Comparing multiple treatment options using meta-analytical methods requires complex statistical methods called mixed treatment comparisons (MTCs). Such methods offer the possibility to summarize data from many clinical trials comparing the different available options. However, those methods are based on a number of assumptions and inherent difficulties that are discussed and illustrated with examples from the psychiatric literature to help readers to understand the strengths and weaknesses of these methods. This review will help enable readers to critically appraise the methodology and results of publications that use MTCs. Copyright © 2013 John Wiley & Sons, Ltd.

Pharmacoepidemiological studies provide valuable information on the relationships between psychotropic drug use and adverse outcomes in older people. To minimize the influence of misclassification bias in pharmacoepidemiological studies, more emphasis should be given to methodological aspects of exposure assessment. This study evaluated the validity of a dosage assumption of one unit per day for measuring legend duration of psychotropic drug exposures among older people. Using data from the Finnish Prescription Register, the study analysed 62,320 psychotropic drug prescriptions dispensed for people aged ≥ 75 years (n = 52,729) in September 2009. The proportions of prescriptions in which the prescribed dose deviated from one unit per day were assessed for categories and subcategories of psychotropic drugs. The prescription was considered misclassified (a) if the prescribed drug was intended for “as needed” use, (b) if the prescription included a dose range, or (c) if the prescribed dose was below or above one unit per day. Among antidepressants, less than every fourth (23.7%) prescription was misclassified. The proportions of misclassification varied substantially across subcategories, being 13.1% for selective serotonin reuptake inhibitors (SSRIs), 25.3% for other antidepressants and 53.8% for tricyclic antidepressants. Of the benzodiazepine and antipsychotic prescriptions, 79.9% and 57.6%, respectively, were misclassified. In conclusion, the dosage assumption of one unit per day is valid for measuring the legend duration of SSRI and other antidepressant exposures among older people. Among other psychotropic drugs, the dosage assumption is likely to lead to severe exposure misclassification. Copyright © 2013 John Wiley & Sons, Ltd.

Information on which older adults attend mental health care and whether they profit from the care they receive is important for policy-makers. To assess this information in daily practice, the “Mental health care Monitor Older adults” (MEMO) was developed in the Netherlands. The aim of this paper is to describe MEMO and the older adults who attend outpatient mental health care regarding their predisposing and enabling characteristics and need for care. In MEMO all patients referred to the division of old age psychiatry of the participating mental health care organisations are assessed at baseline and monitored at 4, 8 and 12-month follow-up. Primary outcomes are mental and social functioning, consumer satisfaction, and type of treatment provided (MEMO Basic). Over the years, MEMO Basic is repeated. In each cycle, additional information on specific patient groups is added (e.g. mood disorders). Data collection is supported by a web-based system for clinicians, including direct feedback to monitor patients throughout treatment. First results at baseline showed that the majority of patients that entered the division of old age psychiatry was female (69%), had low education (83%), lived alone (53%), was depressed (42%) and had a comorbid condition (82%). It seemed that older immigrants were not sufficiently reached. The current study is the first in the Netherlands to evaluate patient characteristics and outcome in mental health care provided for older adults in day-to-day practice. If MEMO works out successfully, the method should be extended to other target groups. Copyright © 2013 John Wiley & Sons, Ltd.

The Severity of Dependence Scale (SDS) measures with five items the degree of psychological dependence on several illicit drugs, including cannabis. Its psychometric properties have not yet been examined in young adult frequent cannabis users, an eminently high-risk group for cannabis dependence.

Internal consistency and criterion validity of the SDS were investigated within an enriched community based sample of 577 Dutch frequent (≥ three days per week in the past 12 months) cannabis users between 18–30 years. Criterion validity was tested against the Composite International Diagnostic Interview (CIDI) 3.0 DSM-IV diagnosis cannabis dependence, and psychometric properties were assessed separately for males and females and for ethnic subgroups.

Principal component analysis showed that all items of the scale loaded on a single factor and reliability of the SDS total score was good (Cronbach's α = 0.70). However, criterion validity against the CIDI diagnosis cannabis dependence was low: area under curve (AUC) was 0.68 (95% confidence interval: 0.64–0.73) and at the optimal differentiating cut-off (SDS ≥ 4), sensitivity was 61.3% and specificity 63.5%. Results were similar for subgroups on gender and ethnicity.

