When used appropriately, IRT can be a powerful tool for questionnaire development, evaluation, and refinement, resulting in precise, valid, and relatively brief instruments that minimize response burden.
In this population, a brief cognitive test is a more accurate approach to cognitive assessment than the current observational methods employed using the MDS 2.0.
BackgroundInstruments to measure mental health and well-being are largely developed and often used within Western populations and this compromises their validity in other cultures. A previous qualitative study in Singapore demonstrated the relevance of spiritual and religious practices to mental health, a dimension currently not included in exiting multi-dimensional measures. The objective of this study was to develop a self-administered measure that covers all key and culturally appropriate domains of mental health, which can be applied to compare levels of mental health across different age, gender and ethnic groups. We present the item reduction and validation of the Positive Mental Health (PMH) instrument in a community-based adult sample in Singapore.MethodsSurveys were conducted among adult (21-65 years) residents belonging to Chinese, Malay and Indian ethnicities. Exploratory and confirmatory factor analysis (EFA, CFA) were conducted and items were reduced using item response theory tests (IRT). The final version of the PMH instrument was tested for internal consistency and criterion validity. Items were tested for differential item functioning (DIF) to check if items functioned in the same way across all subgroups. Results: EFA and CFA identified six first-order factor structure (General coping, Personal growth and autonomy, Spirituality, Interpersonal skills, Emotional support, and Global affect) under one higher-order dimension of Positive Mental Health (RMSEA = 0.05, CFI = 0.96, TLI = 0.96). A 47-item self-administered multi-dimensional instrument with a six-point Likert response scale was constructed. The slope estimates and strength of the relation to the theta for all items in each six PMH subscales were high (range:1.39 to 5.69), suggesting good discrimination properties. The threshold estimates for the instrument ranged from -3.45 to 1.61 indicating that the instrument covers entire spectrums for the six dimensions. The instrument demonstrated high internal consistency and had significant and expected correlations with other well-being measures. Results confirmed absence of DIF.ConclusionsThe PMH instrument is a reliable and valid instrument that can be used to measure and compare level of mental health across different age, gender and ethnic groups in Singapore.
JG. Personality traits as prospective predictors of suicide attempts.Objective: To examine higher order personality factors of negative affectivity (NA) and disinhibition (DIS), as well as lower order facets of impulsivity, as prospective predictors of suicide attempts in a predominantly personality disordered sample. Method: Data were analyzed from 701 participants of the Collaborative Longitudinal Personality Disorders Study with available follow-up data for up to 7 years. Cox proportional hazards regression analyses was used to examine NA and DIS, and facets of impulsivity (e.g. urgency, lack of perseverance, lack of premeditation and sensation seeking), as prospective predictors of suicide attempts. Results: NA, DIS and all facets of impulsivity except for sensation seeking were significant in univariate analyses. In multivariate models which included sex, childhood sexual abuse, course of major depressive disorder and substance use disorders, only NA and lack of premeditation remained significant in predicting suicide attempts. DIS and the remaining impulsivity facets were not significant. Conclusion: NA emerged as a stronger and more robust predictor of suicide attempts than DIS and impulsivity, and warrants greater attention in suicide risk assessment. Distinguishing between facets of impulsivity is important for clinical risk assessment. Significant outcomes• Negative affectivity is a more robust prospective predictor of suicide attempts than DIS and impulsivity, remaining significant even after controlling for numerous other established risk factors, including disinhibition ⁄ impulsivity, childhood sexual abuse, sex, and course of major depressive disorders (MDD) and substance use disorders (SUD).• DIS was not a significant prospective predictor of suicide attempts when controlling for negative affectivity and covariates (sex, childhood sexual abuse, and course of MDD and SUD).• Among the impulsivity facets only lack of premeditation remained significant in a model with negative affectivity and covariates. Limitations• Sample limited to treatment-seeking individuals with personality disorder(s) and ⁄ or MDD.• Negative affectivity and DIS, and facets of impulsivity were assessed using self-report measures, NEO Personality Inventory (NEO-PI) and Schedule for Non-adaptive and Adaptive Personality (SNAP). Although both are well-validated, they are not definitively established models of personality, and our internal consistency for the sensation seeking (E5) facet was only moderate.• We were able to conduct analyses on those who had follow-up data. Those with follow-up data have lower scores on SNAP DIS and SNAP aggression than those who have only baseline data; participants lost to follow-up who on average had higher scores on DIS and aggression may have had suicide attempts that were not able to be assessed.
Little is known about the adolescent risk factors and young adult health-related outcomes associated with running away from home. We examined these correlates of running away using longitudinal data from 4,329 youth (48% female, 85% white) who were followed from Grade 9 to age 21. Nearly 14% of the sample reported running away in the past year at Grade 10 and/or Grade 11. Controlling for demographics and general delinquency, running away from home was predicted by lack of parental support, school disengagement, greater depressive affect, and heavier substance use at Grade 9. In turn, runaways had higher drug dependence scores and more depressive symptoms at age 21 than non-runaways, even after taking these antecedent risk factors into account. Runaway status did not predict alcohol dependence risk at age 21. Results highlight the importance of substance use and depression, both as factors propelling adolescents to run away and as important long-term consequences of running away. Keywordsrunaway; substance abuse; depression; longitudinal It is challenging at best to estimate the percentage of adolescents who run away from home, but national surveys suggest that 6-7% of adolescents do so in any given year (SAMHSA, 2004;Sanchez, Waller, & Greene, 2006;Tyler & Bersani, 2008). Most runaways are gone for less than a week and stay within 50 miles of home (Hammer, Finkelhor, & Sedlak, 2002), eventually returning to their parents or guardian (Milburn et al., 2007). Nonetheless, being on their own for even a short period of time may exacerbate the problems that caused the youth to run away in the first place, as well as increase their likelihood of engaging in high-risk behavior, being exploited or victimized by others, and resorting to illicit activities in order to secure basic necessities such as food and a place to stay while away from home (Chen, Thrane, Whitbeck, Johnson, & Hoyt, 2007;Kipke, Simon, Montgomery, Unger, & Iversen, 1997;Wagner, Carlin, Cauce, & Tenner, 2001). Better understanding the risk factors for running away from home and the long-term consequences of this behavior is necessary in order to better serve these at-risk youth.Perhaps the most commonly cited reason why adolescents run away from home is to escape a negative family environment (National Runaway Switchboard, 2008; Van der Pleog & Scholte, 1997). High rates of family physical or sexual abuse among runaway and homeless youth are well-documented (Kipke, Palmer, LaFrance, & O'Connor, 1997;Whitbeck, Hoyt, & Ackley, 1997). In a rare study of runaway adolescents and their parents, Safyer and colleagues (2004) found that 41% of the adolescents attributed their runaway behavior to a Correspondence concerning this article should be addressed to: Dr. Joan S. Tucker, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138. Electronic mail may be sent to jtucker@rand.org.. poor relationship dynamic with their parents. Interestingly, only 7% of parents agreed and most (89%) believed that their child was solely to blame for the runawa...
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