Computerized administration of the Symptom Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-C) in psychosomatic outpatients

This study investigated whether the method of administration (computer vs. paper-and-pencil) influenced mean scores on the Symptom-Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-C). The performance of 32 psychosomatic outpatients on the computerized version was compared with the performance of a matched control group on the paper-and-pencil version. No systematic differences were observed in group means.     

Alexithymia and personality in relation to dimensions of psychopathology

OBJECTIVE: The authors examined the capacity of alexithymia to predict a broad range of psychiatric symptoms relative to that of other personality dimensions, age, and gender. METHOD: The Toronto Alexithymia Scale, the Temperament and Character Inventory, and the SCL-90-R were administered to 254 psychiatric patients. Multivariate linear regression analyses were performed. RESULTS: The difficulties identifying feelings factor of the Toronto Alexithymia Scale significantly predicted all SCL-90-R subscale scores and was particularly effective, relative to the personality dimensions of the Temperament and Character Inventory, in predicting somatization. The Temperament and Character Inventory dimensions emerged as distinct and conceptually meaningful predictors for the different SCL-90-R subscales. CONCLUSIONS: A broad range of current psychopathology is associated with difficulties in cognitively processing emotional perceptions. Further research needs to clarify whether alexithymia represents a risk factor for mental illness and poorer outcome.     

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.     

Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder

OBJECTIVE: The objective of this study was to examine the effectiveness of a meditation-based stress management program in patients with anxiety disorder. METHODS: Patients with anxiety disorder were randomly assigned to an 8-week clinical trial of either a meditation-based stress management program or an anxiety disorder education program. The Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory, and the Symptom Checklist--90-Revised (SCL-90-R) were used to measure outcome at 0, 2, 4, and 8 weeks of the program. RESULTS: Compared to the education group, the meditation-based stress management group showed significant improvement in scores on all anxiety scales (HAM-A, P=.00; STAI state, P=.00; STAI trait, P=.00; anxiety subscale of SCL-90-R, P=.00) and in the SCL-90-R hostility subscale (P=.01). Findings on depression measures were inconsistent, with no significant improvement shown by subjects in the meditation-based stress management group compared to those in the education group. The meditation-based stress management group did not show significant improvement in somatization, obsessive-compulsive symptoms, and interpersonal sensitivity scores, or in the SCL-90-R phobic anxiety subscale compared to the education group. CONCLUSIONS: A meditation-based stress management program can be effective in relieving anxiety symptoms in patients with anxiety disorder. However, well-designed, randomized, and controlled trials are needed to scientifically prove the worth of this intervention prior to treatment.     

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.     

Anxiety and caffeine consumption in people with anxiety disorders

Forty-three anxiety disorder patients (DSM-III) who completed the Hopkins Symptom Checklist (SCL-90-R) and a caffeine questionnaire were compared to 124 medical inpatients. Eighty-four percent of the anxious patients were low caffeine consumers (0-249 mg/day) compared to 41% of medical inpatients; 65% of anxiety patients consumed less than 100 mg/day. In anxiety patients, there were no significant correlations between subscale scores of the SCL-90-R and amount of caffeine consumption. Patients who consumed less than 100 mg/day did not differ on anxiety subscale scores of the SCL-90-R from those who consumed more. However, patients who reported becoming anxious in response to drinking coffee had higher SCL-90-R anxiety subscale scores than patients who did not, even though their daily consumption was not different. It appears that anxiety disorder patients have increased caffeine sensitivity which leads to decreased consumption.     

Computer-administered cognitive-behavioral therapy for depression

The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria (RDC) for major or minor depressive disorder. Patients were randomly assigned to computer-administered cognitive-behavioral treatment, to therapist-administered cognitive-behavioral treatment, or to a waiting-list control condition. After treatment and at 2-month follow-up, both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory, SCL-90-R depression and global scales, Hamilton Rating Scale for Depression, and Automatic Thoughts Questionnaire. The treatment groups did not differ from each other at either time.     

