Instructions
to patient: “I am going to ask you a series of questions
about your thoughts, feelings, and activities. Base your answers
on the last 4 weeks. To begin, tell me about your current interests.
Tell me about anything that is of interest to you. For example,
hobbies or work; activities you are involved in or that you would
like to do; interest within the home or outside; with otheer people
or alone; interests that you may be unable to pursue, but which
are of interest to you—for example, swimming even though
it’s winter.”
Intervieweer
then notes: (1) Number of interests reported; (2) degree of detail
reported for each interest; (3) affective aspects of expression
(verbal and nonverbal).
Interviewer then states: “Now I’d like you to tell
me about your average day. Start from the time you wake up and
go to the time you go to sleep.” How the patient deals with
this (and all other) questions is assumed to provide information
about how other activities are dealt with (e.g., with initiative,
exuberance, and energy). Therefore, prompting is indicated only
if the subject seems not to understand what information is being
sought or has forgotten the question.
Interviewer
notes number of activities, degree of detail, intensity and duration
of involvement, and affect associated with presentation of data.
Each
item is now presented using the wording of the item itself. Additional
information may be requested to clarify responses. Item 15, “Accurate
understanding of problems,” is rated by appraising subject’s
awareness and understanding of personal or, if present, clinical
problems. Simple bridges between items may be used to preserve
a conversational quality to the interview. Items are rated as
they are presented using all information acquired. The response
recorded is the clinician’s assessment of the subject’s
response. Thus, if a subject states “a lot” but the
clinician judges “somewhat,” the latter is used. The
only exceptions are the self-evaluation (SE) items in [the interview]
(#3, #8, #13, #16). For these items, the subject specifies which
response code to use (e.g., Not at All, Slightly); the clinician
rater’s appraisal is not considered for SE items.
All
items are coded as follows:
1. Not at all characteristic.
2. Slightly characteristic (trivial, questionable, minimal).
3. Somewhat characteristic (moderate, definite).
4. Very characteristic (a great deal, strongly). Requires verbal
or nonverbal evidence of intensity.
Note: Very characteristic is the level obtained by normal individuals.
The
criteria for applying these codes are quantified for several items
(#1, #2, #4, #5, #12). These quantifiable items (labeled Q in
[the rating scale]) are rated by counting the number of instances
cited by the subject for a particular item (e.g., number of interests,
number of friends):
1. Not at all: 0 items
2. Slightly: 1-2 items
3. Somewhat: 2-3 items
4. Very: 3 or more
When
there is difficulty in choosing between ratings, the following
guidelines are used:
1. In general, rate toward the more apathetic score.
2. Consider the degree of differentiation of responses. For example,
rate “Interest in things” as Slightly if a subject
simply specifies “reading and television” as interest,
but Somewhat if specific books or television programs can be specified.
Similarly, if a subject is interested “only” in reading,
but provides multiple examples of reading materias, rate Somewhat
or Very, based on the number of examples given.
3. Consider the presence of verbal and nonberbal evidence of affect.
For example, rate toward lower apathy if subject uses phrases
such as “very much” or “tremendously,”
or uses facial expression, gesture, or vocal intonation to suggest
affect.
4. If still in doubt, ask the patient whether, for example, “Somewhat”
or “Very” is the more appropriate descriptor. (Marin,
1991)
A project funded by the National Institute on Disability
and Rehabilitation Research.