Validity of the 15-item social inhibition questionnaire in outpatients receiving psychological or psychiatric treatment: The association between social inhibition and affective symptoms

OBJECTIVE

Social inhibition may promote symptoms of depression and anxiety in adults from an outpatient hospital population. The current work builds on a previously corroborated construct of social inhibition and examines the psychometric properties of this assessment tool and its predictive validity in the adult outpatient hospital population.

METHODS

A total of 350 adult outpatients receiving treatment at the department of Medical Psychology or Psychiatry completed measures of social inhibition and symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (9-item Patient Health Questionnaire). Factor analyses, reliability estimates, and regression analyses were used to replicate the robustness of the model of social inhibition, and the 15-item Social Inhibition Questionnaire (SIQ15).

RESULTS

In the current sample (N = 350; M_age = 45 years; 67.4% women), factor analyses confirmed the previously suggested three-factor model of social inhibition as measured by the SIQ15. The subscales of behavioral inhibition, interpersonal sensitivity and social withdrawal proved to be internally consistent (Cronbach's α between 0.87/0.95) and stable over time (test-retest reliability between r = 0.76/0.83). At baseline, interpersonal sensitivity and social withdrawal were associated with anxiety and depressive symptoms. At three months follow-up, only interpersonal sensitivity was related to depressive symptoms.

CONCLUSIONS

Social inhibition is associated with anxiety and depression at baseline and can be reliably assessed with the SIQ15 in an outpatient hospital population. The association of interpersonal sensitivity with depressive symptoms at three-month follow-up suggests an important aim for future research on the development of preventive methods for affective symptoms in socially inhibited outpatients.

[Management of treatment refusal by a psychiatric patient with a life-threatening infectious form of pulmonary tuberculosis]

A Somalian man aged 26 was admitted to a general hospital because of haemophthisis. A severe infectious and life threatening pulmonary tuberculosis was diagnosed. Thereafter, the patient denied having any disease, refused any therapy or diagnostic procedure and wanted to leave the hospital. He was isolated by virtue of the Wet Bestrijding Infectieziekten ('WBI': Bill on Management of Infectious Diseases). Permission for treatment without consent was arranged by virtue of the Wet op de Geneeskundige Behandelingsovereenkomst ('WGBO': Decree on the Medical Contract). The use of measures like fixation and involuntary administration of medication could also be arranged by virtue of the WGBO. The Wet Bijzondere Opnemingen Psychiatrische Ziekenhuizen ('Wet BOPZ': Bill on Compulsory Admission to Psychiatric Hospitals), which exclusively concerns involuntary treatment exclusively of psychiatrics patients, was of no value in this case. Analysis of the different aspects of these three laws led to the conclusion that in case of a somatic disease, whether or not complicated by a psychiatric diagnosis, a treatment without consent must be arranged by virtue of the WGBO.

[Physician-assisted suicide for a patient with a psychiatric disorder: guidelines for psychiatrists. Dutch Association of Psychiatry]

In September 1998, the Dutch Association of Psychiatry published guidelines for the psychiatrist concerning cases of psychiatric patients requesting assistance with suicide. Assistance with suicide is restricted to a psychiatrist in his role as a treating physician of a patient with a psychiatric disorder. Requests for assisted suicide should primarily be considered as requests for help with life. Individual psychiatrists have no moral or legal obligation to assist in suicide. The guidelines require that the request is voluntary, explicit and well considered, the desire for death long-lasting and the suffering unbearable and hopeless. In addition an independent psychiatrist should be consulted as well as former treating physicians, general practitioner, family members and other people involved. If a somatic specialist or a general practitioner is asked to assist in suicide consultation of two psychiatrists is required. The guidelines offer psychiatrists a framework for taking great care when their patients request assisted suicide and will certainly play a part in the legal control of assisted suicide.