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Psychological distress among persons living with hypertension: Validation and application of the Symptom Checklist - 13
*Corresponding author: Addah Temple Tamuno-Opubo, Department of Psychology, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. addahson5@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Tamuno-Opubo AT, Idehen EE, Ishola BS. Psychological distress among persons living with hypertension: Validation and application of the Symptom Checklist - 13. RMC Glob J. 2026;2:24–32. doi: 10.25259/RMCGJ_27_2025
Abstract
Objectives:
This study aims to adapt and validate the 13-item version of the Symptom Checklist (SCL-13) as a brief and culturally relevant tool for assessing psychological distress among people living with hypertension in Nigeria. The adaptation addresses the need for a concise, user-friendly instrument to support mental health assessment in resource-constrained clinical settings.
Material and Methods:
A cross-sectional descriptive study design was employed, involving 62 hypertensive patients (23 males, 39 females; M = 42.91 years, SD = 15.79) recruited from the Obafemi Awolowo University Health Centre, Ile-Ife, Nigeria. The participants were selected using a two-stage sampling method, which combined purposive and convenience sampling. Data were analyzed using descriptive statistics, reliability analysis (Cronbach’s alpha = 0.823), and validity assessment through correlation analyses with the Brief Symptom Inventory-18 (BSI-18) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).
Results:
The SCL-13 demonstrated good internal consistency (α = 0.823) and high convergent validity with the BSI-18 (r = 0.74, p < 0.01), indicating its effectiveness in measuring psychological distress. A moderate negative correlation was found with the CD-RISC-10 (r = −0.399, p < 0.01), indicating that the scale is distinct from resilience-related constructs.
Conclusion:
The SCL-13 is a valid and reliable instrument for measuring psychological distress in hypertensive populations. It is a practical tool that can be used in clinical and research practice due to its conciseness and cultural particularity. Future research ought to examine how it can be applied to other groups of chronic illnesses and how it is sensitive to change in longitudinal designs.
Keywords
Hypertension
Mental Health assessment
Nigerian
Psychological distress
Psychometric validation
INTRODUCTION
Managing hypertension involves more than merely maintaining blood pressure levels; it frequently entails a subtle weight of mental and psychological suffering.1–4 In many places, particularly in Nigeria, where mental health services are limited and unevenly distributed, this distress is rarely identified or treated, leaving many people to cope alone.5,6
The daily demands of managing a chronic condition help to explain this burden. Regular clinic appointments, strict medication schedules, lifestyle changes, and fear of long-term complications can all contribute to anxiety, depressive symptoms, and somatization. These symptoms do not just affect how people feel; they can also lower quality of life and make it harder to follow treatment advice consistently.7,8 Lazarus and Folkman’s stress and coping theory suggests that psychological distress arises when a person judges that the demands they face are greater than their ability to cope.9 For many people with hypertension, worries about keeping to medication, adjusting diet and physical activity, or avoiding stroke and heart disease are clear examples of such pressures.10–12
Although the link between physical health and mental well-being is now better recognized in medicine, routine care for hypertension still tends to center on physical markers such as blood pressure readings, body weight, and laboratory results. Emotional problems are rarely explored in detail or recorded in the notes, and this creates a clear gap in truly holistic care. Tools like the Symptom Checklist-90 (SCL-90) can give a rich picture of psychological symptoms and are known to have strong psychometric properties.13 However, the full SCL-90 is lengthy and can be tiring for patients to complete, especially in busy, low-resource clinics where appointments are brief, literacy levels differ, and there are few mental health specialists. Shorter versions, such as the SCL-52 and the Brief Symptom Inventory-18 (BSI-18), were developed to reduce the time and effort required while preserving diagnostic value.14,15 Even with these options, there is still a clear need for very brief, culturally adapted tools that can be used quickly and comfortably in Nigerian hospital settings, where stigma and limited resources continue to hinder routine mental health assessment.
In this context, the present study introduces a 13-item version of the Symptom Checklist (SCL-13), adapted from the SCL-90 and specifically designed for adults with hypertension in Nigeria. The SCL-13 targets five key domains of psychological distress that are particularly relevant in this group: somatization, obsessive–compulsive symptoms, depression, anxiety, and neuroticism (SODAN). Items were selected and refined so that the scale would stay clinically meaningful while remaining short, easy to read, and simple to administer during regular clinic visits. By offering a compact screening tool that takes local language, culture, and service conditions into account, the SCL-13 aims to support clinicians in noticing and addressing psychological distress as part of everyday hypertension management. This approach is consistent with wider calls to integrate mental health screening into primary care in Nigeria, where reliable and context-appropriate assessment tools are often not available.
