Weighted Root Mean Square Residual Research Articles

Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka.

Nonadherence is a widespread problem among patients receiving hemodialysis, while contributing factors are underexplored due to lack of a validated instrument. The study aimed to develop and validate a new disease-specific instrument determining the factors affecting treatment adherence behaviors among patients receiving hemodialysis in a Sri Lankan hospital. The content validation process using a modified Delphi technique suggested 42-item instrument with an average Item-level Content Validity Index (I-CVI) of 0.94. Subsequent principal component analysis (PCA) revealed 5 components with 17 items (patient-centered psychological and physical factors, factors associated with health care, hemodialysis therapy-related factors, socioeconomic factors, and factors associated with the continuity of the treatment), explaining 67.24% total variance. The reliability estimate based on Mislevy and Bock for each component greater than 0.8 and overall standardized Cronbach's alpha of 0.605, indicated acceptable internal consistency reliability. Root mean square residual (RMSR) and weighted root mean square residual (WRMR) indices of 0.084 and 0.059, respectively, indicated acceptable model fit. The final 17-item instrument provides a valid measure for the factors affecting treatment adherence behaviors of the patients receiving hemodialysis in a Sri Lankan hospital.

Psychometric Properties of the Recovery Experiences Questionnaire in Peruvian Teachers of Regular Basic Education

The objective of this study was to analyze the psychometric properties of the recovery experiences questionnaire in Peruvian teachers of regular basic education. Instrumental design research, with the participation of 740 regular basic education teachers (494 women and 246 men), whose ages were between 21 and 65 years old (M = 40.22, SD = 9.99). Validity evidence based on the internal structure was analyzed using confirmatory factor analysis, based on relation to other variables through correlation analysis, and reliability was calculated using Cronbach’s alpha coefficient. The factorial structure of the questionnaire was confirmed (χ2 = 209.683, degree of freedom (df) = 48, p = 0.000; comparative fit index (CFI) = 0.986; Tucker-Lewis Index (TLI) = 0.981; root mean square error of approximation (RMSEA) = 0.068; standardized residual value mean square (SRMR) = 0.032; Weighted root mean square residual (WRMR) = 0.951); Therefore, the model of 12 items distributed in four factors (Distancing, Relaxation, Seeking challenges, and Control) is satisfactory and the reliability is acceptable, with α values between 0.80 and 0.83. The recovery experiences questionnaire demonstrates validity and reliability for Peruvian regular basic education teachers.

Construct validity of the Clinical Dementia Rating Scale to assess the level of cognitive decline by informants

AbstractBackgroundClinical Dementia Rating Scale (CDR) is one of the most used assessment scales in the care of dementia but it still lacks a detailed analysis of construct validity. We aimed to analyze evidences of construct validity of the CDR to assess the level of cognitive decline by informants.MethodWe analyzed 650 records of elderly subjects belonging to the Brazilian Biobank for Aging Studies. A trained nurse fulfilled the CDR during the clinical interview with a knowledgeable next‐of‐kin, after informed consent. We considered each domain of the CDR as one item. Exploratory (EFA) and Confirmatory factor analysis (CFA) were performed. We used Robust Unweighted Least Squares with promax rotation, with a bootstrapping of 1.000 cases, and Parallel Analysis. Sample adequacy was tested by the Kaiser‐Meyer‐Olkin and Bartlett sphericity tests. UniCo, ECV and Mireal tested the dimensionality. Factor loading ≥ 0.50 and communalities ≥ 0.40 were indicators of good factor solution. In CFA we tested: Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Non‐Normed Fit Index (NNFI), Comparative Fit Index (CFI ), and Weighted Root Mean Square Residual (WRMR). Reliability was tested by standardized Chronbach’s Alpha, Ordinal McDonald’s Ômega and GLB. For the analysis, we used Factor 10.10.3.ResultSample was composed by 55.5% of females, the mean age of the sample was 68.7±11.3 years and 78.8% of the participants were cognitively normal (CDR = 0). KMO was 0.86 and Bartlett was <0.001. Total explained variance was 84.6%. Parallel analysis showed only one dimension and values of UniCo (0.994); ECV (0.919) and MIREAL (0.279) confirmed the unidimensionality of the structure. Factor loadings ranged from 0.846 to 0.945 and communalities from 0.716 to 0.894. Memory was the item with the higher factor loading and communality. All the goodness of fit indexes confirmed the structure of CDR. Indicators of reliability were also very good (Table 1).ConclusionCDR is a unidimensional instrument composed by six items that together explain 84.6% of the ‘level of cognitive decline’. Results indicated that the CDR has very good evidence of construct validity and reliability and can be used to assess the level of cognitive decline by informants.

