One-factor Confirmatory Factor Analysis Research Articles

Validation of the Scale of Emotional Development-Short (SED-S) in Healthy Adults with an Intellectual Disability.

Background: The Scale of Emotional Development-Short (SED-S) assesses the level of emotional development (ED) of persons with intellectual disability (ID) in eight domains across five stages with reference ages from 0 to 12 years. The aim of this study was to apply and validate the SED-S in a sample of healthy adults with ID. Method: Eighty-three mentally healthy adults with ID were assessed using the SED-S. Factor analysis, Cronbach's alpha, and correlational analyses were used to test the scale's internal structure and associations. Results: The results showed that the eight-domain structure of the SED-S is supported by strong inter-domain correlations, a high Cronbach's alpha, and a one-factor confirmatory factor analysis. The SED-S was associated with the severity of ID but not with age or gender. Conclusions: The SED-S can be used in non-clinical settings to better understand and meet the emotional needs of adults with ID.

Psychometric Properties of the Gastrointestinal Symptom Severity Scale in a Sample of Adolescents and Young Adults.

Background: Functional gastrointestinal disorders (FGIDs) are a set of chronic or recurrent gastrointestinal symptoms (GS) with great psychobiological complexity. The appearance of FGIDs harms quality of life and drains medical resources. Methods: Psychometric properties of the Gastrointestinal Symptom Severity Scale (GSSS) based on Rome IV criteria were examined in a sample of 1247 individuals with typical development. Observations were randomly divided into two subsets, namely, subsample 1 (n = 624) and subsample 2 (n = 623). Exploratory factor analysis (EFA) was performed with data from subsample 1, whilst confirmatory factor analysis (CFA) was performed with data from subsample 2. Internal consistency of the scale was assessed for the whole dataset according to ordinal alpha, whilst four-week reliability was measured according to the intraclass correlation coefficient (ICC). Measurement invariance as a function of sex was also examined, and discriminant-convergent validity of the GSSS was examined through hypothesis testing. Results: EFA revealed a two-factor structure with a moderate percentage of explained variance (51.3%), whilst CFA exhibited an excellent fit of the data to the model. A one-factor CFA model demonstrated an acceptable but slightly lower fit. Internal consistency was moderate and test-retest reliability was deemed adequate. Metric invariance was demonstrated as a function of sex. Hypothesis testing demonstrated strong convergent-discriminant validity with measures of sensory sensitivity, obsessive-compulsive symptoms, and pain. Conclusions: The GSSS is a tool with acceptable and promising psychometric properties when administered to neurotypical adolescents and young adults. The self-report GSSS may promote better understanding of GS involvement in the gut microbiota-brain axis in the general population.

Reliability and validity of Oswestry Disability Index among patients undergoing lumbar spinal surgery

BackgroundThe objective of this study was to explore the internal consistency and factor structure of the Oswestry Disability Index among patients undergoing spinal surgery. The sample consisted of 1,515 patients who underwent lumbar spinal surgery at a university hospital between 2018 and 2021.MethodsThe patients responded to the Oswestry Disability Index within 2 months before surgery. Cronbach’s alpha was used to assess the internal consistency. The factor structure was evaluated using exploratory and confirmatory factor analyses.ResultsThe average age of 1,515 patients was 58.5 (SD 15.8) years and 53% were women. The mean ODI score was 43.4% (SD 17.4%). Of the patients, 68% underwent microsurgical excision of the lumbar intervertebral disc displacement or decompression of the lumbar nerve roots. The internal consistency of the Oswestry Disability Index was found to be good, with an alpha of 0.87 (95% CL 0.86 to 0.88). Exploratory factor analysis resulted in unidimensional structure. Item loadings on this retained factor were moderate to substantial for all 10 items. One-factor confirmatory factor analysis model demonstrated an acceptable fit. The correlations between the main factor “disability” and the individual items varied from moderate (0.44) to substantial (0.76). The highest correlations were observed for items “traveling”, “personal care”, and “social life”. The lowest correlations were observed for the item “standing”.ConclusionsThe Oswestry Disability Index is a unidimensional and internally consistent scale that can be used to assess the severity of disability in patients undergoing lumbar spinal surgery. In the studied population, “traveling,” “social life,” “sex life” and “personal care” were the most important items to define the severity of disability, while “walking” and “standing” were the least important items. The generalizability of the results might be affected by the heterogeneity and modest size of the studied cohort.Trial registrationNot applicable.

