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Assessment literacy's vital role in faculty effectiveness within higher education lacks sufficient tools for measuring faculty attitudes on this matter. Employing a sequential mixed-methods approach, this study utilized the theory of planned behavior to develop the Assessment Literacy Attitude Scale (ALAS) and evaluate its psychometric properties within the U.S. higher education context. The qualitative phase involved a literature review of relevant studies and existing selfreport measures, interviews with stakeholders, and panel reviews to shape initial item development. Following the establishment of a conceptual foundation and a comprehensive overview of the scale's construction, our study advanced to the quantitative stage that involves factor analytical and item response theory approaches using data from 260 faculty across three public universities in the U.S. Exploratory factor analysis (EFA) was employed initially to obtain preliminary insights into the scale's factorial structure and dimensionality. Confirmatory factor analysis (CFA) was subsequently applied with separate data and the findings largely supported the conclusions from the EFA. Exploratory and confirmatory factor analyses resulted in 15 items loading across two factors in a good model fit range. Finally, we used nonparametric item response theory (IRT) techniques based on Mokken Scale Analysis (MSA) to evaluate individual items for evidence of effective psychometric properties to support the interpretation of ALAS scores, including monotonicity, scalability, and invariant item ordering. The newlydeveloped scale shows promise in assessing faculty attitudes toward enhancing their assessment literacy. [ABSTRACT FROM AUTHOR]

Estimating the number of latent factors underlying a set of dichotomous items is a major challenge in social and behavioral research. Mokken scale analysis (MSA) and exploratory graph analysis (EGA) are approaches for partitioning measures consisting of dichotomous items. In this study we perform simulation-based comparisons of two EGA methods (EGA with graphical least absolute shrinkage and selector operator; EGAtmfg with triangulated maximally filtered graph algorithm), two MSA methods (AISP: automated item selection procedure; GA: genetic algorithm), and two widely used factor analytic techniques (parallel analysis with principal component analysis (PApc) and parallel analysis with principal axis factoring (PApaf)) for partitioning dichotomous items. Performance of the six methods differed significantly according to the data structure. AISP and PApc had highest accuracy and lowest bias for unidimensional structures. Moreover, AISP demonstrated the lowest rate of misclassification of items. Regarding multidimensional structures, EGA with GLASSO estimation and PApaf yielded highest accuracy and lowest bias, followed by EGAtmfg. In addition, both EGA techniques exhibited the lowest rate of misclassification of items to factors. In summary, EGA and EGAtmfg showed comparable performance to the highly accurate traditional method, parallel analysis. These findings offer guidance on selecting methods for dimensionality analysis with dichotomous indicators to optimize accuracy in factor identification. [ABSTRACT FROM AUTHOR]

Background Health literacy is closely associated with health status, most domestic studies tend to use multidimensional and multi-item tools for assessing health literacy, lacking simple and effective assessment methods. Objective To simplify health literacy scale and conduct psychometric test within the Chinese population. Methods Adults aged 18 years and above were selected from the "China Family Health Index Survey (2021) " for this investigation. Based on inclusion and exclusion criteria, a total of 7 449 participants were selected and randomly divided into two sample sets, including 3 680 cases in sample set 1 and 3 769 cases in sample set 2. The general information questionnaire, Short-form Health Literacy Questionnaire (HLS-SF12), Perception Social Support Scale (PSSS), and Family Health Scale Short-form (FHS-SF) were administered to the respondents. Classical test theory (CTT) and the Mokken model in item response theory (IRT) were used to screen the original items, and validation analyses such as reliability and validity of the simplified scales were also conducted. Results A 9-item version (HLS-SF9) and a 4-item version (HLS-SF4) were simplified by using CTT and the Mokken model, respectively. Both the HLS-SF9 and the HLS-SF4 had no ceiling effect or floor effect, and the Cronbach's α coefficients for both were 0.913 and 0.842, with split-half reliabilities of 0.871 and 0.815, respectively. The exploratory factor analysis of HLS-SF4 revealed one common factor, accounting for 67.813% of the cumulative variance, with factor loadings exceeding 0.81 for each item. The confirmatory factor analysis of HLS-SF9 showed that χ2/df was 10.844, goodness of fit index (GFI) was 0.985, adjusted goodness of fit index (AGFI) was 0.971, normative fit index (NFI) was 0.986, comparative fit index (CFI) was 0.987, and root mean squared error of approximation (RMSEA) was 0.051. The correlation analysis demonstrated positive correlation of HLS-SF9 and HLS-SF4 with PSSS (r=0.367, 0.292, P

Currently, two-level Mokken scale analysis for clustered test data is being developed. This paper contributes to this development by providing model-fit procedures for two-level Mokken scale analysis. New theoretical insights suggested that the existing model-fit procedure from traditional (one-level) Mokken scale analyses can be used for investigating model fit at both level 1 (respondent level) and level 2 (cluster level) of two-level Mokken scale analysis. However, the traditional model-fit procedure requires some modifications before it can be used at level 2. In this paper, we made these modifications and investigated the resulting model-fit procedure. For two model assumptions, monotonicity and invariant item ordering, we investigated the false-positive count and the sensitivity count of the level 2 model-fit procedure, with respect to the number of model violations detected, and the number of detected model violations deemed statistically significant. For monotonicity, the detection of model violations was satisfactory, but the significance test lacked power. For invariant item ordering, both aspects were satisfactory. [ABSTRACT FROM AUTHOR]

Athletes' goal orientations have been associated with a wide array of sport-related behaviors, thoughts, and perceptions. The two main goal orientations defined in the achievement goal theory framework are task and ego orientations. The task and ego orientation questionnaire (TEOSQ) was developed to assess levels of task and ego goal orientations in sport-related settings and is widely used in research in the field of sport psychology. Its use in research rests on the assumption that sum scores of the TEOSQ can be used to order individuals by their levels of the two goal orientations. In this study, the soundness of this assumption is evaluated using Mokken scale analysis (MSA). TEOSQ responses from 749 football players were used in the analysis. Both the monotone homogeneity model and the double monotonicity model were fitted. The scalability coefficients for both the task and ego orientation subscales were 0.45 indicating a moderately good scalability. Invariant item ordering did not hold for either of the two subscales. There is definite room for improvement in the TEOSQ. Several improvement suggestions are made and further research directions are discussed. [ABSTRACT FROM AUTHOR]

