Advertisement

Social Withdrawal Among Individuals Receiving Psychiatric Care: Derivation of a Scale Using Routine Clinical Assessment Data to Support Screening and Outcome Measurement

  • Sebastian Rios
  • Christopher M. Perlman
Article

Abstract

Social withdrawal is a symptom experienced by individuals with an array of mental health conditions, particularly those with schizophrenia and mood disorders. Assessments of social withdrawal are often lengthy and may not be routinely integrated within the comprehensive clinical assessment of the individual. This study utilized item response and classical test theory methods to derive a Social Withdrawal Scale (SWS) using items embedded within a routine clinical assessment, the RAI-Mental Health (RAI-MH). Using data from 60,571 inpatients in Ontario, Canada, a common factor analysis identified seven items from the RAI-MH that measure social withdrawal. A graded response model found that six items had acceptable discrimination parameters: lack of motivation, reduced interaction, decreased energy, flat affect, anhedonia, and loss of interest. Summing these items, the SWS was found to have strong internal consistency (Cronbach’s alpha = 0.82) and showed a medium to large effect size (d = 0.77) from admission to discharge. Fewer individuals with high SWS scores participated in social activity or reported having a confidant compared to those with lower scores. Since the RAI-MH is available across clinical subgroups in several jurisdictions, the SWS is a useful tool for screening, clinical decision support, and evaluation.

