The Leiden Index of Depression Sensitivity-Revised (LEIDS-R) and its revision (LEIDS-RR): An investigation of the internal structure and conceptual validity in a Norwegian sample

This is an Accepted Manuscript of an article published by Taylor & Francis in Nordic Psychology on 19 Feb 2020, available at http://wwww.tandfonline. com/https://doi.org/10.1080/19012276.2020.1727359.The purpose of this study was to evaluate the internal consistency, factor structure, and validity of the Leiden Index of Depression Sensitivity-Revised (LEIDS-R) and a recent revision of the LEIDS-R (LEIDS-RR) in Norway. The LEIDS-R is a self-report inventory measuring cognitive reactivity. Cognitive reactivity is defined as the relative ease with which negative thinking is activated by mild low mood and has been shown to be a strong predictor of relapse of depression. Hospital employees and psychology students (N = 240) completed the LEIDS-R and measures of depression, repetitive negative thinking, and mindfulness. The results showed that Cronbach’s alpha was equally high for both the LEIDS-R and LEIDS-RR total score (α = .92), indicating good internal consistency. Confirmatory factor analysis of the LEIDS-R suggested an acceptable model fit for the original first-order six-factor model. Confirmatory factor analyses of the LEIDS-RR suggested the best fit for a bifactor five-factor model. Correlational analyses showed positive associations of the LEIDS-R and LEIDS-RR scales with depression and repetitive negative thinking and negative relationships with mindfulness. It is concluded that the Norwegian versions of the LEIDS-R and LEIDS-RR appear to be both reliable and valid for future use

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.publishedVersio

Parental internalizing symptoms as predictors of anxiety symptoms in clinic-referred children

Background: Mothers’ and fathers’ internalizing symptoms may influence children’s anxiety symptoms differently. Objective: To explore the relationship between parental internalizing symptoms and children’s anxiety symptoms in a clinical sample of children with anxiety disorders. Method: The sample was recruited through community mental health clinics for a randomized controlled anxiety treatment trial. At pre-intervention, children (n = 182), mothers (n = 165), and fathers (n = 72) reported children’s anxiety symptoms. Mothers and fathers also reported their own internalizing symptoms. The children were aged 8 to 15 years (Mage = 11.5 years, SD = 2.1, 52.2% girls) and all had a diagnosis of separation anxiety, social phobia, and/or generalized anxiety disorder. We examined parental internalizing symptoms as predictors of child anxiety symptoms in multiple regression models. Results: Both mother and father rated internalizing symptoms predicted children’s self-rated anxiety levels (adj. R2 = 22.0%). Mother-rated internalizing symptoms predicted mother-rated anxiety symptoms in children (adj. R2 = 7.0%). Father-rated internalizing symptoms did not predict father-rated anxiety in children. Conclusions: Clinicians should incorporate parental level of internalizing symptoms in their case conceptualizations

The predictive value of depression in the years after heart transplantation for mortality during long-term follow-up

Objective Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality. Methods Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory – version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables. Results Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366–3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220–3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis. Conclusions Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.acceptedVersio

HPA axis related genes and response to psychological therapies: genetics and epigenetics

Background Hypothalamic–pituitary–adrenal (HPA) axis functioning has been implicated in the development of stress-related psychiatric diagnoses and response to adverse life experiences. This study aimed to investigate the association between genetic and epigenetics in HPA axis and response to cognitive behavior therapy (CBT). Methods Children with anxiety disorders were recruited into the Genes for Treatment project (GxT, N = 1,152). Polymorphisms of FKBP5 and GR were analyzed for association with response to CBT. Percentage DNA methylation at the FKBP5 and GR promoter regions was measured before and after CBT in a subset (n = 98). Linear mixed effect models were used to investigate the relationship between genotype, DNA methylation, and change in primary anxiety disorder severity (treatment response). Results Treatment response was not associated with FKBP5 and GR polymorphisms, or pretreatment percentage DNA methylation. However, change in FKBP5 DNA methylation was nominally significantly associated with treatment response. Participants who demonstrated the greatest reduction in severity decreased in percentage DNA methylation during treatment, whereas those with little/no reduction in severity increased in percentage DNA methylation. This effect was driven by those with one or more FKBP5 risk alleles, with no association seen in those with no FKBP5 risk alleles. No significant association was found between GR methylation and response. Conclusions Allele-specific change in FKBP5 methylation was associated with treatment response. This is the largest study to date investigating the role of HPA axis related genes in response to a psychological therapy. Furthermore, this is the first study to demonstrate that DNA methylation changes may be associated with response to psychological therapies in a genotype-dependent manner

Mental disorders in foster children: a study of prevalence, comorbidity and risk factors

Background: The aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors. Methods: Information on mental health was collected from foster parents and from teachers using Developmental and Well-Being Assessment (DAWBA) Web-based diagnostic interview. Child welfare services provided information about care conditions prior to placement and about the child’s placement history. Results: Diagnostic information was obtained about 279 (70.5%) of 396 eligible foster children. In total, 50.9% of the children met the criteria for one or more DSM-IV disorders. The most common disorders were grouped into 3 main diagnostic groups: Emotional disorders (24.0%), ADHD (19.0%), and Behavioural disorders (21.5%). The comorbidity rates among these 3 main groups were high: 30.4% had disorders in 2 of these 3 diagnostic groups, and 13.0% had disorders in all 3 groups. In addition, Reactive attachment disorder (RAD) was diagnosed in 19.4% of the children, of whom 58.5% had comorbid disorders in the main diagnostic groups. Exposure to violence, serious neglect, and the number of prior placements increased the risk for mental disorders. Conclusions: Foster children in Norway have a high prevalence of mental disorders, compared to the general child population in Norway and to other societies. The finding that 1 in 2 foster children presented with a mental disorder with high rates of comorbidity highlight the need for skilled assessment and qualified service provision for foster children and families

