title: Editorial: an author's checklist for measure development and validation manuscripts. Long-term effectiveness and prediction of treatment outcome in cognitive behavioral therapy and sertraline for late-life anxiety disorders. Treatment of generalized anxiety disorder in older adults. Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Reliability, validity and factor structure of the GHQ-28 used among elderly Iranians. Depression in Europe. Geographical distribution among older people. Factor structure of the hospital anxiety and depression scale in older patients with major depression. Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. A clustered randomized trial of the effects of feedback using academic detailing compared to postal bulletin on prescribing of preventative cardiovascular therapy. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Non-Pharmacological Interventions in Older People with Heart Failure: Effects of Exercise Training and Relaxation Therapy Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial.
abstract: A recent special issue of the Journal of Pediatric Psychology included papers focused on evidence -based assessment across several broad domains of assessment in pediatric psychology ( e.g. , adherence , pediatric pain , and quality of life ) . In one of these papers , Holmbeck et al. ( 2008 ) review ed strengths and limitations of existing measures of psychosocial adjustment and psychopathology , concluding that many measures lacked supporting psychometric data ( e.g. , basic indices of reliability and validity ) that would permit a complete evaluation of these measures . Given that measure development and validation papers are frequently published in JPP ( Brown , 2007 ) , it is important that we attend to guiding psychometric principles when developing and disseminating data on new measures to be employed with pediatric population s ( Nunnally & Bernstein , 1994 ) . Thus , the purpose of this paper is to present and describe a checklist for authors to use when su bmi tting measure development papers to JPP . This checklist is included in the Appendix and is also included at the following link on the JPP website : http://www.oxfordjournals.org/our_journals/jpepsy/for _ authors /measure%20development%20checklist.pdf Findings presented by Holmbeck et al. ( 2008 ) indicated that 34 of the 37 measures review ed met pre-established “ evidence -based assessment ” ( EBA ) criteria for “ well-established ” measures ( Cohen et al. , 2008 ) . To be considered “ well-established , ” a measure had to have been presented in at least two peer- review ed journal articles by different investigatory teams , have demonstrated adequate levels of reliability and validity , and be accompanied by supporting information ( e.g. , a measure manual ) . Although most measures that we review ed met these criteria , we also found that most of the 34 “ well-established ” measures were hampered by at least one major psychometric flaw and /or lacked important psychometric data . We concluded that a more fine-grained EBA classification system is needed . One important distinction in this literature relates to differences between empirically supported assessment and evidence -based assessment . This type of distinction was first discussed in the literature on clinical interventions ( e.g. , Spring , 2007 ) . An empirically supported intervention is one that has demonstrated efficacy in r and omized clinical trials or clinic-based effectiveness trials . An evidence -based intervention has empirical support in the manner just described , but also “ integrates research evidence , clinical expertise , and patient preferences and characteristics … empirically-supported treatments  ( ESTs )  are an important component of evidence -based practice ( EBP ) , but EBP can not be reduced to ESTs ” ( Spring , 2007 , p.611 ) . Applying these terms to the field of assessment and measure development efforts , an empirically supported assessment measure would be one that demonstrates satisfactory psychometric characteristics , broadly defined . To be evidence based , the measure should also demonstrate utility in clinical setting s , be useful in making diagnoses , be sensitive to treatment effects , and /or provide incremental validity above and beyond other similar measures . Although papers in the special issue of JPP frequently referred to “ evidence -based assessment ” ( Cohen et al. , 2009 ) , the articles included in the issue tended to evaluate the degree to which the measures were empirically-supported rather than evidence based . To be “ evidence -based , ” our review s would have needed to integrate an evaluation of clinical utility , diagnostic utility , and treatment sensitivity with the empirical psychometric data presented in each review . As noted , the published review s were more likely to focus on the latter rather than on the former . As suggested by Mash and Hunsley ( 2005 ) , detailed EBA profiles would provide a complete evaluation of evidence across each of several psychometric and clinical ly relevant dimensions , including : ( a ) internal consistency , ( b ) test – retest reliability , ( c ) the availability of normative data , ( d ) content validity , ( e ) construct validity , ( f ) convergent and discriminant validity , ( g ) criterion-related validity , ( h ) incremental validity , ( i ) clinical utility , ( j ) diagnostic utility , and ( k ) treatment sensitivity . The focus on incremental validity and clinical and diagnostic utility raises the bar from a focus on “ empirical support ” ( i.e. , where the focus would tend to be primarily on psychometric data ) to a broad focus on the “ evidence base ” for a measure . In developing the checklist that is the focus of this article , we attempted to provide a list of criteria relevant to establishing the evidence base ( and not just empirical support ) for a measure . In addition to shifting the focus from providing “ empirical support ” for a measure to providing an “ evidence base ” for our instruments , a checklist for measure development papers would permit JPP review ers to evaluate such papers in the same way that review ers of r and omized clinical trials make use of the Consoli date d St and ards of Reporting Trials ( CONSORT ) checklist and flowchart ( Altman et al. , 2001 ) . The CONSORT checklist contains reporting st and ards with respect to method ological features of and the manner in which results are reported in clinical trials . Moreover , authors are required to provide a flowchart that describes details of sample recruitment and attrition during the course of the study . Thus , a checklist for measure development papers would serve two interrelated purpose s : ( a ) it would provide guidance to authors as they embark on the measure development process and would provide a list of criteria authors can use as they develop an evidence base for their measures , and ( b ) it would begin to st and ardize the manner in which psychometric and other assessment -related data are presented in measure development papers for this journal . Before providing a more detailed overview of the checklist , it is important to note that this checklist is rather exhaustive ( see Appendix ) . As such , it represents what would “ ideally ” be expected for a measure development or validation manuscript rather than minimal criteria for such papers . No one paper can provide a complete evaluation of all important psychometric and clinical ly relevant dimensions that will establish once- and -for-all the evidence base for a measure . Instrument refinement is part of a measure development process that gradually builds an evidence base for a scale ( see Smith & McCarthy , 1995 , for suggestions on measure refinement ) . Indeed , the validation of any measure is a cumulative process that occurs across many different types of research studies and across research programs BACKGROUND Although anxiety disorders are prevalent in older adults , r and omized controlled trials of treatment effectiveness for late-life anxiety are scarce and have focused primarily on the effectiveness of psychotherapeutic interventions . However , recent findings suggest that in some cases , pharmacological treatment may be more beneficial for late-life anxiety disorders . As yet , there have been no systematic studies investigating prognostic factors for the outcome of cognitive behavioral therapy ( CBT ) and pharmacotherapy for late-life anxiety . The objective of the present study was to study long-term treatment outcomes and to explore differential predictors for both short-term and long-term treatment outcomes of sertraline and CBT for late-life anxiety disorders . METHODS Participants of a r and omized controlled trial ( RCT ) comparing sertraline and CBT for the treatment of late-life anxiety were contacted one year after completing their treatment , so that predictors for both short-term and long-term treatment outcome could be established . RESULTS Sertraline showed a greater reduction of symptoms than CBT on anxiety ( Hamilton Anxiety Rating Scale ; HARS ) and worry ( Worry Domain Question naire ) ratings at one-year follow-up . The strongest predictor for short-term CBT outcome was poor perceived health , explaining 40 % of the variance in post-treatment residual gain scores on the HARS . The strongest predictor for long-term CBT outcome was neuroticism , explaining 20 % of the variance in residual gain scores at one-year follow-up . Analyses revealed no significant predictors for treatment outcome in sertraline participants . CONCLUSIONS Our study suggests that long-term use of sertraline might be more beneficial for late-life anxiety than a 15-week CBT program . Poor perceived health and neuroticism are predictive of less improvement after CBT in anxious older adults . Implication s of these findings are discussed Older adults with generalized anxiety disorder ( GAD ; N = 75 ; M age = 67.1 years ) were r and omly assigned to cognitive-behavioral therapy ( CBT ) , a discussion group ( DG ) organized around worry-provoking topics , or a waiting period . Participants in both active conditions improved relative to the waiting list . Although CBT participants improved on more measures than DG participants , the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up . Effect sizes were smaller than in younger sample s , but CBT showed large effects and DG showed medium-sized effects Overall , results indicate that brief treatment of late-life GAD  is beneficial , but they provide only limited support for the superiority of CBT to a credible comparison intervention BACKGROUND Although anxiety is quite prevalent in late life , its impact on disability , well-being , and health care utilization of  older persons  has not been studied . Older persons are a highly relevant age group for study ing the consequences of anxiety , since their increasing numbers put an extra strain on already limited health care re sources . METHODS Data of a large community-based r and om probability sample ( N = 659 ) of older subjects ( 55 - 85 year ) in the Netherl and s were used to select three groups : subjects with a diagnosed anxiety disorder , subjects with merely anxiety symptoms and a reference group without anxiety .  