The bipolar depression rating scale (BDRS) : its development, validation and utility

Objectives: Unipolar and bipolar depression differ neurobiologically and in clinical presentation. Existing depression rating instruments, used in bipolar depression, fail to capture the necessary phenomenological nuances, as they are based on and skewed towards the characteristics of unipolar depression. Both clinically and in research there is a growing need for a new observer-rated scale that is specifically designed to assess bipolar depression.

Methods: An instrument reflecting the characteristics of bipolar depression was drafted by the authors, and administered to 122 participants aged 18–65 (44 males and 78 females) with a diagnosis of DSM-IV bipolar disorder, who were currently experiencing symptoms of depression. The Bipolar Depression Rating Scale (BDRS) was administered together with the Hamilton Depression Rating Scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS).

Results: The BDRS has strong internal consistency (Cronbach's alpha = 0.917), and robust correlation coefficients with the MADRS (r = 0.906) and HAM-D (r = 0.744), and the mixed subscale correlated with the YMRS (r = 0.757). Exploratory factor analysis showed a three-factor solution gave the best account of the data. These factors corresponded to depression (somatic), depression (psychological) and mixed symptom clusters.

Conclusions: This study provides evidence for the validity of the BDRS for the measurement of depression in bipolar disorder. These results suggest good internal validity, provisional evidence of inter-rater reliability and strong correlations with other depression rating scales.

Scale matters : the need for a Bipolar Depression Rating Scale (BDRS)

Objective: To briefly review the clinical and biological distinctions between unipolar and bipolar depression critiquing in particular currently available depression rating scales and discuss the need for a new observer-rated scale tailored to bipolar depression.

Method: Relevant literature pertaining to the symptomatic differences between bipolar disorder and unipolar disorder as well as their measurement using existing assessment scales was identified by computerized searches and reviews of scientific journals known to the authors.

Results: Bipolar depression is distinct from unipolar depression in terms of phenomenology and clinical characteristics. These distinguishing features can be used to identify bipolarity in patients that present with recurrent depressive episodes. This is important because current self-report and observer-rated scales are optimized for unipolar depression, and hence limited in their ability to accurately assess bipolar depression.

Conclusion: The development of a specific bipolar depression rating scale will improve the assessment of bipolar depression in both research and clinical settings and assist the development of better treatments and interventions.

The validity and internal structure of the bipolar depression rating scale (BDRS): data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder

Background: The phenomenology of unipolar and bipolar disorders differ in a number of ways, such as the presence of mixed states and atypical features. Conventional depression rating instruments are designed to capture the characteristics of unipolar depression and have limitations in capturing the breadth of bipolar disorder.

Method: The Bipolar Depression Rating Scale (BDRS) was administered together with the Montgomery Asberg Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) in a double-blind randomised placebo-controlled clinical trial of N-acetyl cysteine for bipolar disorder (N = 75).

Results: A factor analysis showed a two-factor solution: depression and mixed symptom clusters. The BDRS has strong internal consistency (Cronbach's alpha = 0.917), the depression cluster showed robust correlation with the MADRS (r = 0.865) and the mixed subscale correlated with the YMRS (r = 0.750).

Conclusion: The BDRS has good internal validity and inter-rater reliability and is sensitive to change in the context of a clinical trial.

Transcultural adaption and validation of the Spanish version of the Bipolar Depression Rating Scale (BDRS-S)

The Bipolar Depression Rating Scale (BDRS) arguably better captures symptoms in bipolar depression especially depressive mixed states than traditional unipolar depression rating scales. The psychometric properties of the Spanish adapted version, BDRS-S, are reported.

The overt behaviour scale (OBS): a tool for measuring challenging behaviours following ABI in community settings

OBJECTIVES: The Overt Behaviour Scale (OBS) was designed as a comprehensive measure of common challenging behaviours observed after acquired brain injury (ABI) in community settings. The OBS comprises 34 items in nine categories that measure aggression, inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and lack of initiation. The aim of the current study was to determine the reliability, validity and responsiveness of the OBS. METHOD: Two adult community-based samples of people with ABI were recruited. Sample 1 (n= 30) were concurrently evaluated on the OBS by two raters and again 1 week later to test stability. Other validating scales were also administered. Sample 2 (n= 28) were clients of the ABI Behaviour Consultancy who were treated for challenging behaviours and were administered the OBS before treatment commenced and then again 4 months later. RESULTS: Inter-rater reliability and stability coefficients for the OBS total score was strong (0.97 and 0.77, respectively). Initial evidence of convergent and divergent validity was shown by the differential pattern of correlations with other measures. Moderate-to-strong coefficients (range 0.37-0.66) were observed between the OBS and other measures that had behavioural content (i.e. Mayo-Portland Adaptability Inventory, Current Behaviour Scale, Neurobehavioural Rating Scale-Revised). Divergent validity was shown by the lack of correlation between the OBS and the sub-scales of these tools that do not measure challenging behaviour. Finally, responsiveness was demonstrated with a significant decrease in OBS scores in the expected direction over the 4-month period. This improvement was confirmed by corroborating evidence from key informants. CONCLUSION: The OBS shows promise as a reliable, valid and responsive measure that can be used for the systematic assessment of challenging behaviours in community settings.

