Schwartz Outcome Scale-10

Instructions: Please respond to each statement by circling the number that best fits how you have generally felt
over the last 7 days. There are no right or wrong responses. Often the first answer that comes to mind is best.

1. Given my current physical condition, I am satisfied with what I can do.

0 1 2 3 4 5 6
Never All or nearly
all of the
time
2. I have confidence in my ability to sustain important relationships.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
3. I feel hopeful about my future.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
4. I am often interested and excited about things in my life
0 1 2 3 4 5 6
Never All or nearly
all of the
time
5. I am able to have fun.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
6. I am generally satisfied with my psychological health.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
7. I am able to forgive myself for my failures.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
8. My life is progressing according to my expectations.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
9. I am able to handle conflicts with others.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
10. I have peace of mind.
0 1 2 3 4 5 6
Never All or nearly
all of the
time
 INSTRUMENTS

The Schwartz Outcome Scale – 10©: KEYWORDS

SOS-10 QUESTIONNAIRE, PSYCHOMETRIC
A Brief Measure of Psychological Well-Being VALIDATION, SCHWARTZ OUTCOME SCALE -10,
PSYCHOLOGICAL WELL-BEING, TREATMENT
Matthew R. Baity, Ph.D., Kendra Kehl-Fie, BA, OUTCOME, BRIEF OUTCOME SCALES, HEALTH-
REALTED QUALITY OF LIFE (HRQL),
Mark A. Blais, Psy.D. INTERPRETATION
Massachusetts General Hospital and Harvard Medical School, Boston, MA, U.S.A.

expect to improve with successful

Abstract treatment?” These interviews were
The current article presents information on a brief 10-item measure of well-being called the analyzed for convergent themes and the
resulting thematic material was used to
Schwartz Outcome Scale – 10 (SOS-10). Rationale and procedures for test development
generate the initial SOS-10 item pool. Using
are introduced, as well as the presentation of multisite research data supporting the both rational and empirical methods, the
psychometric characteristics of this test. Interpretation of the SOS-10 is based on a number of items was reduced to 201 (see
normative database from over 9000 clinical and nonclinical participants. The low burden Blais, et al., 1999 for a detailed description
of the SOS-10 and its demonstrated relationship to a range of relevant treatment variables of the complete test development process).
make it an ideal measure to help assess outcome in any treatment program. A one parameter Rasch model was
employed to reduce the scale to its final
length of 10 items while retaining all the
The Schwartz Outcome asks patients to rate how well they are
positive characteristics of the 20-item
Scale – 10©: A brief currently handling a series of important
scale. Rasch difficulty (logit) scores were
measure of psychological psychological and life challenges. The
used to position items on the scale, with the
well-being primary use of the SOS-10 is to monitor
items being ordered from the easiest
The terms “treatment outcome” and change in a patient’s psychological health
(item 1) to the hardest (item 10) to endorse.
“patient reported outcomes” have become over the course of treatment. Additionally,
The SOS-10 is suitable for individuals ages
increasingly present in today’s world of baseline SOS-10 measures can be used to
17 and up, and asks patients to rate how
health services, including both medical and grossly classify a patient’s level of distress
they have been doing over the last week.
mental health fields. Although these areas that may, in turn, have implications for both
are not new ideas, they are carrying greater the level of care and intensity of service a
The ten items are scored on a scale from 0
weight as insurance companies and patient may need.
(Never) to 6 (All or nearly all the time), and
government regulators have begun to scoring consists of simply adding the
mandate the tracking of patients’ Test Development, Administration, and numerical ratings for each item to create a
treatments and improvements. The current Scoring total score. SOS-10 scores range from 0 to
article provides information about a unique The SOS-10 was developed through a 60 with higher scores representing greater
outcome measure that has been developed sophisticated multiphase process that psychological well-being and lower scores
at Massachusetts General Hospital called combined expert content generation, indicating the patient is acknowledging
the Schwartz Outcome Scale-101. The SOS- patient focus groups, classical test theory emotional distress and poorer psychological
10 has been shown to have excellent procedures, and item response analysis. health. We recommend asking patients to
psychometric properties, a growing The contents for the SOS items were complete the scale prior to the beginning of a
normative database, and impressive validity derived from interviews with senior treatment appointment as patient ratings
in a range of clinical settings. In addition, the members of the Department of Psychiatry might be positively or negatively influenced
SOS-10 has been formally translated into at MGH and patient focus groups. The by their affective state immediately following
several other languages while retaining its participants in these interviews were a treatment session. The added benefit of this
psychometric properties 2,3. asked, “What aspects of life would you procedure is that the clinician can quickly
determine whether the SOS-10 is valid
The SOS-10 is a treatment outcome and
program evaluation tool designed to
measure psychological health and well- Table 1.
being. Psychological health is conceived of Interpretive Database Group Means and Standard Deviations (SD)
as an overarching construct that & Separation
encompasses life satisfaction, inter-
personal effectiveness, positive self- Effect Size (d) relative
Group N Mean SD
appraisal, optimism, and the absence of to the non-patient group
psychiatric symptoms. The SOS-10 was Non-patients 2336 45.3 9.3
specifically developed to have very low Outpatients 1598 33.3* 12.8 1.11
burden on patients and clinicians, as well Inpatients 5119 25.6* 14.8 1.48
as to be especially sensitive to treatment- All patients 6717 29.5# 13.8 1.24
Total 9053 32.0 15.6
induced changes across a wide range of
therapeutic interventions. The SOS-10 is Note. *The mean SOS-10 scores for these groups are significantly different (p<.001) from the nonclinical
unique among mental health outcome group
measures in that it does not focus on # The mean SOS-10 score for combined patient group is significantly lower than the non-patient mean
(p < .001).
specific symptoms or disorders but rather
d = Cohen’s4 effect measure. All values are in the large range (<.80).

