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308 Psychological Assessment in Medical Settings chest pain. To confirm a probable somatoform diagnosis, the patient must have at least 5 of the 11 symptoms without demonstrable medical findings. Katon et al. (1990), focusing on the prognostic value of somatic symptoms, used the SCL-90-R to provide an opera- tional definition of high distressed—high utilizers. The investigators observed linear increases in SCL-90-R dimension scores of Somatization, Depression, and Anxiety as they moved progressively through the somatic symptom groups from low to high. Kellner, Hernandez, and Pathak (1992) related distinct dimensions of the SCL-90-R to different aspects of hypochondri- asis. The authors observed high levels of the SCL-90-R Somatization andAnxietyscores to be predictive of hypochondriacal fears and beliefs, whereas elevations on Depression were not. Fear of disease correlated most highly with the SCL-90-R Anxiety score, but the false conviction of having a disease was more highly correlated with somatization. Difficult Patients The Difficult Doctor-Patient Relationship Questionnaire (DDPRQ; Hahn, Thompson, Stern, Budner, & Wills, 1994) is a relatively new instrument that can reliably identify a group of patients whose care is experienced as often difficult by physicians. The construct validity of the instrument has been established by demonstrating strong associations between characteristics that have been associated with physician-experienced difficulty. The instrument classified 11–20% of primary care patients as difficult, using a cutoff point that has been shown to distinguish between patients with difficult characteristics and those without. The DDPRQ score can also be used as a continuous measure. The instrument is available in two formats: the DDPRQ-30, a 30-item version that requires 3–5 minutes to complete, and a 10-item version, the DDPRQ-10, requiring less than 1 minute. The DDPRQ is completed by the physician after meeting with the patient. Prior to the DDPRQ, the study of the difficult patient was limited to anecdote, clinical description, or the evaluation of idiosyncratic characteristics. Patients experienced as difficult are an important group to study because they are more likely to have psychopathology, to use the health care system disproportionately, and to be less satisfied than are patients perceived to be nondifficult when receiving care. Physician- experienced difficulty also takes its toll on physician and health care professionals’ morale and job satisfaction (Hahn, 2000). The DDPRQ has been used in a number of studies and has proven to be an effective and reliable assessment tool. Alcohol and Substance Abuse It is well documented that alcohol abuse and substance abuse are often comorbid with anxiety and depressive disorders. Johnson, Brems, and Fisher (1996) compared psychopathology levels of substance abusers not receiving substance abuse treatment with those in treatment. They found SCL-90-R scores to be significantly higher for the majority of subscales for the treatment versus the nontreatment group. Drug abusers in treatment were found to have more psychological symptoms than were those not in treatment, except on the Hostility and Paranoid Ideation Scales, on which the nontreatment group had higher levels. The authors suggested that the pres- ence of a comorbid condition is associated with a greater like- lihood that drug abusers will seek treatment. Derogatis and Savitz (2000), in their thorough analysis of the SCL-90-R, reviewed numerous studies in general medical populations in which the SCL-90-R—within the context of interview and historical data—identified alcohol and substance abusers. The authors also found that the SCL-90-R was able to identify comorbid psychopathology among substance abusers. Shedler (2000) reviewed the Quick Psychodiagnostics Panel (QPD), which includes a 14-item alcohol and substance abuse scale. All patients answer five of the questions; the re- maining questions are presented only when previous responses suggest substance abuse (i.e., logic branching). The scale is fully automated or portable and can be administered on hand- held computer tablets, representing an innovation in computerized assessment. Initial diagnostic results were promising among patients enrolled in an HMO plan. The Self-Administered Alcoholism Screening Test (SAAST) is a 37-item questionnaire that has been shown to have good reliability and validity when administered to a vari- ety of patient samples. Patient acceptance has also been good when the use of alcoholisviewedasahealthcareissue.Patient endorsement of test items on the SAAST has been an excellent starting point or screening prior to a clinical interview (Davis, 2000). Trauma and Sexual Abuse Sexual abuse and physical abuse are factors associated with medical problems that are often overlooked. Individuals who experience such abuse also experience significant emotional distress and personal devaluation, which can lead to a chronic vulnerability and can compromise the effective