Measurement invariance testing of the MMPI-2 when used with patients suffering a traumatic brain injury

© 2013 Dr. Nathan Raoul AlkemadeThe MMPI-2 is one of the most widely used tests of personality and psychopathology in both clinical and research settings (Archer & Newsom, 2000; Butcher, Rouse & Steven, 1996; Smith, Gorske, Wiggins & Little, 2010). It is suggested the neurological damage from a traumatic brain injury (TBI) can falsely inflate MMPI-2 profiles. Following this theory, the Gass (1991) correction procedure removes 14 items from the MMPI-2. Widespread use of the correction procedure continues despite conflicting results from replication studies. In this study measurement invariance analysis was completed separately on MMPI-2 scales Hs1, Hy3 and Sc8 to assess the Gass correction procedure. A TBI sample (n=254) and a sample generated from the MMPI-2 normative data (n=2600) was used for measurement invariance testing. In measurement invariance Test 1 (baseline model test) all residuals and one item loading for each factor were held to equality. In Test 2 (strict invariance test), all parameters were held to equality across groups. The requirement of invariance is that CFI decrease by equal to or less than .002 (Meade, Johnson and Braddy, 2008). If a model failed the test of strict invariance then a partial invariance model was defined using the backwards elimination procedure. Practical impact analysis was completed using the Millsap and Kwok (2004) procedure to assess the clinical effect from a failure to establish strict invariance. Prior to measurement invariance testing, exploratory factor analysis and confirmatory factor analysis were employed to define a factor model in Hs1, Hy3 and Sc8. A 4-Factor model was selected as best representing the 32 items from Hs1. In Test 1 the model produced reasonable fit indices (RMSEA = .023, CFI = .947, TLI = .943). In Test 2 the decrease in CFI was above the threshold of invariance (RMSEA = .025, CFI = .932, TLI = .930). A partial invariance model was defined with the parameters for four items freed (RMSEA = .023, CFI = .946, TLI = .945). All items passed the tests of no practical impact. In Hy3 a 4-Factor model was selected as best representing the 40 items from this scale not previously analysed in Hs1. In Test 1 the model produced reasonable fit indices (RMSEA .026, CFI = .921, TLI =.915). In Test 2 the decrease in CFI was above the threshold of invariance (RMSEA .043, CFI = .767, TLI =.761). A partial invariance model was defined with the parameters for 20 items freed (RMSEA .026, CFI = .919, TLI =.915). Items 161 and 185 failed the tests of no practical impact. In Sc8 a 5-factor model was selected as best representing the 68 items not previously analysed in Hs1 or Hy3. In Test 1 the model produced reasonable fit indices (RMSEA .015, CFI = .934, TLI = .932). In Test 2 the decrease in CFI was above the threshold of invariance (RMSEA .023, CFI = .838, TLI = .837). A partial invariance model was defined with the parameters for 28 items freed (RMSEA .015, CFI = .932, TLI = .930). Items 17, 92, 190, 278, 281, 291 and 303 failed the tests of no practical impact. Eleven of the 14 items from the Gass correction procedure passed the test of strict invariance, with the other three passing the tests of no practical impact. This finding fails to support continued use of the Gass correction procedure. Additionally the finding is contrary to the hypothesis that neurological content will bias MMPI-2 profiles in specific populations, such as the traumatic brain injury. However, some items were failed the tests of no practical impact and were identified as concerning. The implications from these findings are discussed

Utility of the dimensions of anger reactions-5 (DAR-5) scale as a brief anger measure

Background: Anger is a common emotional sequel in the aftermath of traumatic experience. As it is associated with significant distress and influences recovery, anger requires routine screening and assessment. Most validated measures of anger are too lengthy for inclusion in self-report batteries or as screening tools. This study examines the psychometric properties of a shortened 5-item version of the Dimensions of Anger Reactions (DAR), an existing screening tool. Methods: Responses to the DAR-5 were analysed from a sample of 486 college students with and without a history of trauma exposure. Results: The DAR-5 demonstrated strong internal reliability and concurrent validity with the State Trait Anger Expression Inventory-2 (STAXI-2). Confirmatory factor analysis supported a single factor model of the DAR-5 for the trauma-exposed and nontrauma subsamples. A screening cut-off point of 12 on the DAR-5 successfully differentiated high and low scorers on STAXI-2 Trait Anger and PCL posttraumatic stress scores. Further discriminant validity was found with depression symptom scores. Conclusions: The results support use of the DAR-5 for screening for anger when a short scale is required

Evaluation of the Dimensions of Anger Reactions-5 (DAR-5) Scale in combat veterans with posttraumatic stress disorder

After a traumatic event many people experience problems with anger which not only results in significant distress, but can also impede recovery. As such, there is value to include the assessment of anger in routine post-trauma screening procedures. The Dimensions of Anger Reactions-5 (DAR-5), as a concise measure of anger, was designed to meet such a need, its brevity minimizing the burden on client and practitioner. This study examined the psychometric properties of the DAR-5 with a sample of 163 male veterans diagnosed with Posttraumatic Stress Disorder. The DAR-5 demonstrated internal reliability (α = .86), along with convergent, concurrent and discriminant validity against a variety of established measures (e.g. HADS, PCL, STAXI). Support for the clinical cut-point score of 12 suggested by Forbes et al. (2014, Utility of the dimensions of anger reactions-5 (DAR-5) scale as a brief anger measure. Depression and Anxiety, 31, 166–173) was observed. The results support considering the DAR-5 as a preferred screening and assessment measure of problematic anger

