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Do the Spontaneity and Anger and Aggression subscales of the Ward Atmosphere Scale form homogeneous dimensions? A cross-sectional study of 54 wards for psychotic patients


Jan Ivar Røssberg, Psychiatric Division, Ullevaal University Hospital, N-0407 Oslo, Norway


Objective:  The main aim of this study was to examine the psychometric properties of the two subscales of the Ward Atmosphere Scale (WAS), Spontaneity and Anger and Aggression, which measure the level of expressed emotion. We wanted to examine if the items measuring attitude and behavior form different dimensions.

Method:  A total of 550 patients in 54 different psychiatric wards for psychotic patients completed the WAS and the Good Milieu Index.

Results:  Removing, respectively, four items from the Spontaneity subscale, three items from the Anger and Aggression subscale the psychometric properties improved. The two revised subscales were named Spontaneous Behavior (SB) and Angry, Aggressive Behavior (AAB). A new ‘attitude’ subscale, comprising three items, was named Staff Attitude to Expressed Feelings (SAEF).

Conclusion:  For patients the attitude and behavior items seem to form separate dimensions. The three subscales examined are probably of central importance for patient satisfaction.