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Cognitive and somatic aspects of depression among a rehabilitation sample: Reliability and validity of SCL-90-R research subscales
Abstract
Although research subscales have been developed (Buckelew, DeGood, Schwartz, & Kerler, 1986) to assess the cognitive and somatic item patterning among chronic pain patients using the SCL-90-R, no information is available concerning the reliability or validity of those subscales. This study was designed to assess the internal consistency of these experimental subscales, evaluate the validity of these scales using standardized clinical scales measuring similar constructs, and to further examine the item response patterning with a new pain clinic sample and a rehabilitation center patient sample. The SCL-90-R was administered to 78 patients with chronic pain, 52 patients with spinal cord injury, and a control group of 145 college students. Estimates of internal consistency, represented by coefficient alpha, were .69 for the Somatic Depression subscales and .91 for the Cognitive Depression subscales. Data suggestive of construct validity included differential correlations of r = .78 between the experimental Cognitive Depression scale and the SCL-90-R Obsessive Compulsive scale, r = .66 between the experimental Somatic Depression scale and the SCL-90-R Somatization scale. Similar evidence of divergent validity was not clearly demonstrated with the remaining SCL-90-R subscales. Multivariate analysis of variance revealed that previously found item response patterning was replicated with a new chronic pain sample and with a spinal cord injured sample. Refinement of the research subscales and implications for clinical use among medical/rehabilitation samples is discussed.
... Numerous researchers have called for further experiments and analyses of the SCL-90-R characteristics, including the evaluation of specific populations, disorders, and research targeted toward the discriminatory properties of the subscales (Buckelew, Burk, Brownlee-Duffeck, Frank, & DeGood, 1988;Eich et al., 2003;Elliott et al., 2006;Gilliss, Moore, & Martinson, 1997;Kaplan et al., 1998;Recklitis, Licht, Ford, Oeffinger, & Diller, 2007). The research questions explored by the current study correspond to the calls for further research in other studies both broadly and in many specific facets. ...
... The importance of identifying new subscales in the SCL-90-R is a key component of this study, which addresses the call for further research issued by Gilliss et al. (1997). Buckelew et al. (1988) and Kaplan et al. (1998) stressed the importance of analyzing and interpreting the individual item responses of the SCL-90-R to aid clinicians in making accurate diagnoses and correctly interpreting mental health assessments, which is congruent with the design and objectives of the study. The study's sample includes participants who suffer from severe pathology, including substance abuse, psychosis, personality disorders, and severe depression and anxiety. ...
... A series of studies have attempted to use the analysis of the SCL-90-R to support the introduction of differently structured subscales, items, and item groupings. The findings have not pointed to one consistent and accepted refinement, rather several different subscales and item groupings have been identified across many studies (Buckelew et al., 1988;Elliott et al., 2006;Paap et al., 2011). ...
The Symptom Checklist-90-Revised (SCL-90-R) is a widely used assessment of mental health pathology; however, its factor structure has been called into question by numerous studies. This study assessed a community mental health outpatient sample (N = 336) with the SCL-90-R and analyzed the factor structure. The results indicated that the SCL-90-R measures one large factor, but the test items held together reasonably well when a nine-factor extraction was executed. A shorter 67-item variant, which was a by-product of this study, is hypothesized as having some key advantages over the original 90-item version. Implications for the assessment of the outpatient population with the SCL-90-R and its variants are discussed.
... Validity and reliability have been well established with psychiatric patient and nonpatient samples (32). The SCL-90R and its predecessor (SCL-90) have been used extensively as clinical and research measures with chronic pain patients (33,34), and for identifying chronic pain patient typologies based on hierarchical cluster analyses (16,17). Chronic pain patients have been found to have different response patterns on the SCL-90R compared with psychiatric patients and nonpatients ('normals') (34); therefore, empirically based scoring methods for chronic pain patients have been developed (33,34). ...
... The SCL-90R and its predecessor (SCL-90) have been used extensively as clinical and research measures with chronic pain patients (33,34), and for identifying chronic pain patient typologies based on hierarchical cluster analyses (16,17). Chronic pain patients have been found to have different response patterns on the SCL-90R compared with psychiatric patients and nonpatients ('normals') (34); therefore, empirically based scoring methods for chronic pain patients have been developed (33,34). The scale scores developed by Shutty et al (33) based on exploratory and confirmatory factor analyses with chronic pain patients were used in this study. ...
... The SCL-90R and its predecessor (SCL-90) have been used extensively as clinical and research measures with chronic pain patients (33,34), and for identifying chronic pain patient typologies based on hierarchical cluster analyses (16,17). Chronic pain patients have been found to have different response patterns on the SCL-90R compared with psychiatric patients and nonpatients ('normals') (34); therefore, empirically based scoring methods for chronic pain patients have been developed (33,34). The scale scores developed by Shutty et al (33) based on exploratory and confirmatory factor analyses with chronic pain patients were used in this study. ...
