Standard clinical significance classifications are based on movement between the "dysfunctional" and "functional" distributions; however, this dichotomy ignores heterogeneity within the "dysfunctional" population. Based on the methodology described by Tingey, Lambert, Burlingame, and Hansen (1996), the present study sought to present a 3-distribution clinical significance model for the 21-item version of the Depression Anxiety Stress Scales (DASS-21; P. F. Lovibond & Lovibond, 1995) using data from a normative sample (n = 2,914), an outpatient sample (n = 1,000), and an inpatient sample (n = 3,964). DASS-21 scores were collected at pre- and post-treatment for both clinical samples, and patients were classified into 1 of 5 categories based on whether they had made a reliable change and whether they had moved into a different functional range. Evidence supported the validity of the 3-distribution model for the DASS-21, since inpatients who were classified as making a clinically significant change showed lower symptom severity, higher perceived quality of life, and higher clinician-rated functioning than those who did not make a clinically significant change. Importantly, results suggest that the new category of recovering is an intermediate point between recovered and making no clinically significant change. Inpatients and outpatients have different treatment goals and therefore use of the concept of clinical significance needs to acknowledge differences in what constitutes a meaningful change.

The interpersonal theory of suicide proposes that acquired capability facilitates transformation of suicidal desire into lethal self-destructive behavior (Joiner, 2005). A new measure, the Acquired Capability With Rehearsal for Suicide Scale (ACWRSS), was devised to capture the key facets of acquired capability-pain tolerance and fearlessness of death-while also incorporating deliberate and active means to increase preparedness for suicide. The factor structure of the ACWRSS was tested using confirmatory factor analysis (n = 611). The 7-item ACWRSS conformed to the hypothesized 3-factor structure, demonstrating excellent fit and good internal consistency (α = .83). Measurement invariance across gender was also demonstrated on configural, metric, and scalar levels. Next, in the first longitudinal study of the association between acquired capability and suicide ideation, intention, and readiness (n = 234), the acquired capability facets prospectively predicted specific phases in the motivational-volitional pathway toward suicide readiness. Moreover, 2 of the acquired capability components mediated the relationship between baseline nonsuicidal self-injury and suicide readiness at follow-up. In an inpatient psychiatric sample (n = 108), the ACWRSS was significantly correlated with prior suicide attempts and thoughts and episodes of nonsuicidal self-injury, and its facets demonstrated differential sensitivity to change. The ACWRSS is the first measure of acquired capability that reliably and validly captures all key facets of this critical component of the interpersonal theory of suicide. Its brevity enhances its utility for both research and clinical settings. (PsycINFO Database Record

Objective: This study reports on data collected from the routine use of the Health of the Nation Outcome Scales (HoNOS) and the Medical Outcomes Short Form (SF-36). Three main aims were addressed in using these measures: (i) to establish patient disability levels; (ii) to determine the level of treatment effectiveness; and (iii) to explore the ability of these instruments to predict length of stay and mood change. Method: The clinician-rate HoNOS and the patient-rated SF-36 were included in the assessment battery, at admission and discharge, of consecutive inpatients (n = 754) at one private psychiatric facility over a 2-year period. Results: The sample, on admission, was comparable in illness severity to levels reported at other Australian private psychiatric facilities. Treatment was shown to be effective, and the degree of changes in HoNOS ratings compared favourably with other private psychiatric facilities. Certain factors underlying the structure of the HoNOS and the SF-36 only weakly predicted length of stay and changes in depression and anxiety levels. Conclusion: The HoNOS and the SF-36 provided valid and reliable data on patient function, with the HoNOS being most sensitive to treatment change. However, neither instrument proved useful in predicting length of stay or levels of depression and anxiety at discharge.