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An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales

Abstract

Purpose

The Patient-Reported Outcomes Measurement Information System (PROMIS) aims to develop self-reported item banks for clinical research. The PROMIS pediatrics (aged 8–17) project focuses on the development of item banks across several health domains (physical function, pain, fatigue, emotional distress, social role relationships, and asthma symptoms). The psychometric properties of the anxiety and depressive symptom item banks are described.

Methods

Participants (n = 1,529) were recruited in public school settings, hospital-based outpatient and subspecialty pediatrics clinics. The anxiety (k = 18) and depressive symptoms (k = 21) items were split between two test administration forms. Hierarchical confirmatory factor-analytic models (CFA) were conducted to evaluate scale dimensionality and local dependence. IRT analyses were then used to finalize item banks and short forms.

Results

CFA results confirmed that anxiety and depressive symptoms are separate constructs and indicative of negative affect. Items with local dependence and DIF were removed resulting in 15 anxiety and 14 depressive symptoms items. The psychometric differences between short forms and simulated computer adaptive tests are presented.

Conclusions

PROMIS pediatric item banks were developed to provide efficient assessment of health-related quality of life domains. This sample provides initial calibrations of anxiety and depressive symptoms item banks and creates PROMIS pediatric instruments, version 1.0.

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Abbreviations

PROMIS:

Patient-reported outcomes measurement information system

PedsQL™:

Pediatric quality of life inventory™

HRQOL:

Health-related quality of life

PRO:

Patient-reported outcomes

CFA:

Confirmatory factor analysis

IRT:

Item response theory

LD:

Local dependence

DIF:

Differential item function

References

  1. 1.

    Ader, D. N. (2007). Developing the patient-reported outcomes measurement information system (PROMIS). Medical Care, 45(Suppl 1), S1–S2.

    Article  Google Scholar 

  2. 2.

    Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., et al. (2007). The patient-reported outcomes measurement information system (PROMIS): Progress of an NIH roadmap cooperative group during its first two years. Medical Care, 45(Suppl 1), S3–S11.

    Article  PubMed  Google Scholar 

  3. 3.

    http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml last accessed October 5, 2009.

  4. 4.

    DeWalt, D., Rothrock, N., Yount, S., & Stone, A. A. (2007). PROMIS cooperative group: Evaluation of item candidates: The PROMIS qualitative item review. Medical Care, 45(Suppl 1), S12–S21.

    Article  PubMed  Google Scholar 

  5. 5.

    Walsh, T. R., Irwin, D. E., Meier, A., Varni, J. W., & DeWalt, D. (2008). The use of focus groups in the development of the PROMIS pediatric item bank. Quality of Life Research, 17, 725–735.

    Article  PubMed  Google Scholar 

  6. 6.

    Irwin, D. E., Varni, J. W., Yeatts, K., & DeWalt, D. (2009). Cognitive interviewing methodology in the development of a pediatric item bank: A patient reported outcomes measurement information system (PROMIS) study. Health and Quality of Life Outcomes, 7(3), 1–10.

    Google Scholar 

  7. 7.

    Matza, L. S., Swensen, A. R., Flood, E. M., Secnik, K., & Leidy, N. K. (2004). Assessment of health-related quality of life in children: A review of conceptual, methodological, and regulatory issues. Value in Health, 7, 79–92.

    Article  PubMed  Google Scholar 

  8. 8.

    Ravens-Sieberer, U., Erhart, M., Wille, N., Wetzel, R., Nickel, J., & Bullinger, M. (2006). Generic health-related quality-of-life assessment in children and adolescents: Methodological considerations. Pharmacoeconomics, 24(12), 1199–1220.

    Article  PubMed  Google Scholar 

  9. 9.

    Irwin, D. E., Stucky, B. D., Thissen, D., Morgan DeWitt, E., Lai, J. S., Yeatts, K., Varni, J. W., & DeWalt, D. A. (2010). Sampling plan and patient characteristics of the PROMIS pediatrics large scale survey. Quality of Life Research manuscript under review.

  10. 10.

    Reeve, B. B., Hays, R. D., Bjorner, J. B., Cook, K. F., Crane, P. K., Teresi, J. A., et al. (2007). Psychometric evaluation and calibration of health-related quality of life items banks: Plans for the patient-reported outcome measurement information system (PROMIS). Medical Care, 45, S22–S31.

    Article  PubMed  Google Scholar 

  11. 11.

    Muthén, B., du Toit, S. H. C., & Spisic, D. (1997). Robust inference using weighted least squared and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. Los Angeles, CA: Muthén & Muthén, Unpublished technical report.