Psychometric properties of the caregiver assessment of movement participation scale for screening children with development coordination disorders

Using Rasch analysis, the psychometric properties of a newly developed 35-item parent-proxy instrument, the Caregiver Assessment of Movement Participation (CAMP), designed to measure movement participation problems in children with Developmental Coordination Disorder, were examined. The CAMP was administered to 465 school children aged 5–10 years. Thirty of the 35 items were retained as they had acceptable infit and outfit statistics. Item separation (7.48) and child separation (3.16) were good; moreover, the CAMP had excellent reliability (Reliability Index for item = 0.98; Person = 0.91). Principal components analysis of item residuals confirmed the unidimensionality of the instrument. Based on category probability statistics, the original five-point scale was collapsed into a four-point scale. The item threshold calibration of the CAMP with the Movement Assessment Battery for Children Test was computed. The results indicated that a CAMP total score of 75 is the optimal cut-off point for identifying children at risk of movement problems.

Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease.

Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD.

Towards a BIM-based energy rating system

Governments in Australia are faced with policy implementation that mandates higher energy efficient housing (Foran, Lenzen & Dey 2005). To this effect, the National Construction Code (NCC) 2013 stipulates the minimum energy performance for residential buildings as 114MJ/m2 per annum or 6 stars on an energy rating scale. Compliance with this minimum is mandatory but there are several methods through which residential buildings can be rated to comply with the deemed to satisfy provisions outlined in the NCC. FirstRate5 is by far the most commonly used simulation software used in Victoria, Australia. Meanwhile, Building Information Modelling (BIM), using software such as ArchiCAD has gained a foothold in the industry. The energy simulation software within ArchiCAD, EcoDesigner, enables the reporting on the energy performance based on BIM elements that contain thermal information. This research is founded on a comparative study between FirstRate5 and EcoDesigner. Three building types were analysed and compared. The comparison finds significant differences between simulations, being, measured areas, thermal loads and potentially serious shortcomings within FirstRate5, that are discussed along with the future potential of a fully BIM-integrated model for energy rating certification in Victoria. © 2014, The Association for Computer-Aided Architectural Design Research in Asia (CAADRIA), Hong Kong.

Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: a large scale, multi-centered, longitudinal study in China

Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients' needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients' self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients.

Recovery from gynaecological day surgery : are we underestimating the process

This paper reports a study investigating the post operative experiences of 80 women following gynaecological day surgery. Women kept a diary for the first 4 days following surgery. The diary included a recovery rating scale and a symptom management index focusing particularly on symptoms. A telephone interview conducted on post-operative day 10 further explored experiences. Results at day 4 indicated women experienced significant problems with pain, moving around and tiredness. By day 10, women were still experiencing tiredness, pain and other lingering problems. The study indicates that patients experience more problems than discharge education assumes.

Parent-proxy and child self-reported health-related quality of life: using qualitative methods to explain the discordance

Background: Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.

Method: The sample consisted of 15 parent–child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.

Results: There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.

Discussion: This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.

Construct validity of the Chinese version of the disability of the arm, shoulder and hand questionnaire (DASH-HKPWH)

The study evaluated the construct validity of the Chinese Hong Kong version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH). Three hundred and thirty four patients with a broad range of upper extremity disorders were recruited into the study. Each completed DASH-HKPWH and SF-36 forms and their pain intensity (numeric pain rating scale) and grip strength were also measured. The mean DASH-HKPWH score was 40 (SD = 20). Principal component factor analysis identified a single factor, which accounted for 47% of the total variance. Pearson correlation was applied to assess convergent and divergent validity of the DASH-HKPWH by comparison with the above-mentioned subjective and objective measurements. Our findings were comparable to the DASH of other languages

Managing sport in drought-new stakeholders and new governance issues : a case study

Globally, almost every nation is facing some form of water crisis (World Commission on Water 2000). In Australia, the sport and recreation industry is one of the highest consumers of water. Other high water consuming industries (such as agriculture and farming) have been forced to adhere to strict managerial and governance reform due to the water crisis, yet in the sport and recreation industry, such changes are yet to be implemented and fully realised across the sector.

This research examines the impacts of drought and sustainable water management for sport and recreation. Specifically, it provides a case study of sport and recreation provision in a municipality that has already undergone considerable reform due to long-term drought. Sport and recreation use water for purposes such as irrigation of playing fields/pitches, filling swimming pools, stadium amenities and facilities, kitchens, maintenance and cleaning, and clubhouse amenities.

For sports that are heavy users of water for the maintenance of playing fields (such as soccer, Australian Rules football, rugby league, rugby union, grass and clay tennis courts to name a few) the impacts of drought and water restrictions have been severe. Some sports have reported an increase in the risk of injury to participants because of the condition of un-watered playing fields (Sport and Recreation Victoria 2007). Others have been forced to delay or shorten their seasons (Sleeman 2007), or worse still, cancel training and organised competition completely (Connolly and Bell 2007). While the impact of water restrictions has been profound on most sports, there are some sports that are not heavy water users and the impact of drought and water restrictions has been minimal. This problem creates issues and apparent inequities raising the need to further examine water consumption in sport and recreation. The potential outcome that arises is that the future of those sports that cannot conduct their competitions may be disadvantaged, while other sports that do not have such problems may be able to flourish.

