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CSQ: five factors or fiction?

OBJECTIVE: The Coping Strategies Questionnaire (CSQ), a rationally constructed pain coping assessment instrument, was conceived to measure the extent to which patients used six different cognitive coping strategies and two behavioral coping strategies. A number of studies have factor analyzed the original scales but have not found a reliable factor structure. Recent studies by Turtle et al. and Swartzman et al. have obtained a five-factor solution performing exploratory factor analysis on the individual items. Robinson and associates from the University of Florida performed an item level exploratory factor analysis on a much larger sample (n = 965) and found a six-factor solution that was relatively supportive of the original rationally derived scales. The purpose of the present investigation was to perform a confirmatory factor analysis using the LISREL structural equation modeling program to compare these three different factor structures. PATIENTS: A sample of 472 chronic patients was used. RESULTS AND CONCLUSIONS: The results indicated that the Florida six-factor model was a better fit to the sample data than either of the five-factor models. Creation of the Coping Strategy Questionnaire Revised (CSQ-R), which retains 27 of the original items, is suggested.

Adaptation, Psychological↗

Latent variables in psychology and the social sciences.

The paper discusses the use of latent variables in psychology and social science research. Local independence, expected value true scores, and nondeterministic functions of observed variables are three types of definitions for latent variables. These definitions are reviewed and an alternative "sample realizations" definition is presented. Another section briefly describes identification, latent variable indeterminancy, and other properties common to models with latent variables. The paper then reviews the role of latent variables in multiple regression, probit and logistic regression, factor analysis, latent curve models, item response theory, latent class analysis, and structural equation models. Though these application areas are diverse, the paper highlights the similarities as well as the differences in the manner in which the latent variables are defined and used. It concludes with an evaluation of the different definitions of latent variables and their properties.

Factor Analysis, Statistical↗

Effects of job characteristics, team climate, and attitudes towards clinical guidelines.

The aim of this study was to form and test a model of the antecedents and possible moderators of the use of clinical guidelines among healthcare professionals. A postal questionnaire survey of all workers in six health centres around Finland. was carried out in April 1996. The health centres were selected to represent all different areas of Finland. A total of 748 (65.5%) of the healthcare workers completed and returned the questionnaire. Of the respondents 95% were women, 16% physicians or dentists, 31% registered nurses, and 27% practical nurses. It was hypothesized that besides positive attitudes towards guidelines, job characteristics and team climate affect the use of guidelines. Three alternative models of possible main and moderating effects of attitudes, job characteristics, and team climate were formed and tested. These models were tested using hierarchical regression analysis and structural equation modelling (LISREL8). All of the hypothesized main effects and the moderating effect of job characteristics between attitudes towards and the use of guidelines were supported. According to our results important factors behind the general positive or negative attitudes towards guidelines are the usefulness, reliability, practicality, and availability of the guidelines. Also, the overall individual, team, and organizational competence to follow the procedures recommended, seemed to be vital. Moreover, those whose job motivation potential was high were more ready to use clinical guidelines even when their attitudes towards guidelines were the same.

Attitude of Health Personnel↗

The factor structure of the BDI in facial pain and other chronic pain patients: a comparison of two models using confirmatory factor analysis.

OBJECTIVES: 1) To compare two measurement models of the BDI in chronic pain sufferers to see which provides the better fit; 2) to assess whether model fit differs for a facial pain sample compared to a sample of pain sufferers attending a multidisciplinary pain clinic; and 3) to establish which affective and somatic sub-scales of the BDI could be used in chronic pain research. DESIGN: Two groups of chronic pain sufferers, a facial pain group, and a group attending a multidisciplinary pain clinic completed self-report questionnaires on pain (Multidimensional Pain Inventory), depression (BDI), and measures of anxiety and depression-related pain cognitions (the Spielberger State-Trait Anxiety Inventory and the Pain Cognitions Questionnaire). The measurement models of the BDI were tested using LISREL structural equation modelling and their construct validity examined using partial correlation analysis. METHOD: A total of 173 people attending a multidisciplinary pain clinic and 157 patients attending a facial pain clinic completed self-report measures of pain and mood prior to their respective clinical consultations. RESULTS: The model offered by Novy et al. (containing one affective factor 'Negative-attitude suicide' and two somatic factors 'Performance difficulty' and 'Physiological manifestations') fitted both pain groups better than the model offered by Williams and Richardson (containing one affective factor 'Self-reproach', one somatic factor 'Somatic disturbance' and one factor with a mixture of both affective and somatic items 'Sadness about health'). However, when the factors were allowed to correlate in the latter model, both models were broadly equivalent. CONCLUSIONS: The two measurement models adequately fitted data in both pain samples when the factors were allowed to intercorrelate in the Williams and Richardson model. Both the affective scales offered by both models could be used in future research, although the somatic factor offered by the Williams and Richardson model offered much higher levels of internal reliability than either of those offered in the Novy et al. model. The findings are discussed in relation to the issue of depression in chronic pain.

