What is a Self-Report Inventory?

Introduction

A self-report inventory is a type of psychological test in which a person fills out a survey or questionnaire with or without the help of an investigator.

Self-report inventories often ask direct questions about personal interests, values, symptoms, behaviours, and traits or personality types. Inventories are different from tests in that there is no objectively correct answer; responses are based on opinions and subjective perceptions. Most self-report inventories are brief and can be taken or administered within five to 15 minutes, although some, such as the Minnesota Multiphasic Personality Inventory (MMPI), can take several hours to fully complete. They are popular because they can be inexpensive to give and to score, and their scores can often show good reliability.

There are three major approaches to developing self-report inventories:

  • Theory-guided inventories are constructed around a theory of personality or a prototype of a construct.
  • Factor analysis uses statistical methods to organize groups of related items into subscales.
  • Criterion-keyed inventories include questions that have been shown to statistically discriminate between a comparison group and a criterion group, such as people with clinical diagnoses of depression versus a control group.

Items may use any of several formats: a Likert scale with ranked options, true-false, or forced choice, although other formats such as sentence completion or visual analogue scales are possible. True-false involves questions that the individual denotes as either being true or false about themselves. Forced-choice is a set of statements that require the individual to choose one as being most representative of themselves.

If the inventory includes items from different factors or constructs, the items can be mixed together or kept in groups. Sometimes the way people answer the item will change depending on the context offered by the neighbouring items.

Personality Inventories

Self-report personality inventories include questions dealing with behaviours, responses to situations, characteristic thoughts and beliefs, habits, symptoms, and feelings. Test-takers-are usually asked to indicate how well each item describes themselves or how much they agree with each item. Formats are varied, from adjectives such as “warm”, to sentences such as “I like parties”, or reports of behaviour “I have driven past the speed limit” and response formats from yes/no to Likert scales, to continuous “slider” responses. Some inventories are global, such as the NEO, others focus on particular domains, such as anger or aggression.

Problems

Unlike IQ tests where there are correct answers that have to be worked out by test takers, for personality, attempts by test-takers to gain particular scores are an issue in applied testing. Test items are often transparent, and people may “figure out” how to respond to make themselves appear to possess whatever qualities they think an organisation wants. In addition, people may falsify good responses, be biased towards their positive characteristics, or falsify bad, stressing negative characteristics, in order to obtain their preferred outcome. In clinical settings patients may exaggerate symptoms in order to make their situation seem worse, or under-report the severity or frequency of symptoms in order to minimise their problems. For this reason, self-report inventories are not used in isolation to diagnose a mental disorder, often used as screeners for verification by other assessment data. Many personality tests, such as the MMPI or the MBTI add questions that are designed to make it difficult for a person to exaggerate traits and symptoms. They are in common use for measuring levels of traits, or for symptom severity and change. Clinical discretion is advised for all self-report inventories.

Items may differ in social desirability, which can cause different scores for people at the same level of a trait, but differing in their desire to appear to possess socially desirable behaviours.

Popular Self-Report Inventories

  • 16 PF.
  • Beck Anxiety Inventory.
  • Beck Depression Inventory.
  • Beck Hopelessness Scale.
  • California Psychological Inventory (CPI).
  • CORE-OM.
  • Eysenck Personality Questionnaire (EPQ-R).
  • Geriatric Depression Scale.
  • Major Depression Inventory.
  • Minnesota Multiphasic Personality Inventory.
  • Myers-Briggs Type Indicator.
  • NEO Personality Inventory (NEO-PI-3).
  • Outcome Questionnaire 45.
  • PSYCHLOPS.
  • State-Trait Anxiety Inventory.

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What was TeenScreen?

Introduction

The TeenScreen National Centre for Mental Health Checkups at Columbia University was a national mental health and suicide risk screening initiative for middle- and high-school age adolescents.

On 15 November 2012, according to its website, the programme was terminated. The organisation operated as a centre in the Division of Child and Adolescent Psychiatry Department at Columbia University, in New York City.

The programme was developed at Columbia University in 1999, and launched nationally in 2003. Screening was voluntary and offered through doctors’ offices, schools, clinics, juvenile justice facilities, and other youth-serving organisations and settings. As of August 2011, the programme had more than 2,000 active screening sites across 46 states in the United States, and in other countries including Australia, Brazil, India and New Zealand.