To further develop an empirically based classification system for chronic pain patients through the examination of age and sex differences, and incorporation of pain duration in the grouping algorithm.
Three hundred seventy-four chronic pain patients (300 aged 13 to 59 years; 74 aged 60 to 89 years) assessed at an outpatient, multidisciplinary pain management centre.
Patients completed measures of demographic and descriptive information, pain intensity (box rating scale), perceived disability (modified Pain Disability Index) and affective distress (Symptom Checklist-90 Revised) before multidisciplinary treatment. Standardized scores from the assessment measures were entered into a series of hierarchical, multivariate cluster analyses to identify underlying patient subgroups.
Age-based patient groupings from prior research were partially replicated. Significant differences in clinical presentations were observed across age and sex groups. Pain duration was found to make an important contribution to the patient groupings. 'Good control' (low pain, disability, distress) and variants of 'chronic pain syndrome' (elevated pain, disability, distress) groupings were identified across all analyses. Two variants of a 'stoic' profile were identified among older patients, with low levels of distress relative to pain and perceived disability. One of these profiles was associated with long pain duration and was found only among males. Several unique clinical profiles were identified for female patients.
There are important age and sex differences in the clinical presentations of chronic pain patients. Some older patients present with unique clinical profiles that may reflect cohort differences, and/or physiological or psychological adjustment processes. There appears to be a greater number of distinct chronic pain presentations among females. Research on the classification of chronic pain patients within homogeneous diagnostic subgroups is needed.
... Thirdly, general psychological wellbeing was screened with the Symptom Check List-90 (SCL-90) [37], and self-efficacy, which is defined as the belief that one is capable of performing in a certain manner to attain certain goals, was assessed with the Dutch General Self-efficacy Scale (GSE) [38]. Personality was assessed with the NEO-Five-Factor Inventory (FFI), measuring five core personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) [39]. ...
... Personality was assessed with the NEO-Five-Factor Inventory (FFI), measuring five core personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) [39]. For the SCL-90, good internal consistency, construct validity, and divergent validity were reported [37]. For the GSE, high internal consistency and item-total correlations were reported, indicating that it is a reliable scale [40]. ...
Background:
Working memory training (WMT) programs can improve working memory (WM). In football players, this could lead to improved performance on the pitch.
Method:
Eighteen professional football players of Maatschappelijke Voetbal Vereniging Maastricht (MVV) participated and followed an online, computerized WMT program. Neuropsychological performance, psychological wellbeing, self-efficacy, and football skills (Loughborough Soccer Passing Test; LSPT) were assessed at three time points, before and after WMT and at three-month follow-up. Descriptive data are reported.
Results:
Baseline characteristics were roughly similar for both groups. Participants performed better on the trained WM tasks, but performance for other neuropsychological test measures or the LSPT did not change. Low compliance rates were observed, showing differences in personality and well-being between compliers and non-compliers.
Conclusions:
WMT is not a feasible and effective strategy to improve non-trained cognitive measures and football performance. However, this study indicates that it is important to take individual characteristics into account.
... The BSI and its parent instrument, the SCL-90-R, are increasingly used with hospitalized populations including SCI patients to assess psychological distress (Tate, Kewman, & Maynard, 1990). Both the BSI and the Zung tests also show to be relatively reliable and valid (Schaeffer et al., 1985;Buckelew, Burk, Brownlee-Duffeck, & Frank, 1987). The reliability coefficients for all BSI scales when used with a sample of able-bodied subjects are very good, ranging from a low of .71 on the Psychoticism scale to a high of .83 on Depression (Derogatis & Spencer, 1982). ...
... If these factors did not replicate, it was hypothesized that three basic components of depression (affective, somatic, and cognitive) could be factored. The selection of three factors was based on studies about depression which suggest somatic, affective, and cognitive dimensions of depression (Buckelew et al., 1987;Zung, 1967;Shutty, DeGood, & Schwartz, 1986). Third, the predictive validities of the Zung, BSI/GSI and BSI/DEP scale were assessed (using the sample of 30 SCI inpatients) by determining the degree to which test scores agreed with clinicians' ratings. ...
Compared 2 measures of depression, the Zung Self-Rating Depression Scale (SRDS) and the Brief Symptom Inventory (BSI), and discussed their use with (1) 162 spinal cord injury (SCI) outpatients and (2) 30 SCI inpatients. Sample 2 was used to study the predictor validity of the tests based on clinicians' ratings of Ss' depression status. Results indicate a fair degree of correlation between these tests. Fairly good test reliability was also found. The SRDS was more clearly delineated into distinct conceptual factors than the BSI. An analysis of predictive validities of the 2 tests using test scores and independent clinician ratings suggests that the BSI and the SRDS were the most useful predictors of depression among SCI Ss. However, the SRDS was superior for identifying SCI persons at risk of being depressed during or after rehabilitation hospitalization. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The SCL-90 was validated in English for individuals with SCI in 1988. 60 This measure includes 90 symptoms of distress rated from 0, representing "not at all," to 4, indicating "extremely." Subjects were instructed to indicate the amount bothered by each of the symptoms. ...