treatment of their medical conditions. Many individuals who have been sexually abused exhibit clinical manifestations of anxiety or depressive disorders, without a clear understanding of the Types of Medical Settings 309 contribution made by their victim experiences (Derogatis & Savitz, 2000). Some investigators have established the utility of the BSI in work with patients who have been sexually abused. Frazier and Schauben (1994) investigated the stressors experienced by college-age females in adjusting to the transition of college life. Significant correlations were found between the magnitude of stress and levels of psychological symptoms on the BSI. Survivors of sexual abuse had significantly higher total scores on the BSI. Coffey, Leitenberg, Henning, Turner, and Bennett (1996) also investigated the consequences of sexual abuse in 192 women with a history of childhood sexual abuse. Women who had been sexually abused revealed a higher total distress score on the BSI than did women in a nonabused control group, and a greater proportion of their BSI subscale scores fell in clinical ranges. Toomey, Seville, Mann, Abashian, and Grant (1995) as- sessed a heterogeneous group of chronic pain patients and observed that those patients with a history of sexual abuse scored higher on the SCL-90-R than did nonabused patients. Similar findings were reported by Walker et al. (1995), who found that female patients with chronic pelvic pain had significantly higher symptomatic distress levels than did a patient group (tubal ligation) without pain.Themeanscoreforchronicpelvic pain sufferers fell in the 60th percentile of psychiatric outpa- tient norms on the SCL-90-R. The pain group also revealed a significantly greater incidence of somaticization disorders, phobias, sexual dysfunction, and sexual abuse as compared to the no-pain group. These studies suggest chronic pain may be another condition that is associated with sexual abuse. Quality of Life and Outcomes Research Andrews, Peters, and Tesson (1994) indicated that most of the definitions of quality of life (QOL) describe a multidimensional construct encompassing physical affective, cognitive, social, and economic domains. QOL scales are designed to evaluate—from the patient’s point of view—the extent to which the patient feels satisfied with his or her level of functioning in the aforementioned life domains. Objective measures of QOL focus on the environmental resources required to meet one’s need and can be completed by someone other than the patient. Subjective measures of QOL assess the patient’s satisfaction with the various aspects of his or her life and thus must be completed by the patient. Andrews et al. (1994) indicated distinctions between QOL and health-related quality of life (HRQL) and between generic and condition-specific measures of QOL. QOL measures differ from HRQL measures in that the former assess the whole aspect of one’s life, whereas the latter assesses quality of life as it is affected by a disease or disorder or by its treatment. Generic measures are designed to assess aspects of life that are generally relevant to most people; condition-specific measures are focused on aspects of the lives of particular disease-disorder populations. QOL scales also provide a means to gauge treatment success. One of the more widely used QOL measures is the Medical Outcomes Study Short Form Health Status (SF-36; Ware, 1993). The scale con- sists of 36 items, yielding scores on eight subscales: physical functioning, social functioning, body pain, general mental health, role limitations due to emotional problems, role limitations due to physical functioning, vitality, and general health perception. New scoring algorithms yielded two new summary scales: one for physical functioning and one for mental functioning (Wetzler, Lum, & Bush, 2000). Wallander, Schmitt, and Koot (2001) provide a thorough review of QOL issues, instruments, and applications with children and adolescents. Much of what they propose is clearly applicable to QOL measurement in adult patients. The authors conclude that QOL is an area that has growing impor- tance but has suffered from methodological problems and has relied on untested instruments and on functional measurement to the neglect of the subjective experience. They offer a set of coherent guidelines about QOL research in the future and support the development of broadly constructed, universal QOL measures, constructed using people with and without identified diseases, rather than disease-specific QOL measures. Given the expanding interest in assessing QOL and treatment outcomes for the patient, it is not surprising to see an accompanying interest in assessing the patient’s (and in some cases, the patient’s family’s) satisfaction with services received. Satisfaction should be considered a measure of the overall treatment process, encompassing the patient’s (and at times, others’) view of how the service was delivered, the ca- pabilities and the attentiveness of the service provider, the perceived benefits of the service, and various other