Listening comprehension in English, as one of the most fundamental skills, has an essential role in the process of learning English. Mokken scale analysis (MSA) is a probabilistic-nonparametric approach to item response theory (IRT) which determines the one-dimensionality and scalability of test. Mokken scaling techniques are a useful tool for researchers who wish to construct unidimensional tests or use questionnaires that comprise multiple binary or polytomous items. The current study utilized the MSA to examine one-dimensionality and scalability of TEOFL iBT listening test, administered on 400 EFL university students in the Iranian context. The results illustrated no main concerns in terms of item scalability. Monoton homogeneity model (MHM) fitted all the items of the test very well as measured by the scalability coefficients and restscore groups method. Considering the invariant item ordering (IIO), it was concluded that the ordering of items according to their mean is invariant across examinees, although HT was small. Dimensionality analysis results using the automated item selection procedure (AISP) depicted that the test is unidimensional-confirming evidence of the validity of the test in measuring a single ability dimension. The empirical application depicted a potential and feasible approach, whereby MSA could be used as a valuable method for exploring the behavior of scaled items in response to varying levels of a latent trait in education research. [ABSTRACT FROM AUTHOR]

Attitudes toward intimate partner violence (IPV) are usually explored by asking participants to respond to some statements describing various instances or situations. Currently, we do not know if responses to such questions or statements are random, leading to a total score which is hard to compare between respondents, or in a hierarchical manner which makes such comparison much more meaningful. The study was conducted to explore the structure of an "attitudes to intimate partner" violence scale used in the Demographic and Health Surveys Program (DHS), for a hierarchy of items according to the criteria of Mokken scaling. Secondary analyses of the data related to attitudes to IPV of South Asian men and women, collected by the DHS from Pakistan, India, Bangladesh, Maldives, and Nepal between 2006 and 2014. A strong Mokken scale was apparent in the data with IPV by men being most justified in cases where the wife neglected the children and least endorsed in the case of refusing to have sex. Men and women endorsed the items in the same order, but some inter country differences were apparent. [ABSTRACT FROM AUTHOR]

A major challenge in the widespread application of Mokken scale analysis (MSA) to educational performance assessments is the requirement of complete data, where every rater rates every student. In this study, simulated and real data are used to demonstrate a method by which researchers and practitioners can apply MSA to incomplete rating designs. The results suggested that when rating data are collected such that each rater rates test-takers in common with at least two other raters, it is possible to use MSA techniques to evaluate rating quality in rater-mediated assessments with incomplete ratings. These results imply that it is possible to evaluate fundamental measurement properties in rater-mediated assessments using a nonparametric approach. Such analyses are important for evaluating the validity, reliability, and fairness of rater-mediated assessments. [ABSTRACT FROM AUTHOR]

Differences in rater judgments that are systematically related to construct-irrelevant characteristics threaten the fairness of rater-mediated writing assessments. Accordingly, it is essential that researchers and practitioners examine the degree to which the psychometric quality of rater judgments is comparable across test-taker subgroups. Nonparametric procedures for exploring these differences are promising because they allow researchers and practitioners to examine important characteristics of ratings without potentially inappropriate parametric transformations or assumptions. This study illustrates a nonparametric method based on Mokken scale analysis (MSA) that researchers and practitioners can use to identify and explore differences in the quality of rater judgments between subgroups of test-takers. Overall, the results suggest that MSA provides insight into differences in rating quality across test-taker subgroups based on demographic characteristics. Differences in the degree to which raters adhere to basic measurement properties suggest that the interpretation of ratings may vary across subgroups. The implications of this study for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Numerous researchers have proposed methods for evaluating the quality of rater‐mediated assessments using nonparametric methods (e.g., kappa coefficients) and parametric methods (e.g., the many‐facet Rasch model). Generally speaking, popular nonparametric methods for evaluating rating quality are not based on a particular measurement theory. On the other hand, popular parametric methods for evaluating rating quality are often based on measurement theories such as invariant measurement. However, these methods are based on assumptions and transformations that may not be appropriate for ordinal ratings. In this study, I show how researchers can use Mokken scale analysis (MSA), which is a nonparametric approach to item response theory, to evaluate rating quality within the framework of invariant measurement without the use of potentially inappropriate parametric techniques. I use an illustrative analysis of data from a rater‐mediated writing assessment to demonstrate how one can use numeric and graphical indicators from MSA to gather evidence of validity, reliability, and fairness. The results from the analyses suggest that MSA provides a useful framework within which to evaluate rater‐mediated assessments for evidence of validity, reliability, and fairness that can supplement existing popular methods for evaluating ratings. [ABSTRACT FROM AUTHOR]

Effective teamwork is integral to the functioning of many professions. Employers desire work-ready graduates who have developed the so-called 'soft skills' involved in teamwork. One way for students to practise and gain feedback on their team skills is through team-based assessment tasks. The TeamUP Rubric was developed to teach and assess five domains of teamwork skills through peer feedback. Initial evaluation of the five domains and use of the TeamUP with health and arts students has provided initial support for its utility as a measure of teamwork. In the current study the scale structure of each of the five domains was evaluated using Mokken scale analysis (MSA). MSA is a non-parametric item response theory approach that evaluates the internal structure of an evaluation tool. One-hundred and seventy-seven primary education students were recruited for the study. All participants were undertaking a teamwork assignment in a unit of study in their education degree at an Australian regional university. They completed the TeamUP Rubric assessment for themselves and for each of the students in their team. Each TeamUP domain met the requirements for a Mokken scale. The current study supports the validity of the scores derived from the TeamUP Rubric and further supports its use as a tool for teaching and assessing teamwork. [ABSTRACT FROM AUTHOR]

As the Global Education Reform Movement (GERM) spreads, key questions that attempt to identify both the nature and the increasing scope and scale of this phenomenon become empirically significant. The concern of this article is to highlight some of the complexities of measuring one key element of the GERM: the privatisation of public education systems. Exploring indicators of privatisation through a set of methods for analysing Likert-style data, Mokken scale analysis and Rasch analysis, we generate a scale to measure an educational phenomenon so complex that it can appear to defy measurement. Our intention is to demonstrate that complex phenomena should not be oversimplified for the purpose of generating numeric data and that measurement is possible. The results, drawn from a European-wide survey, portray a nuanced pattern of privatisation at this regional level in which public funding and ownership remain important, but schools are commonly adopting a wide range of "private-like" practices. [ABSTRACT FROM AUTHOR]