This chapter aims to describe and evaluate the assessment tools to evaluate psychological aspects in people with SCI through a systematic review of scientific literature. The systematic review was conducted in line with COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) on Pubmed, Scopus, Cinahl, and Web of Science. After removing duplicates, 3333 papers were screened, and of these, 476 were included in this systematic review. Among these, 64 papers were considered for this chapter. Results show 46 assessment tools that evaluate the psychological area of persons with SCI. Among these, most scales evaluate the aspect of anxiety and depression, self-efficacy, and coping strategies. The most common assessment tools are the Patient Health Questionnaire-9 (PHQ-9), which is a self-report measure that asks subjects how often they have been bothered by the problems such as feeling depressed, feeling tired, poor appetite, feelings of guilt, or thoughts of suicide; the Spinal Cord Lesion Related Coping Strategies Questionnaire (SCL-CSQ), which is a specific scale developed to evaluate the coping strategies of persons with SCI; and, the Spinal Cord Injury–Falls Concern Scale (SCI-FCS), which is a scale that assesses the degree of attention, with respect to falls in a wheelchair, by people with SCI while they carry out daily activities.
... It is commonly used to measure treatment progress and outcome, due to its high reliability (Cronbach's alpha, ␣ ϭ .87), validity, and utility (Buckelew, Burk, Brownlee-Duffeck, Frank, & DeGood, 1988;Derogatis & Savitz, 2000;Hardt, Gerbershagen, & Franke, 2000). In addition to assessing This document is copyrighted by the American Psychological Association or one of its allied publishers. ...
Mindfulness-based interventions have been found to be beneficial in the treatment of various disorders. In the context of psychosynthesis therapy, mindfulness is employed as having an inner dialogue with the mental system and its psychological and psychosomatic components. However, empirical studies on the effect of this transpersonal-based mindfulness approach are still lacking. This study aimed at investigating the effect of mindfulness in the context of psychosynthesis on psychopathological symptoms. Fifty-eight participants (35 females, 23 males) attending a psychosynthesis seminar provided data on psychopathology (Symptom Checklist-90-Revised; SCL-90–R) and mindfulness (Five Facet Mindfulness Questionnaire; FFMQ) at baseline (T1), postintervention (T2), and 3-week follow up (T3). A significant decrease for all psychopathological symptoms assessed by the SCL-90–R (p < .001) and an increase in mindfulness abilities determined by the FFMQ (p < .001) from T1 to T2 was observed. Postintervention effects remained stable at 3-week follow up. The decrease in psychopathological symptoms from T1 to T2 was significantly correlated to an increase in mindfulness abilities (p < .012). Future studies should investigate the effects of dialogical mindfulness on specific symptomatology including control conditions.
... Self-esteem will be measured with the Rosenberg Self-Esteem Scale (RSES) [49]. The RSES contains ten items, each rated on a four-point Likert scale ranging from 'very untrue' to 'very true' . ...
... For the purposes of this study, we were interested in general psychopathology as measured by the global severity index. Research supporting the reliability and validity of the SCL-90-R has been reported elsewhere (Buckelew et al., 1988). ...
While poor therapeutic alliance is a robust predictor of poor outcome in substance abuse treatment, less is known about the barriers to therapeutic alliances in this group. To explore this issue, this study examined whether the severity of cluster B personality disorders predicted therapeutic alliances concurrently and prospectively in a residential substance treatment program for homeless veterans. Participants were 48 adults with a substance abuse disorder. Personality disorder traits were assessed using the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorders, whereas therapeutic alliance was assessed at baseline using the Working Alliance Inventory. Partial correlations controlling for overall symptom severity measured with the Symptom Checklist 90 and education, revealed cluster B traits at baseline predicted all 4 assessments of therapeutic alliance even after controlling for initial levels of therapeutic alliance. Results suggest that higher levels of cluster B traits are a barrier to the formation of working alliances in residential substance treatment.
... Anxiety and Depression: Symptom Checklist -90-Revised (SCL-90-R) was used to assess depression and anxiety. The SCL-90-R is a screening measure of general psychiatric symptomatology 55 . Two dimensions measuring anxiety (10 items) and depression (13 items) were used in the study. ...
