Delusions-Symptoms-States Inventory Research Articles

Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes.

Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.

Relation of anxiety to hostility in the course of inpatient treatment

The purpose of this study was to examine relationships between anxiety and hostility in hospitalized psychiatric patients, with the passage of time. The used psychometric instruments were the state of anxiety subscale (sA) of the Delusions Symptoms States Inventory (DSSI) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The two questionnaires were administered during the first week of admission and completed again before the discharge of the patient. Two groups of patients emerged and were examined according to the sA scores reported on the second measurement. Group I (n = 44) consisted of patients reporting lower anxiety scores on the second measurement and Group II (n = 22) consisted of patients reporting higher anxiety scores on the second measurement. In Group I, the drop of anxiety scores was accompanied by parallel and highly significant drops of all hostility scores. In Group II, the increased anxiety scores were accompanied by non-significant or marginally significant changes of hostility scores. The notion that hostility and anxiety are positively related was not fully supported. Also, the opposite thesis that there is a negative relationship between anxiety and hostility was not supported. The present study suggests that the levels of anxiety during the course of inpatient treatment are a factor influencing the temporal relationship between anxiety and hostility. Aggr. Behav. 00:1–6. 2005. © 2005 Wiley-Liss, Inc.

Mothers depression in early childhood increases the risk of adolescent anxiety and depression

(2002) Journal of Child Psychology and Psychiatry 43, 457; Spence SH, Najman JM, Bor W et al. . Maternal anxiety and depression, poverty and marital relationship factors during early childhood...

The Personal Disturbance Scale (sAD): normative data and latent structure in a large non-clinical sample

The Personal Disturbance Scale [sAD; Bedford & Foulds (1978) Delusions–Symptoms–States Inventory State of Anxiety and Depression. Windsor: NFER-Nelson] is widely used in diverse settings and yet there are unresolved issues concerning its psychometric properties and normative data for the English speaking version are limited. The sAD was administered to a large sample of the general adult population ( N=758). Demographic variables (gender, age, years of education and occupational status) had only very modest influences on sAD scores. Tables are presented for conversion of raw scores on the Anxiety, Depression and Total scales to percentiles. The sAD scales possessed adequate convergent and discriminant validity, as demonstrated by their pattern of correlations with two other measures of depression and anxiety (the DASS and the HADS). Ten competing models of the latent structure of the sAD were derived from theoretical and empirical sources. These models were evaluated using confirmatory factor analysis. The best fitting model (CFI=0.96) had a tripartite structure, and consisted of a general factor of psychological distress/negative affectivity (all items loaded on this factor) plus orthogonal specific factors of anxiety and depression. Correlated errors specified according to previous empirical findings were permitted. The theoretical and practical implications of this latent structure are discussed.

Hierarchical arrangement of psychiatric symptoms in the context of schizophrenia

Foulds’ model proposing a four-class hierarchical structure of mental illness represents an interesting dimension of psychiatric research and discussion and probably has a significant potential on diagnosis, taxonomy, therapeutics and theory. Psychiatric symptoms were investigated in a group of 244 schizophrenic patients with the purpose of analyzing Foulds and Bedford’s notion that psychiatric symptoms are arranged hierarchically. To achieve this the R (recent) version of the Delusions, Symptoms, States, Inventory (DSSI) was administered in the form of a constructed interview to these patients. The hierarchical arrangement of psychiatric symptoms was verified since a great majority of the cases (80.8%) produced symptom patterns conforming to the hierarchy model. However, patients with duration of illness longer than 10 years reported conforming patterns in a lower percentage (77%), whereas 84.6% of those with a duration of illness less than 2 years reported conforming patterns. The non-conforming patterns were those in which integrated delusions were absent in the presence of delusions of disintegration, neurotic symptoms were absent in the presence of integrated delusions, and dysthymic states were absent in the presence of neurotic symptoms.

