Subscale Items Research Articles

Exploring the psychometric properties of the Persian Depression Anxiety Stress Scale for Youth (DASS-Y): factor structure and reliability in Iranian children and adolescents

BackgroundThe Depression Anxiety Stress Scale for Youth (DASS-Y) is a self-report instrument recently developed to evaluate negative emotional states in children and adolescents. However, the Persian version’s factor structure and psychometric properties have yet to be investigated in Iranian youth. The study aimed to assess the factor structure and reliability of the Persian DASS-Y in a sample of Iranian children and adolescents.MethodsThe study recruited 1,277 children and adolescents, 703 (55.1%) being girls and 574 (44.9%) being boys (aged 7–18 years), from schools in Tehran, Iran. Confirmatory factor analysis (CFA) was conducted to evaluate structural validity and test the fit of three-factor models. Internal consistency reliability was examined using Cronbach’s alpha and McDonald’s omega coefficients for the DASS-Y total and subscale items. Convergent and discriminant validity were also assessed.ResultsThe CFA results supported the original 3-factor structure of the DASS-Y, consisting of Depression, Anxiety, and Stress subscales in both groups of Iranian children and adolescents. Subsequently, the Pearson correlation coefficient assessed the scale’s convergent and discriminant validity, which was relatively appropriate. Also, the DASS-Y’s internal consistency reliability was satisfactory.ConclusionThe Persian DASS-Y is a reliable and valid Instrument for measuring depression, anxiety, and stress in Iranian children and adolescents. It can be helpful for both research and clinical work, helping to assess psychological distress in children and adolescents.

Question the promise: validating the interprofessional attitudes scale in Vietnamese health students

ABSTRACT The Interprofessional Attitudes Scale (IPAS) is a promising tool for assessing interprofessional education (IPE) attitudes, especially in community-oriented initiatives. To meet the need for validated IPE tools in Vietnam, we translated the IPAS into Vietnamese (Viet-IPAS) and evaluated its psychometric properties. The preparatory phases included forward and backward translation, expert consultations, and student feedback, resulting in strong content validity, face validity, linguistic comprehensibility, and test-retest reliability. During the 2020–2021 academic year, health students from the University of Medicine and Pharmacy at Ho Chi Minh City were invited for the main phase. A total of 282 students from medical, nursing, pharmacy, and rehabilitation science programs completed an online survey using the Viet-IPAS. Cronbach’s alphas for the Teamwork, roles and responsibilities (TRR), Patient-centeredness, Interprofessional biases (IB), Diversity and ethics, and Community-centeredness subscales were .84, .79, .56, .86, and .81, respectively. Confirmatory factor analysis indicated an acceptable fit (normed χ2: 2.618, RMSEA: .076, CFI: .874, AGFI: .77). Factor loadings were above .70, except for IB3 and TRR8 items. Modified models by removing IB subscale and TRR8 item showed slightly improved fit. We recommend using the Viet-IPAS with modifications in Vietnamese health student populations and encourage further review and refinement of the instrument.

A Short Form of a Questionnaire on Attitudes Toward Patient Communication in Nurses and Nursing Students (ACO-R): Assessment of Psychometric Properties.

Background: Attitudes toward the communication of nurses and nursing students with patients can influence the health outcomes of their patients. The present study aimed to develop and validate an abbreviated form of the Attitudes Toward Communication (ACO) scale for nurses and nursing students. Methods: Two types of participants were included in this study, 385 nurses and 1408 nursing students (67.30% of the nurses and 82.10% of the students were women). After obtaining their informed consent. Attitudes toward communication (ACO) of nurses and nursing students with patients were evaluated. Results: Internal consistency and construct validity analyses were conducted. A 12-item instrument (ACO-R) was obtained that maintained the factorial structure and ensured the homogeneous distribution of items in the different subscales. The same solution was found for both samples. Conclusions: The instrument showed adequate internal consistency and validity indices. The ACO-R instrument is an efficient, valid, and reliable measure to assess ACO among nursing students and nurses.

Bouncing Beyond Adversity in Oncology: An Exploratory Study of the Association Between Professional Team Resilience at Work and Work-Related Sense of Coherence.

