Self-report Rating Scales Research Articles

Mutilation anxiety differs among females with fibromyalgia and functional dyspepsia and population controls

Background: Studies using self-report rating scales suggest a considerable overlap regarding symptom complaints in patients with fibromyalgia (FM) and functional dyspepsia (FD), while clinical assessments point to important psychological differences. Purpose: To test the hypothesis that measurement of psychological state by means of content analysis of speech will demonstrate differentiation between the two patient groups and between patients with these disorders and age-matched population-based random sample controls. Method: The Giessener Symptom Complaints Checklist assessed somatic complaints. The computerised Gottschalk–Gleser content analysis method assessed psychological state in 42 females with FM, 17 females with FD and 48 population-based, randomly selected control subjects. Results: FM patients score higher on mutilation anxiety than FD and control subjects. FD patients had the highest score for death anxiety. Mutilation anxiety and low hope score identified FM patients (sensitivity 68%, specificity 81%, overall classification 75%), but only 19% of the variation in total somatic complaints could be predicted from these or other psychological state scores. In FD patients, however, death anxiety explained 59% of the variance in gastrointestinal complaints. Interpretation: Psychological state was differentiated among the three groups. Mutilation anxiety may be a psychological marker of an underlying neurobiological vulnerability for FM or may represent a secondary long-term consequence of chronic illness. In FD, death anxiety is directly related to symptom complaints, suggesting a stronger etiological association between emotions and somatic complaints in this disorder.

Should symptoms be scaled for intensity, frequency, or both?

This study evaluated the comparability of two 5-point symptom self-report rating scales: Intensity (from "not at all" to "very much") and Frequency (from "none of the time" to "all of the time"). Questions from the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue 13-item scale was examined. Data from 161 patients (60 cancer, 51 stroke, 50 HIV) were calibrated separately to fit an item response theory-based rating scale model (RSM). The RSM specifies intersection parameters (step thresholds) between two adjacent response categories and the item location parameter that reflects the probability that a problem will be endorsed. Along with patient fatigue scores ("measures"), the spread of the step thresholds and between-threshold ranges were examined. The item locations were also examined for differential item functioning. There was no mean raw score difference between intensity and frequency rating scales (37.2 vs. 36.4, p = n.s.). The high correlation (r = .86, p < .001) between the intensity versus frequency scores indicated their essential equivalence. However, frequency step thresholds covered more of the fatigue measurement continuum and were more equidistant, and therefore reduced floor and ceiling effects. These two scaling methods produce essentially equivalent fatigue estimates; it is difficult to justify assessing both. The frequency response scaling may be preferable in that it provides fuller coverage of the fatigue continuum, including slightly better differentiation of people with relatively little fatigue, and a small group of the most fatigued patients. Intensity response scaling offers slightly more precision among the patients with significant fatigue.

Identity Processes in Adulthood: Theoretical and Methodological Challenges

The study of identity development in adulthood presents a number of fascinating theoretical challenges, including the relationship of identity to physical, cognitive, emotional, and social functioning. Equally challenging is the measurement of identity processes throughout the adult years. In this article, we discuss a theoretical model that relates identity to experiences in adulthood and incorporates the processes of identity assimilation, identity accommodation, and identity balance. We present data examining the relationship between the Identity and Experiences Scale (IES), a 33-item self-report rating scale, and the Defense Mechanisms Inventory (Gleser & Ihilevich, 1969). Relationships of identity processes to hypothesized personality constructs, gender, and age are discussed and examined as a basis for elaborating more fully on the model and its measurement.

The Child Rating Scale and its use with middle school-age students.