These groups were compared with regard to their functioning , subjective well-being , and use of health care services , while controlling for potentially confounding variables . RESULTS Anxiety was associated with increased disability and diminished well-being .  Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms . Although use of health services was increased in anxiety sufferers , their use of appropriate care was generally low . CONCLUSIONS Anxiety has a clear negative impact on the functioning and well-being of older subjects . The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking . Finally , in spite of its grave consequences for the quality of life , appropriate care for anxiety is seldom received . Efforts to improve recognition , disseminate effective treatments in primary care , and referring to specialized care may have positive effects on the management of anxiety in late life BACKGROUND The object of this study was to develop an Iranian version of the General Health Question naire-28 ( GHQ-28 ) for use with elderly subjects . METHODS The GHQ-28 Farsi version was evaluated for face validity among 204 elderly subjects aged 59 years or older , chosen r and omly from residents of Tehran . The Composite International Diagnostic Interview ( CIDI ) was used to establish a gold st and ard diagnosis of mental disorders . RESULTS The GHQ-28 was an internally consistent measure . Cronbach 's alpha , split-half coefficients and test-retest reliability were 0.9 , 0.89 and 0.58 respectively . Four factors were extracted using factor analysis : " depression , " " psychosocial activity , " " anxiety , " and " somatic . " Using receiver operating curve ( ROC ) analysis , the optimum cutoff score for the GHQ-28 in this group was 19/20 ( sensitivity 0.83 , specificity 0.76 ) . Using a loading of 0.6 or greater , a short form of the instrument ( GHQ-15 )  ( alpha=0.9 ) was derived and correlated well with the longer form of the scale ( r=0.97 ) . Using ROC analysis , the optimum cutoff score was 10/11 ( sensitivity 0.83 , specificity 0.69 ) . CONCLUSIONS The short and long forms of the GHQ-28 are suitable screening instruments for elderly Iranian residents , particularly those living in urban areas BACKGROUND This is the first report of results from the EURODEP Programme . AIMS To assess the prevalence of depression  judged suitable for intervention in r and omised sample s of those aged > or = 65 in nine European centres . METHOD The GMS-AGECAT package . RESULTS Differences in prevalence are apparent , 8.8 % ( Icel and ) to 236 % ( Munich ) . When sub-cases and cases are added together , five high- and four low-scoring centres emerge . Women predominated over men . Proportions of sub-cases to cases revealed striking differences but did not explain prevalence . There was no constant association between prevalence and age . A meta- analysis ( n = 13,808 ) gave an overall prevalence of 12.3 % , 14.1 % for women and 8.6 % for men . CONCLUSIONS Considerable variation occurs in the levels of depression across Europe , the cause for which is not immediately obvious . Case and sub-case levels taken together show greater variability , suggesting that it is not a matter of case/sub-case selection criteria , which were st and ardised by computer . Substantial levels of depression are shown but 62 - 82 % of persons had  no depressive level . Opportunities for treatment exist OBJECTIVE Symptomatic anxiety has prognostic significance in major depression . In theory , the Hospital Anxiety and Depression Scale ( HADS ) should be a useful instrument for measuring the severity of symptomatic anxiety in late-life depression . However , the dimensional structure of the HADS has not been evaluated in elderly depressed patients ; it is not known whether the scale actually functions as a bidimensional measure of anxiety and depression in this population . The purpose of this exploratory study , therefore , was to examine the factor structure of the HADS in older patients with major depression . METHOD The HADS was completed by 213 patients , aged 60 years or older , with DSM-III-R unipolar major depression . Principal components analysis was performed on the full 14-item HADS and on each of its subscales . RESULTS Two distinct factors , which corresponded to the instrument 's depression and anxiety subscales , emerged . The two-factor structure proved reasonably stable when the study group was r and omly divided into two halves . Analysis of the subscales result ed in a single factor for each . The subscales had high internal reliability . CONCLUSIONS These findings confirm that the HADS functions as a bidimensional measure of depression and anxiety in older patients with major depression . The results suggest that the HADS is a valid instrument for measuring severity of anxiety , independent of other depressive symptoms , in this population OBJECTIVE To study the prevalence and risk factors of anxiety disorders in the older ( 55 - 85 ) population of The Netherl and