Background: Accurate assessment of health-related quality of life as an endpoint in intervention studies is a major challenge in dementia research. The DEMQOL (29 items) and the proxy version (32 items), which is partly based on the DEMQOL, are internationally used instruments. To date, there is no information on the structural validity, item distribution, or internal consistency for the German language version of these questionnaires.Methods: This psychometric study is based on a secondary data analysis of a sample of 201 outpatients with a mild form of Alzheimer's disease (AD) and their informal caregivers. The informal caregivers who were interviewed were involved in the care of the person with AD several times per week. The analysis for the evaluation of the structural validity was performed using Mokken scale analysis. The internal consistency was calculated using the ρ of the Molenaar Sijtsma statistic and Cronbach's α.Results: For both versions, four subscales were identified: [A] "positive emotions", [B] "negative emotions", [C] "physical and cognitive functioning", and [D] "daily activities and social relationships". For both instruments, the internal consistency of all subscales was considered "good" (ρ = 0.71-0.88, α = 0.72-0.87).Conclusions: The results are a first indication of good construct validity of the instruments used for the German setting. We recommend further investigations of the test-retest reliability and the inter-rater reliability of the proxy instrument. [ABSTRACT FROM AUTHOR]

Model-data fit indices for raters provide insight into the degree to which raters demonstrate psychometric properties defined as useful within a measurement framework. Fit statistics for raters are particularly relevant within frameworks based on invariant measurement, such as Rasch measurement theory and Mokken scale analysis. A simple approach to examining invariance is to examine assessment data for evidence of Guttman errors. I used real and simulated data to illustrate and explore a nonparametric procedure for evaluating rater errors based on Guttman errors and to examine the alignment between Guttman errors and other indices of rater fit. The results suggested that researchers and practitioners can use summaries of Guttman errors to identify raters who exhibit misfit. Furthermore, results from the comparisons between summaries of Guttman errors and parametric fit statistics suggested that both approaches detect similar problematic measurement characteristics. Specifically, raters who exhibit many Guttman errors tended to have higher-than-expected Outfit MSE statistics and lower-than-expected estimated slope statistics. I discuss implications of these results as they relate to research and practice for rater-mediated assessments. [ABSTRACT FROM AUTHOR]

Background: Limited health literacy is known to impact on medication adherence, hospital readmission and potentially poorer health outcomes. The literature on the health literacy of those with musculoskeletal conditions suggests greater functional limitations and increased pain levels. There are a number of measures of health literacy. One that specifically relates to musculoskeletal complaints is the Literacy in Musculoskeletal Problems (LiMP) questionnaire. The LiMP contains 9 multiple choice items that cover anatomy, musculoskeletal conditions and the diagnosis of musculoskeletal complaints. The aim of the study was to evaluate the dimensionality and internal structure of the LiMP in patients attending for osteopathy care at a student-led clinic, as a potential measure of musculoskeletal health literacy.Method: Three hundred and sixty-one (n = 361) new patients attending the Victoria University Osteopathy Clinic completed the LiMP and a demographic and health information questionnaire prior to their initial consultation. Mokken scale analysis, a nonparametric item response theory approach, was used to evaluate the dimensionality and structure of the LiMP in this population, to ascertain whether the questionnaire was measuring a single latent construct - musculoskeletal health literacy. McDonald's omega and Cronbach's alpha were calculated as the reliability estimations. The relationship between the LiMP and a single item screen of health literacy was also undertaken.Results: The 9 items on the LiMP did not form a Mokken scale and the reliability estimations were below an acceptable level (alpha and omega <0.45). LiMP items 5 and 8 were more likely to be answered correctly by those with higher health literacy (p < 0.05), however the effect sizes were small (<0.20).Conclusion: Calculation of a total score for the LiMP, as advocated by the original authors, is not supported based on data in the present study. Further research is required to explore the relationship of the LiMP items to demographic and clinical data, and to other broader measures of health literacy. Further research may also develop a health literacy measure that is specific to patients seeking manual therapy care for musculoskeletal complaints. [ABSTRACT FROM AUTHOR]

Background: Theories, models, and frameworks used by implementation science, including Diffusion of Innovations, tend to focus on the adoption of one innovation, when often organizations may be facing multiple simultaneous adoption decisions. For instance, despite evidence that care management practices (CMPs) are helpful in managing chronic illness, there is still uneven adoption by physician organizations. This exploratory paper leverages this natural variation in uptake to describe inter-organizational patterns in adoption of CMPs and to better understand how adoption choices may be related to one another.Methods: We assessed a cross section of national survey data from physician organizations reporting on the use of 20 CMPs (5 each for asthma, congestive heart failure, depression, and diabetes). Item response theory was used to explore patterns in adoption, first considering all 20 CMPs together and then by subsets according to disease focus or CMP type (e.g., registries, patient reminders). Mokken scale analysis explored whether adoption choices were linked by disease focus or CMP type and whether a consistent ordering of adoption choices was present.Results: The Mokken scale for all 20 CMPs demonstrated medium scalability (H = 0.43), but no consistent ordering. Scales for subsets of CMPs sharing a disease focus had medium scalability (0.4 < H < 0.5), while subsets sharing a CMP type had strong scalability (H > 0.5). Scales for CMP type consistently ranked diabetes CMPs as most adoptable and depression CMPs as least adoptable. Within disease focus scales, patient reminders were ranked as the most adoptable CMP, while clinician feedback and patient education were ranked the least adoptable.Conclusions: Patterns of adoption indicate that innovation characteristics may influence adoption. CMP dissemination efforts may be strengthened by encouraging traditionally non-adopting organizations to focus on more adoptable practices first and then describing a pathway for the adoption of subsequent CMPs. Clarifying why certain CMPs are "less adoptable" may also provide insights into how to overcome CMP adoption constraints. [ABSTRACT FROM AUTHOR]

Mokken scale analysis (MSA) is a probabilistic-nonparametric approach to item response theory (IRT) that can be used to evaluate fundamental measurement properties with less strict assumptions than parametric IRT models. This instructional module provides an introduction to MSA as a probabilistic-nonparametric framework in which to explore measurement quality, with an emphasis on its application in the context of educational assessment. The module describes both dichotomous and polytomous formulations of the MSA model. Examples of the application of MSA to educational assessment are provided using data from a multiple-choice physical science assessment and a rater-mediated writing assessment. [ABSTRACT FROM AUTHOR]

