Six- and ten-item indexes of psychological distress based on the Symptom Checklist-90

Clinicians, provider organizations, and researchers need simple and valid measures to monitor mental health treatment outcomes. This article describes development of 6- and 10-item indexes of psychological distress based on the Symptom Checklist-90 (SCL-90). A review of eight factor-analytic studies identified SCL-90 items most indicative of overall distress. Convergent validity of two new indexes and the previously developed SCL-10 were compared in an archival sample of posttraumatic stress disorder patients (n = 323). One index, the SCL-6, was further validated with archival data on substance abuse patients (n = 3,014 and n = 316) and hospital staff (n = 542). The three brief indexes had similar convergent validity, correlating .87 to .97 with the SCL-90 and Brief Symptom Inventory, .49 to .76 with other symptom scales, and .46 to .73 with changes in other symptom measures over time. These results indicate the concise, easily administered indexes are valid indicators of psychological distress.     

Sleep,resilience, and psychological distress in United States military Veterans

Sleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

Incremental validity of the Minnesota Multiphasic Personality Inventory-2 and symptom checklist-90-revised with mental health inpatients

This study evaluated the incremental validity of scores from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Symptom Checklist-90-Revised (SCL-90-R) in a sample of mental health inpatients originally published by Archer, Griffin, and Aiduk (1995). The incremental validity of scores from the SCL-90-R primary symptom dimensions and MMPI-2 Clinical, Content, and Restructured Clinical scales was assessed in a sample of 544 mental health inpatients using conceptually related items from the Brief Psychiatric Rating Scale (BPRS) as criteria. A series of hierarchical multiple regressions indicated that scores from the SCL-90-R primary symptom dimensions exhibited limited incremental validity (Mdn DeltaR(2) = .01, range = 0-.01), whereas scores from MMPI-2 scales contributed additional information in the prediction of ratings on all but one BPRS item (Mdn DeltaR( 2) = .08, range = .04-.12).     

Different Associations of Health Related Quality of Life with Pain,Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder

The primary aim of this study was to measure psychological distress, pain severity, health related quality of life (QOL) and pain coping strategies in patients with irritable bowel syndrome (IBS) and ulcerative colitis (UC). A second aim was to determine the influence of somatic and psychological variables on health related QOL. Eighty-eight IBS and 66 UC patients completed the Irritable Bowel Syndrome Quality of Life Questionnaire (IBSQOL), Pain Severity Scale of West Haven Yale Multidimensional Pain Inventory (WHYMPY), Symptom Checklist-90-R (SCL-90-R) and Coping Strategies Questionnaire (CSQ). T-tests and GLM Analysis of Covariance were used for statistical analysis. IBS patients had significantly higher levels of psychological distress, pain severity and maladaptive pain coping strategies (catastrophization), and lower QOL than UC patients. Variance of QOL in IBS was explained for the most part by catastrophization (15%), then by psychological distress (8%), and for the less part by pain severity (5%). In UC, pain severity explained 21%, psychological distress 8%, and catastrophization 3% of the variance of QOL. These results suggest there are differences between IBS and UC patients in the role of physical and psychological factors in QOL and emphasize the importance of cognitive processes in IBS.     

Five-Factor Model Personality Traits, Spirituality/Religiousness, and Mental Health Among People Living With HIV

ABSTRACT We examined the association between five-factor personality domains and facets and spirituality/religiousness as well as their joint association with mental health in a diverse sample of people living with HIV ( n =112, age range 18–66). Spirituality/religiousness showed stronger associations with Conscientiousness, Openness, and Agreeableness than with Neuroticism and Extraversion. Both personality traits and spirituality/religiousness were significantly linked to mental health, even after controlling for individual differences in demographic measures and disease status. Personality traits explained unique variance in mental health above spirituality and religiousness. Further, aspects of spirituality and religiousness were found to mediate some of the links between personality and mental health in this patient sample. These findings suggest that underlying personality traits contribute to the beneficial effects of spirituality/religiousness among vulnerable populations.     

