Reliability and validity of the Greek version of the Derogatis Psychiatric Rating Scale (DPRS)

BACKGROUND: The aim of this paper is to report on the Greek version of the Derogatis Psychiatric Rating Scale (DPRS) and its validity and reliability when administered to a Greek sample. The DPRS is a clinician-rated measure of psychiatric symptoms with nine basic and eight complementary symptom dimensions and a Global Pathology Index. METHOD: The DPRS was translated into Greek and administered to 161 psychiatric patients and healthy volunteers. Its validity was assessed against the Semistructured Clinical Interview (SCID) and the Symptoms Checklist-90-Revised (SCL-90-R). The inter-rater reliability and test-retest reliability were also evaluated for each symptom dimension. RESULTS: All the symptom dimensions of the DPRS, except euphoria, have concurrent validity with the SCID on the relevant symptom dimensions diagnoses set by the interview. At the cut-off point 2/3 the DPRS has a sensitivity of 98% and a specificity of 74% in indicating active psychiatric patients. The symptom dimensions of the DPRS also have strong correlations with the relevant dimensions of SCL-90-R. The range for inter-rater reliability was from 0.48 to 0.88, the range for test-retest reliability was from 0.25 to 0.85, and the internal consistency was 0.90. CONCLUSION: The Greek version of the DPRS has acceptable psychometric properties, rendering it a useful screening instrument of global psychopathology as well as a multidimensional measure of some basic psychiatric symptoms.     

Posttraumatic stress disorder: do electrical startle responses and thyroid function usefully supplement self-report? A study of Vietnam War veterans

OBJECTIVE: To investigate the usefulness of electrical startle responses and thyroid function as supplements to self-report measures of posttraumatic stress disorder (PTSD). METHOD: Invitations were sent to all New Zealand Vietnam War veterans known to be living in North Canterbury; 50 responded and the 35 living in or near Christchurch were included. Self-report measures of PTSD (the Davidson Trauma Scale (DTS) and the Symptom Check List (SCL-90-R) ), an eye blink electrical startle response and thyroid function were measured. The DTS was re-administered one to two weeks later to assess short-term test-retest reliability. Six months later the DTS and the electrical startle response were measured again. RESULTS: The veterans reported a wide range of PTSD severity, with 15/35 reporting prior diagnosis of PTSD. The DTS showed high short-term test-retest reliability (r = 0.93) and a moderate correlation after 6 months (r = 0.73). It also showed sensitivity to change; in one to two weeks the scores increased by nearly half a standard deviation, possibly because of an imminent "homecoming" march. The DTS and a PTSD scale from the SCL-90-R were highly correlated (r = 0.89). The total triiodothyronine (T3) to free thyroxine (T4) ratio measure of thyroid function correlated poorly with self-report (r < or = 0.27). The electrical startle response also correlated poorly with self-report (r < or = 0.26), showed low internal consistency between left and right sides (r = 0.43), and correlated 0.39 over six months. It was disliked by the veterans and had increased slightly at 6 month follow-up, perhaps because of sensitization. CONCLUSIONS: The DTS was reliable and correlated highly with the SCL-90-R PTSD scale. Neither thyroid function nor eye blink electrical startle correlated with each other or with self-report, and reliability was not good for electrical startle. These two measures do not appear to add anything useful to the assessment of PTSD.     

Comparison between administration via Internet and paper-and-pencil administration of two clinical instruments: SCL-90-R and GHQ-28

The objective of this study is to compare the results of the Symptom Check List (SCL)-90-R and the General Health Questionnaire (GHQ)-28 administered on paper with the results of administration via Internet. Forty university students were asked to respond to the two questionnaires, first in one format (Internet or paper), and 1 week later in the other format. For the GHQ-28, no statistically significant differences were found between the two forms of presentation, Internet or paper, except in the social dysfunction subscale. In the case of the SCL-90-R, there were differences in the Positive Symptoms Distress Index (PSDI) and in the somatization and obsession-compulsion subscales. The effect of using the two formats in combination was also analyzed. Internal consistency of the instruments is high for both types of presentation (alpha=0.91 in GHQ-28; alpha=0.97 in SCL-90-R). Correlation between the two formats is also high, with values ranging between 0.76 and 0.92, p<0.001, except in the social dysfunction subscale. Finally, correlation between the GHQ-28 and SCL-90-R is also high, for both the paper and Internet results (r=0.88, p<0.01 on paper and r=0.83, p<0.01 via Internet). The differences found should be verified in future research with other types of sample.     

