UBOM-4, a New Scale for Psychic Function and Energy: General Population Normative Values and Influencing Parameters

Objective: We introduce Utena’s Brief Objective Measures of 4 Axes for Psychic Function and Energy (UBOM-4), a new brief test battery for evaluating psychic function concerning intellect, emotion, volition, and imagination. To date, insufficient general population data on the UBOM have been col-lected. This study aimed to establish the normative values for the general population in UBOM-4 and examine the effects of age, sex, and mental health status on the values. Methods: The General Health Questionnaire, 12-item version (GHQ-12) and UBOM-4 were administered to 149 individuals working in or attending professional schools or universities (73 males, 76 females; age: 19 - 65 years). Participants were classified as healthy based on their GHQ-12 responses and psychiatrist interviews. Results: UBOM-4 measures (mean ± SD) were: pulse rate difference (PRD or UBOM-pulse), −0.72 ± 4.31 beats/min; ruler catching time (RCT or UBOM-ruler), more frequently (42%). Discussion: Compared to previous results for healthy individuals, the present results were similar for RCT (UBOM-ruler), DOR (UBOM-random), MRT (UBOM-time), and the drawing pattern, but different for PRD (UBOM-pulse). This difference is probably because PRD is sen-sitive to test situation habituation, sex of examiner, order of subtests, etc. Thus, PRD (UBOM-pulse) should be measured after the subject-examiner relationship stabilizes. Conclusion: Our results suggest that UBOM-4 can be widely used in clinical settings, utilizing the present results as a reference.


Introduction
In 1996, Utena and Miyake [1]  Psychic function is generally thought to consist of four factors: intellect, emotion, volition, and imagination [2]. Therefore, UBOM was proposed as a brief psychophysiological test battery to objectively measure and assess these four factors ( Figure 1).
As shown in Figure 1, psychic function is the system that regulates human behavior from input to output. Fundamentally, behavior is governed by a parallel combination of stimulus and response sets. Human behavior is further controlled by the operation set that couples the two sets from a higher order. This operation set works while mutually interacting with a widely expanding imagination set. In the four-function model of intellect, emotion, volition, and imagination that comprise psychic function, intellect corresponds to the operation set, emotion to the stimulus set, volition to the response set, and imagination to the imagination set. Based on this model, UBOM assesses intellect, emotion, volition, and imagination through four subtests: 1) a pulse rate difference test [1], 2) a ruler catching test [1], 3) a random number generation test [3], and 4) a tree drawing test (Baum Test) [4] [5]. The pulse rate difference test measures stress responses or  [5]. Utena and Miyake used UBOM in patients with psychiatric disorders [1] and its clinical usefulness has been gradually established [5].
Standardizing UBOM results for healthy individuals and understanding the factors that may affect the results will be useful for the future use of UBOM. In this study, we administered UBOM to healthy individuals and used the results to develop standard values for UBOM indices among the healthy general population. Further, we investigated the relationship between the results and the subjects' age, sex, and mental health status as captured by the GHQ-12, and explored factors that may influence UBOM results.

Subjects and Methods
This study was conducted with the approval of the ethical review board of the

Subjects
We recruited subjects among people who are between 19 to 65 years old and participating in the usual social activities. We excluded people from the subjects who are receiving psychiatric treatment. The subjects were participating in usual social activities during the period of at least 1 year before the assessment using UBOM-4.
As shown in Table 1, 149 subjects from the general population who were working [6]

Methods
For all 149 subjects participating in this study, the GHQ-12 was administered first, immediately followed by the UBOM. Both were implemented by the same examiner (DG).