Background: As the worldwide prevalence of chronic illness increases so too does the demand for novel treatments to improve chronic illness care. Quantifying improvement in chronic illness care from the patient perspective relies on the use of validated patient-reported outcome measures. In this analysis we examine the psychometric and scaling properties of the Patient Assessment of Chronic Illness Care (PACIC) questionnaire for use in the United Kingdom by applying scale data to the non-parametric Mokken double monotonicity model.Methods: Data from 1849 patients with long-term conditions in the UK who completed the 20-item PACIC were analysed using Mokken analysis. A three-stage analysis examined the questionnaire's scalability, monotonicity and item ordering. An automated item selection procedure was used to assess the factor structure of the scale. Analysis was conducted in an 'evaluation' dataset (n = 956) and results were confirmed using an independent 'validation' (n = 890) dataset.Results: Automated item selection procedures suggested that the 20 items represented a single underlying trait representing "patient assessment of chronic illness care": this contrasts with the multiple domains originally proposed. Six items violated invariant item ordering and were removed. The final 13-item scale had no further issues in either the evaluation or validation samples, including excellent scalability (Ho = .50) and reliability (Rho = .88).Conclusions: Following some modification, the 13-items of the PACIC were successfully fitted to the non-parametric Mokken model. These items have psychometrically robust and produce a single ordinal summary score. This score will be useful for clinicians or researchers to assess the quality of chronic illness care from the patient's perspective. [ABSTRACT FROM AUTHOR]

Over the past decade, Mokken scale analysis ( MSA) has rapidly grown in popularity among researchers from many different research areas. This tutorial provides researchers with a set of techniques and a procedure for their application, such that the construction of scales that have superior measurement properties is further optimized, taking full advantage of the properties of MSA. First, we define the conceptual context of MSA, discuss the two item response theory ( IRT) models that constitute the basis of MSA, and discuss how these models differ from other IRT models. Second, we discuss dos and don'ts for MSA; the don'ts include misunderstandings we have frequently encountered with researchers in our three decades of experience with real-data MSA. Third, we discuss a methodology for MSA on real data that consist of a sample of persons who have provided scores on a set of items that, depending on the composition of the item set, constitute the basis for one or more scales, and we use the methodology to analyse an example real-data set. [ABSTRACT FROM AUTHOR]

The Techniques for Overcoming Depression (TOD) questionnaire assesses the frequency with which patients being treated for depression use cognitive-behavioral techniques in daily life. This study examined its latent structure, reliability and concurrent validity in depressed cardiac patients. The TOD was administered at the initial and final treatment sessions in three trials of cognitive behavior therapy (CBT) ( n = 260) for depression in cardiac patients. Mokken scaling was used to determine its dimensionality. The TOD is unidimensional in depressed cardiac patients, both at the initial evaluation (H = .46) and the end of treatment (H = .47). It is sensitive to change and the total score correlates with therapist ratings of the patient's socialization to CBT (r = .40, p < .05), homework adherence (r = .36, p < .05), and use of cognitive-behavioral techniques (r = .51, p < .01). TOD scores were associated with post-treatment depression scores in two of the trials ( p < .01 in both analyses). The TOD is a unidimensional, reliable, valid, and clinically informative measure of self-reported use of cognitive-behavioral techniques for overcoming depression in cardiac patients. Studies of the TOD in other depressed patient populations are needed. [ABSTRACT FROM AUTHOR]

This study contributes to the analysis of information sources as a determinant of the travel decision-making process. It focuses on the use of Mokken Scale Analysis (MSA) as a new methodological approach to detect unidimensional hierarchical scale in the analysis of information sources. The paper shows how MSA can be applied in the tourism field. Findings reveal two different scales (active and passive information search scales) for classifying information sources in tourism. Variations in the scales are revealed, taking socio-demographic and travel behavioural variables into consideration. The conclusions clearly explain the implications for tourism marketers and make recommendations for future research. [ABSTRACT FROM AUTHOR]

Background: Although the Symptom Checklist (SCL-90-R) is one of the most widely used self-reported scales covering several psychopathological states, the scalability of the SCL-90-R has been found to be very problematic.Aims: We have performed a clinimetric analysis of the SCL-90-R, taking both its factor structure and scalability (i.e. total scale score a sufficient statistic) into account.Methods: The applicability of the SCL-90-R has been found acceptable in general population studies from Denmark, Norway and Italy. These studies were examined with principal component analysis (PCA) to identify the factor structure. The scalability of the traditional SCL-90-R subscales (i.e. somatization, hostility, and interpersonal sensitivity) as well as the affective subscales (i.e. depression and anxiety and ADHD), were tested by Mokken’s item response theory model.Results: Across the three general population studies the traditional scaled SCL-90-R factor including 83 items was identified by PCA. The Mokken analysis accepted the scalability of both the general factor and the clinical SCL-90-R subscales under examination.Conclusion: The traditional, scaled, general 83 item SCL-90-R scale is a valid measure of general psychopathology. The SCL-90-R subscales of somatization, hostility, and interpersonal sensitivity as well as the affective subscales of depression, anxiety, and ADHD were all accepted by the Mokken test for scalability, i.e. their total scores are sufficient statistics. [ABSTRACT FROM AUTHOR]

Mokken scale analysis uses three types of scalability coefficients to assess the quality of (a) pairs of items, (b) individual items, and (c) an entire scale. Both the point estimates and the standard errors of the scalability coefficients assume that the sample ordering of the item steps is identical to the population ordering, but due to sampling error, the sample ordering may be incorrect and, consequently, the estimates and the standard errors may be biased. Two simulation studies were used to investigate the bias of the estimates and the standard errors of the scalability coefficients, as well as the coverage of the 95% confidence intervals. Distance between item steps was the most important design factor. In addition, sample size, number of items, number of answer categories, and item discrimination were included in the design. Bias of the standard errors was negligible. Bias of the estimates was largest when all item steps were identical in the population, especially for small sample sizes. Furthermore, bias of the estimates decreased as number of answer categories increased and as item discrimination decreased. Coverage of the 95% confidence intervals was close to .950, but for small sample size coverage deteriorated. Coverage also became poorer as number of items increased, in particular for dichotomous items. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQoL) is widely used as an outcome measure in the evaluation of treatment interventions in patients with chronic obstructive pulmonary disease (COPD). In order to address challenges associated with existing fixed-length measures (e.g., too long to be used routinely, too short to ensure both content validity and reliability), a COPD-specific item bank (COPD-SIB) was developed.Methods: Items were selected based on literature review and interviews with Dutch COPD patients, with a strong focus on both content validity and item comprehension. The psychometric quality of the item bank was evaluated using Mokken Scale Analysis and parametric Item Response Theory, using data of 666 COPD patients.Results: The final item bank contains 46 items that form a strong scale, tapping into eight important themes that were identified based on literature review and patient interviews: Coping with disease/symptoms, adaptability; Autonomy; Anxiety about the course/end-state of the disease, hopelessness; Positive psychological functioning; Situations triggering or enhancing breathing problems; Symptoms; Activity; Impact.Conclusions: The 46-item COPD-SIB has good psychometric properties and content validity. Items are available in Dutch and English. The COPD-SIB can be used as a stand-alone instrument, or to inform computerised adaptive testing. [ABSTRACT FROM AUTHOR]