Guided by these aims, the study tested four main hypotheses. First, the SCL-13 was expected to show good internal consistency, reflected in a high Cronbach’s alpha coefficient. Second, the scale was expected to demonstrate convergent validity through a strong positive correlation with the BSI-18. Third, divergent validity was expected, such that SCL-13 scores would show a significant negative correlation with the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).16 Finally, when compared with the longer SCL versions, the SCL-13 was anticipated to offer a more focused and practical way of assessing core psychological distress, without unnecessary repetition of items, making it particularly suitable for hypertension clinics and other low-resource healthcare settings.
MATERIAL AND METHODS
Design
Study design and setting
This study used a cross-sectional descriptive design to describe psychological distress and to test the psychometric properties of the SCL-13 in adults living with hypertension. Data were collected at the Obafemi Awolowo University Health Centre (OAUHC) in Ile-Ife, Nigeria. The health center is a university-based facility with a dedicated hypertension clinic, which runs on specific clinic days. A cross-sectional design was chosen because it makes it possible to assess symptom levels and scale performance at a single point in time, in a real-world clinic setting, without changing patients’ usual care.
Sample and sampling technique
A two-stage sampling approach was used.
In the first stage, the hypertension clinic at OAUHC was purposively selected as the study site. This clinic was considered suitable because it has a large and fairly stable group of registered hypertensive patients who attend routine follow-up visits and blood pressure checks on designated days (Tuesdays and Wednesdays). Having many eligible patients in one place made the clinic a practical and rich setting for an initial validation study.
In the second stage, participants were recruited using convenience (consecutive) sampling. On each clinic day during the 3-month data collection period (April–June 2023), all hypertensive patients in the waiting area who met the inclusion criteria were approached, given information about the study, and invited to take part. In total, 269 hypertensive patients were contacted. Of these, 62 agreed to participate, gave informed consent, and completed all the questionnaires. This yielded a final sample of 62 adults with hypertension who were actively attending the clinic.
Although 62 participants represent a modest sample for psychometric research, this number reflects all eligible and consenting hypertensive patients available within the study period at a single clinic. For a brief 13-item instrument, this yields an acceptable sample-to-item ratio for estimating internal consistency and simple correlations. Nevertheless, the present investigation should be regarded as a preliminary validation study, and the findings need to be replicated in larger and more diverse samples.
Inclusion and exclusion criteria
To be included in the study, participants had to:
Have a diagnosis of hypertension and be formally registered as patients at OAUHC.
Attend the OAUHC hypertension clinic regularly during the study period.
Be at least 18 years old and able and willing to provide informed consent.
The following groups were excluded:
People who did not have a diagnosis of hypertension.
Hypertensive patients with significant medical comorbidities that could interfere with the assessment of psychological distress.
Patients who were unable or unwilling to give informed consent.
Data collection tools
Personal data form
A brief socio-demographic form was developed by the research team to collect basic background information. The form included seven items covering age, sex, marital status, religion, highest level of education, occupation, and approximate average monthly income. These variables were used to describe the sample and to allow exploratory checks of how psychological distress might differ across demographic and socioeconomic groups.
Symptom Checklist-90 (SCL-90)
Psychological distress was initially evaluated using the Symptom Checklist-90 (SCL-90), which was initially designed by Derogatis.13 The SCL-90 is a self-report questionnaire that is created to be broad-based to encompass a large number of psychological symptoms in clinical as well as non-clinical populations. It was employed as a screening tool for distress in persons with hypertension in this study. The SCL-90 contains 90 items that are grouped into ten symptom dimensions: somatization (12 items), obsessive–compulsive symptoms (10 items), interpersonal sensitivity (9 items), depression (13 items), anxiety (10 items), hostility (6 items), phobic anxiety (7 items), paranoid ideation (6 items), psychoticism (10 items), and neuroticism (7 items). Combined with each other, these subscales provide a multi-dimensional image of psychological challenges and the distress associated with them.
