Wenjie Duan
Jingying Wang1
Inês A. Trindade
Andras N. Zsido- 1Social and Public Administration School, East China University of Science and Technology, Shanghai, China
- 2Center for Health and Medical Psychology (CHAMP), School of Behavioural, Social and Legal Sciences, University of Örebro, Örebro, Sweden
- 3Faculty of Humanities and Social Sciences, Institute of Psychology, University of Pécs, Pécs, Hungary
Editorial on the Research Topic
Psychometrics in psychiatry 2022: anxiety and stress disorders
Introduction
As prevalent mental health disorders, anxiety and stress disorders exert a significant impact on global health-related burdens as well as individual wellbeing. This impact has been aggravated by the COVID-19 pandemic and international conflicts, such as the Russo-Ukrainian War (1). Notably, the pandemic has led to a 27.6% and 25.6% upturn in the global prevalence of major depressive disorder and anxiety disorders respectively (2). During the pandemic, quarantine and social isolation have been found to intensify the anxiety levels of residents (3). According to Li et al. (4), Santomauro et al. (2), and Lábadi et al. (5), the pandemic has disproportionately affected women, elderly, children, and adolescents.
The enhancement of outcomes in stress and anxiety heavily depends on operationally defined and measured related concepts. For instance, in order to comprehend the barriers to individual wellbeing amid the COVID-19 pandemic, Li et al. (6) and Choi et al. (7) have developed tools to evaluate fear and perceived stigma. However, the validity of self-reported psychometric tools, long-standing due to their subjectivity, has been a point of concern (8, 9). Moreover, most measures for stress and anxiety disorders have been developed and validated in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) populations. These include, among others, the Perceived Stress Scale (10), Patient Health Questionnaire (11), and Depression Anxiety Stress Scales (12). However, non-WEIRD and socially disadvantaged groups, such as children and individuals with low income or less education, face heightened risks of stress and anxiety (13).
In response to these concerns, this Research Topic aims to consolidate research providing critical insights into new psychometrics in psychiatry. Specifically, it intends to pinpoint limitations in our existing understanding of the differences between clinimetric and psychometric measures, introduce new concepts related to stress and anxiety disorders, adapt validated scales across various contexts, and identify other stress- and anxiety-related determinants in non-WEIRD populations.
Structure and contribution of the Research Topic
In response to our call for advancing knowledge on reliable and valid methods for measuring anxiety and stress, this Research Topic incorporated six manuscripts (Table 1). One manuscript examines the disparities between psychometric and clinimetric approaches in measurement, based on the assessment of arachnophobia. Another introduces the newly-developed Anxiety and Fear of COVID-19 Assessment Scale (AMICO) Pregnant Scale, designed to evaluate the fear and anxiety experienced by pregnant women during the pandemic. Additionally, three manuscripts explore the psychometric properties of anxiety-related concepts across various cultural contexts. Finally, a cross-sectional study identifies factors associated with depression, behavioral problems, and cognitive functions in Chinese adolescents.
Table 1. Summary of contributions to the Research Topic.
Assessment of clinimetric and psychometric measures
Arachnophobia, as a common anxiety disorder, can significantly impact an individual's quality of life. In an effort to discern the discrepancies between subjective (e.g., self-reported questionnaires) and objective (e.g., behavioral approach tests [BAT] and functional Magnetic Resonance Imaging [fMRI]) assessments of arachnophobia, Landová et al. conducted a study involving 30 arachnophobic participants and 32 non-phobic controls, all of whom had been previously diagnosed through clinical interviews. The study employed subjective fear response measures such as the Spider Questionnaire (SPQ), Snake Questionnaire, Disgust Scale-Revised, and a subjective emotional assessment of spider-related visual stimuli. On the other hand, the behavioral fear response was gauged using the BAT, which quantified the participants' level of avoidance behavior toward live spiders. Furthermore, neurophysiological responses were measured using fMRI, resulting in the formulation of a Spider Fear Index. The researchers found that subjective assessments, including the SPQ, BAT, and emotional evaluations of visual stimuli, were not only easy to administer and cost-effective, but also demonstrated reliability as measures of arachnophobia.
