A Meta‐Analysis of the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity

Abstract

The present study examined the relationship between the Rorschach Ego Impairment Index (EII) and psychiatric severity. Search procedures yielded 13 independent samples (total N = 1402, average n = 108, standard deviation = 90) for inclusion in the meta-analysis. Inter-rater reliability analyses demonstrated that coding of effect sizes and moderator variables was completed with good to excellent reliability. Results indicated that higher EII scores were associated with greater psychiatric severity, with an overall weighted effect size of r = 0.29, p = 0.000002 (95% confidence interval = 0.17-0.40), supporting the EII's validity as a measure of psychological impairment. Publication bias analyses did not indicate any significant cause for concern regarding the results. The data were demonstrably heterogeneous (Q = 56.82, p = 0.0000001), and results of post-hoc tests indicated that effect sizes with dependent variables obtained via researcher ratings were significantly larger than any of the following: effect sizes with dependent variables obtained via clinician ratings, informant ratings, information about level of treatment or placement status or self-report ratings (p's = 0.0005, 0.003, <0.001, <0.001, respectively). In addition, there was a trend for effect sizes based on performance-based measures to be larger than those based on information about level of treatment or placement status (p = 0.098) as well as those based on self-report measures (p = 0.076). Other moderator analyses were non-significant (p 's > 0.10). Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • The Rorschach Ego Impairment Index (EII) demonstrated validity in measuring psychiatric severity across a range of normative, outpatient, residential, and inpatient samples. • The degree of the EII's validity in assessing psychiatric severity compared favorably to the overall validity of the Rorschach and the MMPI. • The EII appears to be most valid in capturing psychiatric severity as measured by researcher ratings of social competency or estimated ego impairment.

The validity of individual Rorschach variables: Systematic reviews and meta-analyses of the comprehensive system.

“…In this regard, our results are consistent with those of other Rorschach meta-analyses (Diener et al, 2011;Hiller et al, 1999;Meyer & Handler, 1997) and with psychological assessment validity meta-analyses more generally. For example, based on data from Spangler's (1992) meta-analysis, reported that achievement behaviors (e.g., job performance, income eamed) were more strongly predicted by the achievement motive as assessed implicitly by story narratives (r = .22, k = 82) than when assessed introspectively by self-report (r = .15, it = 104).…”

Associations between the Rorschach Ego Impairment Index and Measures on Intrapsychic and Interpersonal Functioning

“…Similarly, Diener et al [8] observed a stronger association between the EII score and psychiatric severity assessed by researcher ratings (e.g., diagnosis-based rating of ego impairment), with weighted effect size of r = 0.45, p < 0.001, but a weaker association between the EII and psychiatric severity assessed by self-report ratings, with weighted effect size of r = 0.10, p = 0.07. More broadly, RCS scores in general have been observed to correlate more closely with externally assessed criteria (e.g., observer ratings and diagnoses) (r = 0.27) than with self-reported ratings (r = 0.08) [41].…”

“…Previous studies have demonstrated the ability of the EII-2 to reflect the continuum of psychiatric severity [8] and to distinguish between patient groups representing a diverse range of impairment, e.g., inpatients vs. outpatients [9] and patients with psychotic disorder vs. non-patients [10].…”

Invited Commentary: Applying Psychodynamic Developmental Assessment to Explore Mental Functioning in Adolescents

“…The Comprehensive System (CS; Exner 1974Exner , 2003 provides clinicians with a well-validated and reliable cross-cultural method for scoring and interpreting the Rorschach. Different studies, some of them based on metaanalysis, have confirmed the reliability and validity of Rorschach findings (Society for Personality Assessment 2005), particularly those derived from composite indices (Diener et al 2011;Meyer 2000;Porcelli and Mihura 2010;Viglione 1999;Viglione and Meyer 2008). Empirical research and analyses of case studies that focus on youngsters provide similar evidence for the utility of the Rorschach in predicting psychopathological manifestations, psychiatric severity and treatment outcomes in children and adolescents (Erdberg 2007;Exner and Weiner 1995;Smith et al 2001;Tibon and Rothschild 2007;Viglione 1990).…”