Screening Programme

Organisation

The programme was developed by a team of researchers at Columbia University, led by David Shaffer. The goal was to make researched and validated screening questionnaires available for voluntary identification of possible mental disorders and suicide risk in middle and high school students. The questionnaire they developed is known as the Columbia Suicide Screen, which entered into use in 1999, an early version of what is now the Columbia Health Screen. In 2003, the New Freedom Commission on Mental Health, created under the administration of George W. Bush, identified the TeenScreen program as a “model” programme and recommended adolescent mental health screening become common practice.

The organisation launched an initiative to provide voluntary mental health screening to all US teens in 2003. The following year, TeenScreen was included in the national Suicide Prevention Resource Centre’s (SPRC) list of evidence-based suicide prevention programmes. In 2007, it was included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programmes and Practices. In 2009, the organisation launched the TeenScreen Primary Care initiative to increase mental health screening by paediatricians and other primary care providers, the same year the US Preventive Services Task Force recommended annual adolescent mental health screening as part of routine primary care, and the Institute of Medicine recommended expansion of prevention and early identification programmes.

As of 2011, the programme was led by executive director Laurie Flynn, deputy executive director Leslie McGuire and scientific advisor Mark Olfson, M.D., alongside a National Advisory Council of healthcare professionals, educators and advocates.

As of 15 November 2012, TeenScreen has been terminated, will no longer train or register new programmes, and will cease all operations by the end of the year.

Mission and Locations

The mission of the TeenScreen National Centre was to expand and improve the early identification of mental health problems in youth. In particular, TeenScreen aimed to find young people at risk of suicide or developing mental health disorders so they could be referred for a comprehensive mental health evaluation by a health professional. The programme focuses on providing screening to young people in the 11-18 age range. From 2003 until 2012, the programme was offered nationally in schools, clinics, doctors’ offices and in youth service environments such as shelters and juvenile justice settings. As of August 2011, more than 2,000 primary care providers, schools and community-based sites in 46 states offered adolescent mental health screening through the TeenScreen National Centre. In addition, the screening was also being provided in other countries including Australia, Brazil, India, New Zealand and Scotland.

Screening Process

TeenScreen provided materials, training and technical help through its TeenScreen Primary Care and Schools and Communities programmes for primary care providers, schools and youth-serving organisations that provided mental health screening to adolescents. A toolkit was provided, including researched and validated questionnaires, instructions for administering, scoring and interpreting the screening responses. Primary care programme materials included information on primary care referrals for clinical evaluation. In the school and community setting, the screening process was voluntary and required active parental consent and participant assent prior to screening sessions.

The validated questionnaires included items about depression, thoughts of suicide and attempts, anxiety, and substance use. The screening questionnaires typically took up to ten minutes for an adolescent to complete. Once the responses to the questionnaire had been reviewed, any adolescent identified as being at possible risk for suicide or other mental health concerns would then assessed by a health or mental health professional. The result of this assessment determined whether the adolescent could be referred for mental health services. If this was the case, parents were involved and provided with help locating the appropriate mental health services.

Research, Endorsements and Responses

Recommendations and Research

Mental health screening has been endorsed by the former US Surgeon General David Satcher, who launched a “Call to Action” in 1999 encouraging the development and implementation of safe, effective school-based programmes offering intervention, help and support to young people with mental health issues. TeenScreen is included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programs and Practices as a scientifically tested and reviewed intervention. In addition, the US Preventive Services Task Force recommended in 2009 that mental health screening for teenagers be integrated into routine primary care appointments.

Studies have been conducted on the effectiveness and impact of mental health screening for young people. In a 2004 systematic evidence review, the US Preventive Services Task Force found that there were no studies that addressed whether screening as part of primary care reduced morbidity and mortality, nor any information of the potential risks of screening. In a later review, published in 2009, the task force found that there was evidence supporting the efficacy of screening tools in identifying teenagers at risk of suicide or mental health disorders.

