Calibration of an item bank in 474 orthopedic patients using Rasch analysis for computer-adaptive assessment of anxiety

Objective: To calibrate an item bank of anxiety-related questions for use in orthopedic patients within a computer-adaptive test. Design: This is a psychometric study. Setting: The sample of orthopedic patients was recruited in two orthopedic rehabilitation clinics in Germany. Subjects: A total of 474 orthopedic rehabilitation patients were recruited for this study. Interventions: Not applicable. Main measures: The main measure is an adapted version of an existing anxiety item pool for cardiovascular rehabilitation patients. Results: The results of the confirmatory factor analysis and Mokken analysis confirmed a one-factor structure and double monotonicity. An anxiety item bank (48 items) could be developed and calibrated using Rasch analysis. It fitted to the Rasch model with a non-significant item–trait interaction ( χ2(203) = 172.59; P = .94) and was free of differential item functioning. Unidimensionality could be verified and the person separation reliability was .96. The category threshold parameters varied between 4.72 and 3.16 (7.88 logits). Conclusion: The unidimensional anxiety item bank provides the basis for a computer-adaptive test to assess a wide range of anxiety in rehabilitation patients with orthopedic diseases with very good psychometric characteristics.

Development of a Computerized Adaptive Test for Anxiety Based on the Dutch–Flemish Version of the PROMIS Item Bank

We used the Dutch–Flemish version of the USA PROMIS adult V1.0 item bank for Anxiety as input for developing a computerized adaptive test (CAT) to measure the entire latent anxiety continuum. First, psychometric analysis of a combined clinical and general population sample ( N = 2,010) showed that the 29-item bank has psychometric properties that are required for a CAT administration. Second, a post hoc CAT simulation showed efficient and highly precise measurement, with an average number of 8.64 items for the clinical sample, and 9.48 items for the general population sample. Furthermore, the accuracy of our CAT version was highly similar to that of the full item bank administration, both in final score estimates and in distinguishing clinical subjects from persons without a mental health disorder. We discuss the future directions and limitations of CAT development with the Dutch–Flemish version of the PROMIS Anxiety item bank.

Effect of Yoga Program on Mental Health: Competitive Anxiety In Semarang Badminton Athletes

The most obvious factor which really affects the capability of an athlete, especially in Semarang badminton, is psychological factors. One technique supposed to represent all the mental techniques are yoga. A total of 20 athletes (12 men & 8 women) from the badminton club in Semarang participated in this study. Quasi-experimental was used in the study. Two groups were selected according age group and class, and both are candidates of the provincial team. We measured anxiety levels with CSAI-2R and sphygmomanometer. We analyze the data using t-test and index gain. Cognitive anxiety item on the yoga group decreased (x=-2.10; -21.21%), and so did the control group (x=-0.20; -2.19%). Somatic anxiety symptoms were similar to yoga group (x=-3.50; -26.92%), but not for the control group, which increased (x=1.70; 17.71%). Whereas self-confidence has a negative correlation to other variables, the yoga group increased (x=2.00; 12.35%) but the control group decreased (x=-0.30; -1.99%).The last was badminton performance, yoga group increased (x=2.40; 14.67%) and whereas the control group decreased (x=-3.283; -17.23%).

Reliability and Model Fit

The purpose of this article is to highlight the distinction between the reliability of test scores and the fit of psychometric measurement models, reminding readers why it is important to consider both when evaluating whether test scores are valid for a proposed interpretation and/or use. It is often the case that an investigator judges both the reliability of scores and the fit of a corresponding measurement model to be either acceptable or unacceptable for a given situation, but these are not the only possible outcomes. This article focuses on situations in which model fit is deemed acceptable, but reliability is not. Data were simulated based on the item characteristics of the PROMIS (Patient Reported Outcomes Measurement Information System) anxiety item bank and analyzed using methods from classical test theory, factor analysis, and item response theory. Analytic techniques from different psychometric traditions were used to illustrate that reliability and model fit are distinct, and that disagreement among indices of reliability and model fit may provide important information bearing on a particular validity argument, independent of the data analytic techniques chosen for a particular research application. We conclude by discussing the important information gleaned from the assessment of reliability and model fit.