Development and Psychometric Properties of the Synthetic Drug Dependence Scale in a Chinese Sample.

Objective: In contrast to the drug situation in the rest of the world, synthetic drugs, rather than traditional drugs, have been the dominant abused drugs in China since 2019. However, the public misconception that synthetic drugs are not as addictive as traditional drugs, such as opioids and the scarcity of specific measurement instruments, have hindered the clinical diagnosis and treatment of synthetic drug abusers, thus the development of a localized instrument to evaluate dependence on synthetic drugs is in urgently needed.Method: Using a sample of 618 Chinese synthetic drug abusers (Mean age = 34.69 years; 44.17% female), the present study developed and examined the psychometric properties of a self-reporting instrument, the Synthetic Drug Dependence Scale (SDDS), which consists of four subscales: physical dependence, psychological dependence, health injury, and social function injury.Results: The SDDS revealed a three-factor model structure (weighted root mean square residual (WRMR) = 0.876, comparative fit index (CFI) = 0.965, Tucker–Lewis index (TLI) = 0.953, and Root mean square error of approximation (RMSEA) = 0.070), with good internal consistency (composite reliability = 0.912, alfa = 0.801) and convergent validity. Elevated scores on the SDDS were associated with a higher level of reward sensitivity, punishment sensitivity, and stronger impulsivity. Interestingly, psychological dependence was the only significant predictor (p < 0.05) of criterion variables compared with the other three subscales, implying the important role of psychological factors in synthetic drugs dependence. Adequate measurement equivalence across sex, age (18–30 and 31–57 years old), and employment group (employed and unemployed) was also established.Conclusion: The SDDS appears to be an effective and reliable instrument that could be used to further investigate the characteristics of synthetic and traditional drug dependence, promoting a deeper understanding of the physical and psychological roles in drug dependence.