The Delusions-Symptoms-States Inventory (DSSI): construction, applications and structural analyses

This is the third and last report in a series of three articles reviewing and reassessing the late Graham Foulds theoretical conceptions of personality disturbance and personal illness and the scales that were developed to assess them. We have already reported on the Personality Deviance Scales (PDS; Deary et al., 1995) and the Personal Disturbance Scale (DSSI/sAD; Bedford and Deary, 1997). The present report concerns the Delusions-Symptoms-States Inventory (DSSI). The literature on this instrument is reviewed under three broad headings: theoretical background and technical aspects, clinical reviews and other studies. Multivariate analyses of the DSSIs 12 subscales and total structure are reported. All 12 subscales have adequate psychometric characteristics. The higher order structure of the instrument reveals two clear but correlated factors of anxiety and depression-elation. Interpretation of a third higher order factor is less certain. A brief overall assessment of Foulds contribution to differential clinical psychology is made and it is concluded that his theories and clinical psychometric instruments have lasting value

Foulds' hierarchy: validation of predictions in psychiatric and dermatological patients.

Foulds' inclusive non-reflexive law of symptom formation has been hitherto confirmed only on psychiatric or non-clinical persons. Given that respectively a yes-bias and a high frequency of non-classified patients may have inflated the rate of confirming protocols in these groups, a validation study was conducted with the Delusions-Symptoms-States Inventory (DSSI) on 188 psychiatric and 295 dermatological patients. Although non-classified patients were not included in the study (thus lowering the number of conforming patterns), both samples showed percentages of patterns conforming to Foulds' law which were above 85 per cent. No significant intergroup difference was found. The rate of conforming patterns in both groups was lower for members of the two psychotic classes (61-77 per cent). Foulds further hypothesized that the number of pathological sets within a given class grows if there is allocation into a superordinate class. This assumption was confirmed in both groups and for most of the inter-class comparisons. Suggestions were advanced to clarify the issue of the time span to be covered by Foulds' pyramid, to refine the instructions and the response format of the DSSI, and to include into the pyramid further relevant disturbances.

The mental health impact of stillbirth, neonatal death or SIDS: Prevalence and patterns of distress among mothers

Although stressful events have long been implicated in the onset of psychological disorder, available data suggest that the majority of individuals appear to escape serious impairment even following highly traumatic events. Related to this is the question of chronicity and whether those who do become impaired develop mental health problems of an ongoing nature. This paper documents the psychological adjustment of 194 women following a highly stressful event—the death of an infant due to stillbirth, neonatal death or SIDS. Anxiety and depression were measured on four occasions—at 2, 8, 15 and 30 months post-loss—using the Delusions Symptoms States Inventory (DSSI/sAD). For comparative purposes, the mental health of 203 mothers of a surviving infant was similarly assessed. The results demonstrate that bereaved mothers, as a group, manifest significantly higher rates of psychological distress than mothers of living infants for at least 30 months after their loss. Their impairment may be either acute or chronic in form. The majority of bereaved mothers appear not be develop serious mental health problems in response to the loss or experience psychological impairment that is usually self-limiting. For a smaller group of women, the death of a baby may herald serious and ongoing distress. Bereaved mothers who were not distressed soon (2 months) after the loss were unlikely to become so later, but those who were still distressed at 8 months were likely to remain so subsequently.

The multidimensional nature of schizotypal traits: a factor analytic study with normal subjects.

Fourteen published scales of psychotic traits or symptoms (measuring various delusional states, magical ideation, perceptual aberration, disposition towards hallucination, hypomanic personality, schizotypal personality, borderline personality and anhedonia) were combined with the Eysenck Personality Questionnaire to form a Combined Schizotypal Traits Questionnaire (CSTQ) which was administered to 180 normal subjects. Two factor analyses were carried out on the scale scores. The first analysis excluded symptom scores derived from the Delusions Symptoms States Inventory of Foulds and Bedford and yielded a three-factor solution which appeared to measure traits relating to (i) positive psychotic symptomatology; (ii) negative psychotic symptomatology; and (iii) aspects of schizotypy involving social anxiety and cognitive disorganization. The Foulds scales were included in the second analysis which yielded a four-factor solution. The first three factors were similar to those obtained from the first analysis; the fourth factor seemed to measure an asocial component of schizotypy. This last factor was mainly accounted for by the P scale from the EPQ. These results support previous findings suggesting that different schizotypy scales relate to different underlying aspects of schizophrenia. The findings also indicate that psychotic traits are distributed along at least three dimensions.