Factorial Integrity of the Sport Anxiety Scale: A Methodological Note and Revised Scoring Recommendations

Results of several recent studies have called into question the factorial integrity of the Sport Anxiety Scale (SAS; Smith, Smoll, & Schutz, 1990) because two items (14 and 20) that loaded on the Concentration Disruption subscale in our validation and cross-validation samples have loaded or cross-loaded on the Worry subscale in other samples. We agree that this is a serious problem, and we evaluate proposed modifications of the SAS on both conceptual and empirical grounds. For researchers currently using the SAS, we recommend a new scoring system that deletes two troublesome Concentration Disruption items and one Somatic Anxiety item, preserving separate and factorially consistent Somatic, Worry, and Concentration Disruption subscales. We present evidence that our original Worry scale provides a better CFA fit than a suggested “cognitive anxiety” alternative that combines the two concentration disruption items with the Worry scale items. We also describe nonreplication of the SAS three-factor structure in child samples and caution researchers against computing subscale scores for child samples.

Ziprasidone's Effect on Anxiety in a Group of Outpatients With Stable Schizophrenia

Objective: Nearly 50% of patients with schizophrenia hav ecomorbid anxiety disorders. Ziprasidone's unique pharmacological profile, including 5-HT1A agaonism and 5-HT and NE reuptake inhibition, may confer anxiolytic properties. And exploratory analysis was conducted to evaluate improvement in anxiety in stable schizophrenic outpatients, as standard scales assessing psychosis do not adequately address anxity. Stable outpatients were selected to reduce the influence of acute psychosis.Methods: Patients on conventional antipsychotics (n=93), olanzapine (n=88), and risperidone (n=41) were randomized to one of three dosing schedules and received ziprasidone 40–160 mg/day in three 6-week, open-label trials. Anxiety was measured by the PANSS anxiety item (G2: 1, absent, to 7, extreme). Analysis of patients with moderate or greater anxiety (≥4), as well as analysis of those with at least minimal anxiety (≥2), was conducted. Other symptom items were analyzed to address the speccificity of potential treatment differences.Results: In patients with moderate or greater baseline anxiety, significant improvement in the PANSS anxiety time was observed (P<0.05). Significant improvement was also seen in the group of patients with at least minimal baseline anxiety (P<0.05). There were no concomitant signigicant changes in depression or somatic concern in the moderate anxiety subsample.Conclusions: Improvement in the PANSS anxiety item, separate from changes in depression and somatic concern, was observed. In view of the prevalence of anxiety symptoms in schizophrenia, controlled trials utilizing anxiety scales validated in this population are necessary to further evaluate ziprasidone's anxwlytk potential.

Depression in Later Life

BackgroundDepression in later life is often thought to differ from that at other times of adulthood. The evidence for this is controversial but is important to any proposed organic model of depression in the elderly. Here, early- and late-onset depressions in later life are compared.MethodFifty-seven depressed patients with a mean age of 74 were studied, 21 with an early onset (aged 59 or less) and 36 with a late onset. All were suffering from major depression according to DSM–III–R. The measures at entry included severity and symptoms, cognitive function, antecedent life events, physical health and vascular risk factors and/or vascular disease. We also recorded any family history of mood disorders, as well as the course of illness.ResultsThe anxiety item scores of the Hamilton Depression Rating Scale were significantly higher in those with an early onset, but otherwise symptoms differed little. Heritability was greater in the early-onset group. There was a striking association of vascular disease and/or risk with late-onset patients.ConclusionsVascular disease is associated with late-onset depression. This is consistent with the hypothesis that depression in later life is a more ‘biological’ disorder.