Katz Adjustment Scales Research Articles

Expressed emotion and social function

We examined whether expressed emotion (EE) influenced the social functioning of schizophrenia. Twenty-nine subjects meeting the diagnostic criteria of ICD-9 or DSM-III-R participated in the study. The Camberwell Family Interview was conducted to evaluate EE, and subjects were divided into high EE and low EE groups. The subjects had been followed up for 9 months and their social functioning was compared between the two groups as assessed with the Katz Adjustment Scales. In the high EE group, levels of both performance of socially-expected activities and free-time activities slightly declined at follow-up. In contrast, those in the low EE group improved and the score increase in the level of performance of socially-expected activities was significant ( P<0.05). We confirmed the relationship of families' EE status with social functioning in schizophrenia. © 1997 Elsevier Science Ireland Ltd.

Assessment of mild brain trauma: A preliminary study of the influence of premorbid factors

Abstract The present study compared differences in the premorbid factors between a group of mild brain-trauma patients and matched controls. The brain-injured patients employed were similar in age and gender to previous research samples, although their socioeconomic status was somewhat elevated. Higher rates of alcohol and drug use, and rates of prior head injury were found in the experimental subjects. No differences were found in premorbid psychological adjustment, pre-existing physical or somatic factors, cognitive functioning, nor in emotional and behavioral factors as measured by self - and significant-other rating on the Katz Adjustment Scales (KAS). The results indicate that in comparison with controls, mild brain-injured patients are distinguishable only on the basis of prior injury and drug and alcohol use. The implications of the study are discussed in terms of clinical management of mild brain-injured patients.

Reliability and validity of the Katz Adjustment Scales in an epilepsy sample.

Development of quality of life measures de novo is time-consuming and expensive, and a number of instruments are already available for general use. Reevaluation and refinement of quality of life tools are needed to improve the existing pool of measures. In this study, data from a sample of 328 epilepsy patients were used to revise a measure of social adjustment and emotional status developed in the 1960s, the 127-item form R1 of the Katz Adjustment Scales (KAS-R1). Using a comprehensive item analysis procedure, we increased the number of items used in scoring the KAS-R1 from 76 to 113 and substantially improved the reliability of scales in both the original sample of 328 epilepsy patients and in a second administration to a 'cross-validation' sample of 193 epilepsy patients. Support for the validity of the revised KAS-R1 scoring system was obtained in a known groups analysis of patients who had previously undergone surgery for epilepsy: mean scores were significantly higher (p < 0.05) on 11 out of 14 scales in the revised KAS-R1 for patients who were completely seizure-free compared to patients who were having seizures with loss of consciousness, after adjusting for age, gender, and anticonvulsant medication use.

Sex differences in schizophrenia.

Demographic and clinical characteristics of 275 schizophrenics consecutively admitted to seven hospitals were examined. Males were younger than females when first hospitalized, diagnosed and treated. Psychiatrists rated on two rating scales by using a structured interview to compare the symptomatology. Female schizophrenics were more agitated, inappropriate, silly, irrelevant, over-talkative, and exhibiting more flight of ideas, while male schizophrenics were more slowed, hypoactive, grandiose, withdrawn, and showing more blocking, auditory hallucinations and poor communications. Katz Adjustment Scales were rated by the patients and their relatives. Female schizophrenics were perceived by relatives to be more helpless and withdrawn-depressed than male schizophrenics.

Reliability of parental reports using the Katz Adjustment Scales: before and after hospital admission for schizophrenia.

We examined the interrater and test-retest reliability of the KATZ Adjustment Scale (Relative rated or R form) longitudinally in a sample of schizophrenic patients, assessing their function before hospital admission, as well as at 1 and 9 mo. after discharge. Changes in mean scores over those assessments suggested sensitivity to change while mothers and fathers both completed the measure with moderate consistency over time. Interrater reliability was moderate at best and quite poor at initial testing, when the subjects were most disturbed clinically, suggesting that the scales may be acceptable when the individual is stable but that ratings may be unreliable when there is an exacerbation in clinical state.

The heterogeneity of social outcome following head injury.

This study compares nine different measures of social outcome applied to 56 patients seen 0 to 4 years after head injury. Social outcome was found to be heterogeneous: correlations between the measures and a principal components analysis both indicated that time off work (as a percentage of time since injury) was independent of most other measures of social performance. In the group studied, the best measures of non-work social performance were the Katz Adjustment Scales form 2 (socially expected activity) and Bond's Social Scale, which both showed good agreement between subject and informant ratings. If a single outcome measure is desired (to include work and non-work social performance), the most suitable measure was found to be the Glasgow Outcome Scale, original and extended versions.