A team of researchers from Columbia University and the New York State Psychiatric Institute completed a randomised controlled clinical trial on the impact of suicide screening on high school students in New York State from 2002-2004. The study found that students who were given a questionnaire about suicide were no more likely to report suicidal thoughts after the survey than students in the control group who had not been questioned. Neither was there any greater risk for “high risk” students. A subsequent study by the researchers, in 2009, found that screening appeared to increase the likelihood that adolescents would receive treatment if they were at risk for mental health disorders or suicide.

A study published in 2011, involving 2,500 high school students, examined the value of routine mental health screening in school to identify adolescents at-risk for mental illness, and to connect those adolescents with recommended follow-up care. The research, conducted between 2005 and 2009 at six public high schools in suburban Wisconsin, found that nearly three out of four high school students identified as being at-risk for having a mental health problem were not in treatment at the time of screening. Of those students identified as at-risk, a significant majority (76.3%) completed at least one visit with a mental health provider within 90 days of screening. More than half (56.3%) received minimally adequate treatment, defined as having three or more visits with a provider, or any number of visits if termination was agreed to by the provider.

A separate study published in 2011, found that mental health screening was effective at connecting African-American middle school students from a predominantly low-income area with school-based mental health services. Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.

Acceptance and Critical Responses

Recommendations endorsing adolescent mental health screening have been issued by the Institute of Medicine (IOM) and the US Preventative Services Task Force (USPSTF). The American Academy of Paediatrics recommends assessment of mental health at primary care visits and suggests the use of validating screening instruments. These add to statements and recommendations to screen adolescents for mental illness from the American Medical Association (AMA), the Society for Adolescent Health and Medicine, the American Academy of Family Physicians and the National Association of Paediatric Nurse Practitioners. TeenScreen has been endorsed by a number of organizations, including the National Alliance for the Mentally Ill, and federal and state commissions such as the New Freedom Commission.

There is opposition to mental health screening programmes in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. Much of the opposition is led by groups who claim that the organization is funded by the pharmaceutical industry; however, in 2011, an inquiry launched by Senator Charles E. Grassley into the funding of health advocacy groups by pharmaceutical, medical-device, and insurance companies demonstrated to Senator Grassley’s satisfaction that TeenScreen does not receive funding from the pharmaceutical industry. Senator Grassley sent a letter to TeenScreen and 33 other organisations like the American Cancer Society asking about their financial ties to the pharmaceutical industry. TeenScreen replied saying they did not accept money from medical companies.

In 2005, TeenScreen was criticised following media coverage of a suit filed a local screening programme in Indiana by the parents of a teenager who had taken part in screening. The suit alleged that the screening had taken place without parents’ permissions. The complaint led to a change in how parental consent was handled by TeenScreen sites. In 2006, the programme’s policy was amended so that active rather than passive consent was required from parents before screening adolescents in a school setting.

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What is the Adverse Childhood Experiences International Questionnaire?

Introduction

Adverse Childhood Experiences International Questionnaire (ACE-IQ) is a World Health Organisation (WHO), 43-item screening questionnaire.

Purpose

It is intended to measure:

  • Types of child abuse or trauma;
  • Neglect;
  • Household dysfunction;
  • Peer violence;
  • Sexual and emotional abuse; and
  • Exposure to community and collective violence.

Who is it For?

ACE-IQ is meant to be administered to people 18 years or older in all countries, and is currently undergoing validation testing.

What is the Severity of Alcohol Dependence Questionnaire?

Introduction

The Severity of Alcohol Dependence Questionnaire (SADQ or SAD-Q) is a 20 item clinical screening tool designed to measure the presence and level of alcohol dependence.

It is divided into five sections:

  • Physical withdrawal symptoms.
  • Affective withdrawal symptoms.
  • Craving and relief drinking.
  • Typical daily consumption.
  • Reinstatement of dependence after a period of abstinence.

Each item is scored on a 4-point scale, giving a possible range of 0 to 60. A score of over 30 indicates severe alcohol dependence.

Some local clinical guidelines use the SADQ to predict the levels of medication needed during alcohol detoxification.

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What is the Dissociative Experiences Scale?

Introduction

The Dissociative Experiences Scale (DES) is a psychological self-assessment questionnaire that measures dissociative symptoms.

Background

It contains twenty-eight questions and returns an overall score as well as four sub-scale results.

