Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples

Journal of Affective Disorders 69 (2002) 167–175www.elsevier.com/ locate/ jad

Research report

Validation of the Portuguese version of the Social Adjustment Scaleon Brazilian samples

a,b , c c a c c* Ć. Gorenstein , R.A. Moreno , M.A. Bernik , S.C. Carvalho , S. Nicastri , T. Cordas ,c d b,cA.P.P. Camargo , R. Artes , L. Andrade

a ˜ ˜ˆ ´Departamento de Farmacologia, Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazilb ˜ ˜LIM-23, Departamento de Psiquiatria, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil

c ˜ ˜Ínstituto de Psiquiatria, Hospital das Clınicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazild ˜ ˜´ ´ ´Departamento de Estatıstica, Instituto de Matematica e Estatıstica, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

Received 27 April 2000; accepted 4 January 2001

Abstract

Background: Social dysfunction is reported in several psychiatric diseases and its evaluation is becoming an importantmeasure of treatment outcome. The aim of this study was to obtain normative data, to test the validity and the ability of thePortuguese version of the Self-Report Social Adjustment Scale (SAS-SR) to detect different clinical conditions.Methods:The Portuguese version of the SAS-SR was applied to a carefully selected non-psychiatric sample, and to depressed, panic,bulimic and cocaine-dependent patients. Depressed and panic patients were evaluated in two different clinical conditions:acutely symptomatic and in remission.Results: SAS overall and sub-scale scores of the normal sample were consistentlylower than all patient groups, indicating better social adjustment in all areas. Panic patients were impaired to a lower levelthan depressed and cocaine-dependent patients in overall adjustment. Depressed patients in remission, although in bettercondition, were still impaired in relation to normal subjects in overall social functioning, leisure time and marital areas. Inpanic patients in remission, normalization was not achieved in overall functioning, work and marital areas.Limitations:Sample size was small in some groups and the evaluation was cross-sectional.Conclusions: The Portuguese version ofSAS-SR is a useful instrument for detecting differences between psychiatric patients and normal subjects and for theevaluation of different clinical conditions, recommending its use in outcome studies. 2002 Elsevier Science B.V. Allrights reserved.

Keywords: Social Adjustment Scale; Social functioning; Depression; Panic; Normals; Antidepressants

1. Introduction

*Corresponding author. LIM-23, Departamento de Psiquiatria,The importance of assessing the impact of a˜FMUSP, Caixa Postal 3671, CEP 01060-970, Sao Paulo, SP,

psychiatric disorder on patients’ social functioning inBrazil. Tel. / fax: 155-11-3069-6958.E-mail address: [email protected] (C. Gorenstein). terms of the patients’ ability to perform roles and

0165-0327/02/$ – see front matter 2002 Elsevier Science B.V. All rights reserved.PI I : S0165-0327( 01 )00300-7

168 C. Gorenstein et al. / Journal of Affective Disorders 69 (2002) 167–175

their adequacy in interpersonal relationships is now 1980; or Composite International Diagnostic Inter-well recognized (McDowell and Newell, 1996). view, Robins et al., 1988) and then in a semi-Scales that focus specifically on social adjustment, structured clinical interview (Schedules for Clinicalapart from the core symptoms of the disorder, have Assessment in Neuropsychiatry; SCAN, Wing et al.,been available since the 1960s. In her first review of 1990), applied by a trained psychiatrist. Subjectsthe techniques to assess social adjustment, Weissman were considered normal when they did not meet(1975) described the existence of 15 scales that met criteria for any lifetime psychiatric diagnosis accord-the criteria for utility and adequate psychometric ing to ICD-10 or DSM-III-R. The sample consistedproperties. This number increased to 27 in 6 years of 61 subjects of both genders (37 female), aged 20(Weissman et al., 1981), and new instruments, such to 68 (mean6S.D. 38.3612.8), with different levelsas the Social Adaptation Self-evaluation Scale of education: 8 years of school (n 5 8), 11 years of(SASS; Bosc et al., 1997), are still being developed. school (n 516), and college or further educationThe interest in social functioning as a measure of (n 5 37).treatment outcome is increasing, particularly becauseof drug trials showing differential effects on social 2.1.2. Patientsfunctioning (e.g., Dubini et al., 1997). Patients came from specialized clinics of the

