Barbic Skye P, Durisko Zachary, Andrews Paul W
Social Aetiology of Mental Illness (SAMI) Canadian Institute of Health Research (CIHR) Training Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.
PLoS One. 2014 Nov 14;9(11):e112077. doi: 10.1371/journal.pone.0112077. eCollection 2014.
Diagnosis and management of depression occurs frequently in the primary care setting. Current diagnostic and management of treatment practices across clinical populations focus on eliminating signs and symptoms of depression. However, there is debate that some interventions may pathologize normal, adaptive responses to stressors. Analytical rumination (AR) is an example of an adaptive response of depression that is characterized by enhanced cognitive function to help an individual focus on, analyze, and solve problems. To date, research on AR has been hampered by the lack of theoretically-derived and psychometrically sound instruments. This study developed and tested a clinically meaningful measure of AR.
Using expert panels and an extensive literature review, we developed a conceptual framework for AR and 22 candidate items. Items were field tested to 579 young adults; 140 of whom completed the items at a second time point. We used Rasch measurement methods to construct and test the item set; and traditional psychometric analyses to compare items to existing rating scales.
Data were high quality (<1% missing; high reliability: Cronbach's alpha = 0.92, test-retest intraclass correlations >0.81; evidence for divergent validity). Evidence of misfit for 2 items suggested that a 20-item scale with 4-point response categories best captured the concept of AR, fitting the Rasch model (χ2 = 95.26; df = 76, p = 0.07), with high reliability (rp = 0.86), ordered response scale structure, and no item bias (gender, age, time).
Our study provides evidence for a 20-item Analytical Rumination Questionnaire (ARQ) that can be used to quantify AR in adults who experience symptoms of depression. The ARQ is psychometrically robust and a clinically useful tool for the assessment and improvement of depression in the primary care setting. Future work is needed to establish the validity of this measure in people with major depression.
抑郁症的诊断与管理在基层医疗环境中经常出现。当前针对不同临床人群的治疗实践中的诊断与管理侧重于消除抑郁症的体征和症状。然而，存在争议的是，一些干预措施可能会将对压力源的正常适应性反应病态化。分析性沉思（AR）是抑郁症适应性反应的一个例子，其特点是认知功能增强，有助于个体专注于、分析并解决问题。迄今为止，由于缺乏理论推导且心理测量学上可靠的工具，对AR的研究受到了阻碍。本研究开发并测试了一种具有临床意义的AR测量方法。
通过专家小组和广泛的文献综述，我们为AR制定了一个概念框架和22个候选条目。这些条目在579名年轻人中进行了现场测试；其中140人在第二个时间点完成了这些条目。我们使用拉施测量方法来构建和测试条目集；并使用传统心理测量分析将条目与现有的评定量表进行比较。
数据质量很高（缺失率<1%；高信度：克朗巴哈α系数 = 0.92，重测组内相关系数>0.81；具有区分效度的证据）。2个条目不拟合的证据表明，一个有20个条目、4点反应类别的量表最能捕捉AR的概念，符合拉施模型（χ2 = 95.26；自由度 = 76，p = 0.07），具有高信度（rp = 0.86）、有序反应量表结构且无条目偏差（性别、年龄、时间）。
我们的研究为一个有20个条目的分析性沉思问卷（ARQ）提供了证据，该问卷可用于量化有抑郁症状的成年人的AR。ARQ在心理测量学上很稳健，是基层医疗环境中评估和改善抑郁症的一个临床有用工具。未来需要开展工作以确定该测量方法在重度抑郁症患者中的效度。