Team resilience at work (TR@W) is an important resource for bouncing beyond adverse situations. Adopting a health-promoting salutogenic approach, this cross-sectional study explores whether oncology team resilience, which is significantly associated with work-related sense of coherence (Work-SoC), and examines the roles of team member characteristics, quality of work life, and perceived impact of COVID-19. Team members (n = 189) from four oncology settings in Québec (Canada) completed self-administered e-questionnaires. Structural equation modeling was used to identify the best-fitting model and significant relationships among study variables. The results showed a significant positive reciprocal relationship between TR@W and Work-SoC (R = 0.20) and between Work-SoC and TR@W (R = 0.39). These two variables were influenced by gender, gender roles, age, or COVID-19. The resulting model confirms our initial assumption that a higher level of TR@W is significantly associated with a more positive Work-SoC. Our findings provide new insights into subscale items perceived positively by oncology team members, such as perseverance, connectedness, and capability; and identify areas, such as self-care, within the team that may require greater attention to bounce beyond adversity. They also suggest there may be different levels (individual, team, and organizational) of resources under the health salutogenic umbrella.

Early Detection of Psychosis in Eating Disorders: Unnecessary or a Useful Addition?

The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans-diagnostically assessed the prevalence and co-occurrence of at-risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr. This cross-sectional and observational-prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16-35 who were referred for various kinds of non-psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities. Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED-consistent and ED-inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference. From a trans-diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co-morbid ED in other kinds of psychopathology is being overlooked.

Network analysis of misophonia symptoms using the Duke Misophonia Questionnaire

BackgroundMisophonia is a complex disorder characterized by a strong aversion to specific sounds, leading to significant distress and impairment. While the Duke Misophonia Questionnaire (DMQ) is one of the most comprehensive and validated measures for assessing misophonia, the relative importance of specific subscales and items within the DMQ remains unclear. Network analysis enables an understanding of the interconnections among subscales, providing insights into which parts of the measure are most central to the others. This study employed network analysis to examine the interconnections among DMQ subscales and identify the most central components of misophonia symptomatology. MethodsNetwork analysis was conducted on DMQ data from 144 adults with varying levels of misophonia symptoms. Four network models were examined: overall misophonia, symptoms, beliefs, and impairment. Sex differences were also explored. ResultsThe Impairment subscale emerged as the most central in the overall network for both males and females. Key items included cognitive reactions (“I need to get away from the sound,” “I thought about physically hurting the person making the sound”) as well as affective reactions (panic, anger) in the symptom sub-network, non-acceptance of misophonia beliefs (“I hate being like this”) in the belief sub-network, and deterioration of self-esteem due to misophonia in the impairment sub-network. Females reported more severe cognitive and physiological symptoms than males. ConclusionsThe DMQ Impairment subscale and specific items identified as most central in each network may represent key aspects of misophonia symptomatology. Prioritizing these components in assessment and intervention efforts may be beneficial when appropriate.

Under the surface: paranoid and unusual thought content are associated with depressive symptoms and suicidal ideation in adolescents entering psychiatric care

ABSTRACT Background Psychotic Like Experiences (PLEs), suicidal ideation, and depressive symptoms are related and common symptoms in adolescents treated in psychiatric services. However, more granular analysis of the associations between the two types of symptoms is sparse. This study aims to investigate the associations between self-reported PLEs and depressive symptoms on a sub-scale and item level, among adolescents attending secondary level psychiatric care. Methods The sample included 328 adolescents (aged 13–18 years) attending adolescent psychiatry outpatient units of the Helsinki University Hospital. Depressive symptoms were assessed using the BDI-1A (total score and separate Suicidal Ideation item score). PLEs were assessed with the PQ-B and analysed as sum scores for the sub-scales Sensory Distortion, Grandiosity, Disorganised Speech, Paranoia, and Unusual Thoughts. Results High scores on PQ-B subscales Paranoia and Unusual Thoughts were both independently associated with more depression and suicidality. Item analysis showed that the associations between PLEs and depression were driven by two PQ-B Paranoia subscale items, and one Unusual Thoughts subscale item. Discussion The findings suggest that the association between PLEs and depressive symptoms is driven by paranoid experiences and unusual thought content. Professionals in psychiatric care should expect this type of co-occurrence.