Several areas of social functioning, such as work, Institute of Psychiatry of the Clinical Hospital,˜social and leisure activities, and family relationships, School of Medicine, University of Sao Paulo.

are well covered by the Social Adjustment Scale(Weissman and Paykel, 1974), derived from the 2.1.2.1. Depressed patientsStructured and Scaled Interview to Assess Maladjust- Outpatients who met DSM-IV criteria for Re-ment (SSIAM; Gurland et al., 1972a,b). Originally current or Single Major Depressive Episode, treatedan interviewer-rated scale, the SAS was soon con- at the Mood Disorder Unit, were included. Althoughverted to a self-report form (SAS-SR; Weissman and they exhibited anxiety symptoms, they did not fulfillBothwell, 1976). The SAS-SR has the advantage of criteria for any anxiety disorder. They were inter-being simple to administer, inexpensive, waiving viewed using the Schedule for Affective Disordersinterviewers’ training programs, and its results are and Schizophrenia — Lifetime Version (SADS-L,highly correlated with those obtained with the inter- Spitzer and Endicott, 1979), applied by a trainedview form of the scale (Weissman and Bothwell, psychiatrist.1976). SAS-SR scores of acute depressives, al- The first sample included 44 patients of bothcoholics, and schizophrenics were significantly dif- genders (26 female), aged 22 to 75 (mean6S.D.ferent from community sample data (Weissman et 39.1612.4) who completed the questionnaire duringal., 1978). an acute depressive episode, before receiving any

The objective of this study was to obtain norma- treatment (theacutely symptomatic depressive sam-tive data for the SAS-SR Portuguese version from ple). An independent sample of 28 patients of bothBrazilian psychiatric patients and normal subjects in genders (20 female), aged 22 to 54 (mean6S.D.order to assess the psychometric properties and the 35.869.0), who improved considerably in theirusefulness of the scale in a different culture and clinical conditions after receiving antidepressants forlanguage, and to test its ability to detect different at least 8 weeks formed the ‘in remission depressiveclinical conditions. sample’.

2.1.2.2. Panic disorder patients2. Methods Outpatients meeting DSM-III-R criteria for Panic

Disorder with or without Agoraphobia (American2.1. Subjects Psychiatric Association, 1987) treated at the Anxiety

Disorders Clinic were included. Although they ex-2.1.1. Normals hibited depressive symptoms, they did not fulfill

Normal subjects were first selected in a general criteria for any mood disorder.screening (Self-Report Questionnaire, Harding et al., Forty patients of both genders (30 female), aged

C. Gorenstein et al. / Journal of Affective Disorders 69 (2002) 167–175 169

18 to 60 (mean6S.D. 35.7610.2), answered the 2.2.2. Beck Depression Inventory (BDI)questionnaire before receiving any treatment (acutely The Portuguese version of the 21-item Revisedsymptomatic panic sample). An independent sample Form of the Beck Depression Inventory (Beck et al.,of 58 patients of both genders (36 female), aged 22 1979, 1982) was used. The scale consists of itemsto 58 (mean6S.D. 37.668.7), completed the ques- including symptoms and attitudes with intensitiestionnaire after being treated with clomipramine (for ranging from neutral to a maximum level of severity,at least 1 year), and were fully remitted of panic rated 0 to 3 (overall score varies from 0 to 63). Theattacks and phobic symptoms according to clinical scale has been validated in Brazilian samplescriteria (in remission panic sample). (Gorenstein and Andrade, 1996; Gorenstein et al.,

1995, 1999). For samples of patients with affectivedisorders the BDI cut-off scores (Beck et al., 1988)

2.1.2.3. Other patients are: ,10, none or minimal depression; 10–18, mildFourteen male inpatients from the Alcohol and to moderate depression; 19–29, moderate to severe

Drug Dependence Clinic, aged 20 to 34 (mean6S.D. depression; 30–63, severe depression. The scale was24.665.1), matching ICD-10 criteria for cocaine completed by all samples, except the bulimic pa-dependence, were included. They were first inter- tients.viewed by the SCAN, and completed the ques-tionnaire before receiving any treatment. 2.2.3. Hamilton Depression Inventory (HAM-D)

Fifteen outpatients from the Eating Disorder The Portuguese version of the 21-item scaleClinic, mainly women (14 females), aged 22 to 48 (Hamilton, 1960), evaluating mood and somatic(mean6S.D. 30.967.7), matching DSM-IV criteria aspects of depression in relation to their prevalencefor bulimia nervosa before receiving any treatment and severity, was used. The overall score varied fromwere included. They did not evidence any current 0 to 62.Axis I psychiatric comorbidity.

