Scaling clinical judgments of symptom pathology by means of the psychophysiological method of magnitude estimation

Summing scores across heterogeneous symptom items without consideration of their differing psychopathological significance has been criticized as producing an inadequate picture of an individual's clinical status. The purpose of this study was to derive symptom item weights representing clinically judged seriousness of each symptom through the application of Stevens's psychophysical method of magnitude estimation. A nationwide sample of 129 clinicians rated the pathological significance of 221 symptom items in a design such that every rater rated 121 items, 21 of which were rated by all raters and 100 of which were rated only by the A or B subgroup to which each rater was randomly assigned. Each item was rated as to the seriousness of the pathology it would represent if manifested by either a boy child, girl child, boy adolescent, or girl adolescent, with one-fourth of the raters assigned to each condition. The results of 211 two-way analyses of variance revealed that age and age and sex in interaction, but not sex alone, significantly influenced the clinical ratings. The resulting magnitude estimation ratings of symptom pathology ranged from 1.0 to 9.9. They were demonstrated to have satisfactory reliability and convergent validity and to have the psychophysical characteristics of a prothetic continuum.A preliminary version of this paper was presented at the 85th Annual Convention of the American Psychological Association, San Francisco, August 1977. The research was supported by HEW grant MH24886. The authors wish to express appreciation to Walter W. Wengel for his work in developing the median quotient ratings used in the study, to Terrance Auger for making available unpublished raw data, and to Merton S. Krause for helpful suggestions regarding the interpretation of results.