Conversion and somatization disorders; dissociative symptoms and other characteristics

OBJECTIVE: There is a difference in classification of conversion disorder in ICD-10 and DSM-IV. Conversion disorder is included in dissociative disorders in ICD-10. In view of this, we aimed to clarify this discrepancy in the classification of this diagnosis. METHODS: We assessed 87 patients with conversion disorder and 71 patients with somatization disorder for sociodemographic characteristics, suicide ideation, psychiatric symptoms and dissociative symptoms using the Patient Information Form, the Dissociative Experience Scale (DES), the Symptom Check List (SCL-90-R) and the Suicide Ideation Scale. RESULTS: The number of the high school graduates, singles and students with conversion disorders was higher than the number of patients with the same characteristics who have somatization disorder. In conversion disorder, the SCL-90-R total score and the score in paranoid ideation, psychoticism subgroups were higher than the scores in somatization disorders. There were no statistical differences in suicide ideation and the total score of dissociative symptoms between the two disorders. The number of patients whose total DES score of 30 and above was higher in conversion disorders. DISCUSSION: As a result of this present study, we concluded that to enlighten the concepts of conversion, further somatization and dissociation studies are necessary.     

Stress, coping, and depression in non-ulcer dyspepsia patients

Thirty adults with upper gastrointestinal symptoms in the absence of structural organic disease diagnosed with non-ulcer dyspepsia (NUD) were compared to 30 healthy adults who had visited the hepatobiliary clinic for medical evaluation of non-organic complaints without NUD. Medical investigation in both groups were negative. Before independent gastrointestinal physicians conducted diagnostic evaluations, all subjects were evaluated for anxiety and depressive symptoms, stressful life events, coping style, and social support. The measures included Symptom Checklist 90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Ways of Coping Checklist, and Interpersonal Support Evaluation List, and a self-report questionnaire, which measured the quantity of perceived stressful life events. The NUD patients reported significantly more symptoms of depression, more perceived stressful life events, less problem-focused coping, and less social support than the control subjects. Depressive symptoms were negatively correlated with interpersonal support, whereas, problem-focused coping was positively correlated with interpersonal support in the NUD patients. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. The implications of these findings for the diagnosis and treatment of NUD are discussed.     

失眠症患者心理社会因素分析

目的:探讨失眠症患者的应付方式,心理健康状况和社会支持状况.方法:采用应付方式问卷(CSQ)、症状自评量表(SCL-90)和社会支持量表(SSS)对失眠症患者和正常对照者各88例进行测评.结果:失眠症组自责、幻想和退避分量表的得分显著高于对照组,求助分量表的得分显著低于对照组(P＜0.01);失眠症组SCL-90总分及躯体化、抑郁、焦虑、睡眠障碍各因子分与对照组比较,有显著差异(P＜0.01).失眠症组社会支持总分、客观支持和对社会支持的利用度评分显著低于正常对照组(P＜0.05).失眠症组自责与躯体化症状、焦虑、抑郁等因子及总分呈显著正相关,而求助与焦虑、抑郁、偏执和总分呈显著负相关(P＜0.05).结论:失眠症患者多采用不成熟的应付方式,且有较多的心身症状,应付方式和身心健康有相关性.失眠症患者缺乏社会支持.     

Do changes on MCMI-II personality disorder scales in short-term psychotherapy reflect trait or state changes?

The Millon Clinical Multiaxial Inventory (MCMI) has become an important and commonly used instrument to assess personality functioning. Several studies report significant changes on MCMI personality disorder scales after psychological treatment. The aim of the study was to investigate whether pre-post-treatment changes in 39-session psychodynamic group psychotherapy as measured with the MCMI reflect real personality change or primarily reflect symptomatic state changes. Pre-post-treatment design included 236 psychotherapy outpatients. Personality changes were measured on the MCMI-II and symptomatic state changes on the Symptom Check List 90-R (SCL-90-R). The MCMI Schizoid, Avoidant, Self-defeating, and severe personality disorder scales revealed substantial changes, which could be predicted from changes on SCL-90-R global symptomatology (GSI) and on the SCL-90-R Depression scale. The MCMI Dependent personality score was the only MCMI personality scale showing significant change when the SCL-90-R Depression change score was included as a covariate. Splitting patients into those with and without personality disorders did not change the results. Observed changes on MCMI-II personality disorder scales in short-term psychotherapy reflect change in symptomatic state. The MCMI-II Base Rate cut-off points probably include too many patients, justifying the introduction of new scoring procedures in the MCMI-III.     