M117. ELUCIDATING ARCHITECTURE OF NEGATIVE SYNDROME IN SCHIZOPHRENIA

BackgroundThe conceptualization of negative symptoms has been refined in the past decades. Two-factor model comprising Motivation and Pleasure (MAP) and Emotional Expressivity (EE), five-factor model representing five domains of negative symptoms and second-order five-factor model incorporating the two-factor and five-factor models (Anhedonia, Asociality and Avolition regressed on MAP; Blunted Affect and Alogia regressed on EE) have been suggested as latent structure of negative symptoms. In most studies, the item “Lack of Normal Distress” in the Brief Negative Symptom Scale (BNSS) did not fit well in factor models. Nevertheless, the reported correlation and item-total correlation of Distress with other negative symptom domains and BNSS items were not negligible. Emotion deficit was also discussed as a part of negative symptoms conceptualization. As a single item may not be sufficient to represent an underlying construct that is potentially abstract and complex, the Schedule for the Deficit Syndrome (SDS) which comprises “Diminished Emotional Range” that is conceptually relevant to the BNSS Distress was employed. The study aimed to reexamine the conceptualization of negative symptoms by examining the model fit of several models when BNSS Distress and SDS Emotion (EMO) were included in the models using confirmatory factor analyses (CFA).MethodsTwo-hundred and seventy-four schizophrenia outpatients aged 21–65 were assessed on the BNSS and SDS. In the two-factor models, Restricted Affect, Diminished Emotional Range and Poverty of Speech in SDS and all items in BNSS Blunted Affect and Alogia subscales were regressed on EE, Curbing of Interests, Diminished Sense of Purpose and Diminished Social Drive in SDS and all items in BNSS Anhedonia, Asociality and Avolition subscales were regressed on MAP, without EMO, or with EMO regressed on either EE or MAP. Five-factor models and second-order five-factor models were examined, with or without EMO. Lastly, a six-factor model with EMO manifested by the sixth factor and second-order six-factor models in which EMO was regressed on either EE or MAP were tested. Root mean square error of approximation (RMSEA) <0.08, comparative fit index (CFI) >0.95, the Tucker-Lewis Index (TLI) >0.95, and weighted root-mean-square residual (WRMR) <1.0 indicate good model fit. CFAs were conducted using Mplus version 7.4.ResultsThe two-factor models did not yield adequate fit indices. Five-factor model and second-order five-factor model without EMO had good model fit; five-factor model: RMSEA=0.056 (0.044–0.068), CFI=0.996, TFI=0.995, WRMR=0.718; second-order five-factor model: RMSEA=0.049 (0.036–0.061), CFI=0.997, TFI=0.996, WRMR=0.758. When EMO was included as indicator in one of the factors in the five-factor models, only the model in which EMO was regressed on Alogia yielded adequate fit. Similarly, in the second-order five-factor models, adequate fit indices were observed only when EMO was regressed on Alogia and Blunted Affect. The six-factor model fitted the data well, RMSEA=0.053 (0.042–0.064), CFI=0.996, TFI=0.995, WRMR=0.711. Second-order six-factor model with EMO regressed on EE yielded better model fit than MAP, RMSEA=0.050 (0.039–0.061), CFI=0.996, TFI=0.995, WRMR=0.849.DiscussionIn line with previous studies, five-factor and second-order five-factor models without EMO fitted the data well. When EMO was included, a six-factor model and a second-order six-factor model in which the sixth factor was regressed on EE showed good model fit. Emotion, motivation and behavior are intertwined. Our results showed that diminished emotion may also be one of the components of negative symptoms, which had higher association with EE than MAP.

Construct validity of the Motor Development Scale (MDS).

Construct validity for the Motor Development Scale (MDS) has not been established. The aim of this study was to examine whether the unidimensional model of MDS would be appropriate for children aged 4 to 6 years-old and provide construct validity for the items concerning this age group in Brazil. A total of 938 children participated in the study (214 4-year-olds, 643 5-year-olds, and 81 6-year-olds). Confirmatory factor analysis (CFA) was used to evaluate construct validity of the MDS using a unidimensional model. The CFA for the unidimensional model showed excellent adequacy indices for age 4: χ2(2) = 0.581, p = 0.748, comparative fit index (CFI) = 1.000, Tucker-Lewis index (TLI) = 1.090, root mean square error of approximation (RMSEA) = 0.000 (90% confidence interval [90%CI] = 0.000 to 0.093, close fit [Cfit] = 0.841); age 5: χ2(2) = 2.669, p = 0.263, CFI = 0.993, TLI = 0.980, RMSEA = 0.023 (90%CI = 0.000 to 0.085, Cfit = 0.682), weighted root mean square residual (WRMR) = 0.407; and age 6: χ2(9) = 8.275, p = 0.506, CFI = 1.000, TLI = 1.010, RMSEA = 0.000 (90%CI = 0.000 to 0.118, Cfit = 0.653), WRMR = 0.495. Reliability was good: ω = 0.87 (95%CI = 0.81 to 0.92). The proposed unidimensional solution for the MDS provides a concise, parsimonious and reliable way to assess motor development in children aged 4 to 6 years.

Model of Healthcare-Associated Infection Control in Primary Health Care Institutions: A Structural Equation Modeling.

