Rede Aferição departamento de epidemiologia Structural Validity of the Tonic Immobility Scale in a Population Exposed to Trauma: Evidence from Two Large Brazilian Samples Michael Reichenheim Instituto de Medicina Social State University of Rio de Janeiro Berkeley, 28 November 2017
Presentation outline • Overall context – Rede Aferição and PIEVF • Procedural context – Perspective Cross-cultural adaptation – Road-map • The paper (IMRaD) • Beyond the paper / next steps – New analyses – Way forward (towards a ‘Peri-Traumatic Scale’) • Open debate and feedback
Overall context Research Network for the Development of Instruments Applied to Measurement Models in Epidemiology ( Rede Aferição ) and Epidemiological Research Program on Family Violence ( PIEVF )
Overall context Research Network for the Development of Instruments Applied to Measurement Models in Epidemiology ( Rede Aferição ) and Epidemiological Research Program on Family Violence ( PIEVF )
Overall context Research Network for the Development of Epidemiological Measurement Tools and Modeling Rede de Pesquisa para o Desenvolvimento de Instrumentos de Aferição e Aplicação Modelos de Medida em Epidemiologia Sybelle S Castro Mônica Martins Rosane Griep Kátia Bloch Gilberto Kac Sara Heitor Validação curva Projeto Projeto Projeto Projeto FCQ GPG (Intergrowth) MedRisk ‘ELSA-Rio’ ‘ERICA’ (UFTM) (IN-UFRJ) (ENSP) (ENSP) (UFRJ) Alina Gomide Eduardo P Lima Rede Trauma Projeto EDE Elisabeth do Nascimento João Luiz D Bastos (LADI-UFMG) (UFSC) Mauro Mendlowicz Tânia Araujo Projeto PHQ Projeto OIDP Katia Freitas Roger K Celeste (UEFS) (UFRGS) Kionna Santos Rede Aferição Rede FIBRA Projeto HADS Roberto Lourenço Katia Freitas (FM-UERJ) (UEFS) Michael Reichenheim Estela Aquino Projeto Milênio Projeto MUSA Evandro Coutinho Greice Menezes (IMS / ENSP / (UFBA) Maria C Almeida UFRJ / UNIFESP) Projeto TEPT Claudia L Moraes Cursos e material Gustavo Lobato (IMS / IFF) didático Yara Hökerberg (IMS / INI / ENSP) Projeto Violência SANDUC / Pesq Bolsa ELANA EBIA Família no Namoro (IMS / IN-UFRJ) (IMS / FM-UERJ) (IMS / IN-UFRJ) (IMS / IN-UFRJ) Claudia L Moraes Rosana Salles-Costa Rosana Salles-Costa Claudia L Moraes Claudia L Moraes Gloria V. Veiga Claudia L Moraes Stella Taquette Rosely Sichieri Rosely Sichieri Gabriela Interlenghi Rubens Mattos
Overall context Research Network for the Development of Research Instruments Applied to Measurement Models in Epidemiology ( Rede Aferição ) and Epidemiological Research Program on Family Violence ( PIEVF )
Overall context • Epidemiological Research Program on Family Violence (PIEVF) • Distributions, consequences, health services • Covers ( inter alia ) – Violence • Family (psychological, physical, sexual) • Youth / adolescence • Community • Elderly – Substance abuse (alcohol and illicit drugs) – Nutritional and food ‘disorders’ (food insecurity) – Mental health • Common mental disorders / depression / anxiety • Post traumatic stress disorders (PTSD) • Peri-traumatic disorders tonic immobility, dissociative experience, physical reactions
Overall context • Key interest – Brazilian epidemiology – Cross-culturally valid instruments • Research • Applied: prediction, risk assessment, awareness-raising (health services) – Use / adapt available ‘international’ instruments • Whenever possible • To allow external comparisons – Important Cross-cultural adaptation processes (procedural models)
Procedural context • Cross-cultural adaptation model (Herdman et al; Guillemin et al., Beaton et al.) Conceptual Equivalence Operacional Equivalence Item Equivalence Evaluate whether Evaluate the compatibility between the Assess whether items 'mapping' construct and dimensions characteristics of use in the source and the original instrument are covered by the original target populations, so that there is relevant and ‘in tune’ with the instrument are relevant the 'efficacy' in measurement, even if the new context and whether the new context for which it is modus operandi ---layout, mode and 'intensity' of the items are being being adapted. application scenario-- differs. met (in principle). Semantic Equivalence Measurement Equivalence Assess whether the wording/phrasing used in the adapted version converges Evaluate whether measurement equivalent meanings and ideas properties of the original embedded in the items construed in the instrument and the adapted original version, thus leading to version are ‘invariant’. congruent responses in both cultures regarding content and ‘intensity’.
