Problems of internal consistency and scaling in life event schedules

Translation and validation of the German version of the FACE-Q paralysis module in adult patients with unilateral peripheral facial palsy

The aim was to develop and validate a German version of the FACE-Q paralysis module, a patient-reported outcome measure to assess health-related quality of life in adult patients with unilateral facial palsy. The FACE-Q craniofacial questionnaire, which includes the paralysis module, was translated. 213 patients with facial palsy completed the German FACE-Q paralysis along with the established FDI and FaCE questionnaires. Regression analyses were performed to examine the relationships between the different FACE-Q domains and patient and therapy characteristics. The FACE-Q scales had high internal consistency (Cronbach's alpha all > 0.6). High correlations were found between the FACE-Q and the FDI and FaCE (mean rho = 0.5), as well as within the FACE-Q (mean rho = 0.522). Unifactorial influences were found for all domains except Breathing (all p < 0.05). Multivariate independent predictors were found for some FACE-Q domains. Most influential predictors (> 8 subdomains): Patients who received physical therapy scored lower in ten subdomains than those who did not (all p < 0.05). Patients who had surgery scored lower in nine subdomains than patients without surgery (all p < 0.05). The German version of the FACE-Q Paralysis Module can now be used as a patient-reported outcome instrument in adult patients with facial nerve palsy.

Metacognition as a Mediator for Posttraumatic Stress Symptoms Following Childhood Stressful Life Events: An Examination of the Construct Validity of the Metacognitions Questionnaire-Posttraumatic Stress Disorder

Both cognitive and metacognitive theories implicate posttraumatic metacognition as an important factor in the maintenance of posttraumatic stress symptoms (PTSS) following stressful life events (SLEs). The Metacognitions Questionnaire-posttraumatic stress disorder (MCQ-PTSD; Wells, 2009) was previously developed to assess for metacognitions specific to SLEs and resulting PTSS. This study aimed to examine the construct validity of this measure in the context of childhood SLEs specifically. First, we confirmed the factor structure underlying the MCQ-PTSD in our sample. We then assessed whether the MCQ-PTSD would function as expected based on a theoretical model in which, controlling for posttraumatic cognitions, posttraumatic metacognitions were expected to mediate the relationship between childhood SLEs and PTSS. Using data from a racially diverse sample of undergraduate psychology students (N = 402; Agemean = 19.38 ± 1.81) at a large Midwestern university, the two-factor structure of the MCQ-PTSD was confirmed. Among participants who endorsed clinically significant experience of childhood SLEs (n = 203; Agemean = 19.49 ± 1.94), negative metacognitions mediated the relationships of emotional and sexual abuse with PTSS, when controlling for other posttraumatic cognitions. These relationships were not observed for positive metacognitions. These results are consistent with a metacognitive model for PTSD and suggest that the MCQ-PTSD may be a valid measure of posttraumatic metacognitions following childhood SLEs.

The social readjustment rating scale: Updated and modernised

The Social Readjustment Rating Scale, originally devised in 1967 by Holmes and Rahe, measures the impact of life events stress. At the time, the SRRS advanced its field of research by standardising the impact of stress with a set of independently derived weights called 'life change units' (LCUs) for 43 life events found to predict illness onset. The scale has been criticised for being outdated, e.g. "Mortgage over $10,000" and biased, e.g. "Wife begin or stop work". The aim of this cross-sectional survey study is to update and improve the SRRS whilst allowing backwards compatibility. We successfully updated the SRRS norms/LCUs using the ratings of 540 predominantly UK adults aged 18 to 84. Moreover, we also updated wording of 12 SRRS items and evaluated the impact of demographics, personal experience and loneliness. Using non-parametric frequentist and Bayesian statistics we found that the updated weights were higher but broadly consistent with those of the original study. Furthermore, changes to item wording did not affect raters' evaluations relative to the original thereby ensuring cross-comparability with the original SRRS. The raters were not unduly influenced by their personal experiences of events nor loneliness. The target sample was UK rather than US-based and was proportionately representative regarding age, sex and ethnicity. Moreover, the age range was broader than the original SRRS. In addition, we modernised item wording, added one optional extra item to the end of the scale to evaluate the readjustment to living alone and identified 3 potential new items proposed by raters. Backwards-compatibility is maintained.