Attention-deficit/hyperactivity disorder (ADHD) has been often found to be comorbid with other disorders, including anxiety, depression, and unhealthy behaviors such as drinking alcohol and smoking. These factors were often discussed separately, and the mediating effects of mental health on substance use are unknown. To study the mediating effects of anxiety and depression on the relationship between ADHD and drinking/smoking behaviors, we conducted a cross-sectional study of 1870 college students from Shanghai, China. The Adult ADHD Self-Report Scale (ASRS-v1.1) and Wender Utah Rating Scale (WURS) were used to identify the current and past ADHD. Structural Equation Modeling was carried out to clarify the mediating effect of anxiety and depression on the relationship between core ADHD symptoms and smoking/drinking behaviors. We found that inattention as one of the core symptoms of ADHD was associated with an increased risk of depression as a direct effect, as well as slightly increased risk of smoking/drinking behaviors by an indirect effect of depression. Hyperactivity-impulsivity, as another core symptom of ADHD had a robust impact on smoking and drinking behaviors, while being mediated by anxiety and depression. In conclusion, anxiety and depression was associated with further increased risk behaviors of smoking/drinking alcohol among those students with ADHD.
... The Dutch version of the Symptom Checklist-90-Revised (SCL-90-R) consists of the following subscales: anxiety (experiencing anxiety and fear), depression (experiencing symptoms of depression), agoraphobia (being afraid of open spaces), somatization (experiencing physical complaints), inadequacy in thinking and acting (experiencing obsessive thoughts), distrust and interpersonal sensitivity (having difficulty trusting others and feeling socially insecure), hostility (feeling irritated or angry easily), sleeping problems (having difficulties falling asleep, waking up early or other sleeping problems), and general psychological and physical well-being (total score of all separate subscales). Reliability and construct validity of the original SCL-90-R and of the Dutch version have been described as excellent (Arrindell & Ettema, 2003; Buckelew et al. 1988). RRQ The Rumination-Reflection Questionnaire (RRQ, Trapnell & Campbell, 1999) distinguishes rumination from reflection. ...
Individuals with autism spectrum disorders (ASD) have a higher incidence of comorbid disorders in comparison with other patient groups. Empirical evidence on treatments targeting comorbid symptoms is however scarce. Earlier research showed that mindfulness-based therapy for individuals on the autism spectrum (MBT-AS) is effective in reducing symptoms of depression, anxiety, and rumination. In the current study, it was examined whether MBT-AS is effective in alleviating a variety of psychosomatic symptoms and whether these effects were still evident after 9 weeks. Fifty participants took part in a nine-week MBT-AS training. Self-reported symptoms were evaluated at three intervals: (1) before the first session, (2) after the last session, and (3) 9 weeks after the last session. Results showed that symptoms of anxiety, depression, agoraphobia, somatization, inadequacy in thinking and acting, distrust and interpersonal sensitivity, sleeping problems, and general psychological and physical well-being declined significantly during intervention. Positive affect increased, and rumination declined significantly during treatment. Hostility symptoms did not decline significantly during treatment. All symptoms remained stable between post intervention and follow-up. This would seem to indicate that MBT-AS is effective in reducing psychological and physical symptoms and keeping them stable over the longer term. Furthermore, the outcome indicates that rumination is an important mediating factor. In conclusion, MBT-AS appears to be an effective method for reducing a variety of symptoms, and treatment gains remain stable over the longer term.
... Its advantages include less focus on somatic symptoms of depression and ease of administration. Other self-rating scales used, such as the Symptom Checklist-90-Revised (SCL-90-R) 11 and the General Health Questionnaire (GHQ) 12 have limitations of lack of specificity and lengthy administration. In the AS population, lack of validated cut-off scores in the HADS anxiety and depression subscales leads to difficulties in determining the true prevalence of anxiety and depressive disorders. ...
Objective
To determine the prevalence of anxiety and depression in axial spondyloarthritis (SpA) patients by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition patient research version (CB-SCID-I/P), and to examine the effectiveness of the Hospital Anxiety and Depression Scale (HADS) as a screening tool.Methods
We recruited 160 Chinese axial-SpA patients to determine the prevalence of anxiety and depression using the CB-SCID-I/P. Recruited subjects were asked to complete the HADS. HADS, HADS-depression (HADS-D) subscale and HADS-anxiety (HADS-A) subscale were analyzed to determine their effectiveness in screening for depressive and anxiety disorders.ResultsThe prevalence of current major depressive disorder (MDD) and anxiety disorder were 10.6% and 15.6%, respectively. The full-scale HADS outperformed the HADS-D subscale in screening for current MDD (area under the curve [AUC] 0.889; 0.844) and all depressive disorders (AUC 0.885; 0.862) while the HADS-A subscale outperformed the full scale HADS in screening for anxiety disorders (AUC 0.894; 0.846). The optimal cut-off point of the full scale HADS for screening current MDD and all depressive disorders were 7/8 and 6/7, yielding a sensitivity of 82.4% and 83.9%, specificity of 78.7% and 74.8%, respectively. The optimal cut-off point of HADS-A subscale for screening anxiety disorders was 6/7, yielding a sensitivity of 88.0% and specificity of 74.4%.Conclusion
The prevalence of MDD and anxiety disorder in SpA patients were 10.6% and 15.6%, respectively. We recommend using the full-scale HADS in screening for depressive disorders and HADS-A subscale for anxiety disorders.