Journal Article↗

Confirmatory factor analysis of a test used for certification in sport scuba diving.

The purpose of this study was to confirm the underlying factor structure of the entry-level scuba diving certification test published by the National Association of Underwater Instructors (NAUI). The test measures knowledge mastery across 6 content areas. A sample of 400 female and male entry-level scuba diving students aged from 18 to 47 years participated in the study. A rigorous structural equation modeling approach was used to confirm the factor structure of the test. The results verify that two latent factors or constructs accurately represent knowledge mastery for entry-level scuba diving students. Also, cross-validation procedures were used to examine the accuracy of measurement model replication. Collectively, these findings support the construct validity of the test.

Adolescent↗

[Perceptions of classroom goal structures, personal achievement goal orientations, and learning strategies].

We examined the relations among students' perceptions of classroom goal structures (mastery and performance goal structures), students' achievement goal orientations (mastery, performance, and work-avoidance goals), and learning strategies (deep processing, surface processing and self-handicapping strategies). Participants were 323 5th and 6th grade students in elementary schools. The results from structural equation modeling indicated that perceptions of classroom mastery goal structures were associated with students' mastery goal orientations, which were in turn related positively to the deep processing strategies and academic achievement. Perceptions of classroom performance goal stractures proved associated with work avoidance-goal orientations, which were positively related to the surface processing and self-handicapping strategies. Two types of goal structures had a positive relation with students' performance goal orientations, which had significant positive effects on academic achievement. The results of this study suggest that elementary school students' perceptions of mastery goal structures are related to adaptive patterns of learning more than perceptions of performance goal structures are. The role of perceptions of classroom goal structure in promoting students' goal orientations and learning strategies is discussed.

Child↗

Disease-specific quality of life: is it one construct?

The objective of this study was to examine the structure of disease-specific quality of life (QoL). Models of QoL with either one overall construct or more constructs were tested and the relationships (factor loadings) between the constructs and dimensions were established, using structural equation modelling. The models were tested over time to assess the stability of the structure. To generalize the results further, disease-specific questionnaires of two very different chronic diseases have been compared: inflammatory bowel disease (IBD) and Parkinson's disease (PD). Questionnaires were mailed in 1994 and a repeated measurement was conducted in 1995. Data were obtained from 222 IBD patients and 235 PD patients. The results show that for both diseases, disease-specific QoL can be considered as one construct. The stability over time of the structure of the QoL models was satisfactory. In PD the factor loadings between the dimensions and QoL were within a small range and remained the same over time, while in IBD, the factor loadings had a larger range and fluctuated more. These results imply that one meaningful sum score can be obtained from these questionnaires.

Adult↗

The structural error-in-equation model to evaluate individual bioequivalence.

Individual bioequivalence is assessed using an extension of the classical structural equation model, known as the error-in-equation model. This procedure estimates the relationship between individual means, as well as the variance-covariance parameters, of the bioavailabilities measurement model, by considering individual means related through a straight line with a random term, whereas the classical structural equation considers a deterministic linear relationship. We discuss the implications of this approach in terms of the bioavailabilities measurement model and how to test the overall hypothesis of individual bioequivalence. Both models are compared in a simulation study and a case example is presented.

Analysis of Variance↗

Social psychology of mental health: the social structure and personality perspective.

Previous research has revealed a persistent association between social structure and mental health. However, most researchers have focused only on the psychological and psychosocial aspects of that relationship. The present paper indicates the need to include the social and structural bases of distress in our theoretical models. Starting from a general social and psychological model, our research considered the role of several social, environmental, and structural variables (social position, social stressors, and social integration), psychological factors (self-esteem), and psychosocial variables (perceived social support). The theoretical model was tested working with a group of Spanish participants (N = 401) that covered a range of social positions. The results obtained using structural equation modeling support our model, showing the relevant role played by psychosocial, psychological and social, and structural factors. Implications for theory and intervention are discussed.