aspects of the service the patient received. Whereas QOL may measure the result of the treatment rendered, program evaluation may measure how the patient felt about the treatment he or she received (Maruish, 2000). TYPES OF MEDICAL SETTINGS During the past decade, there has been an increasing interest in the assessment of health status in medical and behavioral health care delivery systems. Initially, this interest was shown primarily within those settings that focused on the treatment of physical diseases and disorders. In recent years, psychologists have recognized the value of assessing the general level of health as well. 310 Psychological Assessment in Medical Settings Measures of health status and physical functioning can be classified into one of two groups: generic and condition- specific (Maruish, 2000). An example of a generic measure assessing psychological adjustment to illness would be the PAIS (Derogatis et al., 1995). Several of these measures are listed in Table 13.1 and are reviewed by Derogatis et al. (1995) and Rozensky et al. (1997). Condition-specific measures have been available for a number of years and are used with specific medical disorders, diseases, or conditions. Some of these measures are discussed within this section and listed in Table 13.4. General Medical Settings and Primary Care As the primary care physician becomes the gatekeeper in many managed care and capitated health care organizations and systems, several instruments have been developed to meet the screening and assessment needs of the primary care physician. The Primary Care Evaluation of Mental Disorders (PRIME- MD; Hahn, Kroenke, Williams, & Spitzer, 2000) is a diagnostic instrument designed specifically for use in primary care by internists and other practitioners. The PRIME-MD contains separate modules addressing the five most common cate- gories of psychopathology seen in general medicine: mood disorders, anxiety disorders, alcohol abuse and dependence, eating disorders, and somatoform disorders. The PRIME-MD has been shown to be valid and reliable, is acceptable to patients, and is often selected asaresearchtoolbyinvestigators (Hahn et al., 2000). The central function of the PRIME-MD is detection of psychopathology and treatment planning. However, it can also be used in episodic care, in subspecialty consultations, and in consultation-liaison psychiatry and health psychology assessments. The COMPASS for Primary Care (COMPASS-PC; Grissom & Howard, 2000) is also a valid and reliable instrument designed for internists and primary care physicians. Within the instrument’s 68 items are three major scales—Current Well- Being (CWB), Current Symptoms (CS), and Current Life Functioning (CLF).Thefour-itemCWB scale includes itemson distress, energy and health, emotional and psychological adjustment, and current life satisfaction. The 40-item CS scale contains at least three symptoms from each of seven diagnoses—depression, anxiety, obsessive-compulsive disorder, adjustment disorder, bipolar disorder, phobia, and substance abuse disorders. The 24-item CLF represents six areas of life functioning—self-management, work-school-homemaker, social and leisure, intimacy, family, and health (Grissom & Howard, 2000). Like the PRIME-MD, the COMPASS-PC can be easily administered over various intervals of treatment. Some of the brief instruments discussed earlier are also appropriate for general medical settings. These include the QPD, SCL-90-R, and the SF-36. Specialty Areas In their review of adaptation to chronic illness and disability, Livneh and Antonak (1997) discuss frequently used general measures of adaptation to illness such as the PAIS (Derogatis et al., 1995). The authors also discuss several unidimensional, general measures of adaptation to disability as well. Numer- ous condition-specific measures have been developed in various medical specialty areas. For example, several measures of adaptation to specific conditions have been developed in oncology (Shapiro et al., 2001), in cardiology (Derogatis & Savitz, 2000), in rehabilitation medicine (Cushman & Scherer, 1995), for AIDS-HIV patients (Derogatis & Savitz, 2000), for sleep disorders (Rozensky et al., 1997), for diabetes (Rubin & Peyrot, 2001), for pain treatment (Cushman & Scherer, 1995), for geriatric patients (Scogin, Rohen, & Bailey, 2000), in emergency medicine (Rozensky et al., 1997), in neurology (Livneh & Antonak, 1997), and in renal dialysis (Derogatis & Savitz, 2000). Examples of these measures are listed in Table 13.4. When considering general measures of adaptation or condition-specific measures, the determination of which to use can be based upon the specific referral question posed to the psychologist. If the referral question involves whether the patient’s psychological distress is significant enough to war- rant clinical intervention, then a general measure of adaptation will be clinically useful and sufficient. However, if the referral Table 13.4 Examples of Illness- or Condition-Specific Measures Used Within Medical Settings Disorder Measure Cancer Cancer