Each item is a short statement describing a symptom (for example, “feeling lonely,” “muscle soreness,” or “feelings of guilt”). Respondents are asked how much each symptom has bothered them in the past week. Answers are given on a 5-point Likert scale from 0 (“Not at all”) to 4 (“Extremely”), with higher scores showing more severe or frequent symptoms. Subscale scores and an overall distress score can be calculated by summing or averaging the relevant items.
The SCL-90 has shown strong psychometric performance in different groups. For example, Ardakani et al. (2016) reported a Cronbach’s alpha of 0.92, and among nurses in Eastern Nigeria, the SCL-90-R produced an alpha of 0.97 (Nwankwo and Moneme, 2020).17,18 In the present sample of adults with hypertension, the SCL-90 also showed very good internal consistency (Cronbach’s α = 0.908).
Symptom Checklist-13 (SCL-13)
In this study, the main measure of psychological distress was a shortened 13-item version of the SCL-90 (SCL-13), developed specifically for adults with hypertension in Nigeria. The goal was to create a brief tool that still captured key aspects of distress but could be used easily in a busy clinic.
The starting point for the adaptation was the original 90-item SCL-90, which has ten symptom dimensions. For this research, five subscales judged most relevant to hypertension-related distress were retained: somatization (12 items), obsessive–compulsive symptoms (10 items), depression (13 items), anxiety (10 items), and neuroticism (7 items). Together, these five domains, summarized by the acronym SODAN, produce a pool of 52 items.
Using all 52 items was not realistic in a setting where patients already have long clinic visits, varying literacy levels, and other questionnaires to complete. A shorter measure was needed to reduce the burden and keep the tool practical.
To develop the 13-item version, the 52 items were first grouped by their original subscale and order. Within each subscale, items were organized into small clusters (around four items at a time). From each cluster, one item was chosen to represent that part of the domain, so that about one in four items was kept. Choices were guided by how clearly an item expressed the main feature of the domain, how easy it was to understand, and how suitable it was for Nigerian clinic patients. In the neuroticism subscale, two extra items (originally in positions 4 and 7) were kept because they overlapped with obsessive–compulsive features and were considered clinically relevant for this group.
The final SCL-13 contains five mini-domains in sequence: somatization (items 1–3), obsessive–compulsive symptoms (items 4–5), depression (items 6–8), anxiety (items 9–11), and neuroticism (items 12–13). Each item asks how much the symptom has bothered the respondent over the past week, excluding the day of completion. Responses are given on a 5-point Likert scale from 0 (“Not at all”) to 4 (“Extremely”). Higher scores indicate greater distress.
For the main analyses, all 13 items were summed to create a total psychological distress score, with possible scores ranging from 0 to 52. To make the scores easier to interpret, total scores were grouped into four categories based on cut-offs from the scale development work:
0–5 = no psychological distress
6–21 = mild distress
22–37 = moderate distress
38–52 = severe distress distress, as reported by Tamuno-opubo et al. (2025).19
Before using the SCL-13 in the main study, the 13 items were piloted alongside the full SCL-90 and an intermediate 52-item version (SCL-52). Internal consistency estimates from this pilot showed good reliability for all three versions (SCL-90 α = 0.95, SCL-52 α = 0.74, SCL-13 α = 0.92). Given its strong reliability and brevity, the SCL-13 was selected as the primary distress measure. The full item lists for the SCL-90, SCL-52, and SCL-13 are presented in Appendices IA, IB and IC.
Brief symptom inventory-18 (BSI-18)
General psychological distress was also assessed with the BSI-18, a short self-report tool developed by Derogatis.14 The BSI-18 has 18 items that cover three core symptom dimensions: somatization, depression, and anxiety. Participants indicate how much each symptom has bothered them during the past week using a 5-point Likert scale from 0 (“Not at all”) to 4 (“Extremely”). Higher total scores show greater levels of distress.
The BSI-18 has shown good psychometric properties in various settings, including high internal consistency and a stable factor structure Franke et al. (2017).20 In this study, the BSI-18 demonstrated acceptable reliability (Cronbach’s α = 0.80). Total BSI-18 scores were used to assess the convergent validity of the SCL-13. The two measures were strongly correlated (r = 0.74), indicating that people who scored higher on the SCL-13 also reported more distress on the BSI-18.
Connor-Davidson Resilience scale-10 (CD-RISC-10)
Psychological resilience was measured with the CD-RISC-10.16 The CD-RISC-10 assesses a person’s ability to adapt positively and cope with stress and difficult life events. It contains 10 statements, such as “I am able to adapt when changes occur,” each rated on a 5-point Likert scale from 0 (“Never”) to 4 (“Almost always”). Higher scores reflect greater resilience.
