A very short Symptom Checklist-90-R version for routine outcome monitoring in psychotherapy; The SCL-3/7.

OBJECTIVE: Routine outcome monitoring (ROM) is applied in many physical and mental health treatments. The treatment course is monitored with patient reported outcome measures (PROMs). A potential problem with PROM is response burden. This can be decreased by presenting such measures with less and better selected items. The SCL-90-R is an often used PROM for psychotherapies and a number of very short forms have been developed; the SCL-5, SCL-8, SCL-9 and SCL-10. This study aims to develop a new very short form, the symptom checklist 3 out of 7 (SCL-3/7) and to evaluate the effectiveness of these PROM with the precision relative to the complete SCL-90-R score. METHODS: Item Response Theory analysis was applied to select the 7 best discriminating items, evenly distributed over the latent trait. A routing serves that patients only need to administer 3 items. RESULTS: In a sample of 15,055 cases, the relative precisions of the SCL-3/7 were best for outpatients (122.7%), day care patients (111.8%) and inpatients (108.3). The SCL-5 was best for juvenile patients (110.0%), and the SCL-9 was best for addicted patients (107.2%). CONCLUSION: The SCL-3/7 decreases patient burden in ROM and has a better precision in adult therapies than other SCL-90 short forms.

Comparison of false positive and false negative rates of two indices of individual reliable change: Jacobson-Truax and Hageman-Arrindell methods.

Background: Quantification of change is crucial for correctly estimating the effect of a treatment and for distinguishing random or non-systematic changes from substantive changes. The objective of the present study was to learn about the performance of two distribution-based methods [the Jacobson-Truax Reliable Change Index (RCI) and the Hageman-Arrindell (HA) approach] that were designed for evaluating individual reliable change. Methods: A pre-post design was simulated with the purpose to evaluate the false positive and false negative rates of RCI and HA methods. In this design, a first measurement is obtained before treatment and a second measurement is obtained after treatment, in the same group of subjects. Results: In relation to the rate of false positives, only the HA statistic provided acceptable results. Regarding the rate of false negatives, both statistics offered similar results, and both could claim to offer acceptable rates when Ferguson's stringent criteria were used to define effect sizes as opposed to when the conventional criteria advanced by Cohen were employed. Conclusion: Since the HA statistic appeared to be a better option than the RCI statistic, we have developed and presented an Excel macro so that the greater complexity of calculating HA would not represent an obstacle for the non-expert user.

Measurement Invariance and Construct Validity of the Satisfaction With Life Scale (SWLS) in Community Volunteers in Vietnam.

Worldwide, the Satisfaction With Life Scale (SWLS) has become the most widely used measure of life satisfaction. Recently, an authorized Vietnamese-language version has been introduced. Using a convenience sample comprising community volunteers from Ho Chi Minh City (N = 1073), confirmatory support was found for the cross-national constancy of the one-dimensional structure underlying the SWLS. Corrected item-total polyserial correlations and Omega coefficient were satisfactory. Using multi-group confirmatory factor analysis, configural, metric, and scalar invariance of the SWLS factorial structure were tested by gender, age, marital status, income, and educational level. Strong evidence of scalar invariance was found for gender and education, on which relevant subgroups did not differ in terms of latent means. Partial scalar invariance was found for marital status (item 4 and 5) and income (item 4). Being involved in an intimate relationship or having a higher income were associated with higher latent means. Scalar invariance in relation to age was very poor. Accordingly, caution must be exerted when comparing age groups. A high SWLS score was predictive of good self-rated health. Implications of the findings are briefly discussed.

Cross-cultural validity of the scale for interpersonal behavior.

The Scale for Interpersonal Behavior (SIB) is a 50-item multidimensional measure of difficulty and distress in assertiveness. The SIB assesses negative assertion, expression of and dealing with personal limitations, initiating assertiveness and positive assertion. The SIB was originally developed in the Netherlands. The present study attempted to replicate the original factors with an Italian student sample (n = 995). The four distress and four performance factors were replicable across two methods of analysis (the multiple group method of confirmatory analysis and Tucker's coefficient of congruence (phi). The corresponding scales were internally consistent and showed predicted patterns of correlations with a measure of self-efficacy. Sex and age differences in assertiveness were generally negligible. Italian students had higher positive assertion-performance scores than the Dutch and comparable scores on other performance scales; by contrast, the Italian subjects had significantly higher scores on all SIB distress scales than their Dutch equivalents. This was ascribed to the stronger pressure on people in Italian society to behave assertively (Hofstede's National Masculinity score = 70) as opposed to the Dutch society (National Masculinity score = 14).

Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3.