The concept of invariant measurement is typically associated with Rasch measurement theory (Engelhard, 2013). Concerned with the appropriateness of the parametric transformation upon which the Rasch model is based, Mokken (1971) proposed a nonparametric procedure for evaluating the quality of social science measurement that is theoretically and empirically related to the Rasch model. Mokken's nonparametric procedure can be used to evaluate the quality of dichotomous and polytomous items in terms of the requirements for invariant measurement. Despite these potential benefits, the use of Mokken scaling to examine the properties of multiplechoice (MC) items in education has not yet been fully explored. A nonparametric approach to evaluating MC items is promising in that this approach facilitates the evaluation of assessments in terms of invariant measurement without imposing potentially inappropriate transformations. Using Rasch-based indices of measurement quality as a frame of reference, data from an eighth-grade physical science assessment are used to illustrate and explore Mokken-based techniques for evaluating the quality of MC items. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

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The aim of this study was to develop a psychometrically sound short version of the 17-item Aging Males’ Symptoms (AMS) scale using Mokken scale analysis (MSA) and Rasch analysis. We recruited a convenient sample of 1787 men (age: mean (SD) = 43.8 (11.5) years) who visited a men’s health polyclinic in Taiwan and completed the AMS scale. The scale was first assessed using MSA. The remaining items were assessed using Rasch analysis. We used a stepwise approach to remove items withχ2item statistics and mean square values while monitoring unidimensionality. The item reduction process resulted in a 6-item version of the AMS scale (AMS-6). The AMS-6 scale included a 5-item psychosomatic subscale (original items 1, 4, 5, 8, and 9) and a 1-item sexual subscale (original item 16). Analyses confirmed that the 5-item psychosomatic subscale was a Rasch scale. The AMS-6 correlated well with the AMS scales: the 5-item psychosomatic subscale correlated with the AMS scale (rbetween 0.50 and 0.92); the 1-item sexual subscale correlated with the sexual subscale of the AMS scale (r = 0.81). A 6-item short form of the AMS scale had satisfactory measurement properties. This version may be useful for estimating psychosomatic and sexual symptoms as well as health-related quality of life with a minimal burden on respondents. [ABSTRACT FROM PUBLISHER]

Background: The attitudes of healthcare professionals towards HIV positive patients and high risk groups are central to the quality of care and therefore to the management of HIV/AIDS related stigma in health settings. Extant HIV/AIDS stigma scales that measure stigmatising attitudes towards people living with HIV/AIDS have been developed using scaling techniques such as principal component analysis. This approach has resulted in instruments that are often long. Mokken scale analysis is a nonparametric hierarchical scaling technique that can be used to develop unidimensional cumulative scales. This technique is advantageous over the other approaches; as the scales are usually shorter, while retaining acceptable psychometric properties. Moreover, Mokken scales also make no distributional assumptions about the underlying data, other than that the data are capable of being ordered by item and by person. In this study we aimed at developing a precise and concise measure of HIV/AIDS related stigma among health care professionals, using Mokken scale analysis. Methods: We carried out a cross sectional survey of healthcare students at the Monash University campuses in Malaysia and Australia. The survey consisted of demographic questions and an initial item pool of twenty five potential questions for inclusion in an HIV stigma scale. Results: We analysed the data using the mokken package in the R statistical environment providing a 9-item scale with high reliability, validity and acceptable psychometric properties, measuring and ranking the HIV/AIDS related stigmatising attitudes. Conclusion: Mokken scaling procedure not only produced a comprehensive hierarchical scale that could accurately order a person along HIV/AIDS stigmatising attitude, but also demonstrated a unidimensional and reliable measurement tool which could be used in future studies. The principal component analysis confirmed the accuracy of the Mokken scale analysis in correctly detecting the unidimensionality of this scale. We recommend future works to study the generalisability of this scale in a new population. [ABSTRACT FROM AUTHOR]

The maximum cardinality subset selection problem requires finding the largest possible subset from a set of objects, such that one or more conditions are satisfied. An important extension of this problem is to extract multiple subsets, where the addition of one more object to a larger subset would always be preferred to increases in the size of one or more smaller subsets. We refer to this as the multiple subset maximum cardinality selection problem ( MSMCSP). A recently published branch-and-bound algorithm solves the MSMCSP as a partitioning problem. Unfortunately, the computational requirement associated with the algorithm is often enormous, thus rendering the method infeasible from a practical standpoint. In this paper, we present an alternative approach that successively solves a series of binary integer linear programs to obtain a globally optimal solution to the MSMCSP. Computational comparisons of the methods using published similarity data for 45 food items reveal that the proposed sequential method is computationally far more efficient than the branch-and-bound approach. [ABSTRACT FROM AUTHOR]

A dynamic assessment tool was developed and validated using Mokken scale analysis to assess the extent to which kindergartners are able to construct unconfounded experiments, an essential part of scientific reasoning. Scientific reasoning is one of the learning processes happening within science education. A commonly used, hands-on, experimentation task was adapted to dynamically assess the use of the so-called control of variables strategy (CVS) by children 4 to 6 years of age. In this task, the children were challenged to design experiments using two ramps with up to four independent variables: weight of the ball, steepness of the slope, place of the starting gate, and surface texture of the slope. There were two scores of CVS use: experiment and variable correct score. The analysis showed it was possible to assess CVS use in a reliable and valid manner with the new assessment tool. Irrespective of the number of variables children were allowed to set, experiments validly measured CVS use. Given that the number of variables to be set increased the difficulty of the experiment, this can be used to scale children's CVS use. In other words, it is possible to differentiate between children on the basis of their CVS use. The children's use of CVS positively related to both their age and nonverbal reasoning ability. The present results thus show that it is feasible to evaluate the ability of kindergartners to construct unconfounded experiments using dynamic assessment. This means that kindergartners can use the CVS and might be seen as natural scientists, who can and will try to unravel the physical world around them. Their explorations appear to need sufficient guidance (i.e. within their zone of proximal development) to design multivariable experiments. [ABSTRACT FROM AUTHOR]