Relationship Between Emotional Exhaustion and Job Satisfaction among Nurses

Background: Emotionally exhausted employees tend to have unfavorable relationships with coworkers and the organization. It has been shown that emotional exhaustion and job satisfaction are highly relevant factors for performance in various organizational settings. This study aims to determine the relationship between job satisfaction and emotional exhaustion among nurses working at a psychiatric hospital. Method: A descriptive correlational study is conducted from December 2023 to May 2024. In a non-probability (purposive sample), 190 nurses were selected from hospitals in the Baghdad/Al-Rusafa Health Directorate and the Medical City Directorate. Nurses who work in psychiatric units were selected purposefully for this study. The chosen questionnaire consists of three parts. The first is the patient's socio-demographic characteristics, the Job Satisfaction Survey (JSS), and the third is the Emotional Exhaustion subscale (EE). Results: This study shows that the average participants' age was 30.25 ± 8.7 years, and the majority (53.7%) were female and held a diploma degree (48.9%) in nursing science. They have moderate levels of emotional exhaustion and job satisfaction. The job satisfaction survey results indicate that all dimensions of the subscale's items show moderate satisfaction. A statistical analysis reveals a significant inverse correlation between emotional exhaustion and job satisfaction among Nurses at a p-value of .0002. Conclusions: There is a significant relationship between emotional exhaustion and job satisfaction. These results suggest that emotional exhaustion is a key factor contributing to reduced job satisfaction and its various components, such as fringe benefits and the nature of work promotion. Recommendations: The study recommends effective interventions to address the negative impact of emotional exhaustion in the workplace, especially among new young employees. As such, organizations should prioritize implementing strategies that promote employee well-being and reduce burnout. This research contributes to understanding nurse experiences and needs, informing policies and practices that support their growth and well- being.

Evaluating the Usability and Quality of a Clinical Mobile App for Assisting Physicians in Head Computed Tomography Scan Ordering: Mixed Methods Study.

Among the numerous factors contributing to health care providers' engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. This study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians' computed tomography scan ordering. Our study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. The efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8% and 96.9%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was "customization" (63.6 out of 100). In the Functionality subscale, the HAC app's lowest value was "performance" (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. Evaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps.

The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study

BackgroundThe COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use. ObjectivesThis study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale. MethodsThe study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales. ResultsInter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949–0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values >0.6, whereas two Braden Scale subscales (Mobility, Activity) were below this threshold. Instrument sum scores were strongly correlated (Pearson's r = −0.76 [r2 = 0.58]; p < 0.001), as were three subscale item pairs (mobility rs= −0.56 [r2 = 0.32]; nutrition rs= −0.63 [r2 = 0.39]; level of consciousness/sensory perception rs= −0.67 [r2 = 0.45] p < 0.001). ConclusionBoth the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.

Super-Mentors to Train Multiple Neonatal Advanced Practice Providers: Pros and Cons.

Despite available training programs for neonatal advanced practice providers (Neo APP), including neonatal nurse practitioners and physician assistants, it is difficult to meet the demand for these providers. There are no publications regarding training models with greater than 1 Neo APP learner per mentor. To create and measure outcomes of a 12-month program to educate Neo APP "Super-Mentors" able to train 2 Neo APP learners simultaneously. Super-Mentors were selected and attended monthly classes to learn mentorship concepts and receive support. Learners received didactic content and support through a Fellowship program. Quantitative data regarding recruitment and retention, as well as Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) results were compared pre- and postprogram. Qualitative satisfaction measures via survey from 21 stakeholders were analyzed through a phenomenological approach. Six Super-Mentors trained 14 Neo APPs, as compared to 7 in the previous year. One Neo APP left after training. Summative preprogram MNPJSS scores were better (5.1±0.37) than postprogram (4.7±0.47) ( P <.001). The most important preprogram subscale item was "vacation" versus "quality of assistive personnel" postprogram. Both pre- and postprogram scores reflected positive job satisfaction so differences may not be clinically significant. Qualitative program benefits included faster and increased onboarding, stronger relationships, and dedicated time. Challenges included role clarity among other stakeholders, learning culture, and spacial/technological logistics. Super-Mentors can train twice the number of Neo APP learners, with optimal preparation and support of all stakeholders, adequate space, and appropriate technology.

Effect of Lurasidone on Life Engagement in Schizophrenia: Post-Hoc Analysis of the JEWEL Study.

