The scale has low requirements for test environment, comprehensive content and short test time, and can reflect the current mental health status of visitors, which is easy to understand and master, so it is also widely used in post-disaster psychological rescue work.
The nature and use of SCL-90;
It is one of the professional psychiatric scales for evaluating "psychological and behavioral problems" and belongs to the self-rating scale.
There are 90 items in the scale * * *, which contains a wide range of psychiatric contents, from feeling, emotion, thinking, consciousness, behavior to living habits, interpersonal relationships, eating and sleeping, etc. , and
Use 10 to reflect the psychological state of 10 respectively.
Scope of application of SCL-90:
First, in psychiatric and psychological counseling clinics, as an evaluation tool to understand the mental health problems of patients or counselors, it can also evaluate the curative effect of disease evolution before and after counseling.
Secondly, in general hospitals, SCL-90 is often used to understand the mental symptoms of patients with physical diseases, and the results are satisfactory.
Thirdly, SCL-90 is used to investigate the mental health problems of different occupational groups, and to reflect the mental health problems of different occupational groups from different aspects.
SCL-90 is suitable for adults who have completed nine-year compulsory education, and it is difficult for people with too low education level or too young to understand the meaning of the topic.
Add some necessary knowledge here:
Self-rating scale refers to the scale that evaluates according to one's own subjective feelings. Instead of a "self-answer and self-explanation scale", you can answer it yourself, but you can't explain it yourself. You can only explain it through a psychologist or a professional counselor.
Self-rating scale is relative to other rating scales. Other rating scales refer to the scales rated by psychiatrists or professional psychological counselors after talking with visitors.
Instead of "a yardstick for others to answer and explain", no matter how much other people's feelings account for his yardstick, non-professional psychiatrists or psychological counselors have no right to answer and explain his yardstick, let alone make conclusive answers and explanations.
In practical work, I met some people who searched and downloaded the self-rating scale and other rating scales from the internet, made them for their children, lovers or partners, and explained them according to the results given by the computer and their own or non-authoritative understanding of psychiatry and psychology. This explanation is often upside down, full of mistakes and omissions, seriously misleading the subjects, and even causing serious mental injury, which must be avoided!
Steps to measure SCL-90:
First of all, before starting the evaluation, the staff should explain the general scoring methods and requirements to the subjects, and then let them make an independent self-evaluation that is not influenced by anyone, and fill it in with a pencil (easy to correct) or operate it on the computer.
Each project adopts a five-level scoring system, as follows:
1, None: I feel that I have no such symptoms (problems).
2. Very mild: I consciously have this symptom, but it has no actual or slight influence on the subject.
3. Moderate: Consciously having this symptom has certain influence on the subjects.
4. Bias: I often feel this symptom consciously, which has a considerable impact on the subjects.
5. Severe: Consciously, the frequency and intensity of this symptom are very serious, which has a serious impact on the subjects.
The "influence" mentioned here includes not only the pain and trouble caused by symptoms, but also the psychological and social function damage caused by symptoms. The specific definitions of "light", "medium" and "heavy" are left to self-evaluators, and there are no hard and fast rules.
Second, the staff can read it to people with low self-rated education level one by one, and tell him the meaning of the question itself in a neutral way, without any hint and impartiality.
Third, the time range of evaluation is the actual feeling of "now" or "last week".
Four, at the end of the evaluation, by myself or a clinician to check one by one, where there are missing or repeated evaluation, should remind the self-evaluation to reconsider the evaluation, so as not to affect the accuracy of the analysis.
SCL score -90:
I. Total score
The sum of 90 items can reflect the severity of the disease.
Total average score: the total score is /90, which indicates the score level of the subject's self-feeling between 1 ~ 5.
Number of positive items: the number of items with a single score ≥2, indicating the number of items with "symptoms" of the subjects.
Negative item number (also called negative item score): the number of items with single score = 1, indicating how many items are asymptomatic.
Average score of positive symptoms: (total score-number of negative items)/number of positive items, indicating the average score of subjects in the "symptoms" items. What is the severity range of the items that reflect the subjects' poor self-feeling?
Second, the factor score.
* * * contains 10 factors, that is, all 90 items are divided into ten categories, and each factor reflects the situation of the subjects in a certain aspect. Through the factor score, we can understand the symptom distribution characteristics of the subjects and analyze the general situation.
Interpretation of SCL-90 results
According to the results of national norm, if the total score exceeds 160, or the number of positive items exceeds 43, or the score of any factor exceeds 2, the screening is considered positive and needs further examination.
The name, items and brief description of SCL-90 factor.
First, somatization
Include 1, 4, 12, 27, 40, 42, 48, 49, 52, 53, 56, 58, *** 12. This factor mainly reflects subjective physical discomfort, including complaints of cardiovascular, gastrointestinal and respiratory systems, as well as physical manifestations caused by headache, back pain, muscle aches and various psychological discomfort.