The Child Rating Scale is a socioemotional self-report rating scale design for elementary school children. This study examined the Child Rating Scale with a middle school-age sample (Grades 5 to 8) of 240 students. The Child Rating Scale's four scales have shown moderate to high coefficients alpha. Factor analysis yielded the 4 underlying factors consistent with the current subscales. Supportive convergent validity was found based on the Child Rating Scale subscales' predicted association with the Self-perception Profile for Children and the Psychological Sense of School Membership-Brief. Consistent with current research, decline over grades in rule compliance/acting out and school interest was documented as well as the expected mean sex differences on these two subscales. Possible areas of study are indicated, and the present study's limitations are described. The Child Rating Scale seems to be a promising self-report measure for middle school-age youth.

Diagnosing Alcoholism and Its Addictive Patterns Using Self-Report Rating Scales

Diagnosis of alcoholic patterns raises many difficulties for clinical assessment and especially for self-report measures. Self-report questionnaires, however, represent the most frequently administered device; they are simple to score and interpret, and allow for rapid, pretreatment evaluation. Advantages abound when considering that alcoholic clients may be impatient, inaccessible, or present for one of many intake assessment sessions. Still, self-report measures suffer limitations due to constraints on validity and reliability. This paper reviews current clinical self-report measures and their shortcomings relative to alcoholics and children of alcoholics. Examined first are common protocols. Second, progress on a new test called the ACOA Behavior Profile is briefly reviewed and implications for clinical practice described.

From symptoms to social functioning: differential effects of antidepressant therapy.

Significant impairments in social functioning frequently occur simultaneously with depressive symptoms. The implications of such impairments extend beyond the depressed individual to their family, friends and society at large. Classical rating scales such as the Hamilton rating scale for depression primarily assess the core symptoms of depression. A range of rating scales are available, both self-reporting and administered by clinician; however, many have been criticised for their unspecified conceptual background and for being complex and time-consuming. While antidepressants in general appear to improve social functioning, no clear advantage for any single class of agent has been reported. Recently, a new self-report rating scale, the Social Adaptation Self-evaluation Scale, has been developed and used to compare the novel selective noradrenaline reuptake inhibitor, reboxetine, with the selective serotonin re-uptake inhibitor, fluoxetine. The noradrenergic agent, reboxetine, was shown to be significantly more effective in improving social functioning than the serotonergic agent, fluoxetine. These findings are consistent with previous observations that noradrenaline may preferentially improve vigilance, motivation and self-perception.

Career Self-Efficacy Development and Students With Learning Disabilities

This study investigates self-efficacy beliefs, sources of efficacy information, person input variables (e.g., ability), and outcome expectations in relationship to the career interests of adolescents with learning disabilities (LD). The sample consisted of 96 high school students with LD and included substantial diversity in terms of gender, race/ethnicity, and socioeconomic background. The California Occupational Preference System, or COPSystem, was used to assess career interests and aptitudes, with self-report rating scales used to measure self-efficacy beliefs, sources of efficacy information, and outcome expectations for corresponding career areas. Person input variables other than aptitude (e.g., gender) were also included in the study design. Ratings of self-efficacy beliefs were found to be a substantial predictor of career interest and to consistently mediate the relationship of other measures (e.g., person input variables) to career interest. Ratings of outcome expectations also exhibited associations with career interest, but only to a limited extent when controlling for their shared variance with self-efficacy ratings. Findings indicate the importance of considering subjective factors (i.e., self-efficacy beliefs and outcome expectations) rather than only objective skills (i.e., aptitudes and abilities) as being influential in shaping the career development of adolescents with LD.

The application of a computerized measurement of the content analysis of natural language to the assessment of the effects of psychoactive drugs.

