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An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales

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The Patient-Reported Outcomes Measurement Information System (PROMIS) aims to develop self-reported item banks for clinical research. The PROMIS pediatrics (aged 8–17) project focuses on the development of item banks across several health domains (physical function, pain, fatigue, emotional distress, social role relationships, and asthma symptoms). The psychometric properties of the anxiety and depressive symptom item banks are described.


Participants (n = 1,529) were recruited in public school settings, hospital-based outpatient and subspecialty pediatrics clinics. The anxiety (k = 18) and depressive symptoms (k = 21) items were split between two test administration forms. Hierarchical confirmatory factor-analytic models (CFA) were conducted to evaluate scale dimensionality and local dependence. IRT analyses were then used to finalize item banks and short forms.


CFA results confirmed that anxiety and depressive symptoms are separate constructs and indicative of negative affect. Items with local dependence and DIF were removed resulting in 15 anxiety and 14 depressive symptoms items. The psychometric differences between short forms and simulated computer adaptive tests are presented.


PROMIS pediatric item banks were developed to provide efficient assessment of health-related quality of life domains. This sample provides initial calibrations of anxiety and depressive symptoms item banks and creates PROMIS pediatric instruments, version 1.0.

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Patient-reported outcomes measurement information system


Pediatric quality of life inventory™


Health-related quality of life


Patient-reported outcomes


Confirmatory factor analysis


Item response theory


Local dependence


Differential item function


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Correspondence to Debra E. Irwin.



Listed below are the item stems for the recommended eight-item short forms for the PROMIS Pediatric Anxiety and Depressive Symptoms Scales. All items use a 7-day recall period (the preface is “In the past seven days”), and a 5-point response scale with the options never (0), almost never (1), sometimes (2), often (3) and almost always (4).

  • Anxiety:

  • I felt scared.

  • I worried about what could happen to me.

  • I felt worried.

  • I felt like something awful might happen.

  • I worried when I went to bed at night.

  • I thought about scary things.

  • I felt nervous.

  • I was afraid that I would make mistakes.

  • Depressive symptoms:

  • I felt like I couldn’t do anything right.

  • I felt everything in my life went wrong.

  • I felt unhappy.

  • I felt lonely.

  • I felt sad.

  • I felt alone.

  • I thought that my life was bad.

  • I could not stop feeling sad.

Summed score to scale score translation for these short forms is in Table 7.

Table 7 Summed score to scale score translation table for the recommended short forms

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Irwin, D.E., Stucky, B., Langer, M.M. et al. An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Qual Life Res 19, 595–607 (2010).

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