Second, symptoms of obsessive-compulsive disorder
Including items 3, 9, 10, 28, 38, 45, 46, 5 1, 55, 65, *** 10. This factor is basically the same as the symptoms and definition of clinical obsessive-compulsive disorder. Mainly refers to the kind of meaningless thoughts, impulses, behaviors and other performances that you know are unnecessary but can't get rid of; There are also some common perceptual obstacles, such as "empty brain" and "poor memory", which are also reflected in this factor.
Third, interpersonal sensitivity.
Including 6,21,34,36,37,41,6 1, 69 and 73, ***9. Mainly refers to some subjective feelings of discomfort and inferiority, especially when compared with others. People who feel inferior, depressed and obviously difficult to get along with in interpersonal relationships are often the target of this factor.
Fourth, depression.
Including items 5, 14, 15, 20, 22, 26, 29, 30, 3 1, 32, 54, 7 1 and 79, *** 13. It reflects a wide range of concepts related to clinical depressive symptoms. The feeling and emotion of depression are typical symptoms, which are also manifested as decreased interest in life, lack of desire to exercise, loss of activity ability and so on. , including disappointment, pessimism and other sensory and physical problems related to depression. Several of these factors include concepts such as death and suicide.
Verb (short for verb) anxiety
Including 2, 17, 23, 33, 39, 57, 72, 78, 80, 86, *** 10. Including some mental symptoms and experiences that are usually obviously related to anxiety symptoms in clinic, generally referring to those who can't rest, nervous, neurotic and the signs caused by them. Restless anxiety and panic attacks are the main contents of this factor, which also includes a project reflecting "disintegration"
Sixth, hostility
Including 1 1, 24, 63, 67, 74 and 8 1, * * 6. Mainly from the thinking, emotion and behavior to reflect the hostile performance of the subjects. Its events range from boredom, quarreling and throwing things, to fighting and uncontrollable impulses.
Seven, terror
Including 13, 25, 47, 50, 70, 75, 82, ***7 items. It is basically consistent with the content reflected by the traditional state of terror or square terror. The factors that cause terror include travel, open space, crowds, public places and transportation. There are also projects that reflect social terror.
Eight, paranoia
Including 8, 18, 43, 68, 76, 83, ***6 items. Paranoia is a very complicated concept This factor only includes some basic contents, mainly referring to thinking, such as projection thinking, hostility, doubt, reference to delusion, passive experience, exaggeration and so on.
Nine, spiritual quality
Including 7, 16, 35, 62, 77, 84, 85, 87, 88, 90, *** 10. Among them, there are auditory hallucinations, spreading thoughts, feeling controlled, thinking being inserted and other items that reflect schizophrenia-like symptoms.
X. others
Including 19, 44, 59, 60, 64, 66, 89***7 items, mainly reflecting the sleeping and eating conditions.
Let's give a case to illustrate how to understand the SCL-90 report.
Case 1:
Total score 269
Number of positive items: 57
The above is the whole content of case one report.
First of all, we look at the total score of 269, which is more than 160 and 109, indicating that it is necessary to screen positive and conduct further examination.
Secondly, we calculate that the average score of positive symptoms is about 4. 14, which is the average score of the subjects in the "symptoms" item, indicating that the severity of the items that the subjects feel bad about themselves belongs to the "very serious" range, because the full score of the five-level scoring system is 5.4.14, which is a very high score.
We see that there are 57 positive items, more than 43 items, which further shows that it is necessary to screen positive items for further inspection.
So let's take a look at the factors that exceed 2 points in this case:
Somatization score of 2.25: It indicates that the subject may have various physical discomfort symptoms.
Obsessive-compulsive symptom score 2.6: It means that the subjects may have meaningless thoughts, impulses and behaviors, which are consciously unnecessary, but they can't get rid of them.
Interpersonal sensitivity 3. 1 1: It shows that the subjects are likely to feel uncomfortable and inferior when getting along with others.
Depression score of 4.69: It shows that the subjects are likely to have a decline in interest in life, a lack of desire for activities, and a loss of activity ability.
Anxiety score 2.4: It indicates that the subject may be restless, nervous and neurotic.
Hostility score 2: indicates that the subject may have slight hostility consciousness and behavior.
Paranoia score of 2.66: It indicates that the subject may persist in incorrect cognition and unwise behavior.
Psychotic score of 3.6: it means that the subject is seriously divorced from the real world and cannot make accurate judgments about things and people around him.
Other 3. 17: It means that the subject has poor sleep and diet.
In this case, except for the terrorist factors, all the subjects scored below 2 points, and the rest were above 2 points, indicating that the condition is likely to be very serious and there are so many positive items to be screened. How to start screening?
