Emotional Distress Following Stroke: Interpretive Limitations of the SCL-90-R

Abstract

Evaluation of affective status in medical patients is frequently hampered by the uncertain validity, questionable relevance, or both, of certain items on measures used for this purpose. In this study, we examined the validity of the Symptom Checklist-90-Revised (SCL-90-R) as a measure of psychological distress in stroke patients. Those SCL-90-R symptoms (N = 19) that were designated by at least 8 of 10 expert raters as "usual consequences of stroke" were labeled "stroke symptoms." These items loaded primarily on the Somatization, Obsessive-Compulsive, and Depression scales. Among a sample of 30 patients hospitalized for acute rehabilitation following unilateral stroke, average scores fell at or above the 70th percentile (relative to normative data given in the manual) on five of the nine symptom dimensions and on all three summary indices of distress. Significantly elevated rates of endorsement were found in the stroke group on 12 of the 19 "stroke symptoms" and on 20 of the remaining symptoms as well. Participants with right-hemisphere lesions generally reported higher levels of distress than did the smaller group of patients with left hemisphere involvement. Our study suggests that at least some portion of SCL-90-R elevations is likely to be attributable to endorsement of phenomena that comprise part of the "natural history" of stroke. Our findings underscore the need for clinicians to examine individual responses of neurological patients on such self-report measures, as simple interpretation of summary scale scores can be highly misleading.