Previous work has shown that the CD-RISC-10 is unidimensional and has excellent psychometric qualities, including good internal consistency and construct validity.21 In the current study, the CD-RISC-10 showed acceptable internal consistency (Cronbach’s α = 0.74). It was used as the divergent validity measure for the SCL-13. As expected, higher resilience scores were linked with lower distress scores, supporting the view that the SCL-13 measures a construct that is related to, but distinct from, resilience.
Data collection procedure
Data were collected in the waiting area of the hypertension clinic. On clinic days, the researcher approached eligible patients individually while they waited to see the clinician or pharmacist. After explaining the purpose of the study and answering questions, the researcher invited them to participate and obtained written informed consent from those who agreed.
Once the consent was received, every participant was provided with a questionnaire pack, which comprised the socio-demographic form, the SCL-90/SCL-13 items, the BSI-18, and the CD-RISC-10. The research questionnaires were to be filled in during the waiting period before their clinic appointment so that they were not distracted by the questionnaires during their daily care. The researcher stayed in the waiting area to answer questions, clarify anything that was confusing, and quickly go through the forms to look at any missing responses before gathering them. This method served to minimize unfinished information and enabled the respondents to answer the questions in a home, a relatively comfortable setting.
Data analysis
Information from the completed questionnaires was entered into statistical software for analysis. The socio-demographic profile of the participants and their levels of psychological distress in general were summarized using descriptive statistics, frequencies, percentages, means, and standard deviations. Internal consistency was analyzed to assess the psychometric performance of the SCL-13 with the aid of Cronbach’s alpha. Pearson correlations were then computed between the SCL-13 and the BSI-18, CD-RISC-10, SCL-90, and SCL-52. These analyses were conducted to determine both convergent and divergent validity, as well as to investigate the relationship between the short and long forms of the checklist. All the analyses were conducted according to the standard statistical procedures so that the obtained results were sound and could be interpreted with a certain degree of confidence.
Ethical considerations
The study received the ethical approval of the Research Ethics Committee of the Department of Public Health, Obafemi Awolowo University (HREC No: IPH/OAU/12/2130). Each participant was made aware of the purpose of the research and the implications of their participation. They were informed that the participation would be voluntary, and they could decline or drop out at any time without interfering with the care they obtained, and that their answers would be confidential. In order to maintain privacy, the names were not written on the questionnaires, but anonymous codes were used on all the forms and data files.
RESULTS
As illustrated in Table 1, the 62 individuals who participated in the study had an average age of 42.91 (SD = 15.79); therefore, the sample was composed of both young and older adults. The majority of participants were women (62.90%), and the remainder were men (37.10%). The vast majority of the participants were married (75.80%). Smaller subgroups were found to be single (16.10%), widowed (4.80%), divorced (1.60%), and separated (1.60%). As per religion, three-quarters of the sample were Christian (74.20%), a relatively small number (24.20%) were Muslim, and the remainder of the sample (1.60%) was under other religious groupings. In terms of education, the sample was mostly well educated; 77.40% had tertiary education and 21.00% secondary school education, with only 1.60% having primary school education as the highest education level. None of the participants said that they had no formal education. In the case of monthly income, 61.30% of them claimed to earn an average income, 33.90% claimed to earn a low income, and 4.80% claimed to earn a high income.
| Variables | Groups | Frequency | Percentage (%) |
| Gender | Male | 23 | 37.10 |
| Female | 39 | 62.90 | |
| Marital status | Married | 47 | 75.80 |
| Single | 10 | 16.10 | |
| Divorced | 1 | 1.60 | |
| Separated | 1 | 1.60 | |
| Widower | 3 | 4.80 | |
| Religion | Christianity | 46 | 74.20 |
| Islam | 15 | 24.20 | |
| Others | 1 | 1.60 | |
| Level of education | None | 0 | 0.00 |
| Primary | 1 | 1.60 | |
| Secondary | 13 | 21.00 | |
| Tertiary | 48 | 77.40 | |
| Monthly income | Low | 21 | 33.90 |
| Average | 38 | 61.30 | |
| High | 3 | 4.80 | |
| Age (in years) Mean = 42.91, SD = 15.79 | Ranges between 18 and 62 years | ||
As illustrated in Table 2, the reliability analysis showed that the 13-item SCL-13 (SODAN) had a Cronbach’s alpha of 0.823. This coefficient reflects good internal consistency, suggesting that the items work together coherently and tap into a common underlying construct of psychological distress.
