Diagnostic efficiency among psychiatric outpatients of a self-report version of a subset of screen items of the Structured Clinical Interview for DSM-IV-TR Personality Disorders (SCID-II).

This article describes the identification of a 10-item set of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) items, which proved to be effective as a self-report assessment instrument in screening personality disorders. The item selection was based on the retrospective analyses of 495 SCID-II interviews. The psychometric properties were studied in a prospective validation study in a random sample of Dutch adult psychiatric outpatients, using the SCID-II interview as the gold standard. First, all patients completed the short questionnaire. One week later, they were interviewed with the full SCID-II. After another week, the short questionnaire was readministered. According to the scores obtained with the full SCID-II, 97 patients (50%) had a personality disorder. The set of 10 SCID-II items correctly classified 78% of all participants. The sensitivity, specificity, and positive and negative power were 0.78, 0.78, 0.78, and 0.78, respectively. The results based on the retrospectively obtained data were rather similar to those obtained in the prospective validation study. Therefore, it is concluded that the set of 10 SCID-II items can be useful as a quick self-report personality disorder screen in a population of psychiatric outpatients.

Predictors of quality of life: a model based study.

In this study, predictors of quality of life (QOL) in psychiatric outpatients (n = 410) were investigated using the psychological stress model developed by Taylor and Aspinwall (Psychosocial Stress. Perspective on Structures, Theory, Life-Course and Methods. San Diego, CA: Academic Press, 1996; pp. 71-110). External resources, personal resources, stressors, appraisal of stressors, social support, coping, and QOL were assessed with several questionnaires. The complete original Taylor and Aspinwall model was tested with SEM analyses. These analyses were not able to explain the data adequately. Therefore, initially a more exploratory data analytic strategy was followed using a series of multiple regression analyses. These analyses only partially supported the Taylor and Aspinwall model. In fact, QOL was not predicted by coping, while all other antecedents affected QOL directly, explaining considerable amounts of QOL variance. As a next step, taking the outcomes of the regression analyses as point of departure, new SEM analyses were carried out, testing a modified model. This model, without coping, had an excellent fit. Consequently, modifications of the model are recommended concerning psychiatric outpatients when QOL is the psychosocial outcome measure.

The relationship between dimensional personality models and quality of life in psychiatric outpatients.

This study examines the relationship between personality and quality of life (QOL) in psychiatric outpatients (N=495). Personality was conceptualized using two-dimensional models, respectively, the five-factor model (FFM) and Cloninger's seven-factor model. The WHOQOL-100 was used for assessing QOL. Neuroticism and Harm Avoidance had negative correlations with QOL, whereas Extraversion, Conscientiousness and Self-Directedness correlated positively with QOL. A considerable part of the QOL variance was explained by personality; Cloninger's character factors were superior to the FFM domains. Although not fully comparable, in general our findings are in accordance with earlier studies. Therefore, paying attention to personality and temperament is recommended in future diagnostic procedures, treatment policies, and program evaluations.

Relationship between mood related disorders and quality of life in a population of Dutch adult psychiatric outpatients.

Our objective was to investigate explicitly the relationship between mood-related disorders (MRDs) and quality of life (QOL), while trying to overcome the limitations of earlier research. QOL scores of psychiatric outpatients with MRDs were compared with QOL scores of outpatients without MRD and a sample of the general Dutch population (GDP). QOL was assessed with the World Health Organization Quality of Life assessment instrument, long version (WHOQOL-100), and depressive symptoms were assessed with the Symptom Checklist-90 (SCL-90). Outpatients with MRD had lower scores on all aspects of the WHOQOL-100 compared with the GDP. Compared with outpatients without MRD, the outpatients with MRD scored lower on most aspects of the WHOQOL-100. Within the group with MRDs, patients with major depressive disorder (MDD) had lower QOL scores compared with patients with dysthymic disorder or adjustment disorder with depressed mood. Severity of MRD and MDD was negatively related to QOL. Comorbid personality disorders worsened QOL. Within the group with MRDs, common variance between depressive symptoms and QOL did not exceed 25%. MRDs are negatively related with QOL. Severity of MRD and comorbidity of personality disorders decrease QOL further. MRDs affect all domains and facets of QOL. The relationship found between MRDs and QOL was not caused by an overlap between the concepts depressive symptoms and QOL, shown by the relative small common variance between (depressive) symptoms and QOL.

Quality of life and psychopathology: investigations into their relationship.

OBJECTIVE: Quality of life (QOL) has become a topic of growing interest in medical and psychiatric practice in general, and in research in particular. Although the body of knowledge about the complex relationship between QOL and psychiatric disorders is growing, understanding this relationship still remains difficult. Therefore, the aim of the present study was to get more and new insights into this relationship. It was hypothesized that QOL would be negatively related to the presence as well as the severity of psychopathology. METHOD: A random sample of Dutch adult psychiatric outpatients (n=410) completed the World Health Organization Quality of Life assessment instrument, abbreviated version (WHOQOL-Bref). In addition, DSM-IV axis I and II diagnoses were obtained. Comparisons were made between scores of the psychiatric outpatients, diagnostic subgroups within this population, and the scores of a general population. RESULTS: Compared with the general population, psychiatric outpatients scored significantly worse on all aspects of QOL. Within the group of outpatients, participants with DSM-IV diagnoses had worse scores than those without. Participants with comorbidity had the worst QOL. CONCLUSIONS: It is concluded that QOL scores are negatively related to both the presence and the severity of psychopathology, and that the presence of a personality disorder plays a role in subjectively experienced QOL.