Accumulating evidence suggests that anxiety sensitivity (fear of arousal-related sensations) plays an important role in many clinical conditions, particularly anxiety disorders. Research has increasingly focused on how the basic dimensions of anxiety sensitivity are related to various forms of psychopathology. Such work has been hampered because the original measure--the Anxiety Sensitivity Index (ASI)--was not designed to be multidimensional. Subsequently developed multidimensional measures have unstable factor structures or measure only a subset of the most widely replicated factors. Therefore, the authors developed, via factor analysis of responses from U.S. and Canadian nonclinical participants (n=2,361), an 18-item measure, the ASI-3, which assesses the 3 factors best replicated in previous research: Physical, Cognitive, and Social Concerns. Factorial validity of the ASI-3 was supported by confirmatory factor analyses of 6 replication samples, including nonclinical samples from the United States and Canada, France, Mexico, the Netherlands, and Spain (n=4,494) and a clinical sample from the United States and Canada (n=390). The ASI-3 displayed generally good performance on other indices of reliability and validity, along with evidence of improved psychometric properties over the original ASI.

Sixteen-item Anxiety Sensitivity Index: confirmatory factor analytic evidence, internal consistency, and construct validity in a young adult sample from the Netherlands.

The present investigation examined the factor structure, internal consistency, and construct validity of the 16-item Anxiety Sensitivity Index (ASI; Reiss Peterson, Gursky, & McNally 1986) in a young adult sample (n = 420) from the Netherlands. Confirmatory factor analysis was used to comparatively evaluate two-factor, three-factor, and four-factor models of the anxiety sensitivity construct. Support was found for a hierarchical structure of anxiety sensitivity, with one global higher-order factor and four lower-order factors. Internal consistency for the global and lower-order factors of the 16-item ASI was adequate. Convergent and discriminant associations between the 16-item ASI and general mood and panic-specific variables were consistent with anxiety sensitivity theory. In addition, incremental validity of the anxiety sensitivity construct was established, relative to negative affectivity, for unexpected panic attacks and agoraphobic avoidance.

SCL-90-R emotional distress ratings in substance use and impulse control disorders: One-factor, oblique first-order, higher-order, and bi-factor models compared.

To fully understand the dimensionality of an instrument in a certain population, rival bi-factor models should be routinely examined and tested against oblique first-order and higher-order structures. The present study is among the very few studies that have carried out such a comparison in relation to the Symptom Checklist-90-R. In doing so, it utilized a sample comprising 2593 patients with substance use and impulse control disorders. The study also included a test of a one-dimensional model of general psychological distress. Oblique first-order factors were based on the original a priori 9-dimensional model advanced by Derogatis (1977); and on an 8-dimensional model proposed by Arrindell and Ettema (2003)-Agoraphobia, Anxiety, Depression, Somatization, Cognitive-performance deficits, Interpersonal sensitivity and mistrust, Acting-out hostility, and Sleep difficulties. Taking individual symptoms as input, three higher-order models were tested with at the second-order levels either (1) General psychological distress; (2) 'Panic with agoraphobia', 'Depression' and 'Extra-punitive behavior'; or (3) 'Irritable-hostile depression' and 'Panic with agoraphobia'. In line with previous studies, no support was found for the one-factor model. Bi-factor models were found to fit the dataset best relative to the oblique first-order and higher-order models. However, oblique first-order and higher-order factor models also fit the data fairly well in absolute terms. Higher-order solution (2) provided support for R.F. Krueger's empirical model of psychopathology which distinguishes between fear, distress, and externalizing factors (Krueger, 1999). The higher-order model (3), which combines externalizing and distress factors (Irritable-hostile depression), fit the data numerically equally well. Overall, findings were interpreted as supporting the hypothesis that the prevalent forms of symptomatology addressed have both important common and unique features. Proposals were made to improve the Depression subscale as its scores represent more of a very common construct as is measured with the severity (total) scale than of a specific measure that purports to measure what it should assess-symptoms of depression.

Taxonicity of anxiety sensitivity: a multi-national analysis.

Taxometric coherent cut kinetic analyses were used to test the latent structure of anxiety sensitivity in samples from North America (Canada and United States of America), France, Mexico, Spain, and The Netherlands (total n = 2741). Anxiety sensitivity was indexed by the 36-item Anxiety Sensitivity Index--Revised (ASI-R; [J. Anxiety Disord. 12(5) (1998) 463]). Four manifest indicators of anxiety sensitivity were constructed using the ASI-R: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of publicly observable anxiety reactions, and fear of mental incapacitation. Results from MAXCOV-HITMAX, internal consistency tests, analyses of simulated Monte Carlo data, and a MAMBAC external consistency test indicated that the latent structure of anxiety sensitivity was taxonic in each of the samples. The estimated base rate of the anxiety sensitivity taxon differed slightly between nations, ranging from 11.5 to 21.5%. In general, the four ASI-R based manifest indicators showed high levels of validity. Results are discussed in relation to the conceptual understanding of anxiety sensitivity, with specific emphasis on theoretical refinement of the construct.

