Endorsement Rates Research Articles

Assessing posttraumatic stress in military service members: Improving efficiency and accuracy.

Posttraumatic stress disorder (PTSD) is assessed across many different populations and assessment contexts. However, measures of PTSD symptomatology often are not tailored to meet the needs and demands of these different populations and settings. In order to develop population- and context-specific measures of PTSD it is useful first to examine the item-level functioning of existing assessment methods. One such assessment measure is the 17-item PTSD Checklist-Military version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993). Although the PCL-M is widely used in both military and veteran health-care settings, it is limited by interpretations based on aggregate scores that ignore variability in item endorsement rates and relatedness to PTSD. Based on item response theory, this study conducted 2-parameter logistic analyses of the PCL-M in a sample of 196 service members returning from a yearlong, high-risk deployment to Iraq. Results confirmed substantial variability across items both in terms of their relatedness to PTSD and their likelihood of endorsement at any given level of PTSD. The test information curve for the full 17-item PCL-M peaked sharply at a value of θ = 0.71, reflecting greatest information at approximately the 76th percentile level of underlying PTSD symptom levels in this sample. Implications of findings are discussed as they relate to identifying more efficient, accurate subsets of items tailored to military service members as well as other specific populations and evaluation contexts.

Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions

IntroductionHIV stigma inflicts hardship and suffering on people living with HIV (PLHIV) and interferes with both prevention and treatment efforts. Health professionals are often named by PLHIV as an important source of stigma. This study was designed to examine rates and drivers of stigma and discrimination among doctors, nurses and ward staff in different urban healthcare settings in high HIV prevalence states in India.MethodsThis cross-sectional study enrolled 305 doctors, 369 nurses and 346 ward staff in both governmental and non-governmental healthcare settings in Mumbai and Bengaluru, India. The approximately one-hour long interviews focused on knowledge related to HIV transmission, personal and professional experiences with PLHIV, instrumental and symbolic stigma, endorsement of coercive policies, and intent to discriminate in professional and personal situations that involve high and low risk of fluid exposure.ResultsHigh levels of stigma were reported by all groups. This included a willingness to prohibit female PLHIV from having children (55 to 80%), endorsement of mandatory testing for female sex workers (94 to 97%) and surgery patients (90 to 99%), and stating that people who acquired HIV through sex or drugs “got what they deserved” (50 to 83%). In addition, 89% of doctors, 88% of nurses and 73% of ward staff stated that they would discriminate against PLHIV in professional situations that involved high likelihood of fluid exposure, and 57% doctors, 40% nurses and 71% ward staff stated that they would do so in low-risk situations as well. Significant and modifiable drivers of stigma and discrimination included having less frequent contact with PLHIV, and a greater number of transmission misconceptions, blame, instrumental and symbolic stigma. Participants in all three groups reported high rates of endorsement of coercive measures and intent to discriminate against PLHIV. Stigma and discrimination were associated with multiple modifiable drivers, which are consistent with previous research, and which need to be targeted in future interventions.ConclusionsStigma reduction intervention programmes targeting healthcare providers in urban India need to address fear of transmission, improve universal precaution skills, and involve PLHIV at all stages of the intervention to reduce symbolic stigma and ensure that relevant patient interaction skills are taught.

Validation of a modified version of the PRIME screen for psychosis-risk symptoms in a non-clinical Kenyan youth sample