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 INSTRUMENTS
The Schwartz Outcome Scale – 10©: A Brief
Measure of Psychological Well-Being

(scores of 0 or 60 suggest a biased response patient or group is considered unlikely due Psychometric Research with the SOS-10
set and are considered invalid), and get a to chance alone, thus suggesting the
A number of published studies have
total score before a session starts to have a impact of treatment. Combining the clinical
documented the reliability of the SOS-10.
sense of their patient’s current level of cutoff score of 41 with the reliable change
Blais et al. (1999) reported an internal
distress. score of 8.5 points allows us to
consistency (coefficient alpha) coefficient
operationalize a rigorous definition of
Interpretive Database of .96 (n = 85), and two later studies (n = 100
improvement that includes a meaningful
and n = 376, respectively) with different
Since its publication, the SOS-101 has been increase in well-being (score change of 8.5
samples estimated alpha to be .90 3,6. Laux
used as an outcome measure in a broad or greater), as well as a total score that falls
and Ahern (2003) report a similarly high
range of clinical programs and research into the functional (non-patient; > 41) range
alpha (.95) in their sample of 151 chemical
studies. Many of these treatment programs of scores.
dependency subjects. Two published
and research projects have contributed studies have reported on the 1-week test-
data to aid in the development of an Not all patients are able to report their well-
retest reliability (rtt) of the SOS-10. Blais et
interpretive database for the SOS-10. SOS- being in the nonclinical range, yet achieve
al., (1999) found the rtt of the SOS-10 to be
10 data have been collected for substantial gains from treatment. Therefore,
.87 (n = 32 non-patients) and Young et al.,
non-patients, outpatients, and inpatients. a less conservative definition of improvement
(2003) reported an rtt = .86 (n = 101 college
Presently, this database contains over 9000 may also be used for those patients who
students). The SOS-10 interpretive database,
subjects with 2336 non-patients, 1598 simply show a change score of at least 8.5
which includes data from Blais et al. (1999)
outpatients and 5119 inpatients. The sample points. This is especially pertinent for
and Young et al., (2003), contains 1-week
is 62 percent female and has a mean age of patients who begin treatment with a
retest data on 362 non-patients. In this
30.45 (SD = 14.2). As can be seen in table 1, markedly low (high distress) SOS-10 score
sample, the r tt for the SOS-10 was .88
the SOS-10 provides strong separation or have a baseline level of well-being or
(p < .001). Not only did the SOS-10 scores of
between both the total patient and distress in the clinical range. Alternatively,
these 362 non-patients evidence strong
nonpatient groups, as well as within each a drop in 8.5 points or more represents a
retest reliability, the mean score also
patient group. Using the average coefficient significant decline in well-being form the
showed no significant change across the
alpha (.93) of the published studies previous measurement period. Using the
retest interval.
(described later) that have used the SOS- mean group scores in the Interpretive
10, the standard error of measurement was Database (reported in table 1) along with
Understanding the factor structure of the