Validation of the WHO Quality of Life assessment instrument (WHOQOL-100) in a population of Dutch adult psychiatric outpatients.

BACKGROUND: Research concerning the psychometric properties of the WHO Quality of Life Assessment Instrument (WHOQOL-100) in general populations of psychiatric outpatients has not been performed systematically. AIMS: To examine the content validity, construct validity, and reliability of the WHOQOL-100 in a general population of Dutch adult psychiatric outpatients. METHOD: A total of 533 psychiatric outpatients entered the study (438 randomly selected, 85 internally referred). Participants completed self-administered questionnaires for measuring quality of life (WHOQOL-100), psychopathological symptoms (SCL-90), and perceived social support (PSSS). In addition, they underwent two semi-structured interviews in order to obtain Axis-I and Axis-II diagnoses, according to DSM-IV. RESULTS: The drop-out percentage was low (7.1%). Of the 24 facets of the WHOQOL-100, 22 had a good distribution of scores, leaving out the facets physical environment and transport. Exploratory factor analysis revealed a four-factor structure, which was similar to earlier findings in patients with specific somatic diseases and depressive disorders. Various-a priori expected-positive and negative correlations were found between facets and domains of the WHOQOL-100, and dimensions of the SCL-90 and the PSSS-score, indicating good construct validity of the WHOQOL-100. The internal consistency of all facets and the four domains of the WHOQOL-100 was good (Cronbach's alpha's ranging from 0.62 to 0.93 and 0.64 to 0.84, respectively). Sparse and relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-100 scores. CONCLUSIONS: Content validity, construct validity, and reliability of the WHOQOL-100 in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-100 appears to be a suitable instrument for measuring quality of life in adult psychiatric outpatients.

Relationships between demographic variables and quality of life in a population of Dutch adult psychiatric outpatients.

BACKGROUND: Examinations of the role of demographic characteristics in quality of life (QOL) in psychiatric samples are not new. However, serious limitations of previous research have been that (1) QOL was not assessed according to current recommendations, (2) assessment of QOL was often hampered by a substantial overlap in content between symptoms and QOL measures, and (3) the majority of the study samples had quite specific characteristics hampering the generalizability of results, as a result of which clinical implications of the results remained unclear. The aim of the present study was to investigate explicitly the relationships between demographics and QOL in a sample reflecting the general population of psychiatric outpatients, QOL being assessed in a comprehensive, culturally sensitive, and subjective way, paying attention to the relative importance of its various facets. The main hypothesis was that these relationships would be rather weak. METHOD: From a population of 533 adult Dutch psychiatric outpatients, 495 participants completed the World Health Organization Quality of Life (WHOQOL)-Bref for assessing QOL. Furthermore, several demographic characteristics were recorded. RESULTS: Statistically significant correlations were found between partner relationship, habitual status, work, and sick leave and the WHOQOL-Bref domains social relationships and environment. Psychological health was associated to partner relationship, educational level, and sick leave. The total amount of QOL variance explained by demographics was rather low. CONCLUSION: Amongst factors determining QOL, demographic characteristics are relatively unimportant. Therefore, paying attention to demographics during psychiatric treatment will probably have little effect on improvement of QOL.

Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients.

In this study, the psychometric properties of a quality of life scale, the WHOQOL-Bref, were examined in a population of 533 Dutch adult psychiatric outpatients. Participants underwent two semistructured interviews in order to obtain Axis-I and II diagnoses, according to DSM-IV. Besides the WHOQOL-Bref they also completed questionnaires for measuring psychopathological symptoms (SCL-90) and perceived social support (PSSS). Scores on 25 of the 26 questions of the WHOQOL-Bref had a good distribution. Similar to previous findings, exploratory factor analysis revealed a four-factor structure. A priori expected associations were found between the domains of the WHOQOL-Bref, on the one hand, and dimensions of the SCL-90 and the PSSS-score, on the other hand, indicating good construct validity. The internal consistency of the four domains of the WHOQOL-Bref ranged from 0.66 to 0.80. Domain scores of the WHOQOL-Bref correlated around 0.92 with the WHOQOL-100 domain scores. Relatively low correlations were found between demographic characteristics (age and sex) and WHOQOL-Bref domain scores. It is concluded that the content validity, construct validity, and the reliability of the WHOQOL-Bref in a population of adult Dutch psychiatric outpatients are good. The WHOQOL-Bref, therefore, is an adequate measure for assessing quality of life at the domain level in a population of adult psychiatric outpatients.

Multisensory integration of emotional faces and voices in schizophrenics.

In their natural environment, organisms receive information through multiple sensory channels and these inputs from different sensory systems are routinely combined into integrated percepts. Previously, we reported that in a population of schizophrenics, deficits in audiovisual integration were observed for complex stimuli (auditory and visual syllables), but not for more simple ones (beeps and light flashes). Here, we investigated multisensory integration of emotional information in a group of schizophrenic patients. In Experiment 1, we found a reduced effect of an emotional voice on the categorization of a facial expression. In Experiment 2, the reverse test situation was presented, and, here, we observed an exaggerated effect of a face expression on the categorization of an emotional voice. Results are discussed in the light of current models of multisensory integration and their relevance for schizophrenia.