Differences in 2 diagnostic groups of psychosomatic patients on the Symptom Checklist 90-R (SCL-90-R). Consequences for using SCL-90-R in follow-up research

680 unselected outpatients of our Psychosomatic Clinic were divided into six diagnostic groups and examined by the SCL-90-R. By ANOVA we found differences of means between the diagnostic groups for the global severity score (GSI) and for the subscale scores. We describe the model of Jacobson et al. [1,2] for the determination of cut-off-points and reliable change indices for the assessment of changes over time, e.g. after psychotherapy. Our results lead to the conclusion that, although an overall reliable change index for the GSI can be applied to all psychosomatic patients, cut-off-points should be different following the diagnostic groups. Furthermore, information from the SCL-90-R-subscales as well as other specific symptom scales should be used for the interpretation of significant changes of the GSI.     

Comparison of successful, unsuccessful, and relapsed Vietnam veterans treated for posttraumatic stress disorder

The present study investigated the differences between veterans who benefited from intensive treatment for posttraumatic stress disorder (PTSD) and those who either relapsed or showed no improvement following treatment. Data from 45 combat veterans with PTSD completing at least 6 weeks of treatment in a partial hospitalization program were utilized. Veterans who had improved following treatment and had maintained a positive adjustment 18 months following treatment were found to have had lower rates of alcohol consumption and greater program participation than those who were unimproved or relapsed. These veterans also obtained lower scores on the MMPI-PTSD subscale, the global indices of the SCL-90-R, and seven of nine individual symptom scales of the SCL-90-R. These results were consistent with other recent reports concerning the existence and characteristics of Vietnam veteran symptom overreporters in studies using the MMPI, and suggest possible treatment outcome predictors for these groups.     

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.     

Sociopsychiatric characteristics of adolescents who use computers to excess

OBJECTIVE: This study attempted to investigate current computer use by Korean adolescents, consequences of its excessive use and its relationship to psychiatric symptoms. METHOD: Questions for computer use, Computer-Related Addictive Behavior Inventory (CRABI), computer-induced behavioral alterations and Symptom Checklist-90-Revision (SCL-90-R) were assessed in 1296 students (12-19 years). RESULTS: Students were divided into three group users: minimal users (63.4%), moderate users (30.5%) and excessive users (6.1%). Computer-induced behavioral alterations occurred most frequently to excessive users and it was significantly correlated with total CRABI score. Average score on nine symptom dimensions and three global indexes of SCL-90-R were able to discriminate four decreasing orders of subjective psychiatric complaints: most frequent in excessive users and then moderate, non- and mild users, in order. CONCLUSION: Those adolescents with excessive computer use were found to show serious sociopsychiatric problems.     

Bioenergetic exercises in inpatient treatment of Turkish immigrants with chronic somatoform disorders: a randomized, controlled study

OBJECTIVE: The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. METHOD: In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. RESULTS: According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. CONCLUSIONS: BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.     

Children’s and parent’s psychological profiles in selective mutism and generalized anxiety disorder: a clinical study

Selective mutism (SM) is classified in DSM-5 as an anxiety disorder. The aim of the study was to investigate the psychological features of children with SM and their parental psychological profiles, compared to generalized anxiety disorder (GAD) children and their parents. The parents of 26 preschool children with SM and 32 with children with GAD filled out the child behavior check list for 1½–5 years (CBCL1½–5) and the symptom checklist-90-revised (SCL-90-R). Information about the children and their parents’ histories was collected through clinical interviews. Children with SM scored higher than children with GAD on the CBCL1½–5 withdrawn scale and lower on the attention problems, aggressive behavior, and externalizing problems scales. Mothers of children with SM scored higher on the SCL-90-R obsessive–compulsive subscale and Global Severity Index than mothers of children with GAD, while fathers of children with SM scored higher on the SCL-90-R Phobic Anxiety subscale and on the Global Severity Index than fathers of children with GAD. Parents of children with SM displayed a greater presence of stressful life events than parents of children with GAD. Data appeared to confirm that SM and GAD share a common anxious core, though some differences in the children’s psychological profiles and the parents’ history and personality emerged. Future research should focus on the role of external factors, such as parent–child relationship, in the development of SM.     