| Version | No. of items | Cronbach’s alpha |
| SCL-90 | 90 | 0.908 |
| SCL-52 | 52 | 0.764 |
| SCL (SODAN-13) | 13 | 0.823 |
Convergent validity
As illustrated in Table 3, convergent validity was checked by comparing scores on the SCL-13 with scores on the BSI-18. The correlation was r = 0.74, which was statistically significant at the 0.01 level (p < 0.01). This fairly strong positive relationship means that people who scored higher on the SCL-13 also tended to report more symptoms on the BSI-18. In other words, both tools are picking up similar aspects of psychological distress, which supports the use of the SCL-13 (SODAN-13) as a measure of distress.
*Note: Correlation significant at the 0.05 level (2-tailed test);
**Correlation significant at the 0.01 level (2-tailed test).
SCL: Symptoms check list (SCL: SODAN-13);
BSI: Brief symptom inventory-18 (BSI-18);
CD-RISC-10: 10-item Connor-Davidson resilience scale.
Divergent validity
Divergent validity was explored by correlating SODAN-13 scores with scores on the CD-RISC-10. The Pearson correlation coefficient was r = −0.399, with p < 0.01, showing a moderate and statistically significant negative relationship between distress and resilience. Practically, this means that higher distress on the SODAN-13 was associated with lower resilience on the CD-RISC-10. This pattern fits with the expectation that distress and resilience move in opposite directions but are not the same thing, indicating that the SCL-13 is assessing a construct that is related to, yet distinct from, psychological resilience.
Table 4 presents the intercorrelations among the original SCL-90, the 52-item intermediate version (SCL-52), and the adapted brief form (SCL-13; SODAN-13). As expected, the SCL-52 showed a strong positive correlation with the SCL-90 (r = 0.723, p < 0.01), indicating that the intermediate version retains most of the variance captured by the full scale. In contrast, the association between SCL-13 (SODAN-13) and the SCL-90 was small and not statistically significant (r = −0.085, p > 0.05). Its correlation with the SCL-52 was negligible and also non-significant (r = 0.013, p > 0.05). These trends indicate that despite the fact that the SODAN-13 is based on the longer forms, it is not merely repeating their comprehensive contents; it is rather a shortened index of fundamental psychological distress. The limited overlap with the intermediate form, in conjunction with its brevity, serves to emphasize the SCL-13 (SODAN-13) as a convenient method for use in clinical and research practices where time and respondent overload are to be avoided at all costs. However, the symptoms of distress still need to be captured. In general, the results support the implication that scales should be chosen carefully for their intended use, and the SCL-13 can be viewed as a more focused version of the more comprehensive scales, the SCL-90 and SCL-52.
| Scales | SCL-90 | SCL-52 | SCL-13 |
| SCL-90 | - | ||
| SCL-52 | 0.723** | - | |
| SCL-13 | −0.085 | 0.013 | - |
*Note: Correlation significant at the 0.05 level (2-tailed test);
**Correlation significant at the 0.01 level (2-tailed test).
SCL-90: 90-item symptom checklist;
SCL-52: 52-item intermediate version;
SCL-13: 13-item brief version (SODAN-13).
DISCUSSION
This study set out to examine whether the SCL-13 is a valid and reliable brief instrument for screening psychological distress among Nigerians living with hypertension. In doing so, we focused on internal consistency, convergent and divergent validity, and the association between the short form and its longer predecessors (SCL-90 and SCL-52), with the aim of determining whether the SCL-13 can function as a practical alternative in settings where time and resources are limited.
From a reliability perspective, the SCL-13 (SODAN-13) performed well. The internal consistency coefficient for the 13 items was Cronbach’s alpha = 0.823, which falls within the range typically interpreted as good reliability. This suggests that the items cohere sufficiently to reflect a common underlying construct of psychological distress. Dıgrak and Tezel22 suggest that internal consistency scales with an alpha of above 0.80 are considered strong, and Rammstedt and Beierlein23 concur, stating that scales with high alpha levels tend to be practical to use. Simultaneously, Streiner and Kottner24 warn that extremely large alpha values can occasionally be considered as redundancy and not breadth of coverage. It is not always easy to get a reasonably high alpha (with a short measure), and scales with few items will frequently fail to achieve that level of reliability.25,26 The fact that SCL-13 received an alpha of more than 0.80 indicates that the items chosen to measure distress are able to depict important elements of distress without overreliance on repetition.