Between- and within-person effects of stress on emotional eating in women: a longitudinal study over 49 days

BACKGROUND

Stress is associated with binge eating and emotional eating (EE) cross-sectionally. However, few studies have examined stress longitudinally, limiting understanding of how within-person fluctuations in stress influence EE over time and whether stress is a risk factor or consequence of EE. Additionally, little is known regarding how the biological stress response relates to EE.

METHODS

We used an intensive, longitudinal design to examine between-person and within-person effects of major life stress, daily stress, and cortisol on EE in a population-based sample of women (N = 477; ages 15-30; M = 21.8; s.d. = 3.0) from the Michigan State University Twin Registry. Participants reported past year major life stress, then provided daily ratings of EE and stress for 49 consecutive days. Hair cortisol concentration (HCC) was collected as a longitudinal biological stress measure.

RESULTS

Women reported greater EE when they experienced greater mean stress across days (between-person effects) or greater stress relative to their own average on a given day (within-person effects). Daily stress was more strongly associated with EE than major life stress. However, the impact of daily stress on EE was amplified in women with greater past year major life stress. Finally, participants with lower HCC had increased EE.

CONCLUSIONS

Findings confirm longitudinal associations between stress and EE in women, and highlight the importance of within-person shifts in stress in EE risk. Results also highlight HCC as a novel biological stress measure that is significantly associated with EE and may overcome limitations of prior physiological stress response indicators.

Does Prior Civilian Trauma Moderate the Relationship Between Combat Trauma and Post-deployment Mental Health Symptoms?

In addition to combat trauma, childhood and adult non-military, interpersonal trauma exposures have been linked to a range of psychiatric symptoms (e.g., alcohol use problems, posttraumatic stress disorder [PTSD], depression symptoms) in veterans. However, few studies simultaneously explore the associations between these civilian and combat trauma types and mental health outcomes. Using a sample of combat-exposed veterans who were previously deployed to Iraq and Afghanistan (N = 302), this study sought to (a) understand the independent associations of civilian interpersonal trauma (i.e., childhood trauma and non-military adult trauma) and combat-related trauma with post-deployment alcohol use, PTSD symptoms, and depressive symptoms, respectively and (b) to examine the interactive effects of trauma type to test whether childhood and non-military adult trauma moderate the association of combat trauma with these outcomes. A path analytic framework was used to allow for the simultaneous prediction of these associations. In the final model non-military adult trauma and combat trauma were found to be significantly associated with PTSD symptoms and depression symptoms, but not average amount of drinks consumed per drinking day. Childhood trauma was not associated with any outcomes (i.e., PTSD symptoms, depression symptoms, average amount of drinks consumed per day). Only combat trauma was significantly associated with average amount of drinks consumed per day. Results underscore the importance of assessing multiple trauma types and considering trauma as a non-specific risk factor, as different trauma types may differentially predict various mental health outcomes other than PTSD. Further, results highlight the noteworthiness of considering co-occurring outcomes within the veteran community. Limitations, future directions, and implications of diversity are discussed.

Comparing sensitivity to change using the 6-item versus the 17-item Hamilton depression rating scale in the GUIDED randomized controlled trial

BACKGROUND

Previous research suggests that the 17-item Hamilton Depression Rating Scale (HAM-D17) is less sensitive in detecting differences between active treatment and placebo for major depressive disorder (MDD) than is the HAM-D6 scale, which focuses on six core depression symptoms. Whether HAM-D6 shows greater sensitivity when comparing two active MDD treatment arms is unknown.

METHODS

This post hoc analysis used data from the intent-to-treat (ITT) cohort (N = 1541) of the Genomics Used to Improve DEpression Decisions (GUIDED) trial, a rater- and patient-blinded randomized controlled trial. GUIDED compared combinatorial pharmacogenomics-guided care with treatment as usual (TAU) in patients with MDD. Percent of symptom improvement, response rate and remission rate from baseline to week 8 were evaluated using both scales. Analyses were performed for the full cohort and for the subset of patients who at baseline were taking medications predicted by the test to have moderate or significant gene-drug interactions. A Mokken scale analysis was conducted to compare the homogeneity of HAM-D17 with that of HAM-D6.

