Abstracts
3. Psychiatric Disorders in 620 Referrals to the
Memorial Sloan-Kettering Counseling Center
J. Almanza, MD; J.C. Holland, MD, FAPM; W.S.
Breitbart, MD, FAPM
T here have been few studies of the comorbid psychiatric
disorders in ambulatory patients with cancer referred
to a psychiatric clinic for evaluation and treatment. The Me-
morial Counseling Center, open since May 1996, provided
the opportunity for addressing this problem. This study ex-
amined the overall prevalence of psychiatric disorders in
consecutive individuals referred to the Counseling Center
in the first 6 months of 1997, assessing the specific disorders
and their relationship to medical and demographic variables.
Six hundred twenty cases were retrospectively studied by
chart review: 506 (82%) had cancer, 95 (15%) had no can-
cer, and 19 (3%) did not keep their appointment. Of the 95
cases that had no cancer, 42 (6.8%) were relatives of cancer
patients, 20 (3.2%) were patients with AIDS, 19 (3%) were
patients referred for pain management, and 14 (2%) at-
tended the smoking cessation program. Six attending psy-
chiatrists and four clinical fellows using DSM-IV criteria
evaluated patients. Referrals were largely from the medical
and surgical staff of Memorial. Results showed that the
mean age was 51 year old; 55% were women; 45% were
married; 89% were white; 98% of patients received one or
more DSM-IV Axis I diagnoses: mood disorder (53%), ad-
justment disorder (46%), anxiety disorder (27%), more than
one Axis I diagnosis (42%). Axis II diagnoses were per-
sonality disorder in 16% (primarily obsessive compulsive,
dependent, and borderline). The five most frequent cancer
sites were lung (10%), leukemia (9%), breast (8%), prostate
(7%), and colon/rectum (7%). Pain was present in 34%.
Psychotropic drugs were prescribed in 394 (64%); psycho-
therapy was conducted with 500 individuals (80%); 319
(51.4%) patients received both. In 67%, therapy was con-
ducted over six or more sessions. The Clinician’s Global
Impression Score showed improvement in 55%. In sum-
mary, patients with cancer and their family members re-
ferred to the counseling center of a major cancer research
center showed primarily mood and adjustment disorders.
Concurrent psychotherapy and/or pharmacotherapy led to
improvement in 55% of patients.
4. Spanish Version of the Systems of Belief Inventory
(SBI-15-R): Cross Cultural Research on Spiritual and
Religious Beliefs
J. Almanza, MD; M. Monroy, RN; A. Bimbela, PhD;
D.K. Payne, PhD; J.C. Holland, MD, FAPM
T he System of Belief Inventory (SBI-15-R) was de-
signed to measure religious/spiritual beliefs, practices,
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and social support. Although the English version of the
SBI-15-R scale has been validated in both English and He-
brew, the psychometric properties of the Spanish version
of the SBI-15-R have not been demonstrated. This inves-
tigation was designed to examine the psychometric prop-
erties of the Spanish version of the SBI-15-R. Method:
Transcultural Adaptation: Two bilingual clinicians inde-
pendently performed a forward and backward Spanish
translation of the SBI-15-R. Two items (13.3%) were con-
sidered equivalent in both meaning and word selection; six
items (40%) were equivalent in meaning but not in word
selection; a total of seven items (46.6%) required further
discussion and revision until consensus was reached. Data
Collection: A total of 83 subjects at a general hospital in
Mexico City completed the SBI-15-R: orthopedic patients,
52 (63%); healthy nonpatient relatives, 11 (13%); and
medical staff, 20 (24%). The mean age was 37.6 years; 50
(60.2%) were male, 33 (39.8%) were female; 82 (98%)
were Mexican; 50 (60.2%) were married; 78 (94%) were
Catholic; 23 (27.7%) completed primary education; and 29
(34.9%) worked for the military. The inventory was well
accepted by patients and required 15–20 minutes for com-
pletion. Preliminary Validation: The Mexico scale sample
mean (M⳱34.28) was greater than the U.S. sample mean
(M⳱20.94) though similar to the U.S. religious group
mean (M⳱34.16). Composite scale means for each Mex-
ico group were as follows: patients (M⳱35.44), healthy
nonpatient relatives (M⳱34.8), and staff (M⳱29.3). The
total scale Cronbach alpha was 0.89 and the standardized
Cronbach alpha was 0.90. Composite scale Cronbach al-
phas for each subsample were as follows: patients
(␣⳱0.85), healthy nonpatient relatives (␣⳱0.91), and
staff (␣⳱0.92). Cronbach alpha for the subscale of beliefs
and practices was 0.85 and was 0.81 for the subscale of
social support. A principal component analysis with Vari-
max rotation of the SBI-15-R identified three factors, in
contrast to the two factors found when patients in the
United States completed the English version. The single
U.S. sample belief and practice construct was divided into
1) general spiritual beliefs and practices and 2) beliefs spe-
cific to coping with adversity. Discussion: This prelimi-
nary report produced mixed findings. Although the Spanish
version produced high internal consistency between the
two factors previously found in the United States, the Span-
ish version resulted in three factors. Religious and spiritual
beliefs in Mexico may be more specifically defined than in
the U.S. sample.
Psychosomatics 41:2, March-April 2000