Psychological characteristics of elderly insomniacs

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90-Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale-20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.     

Dispositional and situational coping and mental health among Palestinian political ex-prisoners

We examined, first, differences in dispositional and situational coping, and psychological distress between political ex-prisoners and their matched controls, and second, coping effectiveness in protecting mental health from impacts of imprisonment and military trauma. Thirdly, we tested the hypothesis that compatibility ("goodness of fit") between dispositional and situational coping would predict low psychological distress. Participants were 184 men recruited from a Palestinian community sample, 92 were former political prisoners and 92 non-prisoners. The dispositional coping was assessed as a general response style to hypothetical stressors and situational coping as responses to their own traumatic experiences. Psychological distress was measured by SCL-90-R, and posttraumatic stress disorder, depression and somatoform symptoms by scales based on CIDI 2.1 diagnostic interview. The results showed that, compared to non-prisoners, the political ex-prisoners employed less avoidant, denying, and emotion-focused coping strategies. Military trauma was associated with avoidant and denying coping only among non-prisoners. The ex-prisoners showed more mental health and medical problems, especially when exposed to military trauma. None of the coping styles or strategies were effective in protecting the mental health in general or in either groups. However, main effect results revealed that the high level of active and constructive and low level of emotion-focused coping were associated with low levels of psychiatric symptoms and psychological distress.     

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

Deconstructing therapy outcome measurement with Rasch analysis of a measure of general clinical distress: the Symptom Checklist-90-Revised

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994). Using complementary therapy research samples, the instrument's 5-point rating scale was found to exceed clients' ability to make reliable discriminations and could be improved by collapsing it into a 3-point version (combining scale points 1 with 2 and 3 with 4). This revision, in addition to removing 3 misfitting items, increased person separation from 4.90 to 5.07 and item separation from 7.76 to 8.52 (resulting in alphas of .96 and .99, respectively). Some SCL-90-R subscales had low internal consistency reliabilities; SCL-90-R items can be used to define one factor of general clinical distress that is generally stable across both samples, with two small residual factors.     

Religiousness,Spirituality, and Psychological Distress in Taiwan

Most of the previous research on religion and mental health has focused solely on Western, predominantly Christian societies. Using a 2004 national survey of 1,881 adults in Taiwan, this study investigates the relationships between multidimensional measures of religiousness/spirituality and psychological distress in an Eastern context. Our findings differ from previous studies in the West, showing that: (1) religious-based supernatural beliefs are associated with more distress; (2) daily prayer is associated with less distress; (3) engaging in secular-based supernatural activities like fortune-telling is related to more distress; and (4) the frequency of religious attendance is unrelated to levels of distress. Broader theoretical and empirical implications of these findings are discussed.     

Latin-American immigrant women and mental health: differences according to their rural or urban origin

Spain is one of the EU countries that receive most immigrants, especially from Latin America. The process of migration implies a high level of stress what may have repercussions for the mental health of immigrants. The purposes of this study were: (a) to determine whether the degree of mental health of immigrant women differs according to their rural or urban origin, (b) to compare the mental health of immigrant women with that of the female normative sample of host population (Spain). A sample of 186 Latin American immigrant women (142 from urban areas and 44 from rural areas) was recruited in Barcelona by means of a consecutive case method. A structured interview and the SCL-90-R were administered. The results indicated that the immigrant women from rural origin reported higher levels of psychological symptomatology than those from urban areas. Immigrants reported higher levels of psychological symptomatology than the native female population and in most of the psychological symptoms exceeded 90% of the native Spanish population. Migration is a powerful stressor which may lead to psychological distress. Being female of rural origin and being in an illegal situation is related with an increase in symptomatology.     