Validity testing of the Korean version of the Health Literacy Questionnaire (HLQ) and its application in people with chronic diseases.

Health literacy plays a crucial role in promoting and maintaining the health of patients with chronic illnesses. Therefore, adequate assessments and the application of interventions based on people's health literacy strengths, needs, and preferences are required to improve health outcomes. This study aimed to evaluate the psychometrical properties of the Health Literacy Questionnaire (HLQ) in Koreans with chronic diseases. Data were collected from 278 patients (57.04±15.22 years) diagnosed with chronic disease, including kidney disease, hypertension, and diabetes, who visited the outpatient clinic of a university hospital from June to December 2020. For validity assessment, construct, convergent, and discriminant validities were evaluated, along with the HLQ reliability using Cronbach's α. One-way analysis of variance was used to evaluate mean differences in the HLQ scale scores based on patients' characteristics. The confirmatory factor analysis (CFA) indicated that all items were loaded on their respective factors. The model fit of a full nine-factor CFA model showed satisfactory or better fit compared with nine one-factor CFA model; χ2WLSMV (866) = 576.596 (p < .001), comparative normed fit index of 1.000 (reference: >0.950), Tucker-Lewis index of 0.981 (reference: >0.950), root mean square error of approximation of 0.066 (reference: <0.080), and standardized root mean square residual of 0.055 (reference: <0.080). All scales demonstrated good to excellent internal consistency (Cronbach's α ≥.757). Sociodemographic characteristic variables with significant score differences in HLQ scores were reported across nine scales, with the level of education and income showing significant score differences in 8 and 6 scales, respectively. This study revealed that the Korean version of the HLQ has many strong measurement properties among patients with chronic diseases. The validation indicated the HLQ as a robust tool that is used cross-culturally and is recommended for use in the Korean population.

Comparing RMSEA-Based Indices for Assessing Measurement Invariance in Confirmatory Factor Models.

Fit indices are descriptive measures that can help evaluate how well a confirmatory factor analysis (CFA) model fits a researcher's data. In multigroup models, before between-group comparisons are made, fit indices may be used to evaluate measurement invariance by assessing the degree to which multiple groups' data are consistent with increasingly constrained nested models. One such fit index is an adaptation of the root mean square error of approximation (RMSEA) called RMSEAD. This index embeds the chi-square and degree-of-freedom differences into a modified RMSEA formula. The present study comprehensively compared RMSEAD to ΔRMSEA, the difference between two RMSEA values associated with a comparison of nested models. The comparison consisted of both derivations as well as a population analysis using one-factor CFA models with features common to those found in practical research. The findings demonstrated that for the same model, RMSEAD will always have increased sensitivity relative to ΔRMSEA with an increasing number of indicator variables. The study also indicated that RMSEAD had increased ability to detect noninvariance relative to ΔRMSEA in one-factor models. For these reasons, when evaluating measurement invariance, RMSEAD is recommended instead of ΔRMSEA.

Spanish Validation of the Music in Dementia Assessment Scales

Music therapy has been described as a beneficial intervention for people with dementia. To provide a music therapy outcome measure, McDermott et al. (2015) developed the Music in Dementia Assessment Scales (MiDAS). The preliminary original validation indicated that MiDAS had acceptable to good psychometric properties. This study aimed to present the translation and cross-cultural adaptation of the MIDAS to the Spanish language and to show some validity sources using the Spanish version of the scale. MiDAS was adapted following the guidelines of Beaton et al. (2000), Muñiz et al. (2013) and Ridder et al. (2015), A psychometric validation study was conducted with a sample of 80 care home residents with moderate-severe dementia. Acceptable reliability values according to Cronbach's alpha were obtained, as was good interobserver reliability at one rating time point, based on Kendall's W test. The concurrent criterion validity values were positive, particularly in terms of the correlation coefficients of the criterion measure (specifically, the QoL-AD measures) and the item analysis, as shown by the correlation matrices. A one-factor confirmatory factor analysis (CFA) did not indicate a good fit for the obtained models, but acceptable and optimal values were observed for various parameters. The results indicate the usefulness of this tool, with sources of evidence of validity and reliability, although it is necessary to note the limitations of some of the results, as in the construct validity analysis. The MiDAS-ESP is a useful tool in clinical practice that can be used for measuring the effect of music therapy.