Screening Foster Children for Mental Disorders: Properties of the Strengths and Difficulties Questionnaire

Background High prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders. Methods Foster parents and teachers of 279 foster children completed the SDQ and the diagnostic interview Developmental and Well-Being Assessment (DAWBA). Using the diagnoses derived from the DAWBA as the standard, we examined the performance of the SDQ scales as dimensional measures of mental health problems using receiver operating characteristic (ROC) analyses. Recommended cut-off scores were derived from ROC coordinates. The SDQ predictive algorithms were also examined. Results ROC analyses supported the screening properties of the SDQ Total difficulties and Impact scores (AUC = 0.80–0.83). Logistic regression analyses showed that the prevalence of mental disorders increased linearly with higher SDQ Total difficulties scores (X2 = 121.47, df = 13, p<.001) and Impact scores (X2 = 69.93, df = 6, p<.001). Our results indicated that there is an additive value of combining the scores from the Total difficulties and Impact scales, where scores above cut-off on any of the two scales predicted disorders with high sensitivity (89.1%), but moderate specificity (62.1%). Scores above cut-off on both scales yielded somewhat lower sensitivity (73.4%), but higher specificity (81.1%). The SDQ multi-informant algorithm showed low discriminative ability for the main diagnostic categories, with an exception being the SDQ Conduct subscale, which accurately predicted the absence of behavioural disorders (LHR− = 0.00). Conclusions The results support the use of the SDQ Total difficulties and Impact scales when screening foster children for mental health problems. Cut-off values for both scales are suggested. The SDQ multi-informant algorithms are not recommended for mental health screening of foster children in Norway

Reactive Attachment Disorder and Disinhibited Social Engagement Disorder in School-Aged Foster Children - A Confirmatory Approach to Dimensional Measures

This study aimed to investigate the factor structure and external correlates of the constructs Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The following were addressed: First, do our data support the DSM-5 conceptualization of RAD/DSED as two separate constructs? Second, are RAD and DSED distinct from other well-established dimensions of child psychopathology? Third, what are the external correlates of RAD/DSED in this sample? The study sample included 122 foster children aged 6–10 years. Foster parents completed the Strengths and Difficulties Questionnaire (SDQ), and the RAD/DSED-scale from the Developmental and Well-Being Assessment. Child protection caseworkers completed a questionnaire regarding exposure to maltreatment and placement history. Confirmatory factor analysis (CFA) of the RAD/DSED items identified a good fit for a model with a two-factor structure, which is congruent with the DSM-5 definition of RAD and DSED. A new CFA model, which included the RAD and DSED factors together with the four problem factors of the SDQ (emotional, conduct, hyperactivity-inattention, and peer problems), also demonstrated a good fit with our data. RAD and DSED were associated with the SDQ Impact scale and help seeking behavior. This was partly explained by the SDQ externalizing and peer problem subscales. Our findings lend support for the DSM-5 conceptualization of RAD and DSED as separate dimensions of child psychopathology. Thus, the assessment of RAD and DSED provides information beyond other mental health problems

Self-assessment of health before and after a myocardial infarction

Self-evaluated health represents an important aspect of quality of life that may influence the rehabilitation process after a major illness. However, health is a multi-dimensional concept and relatively little is known about the determinants of, and the interrelationships between the separate aspects of health. In a prospective longitudinal study of myocaridal infarction (MI) patients, two indices of self-evaluated health, maximal physical ability (MPA) and perceived global health (PGH), were used. On the average, both ratings were clearly reduced compared with pre-MI levels even as long as 3-5 yr after the MI. Females and older patients indicated lower MPA before and after the MI, whereas PGH was not related to any sociodemographic variable. The severity of the MI appeared to be of relatively limited importance for self-evaluated health. Heart-related symptoms before and after the MI were more strongly related to lower MPA, whereas non-cardiac health problems and psychological distress more clearly influenced PGH. However, initial illness perceptions were of some importance for both health perceptions. The data suggest that to some extent self-evaluated health can be influenced by educational or psychological support in order to faccilitate readaptation and recovery after a MI.myocardial infarction self-evaluated health quality of life rehabilitation

The Leiden Index of Depression Sensitivity-Revised (LEIDS-R) and its revision (LEIDS-RR): An investigation of the internal structure and conceptual validity in a Norwegian sample

The purpose of this study was to evaluate the internal consistency, factor structure, and validity of the Leiden Index of Depression Sensitivity-Revised (LEIDS-R) and a recent revision of the LEIDS-R (LEIDS-RR) in Norway. The LEIDS-R is a self-report inventory measuring cognitive reactivity. Cognitive reactivity is defined as the relative ease with which negative thinking is activated by mild low mood and has been shown to be a strong predictor of relapse of depression. Hospital employees and psychology students (N = 240) completed the LEIDS-R and measures of depression, repetitive negative thinking, and mindfulness. The results showed that Cronbach’s alpha was equally high for both the LEIDS-R and LEIDS-RR total score (α = .92), indicating good internal consistency. Confirmatory factor analysis of the LEIDS-R suggested an acceptable model fit for the original first-order six-factor model. Confirmatory factor analyses of the LEIDS-RR suggested the best fit for a bifactor five-factor model. Correlational analyses showed positive associations of the LEIDS-R and LEIDS-RR scales with depression and repetitive negative thinking and negative relationships with mindfulness. It is concluded that the Norwegian versions of the LEIDS-R and LEIDS-RR appear to be both reliable and valid for future use