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Discordance Between the SCL-90 and Therapists' Psychopathology Ratings: Implications for Clinical Assessment

Discordance Between the SCL-90 and Therapists' Psychopathology Ratings: Implications for Clinical... Abstract • This study examines the symptom checklist 90 (SCL-90), a patient self-report rating scale, as a screening and baseline psychopathology measure in an outpatient clinic. A low correlation (r=.17) was found between the SCL-90 and the SCL analogue, a matched psychopathology instrument rated by clinicians. The most common causes of discordance in ratings were patients' underreporting of symptoms due to patients' paranoia or fearfulness, overreporting of symptoms consistent with patients' "demonstrative" style, and false-positive Items related to patients' physical illness. We conclude that the SCL-90 has limited validity as a clinical measure in the study of patients seen in evaluation in our setting. References 1. Derogatis LR, Lipman RS, Covi L: The SCL-90: An outpatient psychiatric rating scale . Psychopharmacol Bull 1973;9:13-28. 2. Waskow IE, Parloff MB (eds): Psychotherapy Change Measures . Washington, DC, National Institute of Mental Health, 1975. 3. Derogatis LR, Rickles K, Rock AF: The SCL-90 and the MMPI: A step in the validation of a new self-report scale . Br J Psychiatry 1976;128:280-289.Crossref 4. Edwards DW, Yarvis RM, Mueller DP, et al: Test-taking and the stability of adjustment scales: Can we assess patient deterioration? Evaluation Q 1978;2:275-291.Crossref 5. Derogatis LR, Cleary PA: Factorial invariance across gender for the primary symptom dimensions of the SCL-90 . Br J Soc Clin Psychol 1977;16:347-356.Crossref 6. Derogatis LR, Cleary PA: Confirmation of the structure of the SCL-90: A study in construct validation . J Clin Psychol 1977;33:981-989.Crossref 7. Derogatis LR: SCL-90 Manual-1 . Baltimore, Clinical Psychometrics Research Unit, Johns Hopkins University School of Medicine, 1977. 8. Derogatis LR, Meyer JK, Gallant BW: Invested partners in sexual disorders: Male versus female . Am J Psychiatry 1977;134:385-390. 9. Mellinger GS, Baiter MB, Manheimer DI, et al: Psychic distress, life crises, and use of psychotherapeutic medications . Arch Gen Psychiatry 1978;35:1045-1052.Crossref 10. Davidson J, McLeod MN, White HL: Inhibition of platelet monoamine oxidase in depressed subjects treated with phenelzine . Am J Psychiatry 1978;135:470-472. 11. Glass RM, Allen AT, Uhlenhuth EH, et al: Psychiatric screening in a medical clinic . Arch Gen Psychiatry 1978;35:1189-1195.Crossref 12. Barrett J: Psychiatric diagnoses (Research Diagnostic Criteria) in symptomatic volunteers . Arch Gen Psychiatry 1981;38:153-157.Crossref 13. Derogatis LR, Meyer JK, King KM: Psychopathology in individuals with sexual dysfunction . Am J Psychiatry 1981;138:757-763. 14. Hollingshead AB: Two-Factor Index of Social Position . New Haven, Conn, Hollingshead, 1957. 15. Cohen J, Cohen P: Applied Multiple Regression/Correlational Anal- yses for the Behavioral Sciences . Hillsdale, NJ, Lawrence Erlbaum Associates Inc, 1975. 16. Endicott J, Spitzer RL, Fleiss JL, et al: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;33:766-771.Crossref 17. Prusoff BA, Klerman G, Paykel ES: Pitfalls in the self-assessment of depression . Can Psychiatr Assoc J 1972;33:101-107. 18. Carroll GJ, Fielding JM, Blashki TG: Depression-rating scales: A critical review . Arch Gen Psychiatry 1973;28:361-366.Crossref 19. May PRA, Tuma AH: Choice of criteria for the assessment of treatment outcome . J Psychiatr Res 1964;2:199-209.Crossref 20. Prusoff BA, Klerman G, Paykel ES: Concordance between clinical assessments and patient self-report in depression . Arch Gen Psychiatr 1972;26:546-552.Crossref 21. Kass F, Salamon I, Plutchik R, et al: The assessment of depression: A model for quality review of emergency psychiatry . Am J Psychiatry 1978;135:213-216. 22. Kass F, Skodol A, Charles E, et al: Therapists' recognition of psychopathology: A model for quality review of psychotherapy . Am J Psychiatry 1980;137:87-90. 23. Blumenthal M: Measuring depressive symptomatology in a general population . Arch Gen Psychiatry 1975;32:971-978.Crossref 24. Lazare A, Eisenthal S, Wasserman L: The customer approach to patienthood . Arch Gen Psychiatry 1975;32:553-558.Crossref 25. Kass F, Charles E: An empirically derived rating scale for quantifying patient assets . Am J Psychiatry 1982;139:370-371. 26. Bellak L, Hurvich M, Gediman HK, et al: Ego Functions in Schizophrenics, Neurotics, and Normals: A Systematic Study of Conceptual Diagnostic and Therapeutic Aspects . New York, John Wiley & Sons Inc, 1973. 27. Bordin E: Research Strategies in Psychotherapy . New York, John Wiley & Sons Inc, 1974. 28. Strupp HH, Hadley SW: A tripartile model of mental health and therapeutic outcomes . Am Psychol 1977;35:187-196.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Discordance Between the SCL-90 and Therapists' Psychopathology Ratings: Implications for Clinical Assessment