RESULTS

At week 8, the guided-care arm demonstrated statistically significant benefit over TAU when the HAM-D6 (∆ = 4.4%, p = 0.023) was used as the continuous measure of symptom improvement, but not when using the HAM-D17 (∆ = 3.2%, p = 0.069). Response rates increased significantly for guided-care compared with TAU when evaluated using both HAM-D6 (∆ = 7.0%, p = 0.004) and HAM-D17 (∆ = 6.3%, p = 0.007). Remission rates also were significantly greater for guided-care versus TAU using both measures (HAM-D6 ∆ = 4.6%, p = 0.031; HAM-D17 ∆ = 5.5%, p = 0.005). Patients in the guided-care arm who at baseline were taking medications predicted to have gene-drug interactions showed further increased benefit over TAU at week 8 for symptom improvement (∆ = 7.3%, p = 0.004) response (∆ = 10.0%, p = 0.001) and remission (∆ = 7.9%, p = 0.005) using HAM-D6. All outcomes showed continued improvement through week 24. Mokken scale analysis demonstrated the homogeneity and unidimensionality of HAM-D6, but not of HAM-D17, across treatment arms.

CONCLUSIONS

The HAM-D6 scale identified a statistically significant difference in symptom improvement between combinatorial pharmacogenomics-guided care and TAU, whereas the HAM-D17 did not. The demonstrated utility of pharmacogenomics-guided treatment over TAU as detected by the HAM-D6 highlights its value for future biomarker-guided trials comparing active treatment arms.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT02109939. Registered 10 April 2014.

The Relationship Between Depression Symptoms and Anxiety Symptoms During Acute ECT for Patients With Major Depressive Disorder

BACKGROUND

We investigated the efficacy of electroconvulsive therapy in patients with major depressive disorder and concomitant anxiety symptoms and explored the relationships between depression symptoms and anxiety symptoms during acute electroconvulsive therapy.

METHODS

Major depressive disorder inpatients (N = 130) requiring electroconvulsive therapy were recruited for a maximum of 12 treatments each. Depression symptoms, using the core factor subscale derived from the 17-item Hamilton Depression Rating Scale, and anxiety symptoms, using the anxiety/somatization subscale from the Hamilton Depression Rating Scale-17, were assessed before electroconvulsive therapy, after every 3 electroconvulsive therapy treatments, and after the final electroconvulsive therapy. Both core factor subscale and anxiety/somatization subscale scores were converted to T-score units to compare the degrees of changes between depression symptoms and anxiety symptoms after electroconvulsive therapy. The relationships between core factor subscale and anxiety/somatization subscale were analyzed using the cross-lagged longitudinal model during acute electroconvulsive therapy.

RESULTS

A total 116 patients who completed at least the first 3 electroconvulsive therapy treatments were included in the analysis. Reduction of core factor scale T-scores was significantly greater than that of anxiety/somatization subscale T-scores. The model satisfied all indices of goodness-of-fit (chi-square = 30.204, df = 24, P = 0.178, Tucker-Lewis Index = 0.976, Comparative Fit Index = 0.989, Root Mean Square Error of Approximation = 0.047). Core factor subscale changes did not definitely predict subsequent anxiety/somatization subscale changes.

CONCLUSIONS

Electroconvulsive therapy is effective in the acute treatment of major depressive disorder patients associated with anxiety symptoms. Anxiety symptoms improved less than depression symptoms during acute electroconvulsive therapy. However, earlier reduction in depression symptoms does not definitely drive subsequent relief in anxiety symptoms.

Mental health service use, depression, panic disorder and life events among Swedish young adults in 2000 and 2010: a repeated cross-sectional population study in Stockholm County, Sweden

AIMS

The use of specialised psychiatric services for depression and anxiety has increased steadily among young people in Sweden during recent years. It is not known to what extent this service use is due to an increase in psychiatric morbidity, or whether other adversities explain these trends. The aim of this study is to examine if there is increased use of psychiatric services among young adults in Sweden between 2000 and 2010, and if so, to what extent this increase is associated with differences in depression, anxiety and negative life events.

