Norbert Schmitz

The Symptom Check-List-90-R (SCL-90-R): A German validation study

The Symptom Check-List-90-R (SCL-90-R) is a widely used psychological status symptom inventory. The properties of the German SCL-90-R version were studied in two clinical samples: psychosomatic outpatients and primary care patients. The data were compared with a German community sample. The internal consistency, measured by Cronbachs α coefficients, was found to be high, for the global scale and all original subscales. Mokken scale analysis indicated hierarchical structure for most of the subscales. Concurrent validity, evaluated by studying the relationship between the SCL-90-R subscales and the Inventory of Interpersonal Problems (IIP-C) and the General Health Questionnaire (GHQ-12) was also high. On the basis of receiver operating characteristic (ROC) analyses, it was found that the SCL-90-R was able to differentiate between subjects known to have a given psychological disorder and those who do not. Results of exploratory and confirmatory factor analysis failed to support the original nine factor model and two subsequent factor models. The strong interdependence of the original subscales and the strong first unrotated factor of the exploratory factor analyses raised concern regarding the multi-dimensionality of the SCL-90-R subscales. We concluded that the SCL-90-R is a useful tool for measuring psychological status, measuring change in outcome studies, or screening for mental disorders.

Diagnosing mental disorders in primary care: the General Health Questionnaire (GHQ) and the Symptom Check List (SCL-90-R) as screening instruments

Background: The treatment of mental disorders in Germany is mainly done by primary care physicians. Several studies have shown that primary care physicians have difficulty in diagnosing these disorders. Recently, several self-report questionnaires have been developed that can be used as screening instruments to identify psychopathology in primary care settings and in the community. The aim of this paper was to investigate the screening properties of the General Health Questionnaire (GHQ-12) and the Symptom Check-List (SCL-90-R) in a primary care setting in Germany. Method: A randomly selected sample (nu2009=u2009408) of adult outpatients from 18 primary care offices in Düsseldorf was screened using the German versions of the GHQ-12 and the SCL-90-R. A structured diagnostic interview (SCID) and an impairment rating (IS) were used as a gold standard to which both questionnaires were compared. Test performance was evaluated by receiver operating characteristic (ROC) analysis. Results: We found no difference in the performance of the general scores of the two questionnaires. Both instruments were able to detect cases. Complex scoring methods offered no advantages over simpler ones for the GHQ-12. ROC analysis confirmed that the SCL-90-R subscales “anxiety” and “depression” showed acceptable concurrent validity for the diagnostic groups anxiety and depression (according to DSM-III-R). Conclusions: GHQ-12 and SCL-90-R appeared to be useful tools for identifying mental disorders in primary care practice and research. The use of GHQ-12 or SCL-90-R, employed as a first step, supplemented by a second-stage interview, may enhance the detection rate of mental disorder in primary care settings.

Stress, burnout and locus of control in German nurses

The aim of this study was to evaluate the effects of locus of control and work-related stress on burnout in hospital staff nurses. A convenience sample of 361 staff nurses from nine units in five German hospitals were surveyed using the Maslach Burnout Inventory, the Locus of Control Questionnaire and a Work-Related Stress Inventory. Causal modeling was used to explore the moderating effect of locus of control on burnout. Results support the hypothesized model and suggest that greater work-related stress and burnout would be associated with poorer locus of control in nurses. The findings supported the notion that perceived degree of control is instrumental in enabling nurses to cope with stress and burnout.

On the relation between neuroticism, self-esteem, and depression: results from the National Comorbidity Survey.

There is evidence that neuroticism and self-esteem, two commonly used personality constructs, are associated with depressive illness. Previous studies on this issue have produced mixed results. Some studies found that neuroticism was a stronger predictor of risk for major depression than was self-esteem. The aim of the current report is to analyze the relationship between neuroticism, self-esteem, and depressive disorders in representative community sample. Data from the National Comorbidity Survey (NCS) were reanalyzed. The diagnostic data were coded using the criteria of DSM-III-R based on a modified version of the Diagnostic Interview. Self-esteem was assessed by an empirically abbreviated form of the Rosenberg Self-Esteem Scale. Neuroticism was measured using the 10-item scale from the Transparent Bipolar Inventory (TBI). Logistic regression analysis and classification and regression tree (CART) analysis were used to determine the associations between neuroticism, self-esteem, sociodemographic variables, and past-year depression disorders. Neuroticism and self-esteem were strongly associated with past-year depression disorders. Significant interactions between the two personality constructs and sociodemographic variables were observed. The results suggest that neuroticism and self-esteem should be evaluated simultaneously when analyzing depression disorders. The assessment of both personality constructs may contribute to further understanding of personality-depression correlation. Such knowledge might prove valuable in designing early interventions and treatment.