BackgroundThe PRIME screen is a self-administered questionnaire designed to quickly assess individuals at risk for developing a psychotic disorder. It is shorter in both length and administration time compared to the Structured Interview for Psychosis-Risk Syndromes (SIPS)—a standard instrument for psychosis prodromal risk assessment. Validation of the PRIME against the SIPS has not been reported in large non-clinical populations. MethodsA culturally modified version of the PRIME screen (mPRIME) was administered to Kenyan youth between the ages of 14 and 29. 182 completed both the SIPS and mPRIME. Validation measures (sensitivity, specificity, positive predictive value, negative predictive value) were calculated and the study sample was then broken down into true positives, false positives, and false negatives for comparison on different quantitative measures. ResultsUsing previously suggested thresholds for a positive screen, the mPRIME had a sensitivity of 40% and a specificity of 64.8% for our entire sample. Positive predictive value (PPV) and negative predictive value (NPV) were 12.3% and 89.7%, respectively. Breaking the sample down by questionnaire outcome showed that true-positive individuals scored higher on average rate and intensity of endorsement of mPRIME items compared to false-positive and false-negatives, while false-negatives on average registered disagreement on all mPRIME questionnaire items. ConclusionsThe mPRIME does not appear to be an effective screener of at-risk individuals for psychosis in our non-clinical sample. Further validation efforts in other general populations are warranted.

Caffeine Use Disorder: A Comprehensive Review and Research Agenda

Caffeine is the most commonly used drug in the world. Although consumption of low to moderate doses of caffeine is generally safe, an increasing number of clinical studies are showing that some caffeine users become dependent on the drug and are unable to reduce consumption despite knowledge of recurrent health problems associated with continued use. Thus, the World Health Organization and some health care professionals recognize caffeine dependence as a clinical disorder. In this comprehensive literature review, we summarize published research on the biological evidence for caffeine dependence; we provide a systematic review of the prevalence of caffeine dependence and rates of endorsement of clinically meaningful indicators of distress and functional impairment among habitual caffeine users; we discuss the diagnostic criteria for Caffeine Use Disorder-a condition for further study included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.); and we outline a research agenda to help guide future clinical, epidemiological, and genetic investigations of caffeine dependence. Numerous controlled laboratory investigations reviewed in this article show that caffeine produces behavioral and physiological effects similar to other drugs of dependence. Moreover, several recent clinical studies indicate that caffeine dependence is a clinically meaningful disorder that affects a nontrivial proportion of caffeine users. Nevertheless, more research is needed to determine the reliability, validity, and prevalence of this clinically important health problem.

Are the misinformed more punitive? Beliefs and misconceptions in forensic psychology

Misconceptions about psycho-legal issues are widespread and threaten the fabric of our legal system. The present study examines how misconception endorsement is related to tough-on-crime beliefs and sentencing decisions. Two hundred and fifty-six students completed a 50-item questionnaire assessing misconceptions related to forensic psychology and determined sentences in four mock-jury scenarios at the beginning and end of an introductory forensic psychology course. Misconception endorsement decreased significantly from 32% to 21%, with every subscale (police and interrogations, service provision, mental illness, memory and cognition, tough on crime) experiencing a significant decrease from pre-test to post-test. This drop in endorsement is meaningful, as misconceptions and beliefs are typically very difficult to change. Additionally, misconception endorsement was positively correlated with tough-on-crime beliefs and punitive (mock) sentencing. This study provides a valuable resource for endorsement rates of psycho-legal misconceptions and the propensity of individual misconceptions to change. It also makes a strong argument for the usefulness of psychology and law courses in reducing potentially harmful misconceptions and tough-on-crime beliefs.

Do drinking games matter? An examination by game type and gender in a mandated student sample

Background: College students who violate alcohol policies engage in riskier alcohol use and demonstrate more problems related to their use than non-violating peers. Drinking games (DG) have been linked to increased alcohol use and negative consequences. Objectives: The present study sought to assess potential differences in DG participation among mandated males and females by examining rates of endorsement, types of DG played, and how types of games are related to alcohol use and related consequences. Methods: Participant data were obtained from 154 undergraduate students mandated to receive an alcohol intervention, Results: DG players were found to have higher typical and peak blood alcohol concentrations, consume more drinks per week on average, consume more standard drinks per highest drinking occasion, and to experience a considerably greater number of alcohol-related consequences than non-players. Males endorsed greater participation in DG and cited “team” and “motor” games more often than females. “Gambling” games were endorsed equally by both sexes, but resulted in increased consequences for females only. Conclusion: Engaging in DG results in higher levels of alcohol consumption. The likelihood of consequences experienced may vary by type of DG in which individuals choose to participate, as well as by gender. Results from this study provide information that can be utilized in targeted alcohol programming efforts, not only for a high-risk population such as mandated students, but tailored to the specific needs of males and females.