Notes

Acknowledgements

The authors thank the Canadian Institute for Health Information and interRAI for making the data available to carry out this research. Jonathan Chen, MSc, at the University of Waterloo, assisted with the preparation of the dataset used in the analyses of this study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Winograd-Gurvich C, Fitzgerald P, Georgiou-Karistianis N, et al. Negative symptoms: A review of schizophrenia, melancholic depression and Parkinson’s disease. Brain Res Bull 2006;70(4):312–321.CrossRefGoogle Scholar
  2. 2.
    Earnst KS, Kring AM. Construct validity of negative symptoms: an empirical and conceptual review. Clin Psychol Rev 1997;17(2):167–189.CrossRefGoogle Scholar
  3. 3.
    Kraepelin E. Dementia praecox and paraphrenia. Malabar, Krieger Publishing Company; 1971.Google Scholar
  4. 4.
    Bleuler E. Dementia Praecox or the Group of Schizophrenias. New York, NY: International Universities Press; 1950.Google Scholar
  5. 5.
    Meehl PE. Schizotaxia, schizotypy, schizophrenia. Am Psychol 1962;17(12):827.CrossRefGoogle Scholar
  6. 6.
    Rado S. 1962 Psychoanalysis of behavior. Vol 1. Grune & StrattonGoogle Scholar
  7. 7.
    Kaiser S, Heekeren K, Simon JJ. The negative symptoms of schizophrenia: category or continuum? Psychopathology 2011;44(6):345–353.CrossRefGoogle Scholar
  8. 8.
    Isella V, Melzi P, Grimaldi M, et al. Clinical, neuropsychological, and morphometric correlates of apathy in Parkinson’s disease. Mov Disord 2002;17(2):366–371.CrossRefGoogle Scholar
  9. 9.
    Reichman WE, Negron A. Negative symptoms in the elderly patient with dementia. International Journal of Geriatric Psychiatry 2001;16(1):S7–11.CrossRefGoogle Scholar
  10. 10.
    Boone KB, Miller BL, Swatz R, et al. Relationship between positive and negative symptoms and neuropsychological scores in frontotemporal dementia and Alzheimer’s disease. J Int Neuropsychol Soc 2003;9(5):698–709.CrossRefGoogle Scholar
  11. 11.
    Chapman LJ, Chapman JP, Raulin ML. Scales for physical and social anhedonia. J Abnorm Psychol 1976;85(4):374.CrossRefGoogle Scholar
  12. 12.
    Kontaxakis VP, Kollias CT, Havaki-Kontaxaki BJ, et al. Physical anhedonia in the acute phase of schizophrenia. Ann General Psychiatry 2006;5(1):1.CrossRefGoogle Scholar
  13. 13.
    Brown LH, Silvia PJ, Myin-Germeys I, et al. When the need to belong goes wrong: the expression of social anhedonia and social anxiety in daily life. Psychol Sci 2007;18(9):778–782.CrossRefGoogle Scholar
  14. 14.
    Horan WP, Brown SA, Blanchard JJ. Social anhedonia and schizotypy: the contribution of individual differences in affective traits, stress, and coping. Psychiatry Res 2007;149(1):147–156.CrossRefGoogle Scholar
  15. 15.
    Blanchard JJ, Collins LM, Aghevli M, et al. Social anhedonia and schizotypy in a community sample: the Maryland longitudinal study of schizotypy. Schizophr Bull 2011;37(3):587–602.CrossRefGoogle Scholar
  16. 16.
    Siegrist K, Millier A, Amri I, et al. Association between social contact frequency and negative symptoms, psychosocial functioning and quality of life in patients with schizophrenia. Psychiatry Res 2015;230(3):860–866.CrossRefGoogle Scholar
  17. 17.
    Fleury M, Grenier G, Bamvita J, et al. Predictors of quality of life in a longitudinal study of users with severe mental disorders. Health Qual Life Outcomes 2013;11:92.CrossRefGoogle Scholar
  18. 18.
    Eckblad M, Chapman L, Chapman J, et al. 1982 The revised social anhedonia scale. Unpublished TestGoogle Scholar
  19. 19.
    Cicero DC, Krieg A, Becker TM, et al. Evidence for the Discriminant Validity of the Revised Social Anhedonia Scale From Social Anxiety. Assessment 2015;23(5):1–13.Google Scholar
  20. 20.
    Chapman LJ, Chapman JP. The Revised Physical Anhedonia Scale. University of Wisconsin: Madison; 1978.Google Scholar
  21. 21.
    Horan WP, Kring AM, Blanchard JJ. Anhedonia in schizophrenia: a review of assessment strategies. Schizophr Bull 2006;32(2):259–273.CrossRefGoogle Scholar
  22. 22.
    Reise SP, Horan WP, Blanchard JJ. The challenges of fitting an item response theory model to the Social Anhedonia Scale. J Pers Assess 2011;93(3):213–224.CrossRefGoogle Scholar
  23. 23.
    Andreasen NC. Negative symptoms in schizophrenia: definition and reliability. Arch Gen Psychiatry 1982;39(7):784–788.CrossRefGoogle Scholar
  24. 24.
    Kay SR, Flszbein A, Opfer LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13(2):261.CrossRefGoogle Scholar
  25. 25.
    Hirdes JP, Curtin-Telegdi N, Morris JN, et al. interRAI: interRAI Mental Health (MH) Assessment Form and user’s Manual for in-Patient Psychiatry. 9.1st ed. Washington, DC: interRAI; 2010.Google Scholar
  26. 26.
    Perlman CM, Hirdes JP, Barbaree H, et al. Development of mental health quality indicators (MHQIs) for inpatient psychiatry based on the interRAI mental health assessment. BMC Health Serv Res 2013;13:15.CrossRefGoogle Scholar
  27. 27.
    Jones K, Perlman CM, Hirdes JP, et al. Screening cognitive performance with the Resident Assessment Instrument for Mental Health Cognitive Performance Scale. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 2010;55(11):736–740.PubMedGoogle Scholar
  28. 28.
    Neufeld E, Perlman CM, Hirdes JP. Predicting inpatient aggression using the interRAI risk of harm to others clinical assessment protocol. The Journal of Behavioral Health Services & Research. 2012;39(4):472–480.CrossRefGoogle Scholar
  29. 29.
    Hirdes JP, Marhaba M, Smith TF, et al. Development of the resident assessment instrument-mental health (RAI-MH). Hospital Quarterly 2000;4(2):44–51.PubMedGoogle Scholar
  30. 30.
    Hirdes JP, Smith TF, Rabinowitz T, et al. The resident assessment instrument-mental health (RAI-MH): Inter-rater reliability and convergent validity. The Journal of Behavioral Health Services & Research 2002;29(4):419–432.CrossRefGoogle Scholar
  31. 31.
    Hirdes JP, Ljunggren G, Morris JN, et al. Reliability of the interRAI suite of assessment instruments: a 12-country study of an integrated health information system. BMC Health Serv Res 2008;8:277.CrossRefGoogle Scholar
  32. 32.
    Hatcher L, O’Rourke N. A step-by-step approach to using SAS for factor analysis and structural equation modeling. Second ed. North Carolina: SAS Institute; 2014.Google Scholar
  33. 33.
    Reeve BB, Hays RD, Bjorner JB, et al. Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS). Med Care 2007;45(5):S22–31.CrossRefGoogle Scholar
  34. 34.
    Sheu C, Chen C, Su Y, et al. Using SAS PROC NLMIXED to fit item response theory models. Behav Res Methods 2005;37(2):202–218.CrossRefGoogle Scholar
  35. 35.
    Samejima F. Estimation of latent ability using a response pattern of graded scores. Psychometrika Monograph Supplement 1969;34(4):100.Google Scholar
  36. 36.
    Chang CH, Reeve BB. Item response theory and its applications to patient-reported outcomes measurement. Evaluation & the Health Professions 2005;28(3):264–282.CrossRefGoogle Scholar
  37. 37.
    Husted JA, Cook RJ, Farewell VT, et al. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 2000;53(5):459–468.CrossRefGoogle Scholar
  38. 38.
    Cohen J. Methods in psychology. A power primer. Psychol Bull 1992;112(1):155–159.CrossRefGoogle Scholar
  39. 39.
    Eisen SV, Normand SL, Belanger AJ, et al. The Revised Behavior and Symptom Identification Scale (BASIS-R): reliability and validity. Med Care 2004;42(12):1230–1241.CrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  1. 1.School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada

Personalised recommendations