In this article, it is shown that citizen process preferences are complex and include several dimensions. The argument relies on data from a representative sample of Spanish citizens (N = 2,450) to assess these dimensions. Using confirmatory factor analysis as well as Mokken analysis, it is shown that citizen process preferences capture support for three different models: participatory, representative and expert-based. The relationships between these dimensions (where the opposition between representation and participation stands as the clearest result) and the substantive and methodological implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

The World Health Organization Disability Assessment Schedule II (WHO-DAS II) is a multidimensional instrument developed for measuring disability. It comprises six domains (getting around, self-care, getting along with others, life activities and participation in society). The main purpose of this paper is the evaluation of the psychometric properties for each domain of the WHO-DAS II with parametric and non-parametric Item Response Theory (IRT) models. A secondary objective is to assess whether the WHO-DAS II items within each domain form a hierarchy of invariantly ordered severity indicators of disability. A sample of 352 patients with a schizophrenia spectrum disorder is used in this study. The 36 items WHO-DAS II was administered during the consultation. Partial Credit and Mokken scale models are used to study the psychometric properties of the questionnaire. The psychometric properties of the WHO-DAS II scale are satisfactory for all the domains. However, we identify a few items that do not discriminate satisfactorily between different levels of disability and cannot be invariantly ordered in the scale. In conclusion the WHO-DAS II can be used to assess overall disability in patients with schizophrenia, but some domains are too general to assess functionality in these patients because they contain items that are not applicable to this pathology. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background It is unclear whether the 6-item Melancholia subscale of the Hamilton Depression Rating Scale (HAM-D6) has better psychometric properties than the parental 17-item version (HAM-D17) in the Chinese populations. Methods The study was to check the Chinese HAM-D17 and HAM-D6 for reliability and validity with Mokken scale analysis and item analysis. We reanalyzed a clinical sample of adult psychiatric outpatients (N = 214; age, mean (SD) = 38.3 (10.5) years; 63.1% female) in Taiwan. Results Our Mokken scale analysis showed that the HAM-D6 was a moderate unidimensional scale (Hs = 0.44) while the HAM-D17 was not (Hs = 0.26). The 5 items of the HAM-D6 had strong invariant item ordering (HT = 0.58). The HAM-D17 and HAM-D6 had comparable reliability (α = 0.79) and validity ( r = 0.91), and the HAM-D6 was more homogenous than the HAM-D17. To predict depression in remission (HAM-D17 ≤ 7), the best cutoff of the HAM-D6 was 4 (specificity, 87.5%; sensitivity, 100%; positive predictive value, 56.0%; negative predictive value, 100%). Discussion The Chinese HAM-D6 was a reliable, valid, and unidimensional scale of depression. [ABSTRACT FROM AUTHOR]

Although actuarial instruments are ubiquitously used in the field of sex offender recidivism risk assessment, there is limited empirical information about the underlying constructs from which they are derived. The following study utilized a nonparametric item response theory procedure, a Mokken analysis, and nonlinear factor analysis (Normal Ogive Harmonic Analysis Robust Method) to explore the underlying constructs of the STATIC-99 scores obtained for male sexual offenders (N = 451) referred for an evaluation to determine if they met criteria for civil commitment under a state’s Sexually Violent Persons Law. The results from the analyses indicated that the STATIC-99 comprises the two previously identified constructs associated with sexual deviancy and antisocial behaviors as well as a third, additional construct, associated with the items pertaining to age and past marital-type relationships. These findings support Hanson and Thornton’s assertion that sexual offender recidivism risk is multifactorial and not the result of a single underlying trait. Implications for future research are discussed. [ABSTRACT FROM PUBLISHER]

Background Previous work using Mokken scaling analysis with the SF-36 has found subscales appearing to show excellent Mokken scaling properties. However, the values of scalability of the subscales are very large, raising the possibility that these are artificially high and this may result from violations of local stochastic independence between items. Objectives To analyse selected items from the Chinese Mandarin form of the SF-36 scale using Mokken scaling and to investigate if violations of local stochastic independence exaggerate scalability. Methods Exploratory Mokken scaling analysis was run using the online public domain software R by entering 19 items from the Chinese Mandarin form of the SF-36 items into the analysis. The items in the resulting scales, judged by the size of Loevinger's coefficient, were analysed for violations of monotony, 95% confidence intervals and invariant item ordering, including inspection of item pair plots. Results Two Mokken scales were obtained, one including items from the Physical Functioning subscale, and one including items from the Mental Health subscale of the Chinese Mandarin form of the SF-36. The Physical Functioning scale was very strong according to Loevinger's coefficient with high invariant item ordering; the Mental Health scale was moderately strong with weak invariant item ordering. Conclusion The strength of the Physical Functioning Mokken scale derived from the Chinese Mandarin form of the SF-36 is probably the result of an item chain and item overlap which violate local stochastic independence. This is due to the nature of the items in the Physical Functioning subscale, all of which relate to physical ability and some of which can only be achieved if previous items in the subscale have been achieved. [ABSTRACT FROM AUTHOR]

