APA 1/2đź”—

Name

DSM-5 Self-Rated Level 1/2 Cross-Cutting Symptom Measure—Adult (APA 1/2)

Table Namepex_bm_apa
Construct

Mental Health

Study Visits

V01, V02, V03

TypeIn-person/Remote Questionnaire (Parent on Self; 5 min)
Quality Control
  • Checks for missing data based on counts for items completed by each participant.
  • Verification of scoring accuracy.
  • Summary statistics to examine item-level frequencies and total scores; Review of response distributions for potential outliers.
Consideration of Mental Health Symptoms Experienced During Pregnancy

The co-occurrence of psychiatric symptoms and substance use during pregnancy is well-documented (Massey et al., 2011, Massey et al., 2012). Phenotypic risk in birthing parents may affect offspring neurodevelopment through both prenatal and postnatal mechanisms, beyond direct exposure alone (Estabrook et al., 2016, Massey et al., 2016, Massey et al., 2018). These factors may confound associations between exposures and neuroimaging or neurodevelopmental outcomes, but they also represent malleable targets for prevention and early intervention. When possible, incorporating parental mental health symptoms as covariates offers a robust strategy to account for these confounding influences.

Instrument Detailsđź”—

The HBCD mental health screening instrument is a two-level screening tool adapted from the DSM-5 Self-Rated Level 1 and Level 2 Cross-Cutting Symptom Measures. Level 1 serves as the initial screening assessment and includes 1–2 questions for each of the first 11 mental health domains listed in Table 1 at the link above (Depression through Dissociation). When a participant endorses symptoms on a Level 1 domain, the corresponding Level 2 assessment is administered. Level 2 provides a more detailed evaluation of symptoms for the following eight domains: Depression, Anger, Mania, Anxiety, Somatic Symptoms, Sleep, Repetitive Behavior, and Personality.

Mental Health Domains Assessed By Levels 1/2đź”—

Unless specified otherwise, Level 2 measures are only administered when symptoms are reported for Level 1.

Domain Level 1 Level 2 HBCD Modifications
Depression Participants proceed to Level 2 irrespective of Level 1 answers;
Level 2 measures replaced with PROMIS-SF v1.0 Depression 8a questionnaire;
Clinical alert is triggered if responses (items from 'I felt worthless' to 'I felt that nothing could cheer me up') exceed threshold of 32
Anger
Mania
Anxiety
Somatic Symptoms Participants proceed to Level 2 irrespective of Level 1 answers
Suicidal Ideation Clinical alert is triggered if response to self-harm question exceeds threshold of 0
Psychosis
Sleep Disturbance Level 2 symptom measures replaced with PROMIS-SF v1.0 Sleep Disturbance 8a
Memory
Repetitive Behaviors
Dissociation
Personality Inventory Participants proceed to Level 2 without completing Level 1;
Includes the Personality Inventory for DSM-5 Brief, which assesses 5 personality trait domains (Negative Affect, Detachment, Antagonism, Disinhibition, & Psychoticism)
Substance Use Domain excluded (SU is measured by a separate set of instruments, e.g. ASSIST, Substance Use Patterns, & TLFB)
Level Measure & Gating Modifications

For Level 1, "Personality Functioning and Substance Use," present in the original measure, was excluded (already captured by a PEX Substance Use instruments).

Level 2 symptom measures for Depression and Sleep Disturbance were replaced with the PROMIS Short Forms v1.0 Depression 8a and Sleep Disturbance 8a. Level 2 also includes the Personality Inventory for DSM-5 Brief, which assesses five personality trait domains: Negative Affect, Detachment, Antagonism, Disinhibition, and Psychoticism.

Gating procedures were adapted for the HBCD population. Participants automatically advanced to the Level 2 Personality Inventory without completing Level 1. For Depression and Somatic Symptoms, all participants completed Level 1 items and proceeded to Level 2 questions regardless of their responses. Future publications should acknowledge the removal of Level 1 and Level 2 Substance Use measures, as well as the modified gating procedures for Personality Inventory, Depression, and Somatic Symptoms.

Clinical Alerts

This measure was modified to alert HBCD study staff when responses exceed thresholds of 0 and 32, respectively, on the Level 1 self-harm item (“Thoughts of actually hurting yourself?”) or Level 2 Depression items (from “I felt worthless” to “I felt that nothing could cheer me up”).

Response Option Changes

A “Decline to answer” option was added to all questions. A “Don’t know” option was initially included, but later removed. Responses marked as “Decline to answer” or “Don’t know” are treated as missing data.

Level 1 items (scored as 0=none, 1=slight, 2=mild, 3=moderate, 4=severe) and gating, including HBCD adaptations:

* All items scored as 0=none, 1=slight, 2=mild, 3=moderate, 4=severe
  Level 1 Items* Gate to level 2 Level 2 measure
Depression depr_001, depr_002 None (all proceed to Level 2) PROMIS Adult Short Form v1.0 Depression 8a
Anger apa_1_anger_001 apa_1_anger_001 ≥ 2 LEVEL 2-Anger-Adult (PROMIS Emotional Distress-Anger-Short Form)
Mania apa_1_mania_001, apa_1_mania_002 apa_1_mania_001 or apa_1_mania_002 ≥ 2 LEVEL 2-Mania-Adult (Altman Self-Rating Mania Scale)
Anxiety apa_1_anx_001 apa_1_anx_001 ≥ 2 LEVEL 2-Anxiety-Adult (PROMIS Emotional Distress-Anxiety-Short Form)
Somatic apa_1_somat_001, apa_1_somat_002 None (all proceed to Level 2) LEVEL 2-Somatic Symptom-Adult (Patient Health Questionnaire 15 Somatic Symptom Severity [PHQ-15])
Self-harm apa_1_suic_001 No Level 2 No Level 2
Psychosis apa_1_psych_001, apa_1_psych_002 No Level 2 No Level 2
Sleep apa_1_sleep_001 apa_1_sleep_001 ≥ 2 Adult v1.0 - Sleep Disturbance 8a
Memory apa_1_memo_001 No Level 2 No Level 2
Repetitive apa_1_repet_001, apa_1_repet_002 apa_1_repet_001 or apa_1_repet_002 ≥ 2 LEVEL 2-Repetitive Thoughts and Behaviors-Adult (adapted from the Florida Obsessive-Compulsive Inventory [FOCI] Severity Scale [Part B])
Dissociation apa_1_disso_001 No Level 2 No Level 2
Personality Not administered Not administered- all to personality inventory Personality inventory for DSM-5 Brief
Substance use Not administered Not administered Not administered

Level 2 items and scoring overview, including HBCD adaptations:

  Level 2 Items Scoring Notes
Depression apa_2_depr_001-apa_2_depr_008 sum all items; look up t-score All items must be answered in order to produce a valid score using the scoring tables
Anger apa_2_anger_001-apa_2_anger_005 sum all items; look up t-score One missing item, pro-rate ((raw score * 5)/(number answered)). Not scored if ≥2 items missing
Mania apa_2_mania_001-apa_2_mania_005 sum all items; score of ≥ 6 indicates high probability of mania One missing item, pro-rate ((raw score * 5)/(number answered)). Not scored if ≥2 items missing
Anxiety apa_2_anx_001-apa_2_anx_007 sum all items; look up t-score Less than 3 missing items, pro-rate ((raw score *7)/(number answered)). Not scored if ≥3 items missing
Somatic apa_2_somat_001-apa_2_somat_015 sum all items; interpreted using the Interpretation Table for the PHQ-15 Somatic Symptom Severity scale Less than 4 missing items, pro-rate ((raw score *15)/(number answered)). Not scored if ≥4 items missing
Sleep apa_2_sleep_001-apa_2_sleep_008 sum all items (note: items 2 and 8 are reverse-scored); look up t-score All items must be answered in order to produce a valid score using the scoring tables
Repetitive apa_2_repet_001-apa_2_repet_005 sum all items; look up t-score One missing item, pro-rate ((raw score * 5)/(number answered)). Not scored if ≥2 items missing
Personality apa_2_pers_001-apa_2_pers_025 sum all items; look up t-score Six missing items, pro-rate ((raw score *25)/(number answered)). Not scored if ≥7 items missing

Resourcesđź”—

Doss, R. A., & Lowmaster, S. E. (2022). Validation of the DSM-5 Level 1 Cross-Cutting Symptom Measure in a Community Sample. Psychiatry Research, 318, 114935. https://doi.org/10.1016/j.psychres.2022.114935

Estabrook, R., Massey, S. H., Clark, C. A. C., Burns, J. L., Mustanski, B. S., Cook, E. H., O’Brien, T. C., Makowski, B., Espy, K. A., & Wakschlag, L. S. (2016). Separating family-level and direct exposure effects of smoking during pregnancy on offspring externalizing symptoms: Bridging the behavior genetic and behavior teratologic divide. Behavior Genetics, 46(3), 389–402. https://doi.org/10.1007/s10519-015-9762-2

Massey, S. H., Lieberman, D. Z., Reiss, D., Leve, L. D., Shaw, D. S., & Neiderhiser, J. M. (2011). Association of clinical characteristics and cessation of tobacco, alcohol, and illicit drug use during pregnancy. The American Journal on Addictions. https://doi.org/10.1111/j.1521-0391.2010.00110.x

Massey, S. H., Mroczek, D. K., Burns, J. L., Clark, C. A. C., Espy, K. A., & Wakschlag, L. S. (2018). Positive parenting behaviors in women who spontaneously quit smoking during pregnancy: Clues to putative targets for preventive interventions. Neurotoxicology and Teratology, 67, 18–24.https://doi.org/10.1016/j.ntt.2018.02.003

Massey, S. H., Neiderhiser, J. M., Shaw, D. S., Leve, L. D., Ganiban, J. M., & Reiss, D. (2012). Maternal self concept as a provider and cessation of substance use during pregnancy. Addictive Behaviors, 37(8), 956–961. https://doi.org/10.1016/j.addbeh.2012.04.002

Massey, S. H., Reiss, D., Neiderhiser, J. M., Leve, L. D., Shaw, D. S., & Ganiban, J. M. (2016). Maternal personality traits associated with patterns of prenatal smoking and exposure: Implications for etiologic and prevention research. Neurotoxicology and Teratology, 53, 48–54. https://doi.org/10.1016/j.ntt.2015.11.010

Roche, M. J., Pincus, A. L., & Cole, P. E. (2019). Linking dimensions and dynamics in psychopathology research: An example using DSM-5 instruments. Journal of Research in Personality, 82, 103852. https://doi.org/https://doi.org/10.1016/j.jrp.2019.103852