2.2.4. Clinical Global Impression Scale (CGI)The items global improvement and severity of

2.2. Instruments illness of this global scale (Guy, 1976) were used toevaluate the two samples of depressed patients.

2.2.1. Social Adjustment Scale (SAS)The Self-Report Social Adjustment Scale (Weis- 2.3. Statistical analysis

sman and Bothwell, 1976) is a 42-item scale,measuring either affective or instrumental perform- The concurrent validity, i.e. the capability of theance over the past 2 weeks in seven major areas of scale to discriminate different populations, was test-functioning: work (as a worker, housewife or stu- ed by ANOVA followed by Tukey’s multiple com-dent); social and leisure activities; relationship with parison method.extended family; marital role as a spouse; parental In order to evaluate the ability to detect differentrole; membership in the family unit; and economic clinical states, SAS means of acutely symptomaticadequacy. The overall score is obtained by summing and in remission sub-samples (depressed and panicup the scores of all the items actually assessed and patients) were compared using thet-test. In remis-dividing that sum by the total number of items. Each sion sub-sample mean scores were compared toitem is scored on a five-point scale, from which the normal group scores by ANOVA, followed byrole-area means are obtained, the higher scores being Tukey’s multiple comparison method. When theindicative of greater impairment (1, normal; 5, assumptions of the tests were not valid, data weresevere maladjustment). log transformed.

Two mental health professionals (one psychiatrist) Correlation between SAS and other scales wastranslated the SAS-SR into Portuguese and a native evaluated by the Pearson product moment correlationEnglish speaker reviewed this translation. A bilingu- coefficient.al speaker back-translated the Portuguese version to The influence of demographic variables was testedEnglish. on the normal sample data using ANCOVA consider-


ing two factors — gender and educational level — atric samples was tested by ANOVA. Table 1 showsand age as covariable. overall and sub-scores of the seven major areas of

To compare Brazilian scores with those in the the Social Adjustment Scale in different populationsliterature, mean scores obtained by Weissman et al. and the statistical results of ANOVA post-hoc com-(1978) were considered as reference values and parisons (Tukey’s test).compared by Student’st-test with the Brazilian ANOVA showed a significant difference for thesample scores. SAS overall score (P , 0.001) where normal sample

scores were significantly lower than all other groups.Differences between patient groups were evidenced

3. Results between depressed and panic, and cocaine-dependentand panic patients.

3.1. Psychometric properties of the Brazilian Significant differences were also found for sub-version scales [P , 0.001 for all sub-scales, except for

parental and family unit (P , 0.05); Table 1]. Nor-Considering the normal sample, there was no mals were different from all other groups on the

overall effect of demographic variables on SAS (P . sub-scales work, leisure time and extended family.0.70) and on individual subscales (P $ 0.14) except Cocaine-dependent patients were different from de-for an age effect on the parental subscale (P 5 0.04). pressed, panic and bulimic patients on the sub-scaleThe SAS subscales’ reliability estimated by Cron- work; the cocaine-dependent group was also sig-bach’s alpha coefficient was 0.85. nificantly different from panic patients on the sub-

scale extended family. For family unit, the only3.2. Concurrent validity significant difference was between normals and

depressed patients. For economic conditions, normalsThe capability of the scale to discriminate between were different from depressed and bulimic patients.

the normal sample and acutely symptomatic psychi- Post-hoc tests could not be performed for marital and

Table 1aSocial Adjustment Scale scores in different samples

Work Social and leisure Extended family Marital Parental Family unit Economic condition Overall

1. Normal subjects (n 561) 1.2460.28 a*** 1.7760.49 a*** 1.4660.38 a*** 1.5960.39 1.6460.71 1.5760.73 b** 1.6460.93 b***, c* 1.5660.36 a***