A psychometric evaluation of the applicability of LibQUAL+® in a developing country perspective in Bangladesh

PurposeThe purpose of this paper is to assess the psychometric validity of the LibQUAL+® instrument in a developing country context in Bangladesh.Design/methodology/approachThis study adopted a paper-version of the original LibQUAL 22 core-items to survey library users' perceptions of minimum, desired and perceived levels of service quality of university libraries in Bangladesh. The survey accumulated a total of 544 valid responses over a period of two weeks. The means and standard deviations for each service item were computed for the three service levels. The confirmatory factor analysis (CFA) was used to test the original three-factorial structure and to assess the psychometric validity of the LibQUAL instrument. A one-factor CFA and separate CFAs by gender and user group on perceived services were conducted to determine the original three-factor structure of LibQUAL scale. Exploratory factor analyses (EFAs) were also performed on the perceived scores to examine the potential factor structure of the scale. The descriptive statistics including EFAs and the CFA models were performed through IBM® SPSS® Statistics and IBM® SPSS® Amos, respectively.FindingsThe findings of this paper showed that all perceived services fell below the minimum scores. The confirmatory factor analyses found poor model fits for the original three-factor solution of the LibQUAL scale. The EFA results also showed no factorial structure similar to the original LibQUAL dimensions. The findings exhibited a low psychometric quality of LibQUAL in academic library settings in Bangladesh.Originality/valueThis study is the first of its kind to empirically examine the psychometric validity of the LibQUAL scale in a developing country perspective in Bangladesh.

Reliability and Validity of the Korean Version of the High-Performance Work System Scale (HPWS-K).

The application of the concept of high-performance work system (HPWS) to nurses can improve the quality of nursing care by enhancing nurse supply and patient safety culture. This study aimed to test the validity and reliability of the Korean version of the HPWS Scale (HPWS-K) and verify its adequacy for measuring HPWS within the context of nurses working in Korean hospitals. Data analyses were performed by using data from 214 nurses engaged in patient care in Korean general hospitals with over 300 beds, with SPSS version 22.0 and AMOS version 26.0 software. The data collected were translated into Korean and the adapted Korean version was back-translated into English by bilingual nursing professionals. The content validity of the HPWS-K was tested by administering it to 10 participants, and the collected data underwent reliability and validity testing. In the exploratory factor analysis, the total variance explained was 49.97%, and the instrument’s reliability (Cronbach’s α) was 0.87. A one-factor confirmatory factor analysis showed an acceptable model fit. The results confirmed the feasibility of using the HPWS-K with Korean nurses, and its application in this context is expected to contribute to creating a safe and effective healthcare environment in Korea.

The Parent Health Literacy Questionnaire (HLQ-Parent). Adaptation and validity testing with parents of children with epilepsy.

The aim of this study was to adapt the Health Literacy Questionnaire (HLQ) in English and Norwegian for use with parents. The research group evaluated all HLQ items and, where relevant, modified them to refocus the attribution of care to that of a child by a parent. Five cognitive interviews with parents were undertaken to gain a detailed depiction of the meanings and processes they used to respond to the HLQ items. Assessment of the psychometric properties of the revised HLQ was undertaken using data from a cross-sectional survey of 254 parents of children with epilepsy. Analysis included internal consistency (Cronbach's alpha) and confirmatory factor analysis (CFA). Some 22 out of 44 items and the names of three domains were modified (e.g. attribution changed from 'me' to 'my child'). Cognitive interviews indicated that parents interpreted the HLQ-Parent items in the way intended. All but three factor loadings were high to acceptable. All nine HLQ scales showed satisfactory to good internal consistency (Cronbach's alpha 0.70 to 0.87). When fitting one-factor CFA models, correlated residuals were required for four scales to generate an acceptable fit. One scale, '8. Ability to find good health information', required inclusion of two correlated residuals to generate an acceptable CFA model fit, indicating that further work on this scale is warranted. The results from both the adaptation process and the CFA analysis supported the relevance, understanding and theoretical structure of the instrument in a parental context.

