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As part of a scale development project, we fit a nominal response item response theory model to responses to the Health Care Engagement Measure (HEM). When using the original 5-point response format, categories were not ordered as intended for six of the 23 items. For the remaining, the category boundary discrimination between Categories 0 ( not at all true) and 1 ( a little bit true) was only weakly discriminating, suggesting uninformative categories. When the lowest two categories were collapsed, psychometric properties improved greatly. Category boundary discriminations within items, however, varied significantly. Specifically, higher response category distinctions, such as responding 3 ( very true) versus 2 ( mostly true) were considerably more discriminating than lower response category distinctions. Implications for HEM scoring and for improving measurement precision at lower levels of the construct are presented as is the unique role of the nominal response model in category analysis.

Item response theory (IRT) model applications extend well beyond cognitive ability testing, and various patient-reported outcomes (PRO) measures are among the more prominent examples. PRO (and like) constructs differ from cognitive ability constructs in many ways, and these differences have model fitting implications. With a few notable exceptions, however, most IRT applications to PRO constructs rely on traditional IRT models, such as the graded response model. We review some notable differences between cognitive and PRO constructs and how these differences can present challenges for traditional IRT model applications. We then apply two models (the traditional graded response model and an alternative log-logistic model) to depression measure data drawn from the Patient-Reported Outcomes Measurement Information System project. We do not claim that one model is “a better fit” or more “valid” than the other; rather, we show that the log-logistic model may be more consistent with the construct of depression as a unipolar phenomenon. Clearly, the graded response and log-logistic models can lead to different conclusions about the psychometrics of an instrument and the scaling of individual differences. We underscore, too, that, in general, explorations of which model may be more appropriate cannot be decided only by fit index comparisons; these decisions may require the integration of psychometrics with theory and research findings on the construct of interest. Supplementary Information The online version supplementary material available at 10.1007/s11336-021-09802-0.

Patients with chronic pain (CP) and substance use disorder (SUD) are complex, not yet adequately described, and in need of comprehensive treatments that address both diseases concurrently. Our objectives were to (a) describe a cohort of CP patients who failed traditional treatment (mainly opioids) – then developed opioid use disorder (OUD) and other SUDs and (b) evaluate a comprehensive inpatient treatment program for these patients. Patients were enrolled in an inpatient CP program. Treatment consisted of medical detoxification, group process/education, external and internal qigong, osteopathic manual medicine, and qigong-based mindfulness. Patients also received 20 h per week of 12-step recovery-based SUD treatment. Patients were evaluated at the beginning of treatment (first assessment, day 1–5 range) and at days 30 and 45. Assessments were: Beck Depression Inventory-II, Brief Pain Inventory, West Haven-Yale Multidimensional Pain Inventory (patient section), and McGill Pain Questionnaire. The Global Impression of Change Scale was administered at day 45. A mixed model analysis was used to evaluate treatment progress. Demographic data revealed an older cohort with OUD, other SUDs, and multiple pain diagnoses who failed traditional treatment. Questionnaire evaluations were consistent and similar across all of the above measures: patients’ scores showed marked, statistically significant improvements in depression, pain, and quality of life ratings. The most substantial improvements occurred between the first and second assessments. The findings are sufficiently encouraging to warrant further evaluation of the protocol and to plan comparative studies.

This study provides binge drinking population estimates for California adults by gender and detailed race/ethnicity categories. This information may be helpful for planning targeted initiatives to decrease binge drinking.Data were from the 2007 and 2009 California Health Interview Surveys. The 98 662 respondents represent an annual estimated population of 27.2 million adults. Survey adjusted binary logistic regression was used to calculate gender-specific binge drinking population rates and multinomial logit regression to estimate binge drinking frequency.Adjusting for socio-demographics, any binge drinking during the past year was reported by 31.0% (95% Confidence Interval = 30.5-31.4%) of men and 18.0% (17.7-18.3%) of women. Rates among White men and women were 30.5% and 19.6%, respectively. Binge drinking rates ranged from 11.9% among Chinese to 42.9% among Mexican men and from 4.8% among Vietnamese to 25.7% among "Other Latino" women. Five race/ethnicity categories of men and seven categories of women were significantly less likely to binge drink compared to Whites. Although Whites had the highest overall binge drinking rates, an estimated 12.5% of White men binge drank less than monthly, significantly exceeded by Mexican and Central American men, 19.9 and 19.6%, respectively. An estimated 9.6% of White women binge drank less than monthly, exceeded only by "Other Latino" women, 13.6%.These findings underscore the importance of detailed gender and race/ethnicity breakdowns when examining any binge drinking. Furthermore, there is variability across Asian and Latino subgroups in the frequency of binge drinking episodes, which is not evident in broad-group population studies.

Confirmatory factor analytic studies of psychological measures showing item responses to be multidimensional do not provide sufficient guidance for applied work. Demonstrating that item response data are multifactorial in this way does not necessarily (a) mean that a total scale score is an inadequate indicator of the intended construct, (b) demand creating and scoring subscales, or (c) require specifying a multidimensional measurement model in research using structural equation modeling (SEM). To better inform these important decisions, more fine-grained psychometric analyses are necessary. We describe 3 established, but seldom used, psychometric approaches that address 4 distinct questions: (a) To what degree do total scale scores reflect reliable variation on a single construct? (b) Is the scoring and reporting of subscale scores justified? (c) If justified, how much reliable variance do subscale scores provide after controlling for a general factor? and (d) Can multidimensional item response data be represented by a unidimensional measurement model in SEM, or are multidimensional measurement models (e.g., second-order, bifactor) necessary to achieve unbiased structural coefficients? In the discussion, we provide guidance for applied researchers on how best to interpret the results from applying these methods and review their limitations.

