Validation of the standardised assessment of personality - abbreviated scale in a general population sample

Abstract

BackgroundPersonality disorder (PD) is associated with important health outcomes in the general population. However, the length of diagnostic interviews poses a significant barrier to obtaining large scale, population‐based data on PD. A brief screen for the identification of people at high risk of PD in the general population could be extremely valuable for both clinicians and researchers.AimWe set out to validate the Standardised Assessment of Personality – Abbreviated Scale (SAPAS), in a general population sample, using the Structured Clinical Interviews for DSM‐IV Personality Disorders (SCID‐II) as a gold standard.MethodOne hundred and ten randomly selected, community‐dwelling adults were administered the SAPAS screening interview. The SCID‐II was subsequently administered by a clinical interviewer blind to the initial SAPAS score. Receiver operating characteristic analysis was used to assess the discriminatory performance of the SAPAS, relative to the SCID‐II.ResultsArea under the curve for the SAPAS was 0.70 (95% CI = 0.60 to 0.80; p < 0.001), indicating moderate overall discriminatory accuracy. A cut point score of 4 on the SAPAS correctly classified 58% of participants. At this cut point, the sensitivity and specificity were 0.69 and 0.53 respectively.ConclusionThe SAPAS operates less efficiently as a screen in general population samples and is probably most usefully applied in clinical populations. © 2015 The Authors Personality and Mental Health published by John Wiley & Sons Ltd

Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: A feasibility study

“…Additionally, the data presented show that using the recommended cut‐off score of 4, the SAPAS did not attain the same high PPV as demonstrated within UK and European outpatient psychiatric samples. Whereas a cut‐off score of 4 on the SAPAS yielded a PPV of 0.80 in a Dutch outpatient psychiatric sample, 0.90 in a UK outpatient psychiatric sample and 0.41 in a UK general population sample, in the present sample using the same cut‐off, the PPV was just 0.26. Whilst increasing the cut‐off score beyond 4 did increase the PPV, a large proportion of positive diagnoses identified by a cut‐off of 4 were missed, suggesting that increasing the cut‐off score beyond 4 would not be recommended.…”

“…A cut‐off point of 4 was used to determine which participants should be further evaluated by using the IPDE screening tool. The IPDE was not administered to patients screening below 4 on the SAPAS because prior research had indicated that scores below 4 were likely to have low specificity for detecting PD and because it was not feasible for clinicians to administer the IPDE to all their patients due to the short duration of routine psychiatric outpatient appointments—prompting the need for this study to determine the feasibility of administering the rapid SAPAS screening measure to all outpatients as an alternative. Those who screened positive on the IPDE screening tool then went on to complete the formal IPDE interview with a trained clinician and received a clinical diagnosis.…”

“…The resulting thoughts and experiences can be distressing and may cause significant impairment to social and occupational functioning. At a population level, PD is associated with reduced life expectancy, increased morbidity and worse outcomes of psychiatric disease . Hence, they have complex care requirements, and robust epidemiological data are essential for effective service planning and resource strategies.…”

“…Initial validation in a UK outpatient psychiatric sample found that scores of 3 and above on the interview version of the SAPAS correctly identified the presence of PD in 90% of patients, with a sensitivity and specificity of 0.94 and 0.85 respectively . Subsequent testing in UK and Dutch community samples has suggested that a cut‐off score of 4 provides the optimal balance of sensitivity and specificity . The SAPAS has since demonstrated validity, reliability and clinical utility in patients with substance abuse, patients with depression and forensic patients.…”

Paranoia and risk of personality disorder in the general population

“…It is a short and simple self‐administered screening interview valid to identify highly probable cases of PD. The SAPAS derives from a previously published longer interview known as the Standardized Assessment of Personality and was originally validated on a clinical sample by Paul Moran (2003) and subsequently validated for the general population . The SAPAS consists of eight dichotomously rated items.…”