2. Acutely symptomatic

depressed patients (n 5 44) 2.5561.11 d*** 2.8560.68 d* 2.1460.64 d** 2.8060.83 d* 2.1660.94 d* 2.3261.11 2.5561.25 d* 2.5560.56 d***, e*

3. In remission depressed

patients (n 5 28) 1.4460.64 2.4060.94 f*** 1.6460.52 2.2960.81 f*** 1.6060.56 1.7760.88 1.9260.91 2.0060.59 f***

4. Acutely symptomatic

panic patients (n 5 40) 2.1060.90 g*** 2.5660.67 g*** 1.9160.52 g*** 2.1460.59 g* 1.7860.51 g** 1.7660.69 2.2961.33 g* 2.1760.43 g***

5. In remission panic

patients (n 5 58) 1.4960.49 h** 1.9760.62 i* 1.5360.43 1.8060.55 h*, i* 1.4260.36 1.7160.54 1.7861.11 1.7160.38 h*, i*

6. Bulimic patients (n 5 15) 2.2860.60 2.8160.87 2.4160.77 2.2860.70 2.6960.63 2.1360.84 3.2161.63 2.5560.63

7. Cocaine dependent (n 514) 3.9961.53 j*** 2.7860.86 2.5961.06 k* 2.0060.00 1.5560.69 2.5761.60 2.7060.78 k*

8. Community sample (n 5399;

Weissman et al., 1978) 1.4060.46 1.8360.52 1.3460.33 1.7560.48 1.4060.42 1.4660.58 1.5960.33

9. Depressed patients (n 5 172;

Weissman et al., 1978) 2.4860.75 2.8560.66 2.1560.69 2.4560.55 2.2760.81 2.8360.89 2.5360.46

10. Alcoholic dependents (n 5 26;

Weissman et al., 1978) 1.8260.62 2.5060.79 2.0260.65 2.0760.64 1.7760.62 2.4661.14 2.2360.61

a Scores are expressed as mean6standard deviation. Results of post-hoc ANOVA comparisons (Tukey test) are shown by lettersconsidering group numbers as in the first column: a, 1±2, 4, 6, 7; b, 1±2; c, 1±6; d, 2±3; e, 2±4; f, 3±1; g, 4±5; h, 5±1; i, 5±3; j,7±2, 4, 6; k, 7±4. The significance of statistic results are presented as follows: ***P # 0.001; **P ,0.01; *P , 0.05. Empty cells indicatethat the subscale was not applicable to the sample or the result was not available (samples 8, 9 and 10).


parental sub-scales due to missing data (at least one ANOVA showed significant differences for total,group had less than two cases), which means that marital, social and work mean scores after treatmentmany subjects were not married and did not have among normals, depressed patients and panic pa-children. tients (P , 0.006). Scores of panic patients in remis-

sion were significantly higher than normal samplemean scores for SAS overall, and sub-scales work

3.3. Ability to detect different clinical conditions and marital.A comparison of panic and depressed patients in

3.3.1. Depressed patients remission showed that SAS overall, and sub-scalesRemission SAS overall and all sub-scale scores leisure time and marital were significantly higher for

except family unit (P 5 0.08) were significantly depressed than for panic disorder patients (ANOVA,lower than the scores of the acutely symptomatic P , 0.006).depressive sub-sample (Student’st-test; significancestatistics in Table 1).

ANOVA indicated significant differences for total, 3.4. Correlation between SAS and other scalesmarital, social and work mean scores among normaland in remission depressed and panic patients (P , In the normal sample, the correlation between0.006). The scores of depressed patients in remission SAS and other scales was significant for BDI (r 5were significantly different from the normal sample 0.35;P ,0.040). Significant correlations were foundmean scores in SAS overall, leisure time and marital in acutely symptomatic and in remission depressedsub-scales. and panic patients for SAS and BDI, HAM-D and

CGI (Table 2). Accordingly, HAM-D explains 20%of SAS overall score variability and CGI global

3.3.2. Panic patients improvement explains 30%, while BDI explainsIn panic patients, SAS overall and sub-scale post- 65.5% of social impairment variability. In cocaine-

treatment scores (Table 1), except for family unit, dependent patients, the correlation between SAS andwere significantly (Student’st-test) lower than be- other scales was significant for BDI (r 5 0.556;P ,

fore treatment. 0.040).

