening in pediatric primary care can identify many, but not all, parents who may need intervention for problems with drugs and/or alcohol. Children should benefit from such screening if it enables parents to acknowledge and receive treatment for substance abuse. Further research is needed to assess whether sensitivity of screening can be improved without sacrificing brevity.

Vineland Survey: Self-administered Checklist Format for Teachers of Young Children in Rehabilitation

We examined the feasibility of administering the Vineland Adaptive Behavior Survey Edition in checklist format to teachers as a means of obtaining more useful teacher ratings of low functioning young children. Teachers completed the Vineland Classroom and Survey Editions as checklists to rate 36 preschoolers (ages 4–1 to 5–11 years; 22 male, 14 female) in a rehabilitation day treatment setting. The Survey Edition was administered to parents using the standard semi-structured interview. The Classroom Edition yielded higher skill estimates than did the two Survey Editions (p < 0.001), which did not differ significantly from each other. The individually administered Diagnostic Inventory for Screening Children (n = 27) provided evidence of external validity of the self-administered Survey Edition format for teachers. The results support use of the Survey Edition in checklist format for teachers who are rating skills of young children with developmental disabilities.

Diagnosing Major Depressive Disorder XII

This paper is the final one in our series examining the DSM-IV diagnostic criteria for major depressive disorder. The data collected were part of the Rhode Island Methods to Improve Diagnostic Assessment and Services project, a unique integration of a research assessment protocol into a community-based clinical practice. We were able to examine a number of psychometric and conceptual issues in the diagnosis of depression because we modified the diagnostic interview to inquire about all diagnostic criteria, as well as additional associated features, of all patients. The results reported in the papers published earlier in the series suggested that some changes in the diagnostic criteria might be warranted. However, before changes are made to the diagnostic nomenclature, the results of any single study should be replicated. The cost of conducting this type of research is high, thereby reducing the likelihood of replication. As part of the Methods to Improve Diagnostic Assessment and Services project, we developed the Diagnostic Inventory for Depression (DID), a self-report scale that was specifically designed to assess the DSM-IV diagnostic criteria for major depressive disorder; thus, this scale could potentially be used to study many of the same questions examined in the present series, though at a fraction of the cost. In the present report, we used the DID to examine questions that were addressed in three of the prior reports in this series. The results of the present analysis based on the DID replicated the previously reported findings based on the SCID. This suggests that a self-report measure such as the DID could be used in other settings to examine the issues studied in the present series of papers, thereby facilitating the compilation of a more substantial literature upon which decisions regarding criteria modification could be based.

Development and testing of a Clinical Learning Environment Diagnostic Inventory for baccalaureate nursing students

Aim. This paper reports the development and testing of the psychometric properties of the Clinical Learning Environment Diagnostic Inventory for baccalaureate nursing students. Background. The quality of the clinical learning environment is an essential factor in determining the quality of nursing students' clinical experience. It is also well-recognized that the clinical setting can be a source of stress and anxiety for students. To design an optimal clinical learning environment for students, instruments based on the cognitive and socio-emotional aspects of the learning process are necessary. Method. The hypothetical construct of the clinical learning environment was derived from a comprehensive review of the literature, including experiential learning theory and the epistemology of practice. Developing the instrument involved the collection of items through semi-structured interviews, assessing content validity and determining the scaling. After a pilot study, the instrument was tested with 312 undergraduate students and 157 preceptors between September and December 2004. The factor structure was determined by exploratory factor analysis. Results. Exploratory factor analysis produced a five-factor solution that was similar to the hypothetical model. Cronbach's alpha internal consistency reliability coefficients ranged from 0.65 to 0.77 across the five factors. Three-week test-retest reliability coefficients ranged from 0.59 to 0.74. Criterion-related validity and construct validity were estimated by the correlation between the Clinical Learning Environment Diagnostic Inventory and appropriate other instruments and a set of comparison data obtained from the students and preceptors. Conclusion. The findings yielded acceptable estimates of reliability and validity of the Clinical Learning Environment Diagnostic Inventory. Therefore, this instrument is considered useful for assessing learning environments in clinical settings.

Diagnosing Major Depressive Disorder VI

Considerable research has evaluated biological and psychological tests for various psychiatric disorders; however, few objective tests are included in DSM-IV as diagnostic criteria. It was recently suggested that existing tests are insufficiently accurate to be included as diagnostic criteria. While it is true that there are limitations in the sensitivity and/or specificity of such tests, this should not rule them out as effective diagnostic criteria. Studies examining the diagnostic efficiency of the DSM criteria sets demonstrate that the individual criteria vary in their sensitivity and specificity. In the present article, we suggest that the same standard should be applied to the evaluation of objective tests. That is, we suggest changing the perspective used to evaluate the performance of biological and psychological measures from the traditional one examining them as diagnostic tests to one in which these measures are evaluated as diagnostic criteria. To our knowledge, no previous investigators have compared the psychometric performance of an objective test to the psychometric performance of the DSM-IV symptom criteria. The recent report from the committee to develop a research agenda for the initial planning phase for DSM-V discussed the use of self-report symptom scales as possible diagnostic criteria in nonpsychiatric settings. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined the performance of a self-report depression questionnaire as a diagnostic criterion for major depressive disorder (MDD). We compared the performance of the Diagnostic Inventory for Depression to the performance of the DSM-IV MDD symptom criteria in 1138 psychiatric outpatients. The results indicated that the diagnostic efficiency of the Diagnostic Inventory for Depression was similar to the loss of interest or pleasure criterion, and superior to all of the remaining DSM-IV MDD symptom criteria except low mood. We discuss issues related to the possible use of a self-administered depression symptom scale as a diagnostic criterion.