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1983.01790040043006
Publisher site
See Article on Publisher Site

Abstract

Abstract • This study examines the symptom checklist 90 (SCL-90), a patient self-report rating scale, as a screening and baseline psychopathology measure in an outpatient clinic. A low correlation (r=.17) was found between the SCL-90 and the SCL analogue, a matched psychopathology instrument rated by clinicians. The most common causes of discordance in ratings were patients' underreporting of symptoms due to patients' paranoia or fearfulness, overreporting of symptoms consistent with patients' "demonstrative" style, and false-positive Items related to patients' physical illness. We conclude that the SCL-90 has limited validity as a clinical measure in the study of patients seen in evaluation in our setting. References 1. Derogatis LR, Lipman RS, Covi L: The SCL-90: An outpatient psychiatric rating scale . Psychopharmacol Bull 1973;9:13-28. 2. Waskow IE, Parloff MB (eds): Psychotherapy Change Measures . Washington, DC, National Institute of Mental Health, 1975. 3. Derogatis LR, Rickles K, Rock AF: The SCL-90 and the MMPI: A step in the validation of a new self-report scale . Br J Psychiatry 1976;128:280-289.Crossref 4. Edwards DW, Yarvis RM, Mueller DP, et al: Test-taking and the stability of adjustment scales: Can we assess patient deterioration? Evaluation Q 1978;2:275-291.Crossref 5. Derogatis LR, Cleary PA: Factorial invariance across gender for the primary symptom dimensions of the SCL-90 . Br J Soc Clin Psychol 1977;16:347-356.Crossref 6. Derogatis LR, Cleary PA: Confirmation of the structure of the SCL-90: A study in construct validation . J Clin Psychol 1977;33:981-989.Crossref 7. Derogatis LR: SCL-90 Manual-1 . Baltimore, Clinical Psychometrics Research Unit, Johns Hopkins University School of Medicine, 1977. 8. Derogatis LR, Meyer JK, Gallant BW: Invested partners in sexual disorders: Male versus female . Am J Psychiatry 1977;134:385-390. 9. Mellinger GS, Baiter MB, Manheimer DI, et al: Psychic distress, life crises, and use of psychotherapeutic medications . Arch Gen Psychiatry 1978;35:1045-1052.Crossref 10. Davidson J, McLeod MN, White HL: Inhibition of platelet monoamine oxidase in depressed subjects treated with phenelzine . Am J Psychiatry 1978;135:470-472. 11. Glass RM, Allen AT, Uhlenhuth EH, et al: Psychiatric screening in a medical clinic . Arch Gen Psychiatry 1978;35:1189-1195.Crossref 12. Barrett J: Psychiatric diagnoses (Research Diagnostic Criteria) in symptomatic volunteers . Arch Gen Psychiatry 1981;38:153-157.Crossref 13. Derogatis LR, Meyer JK, King KM: Psychopathology in individuals with sexual dysfunction . Am J Psychiatry 1981;138:757-763. 14. Hollingshead AB: Two-Factor Index of Social Position . New Haven, Conn, Hollingshead, 1957. 15. Cohen J, Cohen P: Applied Multiple Regression/Correlational Anal- yses for the Behavioral Sciences . Hillsdale, NJ, Lawrence Erlbaum Associates Inc, 1975. 16. Endicott J, Spitzer RL, Fleiss JL, et al: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;33:766-771.Crossref 17. Prusoff BA, Klerman G, Paykel ES: Pitfalls in the self-assessment of depression . Can Psychiatr Assoc J 1972;33:101-107. 18. Carroll GJ, Fielding JM, Blashki TG: Depression-rating scales: A critical review . Arch Gen Psychiatry 1973;28:361-366.Crossref 19. May PRA, Tuma AH: Choice of criteria for the assessment of treatment outcome . J Psychiatr Res 1964;2:199-209.Crossref 20. Prusoff BA, Klerman G, Paykel ES: Concordance between clinical assessments and patient self-report in depression . Arch Gen Psychiatr 1972;26:546-552.Crossref 21. Kass F, Salamon I, Plutchik R, et al: The assessment of depression: A model for quality review of emergency psychiatry . Am J Psychiatry 1978;135:213-216. 22. Kass F, Skodol A, Charles E, et al: Therapists' recognition of psychopathology: A model for quality review of psychotherapy . Am J Psychiatry 1980;137:87-90. 23. Blumenthal M: Measuring depressive symptomatology in a general population . Arch Gen Psychiatry 1975;32:971-978.Crossref 24. Lazare A, Eisenthal S, Wasserman L: The customer approach to patienthood . Arch Gen Psychiatry 1975;32:553-558.Crossref 25. Kass F, Charles E: An empirically derived rating scale for quantifying patient assets . Am J Psychiatry 1982;139:370-371. 26. Bellak L, Hurvich M, Gediman HK, et al: Ego Functions in Schizophrenics, Neurotics, and Normals: A Systematic Study of Conceptual Diagnostic and Therapeutic Aspects . New York, John Wiley & Sons Inc, 1973. 27. Bordin E: Research Strategies in Psychotherapy . New York, John Wiley & Sons Inc, 1974. 28. Strupp HH, Hadley SW: A tripartile model of mental health and therapeutic outcomes . Am Psychol 1977;35:187-196.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Apr 1, 1983

References