s. METHOD The Longitudinal Aging Study Amsterdam ( LASA ) is based on a r and om sample of 3107 older adults , stratified for age and sex , which was drawn from the community registries of 11 municipalities in three regions in The Netherl and s. Anxiety disorders were diagnosed using the Diagnostic Interview Schedule in a two-stage screening design . The risk factors under study comprise vulnerability , stress and network-related variables . Both bivariate and multivariate statistical methods were used to evaluate the risk factors . RESULTS The overall prevalence of anxiety disorders was estimated at 10.2 % . Generalized anxiety disorder was the most common disorder ( 7.3 % ) , followed by phobic disorders ( 3.1 % ) . Both panic disorder ( 1.0 % ) and obsessive compulsive disorder ( 0.6 % ) were rare . These figures are roughly similar to previous findings . Ageing itself did not have any impact on the prevalence in both bivariate and multivariate analyses . The impact of other factors did not change much with age . Vulnerability factors ( female sex , lower levels of education , having suffered extreme experiences during World War II and external locus of control ) appeared to dominate , while stresses commonly experienced by older people ( recent losses in the family and chronic physical illness ) also played a part . Of the network-related variables , only a smaller size of the network was associated with anxiety disorders . CONCLUSIONS Anxiety disorders are common in later life . The risk factors support using a vulnerability-stress model to conceptualize anxiety disorders . Although the prevalence of risk factors changes dramatically with age , their impact is not age-dependent . The risk factors indicate which groups of older people are at a high risk for anxiety disorders and in whom active screening and treatment may be warranted BACKGROUND Interventions to promote prescribing of preventive therapies in patients with cardiovascular disease ( CVD ) or diabetes have reported variable success . OBJECTIVE ( i ) To evaluate the effect of prescribing feedback on GP practice using academic detailing compared to postal bulletin on prescribing of CVD preventive therapies in patients with CVD or diabetes at 3 and 6 months post intervention and ( ii ) to evaluate the intervention from a GP 's perspective . METHODS Volunteer GP practice s ( n = 98 ) were r and omized to receive individualized prescribing feedback via academic detailing ( postal bulletin plus outreach visit ) ( n = 48 ) or postal bulletin ( n = 50 ) . The proportion of  CVD or diabetic patients on  statins and antiplatelet agents/warfarin  pre- and post-intervention was calculated for each GP practice . Multivariate regression with a r and om effects model was used to compare differences between the groups adjusting for GP clustering and confounding factors . beta-Coefficients and 95 % confidence intervals ( CIs ) are presented . RESULTS There was a 3 % increase in statin prescribing in CVD patients at 6 months post-intervention for both r and omized groups , but there was no statistical difference between the groups ( beta = 0.004 ; 95 % CI = -0.01 to 0.02 ) .  Statin and antiplatelet/warfarin prescribing also increased in the diabetic population ; there was no significant differences between the groups . GPs participating in the project expressed a high level of satisfaction with both interventions . CONCLUSION Prescribing of preventive therapies increased in both r and omized groups over the study period . But academic detailing did not have an additional effect on changing prescribing over the postal bulletin alone BACKGROUND Research on the dimensional structure and reliability of the  Hospital Anxiety and Depression Scale  ( HADS  ) and its relationship with age is scarce . Moreover , its efficacy in determining the presence of depression in different patient groups has been question ed . METHODS Psychometric properties of the HADS were assessed in six different groups of Dutch subjects ( N = 6165 ) : ( 1 ) a r and om sample of younger adults ( age 18 - 65 years ) ( N = 199 ) ; ( 2 ) a r and om sample of elderly subjects of 57 to 65 years of age ( N = 1901 ) ; ( 3 ) a r and om sample of elderly subjects of 66 years or older ( N = 3293 ) ; ( 4 ) a sample of consecutive general practice patients ( N = 112 ) ; ( 5 ) a sample of consecutive general medical out- patients with unexplained somatic symptoms ( N = 169 ) ; and ( 6 ) a sample of consecutive psychiatric out- patients ( N = 491 ) . RESULTS Evidence for a two-factor solution corresponding to the original two subscales of the HADS was found , although anxiety and depression subscales were strongly correlated . Homogeneity and test-retest reliability of the total scale and the subscales were good . The dimensional structure and reliability of the HADS was stable across medical setting s and age groups . The correlations between HADS scores and age were small . The total HADS scale showed a better balance between sensitivity and positive predictive value ( PPV ) in identifying cases of psychiatric disorder as defined by the Present State Examination than the depression subscale in identifying cases of unipolar depression as defined by ICD-8 . CONCLUSIONS The moderate PPV suggests that the HADS is best used as a screening question naire and not as a ' case-identifier ' for psychiatric disorder or depression Background : Effective management of heart