A variety of methods for evaluating the psychometric quality of rater-mediated assessments have been proposed, including rater effects based on latent trait models (e.g., Engelhard, 2013; Wolfe, 2009). Although information about rater effects contributes to the interpretation and use of rater-assigned scores, it is also important to consider ratings in terms of the structure of the rating scale on which scores are assigned. Further, concern with the validity of rater-assigned scores necessitates investigation of these quality control indices within student subgroups, such as gender, language, and race/ethnicity groups. Using a set of guidelines for evaluating the interpretation and use of rating scales adapted from Linacre (1999, 2004), this study demonstrates methods that can be used to examine rating scale functioning within and across student subgroups with indicators from Rasch measurement theory (Rasch, 1960) and Mokken scale analysis (Mokken, 1971). Specifically, this study illustrates indices of rating scale effectiveness based on Rasch models and models adapted from Mokken scaling, and considers whether the two approaches to evaluating the interpretation and use of rating scales lead to comparable conclusions within the context of a large-scale rater-mediated writing assessment. Major findings suggest that indices of rating scale effectiveness based on a parametric and nonparametric approach provide related, but slightly different, information about the structure of rating scales. Implications for research, theory, and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Hierarchical scales are useful in understanding the structure of underlying latent traits in many questionnaires. The Attitudes to Ageing Questionnaire (AAQ) explored the attitudes to ageing of older people themselves, and originally described three distinct subscales: (1) Psychosocial Loss (2) Physical Change and (3) Psychological Growth. This study aimed to use Mokken analysis, a method of Item Response Theory, to test for hierarchies within the AAQ and to explore how these relate to underlying latent traits. Methods: Participants in a longitudinal cohort study, the Lothian Birth Cohort 1936, completed a cross-sectional postal survey. Data from 802 participants were analysed using Mokken Scaling analysis. These results were compared with factor analysis using exploratory structural equation modelling. Results: Participants were 51.6% male, mean age 74.0 years (SD 0.28). Three scales were identified from 18 of the 24 items: two weak Mokken scales and one moderate Mokken scale. (1) ‘Vitality’ contained a combination of items from all three previously determined factors of the AAQ, with a hierarchy from physical to psychosocial; (2) ‘Legacy’ contained items exclusively from the Psychological Growth scale, with a hierarchy from individual contributions to passing things on; (3) ‘Exclusion’ contained items from the Psychosocial Loss scale, with a hierarchy from general to specific instances. All of the scales were reliable and statistically significant with ‘Legacy’ showing invariant item ordering. The scales correlate as expected with personality, anxiety and depression. Exploratory SEM mostly confirmed the original factor structure. Conclusions: The concurrent use of factor analysis and Mokken scaling provides additional information about the AAQ. The previously-described factor structure is mostly confirmed. Mokken scaling identifies a new factor relating to vitality, and a hierarchy of responses within three separate scales, referring to vitality, legacy and exclusion. This shows what older people themselves consider important regarding their own ageing. [ABSTRACT FROM AUTHOR]

Proponents of the European project often portray further enlargement of the European Union as a complement to the process of building an ever closer union. The eurozone crisis, however, has highlighted the risks associated with pursuing deeper integration in a diverse union and reignited the debate on differentiated integration. This contribution examines how public attitudes towards the processes of deepening and broadening are related and asks whether European citizens see them as complementary or conflicting. Using multilevel analysis of Eurobarometer data, the contribution examines the factors – individual and contextual – that shape attitudes towards enlargement and deeper political integration across the 27 member states. The findings suggest that the ‘winners’ of integration – high-skilled individuals in core eurozone countries – are most likely to support deepening, but oppose further enlargement out of fear that an ever wider union might be costly. [ABSTRACT FROM PUBLISHER]

Purpose: To validate the Chinese Mandarin version of the Medical Outcomes Study Social Support Survey (MOS-SSS-CM) using a model of ordinal unidimensional measurement known as Mokken scaling. Methods: We administered in face-to-face interviews the MOS-SSS-CM to 200 patients with coronary heart disease. Data were analysed using Mokken scaling. Results: The MOS-SSS-CM contains a set of items which meet the criteria of a reliable ( Rho = 0.87) moderate Mokken scale ( H = 0.40) with weak invariant item ordering ( H = 0.39). Conclusions: The MOS-SSS-CM has a hierarchy of items which can be interpreted in terms of concerns with the physical aspects of social support through the need for companionship to items related to more personal worries. [ABSTRACT FROM AUTHOR]

Background: To develop and calibrate the activities of daily living item bank (ADLib-cardio) as a prerequisite for a Computer-adaptive test (CAT) for the assessment of ADL in patients with cardiovascular diseases (CVD). Methods: After pre-testing for relevance and comprehension a pool of 181 ADL items were answered on a five-point Likert scale by 720 CVD patients, who were recruited in fourteen German cardiac rehabilitation centers. To verify that the relationship between the items is due to one factor, a confirmatory factor analysis (CFA) was conducted. A Mokken analysis was computed to examine the double monotonicity (i.e. every item generates an equivalent order of person traits, and every person generates an equivalent order of item difficulties). Finally, a Rasch analysis based on the partial credit model was conducted to test for unidimensionality and to calibrate the item bank. Results: Results of CFA and Mokken analysis confirmed a one factor structure and double monotonicity. In Rasch analysis, merging response categories and removing items with misfit, differential item functioning or local response dependency reduced the ADLib-cardio to 33 items. The ADLib-cardio fitted to the Rasch model with a nonsignificant item-trait interaction (chi-square=105.42, df=99; p=0.31). Person-separation reliability was 0.81 and unidimensionality could be verified. Conclusions: The ADLib-cardio is the first calibrated, unidimensional item bank that allows for the assessment of ADL in rehabilitation patients with CVD. As such, it provides the basis for the development of a CAT for the assessment of ADL in patients with cardiovascular diseases. Calibrating the ADLib-cardio in other than rehabilitation cardiovascular patient settings would further increase its generalizability. [ABSTRACT FROM AUTHOR]

The article reports the results of a Mokken Scale Procedure (MSP) developing a hierarchical cross-national scale gauging attitudes toward illegal immigration, and a subsequent qualitative cross-national assessment of this scale. Responses to a 20-item Likert-type-scale were collected in two national representative surveys in the Netherlands and New Zealand. The MSP analysis yielded a cumulative scale with the same four items for each with an acceptable ‘scalability’ in both samples, ofH > .40. This cross-national four-item scale was evaluated by means of in-depth interviewing nine participants in the Netherlands and 15 participants in New Zealand. Analysis of the interviews shows that individually ranking the items of the scale is similar to the rank order generated by MSP, but the individual evaluation of the degree of negativity of items strongly depends on the way illegal immigrants are framed by subjects. The contribution of a mixed methods approach is discussed. It is suggested that the present quantitative measuring instruments measure a general average attitude, which may be likened to a measure of the average temperature of a country at a certain moment, while qualitative evaluations vary with the way illegal immigrants are framed by individuals, like variations in local temperature [ABSTRACT FROM AUTHOR]

This paper examines participation in female-typed household tasks by husbands in 32 countries in the 2002 International Social Survey Program. Mokken scaling shows widespread and systematic ordering of married men’s performance of stereotypically female tasks, a hierarchy which is obscured by conventional measures of couples’ task-sharing. The hierarchy gives rise to a typology of men’s conformity to the social conventions of this task hierarchy. Multilevel, multinomial models test hypotheses on the micro-level predictors of husbands’ pattern of housework participation, as well as expectations for country differences. [ABSTRACT FROM AUTHOR]

The article presents the authors' response to comments on their article on marginal models and Mokken scale analysis. They argue that they are more interested in the ordering of the item steps for each item pair to find the ordering of the response options. They also clarify issues on the use of Mokken scale analysis.

