Evaluating the Responsiveness to Therapeutic Change with Routine Outcome Monitoring: A Comparison of the Symptom Questionnaire‐48 (SQ‐48) with the Brief Symptom Inventory (BSI) and the Outcome Questionnaire‐45 (OQ‐45)

Abstract

Assessment of psychological distress is important, because it may help to monitor treatment effects and predict treatment outcomes. We previously developed the 48-item Symptom Questionnaire (SQ-48) as a public domain self-report psychological distress instrument and showed good internal consistency as well as good convergent and divergent validity among clinical and non-clinical samples. The present study, conducted among psychiatric outpatients in a routine clinical setting, describes additional psychometric properties of the SQ-48. The primary focus is on responsiveness to therapeutic change, which to date has been rarely examined within psychiatry or clinical psychology. Since a questionnaire should also be stable when no clinically important change occurs, we also examined test-retest reliability within a test-retest design before treatment (n = 43). A pre-treatment/post-treatment design was used for responsiveness to therapeutic change, comparing the SQ-48 with two internationally widely used instruments: the Brief Symptom Inventory (n = 97) and the Outcome Questionnaire-45 (n = 109). The results showed that the SQ-48 has excellent test-retest reliability and good responsiveness to therapeutic change, without significant differences between the questionnaires in terms of responsiveness. In sum, the SQ-48 is a psychometrically sound public domain self-report instrument that can be used for routine outcome monitoring, as a benchmark tool or for research purposes. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message The SQ-48 is developed as a public domain self-report questionnaire, in line with growing efforts to develop clinical instruments that are free of charge. The SQ-48 has excellent test-retest reliability and good responsiveness to therapeutic change or patient progress. There were no significant differences in terms of responsiveness between the SQ-48 and BSI or OQ-45. The SQ-48 can be used as a routine evaluation outcome measure for quality assurance in clinical practice. Providing feedback on patient progress via outcome measures could contribute to the enhancement of treatment outcomes.

Testing for response shift in treatment evaluation of change in self‐reported psychopathology amongst secondary psychiatric care outpatients

“…Consequently, the second assessment was not necessarily the end assessment (possibly interim assessment), nor was it due to meeting treatment goals or patient disengagement. For the purpose of this study, we selected ROM data of outpatients with common mental disorders who had both pre‐post treatment data of SQ‐48 (Carlier et al, ). General criteria to be eligible for ROM are: all psychiatric inpatients and outpatients, who are literate and have sufficient command of the Dutch language, and who are willing and able to complete self‐report instruments.…”

“…Other psychopathology: somatoform disorders (most); personality disorders; bipolar disorders; disorders usually first diagnosed in infancy, childhood or adolescence; adjustment disorders; impulse‐control disorders not elsewhere classified; dissociative disorders; eating disorders; mental disorders due to a general medical condition not elsewhere classified. On the basis of Table S1 of Carlier et al () and adapted for this study.…”

“…All patients were treated by psychiatrists or clinical psychologists/psychotherapists according to the principle of stepped‐care and (inter)national evidence‐based treatment guidelines (e.g., Cuijpers et al, ; Van Fenema, Van Der Wee, Bauer, Witte, & Zitman, ) concerning pharmacotherapy or psychotherapy (mainly cognitive behavioral therapy, CBT) or a combination of both (Van Fenema et al, ; Van Noorden, Van Fenema, van der Wee, Zitman, & Giltay, ). Treatment was not assigned, controlled, or influenced by the research team (Carlier et al, ).…”

“…Other disorders mostly included somatoform disorders (about 14.3%, not in table). The mean interval between pretreatment and post‐treatment assessments was 18.9 weeks ( SD = 7.6) (Table ; Carlier et al, ).…”

Routine Outcome Monitoring in Mental Health Care and Particularly in Addiction Treatment: Evidence-Based Clinical and Research Recommendations

“…Some instruments or questionnaires are designed specifically for ROM, while others are not, but can be used nevertheless. Examples of generic mental health questionnaires designed specifically for ROM are: the Outcome Rating Scale [ORS; 27; see also paragraph "Practical use of ROM in addiction treatment"] and the Session Rating Scale [SRS; 27]; the Outcome Questionniare-45 (OQ-45) and OQ-System [28; see also paragraph "Practical use of ROM in addiction treatment"]; and the licence-free Symptom Questionnaire-48 (SQ-48 [29,30]; for its web-based ROM system [7] 34,35]. Which ROM instrument(s)/system to choose are less important than the fact that ROM basically implies multiple measurements during treatment, and not solely a pre-and a post-treatment measurement.…”