Measurement invariance of DSM-IV alcohol, marijuana and cocaine dependence between community-sampled and clinically overselected studies.

To examine whether DSM-IV symptoms of substance dependence are psychometrically equivalent between existing community-sampled and clinically overselected studies. A total of 2476 adult twins born in Minnesota and 4121 unrelated adult participants from a case-control study of alcohol dependence. Life-time DSM-IV alcohol, marijuana and cocaine dependence symptoms and ever use of each substance. We fitted a hierarchical model to the data, in which ever use and dependence symptoms for each substance were indicators of alcohol, marijuana or cocaine dependence which were, in turn, indicators of a multi-substance dependence factor. We then tested the model for measurement invariance across participant groups, defined by study source and participant sex. The hierarchical model fitted well among males and females within each sample [comparative fit index (CFI) > 0.96, Tucker-Lewis index (TLI) > 0.95 and root mean square error of approximation (RMSEA) < 0.04 for all], and a multi-group model demonstrated that model parameters were equivalent across sample- and sex-defined groups (ΔCFI = 0.002 between constrained and unconstrained models). Differences between groups in symptom endorsement rates could be expressed solely as mean differences in the multi-substance dependence factor. Life-time substance dependence symptoms fitted a dimensional model well. Although clinically overselected participants endorsed more dependence symptoms, on average, than community-sampled participants, the pattern of symptom endorsement was similar across groups. From a measurement perspective, DSM-IV criteria are equally appropriate for describing substance dependence across different sampling methods.

Premonitory urges for tics in adult patients with Tourette syndrome

Objective: Patients with Tourette syndrome (TS) often report characteristic sensory experiences, also called premonitory urges (PUs), which precede tic expression and have high diagnostic relevance. This study investigated the usefulness of a scale developed and validated in children and adolescents–the Premonitory Urge for Tics Scale (PUTS, Woods et al., 2005 [13])–for the assessment of PUs in adult patients with TS. Method: Standard statistical methods were applied to test the psychometric properties of the PUTS in 102 adult TS outpatients recruited from two specialist clinics in the United Kingdom. Results: The PUTS showed good acceptability and endorsement rates, with evenly distributed scores and low floor and ceiling effects. Item-total correlations were moderate to strong; PUTS total scores were significantly correlated with quantitative measures of TS severity. The PUTS showed excellent internal consistency reliability (Cronbach’s alpha=0.85) and Spearman’s correlations demonstrated satisfactory convergent and discriminant validity. Conclusions: Although originally devised to assess urges to tic in young patients with TS, the PUTS demonstrated good psychometric properties in a large sample of adults recruited at specialist TS clinics. This instrument is therefore recommended for use across the life span as a valid and reliable self-report measure of sensory experiences accompanying tic expression.

Supports and barriers to higher education and employment for individuals diagnosed with mental illness

OBJECTIVE: This study examined supports and barriers to higher education and employment based on quantitative and qualitative reports of individuals diagnosed with mental illness who were enrolled in a program that addressed higher education and employment goals. PARTICIPANTS: Forty-eight adult participants with various mental health diagnoses. METHODS: A one-group posttest quantitative survey design and qualitative focus groups were used. RESULTS: The mean number of supports for higher education was 9.8 and for employment was 6.2. Quantitative supports with the highest endorsement rates reflected a combination of supports internal and external to the individual. The qualitative data reflected supports primarily external to the individual. The mean number of barriers for higher education was 4.8 and for employment was 4.25. Barriers common to both higher education and employment in the quantitative and qualitative data reflected internal barriers such as fears and anxieties, lost motivation and inability to concentrate. CONCLUSIONS: Quantitative and qualitative results demonstrate that substantial internal and external supports and barriers exist for individuals diagnosed with mental illness with goals of higher education and employment. Individuals would benefit from an approach that is customized and includes an evaluation of supports and barriers and internal and external resources to address them.

