Mokken scale analysis of mental health and well-being questionnaire item responses: a non-parametric IRT method in empirical research for applied health researchers

Štochl, Jan; Jones, Peter B.; Croudace, Tim

doi:10.1186/1471-2288-12-74

Cited by 198 publications

(204 citation statements)

References 31 publications

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“…The stochastic cumulative scaling model offered by this approach is ideally suited when the intention is to score an underlying latent trait by simple addition of the item response values. 76 It has been shown to have a number of advantages over some other measurement models; for example, it includes an item parameter that shows how items differ in their distribution, it is probabilistic rather than deterministic and it can be applied in situations in which latent variables must be operationalised with only a small number of indicators. 77 The process has a number of assumptions which are to be found in most non-parametric and parametric (e.g.…”

Section: Mokken Scalingmentioning

confidence: 99%

Assessing the risk of self-harm in an adult offender population: an incidence cohort study

Horton

Wright²,

Dyer

et al. 2014

Health Technology Assessment

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BackgroundSelf-harm is common among prisoners, particularly female prisoners. In 2007, concerned about the rising incidence, the prison service introduced a care-planning system called Assessment, Care in Custody, and Teamwork (ACCT). To date, it does not incorporate a standardised diagnostic test to estimate the risk of future self-harm.ObjectiveTo identify potential screening instruments, or items from those instruments, to predict the risk of self-harm among prisoners.ParticipantsPrisoners who had been assigned to an ACCT during the recruitment period.DesignA multistage prospective cohort study. Following a pilot study, instruments were administered to prisoners by interview at baseline, and followed up for 6 months (or until point of release if this was sooner) to ascertain self-harm status. Instruments were assessed for unidimensionality, scalability (Mokken) and quantitative structure (Rasch). Area under the curve (AUC) analysis was used to examine the ability of instruments and/or their items to predict future self-harm. Cox proportional hazards regression models were used to examine the multivariate predictive ability of the scales and various sociodemographic and sentencing factors.SettingThree prisons (including one women’s prison) in northern England.Main outcome measuresA set of standardised questionnaires, including the Prison Screening Questionnaire (PriSnQuest), Revised Borderline Symptom List-23 (frequency-based responses) (BSL-23-F), Self-Harm Inventory (SHI), Patient Health Questionnaire (PHQ-9) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), together with sociodemographic and sentencing data.ResultsIn total, 450 prisoners consented to participate in the study, of whom 26% were female. The mean age of participants was 31.2 years. Over half of male prisoners recruited were on remand, compared with just over one-fifth (22.6%) of female prisoners. The average tariff of those sentenced was 41 months, of which 14.7 months, on average, had been served. Just over one-third of ACCTs had been initiated because of a known self-harm event, and over one-quarter (27.8%) of participants self-harmed during the follow-up period. Thus, almost half (46.7%) of those entered into the study were reported to have self-harmed, either from their index ACCT, or subsequently, or both. Cutting was the most frequent behaviour (51%). All screening instruments showed some evidence of unidimensionality, and four out of five showed scaling criteria consistent with ordinal scaling, so verifying the validity of the cut points. However, many showed gender bias and failure to fit the Rasch measurement model. While a resolution was made in most cases, both ordinal raw scores and latent interval scale estimates failed to show predictive value when applied within AUC analysis (0.491–0.566) or adjusted Cox proportional hazards models. However, good predictive values were shown for gender-specific sets of items, thus providing easily applied screening indexes.ConclusionsWhile four out of five potential screening instruments were found to have acceptable psychometric properties within this setting, their predictive validity of all instruments was poor under AUC analysis. Gender-specific item sets were put together to form two screening indexes with formative indicators which gave reasonable AUC values, particularly so for females. The indexes provide identification of low–medium–high risk of self-harm, and so may help to inform potential care pathways and decisions to sign prisoners off from the ACCT. Future work should concentrate on refining a set of predictive screening items among different offender populations and investigating the time point at which this set of items should be administered. Future work may also look at the different magnitudes of risk as indicators for care pathways.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Mokken Scalingmentioning

confidence: 99%

Assessing the risk of self-harm in an adult offender population: an incidence cohort study

Horton

Wright²,

Dyer

et al. 2014

Health Technology Assessment

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“…Mokken scaling is a non-parametric IRT method that can be used to investigate important and clinically useful properties of scales (e.g., see Stochl, Jones, & Croudace, 2012). First, it can be investigated whether a scale conforms to the properties of the monotone homogeneity model (MHM) that is characterised by the assumptions of unidimensionality, local independence and latent monotonicity.…”

Section: Introductionmentioning

confidence: 99%

Estimating the level of functional ability of children identified as likely to have an intellectual disability

Murray¹,

McKenzie²,

Booth³

et al. 2013

Research in Developmental Disabilities

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Screening tools can provide an indication of whether a child may have an intellectual disability (ID). Item response theory (IRT) analyses can be used to assess whether the statistical properties of the tools are such that their utility extends beyond their use as a screen for ID. We used non-parametric IRT scaling analyses to investigate whether the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) possessed the statistical properties that would suggest its use could be extended to estimate levels of functional ability and to estimate which, (if any), features associated with intellectual impairment are consistently indicative of lower or higher levels of functional ability. The validity of the two proposed applications was assessed by evaluating whether the CAIDS-Q conformed to the properties of the Monotone Homogeneity Model (MHM), characterised by uni-dimensionality, local independence and latent monotonicity and the Double Monotone Model (DMM), characterised by the assumptions of the MHM and, in addition, of nonintersecting item response functions. We analysed these models using CAIDS-Q data from 319 people referred to child clinical services. Of these, 148 had a diagnosis of ID. The CAIDS-Q was found to conform to the properties of the MHM but not the DMM. In practice, this means that the CAIDS-Q total scores can be used to quickly estimate the level of a person's functional ability. However, items of the CAIDS-Q did not show invariant item ordering, precluding the use of individual items in isolation as accurate indices of a person's level of functional ability.

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“…The H coefficients express the degree of homogeneity of a set of items; when 0.3≤H<0.4, the scale is considered weakly unidimensional. If 0.4≤H<0.5, it is considered moderately unidimensional, and if H>0.5 [40,41], the scale is considered strong.…”

Section: Unidimensionalitymentioning

confidence: 99%

Game Addiction Scale Assessment Through a Nationally Representative Sample of Young Adult Men: Item Response Theory Graded�Response Modeling (Preprint)

Khazaal¹,

Breivik²,

Billieux³

et al. 2018

Preprint

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Mokken scale analysis of mental health and well-being questionnaire item responses: a non-parametric IRT method in empirical research for applied health researchers

Cited by 198 publications

References 31 publications

Assessing the risk of self-harm in an adult offender population: an incidence cohort study

Assessing the risk of self-harm in an adult offender population: an incidence cohort study

Estimating the level of functional ability of children identified as likely to have an intellectual disability

Game Addiction Scale Assessment Through a Nationally Representative Sample of Young Adult Men: Item Response Theory Graded�Response Modeling (Preprint)

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