Table 2aCorrelation among SAS scores and other scales in depressed patients in different clinical conditions

Work Social and Extended Marital Family Overallleisure family unit

BDIAcutely symptomaticdepressed patients ns 0.565** ns ns ns 0.626***

In remission depressedpatients 0.720*** 0.793*** 0.655*** 0.511* 0.481* 0.809***

HAM-DIn remission depressedpatients 0.484* ns 0.405* ns ns 0.445*

CGISeverity of illness (in remissiondepressed patients) 0.451* ns ns ns ns 0.429*

Global improvement (inremission depressed patients) 0.621** 0.485* 0.452* ns ns 0.559**

a Correlation is expressed by Pearson product-moment coefficients. The significance of statistic results are presented as follows:*** P , 0.001; **P , 0.01; *P , 0.05. ns, correlation not statistically significant.


3.5. Comparison of Brazilian SAS scores and omic conditions were impaired to a higher level inliterature reference values depressed and bulimic patients.

Despite the small sample size, our data on bulimicNo significant difference was found in mean SAS and cocaine-dependent patients are consistently simi-

scores for the normal sample and the community lar to those found in the literature (e.g., Johnson andsample described by Weissman et al. (1978). The Berndt, 1983; Kasarabada et al., 1999). Overall SAS,same result was obtained when these depressed marital, and family unit impairment observed in thepatients before treatment were compared with the bulimic patients were in keeping with those reporteddepressed patients of Weissman’s study. in other studies (Keel et al., 2000) and with the

findings of social maladjustment in bulimia nervosa(e.g., Herzog et al., 1986; Fallon et al., 1991).

4. Discussion Although social impairment in depressed patientsis well documented (e.g., De Lisio et al., 1986;

Considerable attention is currently being given to Paykel and Weissman, 1973; Perugi et al., 1988;the extent of social impairment and dysfunction Weissman et al., 1978), this is the first studyassociated with psychiatric disorders and to the reporting data for a Brazilian population. The samedevelopment of instruments for its evaluation. The level of impairment was observed in these depressedSocial Adjustment Scale — Self-Report form has patients and in those reported by Weissman et al.been translated into other languages, but a Por- (1978). Similar results for depressed patients andtuguese version was not available. normal subjects were also reported in other studies

This study shows the validity of the SAS-SR (e.g., Friedman et al., 1999; Leader and Klein, 1996;through a comparison of the social functioning of Stewart et al., 1988). Thus, it seems that depressiondifferent psychiatric disorder populations with that of affects social functioning in a similar way in differ-a normal subject sample. In contrast to most studies ent cultural settings.where the control group is taken from the general In agreement with other studies (Agosti et al.,population, this was a carefully selected non-psychi- 1991, 1993; Kocsis et al., 1988, 1997; Stewart et al.,atric sample not matching criteria for any lifetime 1988), the Portuguese version of SAS-SR alsopsychiatric diagnosis. Thus, the normal group data showed evidence of improvement in the psychosocialcan be taken as a reference pattern of the social functioning of depressed treated patients, since the infunctioning of the Brazilian population. It is interest- remission sample overall and sub-scale scores wereing to note that these normal sample data and those significantly lower than in the acutely symptomaticof Weissman et al.’s (1978) community sample are patients. However, although showing an improvedquite similar, which suggests that the social func- functioning when treated, depressed patients weretioning of normals is similar in these different still impaired in relation to normal subjects in overallcultures. social functioning, leisure time, and marital areas.

The concurrent validity of the SAS-SR was at- The finding that social functioning remains im-tested by the scale’s ability to differentiate normal paired, to a certain extent, in depressed treatedsubjects from psychiatric patients. SAS overall and patients, is supported by other studies. De Lisio et al.sub-scale scores of the normal sample were con- (1986) found that depressed outpatients in remissionsistently lower than those of depressed, panic, remained impaired in the social and leisure areas.bulimic and cocaine-dependent patients. Among Stewart et al. (1988) reported that the social func-patient sub-groups, the overall social functioning of tioning of depressed patients who responded topanic patients seems to be less affected than in other treatment was impaired at a significantly higher leveldiagnoses. Impairment in specific areas was different than community control subjects. Agosti and Stewartamong groups. For instance, work dysfunction was (1998) compared the SAS scores of depressedhigher in cocaine-dependent patients; impairment of patients who responded to acute treatment and had afamily unit was higher in depressive patients; econ- sustained 6-month period of remission with the