Linguistic adaptation and psychometric properties of the health literacy questionnaire in serbian language among people with chronic diseases.

To translate the Health Literacy Questionnaire (HLQ) to Serbian language and examine its psychometric characteristics. This cross-sectional study was conducted among 295 people with chronic diseases from the Foča region (Republic of Srpska, Bosnia and Herzegovina). The HLQ was translated according to the translation integrity procedure. Construct validity was tested using confirmatory factor analysis (CFA) using the maximum likelihood estimator and reliability was estimated using the α and ω coefficients. Minor linguistic differences in 17 items were observed between the original and the initial forward translation and were corrected. The parameters of one-factor CFA on domains 3 and 8 fitted well. The parameters of the CFA for domains 1, 2, 4, 5, 6, 7 and 9 were acceptable after modification using residuals' correlation. The α and ω coefficients for all domains were good to excellent (>0.80). Each domain of the HLQ in Serbian has acceptable construct validity and overall good reliability. This study adds to the growing evidence that the HLQ is a useful tool to provide in-depth multidimensional information on health literacy to improve researchers and policymakers understanding of the health literacy strengths, needs and preferences across cultures and languages.

Psychometric validity and reliability of the 10- and 2-item Connor-Davidson resilience scales among a national sample of Americans responding to the Covid-19 pandemic: an item response theory analysis.

PurposePsychometric validity/reliability of 10-item and 2-item abbreviations of the Connor–Davidson Resilience Scale (CD-RISC-10; CD-RISC-2) was investigated via item response theory and classic approaches.MethodsWe sampled 5023 adult American participants in a June/July 2020 survey on the COVID-19 pandemic’s psychological effects. Our questionnaire incorporated the CD-RISC-10 with other validated measures. CD-RISC-10 items were ranked on item-to-scale correlations, loadings on a one-factor confirmatory factor analysis model, and item slope/threshold parameters plus information curves from a unidimensional graded response model. Concurrent validity of the highest ranked item pair was evaluated vis-à-vis the CD-RISC-10 and CD-RISC−2. Internal consistency, based on average variance extracted (AVE) and multiple reliability coefficients, was also compared. Convergent/divergent validity was tested by correlating anxiety, depression, fear of COVID-19, anxiety sensitivity, coping, and personality measures with both scales and the highest ranked item pair. Binary agreement/classification indexes assessed inter-rater reliability.ResultsItems 2 and 9 from CD-RISC-10 ranked the highest. Reliability coefficients were > 0.93, > 0.72, and > 0.82 for the CD-RISC-10, CD-RISC-2, vs summation of items 2 and 9. AVEs were 0.66, 0.67, and 0.77. CD-RISC abbreviations and the summation of items 2 and 9 correlated negatively with anxiety (> − 0.43), depression (> − 0.42), and fear of COVID-19 (> − 0.34); positively with emotional stability (> 0.53) and conscientiousness (> 0.40). Compared to the CD-RISC-2, summative scores of items 2 and 9 more efficiently classified/discriminated high resilience on the CD-RISC-10.ConclusionWe confirmed construct validity/reliability of copyrighted CD-RISC abbreviations. The CD-RISC-10’s items 2 and 9 were psychometrically more salient than the CD-RISC−2.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11136-022-03125-y.

Identifying correlates of salt reduction practices among rural, middle-aged Muslim Indonesians with hypertension through structural equation modeling.

Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants' frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (β = 0.25), and by seeking health information (β = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (β = 0.34), receiving support from health professionals (β = 0.23) and Islamic spiritual practice (β = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (β = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.

