Clinical Insight Into Latent Variables of Psychiatric Questionnaires for Mood Symptom Self-Assessment.
Clinical Insight Into Latent Variables of Psychiatric Questionnaires for Mood Symptom Self-Assessment.
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DOI：
10.2196/mental.6917
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发表时间：
2017-05-25
影响因子：
5.2
通讯作者：
De Vos M
中科院分区：
文献类型：
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作者：
Tsanas A;Saunders K;Bilderbeck A;Palmius N;Goodwin G;De Vos M
我们最近描述了一种新的情绪监测问卷，称为情绪缩放（MZ）。 MZ 包括 6 个项目，采用 7 点李克特量表评估情绪症状；我们之前曾使用标准主成分分析（PCA）来尝试性地了解其属性，但多个非零载荷的存在阻碍了对其潜在变量的解释。本研究的目的是使用算法方法严格研究 MZ 的内部属性和潜在变量，这可能会比 PCA 产生更可解释的结果。此外，我们还探索了其他三种广泛使用的精神病学问卷，以调查与 MZ 的潜在变量结构相似性：（1）奥特曼躁狂自评量表（ASRM），评估躁狂； （2）抑郁症状快速清查（QIDS）自我报告，评估抑郁症； (3) 广泛性焦虑障碍（7 项）(GAD-7)，评估焦虑。我们收集了 131 名参与者的回应：48 名双相情感障碍 (BD)、32 名边缘性人格障碍 (BPD) 和 51 名健康对照 (HC)，纵向收集（中位[四分位距，IQR]：363 [276] 天）。参与者被要求每周完成 ASRM、QIDS 和 GAD-7（所有 3 份问卷均在网络上完成），每天完成 MZ（使用基于定制的智能手机应用程序）。我们应用稀疏 PCA (SPCA) 来确定四份问卷的潜在变量，其中原始项目的一小部分对每个潜在变量有贡献。我们发现 MZ 在所研究的三个队列中具有很大的一致性。使用SPCA得出三个主要成分，可以初步解释为（1）焦虑和悲伤，（2）积极情绪，以及（3）烦躁。由焦虑和悲伤组成的 MZ 主成分解释了 BD 和 BPD 的大部分方差，而 MZ 的积极影响解释了 HC 的大部分方差。 ASRM 中的潜在变量对于患者组是相同的，但对于 HC 来说是不同的；然而，潜在变量在患者组和 HC 中具有共同的项目。相反，QIDS 在各组之间的主要成分总体上非常不同；睡眠是 HC 和 BD 的一个关键因素，但在 BPD 中则不存在。在 GAD-7 中，紧张是解释 BD 和 HC 大部分差异的主要因素。这项研究对于理解自我报告的情绪具有重要意义。 MZ 具有一致的、直观可解释的潜在变量结构，因此可能是通用情绪评估的良好工具。烦躁似乎是区分 BD 和 BPD 的关键潜在变量，可能有助于鉴别诊断。焦虑和悲伤密切相关，这一发现可能会为共同解决这些共变症状的治疗效果提供信息。焦虑和紧张似乎是双相情感障碍的主要潜在症状之一，值得临床实践中密切关注。
We recently described a new questionnaire to monitor mood called mood zoom (MZ). MZ comprises 6 items assessing mood symptoms on a 7-point Likert scale; we had previously used standard principal component analysis (PCA) to tentatively understand its properties, but the presence of multiple nonzero loadings obstructed the interpretation of its latent variables. The aim of this study was to rigorously investigate the internal properties and latent variables of MZ using an algorithmic approach which may lead to more interpretable results than PCA. Additionally, we explored three other widely used psychiatric questionnaires to investigate latent variable structure similarities with MZ: (1) Altman self-rating mania scale (ASRM), assessing mania; (2) quick inventory of depressive symptomatology (QIDS) self-report, assessing depression; and (3) generalized anxiety disorder (7-item) (GAD-7), assessing anxiety. We elicited responses from 131 participants: 48 bipolar disorder (BD), 32 borderline personality disorder (BPD), and 51 healthy controls (HC), collected longitudinally (median [interquartile range, IQR]: 363 [276] days). Participants were requested to complete ASRM, QIDS, and GAD-7 weekly (all 3 questionnaires were completed on the Web) and MZ daily (using a custom-based smartphone app). We applied sparse PCA (SPCA) to determine the latent variables for the four questionnaires, where a small subset of the original items contributes toward each latent variable. We found that MZ had great consistency across the three cohorts studied. Three main principal components were derived using SPCA, which can be tentatively interpreted as (1) anxiety and sadness, (2) positive affect, and (3) irritability. The MZ principal component comprising anxiety and sadness explains most of the variance in BD and BPD, whereas the positive affect of MZ explains most of the variance in HC. The latent variables in ASRM were identical for the patient groups but different for HC; nevertheless, the latent variables shared common items across both the patient group and HC. On the contrary, QIDS had overall very different principal components across groups; sleep was a key element in HC and BD but was absent in BPD. In GAD-7, nervousness was the principal component explaining most of the variance in BD and HC. This study has important implications for understanding self-reported mood. MZ has a consistent, intuitively interpretable latent variable structure and hence may be a good instrument for generic mood assessment. Irritability appears to be the key distinguishing latent variable between BD and BPD and might be useful for differential diagnosis. Anxiety and sadness are closely interlinked, a finding that might inform treatment effects to jointly address these covarying symptoms. Anxiety and nervousness appear to be amongst the cardinal latent variable symptoms in BD and merit close attention in clinical practice.