DES is intended to be a screening test, since only 17% of patients with scores over 30 will be diagnosed with having dissociative identity disorder. Patients with lower scores above normal may have other post-traumatic conditions.

The DES-II contains the same questions but with a different response scale.

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What is the CRAFFT Screening Test?

Introduction

The CRAFFT is a short clinical assessment tool designed to screen for substance-related risks and problems in adolescents.

CRAFFT stands for the key words of the 6 items in the second section of the assessment:

  • Car.
  • Relax.
  • Alone.
  • Forget.
  • Friends.
  • Trouble.

As of 2020, updated versions of the CRAFFT known as the “CRAFFT 2.1” and “CRAFFT 2.1+N” have been released.

The older version of the questionnaire contains 9 items in total, answered in a “yes” or “no” format.

  • The first three items (Part A) evaluate alcohol and drug use over the past year; and
  • The other six (Part B) ask about situations in which the respondent used drugs or alcohol and any consequences of the usage.

The CRAFFT 2.1 screening tool begins with past-12-month frequency items (Part A), rather than the previous “yes/no” question for any use over the past year, and the other six (Part B) questions remain the same.

The CRAFFT can function as a self-report questionnaire or an interview to be administered by a clinician. Both employ a skip pattern: those whose Part A score is “0” (no use) answer the Car question only of Part B, while those who report any use in Part A also answer all six Part B CRAFFT questions. Each “yes” answer is scored as “1” point and a CRAFFT total score of two or higher identifies “high risk” for a substance use disorder and warrants further assessment.

Development and Brief History

The CRAFFT Screening Test was developed by John R Knight, MD and colleagues at the Centre for Adolescent Behavioural Health Research (CABHRe), formerly known as the Centre for Adolescent Substance Abuse Research (CeASAR) at Boston Children’s Hospital. Their goal was to develop a screening tool that – like the CAGE questionnaire used for adults – was brief and easy to administer and score. Unlike the CAGE, the CRAFFT was designed to be developmentally appropriate for adolescents and screen conjointly for both alcohol and drug use. Because motor vehicle crashes are a leading cause of death among adolescents, and often associated with alcohol and drug use, the CRAFFT includes a risk item to evaluate whether an adolescent has ever ridden in a car driven by someone (including themselves) who was under the influence of alcohol or other drugs. It has been established as valid and reliable for identifying youth who need further assessment and therapeutic intervention. The CRAFFT was originally designed to screen adolescents at high risk of substance use disorders in primary medical care offices. However, the necessity for a universal adolescent screening measure was made apparent by research findings suggesting that half of high school students drink, a third binge drink, and a fourth use marijuana. For drug use specifically, studies show that more than half of high school seniors have used an illegal drug of any kind and a fourth have used illegal drugs other than marijuana. In addition, more than two-thirds of high school seniors, half of sophomores, and a third of eighth graders have used alcohol in the past year. These findings also contributed to the identification of a need for a tool like the CRAFFT to be developed and widely implemented.

CRAFFT 2.1

This revised version of the CRAFFT screening tool incorporates changes that enhance the sensitivity of the system in terms of identifying adolescents with substance use, and presents new recommended clinician talking points, informed by the latest science and clinician feedback, to guide a brief discussion about substance use with adolescents. The CRAFFT 2.1 provides an updated and revised version of this well-validated and widely utilised adolescent substance use screening protocol. Although the previous version of the CRAFFT will still be available, CABHRe recommends that clinicians transition to using version 2.1.

The CRAFFT 2.1 screening tool begins with past-12-month frequency items, rather than the previous “yes/no” question for any use over the past year. A recent study examining these opening yes/no questions found that they had relatively low sensitivity in identifying youth with any past-12-month alcohol or marijuana use (62% and 72%, respectively). Research also has suggested that yes/no questions may contribute to lower sensitivity on certain measures by inhibiting disclosure of less socially desirable behaviours; i.e. they may be more prone to social desirability bias.

Alternatively, questions that ask “how many” or “how often” implicitly imply an expectation of the behaviour, and may thus mitigate discomfort around disclosure. The instruction, “Say ‘0’ if none” follows each question to convey that non-use is also normative. The CRAFFT 2.1 begins with past-12-month frequency items; i.e. “During the past 12 months, on how many days did you … [drink/use substance name]?”