In this study, the authors consider several indices to indicate whether multidimensional data are “unidimensional enough” to fit with a unidimensional measurement model, especially when the goal is to avoid excessive bias in structural parameter estimates. They examine two factor strength indices (the explained common variance and omega hierarchical) and several model fit indices (root mean square error of approximation, comparative fit index, and standardized root mean square residual). These statistics are compared in population correlation matrices determined by known bifactor structures that vary on the (a) relative strength of general and group factor loadings, (b) number of group factors, and (c) number of items or indicators. When fit with a unidimensional measurement model, the degree of structural coefficient bias depends strongly and inversely on explained common variance, but its effects are moderated by the percentage of correlations uncontaminated by multidimensionality, a statistic that rises combinatorially with the number of group factors. When the percentage of uncontaminated correlations is high, structural coefficients are relatively unbiased even when general factor strength is low relative to group factor strength. On the other hand, popular structural equation modeling fit indices such as comparative fit index or standardized root mean square residual routinely reject unidimensional measurement models even in contexts in which the structural coefficient bias is low. In general, such statistics cannot be used to predict the magnitude of structural coefficient bias.

Objective. To identify correlates of perceived pain-related restrictions in a community sample of women with fibromyalgia. Method. The fibromyalgia group was composed of white women with a self-reported, physician-given fibromyalgia diagnosis ( N = 238) from the Biopsychosocial Religion and Health Study (BRHS). BRHS respondents had participated in the larger Adventist Health Study-2. To identify associations with pain-related restrictions, we used hierarchical linear regression. The outcome measure was subjects' pain-related restrictions (one SF-12 version 2 item). Predictors included age, education, body mass index (BMI), sleep apnea, and fibromyalgia treatment in the last year, as well as standardized measures for trauma, major life stress, depression, and hostility. To better interpret the findings, pain-related restrictions also were predicted in women with osteoarthritis and no fibromyalgia. Results. Women with fibromyalgia reporting the more severe pain-related restrictions were those who had experienced trauma accompanied by physical pain, were older, less educated, more depressed, more hostile, had high BMI scores, and had been treated for fibromyalgia in the last 12 months (adjusted R 2 = 0.308). Predictors in women with osteoarthritis were age, BMI, treatment in the last 12 months, experience of a major life stressor, and greater depression symptom severity (adjusted R 2 = 0.192). Conclusions. In both groups, age, BMI, treatment in the last 12 months, and depression predicted pain-related restrictions. Experience of a traumatic event with physical pain was the strongest predictor in the fibromyalgia group. These findings may be useful in constructing novel treatments and prevention strategies for pain-related morbidity in fibromyalgia patients.

The contribution of stress to the pathophysiology of fibromyalgia has been the subject of considerable debate. The primary purpose of the present study was to evaluate the relationship between traumatic and major life stressors and a fibromyalgia diagnosis in a large group of older women and men. Data were from the federally-funded Biopsychosocial Religion and Health Study, and subjects were 10,424 of the 10,988 survey respondents—two-thirds women and one-third men—providing responses to a fibromyalgia question. Average age was 61.0 ± 13.5 years. A physician-given fibromyalgia diagnosis in a subject’s lifetime was reported by 3.7% of the sample, 4.8% of the women and 1.3% of the men. In two multivariable logistic regression models (all respondents and women only, controlling for age, sex, race/ethnicity, and education), two traumatic experience types (sexual and physical assault/abuse) were associated with a fibromyalgia diagnosis. Two other trauma types (life-threatening and emotional abuse/neglect) and major life stress experiences were not. The highest odds ratios in both models were those for sexual assault/abuse followed by physical assault/abuse. The relationship between age and fibromyalgia was curvilinear in both models (odds ratios rising until approximately age 63 and declining thereafter). In the all-subjects model, being a woman increased the odds of a fibromyalgia diagnosis, and in both models, fibromyalgia was associated with being White (versus non-White) and lower education. We recommend that researchers investigate the relationship between stress and fibromyalgia in concert with genetic and biomarker studies.

Serious mental illness often is associated with an increased risk of diabetes and sub-optimal diabetes care.To examine diabetes prevalence and care among Medicaid patients from one county mental health system.Retrospective cohort study combining county records and 12 months of state Medicaid claims.Patients ages 18 to 59 receiving mental health services between November 1 and 14, 2004.Dependent variables were glycolated hemoglobin A1C (HbA1c) testing, lipid testing, and eye examinations. Psychiatric status was assessed by second generation antipsychotic prescription (SGA) and low Global Assessment of Functioning (GAF) score.Among psychiatric patients, 482 (11.8%) had diabetes. Among those with diabetes, 47.3% received annual HbA1c testing, 56.0% lipid testing, and 31.7% eye examinations. Low GAF scores were associated with lower likelihood of lipid testing (OR 0.43). SGA prescription reduced the likelihood of HbA1c testing (OR 0.58) but increased the likelihood of eye examinations (OR 2.02). Primary care visits were positively associated with HbA1c and lipid testing (ORs 5.01 and 2.21, respectively). Patients seen by a fee-for-service psychiatrist were more likely to have lipid testing (OR 2.35) and eye examinations (OR 2.03).Among Medicaid psychiatric patients, worse diabetes care was associated with SGA prescription, more serious psychiatric symptoms, and receiving psychiatric care only in public mental health clinics. Diabetes care improved when patients were seen by fee-for-service psychiatrists or primary care physicians. Further study is needed to identify methods for improving diabetes care of public mental health patients.