Water, and those who control the supply of it, then defines which sports are able to flourish and sustain sport development pathways, compared to those whose survival may be in jeopardy. This research explores the stakeholder management and governance issues that have resulted for sport and recreation in the City of Greater Geelong (CoGG) located in Victoria, Australia--a region in long-term water crisis. The supply of sport and recreation facilities in the CoGG (like most municipalities in Australia) is largely the responsibility of the municipal council. The corporation responsible for the supply of water to the municipality is Barwon Water.

Although other sport and recreation facilities exist in the CoGG, the municipal council of CoGG owns and maintains over 120 sporting ovals (including the stadium used by its professional Australian Football League (AFL) team, the Cats), six swimming pools, and three golf courses. The CoGG host their professional AFL team, a range of local, national and international sport events, and provide a wide range of sport and recreation facilities for the community residents.

Eight interviews were conducted in total. Interviews were conducted with representatives from CoGG municipal council (who are responsible for the delivery of sport and recreation services and facilities in Geelong), and representatives from Barwon Water (who are responsible for the ongoing provision and maintenance of sport and recreation services and facilities) through the provision of water. Results show that the ten highest users of water in the municipality are sport and recreation facilitieswhich between them use almost one-third of the city's total water consumption (City of Greater Geelong 2006).

The municipal council is under considerable pressure to find ways to continue to provide sport and recreation opportunities for community members, as well as professional athletes and teams who use these facilities despite water restrictions. After all, these facilities provide benefit to spectators and participants, as well as businesses that rely on visitors to Geelong for sport and recreation events.

Due to such pressures, from 2007, the CoGG and Barwon Water agreed to provide the sport and recreation sector with water allocations rather than to be denied of all water under the water restriction regimes in place in the municipality. During 2007 summer sport season, this allowed the CoGG to keep 16 of its 120 sporting ovals open for participation through allocating all available water to these fields in order to keep them safe and playable. However, CoGG and Barwon Water were required to devise a rating scale to determine which sports (and sport facilities) were to share the allocated water, and which were not. These decisions also had knock on effects through sports. In order to ensure the safety of the playing surfaces, the CoGG and Barwon Water also restricted use of fields to competition only, therefore sport participants were forced to train on local beaches and other parkland areas-transferring issues of safety and public liability to other locations and facilities in the community. Further, it was reported that scheduling of competition seasons and individual matches; as well as the allocation of "home ground" gate receipts and concessions profits were required to be governed by the CoGG and Barwon Water as the competing sports were unable to agree. Perhaps more importantly, the rating scale developed for water allocation also resulted in some sports being rated as ineligible for water and as a result were unable to stage their entire competitions.

Clearly, the water allocation rating scale, and approach taken in this municipality to the continued delivery of sport and recreation has provided a workable solution. However, this study also signals that new stakeholders have entered the arena for the governance of sport. Governance structures in sport and recreation are being impacted as a result of the water crisis.

Those making decisions about which sport and recreation activities and/or facilities will be assisted with water resources are being made by local councils and water corporations. Sport managers are being required to understand existing areas of knowledge (such as turf management) in different ways, to gain knowledge in new areas (such as sustainable water management), and to lobby new stakeholder groups (such as water corporations) in order to secure their futures. The continued existence of some sports is no longer in the hands of governing bodies, but in the hands of local councils, and water corporations.

Clearly, any of the solutions implemented as discussed above, require multiple stakeholders to interact, and to reach agreement in order to assist in sustainable management of water in sport and recreation. In this sense, the management of water in sport (and all other industries) is more than a rational decision about policy, legislation, restrictions and resource allocations. It is a social and political process requiring scholarly attention for practical solutions.

An examination of the limitations in investigative interviewer's use of open-ended questions

Best-practice guidelines in the area of investigative interviewing of children specify the importance of using open-ended questions. However, use of open-ended questions per se does not maximise interview outcome; open-ended questions can vary markedly in quality. The aim of this study was to identify the nature of investigative interviewers' limitations when using open-ended questions, and to compare how representative these limitations are in three distinct interview paradigms. These interview paradigms include: (a) interviews in which trained actors played the role of a 5-6-year-old child; (b) interviews where 5-6-year-old children recalled an innocuous event that was staged in their school; and (c) actual field interviews where child witnesses aged 5 to 7 years recalled an abusive event. Overall, several common problems that would restrict children's opportunity to provide elaborate and accurate narrative accounts of events were identified and described. Our identification of these problems (using a dichotomous rating scale) was found to be consistent with an independent expert, and their presence was not limited to those interviewers who used a low frequency of open-ended questions. The implications of the findings for researchers and trainers in the area of investigative interviewing of children are discussed.