METHODS

This is a repeated cross-sectional study of 20-30-year old men and women in Stockholm County in 2000 and 2010 (n = 2590 and n = 1120). Log-binomial regression analyses were conducted to compare the prevalence of service use, depression and panic disorder between the two cohorts. Self-reported life events were entered individually and as a summary index, and entered as potential mediators. Different effects of life events on service use were examined through interaction analysis. We report prevalence proportion ratios (PPR) with 95% confidence intervals.

RESULTS

Specialised psychiatric service use, but also depression and panic disorder was more common in the younger cohort (current service use 2.4 and 5.0%). The younger cohort did not report more life events overall or among those with depression or anxiety. Neither depression, panic disorder nor life events could explain the increased use of psychiatric services in the younger cohort (Fully adjusted model PPR = 1.70, 1.20-2.40 95% CI). There was no significant interaction between cohort and life events in predicting psychiatric service use.

CONCLUSION

This study provides initial support for an increase in service use among young adults compared with 10 years earlier. The increased service use cannot be explained with increasing worse life situations.

Measurement of Stress: Scaling the Magnitudes of Life Changes

This paper evaluates models and measurements of the stress induced by life changes to determine whether a single scale can explain several different phenomena, including judgments of “ratios” and “difference” as well as “combinations.” Judgments of “ratios” and “differences” were found to be approximately monotonically related, suggesting that these judgments should not be taken at face value, but instead that the same comparison operation governs both tasks. Judgments of “combinations” of stressful events were not simply the sums of their separate events; instead, they showed two systematic departures from additivity. First, the effect of a given event was less when it was the least stressful event in a combination than when it was the most, as if the most stressful event carries extra configural weight. Second, each additional stressor had diminishing marginal effect on the overall judgment. All three sets of data could be explained with a single scale using the theory that “ratios” and “differences” are both governed by subtraction and that “combination” judgments are a configurally weighted combination of the same scale values. This unified scale of stress seems preferable to the previous scale that was based on magnitude estimation.

Stress and the Industrial Relations Process: Development of the Industrial Relations Event Scale

Although organizational stress has been the focus of much attention, there is a paucity of research on the stress associated with involvement in industrial relations. This article outlines the development of the Industrial Relations Event Scale (IRES), a measure designed to assess stressful events associated with the practice of industrial relations. The format of the IRES allows for the measurement of the occurrence, desirability, and perceived impact of each item. Test – retest reliability and internal consistency are satisfactory. The IRES also shows acceptable concurrent and known-group difference validity. A 20-item short form of the IRES was developed, with similar psychometric properties to the 63-item IRES. Future research priorities for the IRES and industrial relations stress in general are identified.

Psychometric Properties of the Life Events Checklist

The Life Events Checklist (LEC), a measure of exposure to potentially traumatic events, was developed at the National Center for Posttraumatic Stress Disorder (PTSD) concurrently with the Clinician Administered PTSD Scale (CAPS) to facilitate the diagnosis of PTSD. Although the CAPS is recognized as the gold standard in PTSD symptom assessment, the psychometric soundness of the LEC has never been formally evaluated. The studies reported here describe the performance of the LEC in two samples: college undergraduates and combat veterans. The LEC exhibited adequate temporal stability, good convergence with an established measure of trauma history—the Traumatic Life Events Questionnaire (TLEQ)— and was comparable to the TLEQ in associations with variables known to be correlated with traumatic exposure in a sample of undergraduates. In a clinical sample of combat veterans, the LEC was significantly correlated, in the predicted directions, with measures of psychological distress and was strongly associated with PTSD symptoms.