GHQ-12
Developed from 1960 to 1970 by Goldberg, the GHQ is a self-report-style questionnaire that screens for mild non-psychotic psychiatric disorders. The 12-item edition of the GHQ (GHQ-12) is particularly convenient because of the small number of questions, and its validity is comparable to that of the other editions [7] [8] [9] [10]. A previous study found the cutoff value of 4 points to be most appropriate when the GHQ-12 was used to screen for psychiatric disorders [11], with participants responding on a four-point scale ("Not at all," "Same as usual," "Rather more than usual," and "Much more than usual"). There are two methods of GHQ-12 scoring, the Likert method and the GHQ method [12]. In this study, we used the GHQ method which produces a dichotomous score of 0 or 1; "Not at all" and "Same as usual" responses were scored 0, and "Rather more than usual" and "Much more than usual" responses were scored 1. PRD (UBOM-pulse) = (heart rate with pressure) − (resting heart rate)

UBOM
2) Ruler catching test: Examinees were instructed as follows: "We will now conduct a ruler catching test. This is a test in which you are asked to catch the falling ruler with your dominant hand. The ruler will be dropped with no warning, but please catch it as quickly as possible once it is falling." A 40-cm com- Note that the RCT (UBOM-ruler) measure in this study used average drop distance (cm) rather than time (secs).
3) Random number generation test: A pencil and Japanese writing paper with 20 boxes per column were prepared. Examinees were told the following: "We will now conduct a random number generation test. You are asked to write one number in each box on the Japanese writing paper. Please use only numbers it was a correction, for example, with a double underline, and to write over the same area (box). To avoid wasting test time, examinees were asked not to make corrections with an eraser.

4) Tree drawing test (Baum Test): Examinees were instructed as follows:
"Please draw one fruit-bearing tree." A specific sheet of paper (white, paper size: B6) was placed vertically in front of the examinee, and they were provided with a 2B pencil and an eraser. At this point, the examinee and examiner were seated on either side of the corner of a desk. Examinees were further instructed: "There The primary criterion of "usual pattern" is that the integrity or the gestalt quality of a drawing is good. Drawings of the usual pattern include representational sketches, cartoonish figures, and elucidative ideographic pictures. They also include figures with their trunks drawn by single lines but carefully and minutely.
Crude drawings or those with weak pen momentum are classified as a usual pattern if they do not bear features of the abnormal pattern. Drawings without crowns but with trunks open at the end of papers are also classified as usual pattern when they can be regarded as drawn off the edge or they are restricted to limited areas of whole drawings. If the contour of the tree is fuzzy or absent with leaves, fruits, and branches dispersedly drawn, it is still classified as usual pattern if its integrity is intact. Moreover, even if trees are drawn intangible, rough, or thin, they may still be classified as usual pattern if their integrity is recognized as good.
The classification criteria for the positive unusual pattern mainly consist of chaos and leak. Chaos represents the appearance or form of a drawing as a whole that is chaotic. Leak means that the trunk or branches or the top of the crown of a drawing remain open and not closed at their ends. This appearance signifies that the inside and outside of a trunk or branch is linked, with the inside being open to the outside, namely leaked. When the differential classification between chaotic and rough, crude, or intangible features of negative unusual patterns is difficult, it is recommended that drawings with Gestaltzerfall (shape decomposition) be classified as positive unusual pattern. Open Journal of Psychiatry The classification criteria for the negative unusual pattern consist of the following two principal items: 1) more than two of the following six points are satisfied: crude, stiff, intangible, thin, rough, and shriveled, and trunks drawn crudely by single thin lines; 2) drawings judged as intangible, rough, or thin with worse integrity than that of the usual pattern.
The mixed pattern bears characteristics of both the positive and negative unusual patterns described above. Example drawings of usual, positive unusual, and negative unusual patterns are shown in Figure 2: A1 -A4 represent the usual pattern, with B1-B4 illustrating the positive unusual pattern, and C1-C3 the negative unusual pattern. In the four B drawings, B1 -B3 are examples of leak, and B4 is of chaos. In the three C drawings, C1 is rough and stiff, C2 is thin and crude, and C3 is rough and shriveled.
Judgments regarding usual and unusual were all carried out by a sole reviewer.
According to Utena and Miyake, the interrater reliability when 205 cases were Open Journal of Psychiatry judged for drawing type by two independent raters was high with κ ＝ 0.634; therefore, this method of rating drawing patterns has a certain degree of objectivity [5]. The measured data were entered into the UBOM software (Hitachi   Denshi Techno