Symptom patterns among chronic schizophrenic in-patients.

The Delusions-Symptoms-States Inventory (DSSI) was administered to 33 chronic non-paranoid schizophrenic patients resident on long-stay wards. It was found that the vast majority of cases (81 per cent) produced symptom patterns conforming to the hierarchy of classes of personal illness model, but with a radically different distribution among the classes from that in acutely ill patients. Within the model a half of the patients were allotted to the two lowest classes--Class 0 (Symptom-free) and Class 1 (Dysthymic States). When each set of items was considered separately and independently of the model, it was found that a half of the group professed to have recently experienced delusions. Affective states and depressive symptoms were reported by over a third of the patients.

A test of the hierarchical model of personal illness.

To test the Foulds and Bedford hierarchical model of personal illness, the Delusions-Symptoms-States Inventory (DSSI) was administered to 100 psychiatric in-patients. Ninety-six had symptom patterns compatible with the hierarchy. This is significantly more than expected on the basis merely of the number of DSSI items affirmed, and overall the results support the model.

Validation of the Delusions‐Symptoms‐States Inventory

Three studies are presented as supportive validatory evidence for the Delusions‐Symptoms‐States Inventory (DSSI). Firstly, senior psychologists and psychiatrists were asked to allocate the 84 DSSI items to clinical syndromes. For 17 items the assignment did not correspond to that of the authors, e.g. ‘neurotic depression’ items alloted to ‘psychotic depression’. Secondly, further referees had to put these 17 items into the DSSI sets, e.g. state of anxiety. This was done as predicted in all but two cases. The third study used clinicians of varied experience to rate their patients according to the presence of the syndromes. These ratings broadly agreed with the patients' scores on the DSSI sets, and for nine of the twelve the association was statistically significant.

Psychomotor traits, social desirability and the personal illness hierarchy.

Seventy-eight psychiatric in-patients were allocated to personal illness classes by means of the Delusions-Symptoms-States Inventory (DSSI). Paper and pencil measures of psychomotor speed and scatter of tapping were administered with an immediate retest. It is suggested that from a social desirability position one would have to predict that the more personally ill (i.e. those endorsing the more socially undesirable items) would be slower and more diffuse on these measures. We found, however, such patients to be more constricted and slower. It is concluded that such a combination adds to the utility and validity of the hierarchy of classes of personal illness.

Class change in the personal illness hierarchy.

Sixty-eight psychiatric in-patients who had completed the Delusions-Symptoms-States Inventory (D.S.S.I.) on admission were retested after one month. On first testing 92.6 per cent conformed to the hierarchy of classes of personal illness model, and on the second occasion 91.2 per cent. Of those who could improve, 72 per cent did so, most commonly by moving down one hierarchy class, e.g. from the Neurotic Symptoms class to the Dysthymic States class. (On the other hand only 30 per cent of the 61 patients who originally reported symptoms did not do so after one month.) Thus although it is clear that the patients as a group changed markedly, they have not departed from the hierarchy. These results indicate that either the symptoms further up the hierarchy remit before those lower in the hierarchy or they remit together. Certainly those lower in the hierarchy do not go first. It is suggested that the results would be difficult to accommodate within strict disease-entity models, and that they have different implications for both treatment and the assessment of change in current state.

Hierarchy of classes of personal illness.

A hierarchy of classes of personal illness model is proposed and was assessed using a new self-report measure, the Delusions-Symptoms-States Inventory (DSSI). Of 480 psychiatric patients 93.3% had a symptom patterns conforming to the model. It was additionally found that single syndrome patterns, within a particular class, occurred significantly more often than those not classifiable in any higher class. Finally, the relationship between each possible pair of the 12 syndromes was examined. Some of the implications of the model and the data are discussed in terms of the development, remission, assessment, and treatment of personal illness.