Adult↗

The relationships between depression and other outcomes of chronic illness caregiving.

BACKGROUND: Many caregivers with chronically ill relatives suffer from depression. However, the relationship of depression to other outcomes of chronic caregiving remains unclear. This study tested a hypothesized model which proposed that hours of care, stressful life events, social support, age and gender would predict caregivers' outcomes through perceived caregiver stress. Depression was expected to mediate the relationship between perceived stress and outcomes of chronic caregiving (physical function, self-esteem, and marital satisfaction). METHODS: The sample for this secondary data analysis consisted of 236 and 271 subjects from the Americans' Changing Lives, Wave 1, 1986, and Wave 2, 1989, data sets. Measures were constructed from the original study. Structural equation modeling was used to test the hypothesized model, and an exploratory structural modeling method, specification search, was used to develop a data-derived model. Cross-validation was used to verify the paths among variables. RESULTS: Hours of care, age, and gender predicted caregivers' outcomes directly or through perceived caregiver stress (p < .01). Depression mediated the relationship between perceived stress and psychological outcomes and explained 40% and 11% of the variance in self-esteem and marital satisfaction, respectively. CONCLUSION: Depression predicted psychological outcomes. Whether depression predicts physical health outcomes needs to be further explored.

Journal Article↗

Effect of patient sex, clinician sex, and sex role on the diagnosis of Antisocial Personality Disorder: models of underpathologizing and overpathologizing biases.

This study examined the influence of patient sex and clinician sex and sex role for a case, meeting minimum diagnostic criteria for Antisocial Personality Disorder, in which patient sex was varied. The purpose was to provide an in-depth evaluation of the process by which patient sex and characteristics of clinicians may contribute to bias in personality disorder diagnoses. Psychologists (N = 167) read two cases, including the target case, and provided symptom ratings and diagnoses. A sex-unspecified condition served as a baseline to assess for over- and underpathologizing bias, and diagnoses based on the symptom ratings were compared to assigned diagnoses. Clinician sex role was assessed using the Bem Sex Role Inventory-Short Form. Results revealed that bias occurred when the patient's sex (female) was inconsistent with the gender weighting of the symptoms in the case (masculine), but the direction of the bias was consistent with sex roles (underdiagnosis of sex-role-inconsistent diagnoses, overdiagnosis of sex-role-consistent diagnoses). Path models of over- and underdiagnostic bias were developed using structural equation modeling. Patient sex had a direct effect on diagnostic ratings whereas clinician sex role had an indirect effect through symptom ratings.

Adult↗

Environmental factors as predictors of smoking among ninth-grade adolescents in Pitkäranta (Russian Karelia) and in eastern Finland.

The purpose of this study was to assess whether similar environmental factors predict adolescents' smoking in two different cultures: in the Pitkäranta district in Russian Karelia and in eastern Finland. The data were gathered by self-administered questionnaires from ninth-grade students in 10 comprehensive schools in Pitkäranta (n = 385) and from age-matched students in 24 schools in eastern Finland (n = 2,098). Structural equation modeling (SEM) was used to test whether similar path structures fit for boys and for girls in Pitkäranta and in eastern Finland, and to test whether regression coefficients were similar between the cultures by sex. Smoking by family members and best friends was positively related to adolescents' smoking both directly and indirectly. Environmental factors were similar predictors of smoking between the cultures for boys. For girls, different regression coefficients in Pitkäranta and in eastern Finland were found. Best friend's smoking was the most important predictor of adolescents' own smoking in every sub-sample. When indirect relationships were identified, the significance of parents' and siblings' smoking, in addition to smoking by best friends, was strongly supported.

Adolescent↗

Factors influencing intention to obtain a genetic test for colon cancer risk: a population-based study.

BACKGROUND: The availability of genetic testing for cancer risk has prompted an examination of the intention of the general public to undergo testing. This study expands a previous psychosocial model of factors influencing intention to undergo genetic testing for cancer in general to the context of colon cancer. METHODS: A sample of 1,836 adult residents of Vermont, New Hampshire, and Maine were interviewed via telephone. The survey instrument included measures derived from the Health Belief Model and additional psychosocial measures adapted from the literature. Structural Equation Modeling techniques were used to examine factors associated with the likelihood to undergo genetic testing. RESULTS: Perceived barriers and benefits of testing, and perceived susceptibility to colon cancer had direct associations with likelihood. Optimism and pessimism had both direct and indirect effects. Age, socioeconomic status, family history, and awareness of genetic testing had indirect effects, and acted through the other factors. The model explained 22% of the variance in likelihood. CONCLUSIONS: Perceived barriers, benefits, susceptibility, optimism, and pessimism directly influenced likelihood, and may also mediate the effect of background factors examined in this study. These findings suggest effective educational strategies to improve decision-making concerning genetic testing for colon cancer risk in the general population.