The convergent validity was supported by the correlation between the SCL-13 scores and the BSI-18 scores. The relationship between the two overall scores in this sample was found to be r = 0.74 (p < 0.01), which is highly positive. That is, patients who said more distress on the SCL-13 were also those who said more on the BSI-18. This is in line with the purpose of the two instruments as general psychological distress measures. Derogatis,14 the author of BSI-18, has noted that BSI-18 is an effective measure of distress in clinical and non-clinical samples, and the current results support the argument that the SCL-13 is tapping into a similar construct. Past studies have shown that scales that are created to measure related domains of symptoms generally portray a high level of positive correlations when used on the same population.26,27 Simultaneously, Boyraz et al.28 refer to the fact that the instruments might not act in the same manner in different cultural environments. Zeb et al.29 also state that the tools created within Western contexts might not be able to grasp the way the distress is manifested in different contexts. The strong association between SCL-13 and BSI-18 in this Nigerian hypertensive sample, therefore, suggests both that the SCL-13 is aligned with established distress measures and that its cultural adaptation may have enhanced its usefulness in this context.
Divergent validity was examined using the CD-RISC-10. The correlation between SODAN-13 and the CD-RISC-10 was moderate and negative (r = −0.399, p < 0.01), indicating that higher distress scores were associated with lower resilience; however, the two scales did not overlap to the point of measuring the same construct. This pattern aligns with theoretical expectations: Connor and Davidson16 describe resilience as a capacity inversely related to distress, and Minnett and Stephenson30 also report negative correlations between resilience measures and indices of psychological symptoms. However, the relationship is not necessarily simple or uniform. McCrea et al.31 highlight that elements of resilience and distress may co-exist, especially when resilience is conceptualized as an ongoing process of coping rather than a static trait. Ong et al.32 add that the strength and direction of the association can differ depending on the population and the type of adversity, such as chronic illness. In this study, the moderate inverse correlation suggests that the SCL-13 captures a construct related to, yet distinct from, resilience, consistent with the idea that distress and resilience are separate, yet interconnected, psychological domains in hypertensive populations.
The relationships between the SCL-13 and its longer parent scales were small and non-significant. Specifically, SODAN-13 showed a weak negative correlation with the full SCL-90 and a negligible, non-significant correlation with the 52-item SCL-52. These findings indicate that, although the SCL-13 items were drawn from the longer forms, the short scale does not simply reproduce the broader content of the SCL-90 or SCL-52. Instead, it appears to function as a focused screening tool that concentrates on key indicators of psychological distress. Derogatis et al.33 emphasized that abbreviated versions of the SCL family are developed to balance the depth of assessment with ease of use. The present results suggest that the SCL-13 pushes that balance further towards practicality without completely detaching from the conceptual foundations of the original instrument.
This conclusion is broadly consistent with findings from other work on short measures. Chen and Lou,34 for example, argue that carefully constructed brief scales can maintain adequate validity while substantially reducing respondent burden in routine clinical practice. Some authors have expressed reservations that shortening scales may narrow the coverage of constructs and omit important facets of the domain.35,36 In the current study, the very low correlations between the SCL-13 and the longer SCL versions suggest that the short form is not interchangeable with the full SCL-90 or SCL-52. Rather, it appears to operate as a targeted instrument that is particularly useful when the priority is to screen efficiently for distress—for example, in hypertension clinics—rather than to capture the full range of psychopathology.
Implications for theory, practice, and future research
Theoretical implications
The study’s conclusions are significant in the theoretical context of psychological distress assessment instruments. The article contributes to the hypothesis that psychometric tests could be brief, reasonably precise, and valid by applying the SCL-13 and proving its reliability and effectiveness. The accuracy of SCL (SODAN-13) is also warranted by the fact that it has a strong convergent correlation with BSI-18 and a moderate negative relationship with resilience, which is also acceptable in terms of divergent validity. This contributes to the growing body of information that emphasizes the need to adjust psychometric instruments to cultural contexts and render them relevant and applicable. Further, the findings of moderate divergent validity also suggest the inferred negative association between psychological distress and resilience, which introduces the theoretical dimension in the relationship of similar dimensions in the population with chronic illnesses.
