Traditional and Contemporary Views of Psychological Testing

Using a combination of classical test theory and Rasch item analysis, we developed a short scale designed to measure the effectiveness of mental health treatment across a wide range of mental health services and populations. Item development for the scale was guided by literature review and interviews with senior clinicians and with patients. Using 3 different samples consisting of inpatients, outpatients, and nonpatients, we reduced our initial item pool from 81 to 10 items. The 10-item scale had an alpha of .96 and showed strong correlations with commonly used measures of psychological well-being and distress. Our results suggest that the scale appears to measure a broad domain of psychological health. The scale appeared to lack ceiling and floor effects, and it discriminated between inpatients, outpatients, and nonpatients, suggesting the scale has excellent potential to be broadly responsive to a variety of treatment effects. In addition, the new scale proved to be sensitive to treatment changes in a sample of 20 psychiatric inpatients. Overall, the initial data suggest that we have developed a brief, sensitive outcome measure designed to have wide application across psychiatric and psychological treatments and populations.     

Self-reported levels of psychopathology of drug abusers not currently in treatment

This study assessed levels of psychopathology, as measured by the Symptom Checklist-90-Revised, of drug users not in treatment. These levels were then compared with levels of psychopathology reported previously in the literature of drug users in treatment, the general population, psychiatric inpatients, and psychiatric outpatients. Results suggest that drug users not in treatment endorse significantly lower levels of psychopathology than drug users in treatment, psychiatric inpatients, and psychiatric outpatients. However, they endorse significantly higher levels of pathology than adult nonpatients and they appear most similar to adolescent nonpatients. Implications for clinical work (prevention and intervention) as well as for future research are discussed. The study also established preliminary cultural validity of SCL-90-R with Alaska Natives.     

Social Skills Training for Psychiatric Patients,II

In this second paper on social skills training for psychiatric patients the author critically reviews the controlled clinical outcome studies of social skills training in a number of psychiatric populations: mentally retarded persons, depressed patients, psychiatric outpatients, and psychiatric inpatients. He points out that more research is needed to determine the effectiveness of social skills training, especially for patients with debilitating chronic mental illness.     

The Short-Term Psychological Impact of the COVID-19 Pandemic in Psychiatric Patients: Evidence for Differential Emotion and Symptom Trajectories in Belgium

The spread of COVID-19 and the implementation of various containment strategies across the world have seriously disrupted people’s everyday life, and it is especially uncertain what the psychological impact of this pandemic will be for vulnerable individuals, such as psychiatric (ex-)patients. Governments fear that this virus outbreak may prelude a major mental health crisis, and psychiatrists launch critical calls to flatten an upcoming mental ill-health surge. Here, we aim to add nuance to the idea that we are heading towards a mental health pandemic and that psychiatric populations will unavoidably (re)develop psychopathology. Despite being subjected to the same challenges posed by COVID-19, we argue that people with a history of psychiatric illness will psychologically deal with this adversity in different ways. To showcase the short-term differential impact of COVID-19 on patients’ mental health, we present the day-to-day emotion and symptom trajectories of different psychiatric patients that took part in an experience sampling study before, during, and after the start of the first wave of the COVID-19 pandemic in March 2020 and associated lockdown measures in Belgium. Piecewise regression models show that not all patients’ psychological well-being is affected to a similar degree. As such, we argue that emphasizing human resilience, also among the more vulnerable in society, may be opportune in these unsettling times.     

Exploring the hand test with medically ill children and adolescents

Pediatric psychologists use the tools of assessment to evaluate the psychological functioning of youth with chronic and acute medical illnesses. This study is an exploration of the use of a performance-based measure, the Hand Test (HT; Wagner, 1983), with pediatric medical patients. A sample of medical inpatients (n = 27) and psychiatric outpatients (n = 24) were administered the HT, a self-report measure, and a parent-report behavior rating scale. Results indicate that the psychiatric group scored higher than the medical group on HT Aggression, Withdrawal, and Pathological scores. The Aggression (d = 0.90) and Pathological (d = 0.80) variables were particularly robust in differentiating between groups, but the Crippled variable did not differ between groups. Hierarchical logistic regression demonstrated the incremental validity of the HT over behavior ratings alone in the classification of clinical groups. Analyses indicated that the HT can add important information in the differentiation of medically ill children from those with psychological disturbance.     