Inventory of Problem Situations (CCIPS) Profile of Mood States for Cancer (PMS-C) Mental Adjustment to Cancer Scale Cancer Behavior Inventory (CBI) Rheumatoid Arthritis Impact Measurement Scales arthritis Diabetes mellitus Diabetic Adjustment Scale (DAS) Problem Areas in Diabetes (PAID) Spinal cord Psychosocial Questionnaire for injury Spinal Cord Injured Persons Traumatic brain Glasgow Coma Scale injury Portland Adaptability Inventory Rancho Los Amigos Scale Dentistry Dental Anxiety Scale Pain McGill Pain Questionnaire (MPQ) West Haven-Yale Multidimensional Pain Inventory (WHYMPI) Measure of Overt Pain Behavior Pain Patient Profile (P-3) Future Directions 311 question concerns the quality of a patient’s adjustment to a specific illness at a particular stage of that illness compared with the typical patient with that illness, then a condition- specific measure—if available—may be more meaningful. Quality of life constructs combine normative data from both general and illness-specific populations. Researchers such as Derogatis et al. (1995) support the use of a modular strategy, combining general instruments with modules developed from illness-specific samples. In this way, an illness-specific measure can be used as an additional domain of the general instrument or as a distinct, stand-alone measure. SUMMARY As can be seen from the broad range of topics covered within this chapter, psychological assessment in medical settings is diverse and can in some instances be highly specialized. The individuals practicing in these settings may prefer the professional identity of clinical psychologist, clinical health psychologist, or clinical neuropsychologist. All three of these specialists have a place in performing formal assessments within medical settings, with the latter two being more specialized with regard to particular medical populations and specific medical disorders. With regard to training and employment, medical settings have played an important historical role in the development of psychological assessment and will likely continue to do so in the future. FUTURE DIRECTIONS Future developments in the area of psychological assessment in medical settings will center around such concepts as specificity, brevity, and normative standards for particular medical populations. Assessments will be targeted to address specific outcome and quality-of-life questions rather than general psychological status and will be utilized across large health care systems as well as with specific disease entities. This goal will require more precise development of specific normative standards for specific, well-defined patient groups and subgroups. Because of economic pressures, including the need to see patients for less time and to see a greater number of patients, there will continue to be a pressure on test authors and publishers to create short forms and shorter instruments. As the former trend continues to take place, we must bear in mind the psychometric costs associated with accompanying threats to validity (Smith, McCarthy, & Anderson, 2000). Psychological assessment will become incorporated in cost- utility analysis, as outcomes involving patient adjustment, well-being, and quality of life become more central and quantifiable as part of the economic dimensions of treatment (Kopta, Howard, Lowry, & Beutler, 1994). Brevity, cost- efficiency, minimal intrusiveness, and broader applicability will be salient concepts in the design of future assessment systems (Derogatis et al., 1995). Although it has been recommended for many years that clinician-based judgments yield to actuarial or mechanical judgments (cf. Grove, Zald, Lebow, Snitz, & Nelson, 2000), and without question there has been a useful trend in this di- rection of at least partial reliance on empirically derived decision aids, we do not foresee a time in the near future when clinicians will abrogate their assessment roles completely to actuarial or mechanical methods. This position is not based on philosophical or scientific disagreement with the relevant decision-making literature; rather, it is based on the belief that a sufficient number of appropriate mechanical algorithms will continue to be lacking for years to come (cf. Kleinmuntz, 1990). Computer-administered assessment, as well as planning for treatment and prevention, will likely be an important compo- nent of the future in psychological assessment in medical settings, as has been suggested regarding psychological assessment in general (see the chapter by Butcher in this volume; Butcher, Perry, & Atlis, 2000; Garb, 2000; Snyder, 2000). Maruish (2000) sampled several computerized treatment and prevention programs involving depression, obsessive- compulsive disorders, smoking cessation, and alcohol abuse. Symptom rating scales, screening measures, diagnostic inter- views, and QOL and patient satisfaction scales already have been or can easily be computerized, making administration of these measures efficient and cost-effective. As computer technology advances with interactive voice response (IVR), new opportunities