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Inventory

Beberapa inventory digunakan untuk menilai secara objektif gangguan


psikosomatis antara lain Beck, Hamilton, Geriatric Depression Scale
dan atau Hospital Anxiety and Depression Scale (HADS). Sedangkan
pada Global Assesment Functioning (GAF) digunakan sebagai alat yang
digunakan untuk menilai kemampuan adaptasi seseorang dengan
stressor yang ada
Hamilton Depression Scale dan Beck Depression Scale merupakan alat
yang digunakan untuk menilai derajat beratnya depresi, baik dalam
lingkup klinis maupun penelitian. Alat ini dapat digunakan untuk
menilai baseline sebelum mulai terapi maupun sebagai evaluasi
pengobatan. Penilain depresi pada geritari menggunakan alat khusus
yaitu Geriatric depression scale.
Hamilton Anxiety Scale

merupakan skala yang dikembangkan untuk

mengukur beratnya gejala ansietas dan secara luas digunakan untuk


keperluan klinis dan penelitian. Skala ini terdapat 14 pertanyaan, tiap
pertanyaan terdiri dari gejala, dan mengukur psychic anxiety (mental
agitation dan psychological distress) dan somatic anxiety (physical
complaints related to anxiety).
Sedangkan Holmes dan Rahe Stress Test berupa kumpulan dari
stressor yang terdapat dalam kehidupan dan potensinya dalam
menimbulkan gejala somatis.

Skor > 300 menunjukkan risiko

terajdinya penyakit, Skor 150-299 menunjukkan risiko sedang dalam


menimbulkan penyakit dan Skor < 150 menunjukkan risiko rendah
terjadinya penyakit.

Beck Anxiety Inventory 1

Beck Anxiety Inventory


Below is a list of common symptoms of anxiety. Please carefully read each item in the list. Indicate how much you
have been bothered by that symptom during the past month, including today, by circling the number in the
corresponding space in the column next to each symptom.

Not At All

Numbness or tingling
Feeling hot
Wobbliness in legs
Unable to relax
Fear of worst
happening
Dizzy or lightheaded
Heart pounding/racing
Unsteady
Terrified or afraid
Nervous
Feeling of choking
Hands trembling
Shaky / unsteady
Fear of losing control
Difficulty in breathing
Fear of dying
Scared
Indigestion
Faint / lightheaded
Face flushed
Hot/cold sweats
Column Sum

Mildly but it
didnt bother me
much.

Moderately - it
wasnt pleasant at
times

Severely it
bothered me a lot

0
0
0
0
0

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3

Scoring- Sum each column. Then sum the column totals to achieve a grand score. Write that
score here ____________ .
Interpretation
A grand sum between 0 21 indicates very low anxiety. That is usually a good thing. However, it is
possible that you might be unrealistic in either your assessment which would be denial or that you have
learned to mask the symptoms commonly associated with anxiety. Too little anxiety could indicate that
you are detached from yourself, others, or your environment.
A grand sum between 22 35 indicates moderate anxiety. Your body is trying to tell you something. Look
for patterns as to when and why you experience the symptoms described above. For example, if it occurs
prior to public speaking a nd your job requires a lot of presentations you may want to find ways to calm
yourself before speaking or let others do some of the presentations. You may have some conflict issues that
need to be resolved. Clearly, it is not panic ti me but you want to find ways to manage the stress you feel.
A grand sum that exceeds 36 is a potential cause for concern. Again, look for patterns or times when you
tend to feel the symptoms you have circled. Persistent and high anxiety is not a sign of personal weakness or
failure. It is, however, something that needs to be proactively treated or there could be significant impacts to
you mentally and physically. You may want to consult a physician or counselor if the feelings persist.

11.
0
1
2
3

I am no more irritated by things than I ever was.


I am slightly more irritated now than usual.
I am quite annoyed or irritated a good deal of the time.
I feel irritated all the time.

0
1
2
3

I have not lost interest in other people.


I am less interested in other people than I used to be.
I have lost most of my interest in other people.
I have lost all of my interest in other people.

0
1
2
3

I make decisions about as well as I ever could.