Entwicklung und Evaluation des Fragebogens zu belastenden Sozialerfahrungen in der Peergroup (FBS)

Theoretischer Hintergrund: Im deutschsprachigen Raum liegt kein geeignetes Instrument zur retrospektiven Erfassung von Peerviktimisierung vor. Fragestellung: Ziele der Studie waren die Entwicklung und Evaluation einer Ereignisliste, mit der belastende Sozialerfahrungen in der Peergroup retrospektiv erfasst werden können. Methode: Der Fragebogen zu belastenden Sozialerfahrungen (FBS) wurde nach inhaltlichen Überlegungen erstellt. Die psychometrischen Eigenschaften wurden mittels einer Internetbefragung (N = 995) überprüft. Ergebnisse: Die Stichprobe war hinsichtlich psychischer Symptomatik und sozialer Ängstlichkeit überdurchschnittlich belastet. Die Stabilität der Angaben kann als zufriedenstellend beurteilt werden. Die Konstruktvalidität wird durch Zusammenhänge des FBS mit psychischer Symptombelastung und sozialen Ängsten bestätigt. Signifikant höhere FBS-Werte der hoch Sozialängstlichen verglichen mit den niedrig Sozialängstlichen liefern Hinweise auf diskriminative Validität. Schlussfolgerung: Der Einsatz des FBS in Forschung und Praxis kann empfohlen werden. Weitere Validierungsstudien an klinischen und nicht klinischen Stichprobe stehen aus.

Psychometric properties of the Trauma Assessment for Adults

BACKGROUND

The Trauma Assessment for Adults (TAA) was developed to facilitate the assessment of exposure to traumatic events that could result in posttraumatic stress disorder (PTSD). The TAA inquires about numerous potentially traumatic events that an individual may have experienced. Although the TAA has been used extensively for clinical and research purposes, its psychometric properties have never been formally evaluated. The objective of the present investigation was to evaluate the psychometric properties of this frequently used measure.

METHODS

The studies reported here describe the performance of the TAA in two samples-college undergraduates (N=142) and community mental health center clients (N=67). Among undergraduates, 1-week temporal stability was evaluated and, in both samples, item- and scale-level convergence of the TAA with an established trauma exposure measure was assessed. Convergence of the TAA with clinically related constructs was also evaluated.

RESULTS

The TAA exhibited adequate temporal stability (r=.80) and satisfactory item-level convergence with existing measures of trauma history among college students. In the clinical sample, the TAA again converged well with an established measure of trauma exposure (r=.65). It was not as strongly predictive, in either sample, of trauma-related distress relative to an alternate trauma exposure measure.

CONCLUSION

Although it performs satisfactorily, the TAA does not appear to be superior to other existing measures of trauma exposure.

Testing a gender additive model: the role of body image in adolescent depression

Despite consistent evidence that adolescent girls are at greater risk of developing depression than adolescent boys, risk factor models that account for this difference have been elusive. The objective of this research was to examine risk factors proposed by the gender additive model of depression that attempts to partially explain the increased prevalence of depression in adolescent girls. The theory suggests that body image and eating related variables predict depression for girls, but not for boys, above and beyond the variance accounted for by other well-known risk factors, some of which were examined in the current study. The sample was 247 adolescent girls and 181 adolescent boys studied over a 24-month duration. Results suggest that body dissatisfaction is a potent predictor of depression for girls, but not for boys, above and beyond the predictive effects of other established risk factors. Results provide insight into the etiology of adolescent depression and the disparate rate of depression among adolescent girls and provide direction for identifying high-risk individuals and developing effective prevention programs.

A prospective test of cognitive vulnerability models of depression with adolescent girls

This study sought to provide a more rigorous prospective test of two cognitive vulnerability models of depression with longitudinal data from 496 adolescent girls. Results supported the cognitive vulnerability model in that stressors predicted future increases in depressive symptoms and onset of clinically significant major depression for individuals with a negative attributional style, but not for those with a positive attributional style, although these effects were small. This model appeared to be specific to depression, in that it did not predict future increases in bulimia nervosa or substance abuse symptoms. In contrast, results did not support the integrated cognitive vulnerability self-esteem model that asserts stressors should only predict increased depression for individuals with a confluence of negative attributional style and low self-esteem, and this model did not appear to be specific to depression.