This new set of frequency questions was tested in a recent study of 708 adolescent primary care patients ages 12-18 that found a sensitivity of 96% and specificity of 81% for detecting past-12-month use of any substance, suggesting better performance in identifying substance use compared to that of the “yes/no” questions found in the prior study.

The CRAFFT 2.1 has been translated into the following languages: Albanian, Arabic, Burmese, Simplified Chinese, Traditional Chinese, Cape Verdean Creole, Haitian Creole, Dutch, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Latin Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese.

CRAFFT 2.1+N

The CRAFFT 2.1+N expands upon the content from the CRAFFT 2.1 with the inclusion of the Hooked On Nicotine Checklist (HONC), which is a 10-item questionnaire that screens for dependence on tobacco and nicotine. If a teen indicates use of a vaping device containing nicotine and/or flavours or any tobacco products within the frequency questions, they are prompted to answer the HONC questions as well. A positive response to one or more of the items calls for further assessment regarding a serious problem with nicotine.

Psychometrics

Research has shown that CRAFFT has relatively high sensitivity and specificity, internal consistency, and test-retest reliability as a screener for alcohol and substance misuse. The CRAFFT questionnaire has been validated against the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and demonstrates good ability to distinguish between those with and without clinical levels of any DSM-5 substance use disorder. It is supported by many studies as a reliable and valid assessment of substance use and misuse in adolescents and is considered an effective tool for assessing whether further assessment is warranted. It has been well-validated against criterion standard psychological tests and structured psychiatric diagnostic interviews. It has been recommended by the American Academy of Paediatrics’ Committee on Substance Abuse for use with adolescents. Findings suggest that paediatricians should regularly screen for substance use disorders in adolescents using the CRAFFT.

The CRAFFT has been translated into many languages, including Albanian, Arabic, Burmese, Simplified Chinese, Traditional Chinese, Cape Verdean Creole, Haitian Creole, Dutch, French, German, Greek, Hebrew, Hindi, Japanese, Khmer, Korean, Laotian, Lithuanian, Nepali, Portuguese (Brazil), Portuguese (Portugal), Romanian, Russian, Somali, Spanish (Latin Am), Spanish (Spain), Swahili, Telugu, Turkish, Twi, and Vietnamese. Studies attest to its validity and reliability across cultures.

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What is the Michigan Alcoholism Screening Test?

Introduction

The Michigan Alcoholism Screening Test (MAST) screening tool was developed in 1971, and is one of the oldest alcoholism-screening tests for identifying dependent drinkers.

Background

Its use is constructed for the general population. There are other versions of the MAST screening tool, all of which can be self-administered or via interview with someone who is trained in the tool being used. All MAST screening tools are scored on a point scale system.

As stated on the Project Cork website (now archived), there are 25 questions to the MAST screening tool. The tool’s length makes administering it inconvenient in many busy primary health care and emergency department settings. The tool also mainly focuses on the patient’s problems throughout their lifetime, rather than the problems currently displayed by the patient. The questions throughout the screening tool operate in the past tense, which means that it is less likely to detect any problems with alcohol in its early stages, according to T. Buddy. The extended questioning is a benefit in a sense that one accomplishes a bit of the assessment section when conducting the screening; furthermore, it allows the individual conducting the screening to achieve better communication and rapport with the client.

The MAST-G screening tool is directed towards screening geriatric clients and has one less question than the MAST tool. There has always been an underlying concern as to the sensitivity and reliability when questioning geriatric clients.

Another related screening tool is the “brief MAST”, which is much shorter than the previous tests at 10 questions. There is also the Short-MAST tool similar to the brief test; it contains 13 questions. Which tool to use is decided by the screener.

Variations

  • MAST.
  • MAST-G.
  • Brief MAST.
  • Short-MAST.
  • Short-MAST-G.

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What is the Hospital Anxiety and Depression Scale?

Introduction

Hospital Anxiety and Depression Scale (HADS) was originally developed by Zigmond and Snaith (1983) and is commonly used by doctors to determine the levels of anxiety and depression that a person is experiencing.