Development of Guidelines for Adults on How to Communicate With Adolescents About Mental Health Problems and Other Sensitive Topics

There is little evidence-based information available to guide adults in the general community on communicating effectively with adolescents about mental health problems or other sensitive topics. The Delphi methodology was used to develop guidelines to fill this evidence gap. An online questionnaire containing potential guideline statements was developed following a literature search and input from two focus groups. Two expert panels (Youth Mental Health First Aid instructors and young consumer advocates) rated the questionnaire over three rounds, according to whether or not they believed that the statements should be included in the guidelines. Results were analyzed by comparing endorsement rates between the panels. Of the 175 statements presented, 80 were rated as essential or important by ≥90% of both panels and were included in the guidelines. The Delphi process has offered an effective way to achieve consensus between expert panels on useful tips to help adults communicate with adolescents.

Evaluation of the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) in a sample of Vietnamese adults

PurposeThere are significant gaps in the literature on the prevalence of mental health problems and associated needs in Vietnam. A thorough understanding of culture-specific expressions of psychiatric distress is vital for the identification of the mental health needs of a community, and more research on the development and evaluation of culturally-sensitive mental health assessments is warranted. This study aims to evaluate the psychometric properties of the World Health Organization 20-item Self-Reporting Questionnaire (SRQ-20) in an epidemiologic study of Vietnamese adults. MethodsA latent variable modeling approach investigated the underlying factor structure of the SRQ-20 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on SRQ-20 item-level data gathered from 4980 participants. ResultsBased on scree plots and EFA results, two latent structures were deemed plausible and were subsequently subjected to further modeling. A bi-factor model (BFM) and a correlated three-factor model solution (Negative Affect, Somatic Complaints, and Hopelessness) provided reasonable fits. The BFM specifies a single dominant General Distress factor (all SRQ-20 items) with orthogonal group factors for the subsets of items: Negative Affect (9 items), Somatic Complaints (8 items), and Hopelessness (3 items). This model fit the data as well or better than the three-factor model. Results also showed differences in endorsement rates of SRQ-20 items among males and females. ConclusionsStudy results provide an evaluation of the psychometric properties of a commonly used screening tool and offer insight into the presentation of mental distress in a representative sample of Vietnamese adults.

Effects of Subliminal Affective Priming on Helping Behavior Using the Foot-in-the-Door Technique

Two experiments examined the effect of subliminal affective priming on compliance using the foot-in-the-door (FITD) paradigm. Prior to the target request, participants were exposed to subliminal emotional expressions. FITD (presence vs. absence of initial request) was crossed with Priming (positive, negative, neutral, and absence of prime-blank screen) in a between-subjects design. 180 students volunteered as participants (M=22 years). 20 participants (10 females) were assigned to each of eight experimental conditions plus the control condition that neither involved the initial request nor the priming experiment. Participants were asked to judge whether target sentences were relevant or not for road safety instruction. In Experiment 1, emotional valence of prime stimuli affected both endorsement rate and time devoted to the target request but not participants' attitude. Affective priming effects did not interact significantly with the FITD effect. In experiment 2, in 180 more students, the attitude measure was replaced by an implicit recognition task. Results showed that regardless of priming condition, in the absence of FITD, participants recognized target sentences better than in the presence of FITD. Conversely, in the presence of the FITD, participants recognized more accurately previously seen sentences that were primed by positive emotions relative to other priming conditions. The latter result suggests that the presence of the FITD involves a significant amount of cognitive resources so that only stimuli emotionally relevant to the task's goal (i.e., positive) tend to be processed. Together, these results could explain how, contrary to helping behavior, compliant behavior that has no direct association with the prime stimuli was not easily influenced by the affective subliminal priming.

