Idiographic instruments

As noted earlier, idiographic instruments have a standard structure, but a content that is tailored to the requirements of a particular study or individual. They are not used to assess depression exclusively, but they have been used sufficiently often in depression to warrant their inclusion in this chapter.

GOAL-ATTAINMENT SCALE (GAS)

The GAS was designed to assess how far goals have been achieved, on a five-point scale. Typically, the scores range from +2 to -2, with 0 as the expected level of attainment. At least two points, preferably more, should be behaviourally 'anchored' by descriptors. For example, the expected goal may be 'spends at least 6 hours out of bed'; +2 could be 'gets up regularly before 8 a.m. and remains up'; +1 could be 'spends most of the day out of bed'; -1 could be 'gets up for occasional meals'; -2 could be 'spends nearly all the time in bed'. The method was originally devised to monitor broad treatment strategies and intervention programmes (Kiresuk & Sherman, 1968), but is now often used to assess individual progress.

VISUAL ANALOGUE SCALE (VAS)

This consists of a 10-cm line with bipolar adjectives at each end. Subjects are asked to put a cross anywhere on the line that best describes how they are feeling in terms of the adjectives. Scoring is simply the distance from the end of the line to the point of endorsement. It has long been used to measure aspects of mood (Zealley & Aitken, 1969). It is particularly useful when there are no standard scales available to measure a particular construct, or to rate a concept on many different dimensions but with the same format. It is quick to complete and to score. When administered longitudinally, VAS ratings are moderately correlated with questionnaire scores of mental state, but only in about 60% of subjects (Morrison & Peck, 1990).

SEMANTIC DIFFERENTIAL (SD)

As its name implies, the SD was originally devised to measure the meanings of particular concepts across different individuals (Osgood et al., 1957). It consists of a concept to be rated above a line divided into seven boxes. Subjects are asked to put a cross in the box that most accurately reflects their view or interpretation of the concept. The concepts can be rated on any number of bipolar scales. It could be regarded as a special form of the VAS.

PERSONAL QUESTIONNAIRE RAPID SCORING TECHNIQUE (PQRST)

This ingenious method requires subjects to state their problems (up to 10) in their own words, and to rate them from 'maximum possible' to 'absolutely none' in a series of paired comparisons. It is particularly useful for detailed analyses of an individual's problems, and for tracking them over time. Versions of different lengths are available. A key reference is Mulhall (1976); it has been used in a number of clinical areas—for example, to analyse change in different forms of psychotherapy (Barkham et al., 1989).

CORRELATIONS BETWEEN RATING SCALES

Correlations between observer- and self-completed scales were investigated by Sayer et al. (1993); the correlations between the HDRS and the BDI varied between +0.16 and +0.73 (that is, low to high). The reported low correlations may reflect the use of a restricted range of severity in the participating subjects; thus, Fitzgibbon et al. (1988) found moderate correlations in samples with restricted scores (for example, r = +0.43 in medical patients), but higher correlations when samples were wider and included depressed patients, medical patients and healthy volunteers (r = +0.89). The finding of a high correlation may give a misleading impression of the degree of agreement between instruments; patients categorised as mild on one measure may be judged as severe on other measures (Enns et al., 2000).

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Letting Go, Moving On

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