New scale validation
During the COVID-19 pandemic, Muñoz-Vela et al. identified heightened vulnerability and specific challenges faced by marginalized social groups, including pregnant women, who exhibited increased risks of anxiety and stress-related disorders. To accurately assess these psychological dimensions, the researchers adapted the Anxiety and Fear of COVID-19 Assessment Scale (AMICO), creating a specialized version for pregnant women, dubbed AMICO_Pregnant. This novel scale was psychometrically evaluated in a study involving 1,013 pregnant women residing in Spain. The analysis revealed two distinct factors across 16 items-fear and anxiety-both demonstrating strong model fit parameters. Furthermore, the scale exhibited high internal consistency, indicative of its reliability as a measure of pandemic-related fear and anxiety among pregnant individuals.
Evaluating cross-context adaptations
The Perceived Stress Scale (PSS) is a prominent instrument for measuring subjective stress; however, its short version's adaptation into German requires further examination, as indicated by Schäfer et al.. Their study, which included a sample of 1,437 participants from an online panel, not only assessed traditional psychometric properties but also incorporated an innovative machine-learning technique-ant-colony-optimization (ACO) algorithms-to refine the item selection process. In addition to these methodologies, the authors utilized network analysis, an emerging psychometric tool, to evaluate the construct validity of the revised scale. Their findings identified a bifactor model with dimensions labeled “helplessness” and “self-efficacy,” both demonstrating robust psychometric characteristics, such as construct validity, internal consistency, and test-retest reliability.
Adaptation difficulties during the postpartum period are commonly reported among mothers, yet previous measures have either overlooked the distinctive characteristics of this stage or failed to acknowledge the continuum between pregnancy-related anxiety and anxiety experienced at other stages of life. Ionio et al. emphasized the importance of the Postpartum Specific Anxiety Scale (PSAS) as the sole instrument designed to assess postpartum anxiety. However, the Italian version of the PSAS requires validation. In a study involving a cross-sectional sample of 457 new mothers, the authors demonstrated that the Italian adaptation of the PSAS retains the psychometric properties of the original scale, exhibiting satisfactory construct and convergent validity, as well as internal consistency. Furthermore, multi-group confirmatory factor analysis suggests that the PSAS is psychometrically invariant across different cultural contexts, specifically between Italy and the United Kingdom.
Zhang et al. adapted the Odor Awareness Scale for the Chinese population, offering evidence of its construct, convergent, and concurrent validity, as well as its internal consistency and test-retest reliability. Employing a sample of 978 college students, the authors demonstrated that their three-factor adaptation of the Chinese Odor Awareness Scale yielded favorable model fit indices. The scale's subscales assess odor sensitivity, impact, and attention, respectively. Moreover, the scale exhibited positive correlations with individual body odor-sniffing behaviors and anxiety levels.
Survey design paper
Dong et al. analyzed survey data from the 2018 China Family Panel Studies (CFPS), examining a cohort of 2,584 adolescents between the ages of 10 and 15 in China. Employing a quantitative methodology, the researchers utilized t-tests, one-way analysis of variance (ANOVA), and multivariate linear regression to identify factors correlated with depression, problematic behaviors, and cognitive outcomes. The findings underscored that determinants of mental health were primarily associated with school-related factors and the depressive symptoms of parents. Moreover, determinants of problematic behavior included lower maternal education, the adolescents' poor health, elevated academic stress, and parental depression. Regarding cognitive outcomes, poor academic performance and paternal depression emerged as significant predictors.
Conclusion
The increasing global prevalence of anxiety and stress disorders requires a comprehensive and inclusive methodology for their assessment and treatment. This Research Topic collated an assortment of contributions on measurement tools and definitions of stress- and anxiety-related concepts, enabling a review of evidence for different procedures and tools. This understanding is essential for addressing conditions and processes that impede the functioning and wellbeing of individuals, groups, and institutions. Nevertheless, it must be highlighted that there is a pressing need for more systematic or meta-analytic review studies focussing on psychometric scales, given their potential to investigate a broad spectrum of diagnostic accuracy measures in individuals of diverse demographic characteristic (14, 15). Despite these gaps, we remain hopeful that this compilation of articles will stimulate scholars to explore new territories and offer a comprehensive guide for future research endeavors.
Author contributions
WD: Conceptualization, Writing – original draft, Writing – review & editing. JW: Conceptualization, Writing – original draft, Writing – review & editing. IT: Writing – review & editing. AZ: Writing – review & editing.
Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research is sponsored by Trajectory Modeling of Sudden Crisis Disorders and a Randomized Controlled Targeted Intervention Trial (23ZR1415000), 2023 Natural Science Foundation of Shanghai Municipality.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Celuch M, Savolainen I, Oksa R, Oksanen A. Psychological distress and perceived stress outcomes of anxieties related to COVID-19 and Russia's attack on Ukraine. J Loss Trauma. (2023) 22:1–26. doi: 10.1080/15325024.2023.2236009
2. Santomauro DF, Mantilla Herrera AM, Shadid J, Zheng P, Ashbaugh C, Pigott DM, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. (2021) 398:1700–12. doi: 10.1016/S0140-6736(21)02143-7
3. Wu S, Yao M, Deng C, Marsiglia FF, Duan W. Social isolation and anxiety disorder during the COVID-19 pandemic and lockdown in China. J Affect Disor. (2021) 294:10–6. doi: 10.1016/j.jad.2021.06.067
4. Li Y, Duan W, Chen Z. Latent profiles of the comorbidity of the symptoms for posttraumatic stress disorder and generalized anxiety disorder among children and adolescents who are susceptible to COVID-19. Children Youth Serv Rev. (2020) 116:105235. doi: 10.1016/j.childyouth.2020.105235
5. Lábadi B, Arató N, Budai T, Inhóf O, Stecina DT, Sík A, et al. Psychological well-being and coping strategies of elderly people during the COVID-19 pandemic in Hungary. Aging Mental Health. (2022) 26:570–577. doi: 10.1080/13607863.2021.1902469
6. Li TT, Bu H, Duan WJ. A brief measure of perceived courtesy and affiliate stigma on COVID-19: a study with a sample from China. Person Indiv Differ. (2021) 180:110993. doi: 10.1016/j.paid.2021.110993
7. Choi EPH, Duan W, Fong DYT, Lok KYW, Ho M, Wong JYH, et al. Psychometric evaluation of a Fear of COVID-19 Scale in China: cross-sectional study [Journal Article]. JMIR Form Res. (2022) 6:e31992. doi: 10.2196/31992
8. Marx RG, Bombardier C, Hogg-Johnson S, Wright JG. Clinimetric and psychometric strategies for development of a health measurement scale. J Clin Epidemiol. (1999) 52:105–11. doi: 10.1016/S0895-4356(98)00148-6
9. Carrozzino D, Patierno C, Pignolo C, Christensen KS. The concept of psychological distress and its assessment: a clinimetric analysis of the SCL-90-R. Int J Stress Manag. (2023) 30:235–48. doi: 10.1037/str0000280
10. Cohen S, Kamarck T, Mermelstein R. A global masure of perceived stress. J Health Soc Behav. (1983) 24:385–96. doi: 10.2307/2136404
11. Banks MH. Validation of the General Health Questionnaire in a young community sample. Psychol Med. (1983) 13:349–53. doi: 10.1017/S0033291700050972
12. Brown TA, Chorpita BF, Korotitsch W, Barlow DH. Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behav Res Ther. (1997) 35:79–89. doi: 10.1016/S0005-7967(96)00068-X
13. Foubert L, Noël Y, Spahr CM, Slavich GM. Beyond WEIRD: associations between socioeconomic status, gender, lifetime stress exposure, and depression in Madagascar. J Clin Psychol. (2021) 77:1644–65. doi: 10.1002/jclp.23131
14. Stockings E, Degenhardt L, Lee YY, Mihalopoulos C, Liu A, Hobbs M, et al. Symptom screening scales for detecting major depressive disorder in children and adolescents: a systematic review and meta-analysis of reliability, validity and diagnostic utility. J Affect Disor. (2015) 174:447–63. doi: 10.1016/j.jad.2014.11.061
Keywords: scale development, validation, machine learning, mental health, non-WEIRD population
Citation: Duan W, Wang J, Trindade IA and Zsido AN (2024) Editorial: Psychometrics in psychiatry 2022: anxiety and stress disorders. Front. Psychiatry 14:1352047. doi: 10.3389/fpsyt.2023.1352047
Received: 07 December 2023; Accepted: 13 December 2023;
Published: 05 January 2024.
Edited and reviewed by: Marco Grados, Johns Hopkins University, United States
Copyright © 2024 Duan, Wang, Trindade and Zsido. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wenjie Duan, duan.w@outlook.com; duan.w@ecust.edu.cn
†ORCID: Wenjie Duan orcid.org/0000-0002-1251-3685