Cross-cultural confirmation of bi-factor models of a symptom distress measure: Symptom Checklist-90-Revised in clinical samples.

Four decades have elapsed since the introduction for clinical and research purposes of the Symptom Checklist-90(-R). Yet, its underlying dimensional structure has not been clearly delineated. A shift has been observed in the methods utilized-from predominantly exploratory factor analytic in nature in the first two decades or so to different confirmatory methods in recent years. A need remains to search for a structure that remains invariant across samples and nations. In that context, the present study attempted to replicate and extend recent findings yielded in a Hungarian general population sample (N=2,874) with two psychiatric patient samples from Hungary (N=972) and The Netherlands (N=1,902). In doing so, four models were contrasted: the one-factor model, Derogatis' nine factor model, a second-ordered factor model, and a bi-factor model. The bi-factor model was shown to yield the closest fit to the data in both countries. Further studies are needed to determine the stable number and kind of subscale scores that reflect the specific (primary) symptoms best, that is, those subscales with minimal shared variance with the overall general psychological distress dimension.

Anxiety sensitivity in six countries.

In the present study, the Anxiety Sensitivity Index-Revised (ASI-R; ) was administered to a large sample of persons (n=2786) from different cultures represented in six different countries: Canada, France, Mexico, The Netherlands, Spain, and the United States. We sought to (a) determine the factor structure and internal consistency of the ASI-R and (b) examine the correlations of the measure with psychiatric symptoms and personality dimensions in a single European non-English speaking country (The Netherlands). Partially consistent with the original hypothesis, the underlying structure of the anxiety sensitivity construct was generally similar across countries, tapping fear about the negative consequences of anxiety-related physical and social-cognitive sensations. Lower-order factors were moderately to strongly correlated with one another and showed good internal consistency. The observed lower-order ASI-R factors correlated with established psychiatric symptoms and with the personality trait of neuroticism. Partial correlations indicated that both factors are useful in accounting for variance in symptom measures. We discuss the results of this investigation in relation to the cross-cultural assessment of the anxiety sensitivity construct.

Masculine Gender Role Stress: a potential predictor of phobic and obsessive-compulsive behaviour.

Eisler and Blalock (Clin. Psychol. Rev. 11 (1991) 45) developed a cognitively mediated notion of Masculine Gender Role Stress (MGRS) which assumes that rigid commitment to masculine schemata for appraisal and coping with life's problems may both produce stress and result in dysfunctional coping patterns in men. Previous findings obtained in a non-clinical sample pointed to the ability of the MGRS General scale to predict different forms of irrational fears. Using a predominantly psychologically distressed sample, the present study replicated this finding. In addition, different subordinate concepts of MGRS (Physical inadequacy, Emotional inexpressiveness, Subordination to women, Intellectual inferiority, and Performance failure) predicted Agoraphobic fears, Blood-Injury fears, Social fears, and Obsessional checking and washing compulsions distinctively. Intellectual inferiority was the strongest predictor of Social fears. Most MGRS measures emerged as better predictors of Checking than of Washing rituals. There were no sex differences in the predictive capabilities of any of the MGRS measures on any of the criterion measures. A hypothetical explanation is given for the observation of MGRS being more strongly predictive of Checking than of Washing rituals using the concept of "inflated responsibility". Implications for assessment, treatment and further studies are briefly pinpointed.

Cross-cultural validity of the masculine and feminine gender role stress scales.

The objective was to examine the usefulness of Dutch versions of the Masculine Gender Role Stress (MGRS; Eisler & Skidmore, 1987) Scale and the Feminine Gender Role Stress (Gillespie & Eisler, 1992) Scale in The Netherlands. Undergraduate students (N = 2,239) completed both gender role stress scales. A subgroup (n = 508) also completed questionnaires about masculinity-femininity and daily hassles. With regard to both gender role stress scales, results of confirmatory factor analyses supported the original 5-factor structures and revealed no cross-sex differences on the factor models. Reliability and homogeneity indexes were all well within acceptable to satisfactory limits. Further evidence of construct validity was found in (a) medium to large correlations with daily hassles, (b) sex differences on the FGRS scale, and (c) small to medium correlations with masculinity-femininity. The major discrepancy with previous studies was that for Dutch female and male students, the MGRS scale was not sex specific. Taken together, this study sustained the utility of both gender role stress scales for use in The Netherlands.