scores of the Weissman et al. (1971) community et al. (1994), panic-agoraphobic patients experiencesample. They found no difference in overall adjust- significantly less impairment of work and leisurement scores between the two samples, but patients activities, sexual life and social relations than depres-were more affected in social and leisure functioning sives. In contrast, depression appeared to impair allthan the control group. social functions, especially those involving pleasure.

Kocsis et al. (1988) found that chronically de- The authors suggested that certain social parameters,pressed patients treated with imipramine showed such as impairment of leisure functions, could dis-significantly greater improvement in overall social tinguish depressive from panic patients.functioning than did a placebo control group. How- In the present study panic patients were impairedever, few dysthymic treatment responders in these overall and in all the areas of social adjustment,studies achieved levels of social functioning compar- when compared to the normal sample. However,able to that of normal controls. Friedman et al. panic patients were less affected than depressed and(1999) showed that dysthymic patients did not cocaine-dependent patients on overall adjustment.achieve a community level social adjustment after 6 Also, cocaine-dependent patient scores were highermonths of effective treatment. Taken together, these than panic patients in the areas of work and relation-studies suggest, as pointed out by Bauwens et al. ship with extended family.(1998), that in depression, the social maladjustment The treatment outcome also seemed different ininvolving leisure activities persists after remission, depressed and panic patients. In remission scoreswhile work impairment appears to be related mainly were significantly lower than scores in acutelyto the depressive episodes. Thus, the incapacity to symptomatic patients for both groups. However,enjoy leisure time may represent a trait marker of normalization was not achieved for overall func-depression or it could be a residual depressive tioning and marital areas in panic and depressedsymptomatology (Perugi et al., 1988). No conclusion patients, but work seemed worse in panic whilecan be drawn until further studies evaluating the social and leisure areas were worse in depressivesocial functioning of depressed patients after long- patients. Compared to depressed patients, the treat-term remission become available. ment outcome in panic patients was better in overall

The correlation between SAS and clinical outcome SAS and in the leisure and marital areas.measures, such as the Hamilton Depression Rating In conclusion, the Portuguese version of SAS-SRScale and the Clinical Global Impression, showed has been shown to be a useful instrument forthat improvement in depressive symptoms does not detecting differences between psychiatric patientsentirely account for the improvement in social and normal subjects and for the investigation offunctioning. In fact, approximately 20 and 30% of different clinical conditions. This study also con-the SAS overall score variability are explained by firmed the relevance of the measurement of socialHAM-D or CGI-global improvement, respectively. adjustment in addition to the assessment of clinicalIn contrast, the correlations were higher between conditions in outcome studies.BDI and SAS, two self-rating scales, showing thatsocial functioning should be measured apart from theusual clinical state scales.

In comparison with depression, fewer studies have Acknowledgementsaddressed the social functioning in panic disorderpatients. A large epidemiological study (Markowitz This research was developed at LIM-23, Depar-et al., 1989) concluded that panic disorder is associ- tamento de Psiquiatria, Faculdade de Medicina da

ãted with social, marital, and financial impairment, Universidade de Sao Paulo. The authors wish tosimilar to that associated with major depression. This thank Adriano Segal, and Maristela Precivale andcontrasts with Noyes et al. (1990), who suggested Eliana de Benedictis for their help with data collec-that panic disorder patients report relatively little tion and statistical analysis, respectively. C.G. isdistress or social maladjustment. According to Perugi supported by CNPq. A.P.P. Camargo was supported


Brazilian university students on the Beck Depression and theby FAPESP. R.A. is supported by CNPq and FAP-State-Trait anxiety inventories. Psychol. Rep. 77, 635–641.ESP.

Gorenstein, C., Andrade, L., Vieira Filho, A.H.G., Tung, T.C.,Artes, R., 1999. Psychometric properties of the Portugueseversion of the Beck Depression Inventory on Brazilian collegestudents. J. Clin. Psychol. 55, 1–10.

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Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples