Two new reliability indices, ordinal coefficient alpha and ordinal coefficient theta, are introduced. A simulation study was conducted in order to compare the new ordinal reliability estimates to each other and to coefficient alpha with Likert data. Results indicate that ordinal coefficients alpha and theta are consistently suitable estimates of the theoretical reliability, regardless of the magnitude of the theoretical reliability, the number of scale points, and the skewness of the scale point distributions. In contrast, coefficient alpha is in general a negatively biased estimate of reliability. The use of ordinal coefficients alpha and theta as alternatives to coefficient alpha when estimating the reliability based on Likert response items are recommended. The choice between the two ordinal coefficients depends on whether one is assuming a factor analysis model (ordinal coefficient alpha) or a principal components analysis model (ordinal coefficient theta).
Background
Disease burden estimates rarely consider comorbidity. Using a recently developed methodology for integrating information about comorbidity into disease burden estimates, we examined the comparative burdens of 9 mental and 10 chronic physical disorders in the National Comorbidity Survey Replication (NCS-R).
Methods
Face-to-face interviews in a national household sample (n = 5,692) assessed associations of disorders with scores on a visual analog scale (VAS) of perceived health. Multiple regression analysis with interactions for comorbidity was used to estimate these associations. Simulation was used to estimate incremental disorder-specific effects adjusting for comorbidity.
Results
74.9% of respondents reported one or more disorders. 73.8–98.2% of respondents with disorders reported having at least one other disorder. The best-fitting model to predict VAS scores included disorder main effects and interactions for number of disorders. Adjustment for comorbidity reduced individual-level disorder-specific burden estimates substantially, but with considerable between-disorder variation (.07–.69 ratios of disorder-specific estimates with and without adjustment for comorbidity). Four of the five most burdensome disorders at the individual level were mental disorders based on bivariate analyses (panic/agoraphobia, bipolar disorder, PTSD, major depression) but only two based on multivariate analyses, adjusting for comorbidity (panic/agoraphobia, major depression). Neurological disorders, chronic pain conditions, and diabetes were the other most burdensome individual-level disorders. Chronic pain conditions, cardiovascular disorders, arthritis, insomnia, and major depression were the most burdensome societal-level disorders.
Conclusions
Adjustments for comorbidity substantially influence estimates of disease burden, especially those of mental disorders, underlining the importance of including information about comorbidity in studies of mental disorders.
Findings suggest meaningful comparisons of SWLS means across gender may be valid in some situations, but most likely not across culture or age groups. Participants mostly ascribe similar meaning to like items on the SWLS regardless of their gender, but age and especially culture seem to influence this process.
The McGill Quality of Life Questionnaire-Revised improves on and can replace the McGill Quality of Life Questionnaire since it contains improved wording, a somewhat expanded repertoire of concepts with fewer items, and a single subscale for the physical domain, while retaining good psychometric properties.
Highlights
Adverse mental health outcomes due to COVID-19 quarantine vary by reason for quarantine
Quarantine is associated with suicidal thoughts except when done due to recent travel
Quarantine surveillance should include active mental health assessment and outreach
Individuals who have quarantined during the COVID-19 pandemic are at increased risk for adverse mental health consequences beyond the quarantine period itself and should receive “flagged” for ongoing mental health monitoring
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