Reducing teachers' psychological distress through a mindfulness training program

Teachers constitute one of the professional collectives most affected by psychological problems. The purpose of this quasi-experimental study is to examine the efficacy of a mindfulness training programme to reduce psychological distress in a group of teachers. The sample comprised 68 teachers of Secondary School Education, from various public schools; half of them formed the experimental group, and the another half the control group. The levels of psychological distress were measured, in both groups, by the Symptom Checklist-90-R (SCL-90-R) before and after the application of the programme. Statistical analysis shows the significant reduction of three general measures of psychological distress (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total), as well in all its dimensions (somatization, obsessive-compulsive, interpersonal sensibility, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism), in the experimental group compared with the control group. Follow-up measures show that these results were maintained for four months after termination of the intervention in the experimental group.     

How Much Distress Is Too Much on Deployed Operations? Validation of the Kessler Psychological Distress Scale (K10) for Application in Military Operational Settings

The aim of this study was threefold: (a) to assess the factor structure of the Kessler Psychological Distress Scale (K10) to determine whether interpreting the scale as a single dimensional measure of psychological distress is justified in military operational setting; (b) to validate the K10 for mental health surveillance in operational settings against self-reported occupational impairment; (c) to evaluate whether the K10 has better discriminatory power than de facto standards for mental health surveillance on deployment, namely the Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist, Civilian version. A convenience sample of Canadian Armed Forces personnel serving in Afghanistan (N = 1,264) completed self-report measures of psychological distress and occupational impairment. On examination of 6 competing models, the authors determined that interpreting the K10 as a measure of unspecified psychological distress is justified. Using receiver operating characteristic (ROC) curve analysis, they identified new cutoff values for dichotomous and polychotomous scoring methods. After comparing the area beneath the ROC curves for each of the 3 mental health surveillance questionnaires, the authors determined that all measures perform well as predictors of self-rated occupational impairment, with values ranging from .86 to .90. These results highlight the importance of cross-setting validation and demonstrate that validating psychological screening questionnaires against self-report measures of occupational impairment can be a useful strategy for understanding the manifestation of psychological distress on deployed military operations.     

Psychological profile of Greek doctors: differences among five specialties

The aim of the present study was to explore the differences in the psychological profiles between genders and different specialties among Greek doctors. Five-thirty nine doctors in five different specialties, namely 115 general practitioners, 168 internists, 81 surgeons, 108 microbiologists and 67 anesthesiologists, participated in the study. 253 participants were specialized doctors and 286 participants were medical residents. The sample consisted of 280 women and 259 men. The mean age of the sample was 38.75(±7.98) years. A cross sectional survey study was conducted. Symptom Check List 90-Revised (SCL-90-R) was used to collect the data. Multivariate Analysis of Variance indicated the significant effect of specialty (Wilks’ Lambda = .20, p = .000), the effect of gender (Wilks’ Lambda = .90, p = .000) as well as their interaction (Wilks’ Lambda = .68, p = .000) on participants’ scores in SCL-90-R subscales. Internists reported high scores in 8 out of 9 subscales of SCL-90-R. Surgeons scored significantly higher compared to all other specialties in hostility(HS) subscale. Women reported statistically higher scores in almost all subscales of the SCL-90-R test compared to men, apart from HS (p = .191). Gender and specialty choice play role in the psychological profile of Greek doctors. Women and internists seem to be more prone to psychopathology. These findings should be taken into account in future studies and interventions.     

抗震救灾官兵心理健康状况及相关因素分析

了解参加抗震救援官兵的心理健康状况及相关因素,为进行心理危机干预提供科学依据。方法 采用症状自评量表（SCL-90）、简易应对方式问卷（SCSQ）、艾森克人格问卷简式量表中国版（EPQ-RSC）及军事应激症状核查表（PCL-M）,对空军某部抗震救援官兵进行心理测评。结果 消极应对和PCL-M总分与SCL-90总分及各因子分呈正相关（p＜0.01）;积极应对方式与PCL-M总分、SCL-90总分及4项因子分呈低相关（p＜0.01）;不同气质类型PCL-M总分及SCL-90各项统计指标之间均有显著性差异（p＜0.01）。结论 气质类型与应对方式对心理健康状况有很大影响,个别官兵应及时给予心理疏导     