Differences in symptomatology and social adjustment between urban and rural schizophrenics.

The symptomatology and social adjustment between urban and rural schizophrenics were compared in 275 consecutive admissions of schizophrenics, who were rated on the Katz Adjustment Scales by the patients themselves and their relatives at admission and 1 year after hospital discharge, or at readmission if it occurred within 12 months of discharge. Numerous significant differences were found in symptomatology and social adjustment between urban and rural schizophrenics. Urban schizophrenics reported lower expectations for performance of social activities than rural schizophrenics. Urban schizophrenics were perceived by relatives to be more helpless, suspicious, nervous, bizarre, hyper-active and less emotionally stable than rural schizophrenics. According to relatives' evaluations, urban schizophrenics performed less in social activities and participated less in leisure-time activities than rural schizophrenics. Relatives of urban schizophrenics were also found to have lower expectations for patients' performance of social activities than their rural counterparts.

Inter-Rater Reliability of Informants' Ratings: Katz Adjustment Scales, R Form

The Katz Adjustment Scales (R Form) is a widely used instrument for assessing the adjustment of psychiatric patients in the community from reports of friends or family members. Inter-rater reliability of the scales was examined by comparing maternal and paternal ratings of 15 young, adult, male schizophrenic patients prior to hospitalization. Ratings by the two parents were found in close agreement on scales measuring the principal domains of behavior and others on which ratings of directly observable behaviors are required. However, agreement between parents was substantially less on scales requiring inferences about the patients' adjustment. Implications of the findings are discussed.

The social adjustment of Filipino nonmigrants, emigrants, and immigrants to Hawaii

This study compared the social adjustment of a group of Filipinos who had initiated definite arrangements to emigrate to Hawaii (emigrants) with another group of Filipinos from the same communities as the emigrants who expressed no intention to emigrate (nonmigrants). These two samples were then compared with a group of recent Filipino immigrants to Hawaii. Social adjustment was measured by the Katz Adjustment Scales, relative's rating form, in terms of clusters of symptomatic and social behavior. The results showed that the immigrants in their social adjustment were less emotionally expressive than the emigrants, who were in turn, less expressive than the nonmigrants. However, significant cluster score differences obtained primarily between the Philippine samples and the immigrants, while there was a general lack of significance between the nonmigrants and the emigrants. The overall decline in the level of emotional expression of the immigrants was attributed to their adherence to the paramount Philippine value of social acceptance as their modal means of adjustment to the immigration experience. Thus, the direction and nature of changes in the emotional expression of Filipino immigrants follow from their culture and its integral norms and values rather than being derivative of processes of acculturation.

Early prediction of post-hospitalization relapse

One-hundred-and-forty-eight patients, 71 of whom were diagnosed as schizophrenic and the remaining 77 diagnosed as non-schizophrenic, were interviewed “in the blind” 7–9 weeks after discharge from hospitalization and administered the Form S of the Katz Adjustment Scales. Concurrently, the Form R of the Adjustment Scales was completed by the closest available significant other. These patients were then followed for a period of 12 months or until relapse occured in an effort to determine if the data collected 7–9 weeks post-discharge would be predictively effective in distinguishing the prospective relapser. While the interview data afforded no substantial differentiation between relapsers and non-relapsers, data from two of the Adjustment Scales proved extremely effective for this purpose when the ratings of the patient were subtracted from the ratings of the significant other, creating a difference ( d) score. Using the d scores of the two scales “in tandem”, 20 of the 22 non-schizophrenic relapsers were correctly identified while identifying only 14 of the 55 non-relapsers falsely. The same technique was not as useful for the entire schizophrenic sample in that many of the significant others had only limited contact with the ex-patient. When a subgroup of the schizophrenic patients ( N = 49) was created, based on a high frequency of contact between the patient and the significant other, the d score method proved quite accurate, correctly identifying 9 of 10 relapsers and misidentifying only 6 of the 39 non-relapsers. It is suggested that the significant differences between the ratings of the patient and the significant other, for the same behavioral items, may reflect the early decompensation of the relapsers, or may be some index of the limited interpersonal contact between the ex-patient and his significant others. In either event, the use of the Katz Adjustment Scales, early after discharge, appears to be a viable technique to detect the prospective relapser.

Intrapsychic and environmental variables as predictors of length of hospitalization.