Longitudinal assessment of depression during the first year after stroke: Dimensionality and measurement invariance

ObjectiveRepeated measurement of depression using summative scores of commonly used depression scales assumes that the construct is unidimensional and invariant across time, but little is known about the validity of these assumptions in stroke patients. The study examined the assumptions during the first year after mild to moderate stroke using the 8-item Patient Health Questionnaire (PHQ-8). MethodsData were obtained from the 2014–2016 Brain Attack Surveillance in Corpus Christi project, a population-based stroke surveillance study with longitudinal follow-up in Texas, United States. Depressive symptoms were assessed with the PHQ-8 at 3, 6, and 12 months post-stroke (n = 648, 542, 533, respectively). Dimensionality of the PHQ-8 was examined using exploratory bifactor analysis and confirmatory factor analysis (CFA). Based on a one-factor CFA model, longitudinal measurement invariance was examined by fitting configural, weak, strong and strict invariance models sequentially. ResultsMean age was 65.6 (SD = 11.2), half were women, and 56.7% were Mexican American. Reliability measures suggested a generally unidimensional construct (Omega Hierarchical: 0.79–0.86), good internal consistency (Cronbach's alpha: 0.84–0.88) and good temporal stability (intraclass correlation coefficient: 0.838). Configural invariance for equality of item-factor structure (RMSEA = 0.038, CFI = 0.982, WRMR = 0.970) was supported. Partial weak invariance for equality of factor loadings (p = 0.11) was supported by chi-square difference tests, whereas full longitudinal invariance was supported by changes in comparative fit index and root mean square error of approximation. ConclusionsThe findings suggest the PHQ-8 may be a reasonable tool for repeated measurement of depression in stroke patients, and more research on its longitudinal psychometric properties is needed.

Psychometric evaluation of a comprehensive medication management service experience instrument

BackgroundThe Health-Systems Alliance for Integrated Medication Management (HAIMM) instrument was developed to estimate patient experience following pharmacist-delivered comprehensive medication management (CMM). ObjectivesThe objective of this paper was to assess the psychometric properties and factor structure of the HAIMM instrument. MethodsData were collected from 5 members of the HAIMM collaborative. A one-factor confirmatory factor analysis (CFA) model was used to assess instrument dimensionality. A partial-credit item response theory model was used to assess the psychometric properties of the ten-item HAIMM patient experience instrument, consisting of tests for rating scale functioning, person and item fit, and content validity. ResultsAmong 516 respondents, there was a strong skew toward high satisfaction, including a strong ceiling effect. CFA results suggest a unidimensional construct. Item difficulty was spread across a low range and content redundancies were identified. The mean-square values for both infit and outfit all fell within the recommended range, whereas the z-standard fit was within the recommended range for most items. The 5-point Likert scale used in the HAIMM instrument did not distinguish between participants’ level of experience following the pharmacist-delivered CMM service. ConclusionThe psychometric analysis showed the HAIMM survey tool does not cover all of the content that should be assessed to fully evaluate CMM experiences. In its current form, the HAIMM instrument should not be used to make comparisons about the quality of CMM services provided, although it may be useful to monitor patient satisfaction for quality improvement purposes. Further research is required to develop an improved instrument that contains expanded content coverage, response options, and aspects of CMM to be useful by health care providers, health systems, and other decision makers.

Translation and validation in Brazilian Portuguese of the reactions to homosexuality scale

