Generic health surveys have been proposed for use in increasingly diverse applications and populations. This paper describes the history of generic tools in the past 30 years and suggests a more modern measurement platform for advances in the 21st century. Many generic tools lack the precision required for effective health care decision making. A meaningful goal for the next era of development of generic measures should be the generation of equiprecise measurement for generic health concepts. Equiprecise tests yield measures of equal precision at all levels of the underlying construct. Equiprecise measurement can be achieved through conjoint use of computerized-adaptive testing as the survey platform and item response theory as the measurement theory.

Generic Health Measurement: Past Accomplishments and a Measurement Paradigm for the 21st Century

Multiple sclerosis (MS) is a chronic inflammatory disease of the brain and spinal cord. Individuals with MS are typically diagnosed in early to middle adulthood. Cognitive impairment and disruption of emotional and behavioral control and psychosocial functioning are often associated with MS (Bishop & Frain, 2011; Chiaravalloti & Deluca, 2002; Conway & Cohen, 2010; Feinstein, 2011; Halper et al., 2003). Common symptoms include fatigue, numbness, vision problems, dizziness and vertigo, pain, emotional changes, depressive symptoms, bowel and bladder dysfunction and spasticity (National Multiple Sclerosis Society, 2008). Depressive symptoms can be characterized by poor mood, losing interest in previously enjoyable experiences, fatigue, and feelings of worthlessness (Siegert & Abernethy, 2005). Studies related to MS and depressive symptoms suggest that people with MS experience significantly higher depressive symptoms than the general population (Chwastiak et al., 2002; Pattern, Beck, Williams, Barbui, & Metz, 2003; Patten, Metz, & Reimer, 2000; Rao, Huber, & Bomstein, 1992). One study found depression to be the most significant individual predictor of health distress in a sample of individuals with MS (White, White, & Russell, 2008). Furthermore, several MS studies have estimated that individuals with MS have a 37% to 54% risk of lifetime major depression that can dramatically affect their physical, social, and mental functioning (Chwastiak et al., 2002; Patten et al., 2003), with self-reported lifetime depression as high as 50% (Feinstein, 2011). The negative sequelae associated with depressive symptoms in MS include decreased perceived cognitive function (Maor, Olmer, & Mozes, 2001), increased fatigue (Koch, Mostert, Heerings, Uyttenboogaart, & De Keyser, 2009; Patten, Lavorato, & Metz, 2005) and sleep difficulties (Bamer, Johnson, Amtmann, & Kraft, 2010).

A number of self-reported instruments (scales or measures) have been used to screen for high depressive symptoms or major depressive disorder (MDD). The Patient Health Questionnaire-9 (PHQ-9) developed by Spitzer, Kroenke, and Williams (1999) is used to screen for MDD with items corresponding to the symptoms identified in the Diagnostic and Statistical Manual (American Psychiatric Association, 2000). The PHQ-9 also measures the severity of depressive symptoms and has been widely applied in medical settings (Kroenke, Spitzer, Williams, & Lowe, 2010). Depressive symptoms also have been measured using the 20-item Center for Epidemiologic Studies Depression Scale (CESD-20) developed by Radloff (1977) to measure the severity of depressive symptoms in adults and adolescents. Unlike the PHQ-9, the CESD was originally constructed for use with the general community (Cole, Rabin, Smith, & Kaufman, 2004; Miller, Anton, & Townson, 2008). In addition, the 10-item version of the CESD (CESD-10) was developed to reduce respondent burden, (Andresen, Malmgren, Carter, & Patrick, 1994) and is well known for its quick administration and scoring (Sakakibara, Miller, Orenczuk, Wolfe, & SCIRE Research Team, 2009).

More recently, a depressive symptom item bank was developed by the National Institutes of Health's Patient Reported Outcome Measurement Information System (PROMIS) as one of many instruments to measure patient-reported outcomes relevant to a range of chronic diseases (Cella et al., 2010; Teresi et al., 2009). Both PHQ-9 and CESD-10 were developed within the Classical Test Theory (CTT) framework. PROMIS used an Item Response Theory (IRT) approach to develop item banks (as opposed to static instruments) to measure emotional distress, including depression (Pilkonis et al., 2011). The PROMIS item banks include a set of items calibrated to IRT that can be administered by Computerized Adaptive Testing (CAT) or by selecting a subset of items for use as fixed-length short forms. PROMIS developed several fixed length short forms. The 8-item version 1b (PROMIS-D-8) was used in this study. The PROMIS depression short form consists of eight items that were selected from the item bank based on CAT simulation results, item information, and content (Pilkonis et al., 2011). The IRT-based scoring of the PROMIS-D-8 was derived using all the items in the item bank, and as a result the PROMIS-D-8 is directly comparable to PROMIS Depression CAT scores and to the scores from different short forms, allowing meaningful comparisons across studies and populations. Another important advantage of the PROMIS-D-8 compared to other measures of depression, such as the PHQ-9 and CESD-10, is the lack of somatic symptoms that often overlap between depression and MS.

Because several measures of depressive symptoms are available, it is important to evaluate the psychometric strengths and weaknesses of each. Such information can help direct future research by identifying measures that are most suitable for a given purpose (e.g., epidemiological studies, clinical care). Instruments assessing depressive symptoms often sample items from multiple domains (e.g., mood, cognition, behavior, somatic symptoms) to capture a comprehensive set of manifest indicators of depression, and most instruments contain somatic items that could be related to disease rather than to depression in individuals with chronic illness and disability. Because of these differences, the factor structures of these instruments can differ from each other. The PROMIS-D item bank (and by extension the short form) was specifically developed to be unidimensional. While some studies of primary care and substance abuse samples have suggested the PHQ-9 is also unidimensional (Cameron, Crawford, Lawton, & Reid, 2008; Dum, Pickren, Sobell, & Sobell, 2008; Hansson, Chotai, Nordstom, & Bodlund, 2009), studies of the measure in spinal cord injury samples have been mixed supporting both a 1-factor (Kalpakjian et al., 2009) and a 2-factor structure of affective and somatic symptoms (Richardson & Richards, 2008). The original, full length CESD-20 was found to have four factors of depressed mood, positive affect, somatic symptoms and interpersonal symptoms in people with MS (Verdier-Taillefer, Gourlet, Fuhrer, & Alperovitch, 2001). However, research on the factor structure of the CESD-10 for older adults has been mixed with some research support for a 2-factor structure of depressed mood and positive affect (Lee & Chokkanathan, 2008) and others suggesting a 3-factor structure of depressed mood, positive affect, and somatic symptoms (Cheng, Chan, & Fung, 2006).

Our literature review found no studies that examined the factor structure of the CESD-10 or the PHQ-9 in a sample of persons with MS. Differences in factor structure, and item content may indicate that different instruments measure different facets of depression. Determining which aspects of depression are most relevant to specific research protocols or clinical use is an important step in selecting among competing measures of depression.

The purpose of this study was to examine and compare psychometric properties of the PHQ-9, CESD-10, and PROMIS-D-8 in persons with MS and provide guidance to MS clinicians and researchers. We selected these instruments because they represent a diverse array of depression measures in medical populations, developed for different purposes and measuring different aspects of depression. The PHQ-9 corresponds to major depression and was developed for clinical use. The CES-D full version and short forms were developed for large epidemiological studies and sample a wide array of aspects of depression (mood, somatic). The PROMIS-D-8 excludes somatic symptoms and was developed for use with several medical populations. We evaluated unidimensionality, inter-item reliability, and convergent/discriminant validity, and assignment to depression severity categories based on scores. While factor structures of various measures for the same construct (such as depression) can differ, any instrument that provides a summary score needs to be sufficiently unidimensional. This is an assumption of both CTT and IRT based instruments (de Bonis, Lebeaux, de Boeck, Simon, & Pichot, 1991). This means that a set of items measures primarily the same construct. For instance, a summary score provided by a depression instrument, orders respondents on a continuum of depressive symptoms. Most commonly people with higher score have a higher level of depressive symptoms. If the item set is not sufficiently unidimensional and measures different constructs, the scores could not be ordered on one continuum and the summary score could not be meaningfully interpreted, because it could measure any of the dimensions or a mixture of dimensions. The assumption of unidimensionality must therefore be met by any instrument that provides a summary score.

/pdf/comparing-cesd-10-phq-9-and-promis-depression-instruments-in-394mzhhddf.pdf

Comparing CESD-10, PHQ-9, and PROMIS Depression Instruments in Individuals with Multiple Sclerosis

Recent studies have started to suggest that, beyond effects of individual socioeconomic profiles, socioeconomic characteristics of residential neighborhoods are independently associated with blood pressure. However, mechanisms involved in these associations remain unknown. To distinguish between different mechanisms, we investigated whether specific risk factors of hypertension (physical inactivity, alcohol consumption, smoking, body mass index, waist circumference, and resting heart rate) intervene as mediators in the associations between individual or neighborhood socioeconomic characteristics and systolic blood pressure. We relied on data from the RECORD Cohort Study (Residential Environment and CORonary heart Disease) on 5941 participants recruited in 2007-2008, aged 30 to 79 years, residing in 1824 neighborhoods in the Paris metropolitan area. Systolic blood pressure increased independently and regularly with both decreasing individual education and decreasing residential neighborhood education. Body mass index/waist circumference and resting heart rate mediated an appreciable share of the associations between education and blood pressure and, adding validity to the finding, were the 2 most significant mediators for the effects of both individual education and neighborhood education. We found that 52% (95% CI: 25% to 79%) of the association between neighborhood education and blood pressure was mediated by body mass index/waist circumference and 20% (95% CI: 5% to 36%) by resting heart rate. Future research will have to clarify the exact mechanisms through which body weight and shape and resting heart rate intervene as mediators in the associations between individual/neighborhood education and blood pressure.

Individual/Neighborhood Social Factors and Blood Pressure in the RECORD Cohort Study. Which Risk Factors Explain the Associations?

In this paper, some psychometric models will be presented that belong to the larger class oflatent response models (LRMs). First, LRMs are introduced by means of an application in the field ofcomponential item response theory (Embretson, 1980, 1984). Second, a general definition of LRMs (not specific for the psychometric subclass) is given. Third, some more psychometric LRMs, and examples of how they can be applied, are presented. Fourth, a method for obtaining maximum likelihood (ML) and some maximum a posteriori (MAP) estimates of the parameters of LRMs is presented. This method is then applied to theconjunctive Rasch model. Fifth and last, an application of the conjunctive Rasch model is presented. This model was applied to responses to typical verbal ability items (open synonym items).

/pdf/psychometric-latent-response-models-4f99s2axdj.pdf

Psychometric latent response models

Background
Long-term adherence is a major issue in patients receiving home continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS). In a multicenter prospective cohort (the Institut de Recherche en Sante Respiratoire des Pays de la Loire [IRSR] sleep cohort) of consecutive OSAHS patients in whom CPAP had been prescribed for at least 90 days, we studied the impact on long-term treatment adherence of socioeconomic factors, patients and disease characteristics prior to CPAP initiation.

/pdf/influence-of-marital-status-and-employment-status-on-long-2rzel2zikv.pdf

Influence of Marital Status and Employment Status on Long-Term Adherence with Continuous Positive Airway Pressure in Sleep Apnea Patients

An IRT model based on the Rasch model is proposed for composite tasks, that is, tasks that are decomposed into subtasks of different kinds. There is one subtask for each component that is discerned in the composite tasks. A component is a generic kind of subtask of which the subtasks resulting from the decomposition are specific instantiations with respect to the particular composite tasks under study. The proposed model constrains the difficulties of the composite tasks to be linear combinations of the difficulties of the corresponding subtask items, which are estimated together with the weights used in the linear combinations, one weight for each kind of subtask. Although the model does not belong to the exponential family, its parameters can be estimated using conditional maximum likelihood estimation. The approach is demonstrated with an application to spelling tasks.

An item response model with internal restrictions on item difficulty

Measuring the severity of depression through a self-report inventory: A comparison of logistic, factorial and implicit models

Problèmes méthodologiques posés par la classification des problèmes de schizophrénie: recherche de corrélations ou de relations d'appartenance?

An application of Embretson's multicomponent latent trait model to synonym tests

This study on a delusional misidentification patient with both FrEgoli symptoms and intermetamorphosis investigates the cognitive structure of others and of the self-representations with a new cl

Person identification and self-concept in the delusional misidentification syndrome

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