failure relies on optimal use of non-pharmacological therapy alongside medical treatment . Yet , there is an inadequate use of non-pharmacological therapy in caring for older people with heart failure . Objective : To examine the effects of relaxation therapy and exercise training on psychological outcomes and disease-specific quality of life of older heart failure patients . Methods : Subjects undertook relaxation  ( n = 59 ) , exercise training ( n = 32 ) or received attention placebo ( n = 62 ) for 12 weeks . The relaxation group attended two training sessions , one revision workshop , and continued with twice-daily taped-directed home relaxation practice , with support from the intervener through bi-weekly telephone contact , for 12 weeks . The exercise group undertook 12 weekly sessions of resistance training and aerobic exercise and thrice weekly home exercise . The control group received regular telephone calls for general ‘ greetings ’ . Results : The relaxation and exercise groups reported a significantly greater improvement in psychological [ F(2 , 149 ) = 6.69 , p = 0.002 ] and various disease-specific quality of life outcomes [ dyspnea : F(2 , 149 ) = 5.72 , p = 0.004 ; fatigue : F(2 , 149 ) = 3.78 , p = 0.25 ; emotion : F(2 , 149 ) = 6.68 , p = 0.001 ] , compared with those who received the attention placebo . While relaxation therapy was more effective to reduce psychological distress , with depression in particular ( p < 0.001 ) , exercise therapy worked better to control fatigue symptoms ( p = 0.03 ) . Conclusion : Relaxation therapy and exercise training are effective to improve the psychological and physical health of older heart failure patients . They should be used as an individual treatment modality , or as care components of a disease management program CONTEXT Generalized anxiety disorder ( GAD ) is one of the most common psychiatric disorders in older adults ; however , few data exist to guide clinicians in efficacious and safe treatment . Selective serotonin reuptake inhibitors ( SSRIs ) are efficacious for younger adults with GAD , but benefits and risks may be different in older adults . OBJECTIVE To examine the efficacy , safety , and tolerability of the SSRI escitalopram in older adults with GAD . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial in primary care practice s and related specialty clinics in Pittsburgh , Pennsylvania , of 177 participants aged 60 years or older with a principal diagnosis of GAD r and omized to receive either escitalopram or placebo and conducted between January 2005 and January 2008 . INTERVENTIONS Twelve weeks of 10 to 20 mg/d of escitalopram ( n = 85 ) or matching placebo ( n = 92 ) . MAIN OUTCOME MEASURES Cumulative response defined by Clinical Global Impressions-Improvement score of much or very much improved ; time to response ; and anxiety and role functioning changes measured by the Clinical Global Impressions-Improvement scale , Hamilton Anxiety Rating Scale , Penn State Worry Question naire , Late-Life Function and Disability Instrument activity limitations subscale , and the role-emotional impairment and social function subscales of the Medical Outcome Survey 36-item Short Form . RESULTS In the primary analytic strategy in which participants ( n = 33 ) were censored at the time of dropout , mean cumulative response rate for escitalopram was 69 % ( 95 % confidence interval [ CI ] , 58%-80 % ) vs 51 % ( 95 % CI , 40%-62 % ) for placebo ( P = .03 ) . A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo ( 57 % ; 95 % CI , 46%-67 % ; vs 45 % ; 95 % CI , 35%-55 % ; P = .11 ) . Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning ( Clinical Global Impressions-Improvement scale : effect size , 0.93 ; 95 % CI , 0.50 - 1.36 ; P < .001 ; Penn State Worry Question naire : 0.30 ; 95 % CI , 0.23 - 0.48 ; P = .01 ; activity limitations : 0.32 ; 95 % CI , 0.01 - 0.63 ; P = .04 ; and the role-emotional impairment and social function : 0.96 ; 95 % CI , 0.03 - 1.90 ; P = .04 ) . Adverse effects of escitalopram ( P < .05 vs placebo ) were fatigue or somnolence ( 35 patients [ 41.1 % ] ) , sleep disturbance ( 12 [ 14.1 % ] ) , and urinary symptoms ( 8 [ 9.4 % ] ) . CONCLUSIONS Older adults with GAD r and omized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks ; however , response rates were not significantly different using an intention-to-treat analysis . Further study is required to assess efficacy and safety over longer treatment duration s. TRIAL REGISTRATION clinical trials.gov Identifier : NCT00105586
target: Conclusions : Of the most commonly used measures , the majority lacked sufficient evidence to warrant their use with older adults .
  Based on psychometric evidence , three measures ( Beck Anxiety Inventory , Penn State Worry Question naire , and Geriatric Mental Status Examination ) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults .
  In addition , two measures developed specifically for older adults ( Worry Scale and Geriatric Anxiety Inventory ) were also found to be appropriate for use with older adults
background: Objectives : The authors set out to systematic ally review the research literature in order to identify the anxiety measures most commonly used in the assessment of older adults .
  Once identified , the literature was review ed to determine the extent to which these instruments had age-relevant norms and psychometric data supporting their use with older adults .