Assessing clinical significance of treatment outcomes using the DASS-21.

Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change.

Stains on the caring mantle. Doctors in aboriginal Australia have a history.

Doctors new to Aboriginal Australia are not infrequently surprised that their choice to work with the needy and underprivileged is not cause for unconditional positive regard. The naïveté of this position reflects the assumption that the nature of medical work somehow separates doctors from other less caring Europeans who have intruded into Aboriginal Australia. In this paper the ambivalence with which medical professionals are viewed by Aborigines is explored through an examination of particular historical instances drawn from northern Australia, particularly the Kimberley region of Western Australia. It may be that a willingness to interrogate preconceived notions of privileged access will be in the best interests of the profession, and of doctors choosing to work in Aboriginal Australia.