Reliability and Validity of the SA-45: Further Evidence from a Primary Care Setting

Abstract

A project designed to demonstrate the benefits of integrating behavioral healthcare services in primary medical care settings provided an opportunity to further investigate the psychometric properties of the SA45 using data from a sample of 126 adults seeking medical services in a family practice setting. Specifically, the appropriateness of the SA45's adult nonpatient norms, as well as cross-validation of its test-retest reliability and construct validity, was investigated from the first set of data gathered for this project. The results suggested that use of the SA45 nonpatient norms with primary care populations is appropriate. Three-month test-retest correlations between Depression scale scores and SA-45 and SA-24-predicted GSI scores were found to be moderate but highly significant. In addition, correlations among the SA-45 scales and indices and their correlations with the SF-12 Mental and Physical Component Summary scales added further support for the psychometric integrity of the SA-45. Finally, only partial indirect support was obtained for the SA-45's ability to accurately classify patients as requiring further evaluation for behavioral health problems. Limitations of the study are discussed and suggestions for future research are presented.

Keywords

SA-45 primary care SF-12 integrated primary behavioral healthcare screening for mental disorders

Get full access to this article

View all access options for this article.

References

Anastasi, A. (1988). Psychological testing (6th ed.). New York: Macmillan Publishing.

Borus, J. F. (1985). Psychiatry and the primary care physician. In H. I. Kaplan & B. J. Sadock (Eds.), Comprehensive textbook of psychiatry/IV (4th ed., pp. 1302-1308). Baltimore: Williams & Wilkins.

Davison, M. L. , Bershadsky, B. , Bieber, B. , Silversmith, D. , Maruish, M. E. , & Kane, R. L. (1997). Development of a brief, multidimensional self-report instrument for treatment outcomes assessment in psychiatric settings: Preliminary findings. Assessment, 4, 259-276.

Derogatis, L. R. , Lipman, R. S. , & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale-preliminary report. Psychopharmacology Bulletin, 9, 13-27.

Detection of psychological disorders unrelated to outcomes . (1996, September). Behavioral Healthcare Outcomes, 1, 7-9.

Ficken, J. (1995). New directions for psychological testing. Behavioral Health Management, 20, 12-14.

Johnson, J. G. , Spitzer, R. L. , Williams, J. B. , Kroenke, K. , Linzer, M. , Brody, D. , deGruy, F. , & Hahn, S. (1995). Psychiatric comorbidity, health status, and functional impairment associated with alcohol abuse and dependence in primary care patients: Findings of the PRIME MD-1000 study. Journal of Consulting and Clinical Psychology, 63, 133-140.

Kessler, L. G. , McGonagle, K. A. , Zhao, S. , Nelson, C. B. , Hughes, M. , Eshleman, S. , Wittchen, H. , & Kendler, K. S. (1994). Lifetime and 12-month prevalence of DSM-III-R psy- chiatric disorders. Archives of General Psychiatry, 51, 8-19.

Kobak, K. A. , Taylor, L. V. , Dottl, S. L. , Greist, J. H. , Jefferson, J. W. , Burroughs, D. , Mantle, J. M. , Katzelnick, D. J. , Norton, R. , Henk, H. J. , & Serlin, R. C. (1997). A computer-assisted telephone interview to identify mental disorders. Journal of the American Medical Association, 278, 905-910.

10.

Locke, S. E. , & Larsson, K. M. (1997). Clinical presentation, screening, and treatment of somatization in primary care. In J. D. Haber & G. E. Mitchell (Eds.), Primary care meets mental health: Tools for the 21st century (pp. 179-191). Tiburon, CA: CentraLink Publications.

11.

Maruish, M. E. (1994). Introduction. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (pp. 3-21). Hillsdale, NJ: Erlbaum.

12.

Maruish, M. E. (Ed.). (in press-a). Handbook of psychological assessment in primary care settings. Mahwah, NJ: Erlbaum.

13.

Maruish, M. E. (in press-b). Introduction. In M. E. Maruish (Ed.), Handbook of psychological assessment in primary care settings. Mahwah, NJ: Erlbaum.

14.

Regier, D. A. , Narrow, W. E. , Rae, D. S. , Manderscheid, R. W. , Locke, B. , & Goodwin, F. K. (1993). The de facto U.S. mental and addictive disorders service system: Epidemiologic Catchment Area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50, 85-94.

15.

Rouse, B. A. (Ed.). (1995). Substance abuse and mental health statistics sourcebook. DHHS Publication No. (SMA) 95-3064. Washington, DC: Superintendent of Documents, U.S. Government Printing Office.

16.

Selden, D. R. (1997). Integration of primary care and behavioral health: The driving forces. In J. D. Haber & G. E. Mitchell (Eds.), Primary care meets mental health: Tools for the 21st century (pp. 13-25). Tiburon, CA: CentraLink Publications.

17.

Sperry, L. , Brill, P. L. , Howard, K. I. , & Grissom, G. R. (1996). Treatment outcomes in psychotherapy and psychiatric interventions. New York: Brunner/Mazel.

18.

Strategic Advantage, Inc. (1996). Symptom Assessment-24 Questionnaire (SA-24). Minneapolis, MN: Author

19.

Strategic Advantage, Inc. (1998). Symptom Assessment-45 Questionnaire (SA-45) technical manual. Toronto, Canada: Multi-Health Systems.

20.

Strosahl, K. (1996). Mind and body primary mental health care: New model for integrated services. Behavioral Healthcare Tomorrow, 5, 93-96.

21.

Ware,J. E.,Jr. , Kosinski, M. , & Keller, S. D. (1994). SF-12 physical and mental health summary scales: A user's manual (3rd ed.). Boston: The Health Institute, New England Medical Center.

22.

Ware,J. E., Jr. , Kosinski, M. , & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales (2nd ed.). Boston: The Health Institute, New England Medical Center.

23.

Ware, J. E., Jr. , Snow, K. K. , Kosinski, M. , & Gandek, B. (1993). SF-36 Health Survey manual and interpretation guide. Boston: The Health Institute, New England Medical Center.

24.

Zung, W. K. , Broadhead, W. E. , & Roth, M. E. (1993). Prevalence of depressive symptoms in primary care. The Journal of Family Practice, 37, 337-344.