I put off making decisions more than I used to.
I have greater difficulty in making decisions more than I used to.
I can't make decisions at all anymore.

0
1
2
3

I don't feel that I look any worse than I used to.


I am worried that I am looking old or unattractive.
I feel there are permanent changes in my appearance that make me look
unattractive
I believe that I look ugly.

0
1
2
3

I can work about as well as before.


It takes an extra effort to get started at doing something.
I have to push myself very hard to do anything.
I can't do any work at all.

0
1
2
3

I can sleep as well as usual.


I don't sleep as well as I used to.
I wake up 1-2 hours earlier than usual and find it hard to get back to sleep.
I wake up several hours earlier than I used to and cannot get back to sleep.

0
1
2
3

I don't get more tired than usual.


I get tired more easily than I used to.
I get tired from doing almost anything.
I am too tired to do anything.

0
1
2
3

My appetite is no worse than usual.


My appetite is not as good as it used to be.
My appetite is much worse now.
I have no appetite at all anymore.

0
1
2
3

I haven't lost much weight, if any, lately.


I have lost more than five pounds.
I have lost more than ten pounds.
I have lost more than fifteen pounds.

12.

13.

14.

15.

16.

17.

18.

19.

20.
0
1
2
3

I am no more worried about my health than usual.


I am worried about physical problems like aches, pains, upset stomach, or
constipation.
I am very worried about physical problems and it's hard to think of much else.
I am so worried about my physical problems that I cannot think of anything else.

0
1
2
3

I have not noticed any recent change in my interest in sex.


I am less interested in sex than I used to be.
I have almost no interest in sex.
I have lost interest in sex completely.

21.

INTERPRETING THE BECK DEPRESSION INVENTORY


Now that you have completed the questionnaire, add up the score for each of the twenty-one
questions by counting the number to the right of each question you marked. The highest possible
total for the whole test would be sixty-three. This would mean you circled number three on all
twenty-one questions. Since the lowest possible score for each question is zero, the lowest
possible score for the test would be zero. This would mean you circles zero on each question.
You can evaluate your depression according to the Table below.
Total Score____________________Levels of Depression
1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression

SUICIDE
0 |__| Absent.
1 |__| Feels life is not worth living.
2 |__| Wishes he/she were dead or any thoughts of possible
death to self.
3 |__| Ideas or gestures of suicide.
4 |__| Attempts at suicide (any serious attempt rate 4).

INSOMNIA: EARLY IN THE NIGHT


0 |__| No difficulty falling asleep.
1 |__| Complains of occasional difficulty falling asleep, i.e.
more than 12 hour.
2 |__| Complains of nightly difficulty falling asleep.

INSOMNIA: MIDDLE OF THE NIGHT


0 |__| No difficulty.
1 |__| Patient complains of being restless and disturbed
during the night.
2 |__| Waking during the night any getting out of bed rates
2 (except for purposes of voiding).

INSOMNIA: EARLY HOURS OF THE MORNING


0 |__| No difficulty.
1 |__| Waking in early hours of the morning but goes back
to sleep.
2 |__| Unable to fall asleep again if he/she gets out of bed.

WORK AND ACTIVITIES


0 |__| No difficulty.
1 |__| Thoughts and feelings of incapacity, fatigue or
weakness related to activities, work or hobbies.
2 |__| Loss of interest in activity, hobbies or work either
directly reported by the patient or indirect in
listlessness, indecision and vacillation (feels he/she has
to push self to work or activities).
3 |__| Decrease in actual time spent in activities or decrease
in productivity. Rate 3 if the patient does not spend at
least three hours a day in activities (job or hobbies)
excluding routine chores.
4 |__| Stopped working because of present illness. Rate 4 if
patient engages in no activities except routine chores,
or if patient fails to perform routine chores unassisted.

8 RETARDATION (slowness of thought and speech, impaired


ability to concentrate, decreased motor activity)
0 |__| Normal speech and thought.
1 |__| Slight retardation during the interview.
2 |__| Obvious retardation during the interview.
3 |__| Interview difficult.
4 |__| Complete stupor.
9

AGITATION
0 |__| None.
1 |__| Fidgetiness.
2 |__| Playing with hands, hair, etc.
3 |__| Moving about, cant sit still.
4 |__| Hand wringing, nail biting, hair-pulling, biting of lips.

