Throwing the Baby Out with the Bathwater: When Can We Trust Self Report with the SMI Inpatient Population?

• Main Author: Lee, Jeffrey A.
• Format: Others
• Published: BYU ScholarsArchive 2010
• Subjects: BPRS-E; inpatient; outcome; SMI; SOQ; Psychology
• Online Access: https://scholarsarchive.byu.edu/etd/2851; https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=3850&context=etd

Reliability of self-report outcome assessment is often called into question with the severely mentally ill population. In the context of inpatient care, demand characteristics may further complicate self-report measures. Although clinician-completed outcome measures, such as the Brief Psychiatric Rating Scale-Expanded Version (BPRS-E), have become industry standard with this population, self-report assessment may be useful under certain conditions. This study sought to explore the relationship between a clinician-completed, the BPRS-E, and a self-completed measure, the SOQ, within the SMI inpatient population. A total of 357 adult participants with a minimum of three assessment iterations were analyzed. The results of the analysis indicated both measures correlated at all assessment iterations (admission, 90-, 180-, 270-, 360+ days), but when divided into SOQ admission clinical and subclinical groups only the clinical group maintained the correlation at all points. A logistical regression analysis indicated that membership in the subclinical group can be predicted by one subscale (Mood Disturbance) and three items (Hallucinations, Uncooperativeness, and Conceptual Disorganization) from the BPRS-E. The change trajectories of both measures were essentially identical; however, when divided into SOQ admission clinical and subclinical scores the SOQ and BPRS-E change trajectories were significantly different from each other and clinical versus subclinical on the same measure were significantly different. Further examination of the subclinical SOQ group revealed two distinct groups, scores that eventually had reliable change and exceeded the cutoff score and those that never did. A logistical regression analyses revealed that membership in these two groups can be reliably predicted by two BPRS-E items (Somatic Concerns and Suspiciousness), in that as each item increases the likelihood of membership in the group that never exceeds the cutoff score also increases. These results suggest that although the SMI inpatient population present with profound limitations, it may be possible to predict those who will eventually provide reliable self-report outcome assessments and those who will not. Although further research is necessary, these results are promising and may provide decision points for clinicians on when and when not to trust self-report outcome assessment with the SMI inpatient population.