A longitudinal evaluation of the Center for Epidemiologic Studies-Depression scale (CES-D) in a Rheumatoid Arthritis Population using Rasch Analysis

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Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the hospital, Anxiety and Depression Scale (HADS)

<p>Abstract</p> <p>Background</p> <p>While it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.</p> <p>Methods</p> <p>Patients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.</p> <p>Results</p> <p>A total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.</p> <p>Conclusions</p> <p>This study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.</p

Variability in depression prevalence in early rheumatoid arthritis: a comparison of the CES-D and HAD-D Scales

<p>Abstract</p> <p>Background</p> <p>Depression is common in rheumatoid arthritis (RA), however reported prevalence varies considerably. Two frequently used instruments to identify depression are the Center for Epidemiological Studies Depression (CES-D) scale, and the Hospital Anxiety and Depression Scale (HADS). The objectives of this study were to test if the CES-D and HADS-D (a) satisfy current modern psychometric standards for unidimensional measurement in an early RA sample; (b) measure the same construct (i.e. depression); and (c) identify similar levels of depression.</p> <p>Methods</p> <p>Data from the two scales completed by patients with early RA were fitted to the Rasch measurement model to show that (a) each scale satisfies the criteria of fit to the model, including strict unidimensionality; (b) that the scales can be co-calibrated onto a single underlying continuum of depression and to (c) examine the location of the cut points on the underlying continuum as indication of the prevalence of depression.</p> <p>Results</p> <p>Ninety-two patients with early RA (62% female; mean age = 56.3, SD = 13.7) gave 141 sets of paired CES-D and HAD-D data. Fit of the data from the CES-D was found to be poor, and the scale had to be reduced to 13 items to satisfy Rasch measurement criteria whereas the HADS-D met model expectations from the outset. The 20 items combined (CES-D13 and HADS-D) satisfied Rasch model expectations. The CES-D gave a much higher prevalence of depression than the HADS-D.</p> <p>Conclusion</p> <p>The CES-D in its present form is unsuitable for use in patients with early RA, and needs to be reduced to a 13-item scale. The HADS-D is valid for early RA and the two scales measure the same underlying construct but their cut points lead to different estimates of the level of depression. Revised cut points on the CES-D13 provide comparative prevalence rates.</p

A review of forgiveness process models and a coping framework to guide future research

Despite substantial advances in other areas of forgiveness research, empirical evaluation of a fundamental aspect of forgiveness, the process itself, has been virtually nonexistent. This article reviews the existing literature and concludes that although numerous process models have been proposed, many lack a coherent theoretical grounding, and few have been empirically validated. Importantly, understanding of the forgiveness process is hindered by a lack of consensus on what forgiveness is, and consequently what constitutes the endpoint of the process. In response to the many shortcomings in the literature, salient issues for future research are identified. The stress and coping model (Lazarus & Folkman, 1984) is proposed as a framework for guiding theorizing and research

Investigating students' preferred learning styles with the aim of developing context specific application

This paper looks at the need for tertiary teachers to increase awareness of students' preferred learning styles. In doing this, it critiques the instruments that have been developed and the convergent nature of institutional formal education. It introduces a new instrument that avoids the worst effects of reductionism by being context specific and it poses some directions for future research

Can a rural community-based work-related activity program make a difference for chronic pain-disabled injured workers?

Objective: To assess the effectiveness of a clinical guidelines-informed multidisciplinary work-related activity program, and to improve the physical, psychological and occupational functioning of chronic pain-disabled injured workers. Design: An uncontrolled, repeated-measures, pilot study was conducted. Setting: The intervention was delivered in a community setting in regional New South Wales. Participants: Participants (n = 30), mean age of 41 years, had a compensable musculoskeletal injury: 60% were male, 63% had back injuries; the mean time off work was 13 months. Intervention: A cognitive-behavioural, interdisciplinary intervention was delivered using a multi-contributor provider model (a clinical psychologist and physiotherapist from separate practices, working in liaison with the participant's occupational rehabilitation provider and treating doctor). Groups of six participants attended for one half day per week for six weeks. Main outcome measures: The outcome measures included: physical functioning, pain intensity and psychological variables, which were assessed pre- and post-program; and medical certification and work participation, which was recorded pre-program and at six-month follow up. Results: Significant gains were made in pain intensity, physical and psychological functioning, and medical certification. The mean effect size of the intervention was medium to large (d = 0.70). There was no significant change in employment status at six-month follow up. Conclusions: The results of this pilot study suggest that independent, rural or community-based practitioners, working collaboratively using an integrated treatment program, can produce positive outcomes for pain-disabled injured workers, and achieve results similar to those reported by metropolitan-based pain clinics

Understanding and accommodating students with apparently mixed levels of engagement

In looking at teaching students with mixed levels of engagement, this paper challenges assumed links between observed participation and engagement. It presents evidence from an instrument that specifically measures Tutorial Style Preferences (the TSP) that suggests that individual differences matter, that engagement is more complex than just observed participation and that engagement can be enhanced by an understanding and by catering to individual differences in learning and teaching environments. It also suggests that summative assessment of observed participation neither measures nor encourages engagement and may even discourage engagement for a significant cohort of students

Can a rural community-based work-related activity program make a difference for chronic pain-disabled injured workers?

Objective: To assess the effectiveness of a clinical guidelines-informed multidisciplinary work-related activity program, and to improve the physical, psychological and occupational functioning of chronic pain-disabled injured workers. Design: An uncontrolled, repeated-measures, pilot study was conducted. Setting: The intervention was delivered in a community setting in regional New South Wales. Participants: Participants (n = 30), mean age of 41 years, had a compensable musculoskeletal injury: 60% were male, 63% had back injuries; the mean time off work was 13 months. Intervention: A cognitive-behavioural, interdisciplinary intervention was delivered using a multi-contributor provider model (a clinical psychologist and physiotherapist from separate practices, working in liaison with the participant's occupational rehabilitation provider and treating doctor). Groups of six participants attended for one half day per week for six weeks. Main outcome measures: The outcome measures included: physical functioning, pain intensity and psychological variables, which were assessed pre- and post-program; and medical certification and work participation, which was recorded pre-program and at six-month follow up. Results: Significant gains were made in pain intensity, physical and psychological functioning, and medical certification. The mean effect size of the intervention was medium to large ( d = 0.70). There was no significant change in employment status at six-month follow up. Conclusions: The results of this pilot study suggest that independent, rural or community-based practitioners, working collaboratively using an integrated treatment program, can produce positive outcomes for pain-disabled injured workers, and achieve results similar to those reported by metropolitan-based pain clinics

Is the essay resubmission option a formative or a summative assessment and does it matter as long as the grades improve?

Typically, essays are used as summative rather than formative assessments and students experience them as tasks rather than learning opportunities. Thus, the aim of this study was to see whether providing students with detailed formative feedback and an opportunity to resubmit their essay would improve their essays writing skills. Twenty-six out of 54 third-year psychology students resubmitted their essay. Of those 26 resubmitted essays, 18 were awarded higher grades. Although the students observed that their skills had improved, they mainly perceived the resubmission option as a 'safety net' and were motivated to use it as a way of improving their grades. Lack of time was the most common reason given for not resubmitting. Therefore, lecturers may be faced with a challenge of finding ways of not only providing formative feedback but also encouraging students to use it as such