10 ANXIETY PSYCHIC
0 |__| No difficulty.
1 |__| Subjective tension and irritability.
2 |__| Worrying about minor matters.
3 |__| Apprehensive attitude apparent in face or speech.
4 |__| Fears expressed without questioning.

11 ANXIETY SOMATIC (physiological concomitants of


anxiety) such as:
gastro-intestinal dry mouth, wind, indigestion, diarrhea,
cramps, belching
cardio-vascular palpitations, headaches
respiratory hyperventilation, sighing
urinary frequency
sweating
0 |__| Absent.
1 |__| Mild.
2 |__| Moderate.
3 |__| Severe.
4 |__| Incapacitating.
12 SOMATIC SYMPTOMS GASTRO-INTESTINAL
0 |__| None.
1 |__| Loss of appetite but eating without staff
encouragement. Heavy feelings in abdomen.
2 |__| Difficulty eating without staff urging. Requests or
requires laxatives or medication for bowels or
medication for gastro-intestinal symptoms.
13 GENERAL SOMATIC SYMPTOMS
0 |__| None.
1 |__| Heaviness in limbs, back or head. Backaches,
headaches, muscle aches. Loss of energy and
fatigability.
2 |__| Any clear-cut symptom rates 2.
14 GENITAL SYMPTOMS (symptoms such as loss of libido,
menstrual disturbances)
0 |__| Absent.
1 |__| Mild.
2 |__| Severe.
15 HYPOCHONDRIASIS
0 |__| Not present.
1 |__| Self-absorption (bodily).
2 |__| Preoccupation with health.
3 |__| Frequent complaints, requests for help, etc.
4 |__| Hypochondriacal delusions.
16 LOSS OF WEIGHT (RATE EITHER a OR b)
a) According to the
b) According to weekly
patient:
measurements:
0 |__| No weight loss.
0 |__| Less than 1 lb weight loss in
week.
1 |__| Probable weight
1 |__| Greater than 1 lb weight loss
loss associated with
in week.
present illness.
2 |__| Definite (according 2 |__| Greater than 2 lb weight loss
to patient) weight
in week.
loss.
3 |__| Not assessed.
3 |__| Not assessed.
17 INSIGHT
0 |__| Acknowledges being depressed and ill.
1 |__| Acknowledges illness but attributes cause to bad food,
climate, overwork, virus, need for rest, etc.
2 |__| Denies being ill at all.
Total score: |__|__|

This scale is in the public domain.

29

TheHolmes-RaheLifeStress Inventory

TheSocial Readjustment RatingScale


INSTRUCTIONS: Mark down thepoint valueof each of theselifeevents that has happened to you
duringtheprevious year. Total theseassociated pointed.

LifeEvent
1. Death of spouse
2. Divorce
3. Marital Separation from mate
4. Detention in jail or other institution
5. Death of a close family member
6. Major personal injury or illness
7. Marriage
8. Being fired at work
9. Marital reconciliation with mate
10. Retirement from work
11. Major change in the health or behavior of a family member
12. Pregnancy
13. Sexual Difficulties
14. Gaining a new family member (i.e. birth, adoption, older adult moving in, etc.)
15. Major business adjustment
16. Major change in financial state (i.e. a lot worse or better than usual)
17. Death of a close friend
18. Changing to a different line of work
19. Major change in number of arguments with spouse (i.e. a lot more or less)
20. Taking on a mortgage (for home, business, etc.)
21. Foreclosure on a mortgage or loan
22. Major change in responsibilities at work (i.e. promotion, demotion, etc.)
23. Son or daughter leaving home (marriage, college, military, etc.)
24. In-law troubles
25. Outstanding personal achievement
26. Spouse beginning or ceasing work outside the home
27. Beginning or ceasing formal schooling
28. Major change in living condition (i.e. new home, remodeling, deterioration, etc.)
29. Revision of personal habits (i.e. dress, associations, quit smoking, etc.)
30. Troubles with the boss
31. Major changes in working hours or conditions
32. Changes in residence
33. Changing to a new school
34. Major change in usual type and/or amount of recreation
35. Major change in church activity (i.e. a lot more or less)
36. Major change in social activities (i.e. clubs, movies, visiting, etc.)
37. Taking on a loan (i.e. car, tv, freezer, etc.)
38. Major change in sleeping habits (i.e. a lot more or less)
39. Major change in number of family get-togethers (i.e. a lot more or less)
40. Major change in eating habits (i.e. a lot more or less, eating hours, surroundings, etc)
41. Vacation
42. Major holidays
43. Minor violations of the law (i.e. traffic tickets, jaywalking, etc.)
Now, add up al thepoints you haveto find your score.