for even more thorough evaluation exist. However, as computer usage and technology develop, so do concerns about patient confidentiality, restricting access to databases, and the integration of assessment findings into effective treatment interventions. Similarly, Rozensky et al. (1997) predicted that there will be less emphasis placed on the diagnosis of psychopathology and more focus on those computerized assessment procedures that directly enhance planning and evaluating treatment strategies. Moreover, as telemedicine or telehealth develops, psychological assessment will need to be an integral part of patient and program evaluation as distance medicine technologies improve continuity of care. Assessment in medical settings will likely continue to become even more specialized in the future. With this trend, more attention will be paid—both within the discipline and by test publishers—to test user qualifications and credentials 312 Psychological Assessment in Medical Settings (cf. Moreland, Eyde, Robertson, Primoff, & Most, 1995). In this same vein, more specific guidelines will be developed to aid in dealing with difficult ethical and legal dilem- mas associated with assessment practices with medical patients, as is already evident within clinical neuropsychology (e.g., Johnson-Greene et al., 1997; Sweet, Grote, & Van Gorp, 2002). Illness and disability necessitate change, resulting in continuous modification in coping and adjustment by the patient, his or her family, and medical personnel (Derogatis et al., 1995). Psychology’s ability to document accurately the patient’s response to disease and treatment-induced change is crucial to achieving an optimal treatment plan. Psychological assessment can be an integral part of the patient’s care system and will continue to contribute crucial information to the patient’s treatment regimen. Carefully planned, programmatic, integrated assessments of the patient’s psychological coping and adjustment will always serve to identify problematic patients as well as those well-adjusted patients who are entering problematic phases of illness and treatment. Assessments that identify taxed or faltering coping responses can signal the need for interventions designed to avert serious adjustment problems, minimize deterioration of well-being, and restore patient QOL. 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ZUKIN 317 CONTEXT OF PSYCHOLOGICAL ASSESSMENTS IN INDUSTRIAL/ORGANIZATIONAL SETTINGS 317 THE NATURE OF ASSESSMENT IN INDUSTRIAL AND ORGANIZATIONAL SETTINGS 318 Purposes 319 Attributes Measured 320 Approaches Used for Assessment in Industry 321 Marketplace and the Business Case 321 PROFESSIONAL AND TECHNICAL CONSIDERATIONS 322 The Role of Assessment Data for Inferences in Organizational Decisions 322 Technical Parameters 323 PURPOSE, FOCUS, AND TOOLS FOR ASSESSMENT IN INDUSTRIAL/ORGANIZATIONAL SETTINGS 325 Purpose of Assessment in Industry 325 Focus of Assessments in Industry 327 Tools 330 MAJOR ISSUES 333 The Business Case 333 Technical Issues 336 Social Policy Issues 338 REFERENCES 339 CONTEXT OF PSYCHOLOGICAL ASSESSMENTS IN INDUSTRIAL/ORGANIZATIONAL SETTINGS Psychologists have been active in the assessment of individuals in work settings for almost a century. In light of the appar- ent success of the applications of psychology to advertising and marketing (Baritz, 1960), it is not surprising that corpo- rate managers were looking for ways that the field could contribute to the solution of other business problems, especially enhancing worker performance and reducing accidents. For example, Terman (1917) was asked to evaluate candidates for municipal positions in California. He used a shortened form of the Stanford-Binet and several other tests and looked for patterns against past salary and occupational level (Austin, Scherbaum, & Mahlman, 2000). Other academic psychologists, notably Walter Dill Scott and Hugo Munsterberg, were also happy to oblige. In this regard, the approaches used and the tools and techniques developed clearly reflected prevailing thinking among researchers of the time. Psychological measurement approaches in industry evolved from procedures used by Fechner and Galton to assess individual differences (Austin et al., 2000). Spearman’s views on generalized intelligence and measurement error had an influence on techniques that ultimately became the basis of the standardized instruments popular in work applications. Similarly, if instincts were an important theoretical construct (e.g., McDougal, 1908), these became the cornerstone for advertising interventions. When the laboratory experimental method was found valuable for theory testing, it was not long before it was adapted to the assessment of job applicants for the position of street railway operators (Munsterberg, 1913). Vocational interest blanks designed for guiding students into careers were adapted to the needs of industry to select people who would fit in. Centers of excellence involving academic faculty consulting with organizations were often encouraged as part of the academic enterprise, most notably one established by Walter Bingham at Carnegie Institute in Pittsburgh (now Carnegie Mellon University). It makes sense, then, that programs such those at as Carnegie, Purdue, and Michigan State University were located in the proximity of large-scale manufacturing enterprises. As will become clear through a reading of this chapter, the legacy of these origins can still be seen in the models and tools of contemporary practitioners (e.g., the heavy emphasis on the assessment for the selection of hourly workers for manufacturing firms). The practice of assessment in work organizations was also profoundly affected by activities and developments during [...]