A psychometric evaluation of a Swedish version of the psychopathology inventory for mentally retarded adults (PIMRA).
The Swedish PIMRA total score is a valid first alert for mental health issues in adults with ID, but always follow up with a full assessment.
01Research in Context
What this study did
Gustafsson et al. (2005) tested a Swedish form of the PIMRA. The PIMRA is a short checklist that staff fill out to spot mental health problems in adults with intellectual disability.
The team wanted to know if the Swedish words still caught the right problems. They compared the scores to what doctors had already found.
What they found
The Swedish PIMRA total scores matched the doctors' diagnoses. That means the checklist works as a first screen.
Two staff who rated the same person often picked different answers for single items. Use the total score, not one line, to decide next steps.
How this fits with other research
Oliver et al. (2002) did the same kind of study on another Swedish screen, the RSMB. Both papers found the same pattern: the total score is solid, but raters disagree on single items. The two studies back each other up.
Cashon et al. (2013) tested a Dutch anxiety scale and also saw high sensitivity but only fair specificity. Gustafsson et al. (2005) echo this: the PIMRA will catch most true cases, yet you will still need a full check to rule in or out a disorder.
Pickard et al. (2022) showed that adults with ID can give their own health answers if you adapt the questions. Gustafsson et al. (2005) used staff report instead. The two papers do not clash; they simply give you two valid choices—ask the client or ask the staff—depending on the person's verbal level.
Why it matters
If you serve Swedish-speaking adults with ID, you now have a free, quick screen for common mental health conditions. Give the PIMRA to two staff who know the client well, average their total scores, and use agency cut-offs to decide who needs a psychologist visit. Do not waste time arguing over single items that raters marked differently.
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02At a glance
03Original abstract
Given the difficulties with symptom identification and the assessment of mental health problems in persons with intellectual disabilities (ID) there has been a focus on the development of relevant assessment schedules for persons with ID. A Swedish version of the psychopathology inventory for mentally retarded adults (PIMRA, informant version), an instrument designed for identification of specific mental health problems in persons with ID, was evaluated in terms of inter-rater reliability, internal consistency, item grouping, criterion and concurrent validity based on a sample of 101 adults with different levels of ID. The Swedish version of the PIMRA had low inter-rater agreement on specific items but good agreement on low or high total score. In order to investigate internal validity, principal component analyses (PCA) were conducted in steps. Consequently, the majority of the 26 items, which remained after three PCA analyses, were grouped in a pattern approximating five of the original PIMRA subscales. The present analysis identified no item grouping matching the original Affective disorder subscale. Based on these results a revised Swedish version was developed. The concurrent validity analysis yielded a strong association between the total scores of the PIMRA and Reiss Screen for Maladaptive Behaviour (RSMB), between subscales on both instruments describing psychotic symptoms and between the RSMB subscale Aggressive behaviour and the PIMRA subscale Adjustment problems. The outcome of the criterion validity analysis indicated that individuals with a clinical diagnosis obtained higher total PIMRA scores than individuals without a clinical diagnosis and a comparison between the PIMRA subscale Psychosis and the clinical diagnosis indicating psychoses according to DSM-III-R or DSM-IV yielded a higher specificity than sensitivity measure. The results indicate that the PIMRA had a potential to identify individuals with mental health problems in persons with different levels (mild, moderate and severe) of ID and identify individuals with a specific mental disorder. Thus, professionals might use the PIMRA as a complement in the diagnostic process.
Research in developmental disabilities, 2005 · doi:10.1016/j.ridd.2004.04.002