The Impact of Exposure to Internet-Based Information About the Rorschach and the MMPI–2 on Psychiatric Outpatients’ Ability to Simulate Mentally Healthy Test Performance

To examine the impact of Internet-based information about how to simulate being mentally healthy on the Rorschach (Exner, 2003) and the MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), 87 psychiatric outpatients completed the tests under 4 conditions: uncoached and Internet-coached outpatients under faking healthy instructions (faking patients and Internet-faking patients) and patients and nonpatients under standard instructions (standard patients and standard nonpatients). On the Rorschach, faking patients and Internet-faking patients did not manage to portray healthy test performance and, like standard patients, revealed a significantly greater number of perceptual and cognitive disturbances than standard nonpatients. Faking patients scored in the psychopathological direction on most variables. Internet-faking patients produced constricted protocols with significantly higher F% (57%) and lower use of provoking and aggressive contents than the other groups. On the MMPI–2, faking patients and Internet-faking patients were able to conceal symptoms and, like standard nonpatients, scored in the normal range on the clinical scales. The validity scale L successfully detected the faking patients and the Internet-faking patients, whereas the F scale only distinguished the Internet-faking patients and K only the faking patients. We conclude that Internet-based information could threaten test validity.     

Development of a spanish version of the Schwartz Outcome Scale-10: a brief mental health outcome measure.

The lack of culturally appropriate psychometric instruments for the assessment of cognitive and emotional functioning in minority populations has been a concern often discussed in the assessment literature. With the increased focus on the measurement of outcome in mental health treatment, the lack of appropriate instruments for minorities has become readily apparent in this venue as well. We report on the Spanish translation of a brief and reliable measure of psychological health and well-being that has been shown to be sensitive to treatment outcomes. The original and Spanish translated versions of this measure are highly correlated, providing clinicians and organizations with a instrument that can be used for assessment of psychological well-being and treatment outcomes with Hispanic patients.     

Patient experiences with treatment in private practice compared with public mental health services

The study compared patient experiences with psychiatric treatment provided by private practitioners and public outpatient clinics. Questionnaires were completed by 642 outpatients in private practice and 6,677 outpatients in public clinics. The questionnaire included a measure of patient experiences comprising six items: treatment outcome, enough time for contact and dialogue with clinician, clinicians' understanding of patient's situation, suitability of therapy and treatment, clinician follow-up of planned actions, and influence on treatment. Patients in private practice had generally better experiences than patients in public outpatient treatment. The difference between private and public patients was largest for patients with poor self-evaluated mental health or those who had just one consultation in the previous three months. Private practitioners appear to have an important role in mental health services delivery, and patients have relatively good experiences with services. Further studies that assess the patient - clinician interaction in different mental health services may give further insights into potential service improvements.     

Rorschach Comprehensive System data for a sample of 116 preadolescent and 117 adolescent nonpatients from Italy

This project provides information on how preadolescent and adolescent nonpatients perform on the Rorschach test, administered and scored following Exner's guidelines (2003). Lis, Salcuni, Parolin, and Superchi (2001) reported previously initial data for 51 adolescent nonpatients living in Italy who were administered this instrument by graduate and postgraduate students in a 2-year research course at the Psychotherapy School of the University of Padua, between July 1998 and February 2001. The current study is an extension of that work and includes information on additional adolescent nonpatients and preadolescent nonpatients, gathered between April 2001 and December 2006. The study thus includes information on 233 participants, 116 preadolescents (aged 12-14) and 117 adolescents (aged 15-18). Individuals were excluded if they had a major medical illness in the past 6 months, any psychiatric hospitalization, psychological treatment within the past 2 years, any felony conviction, or psychological testing within the past year. Interrater reliability statistics at the response level for scoring segments are reported both with percentage of agreement and iota. Rorschach Comprehensive System (CS) findings are presented.     

WASI profile variability in a sample of psychiatric inpatients

This study examined the variability of Wechsler Abbreviated Scale of Intelligence profiles using the subtest range and profile variability index in a sample of 70 psychiatric inpatients. The subtest range and profile variability index were correlated .93 (p<.001), indicating that either measure may be used to assess profile variance. Comparison of profile variability on this abbreviated scale with other Wechsler intelligence scales in similar populations suggests that variability measures are not comparable across the tests.     

Trans Collaborations Clinical Check-In (TC3): Initial Validation of a Clinical Measure for Transgender and Gender Diverse Adults Receiving Psychological Services

One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement-based care, given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in health care. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC³). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final 18-item version was administered to 215 TGD adults (75 transfeminine, 76 transmasculine, 46 nonbinary, 18 unknown; mean age of 30 with a range of 19 to 73), who were recruited for an online study, with other questionnaires assessing negative affect, well-being, gender dysphoria, gender minority stressors, and resilience. Higher scores on the TC³ (indicating better adjustment and comfort with gender) were generally associated with lower depression, anxiety, minority stress, and gender dysphoria and greater life satisfaction, body congruence, and positive aspects of being TGD such as pride in identity and community belongingness. These results support the validity of the TC³ as a brief measure to be used as a clinical tool for TGD people receiving mental health services. Additional research is needed on the reliability and validity of the TC³ across multiple time points to determine utility as a progress monitoring measure. The TC³ should also be further validated with more culturally diverse samples.     

