Item and Scale Differential Functioning of the Mini-Mental State Exam Assessed Using the Differential Item and Test Functioning (DFIT) Framework

Morales, Leo S.; Flowers, Claudia; Gutierrez, Peter R.; Kleinman, Marjorie; Teresi, Jeanne A.

doi:10.1097/01.mlr.0000245141.70946.29

Cited by 62 publications

(53 citation statements)

References 20 publications

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“…DIF was determined by comparing a test statistic (calculated as the area under the curve [AUC] for the difference between item function curves by race) and a critical AUC value [Morales et al, 2006]. We used effect size (AUC) rather than statistical significance for DIF detection because our extremely large sample size rendered even trivial differences significant.…”

Section: Discussionmentioning

confidence: 99%

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Perlman

Kotov

et al. 2015

American J of Med Genetics Pt B

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Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and underendorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. Key words: schizophrenia; race; psychosis INTRODUCTIONOver the last 50 years, several studies have reported differences between individuals of African heritage and Caucasians in relative proportion of psychotic symptoms and diagnosis of schizophrenia versus bipolar disorder. Specifically, reports from samples ascertained in clinical settings have suggested that compared to Caucasians, individuals of African heritage have higher rates of schizophrenia [Robins and Regier, 1991;Strakowski et al., 1993Strakowski et al., , 1996Strakowski et al., , 2003Bresnahan et al., 2007;Gara et al., 2012;Kirkbride et al., 2012] 546Neuropsychiatric Genetics severe psychotic symptoms [Mukherjee et al., 1983;Strakowski et al., 2003;Arnold et al., 2004] and less severe negative symptoms [Sharpley et al., 2001]. Other studies of psychotic symptoms have found race differences in the quality and scope of hallucinations and delusions [Barrio et al., 2003;Yamada et al., 2006].To date, the underlying source of these apparent differences is unknown. It has been argued that the difference could reflect clinician or instrument bias [Neighbors et al., 2003;Trierweiler et al., 2006], although differences remained when clinicians were blinded to ethnicity information [Arnold et al., 2004]. On the other hand, race differences may reflect t...

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Section: Discussionmentioning

confidence: 99%

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Perlman

Kotov

et al. 2015

American J of Med Genetics Pt B

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“…One approach to assessing impact is in terms of effect sizes; for example, analyses are conducted to examine how much mean group differences in total score distributions change with and without inclusion of the items with DIF. Several studies have examined the potential impact of DIF on the relationships of demographic characteristics with health status or cognitive ability variables [12][13][14][15][16][17].…”

Section: Different Methods Of Dif Assessmentmentioning

confidence: 99%

Differential item functioning and health assessment

2007

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Establishing measurement equivalence is important because inaccurate assessment may lead to incorrect estimates of effects in research, and to suboptimal decisions at the individual, clinical level. Examination of differential item functioning (DIF) is a method for studying measurement equivalence. An item (i.e., one question in a longer scale) exhibits DIF if the item response differs across groups (e.g., gender, race), controlling for an estimate of the construct being measured. A distinction between applications in health, as contrasted with other settings such as educational and aptitude testing, is that there are many health-related constructs and multiple measures of each, few of which have received much critical evaluation. Discussed in this article are several methods for detection of differential item functioning (DIF), including non-parametric and parametric methods such as logistic regression, and those based on item response theory. Basic definitions and criteria for DIF detection are provided, as are steps in performing the analyses. Recommendations are presented and future directions discussed.

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“…(See also Collins et al [40] and Morales and colleagues [41] for examples.) In order to assess DIF magnitude, Raju's program DFITP5 was used.…”

Section: Softwarementioning

confidence: 96%

Evaluating measurement equivalence using the item response theory log-likelihood ratio (IRTLR) method to assess differential item functioning (DIF): applications (with illustrations) to measures of physical functioning ability and general distress

et al. 2007

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The fact that many physical function items showed DIF with respect to age, even after adjustment for multiple comparisons, indicates that the instrument may be performing differently for these groups. While the magnitude and impact of DIF at the item and scale level was minimal, caution should be exercised in the use of subsets of these items, as might occur with selection for clinical decisions or computerized adaptive testing. The issues of selection of anchor items, and of criteria for DIF detection, including the integration of significance and magnitude measures remain as issues requiring investigation. Further research is needed regarding the criteria and guidelines appropriate for DIF detection in the context of health-related items.

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Item and Scale Differential Functioning of the Mini-Mental State Exam Assessed Using the Differential Item and Test Functioning (DFIT) Framework

Abstract: Respondents to the English and Spanish versions of the MMSE are comparable on the basis of scale scores. However, assessments based on individual MMSE items may be misleading.

Cited by 62 publications

References 20 publications

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort

Differential item functioning and health assessment

Evaluating measurement equivalence using the item response theory log-likelihood ratio (IRTLR) method to assess differential item functioning (DIF): applications (with illustrations) to measures of physical functioning ability and general distress

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