Practical implications
The SCL (SODAN-13) is a concise, culturally adapted, and simple tool for measuring psychological distress in resource-limited settings, including Nigeria. It is also concise in a way that allows medical practitioners to examine patients for psychological distress without incurring the expense of spending much time. This is especially helpful during busy clinical practice, where time and resources are limited, such as in hypertension clinics. The scale is an effective tool for intervention direction and longitudinal patient follow-ups due to its high reliability and validity. Its use in hypertensive patients also explains the significance of mental health measures during the treatment of chronic diseases and facilitates a comprehensive treatment process.
Future research directions
The future research should examine the predictive validity of the SCL (SODAN-13) by examining how well it predicts long-term psychological outcomes among the clinical population, such as those living with hypertension.
SCL’s cross-cultural adjustment among various populations would ensure its utility in a wider area and would notice any latent differences attributable to culture in psychological distress.
More evidence of the scale’s applicability in therapeutic practice could be found in the examination of its sensitivity to change over time, especially in intervention studies.
The SCL (SODAN-13) has greater potential to gauge the psychological burden of chronic illnesses if it is administered to other groups of chronic illness populations, such as diabetics or cancer patients.
Importance of the new scale
The SCL (SODAN-13) also fulfils the requirement of a short, culture-specific, and efficiency-sensitive instrument for quantifying psychological distress in individuals coping with chronic conditions. Unlike the lengthy scales (such as the SCL-90 and SCL-52) that impose a heavy burden on respondents, the SCL-13 does not, and therefore, the scale is especially appropriate for high-demand healthcare practices. The scale has demonstrated its usefulness in under-resourced settings through its validation in a community in Nigeria, and it can be beneficial to researchers and clinicians interested in enhancing mental health outcomes. Accurate and reliable measurements are the key opportunities of the SCL (SODAN-13) that enable the detection of signs of psychological disturbances early enough and the implementation of necessary interventions in a timely manner, thereby developing comprehensive care.
Limitations
The study was carried out in only one healthcare center, and hence the findings cannot be generalized to other settings or regions.
The sample size was relatively small (N = 62), which may have reduced statistical power, limited the precision of estimates, and constrained the generalizability of the findings. While the ratio of participants to items is sufficient for preliminary reliability and validity analyses of a 13-item scale, it is not adequate for more complex procedures such as exploratory or confirmatory factor analysis. As a result, the current data should be interpreted as initial evidence on the performance of the SCL-13 in a hypertensive clinic population. Future studies using larger, multi-site samples are required to confirm the factor structure and to strengthen confidence in the scale’s psychometric properties.
The dependency on self-reported measures implicates the possibility of response bias that may have impacted the results.
The cross-sectional design does not permit making conclusions on causality between the measured variables.
Only hypertensive patients were the study’s subjects, and thus, the SCL-13’s relevance in dealing with broader populations of subjects might be limited by the study.
CONCLUSION
In this study, the SCL-13, a valid instrument for measuring psychological distress in patients with hypertension, was validated. The scale exhibited moderate divergent validity with the CD-RISC-10 (r = −0.399, p < 0.01) and strong convergent validity with the BSI-18 (r = 0.74, p < 0.01), as well as good internal consistency (Cronbach’s alpha = 0.823). Additionally, the low level of complexity of the design of the SCL-13 renders it a practical solution to a clinical setting in a low-resource environment. Although it is not long, the SCL (SODAN-13) speaks in some ways about psychological distress in a culturally sensitive and specific way. Clinical practice and future research will find these results helpful, as they demonstrate the relevance of using mental testing to address chronic diseases.
Acknowledgments
The authors would also like to appreciate the management and staff of the Obafemi Awolowo University Health Centre (OAUHC) in Ile-Ife, who helped in the study and cooperated with the authors. The participants are specifically thanked for taking the time to participate in this research. The contributions of the research assistants are also acknowledged, as they were instrumental in ensuring the smooth delivery of questionnaires. Lastly, we would like to thank the funding body (where applicable) and the reviewers whose comments served to perfect this study.
Ethical approval
The research/study approved by the Institutional Review Board at Research Ethics Committee of the Department of Public Health of Obafemi Awolowo University, number HREC NO: IPH/OAU/12/2130, dated February 2023-February 2024.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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