Many
of the scales demonstrated weak psychometrics in at least one
of the following ways: (a) lack
of psychometric data [i.e., reliability and / or validity; e.g., HFQ, MASC, PBS, Social Adjustment Scale - Self - Report (SAS - SR) and all perceived self - esteem and self - concept scales], (b) items that fall on more than one subscale (e.g., CBCL - 1991 version), (c) low alpha coefficients (e.g., below.60) for some subscales, which calls into question the utility
of using these subscales in research and clinical work (e.g., HFQ, MMPI - A, CBCL - 1991 version, BASC, PSPCSAYC), (d) high correlations between subscales (e.g., PANAS - C), (e) lack
of clarity regarding clinically - relevant cut - off scores, yielding high false positive and false
negative rates (e.g., CES - D, CDI) and an inability to distinguish between minor (i.e., subclinical) and major (i.e., clinical) «cases»
of a disorder (e.g., depression; CDI, BDI), (f) lack
of correspondence between items and DSM criteria (e.g., CBCL - 1991 version, CDI, BDI, CES - D, (g) a factor structure that lacks clarity across studies (e.g., PSPCSAYC, CASI; although the factor structure is often difficult to assess in studies
of pediatric populations, given the small sample sizes), (h) low inter-rater reliability for interview and observational methods (e.g., CGAS), (i) low correlations between respondents such as child, parent, teacher [e.g., BASC, PSPCSAYC, CSI, FSSC - R, SCARED, Connors Ratings Scales - Revised (CRS - R)-RSB-, (j) the inclusion
of somatic or physical
symptom items on mental health subscales (e.g., CBCL), which is a problem when conducting studies
of children with pediatric physical
conditions because physical
symptoms may be a feature
of the
condition rather than an indicator
of a mental health problem, (k) high correlations with measures
of social desirability, which is particularly problematic for the self - related rating scales and for child - report scales more generally, and (l) content validity problems (e.g., the RCMAS is a measure
of anxiety, but contains items that tap mood, attention, peer interactions, and impulsivity).
The relationship between depressive
symptoms and step count has only been assessed in specific populations with small sample sizes, such as low - socioeconomic status Latino immigrants, 16 elderly Japanese people17 or patients with chronic
conditions such as heart failure18 19 or chronic obstructive pulmonary disease.20 21 Studies yield contradictory results, with some observing no association between depressive
symptoms and daily step count, 19 21 while others report a
negative correlation.16 — 18 20 In one cross-sectional sample
of healthy older adults, an inverse association between depressive
symptoms (using the Goldberg Depression Scale - 15) and accelerometer measured daily step count disappeared after controlling for general health and disability.22 While a systematic review suggests reduced levels
of objectively measured PA in patients with depression, 23 it is not known whether this association is present in those at high risk
of CVD and taken into account important confounding such as gender and age.