To evaluate the effect of lurasidone on a new, patient Life Engagement scale in schizophrenia. This post-hoc analysis included participants (ages 18 to 74) diagnosed with schizophrenia who were randomized to lurasidone (40 mg/day) or placebo in a 6-week double-blind efficacy study and those who continued in a subsequent 12-week open-label extension study during which patients received either 40 or 80/mg day lurasidone (flexibly dosed). Change in life engagement was measured using the Positive and Negative Syndrome Scale (PANSS) 11-item Life Engagement subscale score, and individual subscale items, at week 6 during the double-blind phase and extension phase week 12 during the open-label extension phase. Analysis focused on 478 subjects randomized to lurasidone or placebo during the 6-week trial, and 146 who received lurasidone during the extension phase. During the 6-week trial, there was a significantly greater change on the PANSS11 Life Engagement subscale score from baseline to week 6 in the lurasidone group compared to the placebo group (mean changes of -6.4 and -4.8, respectively, p = 0.006; effect size = 0.27). Further improvement was evident during the extension phase for patients who received lurasidone in both phases, with a mean change from double-blind baseline to week 12 of the open-label treatment phase of -10.1 on in PANSS11 Life Engagement subscale. This post-hoc analysis suggests that lurasidone may improve life engagement in patients with schizophrenia, a meaningful outcome from patients' perspective. Further studies are needed to confirm this effect. Trial registration: EudraCT Numbers: 2016-000060-42; 2016-000061-23.

Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression – Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis

Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale – Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost.

Construct validity of the Braden scale in acute- and long-term care settings in Austria: A structural equation modeling analysis

Objective: The Braden scale is frequently used to assess pressure ulcer risk in health care settings. Selected psychometric properties have been tested using various methods of classical test theory in international studies. However, limited information on construct validity is available. Aim was to determine if the Braden subscale items correlate with the construct pressure ulcer risk and whether the construct validity concerning the factor structure of the Braden scale is adequate in acute and long-term settings.Methods: A quantitative design with secondary analysis of data from one acute (n = 328) and eight long-term care facilities (n = 311) in Austria was used to test construct validity. Data analysis included principal axis factor analysis with Promax rotation and assessment of internal consistency, followed by structural equation modeling.Results: For the acute care setting, a structure equation model with two latent factors and for the long-term care setting with one latent factor was tested according to principal axis factoring results. The Braden subscale items correlated with the construct pressure ulcer risk. Almost all examined model fit indices were within recommended reference values. Thus, the construct validity of the Braden scale was adequate in both settings.Conclusions: The factor structure in the acute care setting did not match that in the investigated long-term care setting. Further research regarding the construct validity of the Braden scale is therefore necessary.

Resident worklife and wellness through the late phase of the pandemic: a mixed methods national survey study

BackgroundSystem contributors to resident burnout and well-being have been under-studied. We sought to determine factors associated with resident burnout and identify at risk groups.MethodsWe performed a US national survey between July 15 2022 and April 21, 2023 of residents in 36 specialties in 14 institutions, using the validated Mini ReZ survey with three 5 item subscales: 1) supportive workplace, 2) work pace/electronic medical record (EMR) stress, and 3) residency-specific factors (sleep, peer support, recognition by program, interruptions and staff relationships). Multilevel regressions and thematic analysis of 497 comments determined factors related to burnout.ResultsOf 1118 respondents (approximate median response rate 32%), 48% were female, 57% White, 21% Asian, 6% LatinX and 4% Black, with 25% PGY 1 s, 25% PGY 2 s, and 22% PGY 3 s. Programs included internal medicine (15.1%) and family medicine (11.3%) among 36 specialties. Burnout (found in 42%) was higher in females (51% vs 30% in males, p = 0.001) and PGY 2’s (48% vs 35% in PGY-1 s, p = 0.029). Challenges included chaotic environments (41%) and sleep impairment (32%); favorable aspects included teamwork (94%), peer support (93%), staff support (87%) and program recognition (68%). Worklife subscales were consistently lower in females while PGY-2’s reported the least supportive work environments. Worklife challenges relating to burnout included sleep impairment (adjusted Odds Ratio (aOR) 2.82 (95% CIs 1.94, 4.19), absolute risk difference (ARD) in burnout 15.9%), poor work control (aOR 2.25 (1.42, 3.58), ARD 12.2%) and chaos (aOR 1.73 (1.22, 2.47), ARD 7.9%); program recognition was related to lower burnout (aOR 0.520 (0.356, 0.760), ARD 9.3%). These variables explained 55% of burnout variance. Qualitative data confirmed sleep impairment, lack of schedule control, excess EMR and patient volume as stressors.ConclusionsThese data provide a nomenclature and systematic method for addressing well-being during residency. Work conditions for females and PGY 2’s may merit attention first.