The value of alexithymia assessments in medical and psychiatric research is well documented, but such assessments in cannabis abusers are scarce. Moreover, despite repeated calls for multimethod alexithymia evaluations, researchers typically use 1 self-report only: the 20-item Toronto Alexithymia Scale. Herein, we evaluated (1) the psychometric properties of the Observer Alexithymia Scale (OAS), (2) the correspondence between 3 alexithymia measures, (3) OAS raters' affect and its relationship to OAS scores, and (4) cannabis abusers' alexithymic features. Eighty-seven cannabis abusers completed self-reports measuring alexithymia (Toronto Alexithymia Scale, Bermond-Vorst Alexithymia Questionnaire-B), depression (13-item Beck Depression Inventory), and anxiety (State and Trait Anxiety Inventory-Form Y) and asked relatives to rate them using the OAS. The raters also completed the self-report scales. The OAS met acceptable reliability and validity standards, with the exception of relatively low interrater reliability for one of its subscales. Rater affect appeared to influence OAS scores, albeit slightly. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. Alexithymia rates were similar to those previously reported in cannabis abusers. Our results demonstrated the adequacy and appropriateness of the OAS in these (and related) clinical samples, which may encourage multimethod alexithymia assessments in both research and clinical practice.

Objective: To calculate binge drinking rates among California adults and describe the characteristics of female and male binge drinkers. Method: Analyses of 2005 California Health Interview Survey (CHIS) data. Results: At least one binge drinking episode over a 30-day period was reported by 1.4 million California women (10.7% of all adult women) and 3.2 million California men (24.7%). For both women and men, factors associated with binge drinking included being 18–44 years of age, smoking, and having mid-range psychological distress scores. There were gender differences in binge drinking risk by race/ethnicity and health status. Method: Given the multi-stage sampling design and non-responses in the 2005 California Health Interview Survey-Specific techniques were employed to ensure that the 43,020 compteted result yeilded reasonable state wide estimates. Conclusion: Binge drinking is a serious public health concern that affects millions of adult Californians.

Item response theory (IRT) was applied to evaluate the psychometric properties of the Spiritual Assessment Inventory (SAI; Hall & Edwards, 1996, 2002). The SAI is a 49-item self-report questionnaire designed to assess five aspects of spirituality: Awareness of God, Disappointment (with God), Grandiosity (excessive self-importance), Realistic Acceptance (of God), and Instability (in one's relationship to God). IRT analysis revealed that for several scales: (a) two or three items per scale carry the psychometric workload and (b) measurement precision is peaked for all five scales, such that one end of the scale, and not the other, is measured precisely. We considered how sample homogeneity and the possible quasi-continuous nature of the SAI constructs may have affected our results and, in light of this, made suggestions for SAI revisions, as well as for measuring spirituality, in general.

Objectives Our objectives were to evaluate the psychometric properties of the Observer Alexithymia Scale (OAS) in eating disorder patients, alexithymia severity across diagnostic subgroups, and correspondence among three alexithymia measures. Method Seventy-five women, each with an eating disorder diagnosis, completed two alexithymia self-reports, the 20-item Toronto Alexithymia Scale (TAS-20) and the Bermond–Vorst Alexithymia Questionnaire—version B (BVAQ-B), and asked a relative or an acquaintance to rate them using the OAS. Results The OAS showed acceptable discriminant validity and interrater reliability. Patients' OAS scores were higher than scores reported for people-in-general samples and lower than those for outpatient clinical samples. No statistically significant OAS, TAS-20, and BVAQ-B score differences were found between the patients with anorexia nervosa restrictive type and those with bulimia nervosa. OAS, TAS-20, and BVAQ-B total scores were moderately, positively, and significantly correlated. Conclusion These clinical data show the psychometric strength of the OAS, which reasonably can be recommended for use with the TAS-20 in research and clinical practice.

The purpose of the present study was to evaluate posttraumatic stress disorder (PTSD)-related hospitalizations in the United States (2002-2011). Over this period, there were an estimated 1,477,944 hospitalizations (915,591 women) with either a primary (reason for hospitalization) or secondary PTSD diagnosis. Population-based hospitalization rates rose from 2002 to 2011; women in the age range of 20 to 44 years had the highest rates and the steepest rise. Most of the hospitalizations for men and women younger than 45 years had been assigned a primary diagnosis of mental illness (including PTSD). Mood and substance use disorders were among the most commonly co-occurring psychiatric diagnoses with PTSD. Suicidal ideation/suicide attempts declined with increasing age. The strongest predictor of this criterion was mood disorder, and its importance as a predictor increased as people aged. Total inflation-adjusted charges for all PTSD-related hospitalizations were $34.9 billion, with 36% being for hospitalizations where a mental illness (including PTSD) was the primary diagnosis.

Bifactor measurement models are increasingly being applied to personality and psychopathology measures (Reise, 2012). In this work, authors generally have emphasized model fit, and their typical conclusion is that a bifactor model provides a superior fit relative to alternative subordinate models. Often unexplored, however, are important statistical indices that can substantially improve the psychometric analysis of a measure. We provide a review of the particularly valuable statistical indices one can derive from bifactor models. They include omega reliability coefficients, factor determinacy, construct reliability, explained common variance, and percentage of uncontaminated correlations. We describe how these indices can be calculated and used to inform: (a) the quality of unit-weighted total and subscale score composites, as well as factor score estimates, and (b) the specification and quality of a measurement model in structural equation modeling. (PsycINFO Database Record

The purpose of this study was to apply a set of rarely reported psychometric indices that, nevertheless, are important to consider when evaluating psychological measures. All can be derived from a standardized loading matrix in a confirmatory bifactor model: omega reliability coefficients, factor determinacy, construct replicability, explained common variance, and percentage of uncontaminated correlations. We calculated these indices and extended the findings of 50 recent bifactor model estimation studies published in psychopathology, personality, and assessment journals. These bifactor derived indices (most not presented in the articles) provided a clearer and more complete picture of the psychometric properties of the assessment instruments. We reached 2 firm conclusions. First, although all measures had been tagged "multidimensional," unit-weighted total scores overwhelmingly reflected variance due to a single latent variable. Second, unit-weighted subscale scores often have ambiguous interpretations because their variance mostly reflects the general, not the specific, trait. Finally, we review the implications of our evaluations and consider the limits of inferences drawn from a bifactor modeling approach.