  12. 12.

    Muthen, L. K., & Muthen, B. O. (2004). Mplus user’s guide (2nd ed.). Los Angeles, CA: Muthen & Muthen (Ed.).

    Google Scholar 

  13. 13.

    Hill, C. D., Edwards, M. C., Thissen, D., Langer, M. M., Wirth, R. J., Burwinkle, T. M., et al. (2007). Practical issues in the application of item response theory: A demonstration using items from the pediatric quality of life inventory™ (PedsQL™) 4.0 generic core scales. Medical Care, 45, S39–S47.

    Article  PubMed  Google Scholar 

  14. 14.

    Samejima, F. (1969). Estimation of latent ability using a response pattern of graded scores, Psychometrika Monograph. No. 17.

  15. 15.

    Samejima, F. (1997). Graded response model. In W. J. van der Linden & R. K. Hambleton (Eds.), Handbook of modern item response theory (pp. 85–100). New York: Springer.

    Google Scholar 

  16. 16.

    du Toit, M. (Ed.). (2003). IRT from SSI. Lincolnwood, IL: Scientific Software International.

    Google Scholar 

  17. 17.

    Orlando, M., & Thissen, D. (2000). Likelihood-based item-fit indices for dichotomous item response theory models. Applied Psychological Measurement, 24, 50–64.

    Article  Google Scholar 

  18. 18.

    Orlando, M., & Thissen, D. (2003). Further examination of the performance of S-X2, an item fit index for dichotomous item response theory models. Applied Psychological Measurement, 27, 289–298.

    Article  Google Scholar 

  19. 19.

    Bjorner, J. B., Smith, K. J., Edelen, M. O., Stone, C., Thissen, D., & Sun, X. (2007). IRTFIT: A macro for item fit and local dependence tests under IRT models. Lincoln, RI: QualityMetric Incorporated.

    Google Scholar 

  20. 20.

    Thissen, D., Steinberg, L., & Wainer, H. (1993). Detection of differential item functioning using the parameters of item response models. In P. W. Holland & H. Wainer (Eds.), Differential item functioning (pp. 67–113). Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  21. 21.

    Thissen, D. (2001). IRTLRDIF: Software for the computation of the statistics involved in item response theory likelihood-ratio tests for differential item functioning. Chapel Hill, NC: L. L. Thurstone Psychometric Laboratory, The University of North Carolina at Chapel Hill.

    Google Scholar 

  22. 22.

    Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society B, 57, 289–300.

    Google Scholar 

  23. 23.

    Williams, V. S. L., Jones, L. V., & Tukey, J. W. (1999). Controlling error in multiple comparisons, with examples from state-to-state differences in educational achievement. Journal of Educational and Behavioral Statistics, 24, 42–69.

    Google Scholar 

  24. 24.

    Steinberg, L., & Thissen, D. (2006). Using effect sizes for research reporting: Examples using item response theory to analyze differential item functioning. Psychological Methods, 11, 402–415.

    Article  PubMed  Google Scholar 

  25. 25.

    Kolen, M. J., & Brennan, R. L. (2004). Test equating, scaling, and linking (2nd ed.). New York, NY: Springer.

    Google Scholar 

  26. 26.

    Dorans, N. J. (2007). Linking scores from multiple health outcome instruments. Quality of Life Research, 16(s1), 85–94.

    Article  PubMed  Google Scholar 

  27. 27.

    Joreskog, K. G., & Sorbom, D. (2003). LISREL 8.5. Lincolwood, IL: Scientific Software International, Inc.

    Google Scholar 

  28. 28.

    Thissen, D., Nelson, L., Rosa, K., & McLeod, L. D. (2001). Item response theory for items scored in more than two categories. In D. Thissen & H. Wainer (Eds.), Test scoring (pp. 141–186). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  29. 29.

    Thissen, D., Reeve, B. B., Bjorner, J. B., & Chang, C.-H. (2007). Methodological issues for building item banks and computerized adaptive scales. Quality of Life Research, 16, 109–116.

    Article  PubMed  Google Scholar 

  30. 30.

    Varni, J. W., Seid, M., & Kurtin, P. S. (2001). The PedsQL™ 4.0: Reliability and validity of the pediatric quality of life inventory™ version 4.0 generic core scales in healthy and patient populations. Medical Care, 39, 800–812.

    Article  CAS  PubMed  Google Scholar 

  31. 31.