Incremental Validity of the MMPI-2 PSY-5 Scales in Assessing Self-Reported Personality Disorder Criteria

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Personality Psychopathology-Five (PSY-5) scales were developed to measure abnormal personality symptomatology. The present study examines the incremental validity of the PSY-5 scales beyond the clinical and content scales in assessing criteria associated with personality disorders. The current sample includes 240 male and 407 female clients from private practice settings who completed the MMPI-2 and the Multiaxial Diagnostic Inventory (MDI), a self-report checklist of Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) symptoms. Six of the MDI personality disorder scales, conceptually related to the PSY-5 scales, are used as criteria. Hierarchical regression analyses determine the incremental validity of each PSY-5 scale. In most analyses, PSY-5 scales add a significant increment of variance to the clinical and content scales. Implications of the results are discussed.

Incremental Validity of the MMPI–2 Restructured Clinical (RC) Scales in a Private Practice Sample

Building on results reported in Sellbom, Graham, and Schenk (2005), in this study, we examined the incremental validity of the newly introduced MMPI–2 (Butcher et al., 2001) Restructured Clinical (RC) scales (Tellegen et al., 2003) over both the Clinical and Content scales. Participants were 647 clients in private practice who were administered the MMPI–2 and the Multiaxial Diagnostic Inventory (Doverspike, 1990) early in therapy. The results indicate that the RC scales had acceptable internal consistency, reduced intercorrelations (compared to the Clinical scales), and promising convergent and discriminant validity. Hierarchical regression analyses revealed that the RC scales added incrementally to both the Clinical and Content scales in predicting self reported clinical symptoms. These findings suggest that the RC scales are relatively homogenous measures of core clinical constructs that can add unique information to the understanding of private practice clients above and beyond the Clinical and Content scales.

Assessing Candidate Disposition for Admission into Teacher Education: Can Just Anyone Teach?

Teacher educators understand that a “highly qualified” teacher must have more than knowledge and skills. Having the disposition or “teacher's heart” is also important. One teachers' college in Arkansas identified dispositions that were valued by its faculty, supported by research, and already existed in its program. Then instruments were selected or developed to assess the extent of each of these dispositions demonstrated by each candidate applying for admission into the teacher education program. Candidates were assessed by responses to interview questions upon entry into and exit from the teacher education program, performances during internship, and self-assessments. Data from these assessments supported a recommendation for continued accreditation from NCATE. The college will continue to conduct validity and reliability studies on the data, and a new self-assessment instrument called DISPOSE (Diagnostic Inventory for Selective Prescription on Self-Evaluation) has been developed and is currently being piloted with teacher education candidates.

Benefits of Long-Term Fibromyalgia Syndrome Treatment with a Multidisciplinary Program

Objectives: To systematically assess the effectiveness of a combination of pharmacologic and nonpharmacologic long-term treatment interventions for the fibromyalgia syndrome [FMS].Methods: Participants involved in an outpatient, one year, multidisciplinary treatment program within a health care setting were studied. After being screened for eligibility, participants in the treatment sample took part in combined standard pharmacologic treatment and non-pharmacologic treatment [including cognitive behavioral therapy/psychoeducational classes, exercise, massage, auricular therapy, microcurrent therapy, and nutritional counseling] in a case controlled manner. A control sample received standard medical care in a rheumatologist's office. Pre- versus post-treatment outcome variables of psychological symptoms and personality features, as measured by the Multiaxial Diagnostic Inventory–Revised, overall impact of FMS as measured by the Fibromyalgia Impact Questionnaire, overall health status as measured by the Shor...

Symptom Correlates of MMPI-2 Scales and Code Types in a Private-Practice Setting

The purpose of this study was to determine empirical symptom correlates of MMPI-2 (Butcher et al., 2001) scales for private-practice clients, a very understudied yet important population. We examined the scores of 240 male and 407 female clients on the Clinical scales, Content scales, Supplementary scales, and frequently occurring code types. We used a factor analyzed version of the Adult Clinical scales of the Multiaxial Diagnostic Inventory (Doverspike, 1990) as a criterion measure. The results generally indicated that the symptom correlates for the MMPI-2 scales and code types were quite similar to those that have been previously reported in other outpatient and inpatient settings. We concluded that descriptors of MMPI-2 scales and code types generated in other settings may be used when interpreting MMPI-2 profiles of private-practice clients.

Patient?Clinician Relationships and Treatment System Effects on HIV Medication Adherence

The study objectives were to determine the impact of the patient-clinician relationship on patient adherence to HIV medication, to identify which aspects of the patient-clinician relationship and the treatment system influenced adherence, and to determine which of these variables remained important when the impact of mental distress and substance abuse were considered. The design was a cross-sectional study using a sample of 120 HIV+ clinic patients. The Primary Care Assessment Survey (PCAS) assessed the clinician-patient relationship and the treatment system. The Composite International Diagnostic Inventory-Short Form (CIDI-SF) screened for mental disorders, and the Brief Substance Abuse History Form measured recent and remote substance use. Patient adherence was assessed using five markers including 3 interview-elicited self-reports, 1 medical chart review, and 1 summary score. Logistic regression analyses identified independent predictors of each adherence behavior. PCAS scores contributed to all five models, and their effects persisted when mental distress and substance abuse were considered. Adherence behaviors are explained by a variety of factors and should be assessed using multiple methods. Further study to illuminate the mechanisms of action of the clinician-patient relationship on adherence to HIV medication is warranted.