Adult↗

Multivariate genetic analysis of twin-family data on fears: Mx models.

We describe the implementation of multivariate models of familial resemblance with the Mx package. The structural equation models allow for the effects of assortative mating, additive and dominant genes, common and specific environment, and both genetic and cultural transmission between generations. Two approaches are compared: a correlational one based on Fulker and a factor model described by Phillips and Fulker. Both are illustrated by application to published data on social fears and fear of leadership measured in monozygotic and dizygotic twins and their parents. In the example data, genetic dominance yields a more parsimonious explanation of the data than does cultural transmission, although neither is needed to obtain a good fit to the data. A model of reduced genetic correlation between generations also fits the data but has inherent limitations in this sample. Extensions to sex-limitation and more complex models are discussed.

Adult↗

Organizational context and provider perception as determinants of mental health service use.

This study refines and tests an individual client model of service use and contrasts it with a model of service provision based on gateway provider perspectives. Structural equation models demonstrate that provider variables account for more service use variation than client variables. The client model accounts for 24% of the variance in service use, while the provider model accounts for 55% of the variance. Youth self-reported mental health was not positively associated with increased services or with provider perception of youth mental health. The provider model demonstrates the critical role played by provider perceptions, which are influenced more by work environment than by client problems.

Adolescent↗

Learning functional structure from fMR images.

We propose a novel method using Bayesian networks to learn the structure of effective connectivity among brain regions involved in a functional MR experiment. The approach is exploratory in the sense that it does not require an a priori model as in the earlier approaches, such as the Structural Equation Modeling or Dynamic Causal Modeling, which can only affirm or refute the connectivity of a previously known anatomical model or a hypothesized model. The conditional probabilities that render the interactions among brain regions in Bayesian networks represent the connectivity in the complete statistical sense. The present method is applicable even when the number of regions involved in the cognitive network is large or unknown. We demonstrate the present approach by using synthetic data and fMRI data collected in silent word reading and counting Stroop tasks.

Adult↗

Confirmatory factor analysis of the Maslach Burnout Inventory among Florida nurses.

Burnout among human service professionals, such as nurses, has been studied in various countries for years using the Maslach Burnout Inventory (MBI). This paper reports on confirmatory factor analyses using LISREL that examined the factorial validity of the MBI. The sample consisted of 151 registered nurses from west-central Florida. Modifications of the initial hypothesized three-factor structure were necessary to adequately fit the data. Findings are compared to the published normative values for the MBI and to similar studies of European nurses. Recommendations for measurement models of the MBI in future studies that use structural equation modeling techniques are offered.

Adult↗

Evaluating a model of parental influence on youth physical activity.

OBJECTIVE: To test a conceptual model linking parental physical activity orientations, parental support for physical activity, and children's self-efficacy perceptions with physical activity participation. PARTICIPANTS AND SETTING: The sample consisted of 380 students in grades 7 through 12 (mean age, 14.0+/-1.6 years) and their parents. Data collection took place during the fall of 1996. MAIN OUTCOME MEASURES: Parents completed a questionnaire assessing their physical activity habits, enjoyment of physical activity, beliefs regarding the importance of physical activity, and supportive behaviors for their child's physical activity. Students completed a 46-item inventory assessing physical activity during the previous 7 days and a 5-item physical activity self-efficacy scale. The model was tested via observed variable path analysis using structural equation modeling techniques (AMOS 4.0). RESULTS: An initial model, in which parent physical activity orientations predicted child physical activity via parental support and child self-efficacy, did not provide an acceptable fit to the data. Inclusion of a direct path from parental support to child physical activity and deletion of a nonsignificant path from parental physical activity to child physical activity significantly improved model fit. Standardized path coefficients for the revised model ranged from 0.17 to 0.24, and all were significant at the p<0.0001 level. CONCLUSIONS: Parental support was an important correlate of youth physical activity, acting directly or indirectly through its influence on self-efficacy. Physical activity interventions targeted at youth should include and evaluate the efficacy of individual-level and community-level strategies to increase parents' capacity to provide instrumental and motivational support for their children's physical activity.

Adolescent↗