To compare the effects of learning about electroconvulsive therapy (ECT) via live observation to learning via an instructional videotape.During their psychiatry clerkship, 122 medical students were randomized using these two educational methods, and their ECT knowledge and attitudes were assessed during the first and last weeks of the 6-week clerkship.For both the knowledge and attitudes measures, the clerkship (time) effect was statistically significant (i.e., posttest scores were higher than pretest scores). The interaction effect was significant for knowledge only (pretest scores for students in the live group were slightly lower at pretest than those for students in the videotape group and slightly higher at posttest). The effect size was very small, however, suggesting little meaningful educational difference between the two instructional methods.Both live demonstration and viewing a videotape appear to be effective methods for teaching medical students about ECT.

In the present study, we evaluated the psychometric properties of the Observer Alexithymia Scale-French translation (OAS-F), a 33-item, observer-rated alexithymia measure. The scale, accessible to lay and professional raters, taps everyday expressions of alexithymia. French university students (N = 159) were asked to rate a person they knew well or ask an acquaintance to rate them. Those being rated (N = 159) were parents, siblings, children, and friends. OAS-F total and subscale scores were comparable to those in the English normative samples. Moreover, OAS scores were reliable, and the scale’s five-factor structure (distant, uninsightful, somatizing, humorless, and rigid) was confirmed. Importantly, too, OAS total scores correlated 0.31 with (self-report) 20-item Toronto Alexithymia Scale (TAS) scores. The OAS-F appears to be a psychometrically sound observer-rated alexithymia measure.

Item response theory (IRT) is an increasingly popular approach to the development, evaluation, and administration of psychological measures. We introduce, first, three IRT fundamentals: (a) item response functions, (b) information functions, and (c) invariance. We next illustrate how IRT modeling can improve the quality of psychological measurement. Available evidence suggests that the differences between IRT and traditional psychometric methods are not trivial; IRT applications can improve the precision and validity of psychological research across a wide range of subjects.

Article-at-a-Glance Background There is growing evidence that Asians and Pacific Islanders perceive their health care more negatively than whites and other racial and ethnic subgroups. This study of differences in health care experiences by race and ethnicity was the first to use nationally representative data. Method Data from the 1998 National Research Corporation Healthcare Market Guide® survey were analyzed. A total of 120,855 respondents were included in the study. Four global satisfaction ratings (overall health plan satisfaction, medical care satisfaction, recommend plan to others, and intent to switch plans) and four composite measures (access to care, providers' delivery of care, customer service, and cost/benefits of care) were examined. Results Nonwhite survey respondents—particularly those in the other/multiracial and Asian/Pacific Islander groups—rated their health plan coverage and medical care lower than whites. Discussion The results of this study are consistent with those of other recent (and comparable) studies in which these racial and ethnic groups are represented. Most strikingly consistent, however, are the lower ratings of Asians/Pacific Islanders and the comparable (and higher) ratings (compared to whites) of African Americans. Why Asians/Pacific Islanders are considerably less satisfied with their medical care than all other racial and ethnic groups in the United States needs to be explored. Access to care and quality of care improvement efforts should be directed at all ethnic minority groups, particularly for limited English-speaking, other/multiracial, Hispanic, and Asian/Pacific Islander subgroups.

The purpose of the present study was to examine the relationships among ratings for depression and health-plan and medical-care satisfaction using data from the 1998 National Research Corporation Healthcare Market Guide® (HCMG) survey (N=120,855). Respondents in families in which one or more members had depression (self-report) gave lower satisfaction ratings than those in families in which no member had depression on four global and four composite satisfaction measures. Although satisfaction ratings, generally, were high and depression effects were small, the authors nevertheless recommend efforts to improve access and quality of mental health care.

© 2015, Copyright © Taylor & Francis Group, LLC. We describe and evaluate a factor rotation algorithm, iterated target rotation (ITR). Whereas target rotation (Browne, 2001) requires a user to specify a target matrix a priori based on theory or prior research, ITR begins with a standard analytic factor rotation (i.e., an empirically informed target) followed by an iterative search procedure to update the target matrix. In Study 1, Monte Carlo simulations were conducted to evaluate the performance of ITR relative to analytic rotations from the Crawford-Ferguson family with population factor structures varying in complexity. Simulation results: (a) suggested that ITR analyses will be particularly useful when evaluating data with complex structures (i.e., multiple cross-loadings) and (b) showed that the rotation method used to define an initial target matrix did not materially affect the accuracy of the various ITRs. In Study 2, we: (a) demonstrated the application of ITR as a way to determine empirically informed priors in a Bayesian confirmatory factor analysis (BCFA; Muthén & Asparouhov, 2012) of a rater-report alexithymia measure (Haviland, Warren, & Riggs, 2000) and (b) highlighted some of the challenges when specifying empirically based priors and assessing item and overall model fit.

To develop a non-condition-specific scale to capture biases, emotions, and expectations generated by medical condition descriptors.An 18-item pilot scale was developed from the literature on physicians' responses to patients they like and dislike, stigma definitions, and discussions with primary care faculty. Exploratory factor analysis was conducted after 440 medical students rated one of 12 diverse conditions. Confirmatory factor analysis was performed after 163 medical students rated two psychiatric conditions. Validity was evaluated by the scale's ability to meaningfully stratify the 12 conditions and identify changes in attitudes toward psychiatric conditions after a psychiatry clerkship.Exploratory factor analysis supported an 11-item unidimensional solution (all factor loadings.40, coefficient alpha =.87). The final scale, the Medical Condition Regard Scale (MCRS), taps the degree to which medical students find patients with a given medical condition to be enjoyable, treatable, and worthy of medical resources. The unidimensional model also was supported by the confirmatory factor analyses for the two psychiatric conditions (both comparative fit indices =.98). The scale stratified the 12 conditions as expected: straightforward medical conditions rated highest, somatoform conditions rated lowest. Students showed greater regard for patients with major depression after the psychiatry clerkship, and students who rotated through an addiction treatment program showed a greater increase in regard for patients with alcoholism than did students not exposed to addiction treatment.MCRS scores are reliable, and the scale appears to be a valid instrument for assessing regard for any medical condition.