Mørder,notitser og personalia

The Millon Clinical Multiaxial Inventory (MCMI) has become an important and commonly used instrument to assess personality functioning. Several studies report significant changes on MCMI personality disorder scales after psychological treatment. The aim of the study was to investigate whether pre–post-treatment changes in 39-session psychodynamic group psychotherapy as measured with the MCMI reflect real personality change or primarily reflect symptomatic state changes. Pre–post-treatment design included 236 psychotherapy outpatients. Personality changes were measured on the MCMI-II and symptomatic state changes on the Symptom Check List 90-R (SCL-90-R). The MCMI Schizoid, Avoidant, Self-defeating, and severe personality disorder scales revealed substantial changes, which could be predicted from changes on SCL-90-R global symptomatology (GSI) and on the SCL-90-R Depression scale. The MCMI Dependent personality score was the only MCMI personality scale showing significant change when the SCL-90-R Depression change score was included as a covariate. Splitting patients into those with and without personality disorders did not change the results. Observed changes on MCMI-II personality disorder scales in short-term psychotherapy reflect change in symptomatic state. The MCMI-II Base Rate cut-off points probably include too many patients, justifying the introduction of new scoring procedures in the MCMI-III.     

Relationship of Internet addiction with impulsivity and severity of psychopathology among Turkish university students

The previous studies have found a relationship between IA and both impulsivity and psychopathology when they were considered separately. The aim of this study was to investigate the relationship of Internet addiction (IA) with impulsivity and severity of psychopathology among Turkish university students. We also wanted to control the effect of impulsivity dimensions on the relationship between IA and psychopathology. A total of 319 university students from two universities in Ankara participated to the study. Students were assessed through the Internet Addiction Scale (IAS), the Symptom Checklist-Revised (SCL-90-R) and the Barratt Impulsiveness Scale-11 (BIS-11). Correlational analyses revealed that severity of IA was related to both SCL-90-R and BIS-11 scores. Among SCL-90-R subscales, severity of obsessive-compulsive symptoms (OCS) was the only predictor for IAS score. Hierarchical regression analysis indicated that interpersonal sensitivity, additional to attentional and motor impulsiveness, was the predictor of IAS score. Although severity of IA is associated with wide range of psychopathology, particularly OCS, interpersonal sensitivity seems to be the main dimension that predict severity of IAS additional to impulsiveness (attentional and motor). Impulsivity seems to be an important construct when considering IA and its treatment among Turkish university students.     

A clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R) in general population studies (Denmark,Norway, and Italy)

Background: Although the Symptom Checklist (SCL-90-R) is one of the most widely used self-reported scales covering several psychopathological states, the scalability of the SCL-90-R has been found to be very problematic. Aims: We have performed a clinimetric analysis of the SCL-90-R, taking both its factor structure and scalability (i.e. total scale score a sufficient statistic) into account. Methods: The applicability of the SCL-90-R has been found acceptable in general population studies from Denmark, Norway and Italy. These studies were examined with principal component analysis (PCA) to identify the factor structure. The scalability of the traditional SCL-90-R subscales (i.e. somatization, hostility, and interpersonal sensitivity) as well as the affective subscales (i.e. depression and anxiety and ADHD), were tested by Mokken’s item response theory model. Results: Across the three general population studies the traditional scaled SCL-90-R factor including 83 items was identified by PCA. The Mokken analysis accepted the scalability of both the general factor and the clinical SCL-90-R subscales under examination. Conclusion: The traditional, scaled, general 83 item SCL-90-R scale is a valid measure of general psychopathology. The SCL-90-R subscales of somatization, hostility, and interpersonal sensitivity as well as the affective subscales of depression, anxiety, and ADHD were all accepted by the Mokken test for scalability, i.e. their total scores are sufficient statistics.     

Psychological symptom patterns and vital exhaustion in outpatients with chronic obstructive pulmonary disease

Background

Several studies have reported high prevalence of anxiety and depression in chronic obstructive pulmonary disease (COPD) outpatients. Moreover, these patients share psychological or psychopathological characteristics that inhibit their ability to cope with the disease. In the present study we aimed to record the prevalence of psychological symptom patterns in a sample of Greek COPD outpatients and to assess which psychological factors (and to which degree) contribute to vital exhaustion (VE).

Methods

The study included 139 COPD outpatients. We used the Symptom Checklist 90 - Revised (SCL-90-R) and the Maastricht Questionnaire (MQ) in order to evaluate psychological symptom patterns and VE, respectively.