The purpose of this study was to construct the model of organization system, management, training and surveillance in healthcare-associated infection prevention and control (IC) of primary health care institutions and identify its effect on patient safety and decreasing economic burden by standardizing IC. A cross-sectional survey was conducted with questionnaires. Data were collected from 268 primary health care institutions in Hubei province, China. Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling. The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels: root mean square error of approximation (RMSEA)=0.071; comparative fit index (CFI)=0.965; tucker-lewis index (TLI)=0.956; weighted root mean square residual (WRMR)=1.014. The model showed that organization system had a direct effect on management (β=0.311, P<0.01), and training (β=0.365, P<0.01). Management and training played an intermediary role that partially promoted organization system impact on surveillance. Results also showed that institutional factors such as the number of physicians, the number of nurses, the designated capacity of beds, the actual number of open beds and surgery trips had positive impacts on management (β=0.050, P<0.01; β=0.181, P<0.01; β=0.111, P<0.01; β=0.064, P<0.01; β=0.084, P=0.04) and training (β=0.21, P=0.03; β=0.050, P=0.02; β=0.586, P=0.01; β=-0.995, P=0.02; β=-0.223, P=0.03). In conclusion, the model of organization system, management, training and surveillance in IC of primary health care institutions is valuable for guiding IC practice.

Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis

Background: About one third of patients with multiple sclerosis (MS) experience dysphagia. Dysphagia can cause complications such as malnutrition, lung infections, aspiration pneumonia and dehydration, thus it is very helpful to diagnose dysphagia as soon as possible. The aim in this study was to translate dysphagia in multiple sclerosis (DYMUS) questionnaire into Farsi and and validate it. Methods: Forward-backward method was used to translate original English version of DYMUS into farsi, and then the questionnaire (one for each patient) was filled in through asking questions from 200 patients with MS by a speech and language pathologist. Confirmatory factor analysis (CFA) was used to examine the construct validity. Internal consistency and test-retest reliability of the DYMUS were evaluated using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. Results: CFA showed that a two-factor model of DYMUS including "dysphagia for solid" and "dysphagia for liquid" fitted the data well [relative chi-square [χ2/degree of freedom (df) = 1.55, CFI = 0.967, Tucker-Lewis index (TLI) = 0.957, root mean square error of approximation (RMSEA) = 0.053, and weighted root mean square residual (WRMR) = 0.874]. The Cronbach's alpha for total score and liquid and solid subscales were 0.776, 0.557, and 0.725, respectively. The DYMUS showed adequate test-retest reliability for the total and subscales (ICC: 0.880-0.956). Moreover, this study has shown a significant relationship between DYMUS score and Expanded Disability Status Scale (EDSS) score, disease duration, type of MS, and self-reported dysphagia. Conclusion: The Persian version of DYMUS is a reliable and valid tool to screen dysphagia among patients with MS.

Decomposing early and adult life social position effects on oral health and chronic diseases in a cross-sectional study of Southern Brazil.

As the socio-economic trajectory can influence on individual health during the life course, the aim of this study was to test a model of socio-economic life course effects on chronic diseases, tooth loss and on oral health-related quality of life using structural equation model (SEM) to decompose direct and indirect effects. This cross-sectional study was performed in southern Brazil, within public healthcare users with 18 years old or more (n = 433). Latent variables were the Oral Health Impact Profile (OHIP), Childhood Socio-economic Status (SESC) and Adulthood (SESA), and Chronic Diseases (CD), and observed variables were sex, age, smoking status and tooth loss. The statistical analysis was performed using structural equation modelling (SEM) using WLSMV estimator. For the final model, we kept only plausible significant paths with P < 0.30. Final model presented an adequate fit: RMSA 0.03, Comparative Fit Index (CFI) 0.97, TLI 0.97, and Weighted Root Mean Square Residual (WRMR) 1.19. The direct effect from SESC to tooth loss was β = -0.08 (P = 0.19) and the indirect was β = -0.12 (P = 0.02). The indirect effect from SESC to OHIP was β = -0.14 (P = 0.01) and there is no direct effect. The direct effect from SESA to tooth loss was β = -0.21 (P < 0.01) and there is no indirect effect. The direct effect from SESA to OHIP was β = -0.14 (P = 0.05). The association of SESA on SESC was β = 0.59 (P < 0.01). SESC had indirect effects on OHIP and number of teeth via SESA, supporting the chain of effects theory, but not for chronic diseases.