This article aims to answer the question whether developing technology is now capable of measuring objectively and accurately the effects of psychoactive pharmacological agents by means of computerized assessments of psychological states and traits through the analysis of content and form of people's speech. At the present time, psychopharmacological researchers involved in clinical trials rely on DSM-IV criteria and standardized self-report measures and observer rating scales to assess psychoactive drug effects. Attention is drawn to the potentially unrecognized measurement errors and relatively low interrater reliability by these methods--for example, all raters are not free of observer bias and every subject administered a drug is not equally and accurately well-informed about the self. The computerized content analysis methods tend to avoid these biases and measurement errors. A review is provided describing the Gottschalk-Gleser method of measuring psychobiological dimensions from the form and content of short (usually five-minute) speech samples of verbal behavior, generally elicited by standardized and purposely ambiguous instructions to talk about any interesting or dramatic personal life experiences. Norms have been obtained by this method of speech elicitation, adjusted for age, sex and educational level. Sections are provided covering cross-cultural and language validation research on the Gottschalk-Gleser content analysis method, the influence of medical or psychiatric illness as well as psychoactive drugs on verbal content analysis-derived scores, and the research carried out for more than 20 years computerizing this content analysis procedure through the development of artificial intelligence software enabling these measurements to be done from typescripts of speech samples on computer diskettes. A brief review deals with the general applications of this method of measurement to basic and clinical psychiatry, psychosomatic medicine, neuropsychology, the diagnostic process in a psychiatry outpatient clinic, children's mental health problems, dream research, and assessment of mental processes during PET scanning of the brain. This is followed by a review of the applications of this method of content analysis of speech to neuropsychopharmacological testing of antianxiety, antidepressive, antipsychotic, and other psychoactive drugs, as well as to pharmacokinetic variables and clinical response. This method is now in the process of being used in clinical trials in psychopharmacology and is recommended for more extensive use in this research area.

Genetic and environmental sources of consistency and variability in positive and negative mood

Several studies have found a genetic influence on person × situation interactions of behaviours and emotions. For five situations we assessed current positive and negative mood for a sample of 168 monozygotic and 132 dizygotic adult twin pairs completing self-report rating scales. We used structural equation model fitting to estimate genetic and environmental influences on the stability and variability of moods across situations. Our results indicate that genetic as well as shared and nonshared environmental influences contribute to the consistency of moods. Contrary to previous findings, the variability of positive and negative mood is mainly attributed to nonshared environmental influences and only marginally attributed to genetic or shared environmental effects. © 1998 John Wiley & Sons, Ltd.

Psychiatric Symptomatology in Adolescents with Cancer

Adolescents with cancer need to cope with their disease and treatment while accomplishing the tasks unique to this developmental period. In this pilot study, the prevalence of psychological morbidity among adolescents with cancer was examined. In addition, assessment methods and risk factors were explored. Forty-three recently diagnosed adolescents with cancer completed the Hospital Anxiety and Depression Scale (HADS), the Beck Depression Inventory (BDI), and the Rotterdam Symptom Checklist (RSCL) and underwent a full psychiatric assessment. In the psychiatric interviews, 9% of the sample was diagnosed with a depressive mood disorder. Results suggest that self-report rating scales can be useful assessment instruments if used as complementary tools. Psychosocial assessment of the adolescent with cancer is nevertheless difficult. This appears to be due to an atypical symptomatology pattern and a tendency toward the masking of distress. Case examination of depressed patients suggests that illness and treatment factors may not be primary risk factors for the development of psychological morbidity. External stressors such as poor family support and past sexual abuse, when compounded by illness and treatment factors, may be more relevant.

Using standardized patients and standardized physicians to improve patient-care quality: results of a pilot study.

We conducted evaluation research with a sample of registered professional staff nurses in a large, inner-city, tertiary medical center for a pilot study of videotaped case scenarios using standardized patients and standardized physicians to enhance nurses' communication and collaboration skills. Change scores from pre-test to post-test on a self-reported rating scale to assess nurse-physician-patient interactions and communications for 28 nurses were compared with a control group of 38 nurses who did not participate in the videotaped sessions. Repeated measures of analysis of variance (ANOVA) detected no statistically significant differences between the intervention and control groups. However, positive changes were noted in some aspects of nurse-physician and nurse-patient interactions in the intervention group. Immediate feedback from the videotaped scenarios heightened nurses' awareness of the impact of their body language. Nurses must continuously practice and enhance their collaborative and communication skills. This pilot study suggests that it is beneficial to use videotaping with standardized patients and standardized physicians to enhance such nurses' skills.

