Concerning the suitability of the Symptom-Check-List (SCL-90-R)

for the diagnosis of acute suicidality

Mangholz, Astrid & Manfred Kuda

Center for psychological medicine –Psychotherapeutical ambulance for university students

University of GöttingenGermany

Poster presented at the 37th Annual Meeting of the Society for Psychotherapy Research

Edinburgh, 2006

For the meantime, the SCL-90-R (Derogatis, 1986; Franke, 1995) is a very frequently used diagnostic instrument in psychotherapeutical outpatient clinics, psychosomatical and psychiatrical hospitals.

In the basis documentation of the psychotherapeutical outpatient clinics for students examined by us, it has been rather used so far as a screening-procedure

Since the student clientele is subject to a clear suicide risk (a.o. Kuda, 2004), we follow the question whether, and in which degree, the SCL-90 (and/or parts from it) is suitable for diagnosing the acute suicidality of this clientele.

Here examined:

1. whether the estimation of suicidality by the clients corresponds with that by the psychotherapists.

2. hether the estimation of acute suicidality by the clients corresponds with the therapist diagnoses of future suicide-danger.

3. whether there are connections between personality-characteristics of the clients and the estimations of suicidality by clients and therapists.

Criteria of suicidality are

A - from the clients view:

Questionnaire test of suicidal – depressive tendencies (FBS, Stork, 1974)

Item 15 of the SCL: Have you had thoughts of taking your own life… in the past 7 days to today? B - from the psychotherapist´s view:

Marking of acute suicidality on a list of 40 single symptoms.Prognosis estimation of the future suicide-danger on a 7-stage scale from "not at all" to "very strongly"

Fig. 1: Characteristics of the sample-test

N 1998 / 99155

2001210

Sex (%) ♀ ♂

43,256,8

40,359,7

Age (in years) AM 25,74,1

19-39

25,94,119-44 SD

from – to (in years)

University terms AM SDfrom – to

9,896,2

1-34

8,995.0

1-31

Fig. 2: Suicide-criteria – from the client’s view

1998 / 99 2001

SCL-item 15:Have you had thoughts

of taking your own life… in the past 7 days? (%)

not at all 58,7 64,3

a little 25,8 19,0

quite 5,2 4,8

strongly 6,5 7,6

very strongly 3,9 3,3

Fig. 3: Suicide-criteria – from the client’s viewQuestionnaire-test about the Estimation of suicide-danger (FBS-Total Score)

1998 / 99 2001

Category (in %):

normality 55,6 62,3

normality doubtful 16,3 19,2

weak suicide-danger 18,9 12,5

strong suicide-danger 8,5 6,0

particularly strong suicide-danger

0,7 -

AMSD

28,09,7

26,39,1

Fig. 4: Suicide-criterion – Psychotherapist’s prognosis of „future suicide- risk“ (in %)

1998 / 99 2000 / 01

Not at all 1 27,7 48,0

2 35,4 27,0

3 22,3 7,4

4 6,1 0,7

5 7,7 4,6

6 0,8 6,1

Very 7strongly

- 6,1

To question 1: It was examined whether the estimation of sucidality by the clients corresponds with that by the psychotherapists

The self-assessment of acute suicidality is significantly connected, at least as a trend with the therapist’s criteria in significant correlation

Most strongly with the diagnosis "suicidality" in the newer sample

The long - lasting suicidal tendencies (FBS) show non-conforming results:In the older sample-test they are linked in a highly-significant way with an unfavourable prognosis

In the newer sample-test they tend towards the therapist’s diagnosis “suicidality”

Fig. 5: Intercorrelation of the suicide –criteria

Psychotherapists

Prognosis SuicideClients suicide risk Ideas

FBS-Total score .291 ** .053.091 .167 (*)

SCL-15 Item .168 *) .174 *.147 (*) .334 **

(acute Suicide-Tendencies_________________________________________ (*) p < .10; * p < .05; ** p < .01

Uppwer row: 1998/99Lower row: 2000/01

To question 2:It was examined whether the estimation of acute sucidality by the clients corresponds with the prognoses of future suicide-danger by the therapists

In the older sample all suicide-criteria are linked with a more unfavourable therapist’s diagnosis of future suicide-danger

In the newer sample, not at all

Fig. 6: Inter-correlationsSuicide-criteria with the prognosis „Suicide-

risk“

1998 / 99 2000 / 01

FBS-Total score .291** .091

SCL-item 15 .168 (*) .147

Suicide ideas .169 (*) .101

*p<.10; *p<.05; **p<.01

To question 3:

It was examined whether there are correlations between personality-characteristics of the clients and the estimations of suicidality by clients and therapists

The self-assessment of acute suicidality (SCL-15) is, in both samples linked with more negative social resonance (GT-1) and higher depressive general mood (GT-4) in a weakly to highly significant relationship

Also in the newer sample-test additionally with pronounced retentivity (GT-5) and/or smaller permeability

The long-lasting suicidal-depressive tendencies (FBS) are linked with all personality-characteristics (via GT), except “subcontrol vs. coercion (GT-3)”, in a significant to highly significant way

Fig.7: Inter-correlationsSuicide criteria and personality-characteristics(Gießen-Test Standard scales)

Clients Therapists

Gießen-test SCL-15 FBS-GPW Prog-suic. suicidality

GT-1: social resonance -.146(*)-.438**

-.450**-.438**

-.172*-.182*

-.138(*)--

GT-2: dominance - subjection ----

-.196*-.179*

----

----

GT-3: undercontrol - compulsion

----

----

----

----

GT-4: depressive general mood -.197*.372**

.407**

.547**.225**

--.204*

--

GT-5: permeability --.228**

.312**

.215**.182*

------

GT-6: social potency ----

.161.331**

.243**--

----

*p<.10; *p<.05; **p<.01Upper Row: 1998 / 99Lower Row: 2001 /2002

Discussion

In the comparison of the two periods the results are not the same,partly unexpectedly

Correspondence exists in the social-biographic characteristics:

The suicide-criteria from the client’s view are nearly identically Distributed the average therapist’s prognoses of suicidality are alike

Overlaps are found in the symptom-frequency, but also differences:Twice as many “sleep disturbances” in the newer sample;Clearly fewer “partner problems”, as well as “Problems with the family of origin”

The inter-correlations of the suicide-criteria are non-uniform in both periods:The prognosis of future suicidality does not have important relations with these criteria in the newer samplethe suicide-criteria from the therapist’s view have nearly no connection with the personality-characteristics in the newer sample.

Corresponding adress: Dr. Manfred Kuda (manfred.kuda@web.de), Burg Grona 37D - 37079 Göttingen