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University of Southampton Research Repository Eprints Soton University of Southampton Research Repository ePrints Soton Copyright © and Moral Rights for this thesis are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder/s. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given e.g. AUTHOR (year of submission) "Full thesis title", University of Southampton, name of the University School or Department, PhD Thesis, pagination http://eprints.soton.ac.uk UNIVERSITY OF SOUTHAMPTON FACULTY OF MEDICINE MEASURING THE MENTAL HEALTH OF THE VETERINARY PROFESSION: PSYCHOMETRIC CONSIDERATIONS BY DAVID JAMES BARTRAM Thesis for the degree of Master of Philosophy December 2011 i UNIVERSITY OF SOUTHAMPTON ABSTRACT FACULTY OF MEDICINE Master of Philosophy MEASURING THE MENTAL HEALTH OF THE VETERINARY PROFESSION: PSYCHOMETRIC CONSIDERATIONS By David James Bartram The UK veterinary profession has an elevated risk of suicide. The ability to measure the psychological health of this occupational group is an important first step towards suicide prevention. The aim of this research was to assess the suitability of the 14- item Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in this context. The psychometric properties of data quality, scaling assumptions, targeting, reliability and validity were rigorously evaluated by the complementary application of traditional and modern psychometric methods to data from two large cross-sectional samples of the veterinary profession (n = 1796 and n = 8829) derived from independent postal surveys. Where possible, the findings were cross-validated between samples. External construct validity was assessed by testing a priori hypothesised associations between WEMWBS scores and other measures of psychological health or psychosocial work characteristics. Internal construct validity was examined using traditional factor analytic techniques and Rasch analysis. The WEMWBS did not show floor or ceiling effects. As hypothesised, scores were negatively associated with anxiety and depressive symptoms and suicidal ideation. Data for the original 14 items deviated significantly from Rasch model expectations (chi-square = 558.2, df = 112, p = < 0.001, PSI = 0.918). A unidimensional 7-item scale (Short WEMWBS, SWEMWBS) with acceptable fit to the model (chi-square = 58.8, df = 56, p = 0.104, PSI = 0.832) was derived by sequential removal of the most misfitting items. Fit statistics for SWEMWBS were consistent across four further random subsets of data drawn from both samples. Interval-level measurements on SWEMWBS retained associations with scores on comparator instruments. The analyses provided a range of evidence of the psychometric properties of WEMWBS and SWEMWBS, consistent with published results for general population samples. The measurement invariance of SWEMWBS between samples of this occupational group and the general population was supported. SWEMWBS has robust measurement properties which support its suitability as an overall indicator of population mental health and well-being in the UK veterinary profession. iii LIST OF CONTENTS Abstract....................................................................................................................... i List of contents......................................................................................................... xiii List of tables............................................................................................................. xiii List of figures............................................................................................................ xiii Declaration of authorship ......................................................................................... xiii Acknowledgements.................................................................................................. xiii List of abbreviations ................................................................................................ xvii Chapter 1: Introduction .............................................................................................. 1 1.0 Introduction ...................................................................................................... 2 1.1 Elevated suicide risk among veterinary surgeons............................................ 2 1.2 Measurement of psychological health.............................................................. 3 1.3 Need for quality measures of the veterinary profession’s mental health.......... 5 1.4 Where to begin................................................................................................. 5 1.5 Research questions ......................................................................................... 6 1.6 Aims and objectives ......................................................................................... 6 1.7 Approach.......................................................................................................... 7 1.8 Contributions to research and practice ............................................................ 9 1.9 Document structure........................................................................................ 10 Chapter 2: Veterinary surgeons and suicide: a structured review of possible influences on increased risk..................................................................................... 11 2.0 Introduction .................................................................................................... 12 2.1 Literature search methodology....................................................................... 12 2.2 Suicide statistics............................................................................................. 13 2.2.1 United Kingdom....................................................................................... 13 2.2.2 Rest of the world ..................................................................................... 20 2.3 Risk factors for suicide and suicidal behaviour .............................................. 22 2.4 Protective factors against suicide and suicidal behaviour.............................. 25 2.5 Conceptual models of suicidal behaviour....................................................... 25 2.6 Possible influences on suicide risk among veterinary surgeons .................... 27 2.6.1 Access to means of suicide..................................................................... 27 iv 2.6.2 Attitudes to death and euthanasia........................................................... 29 2.6.3 Suicide ‘contagion’ .................................................................................. 30 2.6.4 Cognitive and personality factors ............................................................ 30 2.6.5 Work-related stressors ............................................................................ 33 2.6.6 Effects of gender ..................................................................................... 39 2.6.7 Perceived stigma..................................................................................... 41 mental health.................................................................................................... 41 2.7 Towards a hypothetical model to explain suicide risk in veterinary surgeons: a schematic representation ..................................................................................... 48 2.8 Shortfalls in existing published work .............................................................. 50 2.9 Summary........................................................................................................ 50 Chapter 3: Measurement properties of health rating scales .................................... 53 3.0 Introduction .................................................................................................... 54 3.1 Psychometric theory: traditional and modern................................................. 55 3.2 Traditional psychometric methods ................................................................. 55 3.3 Modern psychometric methods ...................................................................... 57 3.4 Rasch analysis ............................................................................................... 58 3.4.1 Limitations of the Rasch model ............................................................... 63 3.5 Quality criteria for the measurement properties of health rating scales ......... 63 3.5.1 Six psychometric properties: data quality, scaling assumptions, targeting, reliability, validity and responsiveness ............................................................. 64 3.6 Conclusion ..................................................................................................... 70 3.7 Summary........................................................................................................ 71 Chapter 4: Materials and methods........................................................................... 73 4.0 Introduction .................................................................................................... 74 4.1 Source of the datasets ..................................................................................
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