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In this study, we assessed the psychometric properties of the Spanish Patient-Reported Outcomes Measurement Information System (PROMIS) Depression in an adult population-representative sample from Spain (n = 1,503). We tested unidimensionality and local independence item response theory (IRT) assumptions with confirmatory factor and bifactor models under the exploratory structural equations modeling framework. We evaluated item monotonicity assumption with Mokken scaling analysis. We calibrated the items with an IRT-graded response model and assessed score reliability and test information, and evidence of validity with regard to scores on external measures. To examine differential item functioning by age, sex, education, and country (United States vs. Spain, N = 2,271), we used ordinal logistic regression. Results support compliance with IRT assumptions. We found few signs of differential item functioning: Only one item showed country differential functioning between the United States (n = 768) and Spain, with minimal impact on the overall score. Information values were equivalent to reliabilities over 0.90 from -1 (low depression) to +4 SD (high depression) around the population score mean. Evidence of validity in relation to concurrent measures was supported by the expected correlation pattern with external variables of depression, but higher than expected correlations with anxiety were found. Results indicate that the Spanish version of PROMIS Depression is adequate for assessing and monitoring depression levels in the general population and that PROMIS Depression is especially suitable for cross-national comparisons. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Most current theories explaining theory of mind (ToM) rely on the concept of 'representation', as it is usually employed in cognitive science, and is thus affected by its epistemic shortcoming, namely its incapacity to use 'sub-signifier' level information. This shortcoming is responsible for the lack of specificity of ToM deficits, which are now found in very different syndromes, from schizophrenia to bipolar disorder or borderline personality disorder, in spite of its original formulation being restricted to childhood autism., Method: Representation, its shortcomings and the way they may affect clinical/research programs undergo a conceptual analysis, which shows how representational-founded semiology leave out information that is essential for symptom specificity and correct symptom assessment. Schizophrenic autism, delusional perception and axial syndromes are studied as examples of both the difficulties that have arisen and possible ways of dealing with them., Results: Transfers of properties between different meanings of 'representation' together with a systematic ambiguity in the use of 'representation' are proposed as the main ways for representational approaches to assure stability to their proposals in spite of the violence exerted on clinical phenomena., Conclusions: It is exposed how systematic ambiguity and epistemic shortcomings both affect Leslie's formulation of ToM and, further, the importance of these characteristics of the concept of 'representation' for general issues in psychiatric semiology., (2009 S. Karger AG, Basel.)