Psychological distress and socioeconomic status in single mothers and their children in a German city

Abstract.Background: The proportion of single mothers in western countries is continuously growing. In contrast to other western countries, support programs in Germany especially for single mothers are rare. This study identifies for the first time in Germany within a large epidemiological sample different subgroups of higher distressed single mothers as important potential target groups for psychosocial support interventions. Facing limited resources, data about these subgroups are helpful to develop and establish specific support programs. Method: In a cross-section study, family status of a complete cohort of school beginners in Duesseldorf (N = 5178 children, aged 5–7 years) was screened within the school eligibility test (recruitment rate 97.5 %, N = 5048). Out of a total of 891 single mothers, 531 fulfilling inclusion criteria (speaking fluent German, not married, living together with the tested child, informed consent) were compared to a control group of married mothers out of the same sample (N = 278). Socioeconomic status, social network and psychological distress of mothers (SCL-90-R) and children (CBCL) were investigated. Results: Socioeconomic status (income, education) of single mothers was lower while psychological distress (SCL-90-R) was elevated compared to the control group. Single mothers without additional personal support for their child, younger, as well as poor single mothers showed higher values of psychological distress. In sons of single mothers, increased behavior problems were found (CBCL). Of all children screened, 907 (18 %) lived in single-parent families. Conclusion: An increased psychological distress of single mothers and their sons could be shown for the first time in Germany within a large epidemiologic sample. This has implications for the planning of preventive interventions and evaluation of associations, e. g., between social variables and distress of single mothers and their children within longitudinal study designs.

Interpersonal problems as predictors of symptom related treatment outcome in longterm psychotherapy.

It is already known from several research projects that interpersonal factors play an important role in the outcome of psychotherapy. This joint multicenter investigation looks into the relevance o...

Assessing clinically significant change: application to the SCL-90-R.

A Symptom Checklist (SCL-90–R) is a potentially useful measure of psychological distress; it is frequently used in psychotherapy research and clinical practice. The purpose of this study was to illustrate the use of the SCL-90–R for determining statistically reliable change and clinical significance outlined by Jacobson and Truax in 1991. This paper describes the concepts of statistical and clinical significance of change. A proposal for obtaining and characterizing samples is made. Then a clinicians perspective is taken. Reliable change estimates and cut-off scores are chosen based on outcome data. Selected data from a single psychotherapeutic process and outcome study then were used to test the estimates of change and cut-off scores.

Application of stratum-specific likelihood ratios in mental health screening

Abstractu2002n Background: The accuracy of a diagnostic procedure is commonly assessed by measuring sensitivity, specificity and positive and negative predictive values. Likelihood ratios provide an alternative method for describing these results, though they are typically reported only for dichotomized outcomes. However, likelihood ratios can also be applied to ordinal or continuous results. Methods: The present paper discusses the application of stratum-specific likelihood ratios in a primary care setting using the General Health Questionnaire (GHQ-12) and the Symptom Check List 90-R (SCL-90-R). A randomly selected sample (nu2009=u2009408) of adult outpatients from primary care offices in Düsseldorf was screened using the German versions of the GHQ-12 and the SCL-90-R. Results: Logistic regression analysis indicated that stratum-specific or multilevel likelihood ratios preserve more information than a fixed threshold approach with a single cutoff point. For each test, five clinically useful strata with monotonically increasing stratum-specific likelihood ratios were selected. Conclusions: Stratum-specific likelihood ratios have enormous practical value, and they are becoming an important way of expressing and comparing the usefulness of different tests. Stratum-specific likelihood ratios reduce the spectrum bias that might arise if only two categories (cases and non-cases) are chosen. Additionally, multilevel likelihood ratios can be used as bedside information to obtain the post-test probability from the pre-test probability of the disorder.

Comparison of the standard and the computerized versions of the Symptom Check List (SCL‐90‐R): a randomized trial

Objective: The purpose of this study was to examine whether computer administration of the Symptom Check List (SCL‐90‐R) is equivalent to paper‐and‐pencil originals.

The relationship between mental disorders and medical service utilization in a representative community sample

Background Frequent use of health services has been associated with mental disorders and psychological distress. The present study aimed to determine how mental disorders affect the likelihood of using health services in a nationally representative sample. Method The analysis was based on data on 3726 respondents aged 18–65 years from the German National Health Interview and Examination Survey, a nationally representative multistage probability survey conducted from 1997 to 1999. Health care utilization in the previous year was measured by a self-report questionnaire. Psychiatric diagnoses were assessed by a modified version of the Composite International Diagnostic Interview. Results The relationship between mental illness and medical service utilization was substantial and significant. Twelve-month prevalence rates for respondents with normal health service use were 10.2 % (affective disorders), 11.9 % (anxiety disorders), 8.9 % (somatoform disorders), and 15.4 % (substance use disorder). In contrast, 12-month prevalence rates for high utilizers were 25.1 % (affective disorders), 29.3 % (anxiety disorders), 22.2 % (somatoform disorders), and 17.1 % (substance use disorder). Conclusions High utilizers of health care service should be assessed for common mental disorders. Efforts should be made to increase awareness, recognition, and appropriate early intervention of mental disorders.