Chronic tension-type headache (CTTH) in children and adolescents is a serious medical condition, with considerable morbidity and few effective, evidence-based treatments. We performed a chart review of 83 adolescents (age range = 13-18 years; 67 girls and 16 boys) diagnosed with CTTH. Two treatment protocols were compared: multimodal (osteopathic manipulative treatments, mindfulness, and qi gong) and pharmacologic (amitriptyline or gabapentin). Four outcomes (headache frequency, pain intensity, general health, and health interference) were assessed at three time points (baseline, 3 months, and 6 months). A fifth outcome, number of bilateral tender points, was recorded at baseline and 6 months. All five were evaluated statistically with a linear mixed model. Although both multimodal and pharmacologic treatments were effective for CTTH (time effects for all measures were significant at p .001), results from each analysis favored multimodal treatment (the five group by time interaction effects were significant at or below the p .001 level). Headache frequency in the pharmacologic group, for example, reduced from a monthly average (95% Confidence Interval shown in parentheses) of 23.9 (21.8, 26.0) to 16.4 (14.3, 18.6) and in the multimodal group from 22.3 (20.1, 24.5) to 4.9 (2.6, 7.2) (a substantial group difference). Pain intensity (worst in the last 24 hours, 0-10 scale) was reduced in the pharmacologic group from 6.2 (5.6, 6.9) to 3.4 (2.7, 4.1) and from 6.1 (5.4, 6.8) to 2.0 (1.2, 2.7) in the multimodal group (a less substantial difference). Across the other three assessments, group differences were larger for general health and number of tender points and less so for pain restriction. Multimodal treatment for adolescent CTTH appears to be effective. Randomized controlled trials are needed to confirm these promising results.

Our study presents pain-related interference rates in a sample of community-dwelling, older adults and determines factors associated with these restrictions. Participants were 9506 respondents to the Biopsychosocial Religion and Health Study (66.8% female and 33.2% male; average age = 62.3 years). In this sample, 48.2% reported no pain-related interference, whereas 37.7% reported moderate and 14.1% reported severe interference. As hypothesized, older age, female gender, lower education, financial strain, traumatic experiences, worse health, increased body mass index, poor sleep, and depressive symptoms all were associated with higher pain interference ratings (ordered logistic regression/three-level pain criterion; odds ratios p < 0.05). Our findings are similar to those from younger adults, and they suggest enduring effects of trauma on health and reveal the complexity of chronic pain in community-dwelling, older adults.

This study investigated the fit of Holland's vocational interest structure for samples of female and male Native American college students. The spatial arrangement of Native American interest types was expected to (a) be ordered in a R-I-A-S-E-C circular order, (b) approximate a hexagon, and (c) occupy a two-dimensional space. Strong Interest Inventory General Occupational Theme scores for 103 female and 73 male Native American college students first were submitted to a multidimensional scaling (MDS) analysis. The MDS analysis allowed a visual test of the circular order and hexagonal hypotheses and a statistical test of the two-dimensional hypothesis. A randomized test of hypothesized order also was used to statistically test the circular order hypothesis. All of the statistical tests and visual analyses supported the circular order and two-dimensional hypothesis. The female interest data, however, were more consistent with Holland's proposed hexagonal interest structure than were the male interest data.

The authors compare trends in the salaries of physician faculty in academic departments of psychiatry with those of physician faculty in all academic clinical science departments from 1980-2006.The authors compared trend lines for psychiatry and all faculty by academic rank, including those for department chairs, by graphing inflation-adjusted (2006 dollars) Association of American Medical Colleges Faculty Survey data over the 27-year span and computing compound annual growth rates.Physician faculty salaries in both psychiatry and all departments increased between 1980 and 2006. Compared with salaries for physician faculty in all specialties, those for psychiatrists were lower and the trend lines were flatter. Salary gaps between chairs and professors increased considerably in all faculty and psychiatry departments.Salaries for academic physicians are rising, and they are keeping pace with inflation. Relatively large and growing gaps exist between psychiatry and all faculty and between chairs and professors in both psychiatry and all clinical sciences departments.

This study attempts to determine the ratio of full-time-equivalent psychiatrists to members and that of nonphysician mental health professionals to psychiatrists in staff and group model health maintenance organizations (HMOs), and to compare the psychiatrist-to-member ratio with previous estimates of the required psychiatrist-to-population ratios in fee-for-service and managed care environments.The Group Health Association of America (now the American Association of Health Plans) collected data on mental health staffing, enrollments, and other characteristics for 30 staff and group model HMOs. The authors evaluated the number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 HMO members, and the ratio of full-time-equivalent nonphysician mental health professionals to psychiatrists.The overall mean number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 members in the responding HMOs was 6.8 and 22.9, respectively. The overall mean ratio of nonphysician professionals to psychiatrists was 4.5. The overall number of psychiatrists per 100,000 members is less than half the requirement estimated by the Graduate Medical Education National Advisory Committee in 1980, which assumed a fee-for-service environment, but it is about 40% to 80% greater than that estimated by other studies under the assumption of a managed care environment.Although a practice environment dominated by managed care may not require as high a psychiatrist-to-population ratio as a predominantly fee-for-service environment, it may well support a greater number of psychiatrists than previous studies have suggested.