While internal consistency of the SDS is good, its use as a screener to differentiate between dependence and non-dependence within populations of young adult frequent cannabis users is not recommended. Copyright © 2013 John Wiley & Sons, Ltd.

The OPCRIT program is a symptom checklist with accompanying algorithms producing operationally defined diagnoses. We undertook a review of studies which had used OPCRIT and had reported statistics concerning its reliability and validity, producing summary measures from 44 studies. The first main measure of interest was inter-rater reliability where mean kappa values indicated that agreement between raters was “substantial” with a marginal improvement at the diagnostic (0.76) versus individual item (0.69) level. The second main measure of interest was convergent validity – the agreement between OPCRIT and clinical diagnoses. Most studies reported these figures as concordance rates suggesting mean agreement, unadjusted for chance, of 69%. Very few studies used the chance-adjusted kappa statistic but where this was used agreement was “fair” (0.39). Agreement between OPCRIT and other research diagnoses was “moderate” (0.60). We also considered differences between the way OPCRIT has traditionally been used in research settings and the naturalistic manner in which it will be employed in the hospital ward. This review provides a summary of the reliability and validity of OPCRIT, which will be considered during the preparation for its use in the routine characterization of mental health patients in clinical settings. Copyright © 2013 John Wiley & Sons, Ltd.

This paper explored the latent class structure of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) (assessed with the Munich Composite International Diagnostic Interview). Secondly, the screening properties of the Cannabis Abuse Screening Test (CAST) in adolescents were assessed with classical test theory using the latent class structure as empirical gold standard. The sample comprised 3266 French cannabis users aged 17 to 19 from the general population. Three latent classes of cannabis users were identified reflecting a continuum of problem severity: non-symptomatic, moderate and severe. Gender-specific analyses showed the best model fit, although results were almost identical in the total sample. The latent classes were good predictors of daily cannabis use, number of joints per day and age of first experimentation. The CAST showed good screening properties for the moderate/severe class (area under receiver operating characteristic curve > 0.85) and very good for the severe class (0.90). It was more sensitive for boys, more specific for girls. Although structural equivalence across gender was rejected, results suggest small gender differences in the latent structure of the DSM-IV. The performance of the CAST in screening for the latent class structure was good and superior to those obtained with the classical DSM-IV diagnoses. Copyright © 2013 John Wiley & Sons, Ltd.

We assessed if the Revised Child Anxiety and Depression Scale (RCADS) measures anxiety symptoms similarly across age groups within adolescence. This is crucial for valid comparison of anxiety levels between different age groups. Anxiety symptoms were assessed biennially in a representative population sample (n = 2226) at three time points (age range 10–17 years) using the RCADS anxiety subscales (generalized anxiety disorder [GAD], obsessive-compulsive disorder [OCD], panic disorder [PD], separation anxiety [SA], social phobia [SP]). We examined longitudinal measurement invariance of the RCADS, using longitudinal confirmatory factor analysis, by examining the factor structure (configural invariance), factor loadings (metric invariance) and thresholds (strong invariance). We found that all anxiety subtypes were configural invariant. Metric invariance held for items on the GAD, OCD, PD and SA subscales; yet, for the SP subscale three items showed modest longitudinal variation at age 10–12. Model fit decreased modestly when enforcing additional constraints across time; however, model fit for these models was still adequate to excellent. We conclude that the RCADS measures anxiety symptoms similarly across time in a general population sample of adolescents; hence, measured changes in anxiety symptoms very likely reflect true changes in anxiety levels. We consider the instrument suitable to assess anxiety levels across adolescence. Copyright © 2013 John Wiley & Sons, Ltd.

