Exposure to unpredictability and mental health: Validation of the brief version of the Questionnaire of Unpredictability in Childhood (QUIC-5) in English and Spanish

Abstract

Unpredictability is increasingly recognized as a primary dimension of early life adversity affecting lifespan mental health trajectories; screening for these experiences is therefore vital. The Questionnaire of Unpredictability in Childhood (QUIC) is a 38-item tool that measures unpredictability in childhood in social, emotional and physical domains. The available evidence indicates that exposure to unpredictable experiences measured with the QUIC predicts internalizing symptoms including depression and anxiety. The purpose of the present study was to validate English and Spanish brief versions (QUIC-5) suitable for administration in time-limited settings (e.g., clinical care settings, large-scale epidemiological studies). Five representative items were identified from the QUIC and their psychometric properties examined. The predictive validity of the QUIC-5 was then compared to the QUIC by examining mental health in four cohorts: (1) English-speaking adult women assessed at 6-months postpartum (N = 116), (2) English-speaking male veterans (N = 95), (3) English-speaking male and female adolescents (N = 155), and (4) Spanish-speaking male and female adults (N = 285). The QUIC-5 demonstrated substantial variance in distributions in each of the cohorts and is correlated on average 0.84 (r’s = 0.81–0.87) with the full 38-item version. Furthermore, the QUIC-5 predicted internalizing symptoms (anxiety and depression) in all cohorts with similar effect sizes (r’s = 0.16–0.39; all p’s < 0.05) to the full versions (r’s = 0.19–0.42; all p’s < 0.05). In sum, the QUIC-5 exhibits good psychometric properties and is a valid alternative to the full QUIC. These findings support the future use of the QUIC-5 in clinical and research settings as a concise way to measure unpredictability, identify risk of psychopathology, and intervene accordingly.

Within-subject changes in methylome profile identify individual signatures of early-life adversity, with a potential to predict neuropsychiatric outcome

“…as an important dimension of early life adversity (37)(38)(39)(40)(41), and these findings have been confirmed and extended by others (42). Here, we assessed unpredictability of the early environment with the Questionnaire of Unpredictability in Childhood (QUIC; (37)).…”

“…The concept was then extended to other proximate sources of signals to the developing brain, including, in addition to caregivers, also the household and environment. The multiple sources and timescales of unpredictability are measured using the Questionnaire on the Unpredictability of Childhood (QUIC) (37,38). The contribution of unpredictable signals from caregivers and home environment ("unpredictability") to children's cognitive and emotional functions has now been established across diverse populations (37,(39)(40)(41)(42)(43)(44), and remains robust upon inclusion in the statistical models of well-established adverse experiences.…”

Annual Research Review: The power of predictability – patterns of signals in early life shape neurodevelopment and mental health trajectories

“…Given the developmental importance of unpredictability and the amenability to prevention and intervention, as described above we have developed a short (5‐item) screening instrument, the QUIC‐5, available in multiple languages including Spanish and English (Glynn et al., 2023; Lindert et al., 2022), to facilitate identification of children who may benefit from preventive efforts. The QUIC‐5 is currently being administered in pediatric clinics in Southern California to test the benefits of screening for unpredictability in addition to standard ACEs.…”

“…In light of the promising findings related to the QUIC, and in recognition that a 38‐item instrument may not be feasible in many clinical and research settings, we subsequently developed a brief 5‐item version of the scale in English and Spanish (QUIC‐5; Lindert et al., 2022). The predictability of the QUIC‐5 was compared to the full QUIC in four independent cohorts, and it predicted internalizing symptoms (anxiety and depressive symptoms) with very similar effect sizes and beyond other forms of adversity, indicating that it is a valid alternative in time‐limited settings.…”

Individual longitudinal changes in DNA-methylome identify signatures of early-life adversity and correlate with later outcome

“…The concept was then extended to other proximate sources of signals to the developing brain, including also the household and environment. The multiple sources and timescales of unpredictability are measured using the Questionnaire on the Unpredictability of Childhood (QUIC) ( Glynn et al, 2019 ; Lindert et al, 2022 ). The contribution of unpredictable signals from caregivers and home environment (“unpredictability”) to children's cognitive and emotional functions has now been established across diverse populations ( Glynn et al, 2018 , 2019 , 2021 ; Davis et al, 2017 , 2019a , 2022 ; Holmberg et al, 2022 ), and remains robust upon inclusion in the statistical models of established adverse experiences.…”