... Revised Scale of Symptoms Checklist 90 (SCL 90-R). The SCL-90-R is used as a screening measure of general psychiatric symptomatology (Buckelew, Burk, Brownelee-Duffeck, Frank, & DeGood, 1988). It includes dimensions measuring somatization, obsessive-compulsive, depression, anxiety, phobic anxiety, hostility, interpersonal sensitivity, paranoid ideation, and psychoticism. ...
Child abuse has proved to be one of the most important social challenges. The present study attempts (a) to determine the prevalence of child abuse in an urban area in Iran and (b) to differentiate abused from non-abused adolescent boys using parental and child characteristics. A survey was conducted to determine the prevalence of different types of child abuse. The prevalence sample comprised 2,100 students selected through a multistage random sampling procedure. Data were collected using the Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory, II (BDI-II), State Trait Anxiety Inventory (STAI), modified Hazan & Shaver Attachment Style Questionnaire (ASQ) and Symptom Check List 90 (SCL-90-R). Descriptive statistics and discriminant function analysis were used to analyze the data. The results showed that 14.85% of the subjects were exposed to child abuse, with emotional abuse being most prevalent (52.09%). Also, it appeared that variables such as parental depression and anxiety and children’s attachment styles, anxiety, and aggression can help discriminate abused boys from their non-abused counterparts.
... Scores of ≥11 are associated with significant morbidity. [19] Others like "Patient Health Questionnaire-9" (PHQ-9) [20] and "Symptom Checklist-90" (SCL-90) [21] are sensitive and time-efficient tools for both anxiety and depression. ...
Diabetes mellitus is considered to be one of the most psychologically demanding of the chronic medical illnesses and is often associated with several psychiatric disorders. Psychiatric disorders can be a risk factor for, as well as a complication of, diabetes leading to bidirectional association between the two morbidities. Physicians caring for people with diabetes must be trained to recognize and manage comorbid psychiatric conditions that commonly occur. Our current article reviews the various screening procedures for effective evaluation of the neuropsychiatric illnesses coexisting with diabetes and other pertinent issues.
... Inclusionary criteria were that participants had to be males between the ages of 18 and 30 years, in good health, and able to understand the informed consent as assessed by the study physician. Participants were excluded if they had evidence of medical or psychiatric disorder that would compromise study participation, current or past history of drug or alcohol abuse or dependence, a history of hypersensitivity to OXT or vehicle, presence of or history of clinically significant allergic rhinitis, smoked more than 10 cigarettes per day and had experiences of any trauma involving either injury or threat of injury to themselves or a close family/friend member or of being a victim of or having witnessed a violent crime (Assessment tool: clinical interview and Symptom Checklist 90-Revised) (Buckelew et al., 1988). Participants intranasally self-administered a single dose of 40 IU oxytocin (Syntocinon spray, Pharmaworld, Zurich, Switzerland) or placebo (containing the carrier without the neuropetide) 45 min before the experiment. ...
The neuropeptide oxytocin functions as a hormone and neurotransmitter and facilitates complex social cognition and approach behavior. Given that empathy is an essential ingredient for third-party decision-making in institutions of justice, we investigated whether exogenous oxytocin modulates empathy of an unaffected third-party toward offenders and victims of criminal offenses. Healthy male participants received intranasal oxytocin or placebo in a randomized, double-blind, placebo-controlled, between-subjects design. Participants were given a set of legal vignettes that described an event during which an offender engaged in criminal offenses against victims. As an unaffected third-party, participants were asked to rate those criminal offenses on the degree to which the offender deserved punishment and how much harm was inflicted on the victim. Exogenous oxytocin selectively increased third-party decision-makers' perceptions of harm for victims but not the desire to punish offenders of criminal offenses. We argue that oxytocin promoted empathic concern for the victim, which in turn increased the tendency for prosocial approach behavior regarding the interpersonal relationship between an unaffected third-party and a fictional victim in the criminal scenarios. Future research should explore the context- and person-dependent nature of exogenous oxytocin in individuals with antisocial personality disorder and psychopathy, in whom deficits in empathy feature prominently.
... There are nine symptom clusters, and respondents indicate the amount of disturbance caused by a particular item on a 6-point Likert scale ranging from 1 (not at all) to 6 (extremely). The SCL-90-R has been found to have good reliability and validity (e.g., Buckelew, 1988), and has been normed on multiple groups, including nonpatient adults. The Cronbach's alpha for this sample was .84 for the Depression subscale and .91 for the Somatization subscale. ...