Psychological Distress in People with HIV/ AIDS: Prevalence Rates and Methodological Issues

Prevalence studies consistently show that most people with HIV illness do not have elevated rates of psychiatric disorder at any given time, but these studies do not permit characterization of overall levels of psychological distress in this population. This paper reviews published studies examining distress and depressive symptomatology in people with HIV/AIDS and matched comparison groups as assessed by self-report rating scales. Findings indicate that distress levels differ considerably across studies in comparison to population norms, although scores typically are not highly elevated for either seropositive or seronegative groups. Methodological issues that may explain variation across studies are discussed, including recruitment methods, composition of samples, and methods of assessing distress. It is suggested that psychological distress in those with HIV/AIDS should be examined with an understanding of the diversity of factors that can contribute to distress, as well as the differential availability of resources to cope with stressors among those infected.

Psychiatric Diagnoses in Children with Alopecia Areata

To identify psychiatric diagnoses in a sample of 12 children with alopecia areata (AA), to assess the possible relationship between life stressors and AA and to correlate any consistent physical findings to psychiatric data. Twelve children with AA completed systematic psychiatric evaluations. The assessments included structured and semistructured interviews, rating scales, and parent checklists. Children had previously undergone immunological and endocrinological blood testing. Seven of the 12 subjects met criteria for anxiety disorders (including simple phobia) on structured interviews. An additional subject met criteria for dysthymia. Self-esteem measures indicated a high positive self-concept, and rating scales measuring anxiety and depression were within normal limits. No significant difference was found between mean number of positive or negative life events of children with AA compared with a normative sample. Although structured interviews revealed a higher than expected rate of anxiety or depressive disorders in this small clinical sample, self-report rating scales and semistructured interviews did not support the conclusion that significant psychopathology was present.

Retrospective Self-Reported Symptoms of Attention-Deficit Hyperactivity Disorder: Reliability of the Wender Utah Rating Scale

We measured the internal consistency and four-week temporal consistency and temporal stability of the Wender Utah Rating Scale and its 25-item short form. The Wender scale is a rationally constructed retrospective self-report rating scale for symptoms of Attention-deficit Hyperactivity Disorder. Both scales manifested excellent internal consistency. Over one month, both versions manifested significant temporal consistency and good temporal stability in the nonclinical sample of 83 successful young adults most likely to be referred for an evaluation of suspected Attention-deficit Hyperactivity Disorder. The collegiate group had a considerably higher Wender score than the original normative group, calling into question the adequacy of the limited normative data. However, both forms of the scale are reliable and comprehensive validation research is advocated.

The Clinical Report: Integrating Family Assessment Instruments into Family Counseling Practice

Family counselors have viewed the use of standardized family assessment instruments with considerable ambivalence. This article briefly describes this ambivalence and argues that the use of self-report questionnaires and observational rating scales can enhance a practitioner's clinical assessment in three ways. First, it complements the practitioner's initial assessment; second, it helps in the development of treatment goals; and third, it provides information for evaluating treatment effectiveness. Furthermore, the author contends that the use of assessment instruments can create a collaborative working relationship between client and family counselor. The clinical report and its instruments are discussed, and a case example illustrates the application of the clinical report.