The purpose of this study was to examine the competing hypotheses that environmental variables contribute independent variance to the prognosis of general psychological disorders or that their predictive potential is accounted for by their relationship to initial level of psychopathology and other biographical data. A survey of the last 10 years of prognostic research for hospitalized psychiatric patients (Clum, Note 1) suggests that the patient's role in the family and their expectations of him play significant parts in his adjustment. Others (Fulkerson & Barry, 1961) have argued that whatever prognostic validity psychological tests have could be attributed to the extent to which they measure severity of illness. A multiple regression analysis which included level of symptomatolog y, measures of the family environment, and biographical data provided the vehicle for testing these hypotheses. The measure of symptomatolog y was provided by the Katz Adjustment Scales (Katz & Lyerley, 1963) (significant-other forms), whcih yielded six symptom factors. The significant other was ,asked to rate his expectations of the patient's performance after hospitalization and the kinds of deviant behavior that would be tolerated before a hospital or mental health professional would be consulted. The patient's role in the family was inferred from two biographical variables, age and living with spouse after hospitalization. Length of hospitalization was the criterion used to determine prognosis. Subjects (JV=119) were consecutively admitted psychiatric patients at the University of Virginia Hospital. This sample was divided to test cross-validities of any significant relationships.

Social adjustment profiles of fatally injured drivers; a replication and extension.

Two samples of fatally injured male drivers were retrospectively compared with a normative population on 18 measures of personal and social adjustment by means of the Katz Adjustment Scales, a device for assessing the behavioral characteristics of persons through interviews with knowledgeable informants. Results obtained from the first sample were essentially replicated in the second, and suggest that fatalities in male drivers, on the average, are seen by informants as having been significantly more belligerent, negative, verbally expansive, hyperactive, and displaying more psychopathology than comparable normative males. Prior existence and prominence of these traits among the cases studied was supported by Department of Motor Vehicles records indicating a high incidence of traffic violations and by excessive blood alcohol levels at autopsy in the majority. The lack of association in these samples between the behavioral traits implicated and either age or blood alcohol level at autopsy suggests the conclusion that whether young or old, drinking or nondrinking, the socially obstreperous driver is at increased risk of becoming a fatality.

Comparative Psychopathology of Suicide Attempts and Assaults

ABSTRACT: Using the Katz Adjustment Scales to measure psycho‐pathology, systematic samples of 108 suicide attempters and 42 persons arrested for assault were tested in Baltimore, Maryland. The subjects' scores were compared with ratings by third‐party respondents, who knew the subjects well, and with scores of 450 controls. Both suicide attempters and assaulters displayed significantly more psychopathology than the controls. The suicide attempters were differentiated from the assaulters on six Katz items: Helplessness, Anxiety, Nervousness, Depression, Stability, and General Psychopathology. An attempt was made to refine prediction and control of these two different life‐threatening behaviors by interpreting the data in terms of Henry and Short's concept of “internal restraint.”

Characteristics of drivers involved in single-car accidents. A comparative study.

This report describes a methodology for retrospective, in-depth, psychological investigation of driver fatalities. The results suggest that fatally injured drivers of single-car accidents can be differentiated from fatally injured drivers of multiple-car accidents on the basis of life-style and personality characteristics. Similarly, an overlap group of multiple-car and single-car drivers with a history of excessive alcohol usage may be differentiated from all other fatally injured drivers on the same basis. The Katz Adjustment scales significantly differentiated the above groups from a normative population on five of 18 scales. Preventive methods suggested by these results include educational efforts directed toward sensitizing persons in contact with high-risk drivers for the purposes of intervention, and the development of automatic safety equipment.

Norms of adjustment and social behavior.

The social behavior and adjustment of 450 nonpatients, randomly drawn from the general population of a metropolitan county, were measured by a rating scale widely used in mental health research: the Katz Adjustment Scales. Variations by sex, age, marital status, and social class suggest that relevant differences be considered when clinical judgments of adjustment are made concerning former psychiatric patients. The field study relies on the reports of a close family member and focuses exclusively on current behavior. These methodologic innovations frequently confirm, but at times challenge, the results of previous studies. Results are presented with a view toward enhancing empirically defined definitions of normality.

A brief follow-up rating

The BFR is presented as an economical method for evaluating post-hospital adjustment in former psychiatric patients. It incorporates areas of post-hospital function which are generally accepted as having social significance and does not emphasize the subject's current level of symptom discomfort. An attempt is made to incorporate information concerning the totality of the subject's adjustment since discharge rather than utilizing information about a single point in time, and to employ reference points relating to premorbid adjustment. The information required for the rating may be collected and scored by personnel at various levels of training. The BFR score correlates significantly with two of Katz's Adjustment Scales: well validated but considerably more complex measures of post-hospital adjustment.