ABSTRACT Internalized homonegativity results from the acceptance of negative attitudes about one’s same-sex orientation, which has negative consequences for the health of gay, bisexual and other men who have sex with men (GBM). We translated the 7-item Reactions to Homosexuality Scale (RHS) to Brazilian Portuguese and assessed its factor structure, validity and reliability. The first step included the translation, back-translation, evaluation, peer review, and pre-testing of the scale. Then, we piloted the scale in two convenience samples of adult Brazilians recruited online during October 2019 and February to March 2020 through advertisements on Grindr and Hornet, respectively. The largest sample was randomly split into two groups for exploratory factor analysis (EFA) then confirmatory factor analysis (CFA). Criterion and construct validity were assessed via correlations between scale scores and study variables. A total of 5573 GBM (sample 1: 218; sample 2: 5355) completed the RHS. EFA (N = 2652) yielded two eigenvalues greater than one (Factor 1: 3.5 and Factor 2: 1.1). A one-factor solution provided the most interpretable model based on examination of scree plot and item factor loadings (χ2(14) = 1373.1, p < 0.001; CFI = 0.89; TLI = 0.84; RMSEA = 0.19; SRMS = 0.09). Though one-factor CFA showed moderate fit, freeing errors terms to covary, based on item content and interpretation, significantly improved model fit (χ2(12) = 309.1, p < .001; CFI = 0.97; TLI = 0.96; RMSEA = 0.09; SRMR = 0.02). As hypothesized, men who did not self-identify as gay (mean score 17.9 compared to those self-identifying as gay: 11.8) and men who reported no sex with men in the past 6 months (mean score 12.6 compared to those who reported sex with men: 10.6) scored higher reflecting higher internalized homonegativity. The RHS was effectively translated and validated in Brazilian Portuguese and can be used to evaluate the role of internalized homonegativity on GBM’s health, as well as its impact on the uptake of HIV prevention technologies.

Investigating the Dimensionality of Early Numeracy Using the Bifactor Exploratory Structural Equation Modeling Framework.

The few studies that have analyzed the factorial structure of early number skills have mainly used confirmatory factor analysis (CFA) and have yielded inconsistent results, since early numeracy is considered to be unidimensional, multidimensional or even underpinned by a general factor. Recently, the bifactor exploratory structural equation modeling (bifactor-ESEM)—which has been proposed as a way to overcome the shortcomings of both the CFA and the exploratory structural equation modeling (ESEM)—proved to be valuable to account for the multidimensionality and the hierarchical nature of several psychological constructs. The present study is the first to investigate the dimensionality of early number skills measurement through the application of the bifactor-ESEM framework. Using data from 644 prekindergarten and kindergarten children (4 to 6 years old), several competing models were contrasted: the one-factor CFA model; the independent cluster model (ICM-CFA); the exploratory structural equation modeling (ESEM); and their bifactor counterpart (bifactor-CFA and bifactor-ESEM, respectively). Results indicated acceptable fit indexes for the one-factor CFA and the ICM-CFA models and excellent fit for the others. Among these, the bifactor-ESEM with one general factor and three specific factors (Counting, Relations, Arithmetic) not only showed the best model fit, but also the best coherent factor loadings structure and full measurement invariance across gender. The bifactor-ESEM appears relevant to help disentangle and account for general and specific factors of early numerical ability. While early numerical ability appears to be mainly underpinned by a general factor whose exact nature still has to be determined, this study highlights that specific latent dimensions with substantive value also exist. Identifying these specific facets is important in order to increase quality of early numerical ability measurement, predictive validity, and for practical implications.

In search of the optimum structural model for Internet Gaming Disorder

BackgroundInternet gaming Disorder (IGD) constitutes a recently proposed clinical disorder (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2013). The present study examined if IGD is best conceptualized as categorical (present/absent), or dimensional (severity ranging from low to high), or both (i.e., hybrid of categorical/dimensional).MethodsRatings of the nine DSM-5 IGD symptoms, as presented in the Internet Gaming Disorder Scale 9-Short Form (Pontes & Griffiths, Comput Hum Behav 45:137-143, 2015), from 738 gamers, aged 17 to 72 years, were collected. Confirmatory factor analysis (CFA), latent class analysis (LCA), and factor mixture modelling analysis (FMMA) procedures were applied to determine the optimum IGD model.ResultsAlthough the findings showed most support for a FFMA model with two classes and one factor, there was also good statistical and substantive support for the one-factor CFA model, and the LCA model with three classes.ConclusionIt was concluded that while the optimum structure of IGD is most likely to be a hybrid model (i.e., concurrently categorical and dimensional), a uni-dimensional model and/or a three-class categorical model are also plausible.