Rating scales in depression: limitations and pitfalls

Since the introduction of antidepressants to psychopharmacology in the 1960s, the Hamilton Depression Rating Scale (HAM-D) has been the most frequently used rating scale for depression. When used as a scale for prediction of outcome with antidepressants, the HAM-D, by its total score, has obtained limited use analogous to the Diagnostic and Statistical Manual of Mental Disorders. 4th ed (DSM-IV) diagnosis of major depression. Most research has been devoted to the use of the HAM-D to discriminate between placebo and active drugs or to show dose-response relationship in patients with major depression. An improvement in the total HAM-D score during a drug trial does not, however, in itself qualify the drug as an antidepressant, because the total score is not a sufficient statistic. The problem of statistical versus clinical significance when analyzing placebo-controlled trials, including dose-response relationship, is outlined, with the recommendation to use effect size statistics.

Event-list construction and treatment of exposure data in research on political violence

Event lists are commonly applied for measuring exposure to various kinds of potentially stressful and traumatizing life events. Before making general conclusions about the psychological effects of exposure to such events, problematic issues related to the use of event-list data need to be discussed and resolved. This article focuses on issues related to the construction and application of event lists for measuring exposure to political violence such as issues related to reliability, the applicability of the additive assumption, whether to weight event-list items, and the possible consequences of incomplete event lists. Alternative future approaches to these measurement issues are also discussed.

A prospective test of the stress-buffering model of depression in adolescent girls: no support once again

The stress-buffering model posits that social support mitigates the relation between negative life events and onset of depression, but prospective studies have provided little support for this assertion. The authors sought to provide a more sensitive test of this model by addressing certain methodological and statistical limitations of past studies with prospective data from 496 adolescent girls. Deficits in peer support predicted increases in depressive symptoms, and negative life events predicted onset of depressive pathology. However, none of the 14 prospective tests provided support for the stress-buffering model despite sufficient power. Results provide scant support for the stress-buffering model and suggest that it might be time to shift attention to alternative multivariate models concerning these risk factors.

Assessment of exposure to political violence and other potentially traumatizing events. A critical review

This paper focuses on the common use of internal-consistency reliability, test-retest, and interrater correlations based on counts of events, events sampling, and factor-analytic techniques in assessment of exposure to political violence and other potentially traumatizing events. The author attributes the continued use of these strategies to a tendency among researchers to identify items from conventional events lists as effect indicators. Through a discussion of four alternative measurement models, the rationale is provided for the proposition that exposure to political violence and similar constructs should be treated as composite variables with causal indicators, rather than as latent variables with effect indicators.

[Stress assessment method for workers (Part 2)--The diagnostic analyses and judgements of stressful conditions of stress-dock examinees on the basis of the total score of numerical-valued stressors they have suffered for the past 1 year]

In order to evaluate the grade of reaction to stressors, especially those in the occupational life of workers, the following stress survey was conducted. This survey consisted of 65 stress questionnaires based on the social readjustment rating scale prepared by Holmes and Rahe, including 18 new questionnaires on the occupational environment. The method is as follows. That is, marriage is given a score of 50 in reference-standard for stress strength and these 65 items for 1,630 workers were evaluated by self-rating method ranging in score from 0 to 100. As for each item, we found the average value for the total sample and we called it the stress score. The subject group (1,426 employees who were examined for Stress-Dock) judged their experience during the past 1 year by their stress scores. The stress scores for the stressors experienced in a year were summed (total experienced stress score). We examined whether the total experienced stress score would be an index of the degree of stress, etc. We then analyzed the relationship between the total experienced stress score and stress conditions (i.e. "severe (hereafter, the assumed severe group)", "borderline (borderline group)" and "not severe (not severe group)"). In addition, the relationship between the total experienced stress score and mental disorders (stress related diseases were the majority) diagnosed by ICD-10 was examined. Our findings and conclusions are as follows: 1. We presented two typical cases. Next, the distribution of the total experienced stress score in all subjects was shown. 2. The average total experienced stress score increased from 135 to 219 points and 312 points in the order, not severe group, borderline group and severe group. It was paid noticeable that the severe group had scores 2.3 high times higher the not severe group. 3. The mental disorders group diagnosed with ICD-10 as mental disorders was large including 888 people, and the average total score for experienced stress score was a high 312 points. This was, as many as 94 points higher than in the normal group, and a significant difference was admitted by both. The difference of 1.1 point was admitted in the LCU numbers. Moreover, in statistical analysis, the score method showed a high significant difference according to F41 and F43 compared with the number of LCU items. We thought that the difference of the score method was more comprehensible than that of the number of LCU items as a result. 4. We took the possible total experienced stress score as 100 points, and examined the score for patients with mental disorders. It was 78.8% in the group with a high 400 points or more, but percentage for patients with mental disorders was only 39.3% in less than 100 points. The greater the point increases the higher the frequency of the appearance of disease. 5. We thought that we were able to measure the degree of worker's stress to obtain the total experienced stress score from life event in the above-mentioned way.