A recent systematic review and meta-analysis of the incidence and prevalence of schizophrenia and other psychoses in England investigated the variation in the rates of psychotic disorders. However, some of the questions of interest, and the data collected to answer these, could not be adequately addressed using established meta-analysis techniques. We developed a novel statistical method, which makes combined use of fractional polynomials and meta-regression. This was used to quantify the evidence of gender differences and a secondary peak onset in women, where the outcome of interest is the incidence of schizophrenia. Statistically significant and epidemiologically important effects were obtained using our methods. Our analysis is based on data from four studies that provide 50 incidence rates, stratified by age and gender. We describe several variations of our method, in particular those that might be used where more data is available, and provide guidance for assessing the model fit. Copyright © 2013 John Wiley & Sons, Ltd.

The aim of this analysis was to identify Young Mania Rating Scale (YMRS) meaningful benchmarks for clinicians (severity threshold, minimal clinically significant difference [MCSD]) using the Clinical Global Impressions Bipolar (CGI-BP) mania scale, to provide a clinical perspective to randomized clinical trials (RCTs) results.

We used the cohort of patients with acute manic/mixed state of bipolar disorders (N = 3459) included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. A receiver-operating characteristic analysis was performed on randomly selected patients to determine the YMRS optimal severity threshold with CGI-BP mania score ≥ “Markedly ill” defining severity. The MCSD (clinically meaningful change in score relative to one point difference in CGI-BP mania for outcome measures) of YMRS, was assessed with a linear regression on baseline data.

At baseline, YMRS mean score was 26.4 (±9.9), CGI-BP mania mean score was 4.8 (±1.0) and 61.7% of patients had a score ≥ 5. The optimal YMRS severity threshold of 25 (positive predictive value [PPV] = 83.0%; negative predictive value [NPV] = 66.0%) was determined. In this cohort, a YMRS score of 20 (typical cutoff for RCTs inclusion criteria) corresponds to a PPV of 74.6% and to a NPV of 77.6%, meaning that the majority of patients included would be classified as severely ill. The YMRS minimal clinically significant difference was 6.6 points. Copyright © 2013 John Wiley & Sons, Ltd.

Brief interventions effectively reduce alcohol problems; however, it is controversial whether longer interventions result in greater improvement. This study aims to determine whether an increase in treatment for people with more severe problems resulted in better outcome. We employed regression-discontinuity analyses to determine if drinking driver clients (n = 22,277) in Ontario benefited when they were assigned to a longer treatment program (8-hour versus 16-hour) based on assessed addiction severity criteria. Assignment to the longer16-hour program was based on two addiction severity measures derived from the Research Institute on Addictions Self-inventory (RIASI) (meeting criteria for assignment based on either the total RIASI score or the score on the recidivism subscale). The main outcome measure was self-reported number of days of alcohol use during the 90 days preceding the six month follow-up interview. We found significant reductions of one or two self-reported drinking days at the point of assignment, depending on the severity criterion used. These data suggest that more intensive treatment for alcohol problems may improve results for individuals with more severe problems. Copyright © 2012 John Wiley & Sons, Ltd.

Background: Efforts to develop and validate fully-structured diagnostic interviews of mental disorders in non-Western countries have been largely unsuccessful. However, the principled methods of translation, harmonization, and calibration that have been developed by cross-national survey methodologists have never before been used to guide such development efforts. The current report presents the results of a rigorous program of research using these methods designed to modify and validate the Composite International Diagnostic Interview (CIDI) for an epidemiological survey in Nepal. Methods: A five-step process of translation, harmonization, and calibration was used to modify the instrument. A blinded clinical reappraisal design was used to validate the instrument. Results: Preliminary interviews with local mental health expert led to a focus on major depressive episode, mania/hypomania, panic disorder, post-traumatic stress disorder, generalized anxiety disorder, and intermittent explosive disorder. After an iterative process of multiple translations-revisions guided by the principles developed by cross-national survey methodologists, lifetime DSM-IV diagnoses based on the final Nepali CIDI had excellent concordance with diagnoses based on blinded Structured Clinical Interview for DSM-IV (SCID) clinical reappraisal interviews. Conclusions: Valid assessment of mental disorders can be achieved with fully-structured diagnostic interviews even in low-income non-Western settings with rigorous implementation of replicable developmental strategies. Copyright © 2013 John Wiley & Sons, Ltd.