Measuring patient symptom change on rural psychiatry units: utility of the symptom checklist-90 revised.

BACKGROUND: Mental health service providers have seen an increased need for demonstrating symptom reductions during the past decade. This change has been particularly evident to those working in inpatient psychiatry facilities where there is considerable need for a brief, easily administered, and low-cost means of tracking symptom change. The current study evaluated the utility of using the Symptom Checklist-90 Revised for tracking symptom reductions in patients admitted to rural adolescent and adult psychiatry units. METHOD: Consecutive admissions to adolescent (N = 104) and adult (N = 125) psychiatry units located in a rural community hospital served as subjects. The mean length of stay was 8 days for adolescents and 7 days for adults. Patients were administered the Symptom Checklist-90 Revised at admission and just prior to discharge. Psychiatrists provided a DSM-IV primary diagnosis for each patient. RESULTS: Principal component analyses on both the adolescent and adult admission and discharge Symptom Checklist-90 Revised subscales resulted in a 1-factor solution. Repeated-measures ANOVAs demonstrated the Global Severity Index to be a sensitive measure of clinically significant admission-to-discharge symptom change. Analyses using psychiatrist-assigned diagnoses revealed that all diagnostic categories evinced significant admission-to-discharge symptom reductions. DISCUSSION: Implications for using the Symptom Checklist-90 Revised to evaluate clinically significant symptom changes on rural inpatient psychiatry units are discussed.

Personal problem-solving scoring of TAT responses: known-groups validation.

Two studies employed a known-groups validation strategy to evaluate a Thematic Apperception Test (TAT) scoring system purported to measure personal problem-solving skills, the Personal Problem-Solving System (PPSS). In Study 1 clinicians rated the records of 46 mental health outpatients for the presence of personal problem-solving skills deficits. Verbatim TAT transcripts from these patients were blindly scored using the PPSS. Participants predicted to demonstrate problem-solving deficits obtained lower PPSS scores. In Study 2 a psychiatric sample (n = 47) and a community-based comparison group (n = 47) completed a life history questionnaire, a checklist of problems currently experienced, a measure of psychiatric symptoms, and responded to 3 TAT cards. TAT responses were again blindly scored using the PPSS. In contrast to the comparison group, psychiatric patients checked a greater number of current problems, endorsed more psychiatric symptoms, and obtained lower scores on the PPSS. A discriminant function analysis using PPSS scores correctly classified 72% of these participants. PPSS scores predicted group membership even after controlling for differences in age, education, the number of problems experienced, and psychiatric symptoms. This combination of variables correctly classified 92% of the participants. Results of both studies are interpreted as supporting the discriminant validity of the PPSS.

Personal problem-solving system for scoring TAT responses: preliminary validity and reliability data.

Personal problem solving has emerged as an important construct in the cognitive-behavioral literature, yet there is a lack of clinically useful, performance-based measures practitioners can use to assess the personal problem-solving skills of their clients. Two studies evaluated the validity and reliability of a scoring system for measuring personal problem-solving processes via the Thematic Apperception Test (TAT; Morgan & Murray, 1935). In Experiment 1, undergraduate students (N = 87) completed two measures of personal problem solving, as well as three TAT cards, which were scored using the Personal Problem-Solving System (PPSS; Renan, 1990). In Experiment 2, an additional group of undergraduates (N = 56) responded to three TAT cards on two separate occasions and also completed a different measure of personal problem solving. Results from both studies supported the use of the PPSS for scoring TAT responses to assess personal problem-solving processes. Suggestions for future research are highlighted.