Using 1989 data from the Faculty Roster System of the Association of American Medical Colleges, the authors examined gender differences in retention and rank attainment of psychiatry faculty who had received their first full-time medical school appointments in 1978. Retention differences between men and women were not significant in either the M.D. or the Ph.D. subgroup. Women M.D.’s in the sample had advanced through the academic ranks to a significantly lesser extent than had men M.D.’s; the rank attainment differences among Ph.D.’s, however, were not significant. These results underscore the need for more study of gender differences in the career paths of faculty in academic psychiatry departments.

In a structural equation model, associations among latent variables - Child Poverty, Risky Family exposure, Religious Engagement, Negative Social Interactions, Negative Emotionality, and Perceived Physical Health - were evaluated in 6,753 Black and White adults aged 35-106 years (M = 60.5, SD = 13.0). All participants were members of the Seventh-day Adventist church surveyed in the Biopsychosocial Religion and Health Study (BRHS). Child Poverty was positively associated with both Risky Family exposure (conflict, neglect, abuse) and Religious Engagement (intrinsic religiosity, religious coping, religiousness). Risky Family was negatively associated with Religious Engagement and positively associated with both Negative Social Interactions (intrusive, failed to help, insensitive, rejecting) and Negative Emotionality (depression, negative affect, neuroticism). Religious Engagement was negatively associated with Negative Emotionality and Negative Social Interactions at a given level of risky family. Negative Social Interactions was positively associated with Negative Emotionality, which had a direct, negative effect on Perceived Physical Health. All constructs had indirect effects on Perceived Physical Health through Negative Emotionality. The effects of a risky family environment appear to be enduring, negatively affecting one's adult religious life, emotionality, social interactions, and perceived health. Religious engagement, however, may counteract the damaging effects of early life stress.

Variability in mental health services utilization by race/ethnicity was evaluated with a Behavioral Model approach. Subjects were 17,705 children 5 to 11 years of age in the 2005, 2007, and 2009 California Health Interview Surveys. Parents identified minor emotional difficulties in 18.7% of these children (ranging from 14.8% in Asians to 24.4% in African Americans) and definite or severe difficulties in 7.4% (5.5% in Asians to 9.7% in “other race”). Overall, 7.6% of children had at least one mental health visit in the prior year (2.3% in Asians to 11.2% in African Americans). Parent-identified need was the most salient predictor of mental health visits for all racial/ethnic groups. Beyond need, no consistent patterns could be determined across racial/ethnic groups with regard to the relationship between contextual, predisposing, and enabling measures and mental health service utilization. Different factors operated for each racial/ethnic group, suggesting the need for studies to examine mental health need, mental health service use, and determinants by racial/ethnic subgroup. These findings suggest that a “one-size-fits-all approach” with regard to policies and practices aimed at reducing mental health disparities will not be effective for all racial/ethnic groups.

Objective To evaluate posttraumatic stress disorder (PTSD) symptom severity, object (interpersonal) relations disturbances, and reality testing disturbances in a sample of physically and sexually abused adolescents. Method Subjects were 37 students, 16 boys and 21 girls, enrolled at a private, residential school for children with various conduct problems. Students completed several psychological tests, including the Child Post-Traumatic Stress Disorder Reaction Index (CPTSD-RI) and the Bell Object Relations and Reality Testing Inventory. Results Of the 37 students, 22 (59.5%) had CPTSD-RI scores in the severe and the very severe ranges. The most common object relations and reality testing disturbances were insecure attachment and uncertainty of perception, respectively. CPTSD-RI scores were positively correlated with two of the four object relations scores (insecure attachment and egocentricity) and with all three reality testing scores (reality distortion, uncertainty of perception, and hallucinations/delusions). Mean CPTSD-RI scores were higher for students whose abuse had involved sex (sexual and physical abuse, sexual abuse only) than they were for students whose abuse had been physical only. Alienation and social incompetence, the two object relations disturbances not correlated with PTSD symptom severity, were associated with having experienced abuse at an early age and having been abused by a parent or stepparent (versus a nonparent). Conclusions To address more effectively the long-term difficulties associated with child maltreatment, clinicians and clinician-investigators ought to evaluate interpersonal and reality testing disturbances, as well as PTSD symptom severity. J. Am. Acad. Child Adolesc. Psychiatry, 1995, 34, 8:1054–1059.

PURPOSE The purpose of the present study was to evaluate primary care outcomes for the Loma Linda University School of Medicine (LLUSM), using Association of American Medical Colleges (AAMC) data files. The two principal objectives were to estimate the percentages of LLUSM graduates who are practicing or will practice primary care medicine and to determine what information available on application to LLUSM is useful in predicting graduates' specialty choices (i.e., primary versus non-primary care). METHOD In 1993-94 data were taken from several AAMC data files (available to all medical schools), including the Graduate Medical Education (GME) Tracking Census and the American Medical College Application Service (AMCAS) Applicant Master File. The second and fourth years after graduation were used as points of evaluation. Primary care (generalist) was defined as taking or having completed a residency in family practice, internal medicine, or pediatrics, and not having taken any fellowship training. RESULTS Fourth year after graduation: 42.4% of the 1,064 LLUSM graduates (1983 to 1990) were training in or had completed residencies in family practice (19.8%), internal medicine (16.2%), or pediatrics (6.4%). Second year of GME: of the 1,365 LLUSM graduates (1983 to 1992), 49.3% were in the primary care pipeline (19.8% in family practice, 21.9% in internal medicine, and 7.6% in pediatrics). Two variables available on admission to medical school were associated with being in the primary care pipeline (second-year GME generalist): being a woman and being a member of a non-underrepresented minority. One variable was associated with being in the non-primary care pipeline: having a rural county code. Undergraduate grades and Medical College Admission Test scores were not good predictors. CONCLUSION The AAMC data files, available to all medical schools, are useful for estimating and evaluating primary care outcomes.

