Psychometrics of the SCL-90-R and Development and Testing of Brief Versions SCL-45 and SCL-9 in Infertile Couples

Abstract

Background Although infertile couples are mentally healthy, dealing with infertility and assisted reproductive technology (ART) treatment is usually associated with psychological distress. It would therefore be useful to have short, multidimensional instruments to be able to identify people who present more intense emotional reactions and follow up their emotional distress throughout the ART. Objectives The goals of the study were to analyze the psychometric adequacy of the original 90-item version of the Symptom Checklist (SCL-90) in a sample of Spanish women and their partners undergoing ART, as well as to develop and analyze two brief versions of the SCL-90, given the absence of adequate short versions for this population. Methods A cross-sectional design for patients and their partners in the process of ART through in vitro fertilization was used. The two brief scales were obtained, which took into account the levels of variance explained by the items and confirmatory factor analysis. Results Two brief instruments were developed. The first, with 45 items (SCL-45-I Infertility), includes nine subdimensions: Somatization, Interpersonal Sensitivity, Obsessive-Compulsive Disorder, Depression, Anxiety, Hostility, Paranoid Ideation, Phobic Anxiety, and Psychoticism. The second instrument contains nine items (SCL-9-I or Global Severity Index [GSI]), one item for each dimension. Both instruments were psychometrically adequate (SCL-45-I: χ2/df = 7.24, RMSEA = .057, 95% CI [.056, .059], CFI = .97, NNFI = .97, SRMR = .049; SCL-9-I: χ2/df = 9.66, RMSEA = .068, 95% CI [.061, .076], CFI = .97, NNFI = .96, SRMR = .035). Measurement invariance analysis by gender was conducted, and the instruments were shown to be suitable for both men and women. Discussion The suitability of the SCL-90-R for use in ART was verified, and two valid instruments—useful and easy to use for nurses, psychologists, and other care providers—were developed.

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“…In this study, psychological symptoms were measured on the scales of somatization, interpersonal sensitivity, obsessive–compulsive disorder, depression, anxiety, and hostility using SCL-90-R by one researcher. This checklist was set based on a 5-point Likert scale (0–4) ranging from none (0) to too much (4), and the higher the score, the more psychological symptoms would be 30 . The participants' psychological symptoms scores were measured in both groups before the intervention and one and three months later.…”

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“…Three scales were used to assess the psychological health status and coping styles of participants. The Symptom Checklist-30 scale (SCL-30) [ 13 ] and the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) [ 14 ] were used to evaluate the emotional response and cognitive response. The Simplified Coping Style Questionnaire (SCSQ) [ 15 ] was used to evaluate behavioral coping.…”

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“…However, among the vast number of short versions, only the SCL-K-9 and the SCL-9-I have been explicitly developed to measure a unidimensional general distress factor. Based on confirmatory factor analysis, both SCL-K-9 and SCL-9-I show marginal support for unidimensionality [10,18].…”

“…the item total correlation, of the SCL-90-R (e.g. SCL-K-9 [17], SCL-9-I [18]). However, among the vast number of short versions, only the SCL-K-9 and the SCL-9-I have been explicitly developed to measure a unidimensional general distress factor.…”