How to Check the Validity of Clinical Severity Indices in Inflammatory Bowel Disease

Although a host of clinical severity indices has been developed for inflammatory bowel disease, none has been appropriately validated. This variation made it difficult to compare the outcomes of different clinical trials. There is no single ‘gold standard’ clinical severity index and each investigator chooses or develops his own index. Therefore, there is a need to develop a single clinical severity index in inflammatory bowel disease that is valid and reliable. The aim of this study is to identify the required standards for a valid and reliable severity index in inflammatory bowel disease and apply them to evaluate the commonly used clinical severity indices in inflammatory bowel disease. Literature search was conducted using MEDLINE and Google scholar database from January 1947 to 2011 to identify the required standards for clinical severity indices in inflammatory bowel disease. We also reviewed the commonly used clinical severity indices in inflammatory bowel disease and their validation studies. Personal communications, websites, and major textbooks were critically reviewed to identify potentially relevant materials. One hundred article was critically evaluated. A new 10-point scoring checklist was developed and applied to assess the disease severity indices in inflammatory bowel disease. The scoring system covers items selection, validity, reliability and responsiveness of the indices. Below is the scoring table. A score is given if the standard is met. 1. Face validity for the items was checked 2. Content validity was assessed by experts. 3. Items with endorsement rate of 80% were identified and removed. 4. Items with discrimination power 5. Items with item-total correlation 6. Internal consistency is acceptable (eg, Cronbach α >0.7). 7. Inter-observer reliability >0.75 8. Test-retest reliability >0.75 9. Construct validity >0.4 10. Responsiveness factor (sensitivity to change) >0.5 The higher the score of the index, the more valid and reliable it is. However, we recommend that 7 is the minimum acceptable score for clinical practice as non-empirical validity are judgmental and it is difficult to assess them properly. Item discrimination power can be substituted by Item total correlation to remove redundant items. Inter-observer reliability is closely related to test-retest reliability and one of them should be enough to assess the reliability of the index. This study defined the required standards for developing disease severity indices in inflammatory bowel disease and developed a 10-point checklist to systematically evaluate current and future indices. Using this checklist will ensure that any new index is valid and reliable

Trainees’ views on the future of psychiatry: a plethora of challenges ahead of us

In 2010 Katschnig published a paper in this journal on internal and external challenges to psychiatry as a profession 1. The article identified six challenges for the profession: three from inside (decreasing confidence about the knowledge base concerning diagnosis and classification; decreasing confidence about the knowledge base regarding therapeutic interventions; and lack of a coherent theoretical basis) and three from outside (client discontent; competition from other professions; and negative public image). The Board of the European Federation of Psychiatric Trainees (EFPT) decided to carry out an online survey among trainees on their opinions regarding these and similar challenges. The questionnaire asked the respondents: a) to indicate the three most important future challenges to psychiatry as a profession and challenges to postgraduate psychiatric training, and b) to rate the importance of eight statements reflecting the major challenges (all of them derived from the six identified by Katschnig) in terms of their importance on a 4 point Likert scale (very important, important, not important, not at all important). Sixty-six trainees from 32 countries, representing national trainee associations within EFPT, participated in this survey. Thirty-nine percent were male; the mean age was 30.9±3.7 years, and the mean number of years of completed training was 3.3±1.6. In the open-ended question on the three most important future threats to psychiatry as a profession, the negative public image of psychiatry was mentioned most frequently (45.4%), followed by the questionable results of studies on psychiatric treatment (42.4%) and by the lack of a coherent theoretical foundation of the discipline (34.8%). Other issues of concern were the funding of the mental health system, the role of pharmaceutical companies, client discontent and problems of recruitment to psychiatry. All of the eight closed questions had a very high endorsement rate (“important” or “very important”). Nearly nine of ten respondents (87.9%) regarded the negative public image of psychiatry as threatening, and related to this, nearly three quarters (74.2%) were concerned with the low status of psychatry within medicine. A majority felt that the questionable validity of psychiatric diagnosis (83.3%), the questionable results of scientific research (78.1%), and the waning confidence in the results of therapeutic intervention studies (72.3%) are a challenge. Lower endorsement, but still above 70%, was obtained for the opposing ideologies and concepts within psychiatry (71.2%). The least important threats were seen in the mounting patient and carer criticism (66.7%) and the intrusion of other professions into psychiatry’s traditional field of competence (63.1%). In relation to the future of psychiatric training, two crucial challenges were identified: to improve the quality of educational opportunities (62.1%), and to achieve international standardization of training programs (31.8%). Clearly, the issue of the negative public image of psychiatry and the problems of the validity of psychiatric diagnosis and treatment studies are a major concern of psychiatric trainees in Europe, which is in accordance with previous findings 2. What is reassuring, however, is that 94% of the respondents are not thinking of leaving the field of psychiatry and as many would advise medical students to choose psychiatry as a specialty. Over 80% said that psychiatry was their first specialty choice. So, this is a determined group, that sees the problems but will certainly cooperate in tackling them.

Is a diagnosis of “mild traumatic brain injury” a category mistake?

Efforts to produce definitions and diagnostic standards for mild traumatic brain injury (TBI) have a long and complex history. The diagnosis of TBI must be considered in the larger context of neuropsychiatric diagnosis. A major reconceptualization of diagnosis is now underway in which the classical syndrome conceptualization is being discarded. We address the question, what are the implications of this revision of thinking in the specific context of TBI? A recent literature on logical structures for neuropsychiatric disorders was reviewed. The symptom pattern of TBI was identified, and a literature survey determined the frequency of these symptom patterns in other disorders and in healthy control populations. The frequency of symptom endorsement in populations without a history of TBI can be equal to endorsement frequencies in populations with a history of mild TBI. In some studies, the frequency of symptom endorsement in healthy controls having no history of head injury actually exceeded the endorsement rates in a comparison group with a history mild TBI. The heterogeneity of this clinical population and their clinical presentations, the absence of a unitary etiology of postinjury deficits, and the complex idiosyncratic time course of the appearance of these deficits argue against the valid implementation of the classical model of diagnosis. In addition, the accepted criteria of diagnostic utility are not satisfied. TBI is not a disease; it is an event. More precisely, TBI is an event or a sequence of events that can, in some instances, lead to a diagnosable neurological or psychiatric disorder.

PTSD symptoms in a cohort of National Guard soldiers deployed to Iraq: Evidence for nonspecific and specific components

There is evidence that some of the symptoms included under the current diagnostic criteria for PTSD are not unique to PTSD and instead represent general distress. This study attempted to delineate the nonspecific and specific components of PTSD by examining the relation of PTSD symptoms to trauma exposure and demoralization in a cohort of National Guard soldiers deployed to Iraq. Data were collected from a cohort of 348 combat deployed National Guard soldiers participating in the readiness and resilience in National Guard soldiers (RINGS) study. Current DSM-IV PTSD diagnoses and trauma exposure were determined 6 to 12 months following soldiers' return from deployment using the Clinician Administered PTSD Scale. Level of trauma exposure (as measured by a combat exposure scale), demoralization and self-reported PTSD symptoms were assessed with self-report questionnaires. Dysphoria symptoms had the weakest relation with trauma exposure and the strongest relation with demoralization. In addition, these symptoms had high rates of endorsement in a group of soldiers without trauma exposure. Intrusions were strongly related to trauma and were significantly higher in the group with trauma exposure compared to the no-trauma group. These findings may not generalize to survivors of other types of trauma, service members from other era's, or even service members from different regions or military branches who have different demographic and duty characteristics. Emphasizing symptoms of PTSD that are strongly related to trauma exposure will be important for the differential diagnosis of PTSD.

Relations between acculturation orientations and antisocial behavior in adolescents and young adults from immigrant families

The aim of this cross-sectional school-based cohort study was to explore the relations between acculturation orientations and antisocial behavior in adolescents from immigrant families. Among 972 French high-school students, 251 were first- second- and third-generation immigrant adolescents. Adolescents with immigrant background reported higher levels of antisocial behavior than non-immigrant adolescents. Separation (rejection of the host culture) had the highest rates of endorsement after integration (biculturalism) and showed a unique association with antisocial behavior after controlling for other cultural, psychopathological and socio-familial variables.

