The emotional distress of children with cancer in China: An Item Response Analysis of C-Ped-PROMIS Anxiety and Depression Short Forms Yanyan Liu 1, Changrong Yuan 1,* Jingting Wang 1, Pamela S. Hinds 2,3, Jichuan Wang 2,3 1.School of Nursing, Second Military Medical University, Shanghai, China; 2. Children’s National Medical Center; 3. Department of Pediatrics, School of Medicine, George Washington University, Washington DC, USA Insert Affiliate Logo Here The C-P-PROMIS items were treated as polytomous indicators with 5 response categories (0-Never, 1-Almost never, 3-Sometimes, 4-Often, and 4-Always). Categorical confirmatory factor analysis (CCFA) was used to examine scale factorial structural, scale unidimensionality, and assess item local dependence. Differential item functioning (DIF) was tested fro each item of the the two PROMIS scales using the multiple indicator multiple cause (MIMIC) model with regard to age and gender. IRT parameters were translated from the corresponding item thresholds and factor loadings estimated from the 2-factor CCFA, which is equivalent to the Graded Response Model (GRM) The Pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) were translated into Chinese and applied in children with cancer in China. This study aimed to analyze the psychometric properties of two C-P-PROMIS emotional distress scales -- the Anxiety and Depressive symptoms scales. Our results show that the Chinese version of Pediatric PROMIS Anxiety and Depressive scales have valid factorial structures; both scales have a high test reliability as long as their T-scores are not on the extremes. Our findings provide evidence that the Chinese version of the two Pediatric PROMIS scales can be readily applied to measure emotional distress symptoms in children with cancer in China. Sample A total of 256 children and adolescents with cancer were recruited from both inpatient and outpatient clinics in two cities (Shanghai and Chengdu) in China between May, 2012 and November, Among all the eligible patients, twelve of them (4.69%) declined to participate and another 12 (4.69%) agreed to participate but did not complete their interviews. Those cases were excluded from the study. Abstract Statistical Analysis Results Discussion Both single-factor and 2-factor CCFA models fits data very well. The items of both Anxiety and Depression scales loaded appropriately on their underlying theoretical factors/constructs. No significant DIF was found for the items of the two scales with respect to gender and age. In regard to the relationships between the Anxiety items and their underlying factor, item Anx 4 (“I felt worried”) had the largest discrimination parameter, which measures the relationship between item and factor; while Anx 8 (“I felt worried when I went to sleep at night”) was the worst (see Table 1). The corresponding items for Depression are Dep 6 (“I felt sad”) and Dep 3 (“I felt everything in my life went wrong”) (see Table 2). The probability of endorsing response category 4 (“Often”) or category 5 (“Always”) was low for all the items of both Anxiety and Depression (see Figs 1 and 2). This is the first study to examine the psychometric properties of the C-Ped-PROMIS Anxiety and Depression short forms among children with cancer in China. Our findings provide evidence that the C-Ped- PROMIS Anxiety and Depression scales are unidimensional; the local independence assumption of IRT holds very well for the PROMIS anxiety and depression scales. However, the probability of endorsing “Often” or “Always” response option was low; compared with the similar study among the U.S. children with cancer by Irwin, Stucky, Thissen, et al. (2010), the reliability of the C-Ped-PROMIS Anxiety and Depression short forms was lower. The findings need to be confirmed in further studies in difference Chinese populations.