Our analysis of factors above 2 points can be regarded as the first positive screening, and then the second positive screening should first screen mental illness. If you are diagnosed with mental illness, then other positive symptoms are probably the manifestations of this kind of mental illness, so we can treat it according to mental illness.
If mental illness can be ruled out, then the depression with the highest score should be screened. If it is diagnosed as depression, other positive symptoms are likely to be manifestations of depression, so it can be treated mainly according to depression.
If depression can also be ruled out, it is necessary to screen interpersonal sensitivity with the second highest score to see if there are social obstacles or major injuries or setbacks related to people until the screening is completed.
Case 2:
Total score 139, total average score 1.54, positive average score 2.48, positive number 33, negative number 57.
Mild interpersonal sensitivity
Mild depressive symptoms
Mild hostile symptoms
Mild psychotic symptoms
The above is the whole content of the report of case 2.
In the face of this report, let's first look at the total score 139, not exceeding 160.
Secondly, we can see that the average score of positive symptoms is 2.48, and the score of "symptomatic" items is less than half of 5 points, which shows that the items that the subjects feel bad about themselves are not serious, and at most they belong to sub-health and cannot reach the degree of "illness".
The number of positive items is 33, which is lower than 43. There is no need to screen positive items.
All the factors except "other" are below 2 points, indicating that the subjects have obvious problems in diet and sleep, but they are still within the normal range, and there is no need to screen positive.
From the above two cases, we can see that the forms of these two SCL-90 reports are not exactly the same. Case one is simple and case two is complicated. This is because psychological tests given by different hospitals are somewhat different in form.
What needs to be known is that no matter what form of SCL-90 report, it will definitely include three parts: the total score, the number of positive (or negative) items and the scores of each factor. The extra part is for more accurate reference of doctors and consultants. Non-professionals do not need to pay attention, as long as they understand these three parts.
At the end of case 2, four mild symptoms are listed, which correspond to the four factors in the "reference" column marked "mild" except "other" in the chart, but as long as the factor score does not exceed 2 points, it can be regarded as no problem.
In this case, the last unlisted "other" score is exactly 2 points, although it does not exceed 2 points, but it shows that the subject is likely to have serious problems in diet and sleep, which deserves further understanding by doctors and consultants.
Regarding SCL-90, we should pay special attention to:
First, the result of SCL-90 is not a diagnosis, but a reference for professional doctors and consultants to diagnose. The results of all psychological tests or psychological evaluations can only be used as a reference for the diagnosis of professional doctors or consultants, and cannot replace the diagnosis itself.
Second, "positive" is symptomatic. A positive screening can only say that the subject may have mental illness, but not necessarily mental illness.
Third, screening positive is not only to screen and explain the factors that exceed 2 points compared with the scale results, but also to conduct interviews and professional medical and psychological evaluations with reference to the diagnostic criteria of corresponding diseases, and it is likely to be more than one round.
Four, SCL-90 is not an accurate scale, there are many limitations, such as:
1, the scale is not comprehensive enough, and it lacks items such as "high mood" and "wandering thinking", which limits its application in all kinds of manic or schizophrenic patients. Due to the lack of such projects, the data made by the above patients may seem normal, but I am really abnormal and need mental illness treatment.
2. General psychological problems, serious psychological problems and neurotic psychological problems may lead to high SCL-90, but these three psychological problems are not mental diseases.
3. SCL-90 For teenagers, especially those who are psychologically "negative" in adolescence, the data is often high or even extreme, but I am really normal.
4. For subjects with poor medical advice, the results of SCL-90 may not reflect the actual situation of the subjects. Because SCL-90 has no test of reliability and validity, it is decided that there is no obvious exaggeration and concealment from the scale.
Every question is an obvious symptom assessment. As long as you have a certain cultural quality, it is not difficult to guess whether it is good or bad. This determines that if the subject is subjectively motivated or driven by disease, it is easy to make a false data.
To sum up, it is emphasized again that SCL-90 can only be used as an auxiliary diagnosis, not as a diagnosis itself. According to the results of SCL-90, it is impossible to draw a conclusion about the subjects' condition, especially whether they are "sick" or "disease-free".
Although SCL-90 is widely used and easy to test and understand, it is still a professional scale for psychiatric clinical testing, and only psychiatrists and professional psychological counselors trained by this scale have the right to explain.
In other words: understanding this scale does not mean that it can be explained. This article is only for popular science and cannot replace professional answers. Patients or visitors who need to test or explain SCL-90 should consult a psychologist or a qualified professional counselor.
The foregoing content of this case comes from "Psychological Counselor of National Vocational Qualification Training Course for National Vocational Skills Appraisal (Level 3)", which was compiled by China Mental Health Association and China Employment Training Technical Guidance Center, and was printed for the 23rd time in February 20 12 by Ethnic Publishing House.