100
73
65
63
63
53
50
47
45
45
44
40
39
39
39
38
37
36
35
31
30
29
29
29
28
26
26
25
24
23
20
20
20
19
19
18
17
16
15
15
13
12
11

150pts or less means a relatively low amount of life change and a low susceptibility to stress-induce health problems.
150 to 300pts implies about a 50% chance of a major stress-induced health problem in the next 2 years.
300pts or more raises the odds to about 80%, according to the Holmes-Rahe prediction model.

Sources: Adapted from Thomas Holmes and Richard Rahe. Holmes-Rahe Social Readjustment Rating Scale, J ournal of
Psychosomatic Research. Vol II, 1967.

Global Assessment of Functioning (GAF) Scale


(From DSM-IV-TR, p. 34.)

Consider psychological, social, and occupational functioning on a hypothetical continuum of mental


health-illness. Do not include im pairment in functioning due to physical (or environmental) limitations.
Code

(Note: Use intermediate codes when appropriate, e.g., 45, 68, 72.)

100
|
91

Superior functioning in a wide range of activities, lifes problems never seem to


get out of hand, is sought out by others because of his or her many positive
qualities. No symptoms.

90
|
81

Absent or minimal symptoms (e.g., mild anxiety before an exam), good


functioning in all areas, interested and involved in a wide range of activities.
socially effective, generally satisfied with life, no more than everyday problems
or concerns (e.g. an occasional argument with family members).

80
|
71

If symptoms are present, they are transient and expectable reactions to


psychosocial stressors (e.g., difficulty concentrating after family argument); no
more than slight impairment in social, occupational or school functioning (e.g.,
temporarily failing behind in schoolwork).

70
|
61

Some mild symptoms (e.g. depressed mood and mild insomnia)


OR some difficulty in social, occupational, or school functioning (e.g., occasional
truancy, or theft within the household), but generally functioning pretty well, has
some meaningful interpersonal relationships.

60
|
51

Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic
attacks)
OR moderate difficulty in social, occupational, or school functioning (e.g.. few
friends, conflicts with peers or co-workers).

50
|
41

Serious symptoms (e.g.. suicidal ideation, severe obsessional rituals, frequent


shoplifting)
OR any serious impairment in social, occupational, or school functioning (e.g.,
no friends, unable to keep a job).

40
|
31

Some impairment in reality testing or communication (e.g., speech is at times


illogical, obscure, or irrelevant)
OR major impairment in several areas, such as work or school, family relations,
judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family,
and is unable to work; child frequently beats up younger children, is defiant at home,
and is failing at school).

30
|
21

Behavior is considerably influenced by delusions or hallucinations


OR serious impairment in communication or judgment (e.g., sometimes
incoherent, acts grossly inappropriately, suicidal preoccupation)
OR inability to function in almost all areas (e.g., stays in bed all day; no job, home,
or friends).

20
|
11

Some danger of hurting self or others (e.g., suicide attempts without clear
expectation of death; frequently violent; manic excitement)
OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces)
OR gross impairment in communication (e.g., largely incoherent or mute).

10
|
1

Persistent danger of severely hurting self or others (e.g., recurrent violence)


OR persistent inability to maintain minimal personal hygiene
OR serious suicidal act with clear expectation of death.

Inadequate information.