Knowledge and Attitude toward Hospice Palliative Care among Community-Dwelling Aged Taiwanese—Analysis of Related Factors

This study was conducted to investigate the knowledge and attitude toward hospice palliative care (HPC) among the elderly, defined as 65 years of age and older, living in the metropolitan area of Taiwan. A cross-sectional questionnaire survey was conducted among the elderly people who received a senior citizen health examination from March to November 2009. A total of 1332 valid questionnaires were returned. Among these individuals, 57.0% recognized the term HPC, of which only 11.7% had heard it from healthcare personnel; 15.2% would like to endorse “Do-Not-Resuscitate” (DNR) on the National Health Insurance Integrated Circuit Card (NHI IC card); and among the 477 participants considering themselves to understand HPC, 65.1% did not think that HPC meant “DNR.” The analysis of t -test and analysis of variance indicates that better knowledge of HPC is more likely present among the participants with higher education levels, those who adopt healthy behaviors, individuals who are aware of HPC, and those who believe that they understand the concept of HPC. The logistic regression analysis demonstrated that a high percentage of the participants who were younger and had higher education levels and who paid attention to news related to health and medicine chose to endorse DNR on the NHI IC card. Providing information to those who are less educated and do not adopt healthy behaviors can improve overall HPC-related knowledge and the endorsement rate of “DNR” on the NHI IC card. Meanwhile, healthcare personnel are encouraged to discuss end-of-life care with elderly people at the proper time.

Scaling Properties of the Combined ICD-10 Dependence and Harms Criteria and Comparisons With DSM-5 Alcohol Use Disorder Criteria Among Patients in the Emergency Department

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), alcohol use disorders (AUDs) classifications offer competing and somewhat overlapping diagnostic tools for assessing alcohol dependence and harms/abuse. Both systems are in active stages of development in anticipation of their next respective iterations. Although much psychometric work has been done studying DSM-IV criteria, efforts toward the ICD-11 have been less prevalent. Data from 3,191 drinkers in seven emergency department sites in four countries (United States, Mexico, Argentina, and Poland) were used to study the psychometric properties of the combined ICD-10 dependence and harms criteria. Comparisons with the proposed set of DSM-5 criteria and diagnostic thresholds are also included. Item response theory analyses of the combined ICD-10 dependence and harms criteria suggested a single underlying factor, both overall and for each site separately, with only moderate differential item functioning across sites. Overall agreement between the summative combined ICD-10 dependence and harms criteria and the proposed 11-criteria DSM-5 scale was very high (r = .97), as was agreement between proposed diagnostic threshold levels of 0-1 (negative AUD), 2-3 (moderate AUD), and 4 or more (severe AUD) criteria endorsed (κ = .84). Although disagreement between the two three-level diagnoses was only 5.5% of the sample, a majority of these were because of differences between endorsement rates of abuse versus harms criteria. Although there is support for efforts to align the two schemes, results are consistent with other studies finding the largest differences between the two systems emanating from differences between the abuse and harms domains. More research is needed before differences between the two systems can be reconciled.

Exploring the Folk Understanding of Belief: Identifying Key Dimensions Endorsed in the General Population

Folk psychological accounts consider beliefs to be shared assumptions or internally represented theories that guide or inform the explanations and predictions about what people say and do. There are numerous studies that explore people’s beliefs on health, politics, religion, paranormal phenomena and delusional themes, but this paper describes the first study to explicitly evaluate if the general population share a relatively consistent definition of the term. A large stratified British sample (N=1000) was asked to rate a set of 14 qualitative descriptors to characterise key operational features of ‘belief ’. Individual features showed endorsement rates of 79–90% and a principal components analysis revealed that the majority of features loaded onto a single component. Despite differences in endorsement levels for individual features, the findings suggest that ‘belief ’ comprises a common set of distinct properties shared by most of the general population.