Gender and race measurement invariance of the Strengths and Difficulties Questionnaire in a U.S. base sample

IntroductionThe Strengths and Difficulties Questionnaire (SDQ) is one the most widely used behavior screening tools for public schools due to its strong psychometric properties, low cost, and brief (25-question) format. However, this screening tool has several limitations including being primarily developed for the purposes of identifying clinical diagnostic conditions and primarily in a European population. To date, there has been minimal comparative research on measurement invariance in relationship to important U.S. socio-demographic metrics such as race and gender.MethodThis study utilized both structural equation modeling (i.e., confirmatory factor analysis) and item response theory (IRT) methods to investigate the measurement invariance of the SDQ across gender (male, female) and race (Black, White). CFA analyses were first conducted for each of the SDQ subscales to identify potential misfit in loadings, thresholds, and residuals. IRT-graded response models were then conducted to identify and quantify the between-group differences at the item and factor levels in terms of Cohen's d styled metrics (d &amp;gt; 0.2 = small, d &amp;gt; 0.5 = medium, d &amp;gt; 8 = large).ResultsThere were 2,821 high school participants (52% Male, 48% Female; 88% Black, 12% White) included in these analyses. CFA analyses suggested that the item-factor relationship for most subscales were invariant, but the Conduct Problems and Hyperactivity subscales were non-invariant for strict measurement invariance. IRT analyses identified several invariant items ranging from small to large. Despite moderate to large effects for item scores on several scales, the test-level effects on scale scores were negligible.DiscussionThese analyses suggest that the SDQ subscale scores display reasonable comparable item-factor relationships across groups. Several subscale item scores displayed substantive item-level misfit, but the test level effects were minimal. Implications for the field are discussed.

Structural validation of the Manchester-Oxford Foot Questionnaire for use in foot and ankle surgery.

The Manchester-Oxford Foot Questionnaire (MOxFQ) is an anatomically specific patient-reported outcome measure (PROM) currently used to assess a wide variety of foot and ankle pathology. It consists of 16 items across three subscales measuring distinct but related traits: walking/standing ability, pain, and social interaction. It is the most used foot and ankle PROM in the UK. Initial MOxFQ validation involved analysis of 100 individuals undergoing hallux valgus surgery. This project aimed to establish whether an individual's response to the MOxFQ varies with anatomical region of disease (measurement invariance), and to explore structural validity of the factor structure (subscale items) of the MOxFQ. This was a single-centre, prospective cohort study involving 6,637 patients (mean age 52 years (SD 17.79)) presenting with a wide range of foot and ankle pathologies between January 2013 and December 2021. To assess whether the MOxFQ responses vary by anatomical region of foot and ankle disease, we performed multigroup confirmatory factor analysis. To assess the structural validity of the subscale items, exploratory and confirmatory factor analyses were performed. Measurement invariance by pathology was confirmed, suggesting the same model can be used across all foot and ankle anatomical regions. Exploratory factor analysis demonstrated a two- to three-factor model, and suggested that item 13 (inability to carry out work/everyday activities) and item 14 (inability to undertake social/recreational activities) loaded more positively onto the "walking/standing" subscale than their original "social interaction" subscale. This large cohort study supports the current widespread use of the MOxFQ across a broad range of foot and ankle pathologies. Our analyses found indications that could support alterations to the original factor structure (items 13 and 14 might be moved from the "social interaction" to the "walking/standing" subscale). However, this requires further work to confirm.

A Randomized Phase 2 KINETIC Trial Evaluating SAGE-324/BIIB124 in Individuals with Essential Tremor.

SAGE-324/BIIB124 is an investigational positive allosteric modulator of GABAA receptors. KINETIC (NCT04305275), a double-blind, randomized, placebo-controlled, phase 2 study, evaluated SAGE-324/BIIB124 in individuals with essential tremor (ET). Individuals aged 18 to 80 years were randomly assigned 1:1 to orally receive 60 mg of SAGE-324/BIIB124 or placebo once daily for 28 days. The primary endpoint was change from baseline in The Essential Tremor Rating Assessment Scale-Performance Subscale (TETRAS-PS) Item 4 (upper-limb tremor) at day 29 with SAGE-324/BIIB124 versus placebo. Between May 2020 and February 2021, 69 U.S. participants were randomly assigned to receive SAGE-324/BIIB124 (n = 34) or placebo (n = 35). There was a significant reduction from baseline in TETRAS-PS Item 4 at day 29 with SAGE-324/BIIB124 versus placebo (least squares mean [standard error]: -2.31 [0.401] vs. -1.24 [0.349], P = 0.0491). The most common treatment-emergent adverse events included somnolence, dizziness, fatigue, and balance disorder. These results support further development of SAGE-324/BIIB124 for potential ET treatment. © 2024 Sage Therapeutics, Inc and The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Item-level heterogeneous treatment effects of selective serotonin reuptake inhibitors (SSRIs) on depression: implications for inference, generalizability, and identification

