Article 4

Abstract

Objectives: To validate the Cumulative Head Injury Scale (CHIS), which is designed to assess the lifetime accumulation of head trauma, and to assess the relationship between head trauma and clinical outcome in psychiatric inpatients. Design: Prospective, descriptive study. Setting: Short-term psychiatric inpatient unit. Participants: 142 psychiatric inpatients prospectively enrolled. Interventions: We administered a 10-item scale that addressed prior episodes of head trauma. Main Outcome Measures: Multiple regression analysis of the Behavior and Symptom Identification Scale (BASIS-32) at discharge, regressed on the BASIS-32 at admission, psychiatric diagnosis, and 3 factor scores computed from a factor analysis of the CHIS. Results: The instrument was segregated into 3 distinct factors, accounting for 75% of the variance: repetitive injuries without altered consciousness (RWO), discrete injuries (DI), and repetitive injuries with altered consciousness (RWA). The DI factor predicted clinical outcome at discharge on the BASIS-32 (P=.0171), after accounting for admission BASIS-32 scores and diagnosis. The RWO factor was significantly related to subject sex (P=.0133), with men scoring higher. The RWA factor was associated with diagnosis (P=.0092), with persons with schizophrenia and bipolar disorders scoring higher. Conclusions: The CHIS demonstrated preliminary validity in assessing the lifetime accumulation of head trauma in a psychiatric inpatient population.