The Counseling Center Assessment of Psychological Symptoms Distress Index: A pragmatic exploration of general factors to enhance a multidimensional scale

Objective: The authors attempted to develop and validate a general distress index for a multidimensional psychological symptom/outcome measure used in over 300 college counseling centers with more than 100,000 cases annually: the Counseling Center Assessment of Psychological Symptoms (CCAPS). Method: Four models were compared for fit indices (n = 19,247): the existing first-order factor model (without a general factor), a second-order factor model, a bifactor model, and a single factor or “total score” model. In separate clinical and non-clinical samples, concurrent and divergent validity were examined using several well-established measures of psychological symptoms, as well as two-week test–retest and treatment utilization data. Results: Second-order and bifactor models which captured a single “distress” factor both exhibited good fit to the data relative to the baseline and “total score” model. Validity data indicated that factors adequately measured meaningful clinical onstructs. Conclusion: Both the bifactor and second-order models indicated the presence of a “distress index” comprised items across many of the CCAPS subscales. This distress scale has strong applicability for benchmarking the overall severity and complexity of patients at different centers, and can be used to help identify colleges and universities with areas of clinical strength, which can be studied to improve the field. Clinically, the distress index offers a parsimonious and efficient method for clinicians to monitor patients’ progress through treatment.