title: Extending the validity of the Personality Assessment Inventory's (PAI) Level of Care Index (LOCI) in multiple psychiatric settings.
abstract: The purpose of this study was to extend the validity and clinical application of the Level of Care Index (LOCI) from the Personality Assessment Inventory (PAI) in 2 independent psychiatric samples. In Study 1 (N = 201), the LOCI effectively differentiated level of care (inpatients from outpatients), and was also meaningfully associated with risk factors for psychiatric admission (e.g., suicidal ideation, self-harming behavior, previous psychiatric admission, etc.), even after controlling for other demographic variables (range of Cohen's ds = 0.57-1.00). Likewise, the LOCI also incremented other risk indicators (suicide and violence history) and relevant PAI indexes (i.e., Mean Clinical Elevation, and Suicide and Violence Potential) in predicting level of care, and explained an additional 6% to 12% of variance in the target variable. Diagnostic efficiency analyses indicated LOCI scores in the range of 15 to 18 optimize positive and negative predictive power, and classification rate. In Study 2 (N = 96), the LOCI was found to be significantly higher in those with a recent psychiatric admission within the past 6 months (d = 0.64), as compared to those without an admission. Similarly, those who were admitted for suicide risk had significantly higher mean LOCI scores as compared to those who did not (d = 0.70). The clinical implications of these findings and potential application of the LOCI are discussed.
authors.affiliation: a Psychological Evaluation and Research Laboratory (PEaRL), Massachusetts General Hospital and Harvard Medical School.
authors.forename: Samuel Justin
authors.initials: SJ
authors.lastname: Sinclair
authors.forename: Michaela
authors.initials: M
authors.lastname: Smith
authors.forename: Wei-Jean
authors.initials: WJ
authors.lastname: Chung
authors.forename: Rachel
authors.initials: R
authors.lastname: Liebman
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Stein
authors.forename: Daniel
authors.initials: D
authors.lastname: Antonius
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Siefert
authors.forename: Greg
authors.initials: G
authors.lastname: Haggerty
authors.forename: Mark A
authors.initials: MA
authors.lastname: Blais
mesh_terms: D000328:Adult; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology*; D010552:Personality Assessment; D012307:Risk Factors; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D014754:Violence; D055815:Young Adult