The psychometric properties of the 10-item Kessler Psychological Distress Scale (K10) in Canadian military personnel

The psychometric properties of the ten-item Kessler Psychological Distress scale (K10) have been extensively explored in civilian populations. However, documentation of its psychometric properties in military populations is limited, and there is no universally accepted cut-off score on the K10 to distinguish clinical vs. sub-clinical levels of distress. The objective of this study was to examine the psychometric properties of the K10 in Canadian Armed Forces personnel. Data on 6700 Regular Forces personnel were obtained from the 2013 Canadian Forces Mental Health Survey. The internal consistency and factor structure of the K10 (range, 0–40) were examined using confirmatory factor analysis (CFA). Receiver Operating Characteristic (ROC) analysis was used to select optimal cut-offs for the K10, using the presence/absence of any of four past-month disorders as the outcome (posttraumatic stress disorder, major depressive episode, generalized anxiety disorder, and panic disorder). Cronbach’s alpha (0.88) indicated a high level of internal consistency of the K10. Results from CFA indicated that a single-factor 10-item construct had an acceptable overall fit: root mean square error of approximation (RMSEA) = 0.05; 90% confidence interval (CI):0.05–0.06, comparative fit index (CFI) = 0.99, Tucker-Lewis Index (TLI) = 0.99, weighted root mean square residual (WRMR) = 2.06. K10 scores were strongly associated with both the presence and recency of all four measured disorders. The area under the ROC curve was 0.92, demonstrating excellent predictive value for past-30-day disorders. A K10 score of 10 or greater was optimal for screening purposes (sensitivity = 86%; specificity = 83%), while a score of 17 or greater (sensitivity = 53%; specificity = 97%) was optimal for prevalence estimation of clinically significant psychological distress, in that it resulted in equal numbers of false positives and false negatives. Our results suggest that K10 scale has satisfactory psychometric properties for use as a measure of non-specific psychological distress in the military population.

F119. MULTILEVEL ANALYSIS IMPROVES THE MODEL FIT OF THE DIMENSIONAL STRUCTURE OF THE PANSS IN PATIENTS WITH SCHIZOPHRENIA

BackgroundPrincipal component analyses (PCA) studies show that schizophrenia symptoms are usually grouped into five domains. However, to infer a latent dimensional structure, confirmatory factor analysis (CFA) is more appropriate than PCA. Most CFA studies addressing the five-factor model yielded poor fit indices. One single study achieved a good fit using a multilevel CFA structure with the interviewers as level. Other possible reasons for sample heterogeneity and subsequent poor model adjustments, such as differences in patients’ clinical profiles across clinical units and clinical staging, were not measured in this study. We aimed to replicate the effect of the CFA multilevel analyses and evaluate the possible influence of other heterogeneity sources as levels, i.e., clinical staging, on the Positive and Negative Syndrome Scale (PANSS) five-factor structure.Methods700 patients with schizophrenia at four different centers had their PANSS analyzed. A Confirmatory Factor Analysis (CFA) was conducted using the following fit index: Comparative Fit Index (CFI) and Non-Normed Fit Index (NNFI) >0.95, the Root Mean Square Errors of Approximation (RMSEA) <0.06, and Weighted Root Mean Square Residual (WRMR) <1.0. Thereafter, we performed multilevel analyses considering the following levels: i) centers, ii) interviewers and iii) clinical staging for schizophrenia (first episode, treatment-resistant schizophrenia and non-treatment resistant schizophrenia).ResultsThe mean (SD) age was 34.9 (10.3) years, mean age of onset was 21.7 (7.5), mean duration of illness means was 13.2 (9.7) years, and 64.3% of the sample was male. The CFA model without multilevel analyses yielded poor fit indices: RMSEA = 0.102 (90% CI: 0.097 – 0.107; Cfit was <0.001), CFI = 0.921 and NNFI = 0.906 and WRMR = 1.952. When the multilevel analysis was applied, all models reached an acceptable fit: i) centers: RMSEA = 0.044 (90% CI: 0.038 – 0.049; CFit = 0.964), CFI = 0.981, NNFI = 0.977, and WRMR = 1.860; ii) interviewers: RMSEA = 0.047 (90% CI: 0.041 – 0.053; CFit = 0.765), CFI = 0.947, NNFI = 0.938, and WRMR = 1.531; iii) clinical stage: RMSEA = 0.052 (90% CI: 0.046 – 0.058; CFit = 0.274), CFI = 0.988, NNFI = 0.985, and WRMR = 2.433.DiscussionGood CFA model fits were only achieved when the multilevel structure was applied. Besides the bias generated by data collection (i.e., local of data collection and raters), the clinical staging is a potential source of variability to consider in schizophrenia dimensional structure. As dimensional approaches gain relevance to reduce heterogeneity in schizophrenia and to investigate their biological substrates, reliable methods to address latent dimensions are required.

