To Be or Not to Be Improved: Patients' Perception of Symptom Improvement - Linking the SCL-90-R to Patient-Rated Global Improvement in a Large Real-World Treatment Sample
Open Access
- 1 October 2020
- journal article
- research article
- Published by S. Karger AG in Psychotherapy and Psychosomatics
- Vol. 89 (6), 357-362
- https://doi.org/10.1159/000509213
Abstract
Introduction: From both a clinical and research perspective, it is important to determine what constitutes a perceivable change in commonly used outcome measures. Objective: We aimed to do so for the Symptom Checklist-90-Revised (SCL-90-R). Methods: Patients from a large real-world sample treated with inpatient psychotherapy (n = 4,791) rated improvements in symptoms on a global 5-point Likert scale at discharge. These ratings were related to pre-post changes in the Global Severity Index (GSI) of the SCL-90-R by use of equipercentile linking. Results: A patient rating of 5 ("clearly improved") was found to be equivalent to an absolute pre-post difference in the GSI of 0.67 or to a percentage improvement of 54%, with the latter corresponding to the common definition of response as a 50% reduction in symptoms. A rating of 1 ("clearly worse") was equivalent to an increase in the GSI >0.50 and to a percentage worsening >55%. "Slightly improved" or "slightly worse" (ratings of 4 or 2) corresponded to pre-post changes in the GSI of 0.07 and 0.50. For severely disordered patients, larger changes were required for ratings of improvement, and for less severely disordered patients, larger changes were required for ratings of worsening. Results for depressive, anxiety, and personality disorders were widely consistent with those of the total sample. Conclusions: This study is the first to link patient ratings of improvement or worsening to changes in the SCL-90-R. Results are relevant to both the interpretation of changes in individual patients and of effect sizes in outcome research. Results require replication.This publication has 19 references indexed in Scilit:
- Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differencesContemporary Clinical Trials, 2015
- Minimal Clinically Important DifferenceJAMA, 2014
- Minimum Clinically Important Difference in the Positive and Negative Syndrome Scale With Data From the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)British Journal of Psychology, 2012
- Equipercentile linking of the Brief Psychiatric Rating Scale and the Clinical Global Impression Scale in a catchment areaEuropean Neuropsychopharmacology, 2012
- A critical review of methods used to determine the smallest worthwhile effect of interventions for low back painJournal of Clinical Epidemiology, 2012
- Clinical implications of Brief Psychiatric Rating Scale scoresThe British Journal of Psychiatry, 2005
- Sufficiently Important Difference: Expanding the Framework of Clinical SignificanceMedical Decision Making, 2005
- Determination of the clinical importance of study resultsJournal of General Internal Medicine, 2002
- Psy-BaDoPsychotherapeut, 1998
- Synthesizing standardized mean‐change measuresBritish Journal of Mathematical and Statistical Psychology, 1988