    Chen, W. H., & Thissen, D. (1997). Local dependence indices for item pairs using item response theory. Journal of Educational and Behavioral Statistics, 22, 265–289.

    Google Scholar 

  32. 32.

    Reeve, B. B. (2000). Item- and scale-level analysis of clinical and non-clinical sample responses to the MMPI-2 depression scales employing item response theory. Unpublished doctoral dissertation, University of North Carolina at Chapel Hill.

  33. 33.

    Santor, D. A., Ramsay, J. O., & Zuroff, D. C. (1994). Nonparametric item analyses of the beck depression inventory: Evaluating gender item bias and response option weights. Psychological Assessment, 6, 255–270.

    Article  Google Scholar 

  34. 34.

    Schaeffer, N. C. (1998). An application of item response theory to the measurement of depression. In C. C. Clogg (Ed.), Sociological methodology (Vol. 18, pp. 271–307). Washington, DC: American Sociological Association.

    Google Scholar 

  35. 35.

    Varni, J. W., Seid, M., & Rode, C. A. (1999). The PedsQLTM: Measurement model for the pediatric quality of life inventoryTM. Medical Care, 37, 126–139.

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Ravens-Sieberer, U., Gosch, A., Rajmil, L., Erhart, M., Bruil, J., Duer, W., et al. (2005). KIDSCREEN-52 quality of life measure for children and adolescents. Expert Review of Pharmacoeconomics and Outcomes Research, 5, 353–364.

    Article  PubMed  Google Scholar 

  37. 37.

    Gibbons, R. D., Weiss, D. J., Kupfer, D. J., Frank, E., Fagiolini, A., Grochocinski, V. J., et al. (2008). Using computerized adaptive testing to reduce the burden of mental health assessment. Psychiatric Services, 59, 361–368.

    Article  PubMed  Google Scholar 

  38. 38.

    Bjorner, J. B., Chang, C. H., Thissen, D., & Reeve, B. B. (2007). Developing tailored instruments: item banking and computerized adaptive assessment. Quality of Life Research, 16, 95–108.

    Article  PubMed  Google Scholar 

  39. 39.

    Shafer, A. B. (2006). Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. Journal of Clinical Psychology, 62, 123–146.

    Article  PubMed  Google Scholar 

  40. 40.

    Watson, D., Clark, L. A., Weber, K., Assenheimer, J. A., Strauss, M. E., & McCormick, R. A. (1995). Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptoms. Journal of Abnormal Psychology, 104, 3–14.

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Watson, D., Clark, L. A., Weber, K., Assenheimer, J. S., Strauss, M. E., & McCormick, R. A. (1995). Testing a tripartite model: II. Exploring the symptom structure of anxiety and depression in student, adult, and patient samples. Journal of Abnormal Psychology, 104, 15–25.

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    Chorpita, B. F., Albano, A. M., & Barlow, D. H. (1998). The structure of negative emotions in a clinical sample of children and adolescents. Journal of Abnormal Psychology, 107, 74–85.

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179–192.

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Pilkonis, P. A., Reise, S. P., Stover, A. M., Riley, W. T., Cella, D. (in press). Items banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS): Depression, anxiety, and anger. Manuscript in press.

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Correspondence to Debra E. Irwin.

Appendix

Appendix

Listed below are the item stems for the recommended eight-item short forms for the PROMIS Pediatric Anxiety and Depressive Symptoms Scales. All items use a 7-day recall period (the preface is “In the past seven days”), and a 5-point response scale with the options never (0), almost never (1), sometimes (2), often (3) and almost always (4).

  • Anxiety:

  • I felt scared.

  • I worried about what could happen to me.

  • I felt worried.

  • I felt like something awful might happen.

  • I worried when I went to bed at night.

  • I thought about scary things.

  • I felt nervous.

  • I was afraid that I would make mistakes.

  • Depressive symptoms:

  • I felt like I couldn’t do anything right.

  • I felt everything in my life went wrong.

  • I felt unhappy.

  • I felt lonely.

  • I felt sad.

  • I felt alone.

  • I thought that my life was bad.

  • I could not stop feeling sad.

Summed score to scale score translation for these short forms is in Table 7.

Table 7 Summed score to scale score translation table for the recommended short forms

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Irwin, D.E., Stucky, B., Langer, M.M. et al. An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Qual Life Res 19, 595–607 (2010). https://doi.org/10.1007/s11136-010-9619-3

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Keywords

  • PROMIS
  • Anxiety
  • Depressive symptoms
  • HRQOL
  • PRO
  • Scale development
  • Surveys
  • Pediatrics