Results

The mean MQ score was 19.6, which is significantly higher than the corresponding score in the general population. Regarding the SCL-90-R dimensions, depression was the highest followed by somatization, obsessive-compulsive and anxiety dimensions. Additionally, a positive correlation was observed between the MQ and the SCL-90-R dimensions. MQ failed to demonstrate correlation with age, gender, education level or the severity of the disease. Depression seems to be responsible for 57.9% of the variation of VE, while obsessive-compulsiveness is responsible for an additional 2.4%. All the remaining dimensions of SCL-90-R had no statistically significant contributions.

Conclusions

Our findings suggest the high prevalence of VE, together with high rates in most of the SCL-90-R dimensions with greater depression, somatization, obsessive-compulsiveness and anxiety in a Greek COPD group at various Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria stages. The coexistence of such symptoms should be further assessed as an eventual unfavorable prognostic factor.     

2型糖尿病患者负性情绪研究

目的：探讨负性情绪与2型糖尿病的关系。方法：对51例2型糖尿病患者与50例正常对照者进行负性情绪比较，采用生活事件量表（LES）、社会支持评定量表（SSRS）、症状自评量表（SCL-90）、抑郁自评量表（SDS）及焦虑自评量表（SAS）测评。结果：与对照组比较，糖尿病组的负性生活事件刺激量和总刺激量得分均显著较高（P均〈0．01）；而社会支持总分、主观支持分及支持利用度分均显著较低（P均〈0．01）。糖尿病组SCL-90总分及躯体化、人际关系敏感、抑郁、焦虑、敌对、恐惧6个因子分与SDS、SAS评分均显著高于对照组（P〈0．05或P〈0．01）。结论：2型糖尿病患者存在明显的负性情绪，有针对性的心理干预可能对其防治起重要作用。     

Replication of dissociation-psychosis link in New Zealand students and inmates

To assess the relationship between dissociative and psychotic experiences, New Zealand university students (N = 119) and prison inmates (N = 42) were administered the Dissociative Experiences Scale (DES) and Symptom Checklist-90-Revised (SCL-90-R). Strong correlations were found between DES scores and the psychoticism and paranoid ideation subscales of the SCL-90-R (students: r = .520, .517, respectively; inmates: r = .637, .649, respectively). While other correlations were also significant (but smaller), these results are consistent with previous studies that have used a range of measures of psychosis or schizotypy with a variety of clinical and nonclinical populations. Such consistent findings in the face of methodological diversity offer strong support for the validity of a link between the concepts of dissociation and psychosis. While this relationship has previously been interpreted indirectly, as dissociative experiences predisposing to psychotic symptoms, we suggest a direct route: that dissociative experiences of various forms may underlie some (or even all) psychotic symptoms.     

Translation and validation of the Depression Outcomes Module (DOM) in Greece

In Greece, as in other countries, major depressive disorder is underdiagnosed. Its severity, implications and outcomes are often not adequately evaluated. The Depression Outcomes Module (DOM) was developed in order to meet the need for a global assessment of this disorder. The objective of the current study was to estimate the psychometric properties of DOM in a Greek population presenting depressive symptoms. The DOM was translated into Greek. Patients were examined twice (baseline and follow-up assessment). The psychometric properties of DOM were calculated. Subjects were 83 psychiatric inpatients and outpatients presenting depressive symptoms. The measures used were DOM, Structured Clinical Interview for DSM III-R (SCID) and Hamilton Rating Scale for Depression (Ham-D). The results were: (a) baseline assessment: test-retest reliability k = 0.90, internal consistency 0.93, sensitivity 97%, specificity 90%; (b) follow up assessment: test-retest reliability k = 0.89, sensitivity 81% and specificity 67%. Recovery from depression detected by DOM at the follow-up was significantly correlated both with pharmacotherapy and with a combination of pharmacotherapy and supportive psychotherapy. It was concluded that the Greek version of DOM is a comprehensive, useful instrument for diagnosing, assessing depression and evaluating its outcomes.     

Prevalence of psychological symptoms in contemporary Chinese rural-to-urban migrant workers: an exploratory meta-analysis of observational studies using the SCL-90-R

Purpose

(1) To estimate the pooled prevalence of psychological symptoms in Chinese migrant workers (CMWs), as measured using the Symptom Checklist-90-R (SCL-90-R) in observational studies conducted in China, and (2) to explore the potential variables associated with the SCL-90-R Global Severity Index (GSI), the overall mental health indicator of CMWs.