Using telephone surveys, we examined exposure to terror, coping, and mental health response in randomly selected Jewish-Israelis (n = 100) and Arab-Israelis (n = 100) living in five Israeli cities affected by terrorism. Jewish-Israelis and Arab-Israelis were randomly selected for study participation and completed telephone surveys in May 2002, following an extended string of terror attacks and hostilities. Although terrorism is designed to target Jewish-Israelis, the rates of exposure were similar in the two groups. Arab-Israelis reported using a wider array of coping strategies, yet also endorsed more frequent PTSD and more severe depression symptoms than Jewish-Israelis. We examined a variety of demographic, ethnic, and religious predictors of different coping styles and found varying results. For example, acceptance coping was best predicted by Arab-Israeli ethnicity, being female, greater religiosity, and lower education. Predictors of mental health response to terror were also examined, with Arab-Israeli ethnicity, being female, adaptation coping and collaborative coping best predicting PTSD and depression symptoms. Arab-Israelis may not have the same access to overarching sources of patriotic support that are readily available to their Jewish compatriots, and civilian and economic inequity experienced by the Arab minority may add to a sense of diminished resources. Our findings justify outreach efforts to overlooked minorities at risk for posttraumatic distress. Women seem to be at particular risk for the development of mental health symptoms following terrorism, which should also be noted for outreach purposes.
... 24 The SCL-90R and its predecessor (SCL-90) have been used extensively as clinical and research measures with chronic pain patients. 25,26 Modified Pain Disability Index (MPDI) ...
An extensive body of research suggests that maladaptive beliefs about chronic pain can have a negative impact on patient adherence and treatment response. A series of studies to develop and validate a clinically-based, self-report instrument for pain beliefs, the Cognitive Risk Profile for Pain (CRPP), was undertaken. We sought to expand the existing body of knowledge for pain beliefs by development of an instrument with a somewhat different content and format than prior pain belief measures, and a primary focus on clinical risk assessment for treatment planning.
Test development and evaluation procedures were applied in the initial stages of CRPP development. We report here on a series of studies to evaluate and refine the structure and content of the CRPP, and to establish its internal reliability, concurrent, and criterion validities. A 68-item version of the CRPP was evaluated, including a total risk score and 9 scale scores: philosophic beliefs about pain (PB), denial that mood affects pain (MP), denial that pain affects mood (PM), perception of blame (BL), inadequate support (IS), disability entitlement (DE), desire for medical breakthrough (MB), skepticism of multidisciplinary approach (SM), and conviction of hopelessness (CH). The CRPP was administered to two large samples of chronic pain outpatients (n=499; 125) in conjunction with other self-report scales for pain and associated beliefs, behaviors, and psychopathology. In a final study, treatment outcome measures were obtained for a subsample of chronic pain patients (n=91) to evaluate criterion validity.
Confirmatory factor analyses showed improved fit for the CRPP scale structure after elimination of 15 items. The resulting 53-item CRPP was found to have good internal consistency for the full score (alpha=0.82) and 7 of 9 scales, with moderate consistency for scales BL and MB. Low to moderate scale intercorrelations were found. Correlations with pain and psychosocial measures suggested good construct validity for the majority of individual scales and total score. Results were inconsistent for scale MP. Multivariate analyses of variances (MANOVAs) based on tertile split of total risk scores showed significant main effects across pain, mood, productivity, and sleep ratings at 3 and 6-month treatment follow-ups. Analyses of clinically significant treatment changes (ie, 2 points on a 11-point Numerical Rating Scales) showed significantly higher prevalence of treatment "failures" at 6 months among CRPP high-risk patients, but no significant differences at 3 months.
Results provide initial support for the CRPP as a reliable, valid, and useful measure of general cognitive risk for pain management. Results were supportive of the content and reliabilities of the majority of scale scores. Scales for denial of mood impact on pain, perception of blame, and desire for medical breakthrough will require further evaluation. Data indicate an association of CRPP total risk with multidimensional outcome from medical treatment of chronic pain, supporting relevance to treatment planning. The unique content and format of the CRPP may be useful in some clinical pain settings. Possible applications of the CRPP for risk assessment and treatment planning for chronic pain are discussed.
It was hypothesized that client vocational interest scores would predict client reactions to counselor intentions in Hill and O'Grady's (1985) process model. Twenty‐four volunteer undergraduate clients (17 women, 7 men) assigned to counseling treatment with 24 doctoral students (14 women, 10 men), reviewed 3 videotaped sessions recording intentions and reactions, respectively. Results indicated that client vocational interests were predictive of reactions clients reported in response to counselor intentions. Issues of working with persons with various vocational interests, limitations, and directions for future research are discussed.