Robustness of two single-item self-esteem measures: cross-validation with a measure of stigma in a sample of psychiatric patients

Robins' Single-item Self-esteem Inventory was compared with a single item from the Coopersmith Self-esteem. Although a new scoring format was used, there was good evidence of cross-validation in 83 current and former psychiatric patients who completed Harvey's adapted measure of stigma felt and experienced by users of mental health services. Scores on the two single-item self-esteem measures correlated .76 (p < .001), .76 and .71 with scores on the longer scales from which they were taken, and .58 and .53, respectively, with Harvey's adapted stigma scale. Complex and perhaps competing models may explain links between felt stigma and poorer self-esteem in users of mental health services.     

Measurement Invariance of the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) across Gender,Age and Treatment Context

The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) was designed to measure quality of life in clinical samples of Latino adolescents aged 12–18 years, but has also been used in community samples. The original measure included three factors: Emotional Regulation (ER), Self-Concept (SC) and Social Context (SoC). The goals of this study are to replicate the factor structure using confirmatory factor analysis (CFA), shorten the instrument and test the degree of measurement invariance across gender, age, and type of sample. Participants for the analyses (N?=?354) came from two populations in the San Juan Metropolitan Area: (1) adolescents from randomly selected households, using a multi-stage probability sampling design (n?=?295), and (2) adolescents receiving treatment at mental health clinics (n?=?59). We first carried out a conceptual item analysis for item reduction purposes and then assessed dimensional, configural, metric and scalar invariance for each factor using the Mplus software system. The original 3-factor structure was replicated with comparable model fit in each treatment context. Metric invariance was attained for all three scales across groups. Either full or partial scalar invariance was also observed with DIF in a total of 6 items. Invariance testing supports the use of the abridged 21 item version of the AQOL-MHS to compare diverse individuals with little bias using observed scores, but for refined estimates the ideal scoring will be from a latent variable model.     

Four studies extending the utility of the Schwartz Outcome Scale (SOS-10)

The Schwartz Outcome Scale (SOS-10; Blais et al., 1999) is a brief, cost free, and easy to administer assessment device designed to measure a broad domain of psychological health. The 4 studies using the SOS-10 reported here extend the initial reliability and validity studies beyond psychiatric patients in a hospital setting to examine (a) test-retest reliability in a college student population, (b) concurrent validity with college students using an indirect technique assessing maladjustment, (c) concurrent validity with college counseling center clients using a self-report measure of client distress, and (d) sensitivity to treatment changes with outpatient clients. These studies lend further support for using the SOS-10 as a measure of psychological well-being and as an outcome measure in varied settings.     

Sex differences in the psychological well-being of Chinese adolescents

This study assessed sex differences affecting the psychological well-being of Chinese adolescents. Various instruments were used to measure psychiatric symptoms and positive mental health. The results showed that female adolescents displayed significantly more psychiatric as well as somatic symptoms and scored lower on scales reflecting positive mental health. The findings are generally consistent with those found in the Western literature, but suggest that, in the Chinese culture, sex differences in mental health begin to appear in adolescents.     

Sex Differences in the Psychological Well-Being of Chinese Adolescents

This study assessed sex differences affecting the psychological wellbeing of Chinese adolescents. Various instruments were used to measure psychiatric symptoms and positive mental health. The results showed that female adolescents displayed significantly more psychiatric as well as somatic symptoms and scored lower on scales reflecting positive mental health. The findings are generally consistent with those found in the Western literature, but suggest that, in the Chinese culture, sex differences in mental health begin to appear in adolescents.     

Sexual assault history and use of health and mental health services

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.     

Replication of the Self-Concept and Identity Measure (SCIM) Among a Treatment-Seeking Sample

Identity distress occurs within a variety of psychiatric conditions. Reliable tools for assessing identity-related functioning among clinical populations are greatly needed. The Self-Concept and Identity Measure (SCIM) is a brief self-report scale designed to assess healthy and disturbed identity dimensions. This measure has been validated within normative but not treatment-seeking samples. The present study used an a priori confirmatory approach to replicate the SCIM’s factor structure among disadvantaged women enrolled in treatment for chemical dependence (N = 216). The original three-factor structure and item loadings generally replicated within this diagnostically diverse, significantly impaired sample. Higher SCIM scores were also associated with other problems, such as emotion dysregulation and depression. Results support the SCIM’s use and scoring with clinical populations.     

Cognitive-Behavioral Therapy for Offender Hopelessness: Lessons from Treatment of Forensic Inpatients

Patients remanded to forensic hospitals often experience a marked situational depression once initial psychotic symptoms subside and the reality of their legal situation becomes evident. Individual psychotherapy is not often used with this population due to a generally high level of impairment. It is suggested, that with modifications, the cognitive-behavioral therapy manual by Michael Thase (in: VanHasselt, Hersen (eds) Sourcebook of psychological treatment manuals for adult disorders, 1996) designed to treat depression in psychiatric inpatients can be used to treat situational depression in forensic inpatients. Modifications include the use of increased behavioral techniques, the addition of a group component, and lengthening of time limits for each treatment phase. Case examples from a first attempt to implement the new treatment program are presented.