... Viswesvaran, C., & Reiss, A D (19 96) Role of social desirability in personality testing for personnel selection: The red herring Journal of Applied Psychology, 81, 66 0 67 9 Schmidt, F L., & Hunter, J E (1998) The validity and utility of selection methods in personnel psychology: Practical and theoretical implications of 85 years of research findings Psychological Bulletin, 2, 262 –274 Ones, D S., Viswesvaran,... The antecedents and consequences of sexual harassment in organizations: A test of an integrated model Journal of Applied Psychology, 82, 578–589 Gaugler, B B., Rosenthal, D B., Thornton, G C., & Bentson, C (1987) Meta-analysis of assessment center validity Journal of Applied Psychology, 72, 493–511 Ghiselli, E E (19 56) Dimensional problems of criteria Journal of Applied Psychology, 40, 1–4 Gilliland,... ratings of job performance Journal of Applied Psychology, 71, 432–439 Owens, W A., & Schoenfeldt, L F (1979) Toward a classification of persons Journal of Applied Psychology, 65 , 569 60 7 Schmidt, F L., Law, K., Hunter, J E., Rothstein, H R., Pearliman, K., & McDaniel, M (1993) Refinements in validity generalization methods: Implications for the situational specificity hypothesis Journal of Applied Psychology, ... adaptive tests Journal of Educational Measurement, 21, 347– 360 Guion, R M (1980) On trinitarian doctrines of validity Professional Psychology, 11, 385–398 Guion, R M (1998) Assessment, measurement, and prediction for personnel decisions Mahwah, NJ: Erlbaum Guion, R M., & Gottier, R F (1 965 ) Validity of personality measures in personnel selection Personnel Psychology, 18, 135– 164 Halbfinger, D M (1999,... meta-analysis of integrity test validities: Findings and implications for personnel selection and theories of job performance Journal of Applied Psychology, 78, 67 9–703 Organ, D., & Ryan, K (1995) A meta-analytic review of the attitudinal and dispositional predictors of organizational citizenship behavior Personnel Psychology, 48, 775–802 Schmidt, F L., Hunter, J E., & Outerbridge, A N (19 86) The impact of job... psychology (pp 37–83) Washington, DC: American Psychological Association Klimoski, R J., & Zukin, L B (1998) Selection and staffing for team effectiveness In E Sundstrom (Ed.), Supporting work team effectiveness (pp 63 –94) San Francisco: Jossey-Bass Landy, F J (19 76) The validity of the interview in police of cer selection Journal of Applied Psychology, 61 , 193–198 Landy, F J (1989) The psychology of. .. 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History of research methods in industrial and organizational psychology: Measurement, design analysis In S Rogelberg (Ed.), Handbook of research methods in industrial and organizational psychology Malden, MA: Basil Blackwell Baritz, L (1 960 ) The servants of power Middleton, CT: Wesleyan University Press Binning, J F., & Barrett, G V (1989) Validity of personnel decisions: A conceptual analysis of the... based on the work of Otis and others, was itself administered to 1,700,000 individuals Tools and techniques for the assessment of job performance were refined or developed to meet the needs of the military relative to evaluating the impact of training and determining the readiness of officers for promotion After the war, these innovations were diffused into the private sector, often by of cers turned businessmen... explorations and cross-sectional generalizations Journal of Applied Psychology, 84, 14–28 Goldberg, L R (1990) An alternative “description of personality”: The Big Five factor structures Journal of Personality and Social Psychology, 59, 12 16 1229 Goldberg, L R (1992) The development of markers for the BigFive structure Psychological Assessment, 4, 26 42 Goleman, D (1995) Emotional intelligence New York: . Harrell, L. (19 96) . To- ward a neurologic model of competency: Cognitive predictors of capacity to consent in Alzheimer’s disease using three different legal standards. Neurology, 46, 66 6 67 2. Marson,. the assessment of individuals in work settings for almost a century. In light of the appar- ent success of the applications of psychology to advertising and marketing (Baritz, 1 960 ), it is not. use of different cutoff scores for different groups of test takers, or the alteration of employment-related tests based on the demographics of test takers. • Americans with Disabilities Act of

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