The HADS is a fourteen item scale that generates: Seven of the items that relate to anxiety and seven that relate to depression. Zigmond and Snaith created this outcome measure specifically to avoid reliance on aspects of these conditions that are also common somatic symptoms of illness, for example fatigue and insomnia or hypersomnia. This, it was hoped, would create a tool for the detection of anxiety and depression in people with physical health problems.

Items on the Questionnaire

The items on the questionnaire that relate to anxiety are

  • I feel tense or wound up.
  • I get a sort of frightened feeling as if something awful is about to happen.
  • Worrying thoughts go through my mind.
  • I can sit at ease and feel relaxed.
  • I get a sort of frightened feeling like ‘butterflies’ in the stomach.
  • I feel restless as I have to be on the move.
  • I get sudden feelings of panic.

The items that relate to depression are:

  • I still enjoy the things I used to enjoy.
  • I can laugh and see the funny side of things.
  • I feel cheerful.
  • I feel as if I am slowed down.
  • I have lost interest in my appearance.
  • I look forward with enjoyment to things.
  • I can enjoy a good book or radio or TV programme.

Scoring the Questionnaire

Each item on the questionnaire is scored from 0-3 and this means that a person can score between 0 and 21 for either anxiety or depression.

Caseness of Anxiety and Depression

A number of researchers have explored HADS data to establish the cut-off points for caseness of anxiety or depression. Bjelland et al. (2002) through a literature review of a large number of studies identified a cut-off point of 8/21 for anxiety or depression. For anxiety (HADS-A) this gave a specificity of 0.78 and a sensitivity of 0.9. For depression (HADS-D) this gave a specificity of 0.79 and a sensitivity of 0.83.

Factor Structure

There are a large number of studies that have explored the underlying factor structure of the HADS. Many support the two-factor structure but there are others that suggest a three or four factor structure. Some argue that the tool is best used as a unidimensional measure of psychological distress.

Criticisms

The factor structure of the HADS has been questioned. Coyne and Sonderen argue in a letter published in the same issue, that Cosco, et al. provides grounds for abandoning HADS altogether. The HADS has also been criticised for its over reliance on anhedonia as being the core symptom of depression, how single-item measures of depression may have the same predictive value as the HADS scale, as well as its use of British colloquial expressions which can be difficult to translate.

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What is the Positive and Negative Syndrome Scale?

Introduction

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia.

It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is known as the “gold standard” that all assessments of psychotic behavioural disorders should follow.

The name refers to the two types of symptoms in schizophrenia, as defined by the American Psychiatric Association:

  • Positive symptoms, which refer to an excess or distortion of normal functions (e.g. hallucinations and delusions); and
  • Negative symptoms, which represent a diminution or loss of normal functions.

Some of these functions which may be lost include normal thoughts, actions, ability to tell fantasies from reality, and the ability to properly express emotions.

The PANSS is a relatively brief interview, requiring 45 to 50 minutes to administer. The interviewer must be trained to a standardised level of reliability.

Interview Items

To assess a patient using PANSS, an approximately 45-minute clinical interview is conducted. The patient is rated from 1 to 7 on 30 different symptoms based on the interview as well as reports of family members or primary care hospital workers.

  • Positive scale:
    • 7 Items, (minimum score = 7, maximum score = 49):
      • Delusions.
      • Conceptual disorganisation.
      • Hallucinations.
      • Excitement.
      • Grandiosity.
      • Suspiciousness/persecution.
      • Hostility.
  • Negative scale:
    • 7 Items, (minimum score = 7, maximum score = 49):
      • Blunted affect.
      • Emotional withdrawal.
      • Poor rapport.
      • Passive/apathetic social withdrawal.
      • Difficulty in abstract thinking.
      • Lack of spontaneity and flow of conversation.
      • Stereotyped thinking.
  • General Psychopathology scale:
    • 16 Items, (minimum score = 16, maximum score = 112):
      • Somatic concern.
      • Anxiety.
      • Guilt feelings.
      • Tension.
      • Mannerisms and posturing.
      • Depression.
      • Motor retardation.
      • Uncooperativeness.
      • Unusual thought content.
      • Disorientation.
      • Poor attention.
      • Lack of judgement and insight.
      • Disturbance of volition.
      • Poor impulse control.
      • Preoccupation.
      • Active social avoidance.