Testing a healthcare provider-patient communicative relationship quality model of pharmaceutical care in hospitals.

Four tertiary hospitals in 2017. Methods The provision of pharmaceutical care was investigated.A cross-sectional questionnaire survey covering different constructs of communicative relationship quality model was conducted and the associations among pairs of the study constructs were explored. Based on the results of confirmatory factor analysis, path analysis was conducted to validate the proposed communicative relationship quality model. Main outcome measure Model fit indicators including Tucker-Lewis index (TLI), comparative fit index (CFI), root mean square error of approximation (RMSEA) and weighted root mean square residual(WRMR). Results There were 589 patients included in our study. The final path model had an excellent fit (TLI = 0.98, CFI = 0.98, RMSEA = 0.05; WRMR = 1.06). HCP participative behavior/patient-centeredness (β = 0.79, p < 0.001) and interpersonal communication (β = 0.13, p < 0.001) directly impact the communicative relationship quality. But patient participative behavior was not a predictor of either communicative relationship quality or patient satisfaction. Conclusion HCP participative behavior/patient-centeredness and interpersonal communication are positively related to relationship quality, and relationship quality is mediator between HCP participative behavior and interpersonal communication with patient satisfaction.

A structural equation model of perceived and internalized stigma, depression, and suicidal status among people living with HIV/AIDS

BackgroundPrevious studies have shown positive association between HIV-related stigma and depression, suicidal ideation, and suicidal attempt among people living with HIV/AIDS (PLWH). But few studies have examined the mechanisms among HIV-related stigma, depression, and suicidal status (suicidal ideation and/or suicidal attempt) in PLWH. The current study examined the relationships among perceived and internalized stigma (PIS), depression, and suicidal status among PLWH in Guangzhou, China using structural equation modeling.MethodsCross-sectional study by convenience sampling was conducted and 411 PLWH were recruited from the Number Eight People’s Hospital from March to June, 2013 in Guangzhou, China. Participants were interviewed on their PIS, depressive symptoms, suicidal status, and socio-demographic characteristics. PLWH who had had suicidal ideation and suicidal attempts since HIV diagnosis were considered to be suicidal. Structural equation model was performed to examine the direct and indirect associations of PIS and suicidal status. Indicators to evaluate goodness of fit of the structural equation model included Chi-square Statistic, Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), Standardized Root Mean Square Residual (SRMR), and Weighted Root Mean Square Residual (WRMR).ResultsMore than one-third (38.4%) of the PLWH had depressive symptoms and 32.4% reported suicidal ideation and/or attempt since HIV diagnosis. The global model showed good model fit (Chi-square value = 34.42, CFI = 0.98, RMSEA = 0.03, WRMR = 0.73). Structural equation model revealed that direct pathway of PIS on suicidal status was significant (standardized pathway coefficient = 0.21), and indirect pathway of PIS on suicidal status via depression was also significant (standardized pathway coefficient = 0.24). There was a partial mediating effect of depression in the association between PIS and suicidal status.ConclusionsOur findings suggest that PIS is associated with increased depression and the likelihood of suicidal status. Depression is in turn positively associated with suicidal status and plays a mediating role between PIS and suicidal status. Therefore, to reduce suicidal ideation and attempt in PLWH, targeted interventions to reduce PIS and improve mental health status of PLWH are warranted.