Abstract Objectives In analysis of randomized controlled trials (RCTs) with patient-reported outcome measures (PROMs), Item Response Theory (IRT) models that allow for heterogeneity in the treatment effect at the item level merit consideration. These models for “item-level heterogeneous treatment effects” (IL-HTE) can provide more accurate statistical inference, allow researchers to better generalize their results, and resolve critical identification problems in the estimation of interaction effects. In this study, we extend the IL-HTE model to polytomous data and apply the model to determine how the effect of selective serotonin reuptake inhibitors (SSRIs) on depression varies across the items on a depression rating scale. Methods We first conduct a Monte Carlo simulation study to assess the performance of the polytomous IL-HTE model under a range of conditions. We then apply the IL-HTE model to item-level data from 24 RCTs measuring the effect of SSRIs on depression using the 17-item Hamilton Depression Rating Scale (HDRS-17) and estimate heterogeneity by subscale (HDRS-6). Results Our simulation results show that ignoring IL-HTE can yield standard errors that are as much as 50 % too small and create significant bias in treatment by covariate interaction effects when item-specific treatment effects are correlated with item location, and that the application of the IL-HTE model resolves these issues. Our empirical application shows that while the average effect of SSRIs on depression is beneficial (i.e., negative) and statistically significant, there is substantial IL-HTE, with estimates of the standard deviation of item-level effects nearly as large as the average effect. We show that this substantial IL-HTE is driven primarily by systematically larger effects on the HDRS-6 subscale items. Conclusions The IL-HTE model has the potential to provide new insights for the inference, generalizability, and identification of treatment effects in clinical trials using PROMs.

Mental health impact of multiple sexually minoritized and gender expansive stressors among LGBTQ+ young adults: a latent classanalysis.

In the United States, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexually minoritized and gender expansive (LGBTQ+) young adults are at increased risk for experiencing mental health inequities, including anxiety, depression and psychological distress-related challenges associated with their sexual and gender identities. LGBTQ+ young adults may have unique experiences of sexual and gender minority-related vulnerability because of LGBTQ+-related minority stress and stressors, such as heterosexism, family rejection, identity concealment and internalized homophobia. Identifying and understanding specific LGBTQ+-related minority stress experiences and their complex roles in contributing to mental health burden among LGBTQ+ young adults could inform public health efforts to eliminate mental health inequities experienced by LGBTQ+ young adults. Therefore, this study sought to form empirically based risk profiles (i.e., latent classes) of LGBTQ+ young adults based on their experiences with familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment, and then identify associations of derived classes with psychological distress. We recruited and enrolled participants using nonprobability, cross-sectional online survey data collected between May and August 2020 (N=482). We used a three-step latent class analysis (LCA) approach to identify unique classes of response patterns to LGBTQ+-related minority stressor subscale items (i.e., familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment), and multinomial logistic regression to characterize the associations between the derived classes and psychological distress. Five distinct latent classes emerged from the LCA: (1) low minority stress, (2) LGBTQ+ identity concealment, (3) family rejection, (4) moderate minority stress and (5) high minority stress. Participants who were classified in the high and moderate minority stress classes were more likely to suffer from moderate and severe psychological distress compared to those classified in the low minority stress class. Additionally, relative to those in the low minority stress class, participants who were classified in the LGBTQ+ identity concealment group were more likely to suffer from severe psychological distress. Familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment are four constructs that have been extensively examined as predictors for mental health outcomes among LGBTQ+ persons, and our study is among the first to reveal nuanced gradients of these stressors. Additionally, we found that more severe endorsement of minority stress was associated with greater psychological distress. Given our study results and the previously established negative mental health impacts of minority stressors among LGBTQ+ young adults, findings from our study can inform research, practice, and policy reform and development that could prevent and reduce mental health inequities among LGBTQ+ young adults.