calculated (SEM = 4) in order to provide a the established clinical cutoff score (41),
SOS-10 is important for two reasons. First, it
confidence interval around SOS-10 scores. the range of SOS-10 scores (0-60) was
helps clarify the nature of the latent
In other words, a change of 4 or fewer divided into 4 severity levels. These levels
construct and second, it provides
points between any two measurement are as follows: Minimal (non-patient range
justification for the method of scoring the
periods is most likely due to chance and/or of 41-59), Mild (33-40) was thought to
scale. In developing the SOS-10, a
measurement error and should not be encompass the range from the clinical
unidimensional solution was seen as a way
interpreted as clinical improvement. cutoff to just below the outpatient mean,
to ensure low burden of use by simplifying
Moderate (25 - 32) distress includes scores
scoring and score interpretation. A number
Using the large patient and nonpatient that fall between the inpatient and
of independent studies have verified the
samples in the database, a cutoff score of outpatient mean and Severe (1 - 24) distress
unidimensional structure of the SOS-10 and
41 was calculated using the formula was thought to be determined by scores
have reported the variance accounted for
suggested by Jacobson and Truax5 to be that fall below the mean of the inpatient
by this single factor solution to range from
the threshold that separates the functional norms. These ranges are based on the
more than 50% to nearly 80% 3,6.
(non-patient) and dysfunctional (patient) available normative data and are only
distribution of SOS-10 scores. In other intended to give a general qualitative
Clinical Utility of the SOS-10
words, patients who score at or above a 41 description of a patient’s current level of
are thought to have a good sense of well- self-reported distress and/or well-being. Since the original development paper,
being and a minimal level of distress, while These descriptors can be used to inform several studies have used the SOS-10 to
patients that score below a 41 are but not replace clinical judgment or other help expand its utility. Hilsenroth,
considered to be in the clinical range. As it measures of patient functioning (e.g., Global Ackerman, and Blagys (2001) found a
was hoped this measure would be used to Assessment of Functioning). significant increase in SOS-10 scores
track treatments over time, a reliable between the 3rd and 9th session of
change score (+/- 8.5) has also been Although we feel the severity levels offer psychotherapy (N = 17) in a group of
calculated using the recommended formula clinicians a convenient method to quickly, patients being seen at a university-based
from Jacobson and Truax5 to help reduce albeit roughly, classify a patient’s degree of outpatient psychological clinic8. These
misinterpretation. distress, future research is needed to findings matched Blais et al.’s (1999) initial
determine how congruent these distress report of significant score increases (less
Therefore, an increase or decrease of at levels are with those obtained from other distress) in a group of 20 inpatients
least 8.5 points on the SOS-10 between any well-validated and accepted instruments. administered the SOS-10 at admission and
two measurement periods of the same discharge. Young et al. (2003) conducted a

Patient Reported Outcomes

 INSTRUMENTS
The Schwartz Outcome Scale – 10©: A Brief
Measure of Psychological Well-Being