Procedural context Cross cultural adaptation model 2 phases • 1 st phase (prototypic) 2 nd phase (psychometric) t Assessing Assessing Pre-testing Assessing construct Assessing content conceptual semantic dimensional validity: construct validity based equivalence equivalence adequacy of the on hypothesized relations internal structures with other 'external' variables (incl. population invariance) Assessing Assessing + Reliability Latent variable item operational Other validities Analyses analyses equivalence equivalence (including IRT) COSMIN - CO nsensus-based S tandards for the selectionof health M easurement IN struments
Procedural context • A road-map to assessing ‘internal’ construct dimensional validity (item and scale properties) – Establishing configural structure equivalence (or its violation) – Establishing metric structure equivalence (or its violation) • Evaluating item reliability / measurement error • Examining 'method effect’ error/residual correlations (local independence) item content redundancy • Assessing factor-based convergent validity • Assessing factor-based discriminant validity – Establishing scalar structure equivalence (or its violation) • Examining item discrimination positioning vis-à-vis the latent trait item coverage redundancy • Assessing information coverage (latent trait) • Evaluating scalability (including cutoff identification for id homogeneous groups) – Establishing configural, metric and scalar ‘universality’ (‘generic diff’ across population subgroups)
On to the paper … Michael Reichenheim (IMS/UERJ) Evandro Silva Freire Coutinho (ENSP/FIOCRUZ) Wanderson Souza (DP/UFFRJ) Ivan Figueira (IPUB/UFRJ) Maria Inês Quintana (DP/UNIFESP) Marcelo Feijó de Mello (DP/UNIFESP) Rodrigo Affonseca Bressan (DP/UNIFESP) Jair de Jesus Mari (DP/UNIFESP) Sergio Baxter Andreoli (DP/UNIFESP)
Introduction • Tonic Immobility (TI) – Temporary catatonic-like state marked by a reversible motor inhibition, muscle hypertonicity, analgesia and relative unresponsiveness to external stimuli – Some authors regard it an evolutionary adaptive component working as the terminal defensive reaction when other resources are unavailable – Usually called as a ‘playing dead’ response in animals TI is a consequence of a predatory attack in the wild when resistance is not successful – This response to threat seems to be evolutionarily beneficial, as it has been linked to higher survival rate to predatory attack in different species
Introduction • Along with other peritraumatic stress reactions (dissociative experiences, physical reactions, etc.), TI has been reported as a risk factor for Post Traumatic Stress Disorder – PTSD • Among victims of violence (traumas), TI seems to predict severity of PTSD and poor response to treatment • Finding still contradictory, thus studies are still relevant … • Measurement tools more so ! • To the best of our knowledge, there are only two measurement tools available to evaluate TI in humans – Tonic Immobility Questionnaire (TIQ) – Tonic Immobility Scale (TIS) proposed by Forsyth et al. in 2000
Introduction • However, – Still few studies on the structural (dimensional) validity of both instruments – In relation to the TIS an important gap since it was the first measurement tool to be proposed and has been the most used so far
Introduction • Forsyth et al. (2000) analyzing women with a history of sexual abuse, satisfactorily evaluates 10 component items via ‘face validity’ ( a priori content validity) • Fusé et al. (2007) – Exploratory Factor Analysis ( n =88) and a single Confirmatory Factor Analysis (n=191) in sexually abused women suggested two distinct latent factors • Tonic Immobility • Anxiety/fear froze/felt paralyzed trembling/shaking unable to move though not restrained fear/panic unable to call out or scream feelings of detachment from surroundings (environment) felt numb/no pain felt cold feared for life felt detached from self
Introduction • Although welcome as a start to the TIS’ scrutiny, this psychometric history is rather incipient and surprising when considering time elapsed since its conception and given its continuous use over the years – Narrow domain (sexual abuse) – Small samples – ‘Superficial’ assessment of configural and metric psychometric properties • “ Aiming to address these limitations and extend the scope of use of TIS, the objective of this study was to reevaluate its dimensional structure through the sequential application in large representative samples of two Brazilian megacities, São Paulo and Rio de Janeiro ”
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