Assessment of nuclear anxiety among American students: stability over time, secular trends, and emotional correlates

Studies of reactions and attitudes toward nuclear war have progressed from the use of anecdotal evidence to multi-item psychological measures. Additional psychometric data and substantive results of the Nuclear Attitudes Questionnaire (NAQ; Newcomb, 1986) are reported here. Data from three independent samples of students from the United States collected in 1984, 1986, and 1987 were compared and contrasted. The 1986 data were obtained immediately following the Chernobyl nuclear power plant accident. Test-retest reliability of the NAQ items and subscales was quite high and comparable among samples and established the across-time stability of the measure. There were several secular trends across years on items and subscales, indicating some increased concern about nuclear power (particularly in 1986), but also a general increase in nuclear concerns, fears, and anxiety. Anticipated sex differences were found on many of the NAQ items and subscales. Correlations between the NAQ subscales and the nine SCL-90-R scales (Derogatis, 1977) were consistent for the 1986 and 1987 samples. In latent variable analyses, a general factor of Emotional Distress was significantly correlated with a general factor of Nuclear Anxiety, as well as specifically with nuclear concern and fear for the future.     

“双37”高射炮兵自我概念与心理健康相关研究

目的:探讨"双37"高射炮兵自我概念与心理健康之间的关系。方法:采用田纳西自我概念量表(TSCS)和临床症状自评量表(SCL-90),对143名"双37"高射炮兵的自我概念与心理健康进行了测量、统计与分析。结果:不同自我概念水平的"双37"高射炮兵在SCL-90上的得分有显著差异,且"双37"高射炮兵自我概念及各因子(自我批评因子除外)均与心理健康状况呈显著的正相关。对"双37"高射炮兵心理健康影响最大的是心理自我,其次是生理自我。结论:引导"双37"高射炮兵正确评价自己、悦纳自己是促进其心理健康的有效途径。     

中学生SCL-90评定结果分析及其常模的建立

随机抽取厦门市10所中学5251名中学生为样本,对SCL-90进行项目分析、信度和效度检验,并运用验证性因素分析探讨该量表结构的适合性;建立厦门市中学生SCL-90的性别与初高中常模并与已有的常模作跨时间和地域的比较。结果表明:SCL-90的同质性信度为0.97,分半信度为0.94,一阶和二阶验证性因素分析的各指标均有较为理想的拟合;有59.0%的中学生存在各种轻微的不良心理反应,有16.1%的中学生存在各种明显的心理症状,这些心理症状主要表现为敌对、强迫、人际关系敏感、抑郁、偏执和焦虑并存在不同程度的性别和年级差异;SCL-90的评定结果存在时段和地域差异,持续时间和强度是该量表使用和结果解释的关键。     

Psychopathological Symptom Dimensions in Patients with Gastrointestinal Disorders

The current study aims to investigate the factorial validity of a widely used psychopathological rating scale, the Symptom Check List-90-R (SCL-90-R), in a group of patients suffering from gastrointestinal disorders, and to determine the specific psychopathological profiles that characterize the individual patient subgroups. Patients suffering from either irritable bowel syndrome, ulcerative colitis, non-erosive reflux disease or erosive reflux disease completed the SCL-90-R at a tertiary care gastroenterology department. Seven factors were identified, with one major distress factor and six minor factors. Comparison of the gastrointestinal disorder subgroups indicated that irritable bowel syndrome patients exhibited significantly more psychological distress compared to the other groups, and that gastrointestinal patients as a group, compared to healthy controls, were characterized by high levels of irritable depression and somatization. In planning further studies we encourage the use of factors identified in our study. The treatment of substantial irritable depression can be an important factor in improving quality of life in patients suffering from gastrointestinal disorders.