Methods

We performed a comprehensive literature search of the major English and Chinese databases (to June 2012). Cross-sectional surveys and case–control studies of CMWs (and controls where appropriate) that reported at least one subscale score of the SCL-90-R were included. Multilevel meta-analysis was used to pool the symptom scores of cross-sectional surveys and mean differences of symptom scores (“Cohen’s d” values) between CMWs and controls of case–control studies. Multilevel meta-analysis with ecological- or study-level covariates was used to explore the associations between variables and SCL-90-R GSI score.

Results

The search yielded 48 cross-sectional surveys (comprising 42,813 CMWs) and seven surveys that included control samples. The pooled psychological symptom scores (95 % confidence interval) of CMWs were statistically higher than those of norms from Chinese general population on all scales of SCL-90-R, except for obsessive–compulsive subscale in study quality subgroup analysis. CMWs also scored statistically higher than those of urban counterpart controls on all scales of SCL-90-R. Multilevel regression meta-analysis model revealed that four covariates that accounted for 33.9 % of SCL-90-R GSI heterogeneity across all surveys, including: “mean age of study sample,” “geographic area,” “per capita GDP,” and “statutory minimum monthly wage” of study site in implementation year.

Conclusion

CMWs have more severe psychological symptoms than the general population, and thus, appear to experience higher level of psychological distress. Macro-economic factors may have impact on the overall mental health of CMWs, but the factors that contribute to mental health and mental distress among CMWs remain to be explored and understood.     

A new rating scale for adult ADHD based on the Symptom Checklist 90 (SCL-90-R)

Attention deficit hyperactivity disorder (ADHD) in adults is increasingly recognized as a clinically important syndrome. The aim of this study was to evaluate the psychometric performance of a new scale for adult ADHD based on the widely used Symptom Checklist 90 Revised (SCL-90-R). Scale performance was assessed in a clinical study including 100 ADHD patients and 65 opiate-dependent patient controls, and in the Zurich study, an epidemiological age cohort followed over 30?years of adult life. Assessments included a ROC analysis of sensitivity and specificity, internal consistency, test-retest reliability, external validity and measurement invariance over nine testing occasions. The new scale showed a sensitivity and specificity of 75 and 54%, respectively, internal consistency over 0.8 (McDonald's omega, Cronbach's alpha), one-year test-retest reliabilities over 0.7, statistically significant and substantial correlations with two other validated self-rating scales of adult ADHD (R?=?0.5 and 0.66, respectively), and an acceptable degree of longitudinal stability (i.e., measurement invariance). The proposed scale must be further evaluated, but these preliminary results indicate it could be a useful rating instrument for adult ADHD in situations where SCL-90-R data, but no specific ADHD assessment, are available, such as in retrospective data analysis or in prospective studies with limited methodical resources.     

The COOP/WONCA charts in an acute psychiatric ward. Validity and reliability of patients' self-report of functioning

We wanted to examine whether persons needing acute psychiatric admittance can give us reliable information about their functional status with the COOP/WONCA charts (Dartmouth Primary Care Cooperative Information Project-World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians), and if this information parallel that of therapists and ward staff. To examine internal consistency, external reliability and test-retest reliability, all patients consecutively admitted to an acute psychiatric department were asked to fill in the COOP/WONCA, Short-Form-36 Health Survey (SF-36) and Symptom Checklist 90--Revised (SCL-90-R) 1-2 weeks after admittance. Their therapists scored a special version of the GAF, and the ward staff scored an observer version of the COOP/WONCA. The first 59 patients repeated the COOP/WONCA scoring after a few days to estimate of test-retest reliability. Of a total of 267 persons admitted in the study period, 102 were included. Non-inclusion was largely due to early discharge. The internal consistency of the COOP/WONCA corresponded to a Cronbach's alpha=0.85. External reliability versus the SF-36 resulted in a correlation of r=-0.82 (P<0.001), and versus the observer version of COOP/WONCA we found r=0.46 (P<0.001). Correlation with GAF was low and not significant. The COOP/WONCA correlated significantly with the SCL-90-R scores (r=0.59, P<0.001). The test-retest correlation was r=0.85 (P<0.001). Correlations varied between sub-groups of patients, but all had consistently high correlations between the various self-scored measures. The COOP/WONCA gives a consistent and reliable report of acutely admitted psychiatric inpatients' own views of their functional capacity. The therapists' views and to some degree the ward staff's views diverge from the patients' opinions, especially for the more seriously disturbed patients.