The Use of the MIND Screener, a Computerized Assessment of Mental Health Treatment Needs, in a Public School District

Although many discuss the importance of early screening, few children and adolescents with mental health treatment needs are identified. The Mental Illness Needs Detection (MIND) Screener, a computer-based self-report measure of mental health treatment needs was developed to identify and assess for these needs efficiently in schools and other community-based settings. In this study, 394 students in a North Florida school district completed screening measures. Principals and local mental health treatment providers completed surveys regarding current identification processes for children in this community. The internal consistency of the MIND was supported with reliability analyses (α = .88) and the good-fit of a one-factor confirmatory factor analysis (CFI = .91, TLI = .90). The MIND scales moderately to highly correlated with another commonly used measure, supporting its validity (r values of .51 to .80). The MIND demonstrated precision through its sensitivity (83%), specificity (63%), and AUC values (.70). Utility of the MIND was also supported with school leadership reporting more satisfaction with the MIND than other previous methods in place. Overall, findings indicate promise for using the MIND in schools to screen children early for mental health treatment needs. It addressed many of the shortcomings of other measures and methods of screenings by assessing for a variety of symptoms, being immediately computer scored, and utilizing self-report.

Multiple Group Analysis in Multilevel Data Across Within-Level Groups: A Comparison of Multilevel Factor Mixture Modeling and Multilevel Multiple-Indicators Multiple-Causes Modeling.

The purpose of this two-part study is to evaluate methods for multiple group analysis when the comparison group is at the within level with multilevel data, using a multilevel factor mixture model (ML FMM) and a multilevel multiple-indicators multiple-causes (ML MIMIC) model. The performance of these methods was evaluated integrally by a series of procedures testing weak and strong invariance models and the latent group mean differences testing after holding for factorial invariance. Two Monte Carlo simulation studies were conducted under the following conditions: number of clusters, cluster size, and the design type in groups. A multilevel one-factor confirmatory factor analysis (CFA) model as a research model in Study 1 was investigated to compare the results under different conditions with those of previous studies. A multilevel two-factor CFA model as a research model in Study 2 was evaluated by fitting alternative models that can be applied when the model is complicated. The results indicated that the two methods were reasonable in multilevel multiple groups analysis across within-level groups. However, pros and cons were found between the two methods. In the multilevel one-factor CFA model, ML MIMIC model was slightly better when the sample size is small. In the multilevel complex model, two alternative models of ML FMM were recommended because the weak invariance testing of ML MIMIC was considerably time-consuming. Finally, it was shown that information criteria, which are criteria for determining whether factorial invariance is established, need to be applied differently according to the sample size conditions. Guidelines for this situation are provided.

Validation of a Swahili version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to a community sample from Kilifi, Kenya.

Depression remains under-investigated in people living with HIV in sub-Saharan Africa due to paucity of adequately validated measures. This study aimed to validate an adapted version of the 9-item Patient Health Questionnaire (PHQ-9) among adults living with HIV compared to those from the community in Kilifi, Kenya. Analysis of data from 450 adults living with HIV and 337 adults from the community was conducted examining the reliability, factorial structure, measurement invariance and discriminant validity of interviewer-administered PHQ-9, Swahili version. Internal consistency of the Swahili PHQ-9 was good overall, in adults living with HIV and those from the community (Macdonald's omega>0.80). The two-week test-retest reliability was acceptable among adults living with HIV (ICC = 0.64). A one-factor confirmatory factor analysis (CFA) model indicated the Swahili PHQ-9 was unidimensional in the overall sample, in adults living with HIV and those from the community. Multi-group CFA substantiated measurement invariance of this unidimensional scale across participant group (adults living with HIV vs. community), sex (females vs. males) and age category (young, middle-age and elderly adults). The Swahili PHQ-9 exhibited good discriminant validity between the two participant groups. No diagnostic interview for mental disorders was administered in the original studies limiting analysis of sensitivity and specificity of the Swahili PHQ-9. The Swahili PHQ-9 is a reliable and valid unidimensional scale. It appears a valuable tool for assessing depressive symptoms that can be generalized across different demographic groups, in primary HIV clinics and the general community within this and similar settings.