The relationship between seizure subtype and interictal personality

A wide variety of interictal personality traits has been associated with complex partial (CP) epilepsy. However, the specificity of these behavioural changes to CP epilepsy has been questioned in several controlled studies. To address this issue, we examined personality and behavioural characteristics in 467 Vietnam veterans 15 years post penetrating head injury. Of this sample, 238 (51%) had developed seizure disorders which were classified as follows: 39 simple partial (SP), 59 CP, 76 partial with secondary generalization (PG), and 64 generalized (G). Seizure patients were compared with two demographically matched control groups: 229 penetrating head-injured Veterans without seizures (PHI-C) and 84 uninjured veterans (UC). Dependent measures included self-report and examiner rating scales, and history of psychiatric treatment. Pre-injury intelligence, brain volume loss (CT scan), seizure frequency and duration of epilepsy served as covariates. We found statistically significant increases in interictal psychopathology in the CP, PG and G groups when compared with the two control groups (PHI-C and UC). No group differences were observed across seizure subtypes. These results suggest that interictal personality and behavioural abnormalities are not specific to individuals with CP seizures. Furthermore, the increased psychopathology in seizure groups when compared with the PHI-C group suggests that personality changes cannot be accounted for by structural brain damage alone.

Differentiating major depression and panic disorders by self-report and clinical rating scales: Roc analysis and information theory

The revised Beck Depression Inventory, Beck Anxiety Inventory, the Cognition Checklist Depression and Anxiety subscales, revised Hamilton Psychiatric Rating Scale for Depression (HRSD-R), and the revised Hamilton Anxiety Rating Scale were administered to 92 outpatients diagnosed only with major depression disorders and 50 outpatients diagnosed only with panic disorders. A receiver operating characteristic (ROC) analysis was used to evaluate each instrument's ability to discriminate the two diagnostic groups. The optimum cut-off score for each scale was determined as a function of prevalence by maximizing information gain. The results indicated that the depression scales were better than the anxiety scales in discriminating the two groups. The HRSD-R was superior to the other depression scales, whereas all the anxiety scales displayed similar discriminating power.

Concordance between clinical and self-report depression scales during the acute phase and after treatment

The concordance between self-report and clinical rating scales of depression increases during progress from the acute depressive episode to recovery or improvement of symptoms. We investigated this convergence in a group of 52 outpatients with DSM-III major depression disorders using three widely employed depression scales and their parallel formats (i.e., alternative modes of administering the scales). The six instruments were applied at admission and after 12 and 24 weeks' treatment. The results indicate that the increase in the global concordance between scales may be a statistical effect deriving from broadening of the range of scores.

Diagnostic accuracy in adolescents of several depression rating scales extracted from a general purpose behavior checklist

Receiver Operating Characteristics (ROC) analysis of six depression scales extracted from the Child Behavior Checklist (CBCL) and Youth Self-report (YSR) in a clinically referred sample of adolescents ( N = 667) showed that their performance in discriminating between depressed and not depressed patients was comparable to other specifically designed depression rating scales (area under the ROC curves between 0.75 and 0.82). Performance was better for boys than for girls. These results suggest that specific depression self-report rating scales may be unnecessary in adolescents if CBCL or YSR data are available, and that self-reports are not more accurate than parent-reports in the identification of depression in this age group.

Viscosity and social cohesion in temporal lobe epilepsy.

Clinical case reports suggest that viscosity, the behavioural tendency to talk repetitively and circumstantially about a restricted range of topics, is common in patients with temporal lobe epilepsy (TLE). Such patients are also reported to exhibit heightened levels of social cohesion, the tendency to become interpersonally "clingy". This "sticky" interpersonal style may be particularly common in TLE patients with a left sided temporal lobe seizure focus. To test this hypothesis, self-report and observer rating scales were developed to assess both viscosity and social cohesion. Subjects consisted of patients with right, left, or bilateral temporal lobe seizure foci, absence or primary generalised tonic-clonic seizures, psychiatric controls (panic disorder patients), and normal controls. Elevations on the viscosity scale were observed primarily in TLE patients with left or bilateral seizure foci. Viscosity scores also correlated with seizure duration and left handedness. No group differences were observed on the social cohesion scale. These findings are consistent with the hypothesis that viscosity results from subtle interictal language disturbances, although other pathogenetic mechanisms are discussed.