AFFECTIVE-DISORDERS FOLLOWING MILD-TO-MODERATE BRAIN INJURY - INTERPRETIVE HAZARDS OF THE SCL-90-R

This article describes an analysis of the Symptom Checklist-90-Revised (SCL-90-R), a self-report measure of emotional distress, demonstrating potentially misleading scale elevations (ie, psychopathology) in data from 23 patients with mild to moderate traumatic brain injury (initial Glasgow Coma Scale score range = 9-15). Average scores were significantly higher than those for the normative control group on 88 of 90 symptoms, seven of nine individual dimensions, and three summary indices. A considerable portion of these elevations was attributable to endorsement of 14 items (15.5%) identified by experts as ''usual consequences'' of traumatic head injury. The Obsessive-Compulsive, Hostility, and Depression scales were especially weighted with brain injury symptoms. These findings corroborate previous reports concerning the hazards of applying to neurological patients psychological instruments that were normed on physically healthy populations. Scores that would indicate pathological abnormality in the latter group may hold substantially different diagnostic significance for the former group. Clinicians should inspect individual responses to self-report questionnaires and seek confirmation from additional sources.