Limitations on the use of scales in psychiatric research

This paper discusses some issues involved in the construction and interpretation of scales in psychiatric research. The issues covered include scale construction, measures of scale homogeneity, the logic of factor analysis and the interpretation of effects manifesting in scale-data, especially interaction effects. The aim of the paper is to "de-mystify" some of the psychometric techniques commonly available, and to emphasize that their appropriate use depends on both a firm understanding of the content area to which they are applied and a rudimentary knowledge of what the methods purport to do.

Revising the Seriousness of Illness Rating Scale: modernization and re-standardization

The burgeoning research in psychosomatic medicine requires quantitative measures reflecting important biological, psychological, and social variables. The Seriousness of Illness Rating Scale (SIRS), although twenty years old, is currently utilized in psychosomatic research as an index of illness seriousness. In light of medical advances during the past two decades, an expansion and re-standardization of the SIRS appeared warranted. Forty-six medical students, residents, and faculty rated the seriousness of 137 disease items. High inter-rater reliability was demonstrated by a concordance coefficient of 0.716 and overwhelming agreement on relative disease item rankings between the three medical groups. Thus, the Seriousness of Illness Rating Scale-Revised (SIRS-R) is an ordinal level scale which reliably measures current views on illness seriousness and can be easily employed in multivariate psychosomatic research.

Life events and schizophrenia. A replication

54 schizophrenic patients paired for age, sex, marital status and social class with 54 normal subjects were investigated with Paykel's Interview for Recent Life Events. The interview covered life events occurring in the 6 months preceding admission to hospital for a schizophrenic episode for the patients and screening for the normal subjects. The schizophrenics reported more life events than the normal controls in the areas of work, health, and social and familial relations, and also experienced more events with a moderate to severe objective negative impact than the latter. While these results confirm the hypothesis that threatening life events can, in many patients, be considered risk factors for the development of an acute schizophrenic episode, they do suggest the need to examine the life event-schizophrenic relation according to a multifactorial approach, such as that provided by the vulnerability model, which includes an evaluation of the role of moderating variables.

A Global Assessment of Recent Stress (GARS) Scale

The Global Assessment of Recent Stress (GARS) Scale was developed to assess current stress perception. Most measurements of environment are derived from life event scales that capture amount of stress or change associated with stressful events that have occurred over the past six to twenty-four months. A scale that provides a more immediate estimate of stress is needed when physiological tests and perceived stress are studied together. The GARS has been subjected to a series of studies concerning its reliability, validity, and factor structure. Results suggest that it may be a useful instrument for helping individuals assess their current feelings of stress.

Life events in Xhosas in Cape Town

A life events scale for research into Xhosa speaking people of Cape Town was developed. It was standardised on 131 residents of Cape Town's three major Black suburbs. Measures of perceived impact and rate of occurrence were elicited. The Spearman Rank correlation between prevalence and impact scores was not significant (r = 0.04). Items were ranked according to composite impact scores. Cultural and social factors were considered to play a part in explaining differences between the present findings and those of other studies. Limitations on the applicability of the scale and methodological issues were discussed. The problems in direct comparison between different cultural groups were emphasized, with particular stress on constraints on life events research in an African setting.

Methodological aspects of life events research

This paper reviews the methodology of studies of recent life events and illness, as relevant to psychosomatic studies. Three critical issues are discussed: the method of data collection; elimination of events which are consequences of illness; quantification of stress. It is concluded that the most important aspect is collection of data by careful interview technique covering defined events and time periods. Self-report event questionnaires, although heuristically valuable in the past, must now be regarded as inadequate. Exclusion of events which may be consequences of illness is also important in psychosomatic studies. Different methods of quantification produce refinements but are less crucial and alternative approaches may give similar results.