Does the Edinburgh Postnatal Depression Scale measure anxiety?

OBJECTIVE: The existence of a separate anxiety and depression dimension within the Edinburgh Postnatal Depression Scale (EPDS) has been reported previously. However, the concurrent validity of this anxiety subscale was never evaluated. We investigated whether (1) this existence of an anxiety subscale could be confirmed and (2) it more highly correlated with other measures of anxiety than the total EPDS. METHODS: The SCL-90-R, the EPDS, and the State-Trait Anxiety Inventory (STAI) were filled out by 197 pregnant women. A principal component analysis (PCA) was used for confirmation of the subscales and correlations were computed between the (subscales of the) EPDS and the other measures of anxiety. RESULTS: The existence of an anxiety scale within the EPDS was confirmed. However, this subscale did not yield higher correlations with other measures of anxiety than did the total EPDS. CONCLUSION: Investigators using the EPDS to screen for depression should realise that the instrument does not exclusively measure depression. It seems that both anxiety symptoms and depressive symptoms are more accurately measured when using the total 10-item EPDS than when using the subscales.     

Anxiety, type A behavior, and cardiovascular disease

Males with anxiety disorders appear to have increased mortality due to circulatory system disease, and Type A behavior is a risk factor for coronary heart disease (CHD). Thus, we determined Type A behavior in anxious patients. Fifty-seven DSM-III defined anxiety disorder patients completed the Jenkins Activity Survey (JAS) and Symptom Checklist-90-Revised (SCL-90-R). Significantly more male (92%) than female (52%) anxious patients had Type A behavior. Correlations between the JAS scales and SCL-90-R subscales were also different between male and female patients; in males, significant correlations were observed for SCL-90-R anxiety with both JAS Type A and JAS Hard-Driving and Competitive, and for SCL-90-R hostility with JAS Hard-Driving and Competitive. However, there were no consistent correlations between the JAS and the SCL-90-R subscales in females. A trend for fathers of anxious patients to have an increased prevalence of CHD was also observed. The increased incidence of Type A behavior in male, but not in female, anxious patients suggest a mechanism for increased mortality due to circulatory disease in male anxiety patients.     

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders

OBJECTIVE: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. METHOD: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures--the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory--were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. RESULTS: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p < .05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p < .05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p < .05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r = 0.49, p < .001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r = 0.51, p < .001; anxiety disorder: r = 0.57, p < .001). CONCLUSION: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.     

Computer-administered rating scales for social anxiety in a clinical drug trial

Computer-administered versions of two clinician-administered symptom rating scales for social anxiety (the Liebowitz Social Anxiety Scale [LSAS] and the Brief Social Phobia Scale [BSPS]) and one paper-and-pencil scale (the Fear Questionnaire) were developed and utilized in a clinical trial for social phobia. The reliability and validity of the computer versions were examined, as were their equivalence to the traditional versions. Correlations between the computer and original versions were high at baseline, and remained high throughout the study. The internal consistency reliability of the computer scales was also high, and almost identical to the original versions. Mean score differences between computer and original versions were not significant at baseline, and no significant differences were found between computer and traditional versions on the amount of change detected from baseline to endpoint. Seventy-seven percent of subjects felt that the computer did not interfere with their visit at baseline and a plurality (36%) preferred the computer, with 30% preferring the clinician and 34% having no preference. By the end of the study, the plurality (41%) had no preference, with 27% preferring the computer and 32% preferring the clinician. Results support the use of these computer-administered symptom rating scales of social anxiety as a viable alternative to the clinician-administered versions with this subset of patients, which should offer researchers and clinicians a reliable and cost-effective method for evaluating social phobia. Depression and Anxiety 7:97–104, 1998. © 1998 Wiley-Liss, Inc.     