Given the lack of understanding of how Korean immigrants express depressive symptoms, the purpose of this descriptive correlational study was to describe somatic symptoms and depressive symptoms and examine the relationship between them, as reported by older adult Korean immigrants. Purposive sampling was used in this study of 160 older adult (ages 65 to 91) Korean immigrants. Most of these participants immigrated to the United States at an older age. They reported a high level of depressive symptoms, and these symptoms were closely associated with somatic symptoms, a finding which coincides with previous studies differentiating Korean individuals from individuals of other cultures. The findings from this study highlight the need for health care providers to be aware of and recognize cultural differences in how patients express depressive symptoms somatically when assessing and treating depression within the older adult Korean immigrant population. [Journal of Gerontological Nursing, xx(x), xx-xx.].
Although a number of investigations have provided evidence for an association between antisocial personality disorder and somatization disorder, the variables underlying this association remain unknown. We examined the relations among measures of primary and secondary psychopathy, somatization, and negative emotionality (NE) in 150 undergraduates. Somatization was positively and significantly correlated with measures of secondary, but not primary, psychopathy, and the relations between secondary psychopathy indices and somatization tended to be significantly stronger in females than in males. Some support was found for the hypothesis that the association between secondary psychopathy and somatization is mediated by NE, but not for the hypothesis that low levels of behavioral inhibition lead to somatization. Although the present findings are consistent with the possibility that somatization is a sex-differentiated manifestation of secondary psychopathic traits, replication of these findings in clinical samples will be necessary.
The relationships among expectation, satisfaction and anxiety, as well as among these factors and the perception of recovery and physician assessment of recovery, are examined in a longitudinal study of patients' attitudes just prior to post-cardiac catheterization treatment. Final assessment of recovery was made six weeks later by interviewing patients (perceived recovery) and the physician (actual medical assessment of recovery). Positive expectations and present satisfaction were negatively correlated with state anxiety, but not associated with perceived or physician assessed recovery. Only patient age was a predictive factor for recovery. Positive correlation between subjective and objective assessments of recovery was found for all age groups, being strongest among young people.
Explored the appropriateness of the Brief Symptom Inventory (BSI) as a measure of psychological distress among 79 traumatic spinal cord injured (SCI) patients (aged 18–70 yrs) and emphasized the limitations of using the BSI as a replacement for the SCL-90—Revised (SCL-90—R). Ss' BSI scores were compared with a nonpatient normative group (N = 974). Ss were significantly more psychologically distressed in somatization, depression, and phobic anxiety than the normative group. However, several somatization symptoms endorsed by these Ss are common physical effects of SCI rather than psychosomatic complaints. When comparing BSI and SCL-90—R scores of the same Ss, significant statistical differences were found with respect to the level of psychological distress being reported by each test. The BSI may not represent an equivalent abbreviated form of the SCL-90—R for the SCI population. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Study Design: A survey of pain intensity and psychological symptoms in patients with chronic neck pain after whiplash injury.
Objectives: To describe the pain and psychological profiles of patients with chronic whiplash.
Summary of Background Data: Reports in the literature mention a constellation of symptoms associated with chronic whiplash injury but no systematic survey using objective patient report measures has been reported.
Methods: One hundred forty consecutive referred patients with chronic neck pain after a motor vehicle accident were studied using the SCL-90-R psychological profile and the McGill Pain Questionnaire.
Results: Psychological profiles and pain intensity ratings, similar to profiles obtained from patients suffering from rheumatoid arthritis and low back pain of organic origin, were obtained.
Conclusions: The SCL-90-R is a convenient instrument to administer to patients with whiplash. It yielded a characteristic profile of pain and appears to be more expedient than other psychometric tests for these patients.
We conducted a study to examine prevalence, predictors, and concomitants of acute stress disorder (ASD) following diagnosis of cancer among 89 patients. In addition to other measures, each participant completed the Stanford Acute Stress Reaction Questionnaire (SASRQ). One-third (33%) of the sample met all ASD symptom criteria. Significantly more women than men met criteria for ASD. For women, predictors for ASD symptoms included being of a younger age, having no prior life-threatening illness, perceiving less social support from friends, and reporting less satisfaction with how the diagnosis got communicated to them. A statistical trend was evident between higher religious/spiritual commitment and fewer ASD symptoms. For men, no factors were significantly related to ASD symptoms. Overall among cancer patients, those who met symptom criteria for ASD reported significantly more impulsive spending, desire to run away to avoid contact with people, giving away personal belongings, thinking about suicide, and forgetting medical information following cancer diagnosis than did cancer patients who did not meet criteria for ASD.
The purpose of this study was to assess the nature and severity of psychological symptoms of distress as reported by patients in a rehabilitation setting. We used the Symptom Checklist 90—Revised (SCL-90-R) to differentiate between levels of distress among our sample of 104 rehabilitation patients and the norms for adult psychiatric and normal populations. The study also attempted to determine if the levels of distress differed among four diagnostic groups (amputees,n=21; brain injury,n=23; cerebrovascular accident group,n=24; and mixed diagnostic group,n=36). Results indicated that our sample differed significantly in the anticipated direction from nonpatient and outpatient psychiatric norms. Our findings did not support the use of the SCL-90-R as a single-criterion screening device. However, our findings confirmed that the SCL-90-R has considerable utility in rehabilitation settings as a research instrument for measuring group differences.