Examination of the Weighted Root Mean Square Residual: Evidence for Trustworthiness?

This study examined the performance of the weighted root mean square residual (WRMR) through a simulation study using confirmatory factor analysis with ordinal data. Values and cut scores for the WRMR were examined, along with a comparison of its performance relative to commonly cited fit indexes. The findings showed that WRMR illustrated worse fit when sample size increased or model misspecification increased. Lower (i.e., better) values of WRMR were observed when nonnormal data were present, there were lower loadings, and when few categories were analyzed. WRMR generally illustrated expected patterns of relations to other well-known fit indexes. In general, a cutoff value of 1.0 appeared to work adequately under the tested conditions and the WRMR values of “good fit” were generally in agreement with other indexes. Users are cautioned that when the fitted model is misspeficifed, the index might provide misleading results under situations where extremely large sample sizes are used.

Brazilian cross-cultural adaptation and validation of the List of Threatening Events Questionnaire (LTE-Q).

Objective:To perform a construct validation of the List of Threatening Events Questionnaire (LTE-Q), as well as convergence validation by identifying its association with drug use in a sample of the Brazilian population.Methods:This is a secondary analysis of the Second Brazilian National Alcohol and Drugs Survey (II BNADS), which used a cross-cultural adaptation of the LTE-Q in a probabilistic sample of 4,607 participants aged 14 years and older. Latent class analysis was used to validate the latent trait adversity (which considered the number of events from the list of 12 item in the LTE experienced by the respondent in the previous year) and logistic regression was performed to find its association with binge drinking and cocaine use.Results:The confirmatory factor analysis returned a chi-square of 108.341, weighted root mean square residual (WRMR) of 1.240, confirmatory fit indices (CFI) of 0.970, Tucker-Lewis index (TLI) of 0.962, and root mean square error approximation (RMSEA) score of 1.000. LTE-Q convergence validation showed that the adversity latent trait increased the chances of binge drinking by 1.31 time and doubled the chances of previous year cocaine use (adjusted by sociodemographic variables).Conclusion:The use of the LTE-Q in Brazil should be encouraged in different research fields, including large epidemiological surveys, as it is also appropriate when time and budget are limited. The LTE-Q can be a useful tool in the development of targeted and more efficient prevention strategies.

Examining the factor structure of the Clinical Opiate Withdrawal Scale: A secondary data analysis from the National Drug Abuse Treatment Clinical Trials Network (CTN) 0003

BackgroundThe Clinical Opiate Withdrawal Scale (COWS) is used to assess withdrawal in clinical trials and practice. The aims of this study were to examine the inter-item correlations and factor structure of the COWS in opioid-dependent men and women. MethodsThis is a secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network 0003, a randomized clinical trial that compared buprenorphine/naloxone tapering strategies. The trial included 11 sites in 10 US cities. Participants were opioid-dependent individuals (n=516) that had data on the COWS. The COWS at study baseline was analyzed in this study. ResultsInter-item correlations showed weak to moderate relationships among the items. A 1-factor model did not fit the data for men (comparative fit index (CFI)=.801, root mean square error of approximation (RMSEA)=.073, weighted root mean square residual (WRMR)=1.132) or women (CFI=.694, RMSEA=.071, WRMR=.933), where resting pulse rate was not related to withdrawal for men, and yawning and gooseflesh skin was not related to withdrawal for women. A reduced model comprised of only the 8 items that were significantly related to the construct of withdrawal in both men and women, and an exploratory 2-factor model, were also assessed but not retained due to inconsistencies across gender. ConclusionsWhen traditional psychometric models are applied to the COWS, it appears that the scale may not relate to a single underlying construct of withdrawal. Further research testing the hypothesized factor structure in other opioid-dependent samples is needed.

Psychometric properties of the Italian Yale Food Addiction Scale in overweight and obese patients.