PANSS Total score minimum = 30, maximum = 210

Scoring

As 1 rather than 0 is given as the lowest score for each item, a patient can not score lower than 30 for the total PANSS score. Scores are often given separately for the positive items, negative items, and general psychopathology. In their original publication on the PANSS scale, Stanley Kay and colleagues tested the scale on 101 adult patients (20-68 years-old) with schizophrenia and the mean scores were,

  • Positive scale = 18.20.
  • Negative scale = 21.01.
  • General psychopathology = 37.74.

Based on meta-analytic results, an alternative five-factor solution of the PANSS was proposed with positive symptoms, negative symptoms, disorganisation, excitement, and emotional distress.

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What is the Subjective Units of Distress Scale?

Introduction

A Subjective Units of Distress Scale (SUDS), also known as the Subjective Units of Disturbance Scale), is a scale ranging from 0 to 10 measuring the subjective intensity of disturbance or distress currently experienced by an individual.

Respondents provide a self report of where they are on the scale. The SUDS may be used as a benchmark for a professional or observer to evaluate the progress of treatment. In desensitisation-based therapies, and the patients’ regular self assessments enable them to guide the clinician repeatedly as part of the therapeutic dialogue.

The SUD-level was developed by Joseph Wolpe in 1969. It has been used in cognitive-behavioural treatments for anxiety disorders (e.g. exposure practices and hierarchy) and for research purposes.

There is no hard and fast rule by which a patient can self assign a SUDS rating to his or her disturbance or distress, hence the name subjective.

Some guidelines are:

  • The intensity recorded must be as it is experienced now.
  • Constriction or congestion or tensing of body parts indicates a higher SUDS than that reported.

The Scale

There a number of version of the scale, and the below is for illustration only:

  • 10 = Feels unbearably bad, beside yourself, out of control as in a nervous breakdown, overwhelmed, at the end of your rope. You may feel so upset that you don’t want to talk because you can’t imagine how anyone could possibly understand your agitation.
  • 9 = Feeling desperate. What most people call a 10 is actually a 9. Feeling extremely freaked out to the point that it almost feels unbearable and you are getting scared of what you might do. Feeling very, very bad, losing control of your emotions.
  • 8 = Freaking out. The beginning of alienation.
  • 7 = Starting to freak out, on the edge of some definitely bad feelings. You can maintain control with difficulty.
  • 6 = Feeling bad to the point that you begin to think something ought to be done about the way you feel.
  • 5 = Moderately upset, uncomfortable. Unpleasant feelings are still manageable with some effort.
  • 4 = Somewhat upset to the point that you cannot easily ignore an unpleasant thought. You can handle it OK but don’t feel good.
  • 3 = Mildly upset. Worried, bothered to the point that you notice it.
  • 2 = A little bit upset, but not noticeable unless you took care to pay attention to your feelings and then realize, “yes” there is something bothering me.
  • 1 = No acute distress and feeling basically good. If you took special effort you might feel something unpleasant but not much.
  • 0 = Peace, serenity, total relief. No more anxiety of any kind about any particular issue.

Utility Does Not Require Precision

In using SUDS in a therapeutic setting, the therapist does not necessarily define the scale, because one of the benefits of asking a patient or client for a SUDS score is that it is simple. Typically, you can ask the client, “On a scale of zero to ten, where zero is the best you can feel and ten is the worst, how do you feel right now?”

The purpose of this question is to enable the patient or client to notice improvements, and the inherent difference between one person’s subjective scale and another person’s is irrelevant to therapy with either individual. Our brains are sophisticated enough that they can usually summarize a large amount of data very quickly, and often accurately.

There is a possibility that in some forms of therapy, the patient will want to see progress and will therefore report progress that isn’t objectively present – a type one error from a statistical point of view. While both type I and type II errors are important in research situations, type one errors can have a therapeutic utility in clinical situations, in which they can provide an indirect opportunity for positive autosuggestion – much like the indirect suggestions employed in Eriksonian hypnosis.

Thus, since the main use of SUDS is for clinical purposes, rather than research purposes, the imprecise nature of the scale is relatively unimportant to its main users: patients and clinicians.

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