Customized computer-based administration of the PCL-5 for the efficient assessment of PTSD:A proof-of-principle study

Objective: To investigate the potential of customized computer-based testing procedures to reduce the mean test length of the Posttraumatic Stress Checklist for DSM-5 (PCL-5). Method: A retrospective analysis was conducted using responses from 942 adults who had completed the full-length (20-item) PCL-5 in the aftermath of Hurricane Sandy. The abilities of 2 testing procedures, curtailment and stochastic curtailment, to lessen the instrument's mean test length while maintaining the same result as the full-length PCL-5 ("positive" or "negative") were evaluated in a post hoc simulation. Curtailment and stochastic curtailment track a respondent's answers as she takes the instrument and stop the test if future items are unable or unlikely to change the result. The performance of each procedure was recorded under 2 scoring methods: a total-score-based method and a cluster-based method. Each procedure's sensitivity, specificity, and overall agreement with the full-length PCL-5 were computed. Results: Curtailment reduced the mean test length by 40% under the total-score-based method, and by more than 70% under the cluster-based method, while exhibiting 100% sensitivity, specificity, and overall agreement with the full-length PCL-5. Stochastic curtailment reduced the mean test length by up to 88% under the total-score-based method, and up to 84% under the cluster-based method, while always exhibiting at least 92% sensitivity and 99.8% overall agreement, as well as 100% specificity, for the full-length PCL-5. Conclusions: Curtailment and stochastic curtailment have potential to enhance the efficiency of the PCL-5 when this assessment is administered by computer. The 2 procedures should be evaluated in future prospective studies. (PsycINFO Database Recor

Item Ordering and Computerized Classification Tests With Cluster-Based Scoring: An Investigation of the Countdown Method

The countdown method is a well-known approach to reducing the average length of screening instruments that are presented by computer. In the countdown method, testing is terminated once the result of the screener (“positive” or “negative”) has been unambiguously determined from prior answers. Previous research has examined whether presenting dichotomously scored items in order from “least to most frequently endorsed” or “most to least frequently endorsed” is more efficient when the countdown method is used. The current study describes the Mean Score procedure, an extension of the above item ordering procedures to polytomously scored items, and evaluates its efficiency relative to the distribution of other possible item orderings in 2 real-data simulations. Both simulations involve item responses to the Posttraumatic Stress Disorder (PTSD) Checklist for DSM–5 (PCL-5). In the first simulation, items were scored polytomously, and a single cutoff point was used to determine the screening result. In the second simulation, items were converted to dichotomous scores, as well as categorized into 4 clusters; a positive result for the entire assessment was obtained if and only if a positive result was obtained for each cluster. The latter simulation also investigated the effect of reordering the clusters themselves on the efficiency of the countdown method. Results indicated that the Mean Score procedure does not necessarily produce the optimal ordering, but tends to assemble an efficient item ordering relative to the distribution of possible orderings. In the second simulation, reordering the clusters themselves affected efficiency. Future research directions are suggested

Mental health in the slums of Dhaka - a geoepidemiological study

Gruebner O, Khan MH, Lautenbach S, et al. Mental health in the slums of Dhaka - a geoepidemiological study. BMC Public Health. 2012;12(1): 177.Background: Urban health is of global concern because the majority of the world's population lives in urban areas. Although mental health problems (e.g. depression) in developing countries are highly prevalent, such issues are not yet adequately addressed in the rapidly urbanising megacities of these countries, where a growing number of residents live in slums. Little is known about the spectrum of mental well-being in urban slums and only poor knowledge exists on health promotive socio-physical environments in these areas. Using a geo-epidemiological approach, the present study identified factors that contribute to the mental well-being in the slums of Dhaka, which currently accommodates an estimated population of more than 14 million, including 3.4 million slum dwellers. Methods: The baseline data of a cohort study conducted in early 2009 in nine slums of Dhaka were used. Data were collected from 1,938 adults (>= 15 years). All respondents were geographically marked based on their households using global positioning systems (GPS). Very high-resolution land cover information was processed in a Geographic Information System (GIS) to obtain additional exposure information. We used a factor analysis to reduce the socio-physical explanatory variables to a fewer set of uncorrelated linear combinations of variables. We then regressed these factors on the WHO-5 Well-being Index that was used as a proxy for self-rated mental wellbeing. Results: Mental well-being was significantly associated with various factors such as selected features of the natural environment, flood risk, sanitation, housing quality, sufficiency and durability. We further identified associations with population density, job satisfaction, and income generation while controlling for individual factors such as age, gender, and diseases. Conclusions: Factors determining mental well-being were related to the socio-physical environment and individual level characteristics. Given that mental well-being is associated with physiological well-being, our study may provide crucial information for developing better health care and disease prevention programmes in slums of Dhaka and other comparable settings

Mental Health and Recovery in the Urban Setting: Brescia and the San Polo District

Urban settings have been historically associated with an increase ofmental illness, in contrast with more rural environments. Also the de-institutionalisation of mental healthcare has seen the coming-back to town of former psychiatric hospital inpatients, initiating other forms of seclusion associated with stigma and self-stigma and stimulating the activation of several community-based initiatives. This chapter reviews the city-mental health relationship, introducing the specific case of Brescia in Italy, and the work of a operative unity for psychiatry—UOP23—leading a transformational project in the San Polo district