The symptom checklist-27-plus (SCL-27-plus): a modern conceptualization of a traditional screening instrument

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Abstract

Background: The symptom checklist SCL-27-plus is a short, multidimensional screening instrument for mental health problems. It contains five scales on current symptoms: depressive, vegetative, agoraphobic, and sociophobic symptoms and pain; a global severity index (GSI-27); a lifetime assessment for depressive symptoms; and a screening question for suicidality.

Method: A reformulated version of screening items constituted a survey of n=374 students. Therefore, a total of 76 items was formulated and presented to the students within a questionnaire booklet, that could be filled out at home.

Results: All scales of the SCL-27-plus showed good to satisfactory reliability (i.e. .90 ≥ Cronbach’s a ≥ .70). The distributions of the scales were less skewed than in older versions of the symptom checklists and scale inter-correlations were lower. The scale “symptoms of mistrust” could not be retained.

Conclusion: The SCL-27-plus demonstrates a clear improvement over the SCL-27. Test-statistical properties were improved. In addition, the supplementation by a lifetime scale for depression and a screener for suicidality shall help the clinician as well as the epidemiologist.

Translated abstract

Hintergrund: Die Symptomcheckliste-27-plus ist ein kurzes, mehrdimensionales Screening-Instrument für psychische Probleme. Sie enthält fünf Skalen zu aktuellen Symptomen (depressive, vegetative, agoraphobische und soziophobische Symptome, Schmerz), einen globalen Schwere-Index, eine Skala zur Lebenszeit-Erfassung von Depression und ein Item zu Suizidalität.

Methode: Reformulierte Screening-Items wurden in einer Stichprobe von n=374 Studenten vorgelegt. Dazu erhielten die Studenten 985 reformulierte Items innerhalb eines Fragebogenheftes, das sie zuhause ausfüllen konnten.

Ergebnisse: Alle Skalen der SCL-27-plus zeigen gute bis befriedigende Reliabilitäten (.90 ≥ Cronbach’s a ≥ .70) . Die Skalen sind weniger schief verteilt als in älteren Versionen der SCL und die Skaleninterkorrelationen liegen niedriger. Die Skala „Symptome von Misstrauen“ konnte nicht erhalten werden.

Schlussfolgerung: Die SCL-27-plus stellt eine klare Verbesserung der SCL-27 dar. Die teststatistischen Eigenschaften wurden verbessert. Die zusätzliche Erfassung von Lebenszeit-Depression und Suizidalität soll dem Kliniker wie dem Epidemiologen zugute kommen.

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Most cited references 11

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Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.

R C Kessler, K McGonagle, S. Zhao … (1994)

This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.

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Factor structure of the brief symptom inventory--18 in adult survivors of childhood cancer: results from the childhood cancer survivor study.

Susan K Parsons, C Recklitis, Mei-Chen Shih … (2006)

The factor structure of the Brief Symptom Inventory--18 (BSI-18; L. R. Derogatis, 2000) was investigated in a sample of adult survivors of childhood cancer enrolled in the Childhood Cancer Survivor Study (CCSS; N = 8,945). An exploratory factor analysis with a randomly chosen subsample supported a 3-factor structure closely corresponding to the 3 BSI-18 subscales: Depression, Anxiety, and Somatization. Confirmatory factor analysis with structural equation modeling validated this 3-dimensional structure in a separate subsample, though an alternative 4-factor model also fit the data. Analysis of the 3-factor model showed consistent fit in male and female participants. Compared with available community-based norms, survivors reported fewer symptoms of psychological distress. Together, results support the hypothesized 3-dimensional structure of the BSI-18 and indicate the measure may be useful in assessing psychological distress in this growing population of cancer survivors.

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Cross-validation of the SCL-27: a short psychometric screening instrument for chronic pain patients.

H J Gerbershagen, J. Hardt (2000)

We constructed a short multidimensional screening instrument for chronic pain patients based on the items contained in the Symptom Check List-90-Revised (SCL-90-R). The proposed dimensional structure of the SCL-90-R was recently shown to be irreproducible in chronic pain patients. As a consequence, the use of the Global Severity Index (GSI) was recommended, although it did not capture all information contained in the many items of the SCL-90-R. Based on an exploratory factor analysis, a six-dimensional structure using 27 items from the SCL-90-R was explored utilizing the data of 2780 chronic pain patients. A short form was prospectively tested on 581 patients in the same setting. Criteria for item selection were high convergent and low discriminant correlations. The assessment of the dimensions was kept short, but a minimum of four items were retained. A questionnaire yielding the dimensions (I) depressive symptoms, (II) dysthymic symptoms, (III) vegetative symptoms, (IV) agoraphobic symptoms, (V) symptoms of social phobia, and (VI) symptoms of mistrust was obtained. Additionally, the GSI of the SCL-90-R could be estimated precisely (r =0.96). The SCL-27 can be used for screening psychopathology in chronic pain patients. The scoring algorithm of the SCL-27 can be used for the 90-item form as well. Copyright 2001 European Federation of Chapters of the International Association for the study of pain.

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Journal

Journal ID (nlm-ta): Psychosoc Med

Journal ID (publisher-id): GMS Psychosoc Med

Title: GMS Psycho-Social Medicine

Publisher: German Medical Science GMS Publishing House

ISSN (Electronic): 1860-5214

Publication date (Electronic): 08 July 2008

Publication date Collection: 2008

Volume: 5

Electronic Location Identifier: Doc08

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[1 ]Department of Mathematical Statistics, Chalmers/Göteborgs Universitet, Göteborg, Sweden

Author notes

*To whom correspondence should be addressed: Jochen Hardt, Department of Mathematical Statistics, Chalmers/Göteborgs Universitet, Chalmers tvägarta 3, 41296 Göteborg, Sweden, E-mail: jochen.hardt@ 123456gmx.de

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Publisher ID: psm000053

PMC ID: 2736518

PubMed ID: 19742283

SO-VID: 6193782a-b2df-4781-bdce-007dc07d062d

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

The symptom checklist-27-plus (SCL-27-plus): a modern conceptualization of a traditional screening instrument Translated title: Die Symptomcheckliste-27-plus (SCL-27-plus): eine moderne Konzeptualisierung eines traditionellen Screening-Instrumentes

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Most cited references 11

Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.

Factor structure of the brief symptom inventory--18 in adult survivors of childhood cancer: results from the childhood cancer survivor study.

Cross-validation of the SCL-27: a short psychometric screening instrument for chronic pain patients.

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