Mokken scale analysis is a popular method for scaling dichotomous and polytomous items. Whether or not items form a scale is determined by three types of scalability coefficients: (1) for pairs of items, (2) for items, and (3) for the entire scale. It has become standard practice to interpret the sample values of these scalability coefficients using Mokken’s guidelines, which have been available since the 1970s. For valid assessment of the scalability coefficients, the standard errors of the scalability coefficients must be taken into account. So far, standard errors were not available for scales consisting of Likert items, the most popular item type in sociology, and standard errors could only be computed for dichotomous items if the number of items was small. This study solves these two problems. First, we derived standard errors for Mokken’s scalability coefficients using a marginal modeling framework. These standard errors can be computed for all types of items used in Mokken scale analysis. Second, we proved that the method can be applied to scales consisting of large numbers of items. Third, we applied Mokken scale analysis to a set of polytomous items measuring tolerance. The analysis showed that ignoring standard errors of scalability coefficients might result in incorrect inferences. [ABSTRACT FROM PUBLISHER]

The author comments on two articles about marginal models for categorical data and Mokken scale analysis. She discusses the optimal scaling for multivariate categorical data. She explores the purpose of Goodman's row-column (RC) association model and correspondence analysis. She also discusses the extensions of the RC model or log multiplicative association (LMA) models.

This paper examines citizens' preferences for a supranational decision-making in 21 European countries based on the data collected from the European Social Survey (ESS). The goal of this study is twofold. The first intention is to create a one-dimensional cumulative scale of political preferences at supranational level. Mokken scaling, a non-parametric item response approach is used for this purpose. We haven't found any single unified European scale and clusters of countries based on citizens' preferences regarding decision-making were carried out. Notably different levels of support emerged for supranational decision-making in different clusters. On that basis, individual scores for the level of supranational decision-making were developed. The second goal is to study the external validity of supranationalism in order to understand empirically which are the main factors responsible for determining the previously created level of supranationalism. Results show that most relevant variable is "trust in the European P" which has a strong positive effect on support for supranational decision-making, while trust in the national parliament has a negative effect on the same variable. The pattern of significant variables is similar across clusters but the ranking of most influential variables on supranationalism varies. [ABSTRACT FROM AUTHOR]

Mokken scale analysis uses an automated bottom-up stepwise item selection procedure that suffers from two problems. First, when selected during the procedure items satisfy the scaling conditions but they may fail to do so after the scale has been completed. Second, the procedure is approximate and thus may not produce the optimal item partitioning. This study investigates a variation on Mokken's item selection procedure, which alleviates the first problem, and proposes a genetic algorithm, which alleviates both problems. The genetic algorithm is an approximation to checking all possible partitionings. A simulation study shows that the genetic algorithm leads to better scaling results than the other two procedures. [ABSTRACT FROM AUTHOR]

The assessment of the number of dimensions and the dimensionality structure of questionnaire data is important in scale evaluation. In this study, the authors evaluate two dimensionality assessment procedures in the context of Mokken scale analysis (MSA), using a so-called fixed lowerbound. The comparative simulation study, covering various theoretically and empirically relevant conditions, indicates that the MSA procedures may result in scales that are inconsistent with the dimensionality of the data set at hand. That is, a single Mokken scale can be multidimensional, and two Mokken scales can pertain to a single dimension. In an illustrative evaluation, MSA using a range of lowerbounds, rather than a fixed lowerbound, was shown to have some benefits, but not to solve all limitations. The results of this study imply that MSA is perfectly suitable to create Mokken scales. However, MSA appears of limited value as a dimensionality assessment method. [ABSTRACT FROM AUTHOR]

Attitudes toward suicide are often investigated by means of questionnaires, most of which are overly long or of low psychometric quality. Eskin's (2004) Attitudes Towards Suicide Scale is short and first investigations suggest good psychometric properties, but its factor structure has scarcely been explored. Hence, we examined this instrument by a data-analytic approach that combines Mokken scaling and confirmatory factor analysis (CFA). Results revealed 6 factors, of which 1 possessed only weak measurement properties. CFAs indicated only borderline fit of models found in prior research, but adequate fit for the scale structures revealed by Mokken scaling. Psychometric properties of these scales were satisfactory. Both the instrument as well as the methodological approach presented here can be recommended for further research. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder is prevalent in the adolescent psychiatric clinical setting and often comorbid with other primary psychiatric diagnoses such as ADHD or social anxiety disorder. Systematic manual-based diagnostic procedures are recommended to identify such comorbidity but they are time-consuming and often not fully implemented in clinical practice. Screening for depressive symptoms in the child psychiatric context using brief, user-friendly and easily managed self-assessment scales may be of clinical value and utility. The aim of the study is to test the psychometric validity of two such scales, which may be used in a two-step screening procedure, the WHO-Five Well-being Index (WHO-5) and the six-item version of Beck's Depression Inventory (BDI-6). Method: 66 adolescent psychiatric patients with a clinical diagnosis of major depressive disorder (MDD), 60 girls and 6 boys, aged 14-18 years, mean age 16.8 years, completed the WHO-5 scale as well as the BDI-6. Statistical validity was tested by Mokken and Rasch analyses. Results: The correlation between WHO-5 and BDI-6 was -0.49 (p=0.0001). Mokken analyses showed a coefficient of homogeneity for the WHO-5 of 0.52 and for the BDI-6 of 0.46. Rasch analysis also accepted unidimensionality when testing males versus females (p > 0.05). Conclusions: The WHO-5 is psychometrically valid in an adolescent psychiatric context including both genders to assess the wellness dimension and applicable as a first step in screening for MDD. The BDI-6 may be recommended as a second step in the screening procedure, since it is statistically valid and has the ability to unidimensionally capture the severity of depressed mood. [ABSTRACT FROM AUTHOR]