Objective This report describes the postdoctoral research training of faculty in departments of psychiatry and relates research training characteristics to current involvement in research. Method Data were taken from a survey of 3,107 doctoral-level faculty in departments of psychiatry at 116 U.S. medical schools. The survey instrument gathered information about faculty members' postdoctoral research training and current research activities and elicited recommendations for research training programs. Results Of the survey respondents, 34.8% had had some form of postdoctoral research training. Most of those had trained in medical schools or intramural programs of the National Institutes of Health and federal institutes on alcoholism, drug abuse, and mental health. Most funding came from the federal government. Postdoctoral research training was significantly related to greater current research involvement across all degree types--M.D., Ph.D., and M.D.-Ph.D. Length of training was related to level of research involvement for M.D.s and Ph.D.s but not M.D.-Ph.D.s. Although most researchers believed their training programs prepared them for independent research, a smaller proportion of M.D.s than M.D.-Ph.D.s or Ph.D.s responded affirmatively to that question. Researchers were more likely than nonresearchers to consider their training adequate. Respondents rated time with mentor, course work in statistics, and length of training as the most important training program features. Both research training and research activities were concentrated in a relatively few institutions. Conclusions These data show the critical importance of both federal support of research training and postdoctoral research training for subsequent research involvement of psychiatric faculty.

Physicians often encounter patients with functional pain disorders such as irritable bowel syndrome (IBS), fibromyalgia (FM), and their co-occurrence. Although these diseases are diagnosed exclusively by patients' report of symptoms, there are few comparative studies about patients' perceptions of these diseases.To compare perceptions of these conditions among 4 groups-3 clinical groups of older women with IBS, FM, or both disorders (IBS plus FM) and 1 similarly aged control group of women with no IBS or FM-using their responses to survey questions about stressful life events, general physical and mental health, and general medical, pain, and psychiatric comorbidities.Using data from the Biopsychosocial Religion and Health Study survey, responses from women were compared regarding a number of variables. To compare stress-related and physical-mental health profiles across the 4 groups, 1-way analyses of variance and χ(2) tests (with Tukey-Kramer and Tukey post hoc tests, respectively) were used, with α set to .05.The present study comprised 3811 women. Participants in the control group, the IBS group, the FM group, and the IBS plus FM group numbered 3213 (84.3%), 366 (9.6%), 161 (4.2%), and 71 (1.9%), respectively, with a mean (standard deviation) age of 62.4 (13.6), 64.9 (13.7), 63.2 (10.8), and 61.1 (10.9) years, respectively. In general, participants in the control group reported fewer lifetime traumatic and major life stressors, better physical and mental health, and fewer comorbidities than respondents in the 3 clinical groups, and these differences were both statistically significant and substantial. Respondents with IBS reported fewer traumatic and major life stressors and better health (ratings and comorbidity data) than respondents with FM or respondents with IBS plus FM. Overall, respondents with both diseases reported the worst stressors and physical-mental health profiles and reported more diagnosed medical, pain, and psychiatric comorbidities.The results revealed statistically significant, relatively large differences in perceptions of quality of life measures and health profiles among the respondents in the control group and the 3 clinical groups.

To estimate fibromyalgia (FM) hospitalisation costs (i.e. charges) for patients in the United States from 1999 to 2007; to determine factors associated with variation in costs of FM and non-FM hospitalisations; and to investigate hospital procedures associated with FM hospitalisations.Data were from the Nationwide Inpatient Sample, a large database of hospitalisations in the U.S. Over the study period, an estimated 63,772 patients - two-thirds women, one-third men - had been hospitalised for FM (FM criterion was the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code 729.1, Myositis and Myalgia, unspecified). Demographics and hospital characteristics were described with frequencies and mean inflation-adjusted charges. Two multivariable linear regressions (one for FM and a second for non-FM patients), with Consumer Price Index (CPI)-adjusted charges (hospital and related services category) in thousands of dollars as the dependent variable, were performed, excluding cases with masked or missing data. Procedures were categorised with a standard classification scheme.Survey-adjusted total CPI-adjusted charges over the study period were estimated to be approximately $1.0 billion. Hospital procedures and Charlson-Deyo Index (co-morbidity severity) scores were the strongest predictors of charges in bivariate and multivariate analyses (for both FM and non-FM patients). The majority of procedures for FM patients were related to musculoskeletal, gastrointestinal, or cardiovascular systems. Most FM patients, however, did not have any procedure or a life-threatening co-morbid illness.Over the nine-year period, hospital charges for FM were substantial. Studies of how to reduce or avoid these costs in the treatment of FM need to be undertaken.

The goals of this study were to (a) examine the phenomenology and developmental correlates of problematic Internet use (PIU) in a large and diverse college student sample; (b) evaluate a developmental process model of PIU in which the expected association between child maltreatment and PIU would be explained by alexithymia; and (c) explore these relations as a function of gender and race. PIU was assessed in a sample of 1,470 college students (62.9 percent female, 37.1 percent male; M(age)=19.13 years [SD=1.49]; 46.1 percent Asian, 28.2 percent Hispanic, 16.3 percent White, 5.9 percent Black, and 3.5 percent Multiracial/Other) who participated in a larger study of young adult adaptation, which included measures of child maltreatment, alexithymia, self-concept, social support, and psychopathology. Males and Asian students endorsed higher levels of PIU than females and other ethnoracial groups, respectively. PIU was related to contemporaneous maladaptation in the form of decreased self-concept, lower social support, and increased psychopathology across groups. Experiences of child maltreatment were related to increased PIU, and mediation analyses showed that this relation was partially explained by alexithymia. These relations were comparable across males and females and between Asian and non-Asian respondents. The analyses provide evidence for the significant role of child maltreatment and the cognitive-affective deficits it precipitates in understanding pathways toward PIU in young adulthood. Our findings suggest that maltreated youth are at disproportionate risk for PIU, and their capacities to regulate and process emotion are important targets for prevention and therapeutic intervention. Language: en