Mental health following separation in a disaster: The role of attachment

Short-term separation from close family members during a disaster is a highly salient event for those involved. Yet, its subsequent impact on mental health has received little empirical attention. One relevant factor may be attachment style, which influences patterns of support-seeking under threatening conditions. Individuals (N = 914) affected by the 2009 Victorian bushfires in southeastern Australia were assessed for disaster experiences, depression, posttraumatic stress disorder (PTSD) symptoms, and attachment style 3–4 years after the fires. Using multigroup structural equation modelling, individuals who reported separation from close family members during the bushfires (n = 471) were compared to those who reported no separation (n = 443). Cross-sectional results indicated that separated individuals had higher levels of PTSD symptoms. Furthermore, attachment anxiety was more strongly positively associated with depression among separated (b = 0.62) versus not separated individuals (b = 0.32). Unexpectedly, among separated individuals, attachment avoidance had a statistically weaker association with depression (b = 0.17 vs. b = 0.35) and with PTSD symptoms (b = 0.06 vs. b = 0.22). These results suggest that attachment anxiety amplifies a negative reaction to separation; meanwhile, for avoidant individuals, separation in times of danger may facilitate defensive cognitive processes

Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster

Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four‐factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3‐ and 9‐month follow‐ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, dRM = −0.61 and dRM = −0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, dRM = −0.36 and dRM = −0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3‐month follow‐up, dRM = −0.21. Intrusion and arousal symptoms also showed continued changes between 3‐ and 9‐month follow‐ups although these effects were very small, dRM = −0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma‐focused therapy directly targeting intrusions as the core component of programmatic treatment.No Full Tex

The role of anger and ongoing stressors in mental health following a natural disaster

Objective: Research has established the mental health sequelae following disaster, with studies now focused on understanding factors that mediate these outcomes. This study focused on anger, alcohol, subsequent life stressors and traumatic events as mediators in the development of mental health disorders following the 2009 Black Saturday Bushfires, Australia’s worst natural disaster in over 100 years. Method: This study examined data from 1017 (M = 404, F = 613) adult residents across 25 communities differentially affected by the fires and participating in the Beyond Bushfires research study. Data included measures of fire exposure, posttraumatic stress disorder, depression, alcohol abuse, anger and subsequent major life stressors and traumatic events. Structural equation modeling assessed the influence of factors mediating the effects of fire exposure on mental health outcomes. Results: Three mediation models were tested. The final model recorded excellent fit and observed a direct relationship between disaster exposure and mental health outcomes (b = .192, p < .001) and mediating relationships via Anger (b = .102, p < .001) and Major Life Stressors (b = .128, p < .001). Each gender was compared with multiple group analyses and while the mediation relationships were still significant for both genders, the direct relationship between exposure and outcome was no longer significant for men (p = .069), but remained significant (b = .234, p < .001) for women. Conclusions: Importantly, anger and major life stressors mediate the relationship between disaster exposure and development of mental health problems. The findings have significant implications for the assessment of anger post disaster, the provision of targeted anger-focused interventions and delivery of government and community assistance and support in addressing ongoing stressors in the post-disaster context to minimize subsequent mental health consequences

Drug-Induced Epigenomic Plasticity Reprograms Circadian Rhythm Regulation to Drive Prostate Cancer toward Androgen Independence

In prostate cancer, androgen receptor (AR)–targeting agents are very effective in various disease stages. However, therapy resistance inevitably occurs, and little is known about how tumor cells adapt to bypass AR suppression. Here, we performed integrative multiomics analyses on tissues isolated before and after 3 months of AR-targeting enzalutamide monotherapy from patients with high-risk prostate cancer enrolled in a neoadjuvant clinical trial. Transcriptomic analyses demonstrated that AR inhibition drove tumors toward a neuroendocrine-like disease state. Additionally, epigenomic profiling revealed massive enzalutamide-induced reprogramming of pioneer factor FOXA1 from inactive chromatin sites toward active cis-regulatory elements that dictate prosur-vival signals. Notably, treatment-induced FOXA1 sites were enriched for the circadian clock component ARNTL. Posttreatment ARNTL levels were associated with patients’ clinical outcomes, and ARNTL knockout strongly decreased prostate cancer cell growth. Our data highlight a remarkable cistromic plasticity of FOXA1 following AR-targeted therapy and revealed an acquired dependency on the circadian regulator ARNTL, a novel candidate therapeutic target. SIGNIFICANCE: Understanding how prostate cancers adapt to AR-targeted interventions is critical for identifying novel drug targets to improve the clinical management of treatment-resistant disease. Our study revealed an enzalutamide-induced epigenomic plasticity toward prosurvival signaling and uncovered the circadian regulator ARNTL as an acquired vulnerability after AR inhibition, presenting a novel lead for therapeutic development