A systematic review.
To review and assess the psychometric properties of depression and anxiety instruments used with populations with spinal cord injury (SCI).
Vancouver, Canada.
Electronic databases were searched for papers reporting psychometric properties of depression and anxiety instruments. Pre-established criteria were used to assess the psychometric properties.
Thirteen papers reporting on the psychometric properties of 13 depression and anxiety instruments are used in this review, and include BDI, BSI, CESD-20, CESD-10, DASS-21, GHQ-28, HADS, Ilfeld-PSI, MEDS, PHQ-9, PHQ-9-Short, SCL-90-R, and the Zung SRS. Reliability data are available for 10 instruments, and validity results are available for 12 instruments. Evidence spanned the spectrum of evaluation criteria varying from poor to excellent. Responsiveness data are generally lacking.
Given that the reliability and validity findings range for the most part from adequate to excellent, and the large amount of work to develop cutoff scores specific for populations with SCI, at present there is no need to develop SCI-specific instruments. As psychometric properties of one measure do not clearly stand out, it is difficult to recommend the use of one over another. Overall, more psychometric data are needed, and if the instruments are to be used to evaluate treatment outcomes or change over time, responsiveness data are also required. Administering the instruments in tandem with each other and with clinical diagnostic interviews would provide valuable information, as would comparison of results to normative data specific to individuals with SCI.
Recent research has begun to document the relationship between chronic pain and psychologic distress among pain patients, yet little attention has been given to the spouses' reaction to the chronic pain condition. The results of this research using the Symptom Checklist-90 (SCL-90) to assess the psychologic distress among both chronic pain sufferers and spouses (61 couples) reveal elevated distress scores among both groups when compared with the norms from a nonpatient sample. Patients and spouses present similar profiles according to the SCL-90 subscales, with patients' scores significantly higher on the somatization, hostility, and psychoticism subscales. No differences by sex were found.
Do spinal cord injured patients who accept responsibility for their injury cope better than those who blame others? Previous investigations have yielded conflicting answers to this question. On the assumption that some portion of the disparity in earlier findings derives from the failure of early investigators to conceptualize "blame" as a dynamic phenomenon, the present study approached the question via a longitudinal study. Specifically, we examined: (1) the evolution of patients' perceptions of responsibility for spinal cord injury, and (2) the changing association of this factor with depression over a 2-year period, beginning with inpatient rehabilitation. Eighteen men with traumatic spinal cord injury were evaluated during acute rehabilitation and again at 18 to 24 months following discharge. Patients assigned proportions of blame for their injury to four possible causal factors (self, environment, chance, others). Three indices of depression were derived from the Beck Depression Inventory (BDI). Eighty-nine percent of the subjects displayed shifts in pattern of blame assignment between initial and follow-up evaluations. Individuals whose self-blame score increased over time exhibited increased depression, as did those who came to attribute to "chance" lesser blame for their injury. During inpatient rehabilitation, no aspect of blame correlated significantly with any of the three BDI indices, although "other blame" and the cognitive/affective BDI index just failed to reach conventional levels (r = .43, p = .07). By contrast, at follow-up evaluation, "self blame" was positively correlated with both the cognitive/affective (r = .51, p = .03) and Total (r = .46, p = .05) BDI scores. All other correlations were not statistically meaningful.(ABSTRACT TRUNCATED AT 250 WORDS)
This research investigated gender differences in psychological adjustment among patients (112 males, 39 females) one year after coronary artery bypass graft surgery (CABG). Information regarding post-CABG depression, non-cardiac chronic conditions, and socioeconomic variables were obtained from a survey. Additional cardiac, surgical, and demographic data were retrieved from a hospital computer database. Women were more likely than men to experience postoperative depression, attributable to their poor health. Depression one year post-CABG was predicted by non-cardiac chronic illnesses, postoperative fatigue and shortness of breath and socioeconomic status.
To review critically the measures used to screen for depression for disability outcomes research and to recommend measures and needed research.
Review of literature pertaining to the development, testing, and use of depression measures for outcomes research.
English language literature from scientists from a broad range of disciplines and research settings, focusing mainly on the Brief Symptom Inventory and the Center for Epidemiology Study-Depression scale.
A literature review was completed through MEDLINE. Based on the review, instruments were selected according to their use among people with disability and the reliability and validity of the instrument. Two instruments were selected for a complete review, and 5 instruments were selected for a brief review.
A critical review of measures that have been and may be used to measure depressive symptomatology among people with disability.
Screening measures of depression are easy to administer and score. Almost all have low respondent burden and good face validity, thereby contributing to a high participation rate for most studies. Some problems exist with the application of these instruments to people with disability (ie, overlap of symptoms of depression and indicators of physical impairment).
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