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Modification of the item was also indicated to include doctor advice.
A modification of the item for future studies will be considered.
After the informant sorted the 54 cards, the interviewer reviewed the "not quite right" stack and asked the informant to suggest a modification of the item, if possible.
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Although replication is clearly needed to support this and all of the findings presented here, this suggests that the deletion or modification of the items exhibiting DIF is not necessary, and may even be inappropriate.
In terms of future action however, even though overall the mean DIF for each major was negligible enough that DTF was not found, future administrations of this test could certainly benefit from some modification of items; particularly item 5 and possibly the additional 7 items that were highlighted by two of the tests employed in the analysis.
Subsequently, a three-resident group discussion was conducted with three separate groups, which led to further modifications of the items.
Subsequent item reduction of the 25-item prototype scale was based on statistical analyses and cognitive interviewing [ 36, 37] Cognitive interviewing with patients indicated wide variability in interpretation (and use) in relation to the telephone item that led to modification of that item (Table 2).
Hence we suggested a modification of this item.
The behavioral manifestation and symptom intensity of depression were assessed as self-report using a modification of the 21-item Beck Depression Inventory [26] as adapted and validated for the Finnish population (www.kela.fi/in/internet/liite.nsf/NET/110607141642EK/File/tutkimuksia86.pdfOpenElement), with the sum score or Beck Depression Index (BDI) ranging from 0 to 55.
Depression symptomatology was measured using a modification of the 20-item Centers for Epidemiologic Studies Depression CESDD) scale [ 62].
We used the Finnish modification of the 13-item Beck Depression Inventory (RBDI) [ 30] to assess symptoms of depression (DEP) [ 31, 32].
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