Cognitive function and distress after common whiplash injury

Introduction – In a prospective study 29 patients fulfilled the criteria of Whiplash-Associated Disorders grade III in the Quebec classification. Material and methods – One month postinjury, computerized neuropsychological tests, a clinical interview and the symptom checklist SCL-90-R were administered. Three whiplash scales were extrapolated from SCL-90-R: pain, subjective cognitive difficulties and sleep disorders. SCL-90-R was repeated 6 months later. Results – One month after the accident, 85% of the patients had resumed work. Subjective cognitive disturbances, however, were frequent but unrelated to test performances, which were within the normal range. Patients reporting stressful life events unrelated to the injury had more symptoms and elevated levels of distress on all SCL-90-R syndrome scales. At follow-up their distress was unchanged, and subjective cognitive function had deteriorated. Conclusion – Stressful life events unrelated to the accident and a high level of distress 1 month postinjury may augment the risk of "late whiplash syndrome". Reassessment 3–6 weeks postinjury as recommended by the Quebec Task Force should include assessment of complicating social factors and a psychological symptom checklist.     

Subjective emotional experience and cognitive impairment in drug-induced akathisia

The purpose of this study was to characterize the subjectively experienced symptoms and cognitive impairment associated with akathisia, which is among the most disabling adverse effects associated with antipsychotic drugs. While subjective experience is considered to be an integral part of akathisia, only a few studies have comprehensively investigated the specific contents of the subjective experiences or of the discomforts of patients with drug-induced akathisia. In addition, the precise relationship of akathisia to cognitive impairment, one of the main constituents of subjective experiences, is largely unknown. Forty-one stable and chronic schizophrenic patients, who were receiving maintenance antipsychotic treatment, were rated using the Barnes Akathisia Rating Scale (BARS) for drug-induced akathisia. Subjective experiences were evaluated using the Symptom Checklist-90-Revised (SCL-90-R), and cognitive function was assessed using the Wechsler Memory Scale (WMS). Analysis of covariance (ANCOVA) with relevant variables as covariates revealed that patients with akathisia (n = 17) had significantly higher scores on the depression subscale of the SCL-90-R than those without akathisia (n = 24). Patients with akathisia also had significantly lower scores on the mental control subtest of the WMS. Further analysis using ordinal logistic regression revealed that the depression subscale of SCL-90-R and the mental control subtest of WMS were significantly associated with the severity of akathisia. These results suggest that akathisia is significantly associated with depressive symptoms and attentional impairment, which reflects the complex nature of akathisia that includes motor, emotional, and cognitive aspects. Several methodological considerations and future directions are discussed.     

A study of the dimensionality and measurement precision of the SCL-90-R using item response theory

We used item response theory (IRT) to (a) investigate the dimensionality of the Symptom Checklist-90-Revised (SCL-90-R) in a severely disturbed patient group, (b) improve the subscales in a meaningful way and (c) investigate the measurement precision of the improved scales. The total sample comprised 3078 patients (72% women, mean age=35±9) admitted to 14 different day hospitals participating in the Norwegian Network of Personality-focused Treatment Programmes. Mokken Scale Analysis was used to investigate the dimensionality of the SCL-90-R and improve the subscales. This analysis was theory-driven: the scales were built on two start items that reflected the content of the disorder that corresponds with the specific scale. The Graded Response Model was employed to determine measurement precision. Our theory-driven IRT approach resulted in a new seven-factor solution including 60 of the 90 items clustered in seven scales: depression, agoraphobia, physical complaints, obsessive-compulsive, hostility (unchanged), distrust and psychoticism. Most of the new scales discriminated reliably between patients with moderately low scores to moderately high scores. In conclusion, we found support for the multidimensionality of the SCL-90-R in a large sample of severely disturbed patients.