The institutional review board of the New York State Psychiatry Institute approved the study protocol.
Participants were individuals evaluated at the Eviction Intervention Services Housing Resource Center (EIS; Rodriguez et al., 2010
), a not-for-profit social service agency in New York City (NYC) that provides legal and housing advocacy for individuals with housing problems including eviction. EIS receives referrals from NYC housing courts, social services agencies, advocacy groups (e.g.
, Emergency Rent Coalition, a network of community organizations that advocates for vulnerable NYC families), and state government programs (e.g.
, Family Eviction Prevention Supplement, a program to pay back rent for families receiving public assistance).
All English- and Spanish-speaking adults who met with an EIS staff member between March 2 and 24, 2010, were invited to participate by the EIS staff. Interested participants were introduced to on-site bilingual research staff who conducted all procedures in the subject’s preferred language. Informed consent was obtained after participants were provided written and verbal explanation of the study purpose and procedures. Clients received $25 for study participation.
Clients were also assessed for HD and the severity of clutter, acquisition, difficulty discarding, distress, and impairment using two scales described in detail below: a) the clinician-administered, semistructured Hoarding Rating Scale–Interview (HRS-I; Tolin et al., 2010
) and b) a self-rating scale, the Saving Inventory-Revised (SI-R; Frost et al., 2004
). The HRS-I is a semistructured interview that assesses severity of clutter, acquisition, difficulty discarding, distress, and impairment, each on a 0 to 8 scale (Tolin et al., 2010
). The HRS-I has excellent internal consistency (α = 0.97) and reliably discriminates hoarding from nonhoarding subjects (sensitivity = 0.97, specificity = 0.97; Tolin et al., 2010
). Consistent with the literature, we used an HRS-I score of at least 14, the cutoff score with optimal sensitivity and specificity, to define HD status (Tolin et al., 2010
). As a secondary measure for HD diagnosis and severity, we used the SI-R (Frost et al., 2004
), a 23-item self-report questionnaire used in previous trials (Gilliam et al., 2009
; Muroff et al., 2007
; Steketee et al., 2010
; Tolin et al., 2007
). The SI-R discriminates people with HD from OCD patients and community controls and correlates significantly with ratings of clutter and impairment; it has three subscales: Clutter, Difficulty Discarding, and Acquisition (Frost et al., 2004
). Internal consistency is excellent for the total score (α = 0.92) and for the three subscales (α = 0.87 to 0.91) (Frost et al., 2004
). Consistent with the literature, we used an SI-R score of at least 40, the cutoff score with optimal sensitivity and specificity, to define HD status (Frost et al., 2004
). Using a structured diagnostic interview modeled after the National Epidemiologic Survey on Alcohol and Related Conditions (Grant et al., 2003
), the research staff asked about age, sex, race/ethnicity, marital status, household composition, and healthcare treatment. Client clinician-administered and self-rating assessments were translated from English to Spanish and were back-translated by a bilingual team of mental health professionals following standard procedures (Brislin, 1986
; Canino et al., 1997
We used a z-test for proportions to compare clinical and demographic correlates between individuals with and without HD. We calculated Cohen kappa to evaluate the level of agreement between clinician-administered (HRS-I) and self-rating (SI-R) assessments of HD.