Construct Validity of the Schwartz Outcome Scale Validation Using a 28-Day Inpatient Chemical Rehabilitation Patient Sample Greg Haggerty, PhD, Kambiz Aflatoon, DO, Krishnendu Ghosh, MD, Ronke Babalola, MD, Zain Ahmed, BS, and Alyson Alois, MA Abstract: The Schwartz Outcome ScaleY10 (SOS-10) is a 10-item self-report that measures quality of life and psychological well-being. It is easy to ad- minister and score, and past research has revealed its utility, validity, and reliability with different samples (i.e., clinical and nonclinical) and in different clinical settings (i.e., inpatient, outpatient, nonpsychiatry medical settings). The present study looks to investigate the utility of the SOS-10 in measuring psychological well-being and quality of life with the 28-day inpatient chemical dependency sample. In addition, the current study looks to investigate its ability to be used as a treatment outcome measure for chemical-dependent inpatients. The results revealed that the SOS-10 was associated with aspects of interpersonal dependency and alexithymia in predicted ways. The SOS-10 was positively associated to ‘‘Healthy Dependence’’ and negatively related to alexithymia and ‘‘DestructiveOverdependence’’ and ‘‘Dysfunctional Detach- ment.’’ The results also showed that the SOS-10showed healthy change from admission to discharge and that this change was paralleled by healthy change in interpersonal dependency and alexithymia. Key Words: Quality of life, psychological well-being, interpersonal dependency, alexithymia, treatment outcome. (J Nerv Ment Dis 2012;200: 343Y348) T he Schwartz Outcome Scale-10 (SOS-10; Blais et al., 1999) has been used as a general outcome measure to assess treatment re- sponse across multiple treatment settings and modalities (i.e., psy- chotherapy, electroconvulsive therapy, psychopharmacology) and patient populations (i.e., inpatient, outpatient, emergency department, acute psychiatry units). The SOS-10 was developed as a product of a literature review, an expert panel from several different mental health domains (i.e., psychology, psychiatry, neurosurgery) and focus groups of patients. This original process produced 81 items sensitive to measuring the change people might experience as a result of successful treatment. The items were administered to patients in several different settings (i.e., outpatient psychotherapy clinic, psychopharmacology clinic, an acute inpatient psychiatric unit, and a nonpatient sample of hospital employees). The analyses of the findings reduced the SOS-10 to its present 10 optimal items. The final version of the SOS-10 asks the respondent to rate the 10 items pertaining to their life and well-being based on how they have been feeling during the past 7 days (Blais et al., 1999; p. 372). The items of the SOS-10 are scored from 0 (never) to 6 (all of the time or nearly all of the time). The measure produces a total score where high scores are reflective of better functioning, more life satisfaction, and higher levels of well-being. Psychometric analysis has found that the SOS-10 has strong internal consistency (Cronbach alpha = 0.96), with item-scale correlations ranging from 0.74 to 0.90. Total scores from the SOS-10 have demonstrated that it is associated with scores for measures of mental health, fatigue, life satisfaction, desire to live, positive and negative affect, self-esteem, hopelessness, alex- ithymia, five-factor model, interpersonal dependency, and mental health, demonstrating the construct validity of this measure (Blais et al., 1999; Dragomirecka et al., 2006; Haggerty et al., 2010a, b; Laux and Ahern, 2003; Rivas-Vasquez et al., 2001; Young et al., 2003). Studies have shown that the SOS-10 is well-suited for mea- suring psychological health and well-being in a number of diverse settings and with diverse patient populations (Dragomirecka et al., 2006; Rivas-Vasquez et al., 2001; Young et al., 2003). Its psycho- metric properties make it appealing for use in research as well because it is versatile and quick and easy to administer and score. The SOS-10 has illustrated good test-retest correlations, Cronbach alphas higher than 0.85, and construct validity with a variety of clinical and psy- chological well-being measures and discriminates between clinical and nonclinical samples (Baity et al., 2009; Blais et al., 1999; Haggerty et al., 2010a, b; Hilsenroth et al., 2001; Owens and Imel, 2009; Young et al., 2003). The present study examines the construct validity of the SOS-10 using a 28-day chemical rehabilitation inpa- tient sample and investigates the associations between it and various indicators that have been linked to psychological health and well- being. The SOS-10’s use has been broadened and increased since its development. The measure has been translated into Spanish (Rivas- Vazquez et al., 2001) and Czech (Dragomirecka et al., 2006) and has demonstrated good psychometric properties. The utility of the mea- sure has been extended outside of the psychiatry population to more normative samples including college undergraduates (Haggerty et al., 2010a; Young et al., 2003). Although the SOS-10 has been well established and validated as a measure of general well-being and life satisfaction in patient populations, it is important to demonstrate its applicability to newer populations. It is important to demonstrate its usefulness in assessing outcome on an inpatient substance use sample as well. This would further broaden its use and also allow for future comparisons be- tween different populations (i.e., normative, psychiatric outpatient, psychiatric inpatient, and substance use services). The present study examines associations between the SOS-10 and measures of alex- ithymia and interpersonal dependency. We also look to see wheth- er change on the SOS-10 is associated with comparable change on alexithymia and interpersonal dependency because these two con- structs have been shown to be related to psychological health and well-being in different nonclinical and clinical populations (Haggerty et al., 2010a, b). Alexithymia The term alexithymia literally translates to ‘‘lack of words for feelings’’ and was used to describe patients with psychosomatic dis- orders who showed difficulty taking part in insight-oriented therapy (Sifneos, 1967). These patients seemed to demonstrate issues with emotional awareness and communication as well as showing deficits with regard to insight into their emotions, symptoms and motivations (Lumley et al., 2007). Alexithymia was originally thought of as ORIGINAL ARTICLE The Journal of Nervous and Mental Disease & Volume 200, Number 4, April 2012 www.jonmd.com 343 Department of Psychiatry and Behavioral Sciences, Von Tauber Institute for Global Psychiatry, Nassau University Medical Center, East Meadow, NY. Send reprint requests to Greg Haggerty, PhD, 320 1st Avenue, Massapequa Park, NY 11762. E-mail: Ghag541@aol.com. Copyright * 2012 by Lippincott Williams & Wilkins ISSN: 0022-3018/12/2004-0343 DOI: 10.1097/NMD.0b013e31824cc210 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.