Self-report alexithymia, depression, and anxiety inventories were completed by 204 (84 women and 120 men) psychoactive substance-dependent patients during their first week of hospitalization. Eighty-five of the 204 patients (41.7%) scored in the alexithymic range on the revised Toronto Alexithymia Scale (TAS-20). Women's average alexithymia, depression (Beck Depression Inventory [BDI]), and anxiety (State-Trait Anxiety Inventory-State [STAI-S]) scores were higher than men's average scores. Ethnic (Hispanic whites v non-Hispanic whites) and diagnostic (alcohol v drug v mixed-substance dependence) group differences were not significant. To examine the interrelationships among alexithymia, depression, and anxiety, a causal model confirmed in medical students was tested. The model was reconfirmed; state anxiety predicted depression and alexithymia, and depression predicted alexithymia. These findings are consistent with previous research and compatible with the view that a state of alexithymia can result from severe anxiety and depression.

Student mistreatment in medical school is a persistent problem with both known and unexplored consequences [corrected].The purpose of this study was to determine whether a perception of having been mistreated in medical school had an association with planning a full-time career in academic medicine.Using Association of American Medical Colleges' 2000-2004 Medical School Graduation Questionnaire data, we evaluated the relationship between students' mistreatment experience and their career choice, academic versus nonacademic setting. Meta-analysis and regression were used to evaluate this relationship.At medical schools where relatively high percentages of graduating seniors were planning academic careers, students reporting mistreatment experiences were less likely at graduation to be planning careers in academic medicine.A perception of having been mistreated in medical school is related to students' career choices, a finding that may be useful to medical school administrators/faculty and students as mistreatment is addressed in program planning, counseling, and faculty recruitment.

Objective: To evaluate three aspects of diabetes care (foot checks, eye examinations, and hemoglobin AlC checks by a physician) among California adults with Type 2 diabetes and serious psychological distress (SPD). Method: Data were from the population-based 2005 California Health Interview Survey. Estimates were that in 2005, 1,516,171 Californians (5.75% of all adults) had a physician-given diabetes diagnosis, and of those, 108,621 (7.16%) had co-morbid SPD. Results: Among Californians with Type 2 diabetes, SPD was associated with fewer physician foot checks (odds ratio = 0.56, 95% Confidence Interval = 0.32 to 0.97) but not with fewer eye examinations or hemoglobin AlC checks. Conclusions: The findings highlight a specific area—foot complication evaluation and prevention—for improving the quality of diabetes care among adult Californians with Type 2 diabetes and SPD.

The application of psychological measures often results in item response data that arguably are consistent with both unidimensional (a single common factor) and multidimensional latent structures (typically caused by parcels of items that tap similar content domains). As such, structural ambiguity leads to seemingly endless "confirmatory" factor analytic studies in which the research question is whether scale scores can be interpreted as reflecting variation on a single trait. An alternative to the more commonly observed unidimensional, correlated traits, or second-order representations of a measure's latent structure is a bifactor model. Bifactor structures, however, are not well understood in the personality assessment community and thus rarely are applied. To address this, herein we (a) describe issues that arise in conceptualizing and modeling multidimensionality, (b) describe exploratory (including Schmid-Leiman [Schmid & Leiman, 1957] and target bifactor rotations) and confirmatory bifactor modeling, (c) differentiate between bifactor and second-order models, and (d) suggest contexts where bifactor analysis is particularly valuable (e.g., for evaluating the plausibility of subscales, determining the extent to which scores reflect a single variable even when the data are multidimensional, and evaluating the feasibility of applying a unidimensional item response theory (IRT) measurement model). We emphasize that the determination of dimensionality is a related but distinct question from either determining the extent to which scores reflect a single individual difference variable or determining the effect of multidimensionality on IRT item parameter estimates. Indeed, we suggest that in many contexts, multidimensional data can yield interpretable scale scores and be appropriately fitted to unidimensional IRT models.

Investigators have suggested that alexithymia is a multidimensional construct and that it is responsive to situational stressors. We tested these hypotheses in a sample of 110 freshman medical students. We conducted factor analyses on the Toronto Alexithymia Scale (TAS), the Beck Depression Inventory (BDI), and the state portion of the State-Trait Anxiety Inventory (STAI) and then used LISREL to examine the relationships among the various factors. The results indicated that the TAS consists of several independent dimensions and that the dimensions associated with difficulties identifying and communicating feelings are positively related to depression and anxiety. Thus, the evidence now affirms that alexithymia (as measured by the TAS) is multidimensional and that certain dimensions are state dependent.

OBJECTIVES To evaluate the relationship between self-reported mental health and binge drinking, as well as health status, sociodemographic, social support, economic resource, and health care access indicators to antihypertension medication adherence. METHOD Analysis of 2003 California Health Interview Survey data. RESULTS Having poor mental health days predicted medication nonadherence, whereas binge drinking did not. Nonadherence predictors included younger age, Latino, non-US citizen, uninsured, less education, and no regular medical care. Adherence predictors were older age, African American, having prescription insurance, a college degree, poor health, comorbid diabetes or heart disease, and overweight or obese. CONCLUSION Better mental health may improve medication adherence among hypertensive individuals.

Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios1, p.05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios1, p.05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.

Graduation Questionnaire data collected by the Association of American Medical Colleges (AAMC) were used to identify student and medical school characteristics associated with future psychiatrists' career plans. Subjects were senior medical students in the class of 1986 who definitely planned to specialize in psychiatry or child psychiatry. Medical school variables such as research experience, publication history, and exposure to a research-oriented environment were associated with plans for a career in academic medicine or research (versus clinical practice). Membership in a non-underrepresented minority group, having taken elective course work at a military or government agency, and having attended a private medical school all were associated with plans for a career in salaried clinical practice (versus private clinical practice).