series of four studies with different latent trait of the SOS-10 is associated with Correspondence to obtain permission
nonpatient and patient populations that depression and anxiety (-.85 and -.73 and a copy of the SOS-10 can be
helped to 1.) further establish test-retest respectively) as well as positive affect (.69),
addressed to:
reliability, 2.) demonstrate a significant trait hope (.44) and social support from
Mark A. Blais, Psy.D.
relationship with a performance-based peers (.20) and family (.21). Together these
Psychological Evaluations and
measure (projective) of maladjustment, as data strongly support the interpretation that
Research Laboratory
well as an established measure of the SOS-10 measures a broad bipolar
One Bowdoin Square, 702
treatment outcome, and 3.) replicate the dimension of psychological health/well-
Boston, MA 02114-2919
SOS-10’s sensitivity to change as reported being and emotional distress.
USA
in earlier studies 1,8. Laux and Ahern (2003) [email protected]
explored the utility of the SOS-10 in a Current Use of the SOS-10
sample of 151 patients [mean age 32 The range of clinical services at MGH that
(SD = 8.9) and 75 percent male] referred by 1. Blais MA, Lenderking WR, Baer L, et al.
now use the SOS-10 in their regular
Development and initial validation of a brief mental
either an employer or the legal system to an practice has expanded greatly. The SOS- health outcome measure. Journal of Personality
outpatient community chemical dependency 10 has been selected as the mental health Assessment 1999; 73: 359-373.
treatment program7. Findings indicated that outcome measure of choice for the parent 2. Laux JM, Young JL, McLaughlin L, et al. The
while the mean score for this sample was health care corporation to which MGH development and evaluation of the French version
in the nonclinical range, the standard belongs. Presently the SOS-10 is being used of the Schwartz Outcome scale-10 (SOS-10-F).
deviation was quite large, indicating that in 14 different hospital systems across all Canadian Journal of Counseling 2006; 40: 195-208.
denial was not universal and that many levels of care within the greater Boston 3. Rivas-Vazquez RA, Rivas-Vazquez A, Blais M, et al.
patients were able to admit to experiencing area. In outpatient clinics, patients are Development of a Spanish Version of the Schwartz
substance use related problems. completing the SOS-10 before their first Outcome Scale-10: A brief mental health outcome
treatment session and then every 3 months measure. Journal of Personality Assessment 2001;
there after that until treatment has ended. 77: 436-446.
Construct Investigation
On the inpatient side, the SOS-10 is 4. Cohen, J. Statistical power analysis for the
The SOS-10 has been conceived of as a administered at admission and again at behavioral sciences (2nd ed.). Hillsdale, 1988,
measure of psychological health and well- Lawrence Erlbaum Associates, Inc.
discharge. In both settings clinicians also
being. Preliminary support for this definition provide a diagnosis and Global Assessment 5. Jacobson NS, Truax, P. Clinical significance: A
has come from research exploring the of Functioning (GAF) score at each visit statistical approach to defining meaningful change
validity correlations of the SOS-10 with in psychotherapy research. Journal of Consulting
allowing for a low burden multi-method
and Clinical Psychology 1991; 59: 12-19.
standard measures of psychopathology. In approach to outcomes measurement. At
psychiatric samples, the SOS-10 has been our primary outpatient clinic, we have 6. Young JL, Waehler CA, Laux JM, et al. Four studies
shown to correlate significantly (and in the extending the utility of the Schwartz Outcome Scale
collected over 3000 different SOS-10 forms
(SOS-10). Journal of Personality Assessment 200l;
expected directions) with multiple from patients and clinicians over the past 80: 130-138.
measures of depression, anxiety, psychosis 2½ years. These outcome data are
and borderline personality traits1. 7. Laux JM, Ahern B. Concurrent validity of the
currently being analyzed with a hope that
Schwartz Outcome Scale (SOS-10) with a
some similarities will be found with chemically dependent population. Journal of
In addition, we have found significant previous research. Addictions and Offender Counseling 2003; 24: 2-10.
correlations between the SOS-10 and four
8. Hilsenroth M, Ackerman S, Blagys M. Evaluating
of the Big Five Personality Traits
the phase model of change during short-term
(Neuroticism -.67; Extraversion .22; Agreea- psychodynamic psychotherapy. Psychotherapy
bleness .34 and Conscientiousness .31), Correspondence regarding this Research 2001; 11: 29-47.
showing the breath of the construct tapped article can be addressed to: 9. Blais MA, Shorey H. Exploring the construct validity
by the SOS. More recently we conducted Matthew R. Baity, Ph.D. of the Schwartz Outcome Scale-10 (SOS-10) in a
an investigation of the latent structure of [email protected] college sample, Presented at the mid-winter
the SOS-10 in a non-clinical sample9. SEM meeting of the Society for Personality Assessment,
analyses from this study indicate that the New Orleans, LA, 2008.

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