A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

The Hospital Anxiety and Depression Scale.

A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.

https://www.jstor.org/stable/pdf/3765916.pdf

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.

Simultaneous inference is a common problem in many areas of application. If multiple null hypotheses are tested simultaneously, the probability of rejecting erroneously at least one of them increases beyond the pre-specified significance level. Simultaneous inference procedures have to be used which adjust for multiplicity and thus control the overall type I error rate. In this paper we describe simultaneous inference procedures in general parametric models, where the experimental questions are specified through a linear combination of elemental model parameters. The framework described here is quite general and extends the canonical theory of multiple comparison procedures in ANOVA models to linear regression problems, generalized linear models, linear mixed effects models, the Cox model, robust linear models, etc. Several examples using a variety of different statistical models illustrate the breadth

/pdf/simultaneous-inference-in-general-parametric-models-y1lbb202vv.pdf

Simultaneous inference in general parametric models.

The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.

The Multidimensional Scale of Perceived Social Support

This study reports the factor structure of the symptoms comprising the General Health Questionnaire when it is completed in a primary care setting. A shorter, 28-item GHQ is proposed consisting of 4 subscales: somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. Preliminary data concerning the validity of these scales are presented, and the performance of the whole 28-item questionnaire as a screening test is evaluated. The factor structure of the symptomatology is found to be very similar for 3 independent sets of data.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700021644

A scaled version of the General Health Questionnaire

Q methodology is more than just a technique for assessing attitudes. It is an approach which has subjectivity as its central focus and aims to allow researchers to present the views and perspectives of different people without insisting on the 'superior', more 'objective' status of the researcher's own construction of reality ( 1 ). It is a way of examining the world from the internal standpoint of an individual.

Q methodology: To use Q methodology successfully, argue the authors, researchers must understand the philosophy that underlies the approach

This study of psychiatric illness among 4098 patients attending 91 general practitioners compares 2 methods of case identification: 'conspicuous morbidity' by the doctor's own assessments, and 'probable prevalence' by the patients' responses to the General Health Questionnaire (GHQ). In general, the latter gives somewhat higher estimates than the former, but there are wide variations in morbidity between practices. The ability of each general practitioner to detect psychiatric illness was measured by computing Spearman's correlation coefficient between his assessments and the GHQ scores of his patients. The mean correlation coefficient was + 0.36, but the range was very wide (0.09-0.60). The first part of the study deals with various demographic characteristics of the patients themselves which are associated with an increased likelihood of the doctor detecting a psychiatric illness; such factors include unemployment, female sex, and marriages which have ended by separation, divorce or death. The second part of the study examines characteristics of the doctors themselves in an attempt to account for the wide variation between them in their ability to detect psychiatric illness. A research psychiatrist made detailed observations on 2098 interviews carried out by 55 general practitioners. Each doctor's verbal and non-verbal styles were recorded minutely, and in addition various global ratings were made. The doctors completed personality inventories and supplied details of training and professional background. It was possible to account for 67% of the variance of correlation coefficient mainly in terms of 2 dimensions: 'interest and concern' and 'conservatism'. The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700030853

Determinants of the ability of general practitioners to detect psychiatric illness

Helping cancer patients disclose their concerns.

A prospective study of the impact of training 41 hospice nurses in assessment skills was used to test hypotheses that blocking behaviours would be used more when patients disclosed feelings and used less when nurses perceived that they had satisfactory professional support. Each nurse was asked to assess a patient's current problems before and after feedback training and 8 months later. Audiotape recordings of these interviews were rated by trained raters. They determined the frequency of nurses' responses which had the function of blocking patient disclosure and the emotional level of patient disclosure. Before each patient assessment each nurse was interviewed and questionnaires administered to measure her perceptions of the support she received. Blocking behaviours were most evident when patients disclosed their feelings (Kendalls r = 0.36, P < 0.001). In interviews containing most patient disclosure of feeling, blocking was significantly less (r = -0.24, P < 0.5) when the nurse felt that practical help would be available if needed and when the nurse felt that her direct supervisor was concerned about the nurse's own welfare (r = -0.37, P < 0.005).

Valerie F. Hillier

Papers

A scaled version of the General Health Questionnaire

Q methodology: To use Q methodology successfully, argue the authors, researchers must understand the philosophy that underlies the approach

Determinants of the ability of general practitioners to detect psychiatric illness

Helping cancer patients disclose their concerns.

Perceived professional support and the use of blocking behaviours by hospice nurses