To assess the dimensionality and psychometric properties of an Italian version of the Yale Food Addiction Scale (YFAS) in a sample of obese/overweight patients attending low-energy diet therapy. Participants were 300 overweight and obese patients who were admitted to a private medical center in Rome, Italy. Controls were 300 (231 women and 69 men) adults from the general population. All of the participants were administered the YFAS and the binge eating scale (BES). The one-factor model of the YFAS reported in previous studies did not fit the data χ(2)(209) = 466.69, p < 0.001, root mean square error of approximation (RMSEA) = 0.07; 90% CI: 0.06/0.08; comparative fit index (CFI) = 0.91; weighted root mean square residual (WRMR) = 1.40]. Through item analysis, it was suggested that five items (items #10, #11, #22, #24, and #25) with low item-total correlations should be removed from the measure. A 16-item one-factor model revealed a better fit to the data (χ(2)(104) = 174.56; p < 0.001; RMSEA = 0.05; 90% CI: 0.04/0.07; CFI = 0.96), although the WRMR was slightly higher than that suggested as an indicator of good fit (WRMR = 1.01). The YFAS-16 had satisfactory internal consistency; it was able to discriminate obese patients from controls and strongly correlated with BES scores. The YFAS-16 assesses all of the "symptoms" represented in the original version and has satisfactory psychometric properties, although the percentage of food addiction diagnoses according to the YFAS-16 is lower than the percentage of diagnoses according to the original version of the questionnaire.

Factor structure and longitudinal invariance of the Center for Epidemiological Studies Depression Scale (CES-D) in adult women: application in a population-based sample of mothers of children with epilepsy

The objective of this study was to examine the factor structure and longitudinal measurement invariance of the Center for Epidemiological Studies Depression Scale (CES-D). The population-based sample included 347 adult women who had children participating in the Health-related Quality of Life in Children with Epilepsy Study. Longitudinal confirmatory factor analysis was used to confirm the factor structure and test for measurement invariance. The original CES-D four-factor model (depressed affect, positive affect, somatic activity, and interpersonal relations) provided the best fit to the data compared to alternate models: [χ(2) = 362.95 (df = 164); Comparative Fit Index (CFI) = 965; Tucker-Lewis Index (TLI) = 0.960; Weighted Root Mean Square Residual (WRMR) = 0.966; Root Mean Square Error of Approximation (RMSEA) = 0.059, 90% confidence interval (CI), 0.051, 0.068] and was used for invariance testing. Results suggested full measurement invariance over time with the final model demonstrating adequate fit [χ(2) = 2303.92 (df = 1,776); CFI = 0.957; TLI = 0.952; WRMR = 1.149; RMSEA = 0.033, 90% CI, 0.030, 0.038]. We conclude that the four-factor structure of the CES-D is supported for adult women and that the measurement of the scale is longitudinally invariant. Clinicians and researchers can be confident that longitudinal changes in CES-D scores reflect true changes in depressive symptomatology and are not an artifact of changes in the interpretation of items in the scale over time.

Validation of the Scale for the Assessment of Illness Behavior (SAIB) in a community sample of elderly people

The aim of this study was to evaluate the construct validity of the SAIB in a community sample of elderly people. The SAIB was administered to a large community sample representative of the German population aged 60–85 years (n=1593). The original model was assessed and then refined through confirmatory and exploratory factor analyses. Criterion validity was evaluated by comparing SAIB scores with external criteria in 3 categories: subjective health, chronic illness and health care utilization. The originally suggested five factor structure of the SAIB yielded a comparative fit index (CFI) of 0.70 and the weighted root mean square residual (WRMR) was 3.68. A shortened questionnaire with 13 items and four factors resulted in better model fit (CFI 0.97 and WRMR 1.3). Correlations between subjective health and the new scales ranged from 0.06 to 0.33. Effect sizes (Cohens d) of mean differences in factor scores between those with and without healthcare system contact varied by healthcare type, ranging from 0.05 to 0.94; effect sizes were largest in relation to contact with psychotherapy and alternative medicine practitioners. We propose a shortened version of the SAIB with a different scale structure, which resulted in better model fit with our data. Neither the original nor revised SAIB appeared to discriminate well in terms of health care use, suggesting that the illness behavior as currently conceptualized may not fully explain the increased use of healthcare in the elderly.