Statistical Analyses
Values for PRD (UBOM-pulse), RCT (UBOM-ruler), DOR (UBOM-random), and MRT (UBOM-time) were grouped by age, sex, and mental health status as represented by the GHQ-12, and drawing patterns were divided by age, sex, and mental health status and classified into usual, positive unusual, negative unusual, or mixed, where age was grouped into 10-year increments (<31, 31 to 40, 41 to 50, >50). Subjects were classified into a high score group and a low score group based on their GHQ-12 scores for a mental health grouping. A lower GHQ-12 score indicates a higher degree of health. To divide subjects into high and low groups so that the number of subjects was not biased toward either group, a total GHQ-12 score of 3 points or above was set as the high group and 2 points or below was set as the low group.
A two-way analysis of variance was conducted to examine the influence of age and sex on mental health status, with GHQ-12 score as the dependent variable and age (4 levels) and sex (2 levels) as independent variables. A three-way analy-

GHQ-12 Scores and Effects of Age and Sex
For the GHQ-12, there were 65 subjects in the high score group with scores of 3 or above and 84 in the low score group with 2 or below. Table 2

UBOM in Healthy Individuals
UBOM test results for the 149 healthy subjects of the present study are shown in

Pulse Rate Difference [PRD (UBOM-Pulse)]
The PRD (UBOM-pulse) results are shown in Table 3. The topmost level displays all ages, the second level age group 1 (<31 years), the third level age group 2 (31 to 40), the fourth level age group 3 (41 to 50), and the bottommost level age group 4 (>50). The first row in each section displays the total score for both males and females, the second row for males, and the third row for females. For   Table 4. Drawing pattern classifications for the Baum Test drawings in all cases by age group. These are divided into the GHQ-12 high score and low score groups. The topmost level displays all ages, the second level age group 1 (<31), the third level age group 2 (31 to 40), the fourth level age group 3 (41 to 50), and the bottommost level age group 4 (>50).   Table 3, and the drawing patterns in Table 4.  Table 3.

Degree of Randomness [DOR (UBOM-Random)]
DOR results are displayed in Table 3 results for the high and low score groups for the GHQ-12 are also displayed in Table 3.

Effects of Age, Sex, and Mental Health Status on PRD (UBOM-Pulse)
A three-way analysis of variance was conducted with PRD(UBOM-pulse) value as the dependent variable and age (4 levels), sex (2 levels), and mental health status (GHQ-12 [2 levels]) as the independent variables. No significant main effects or interactions were found for age, sex, or GHQ-12 score.

Effects of Age, Sex, and Mental Health Status on RCT (UBOM-Ruler)
A three-way analysis of variance was conducted with RCT(UBOM-ruler) value as the dependent variable and age (4 levels), sex (

Effects of Age, Sex, and Mental Health Status on DOR (UBOM-Random)
A three-way analysis of variance was conducted with DOR(UBOM-random) as the dependent variable and age (4 levels), sex (2 levels), and mental health status The value for the GHQ-12 low score group was 0.96 ± 0.20, and for the high score group was 0.92 ± 0.16. The post-hoc analysis revealed a significant difference in the GHQ-12 low score group (0.96 ± 0.19) and high score group (0.85 ± 0.15) (p = 0.005) for males, but no significant difference between the low and high groups was observed in females.

Effects of Age, Sex, and Mental Health Status on MRT (UBOM-Time)
A three-way analysis of variance was conducted with MRT (UBOM-time) as the dependent variable and age (4 levels), sex (2 levels), and mental health status (GHQ-12 [2 levels]) as the independent variables. The results showed a significant interaction between age and GHQ-12 (F[1, 0.892] = 3.308, p = 0.022). The post-hoc analysis revealed a significant difference in the GHQ-12 low score group (0.49 ± 0.26 sec) and high score group (0.77 ± 0.31 sec) (p = 0.006) for age group 2 (31 to 40 years), but no other significant differences were observed.

Effects of Age, Sex, and Mental Health Status on the Drawing
Patterns To investigate the effect of age, sex, and mental health status on the drawing patterns, χ-squared tests were performed on the distribution of the usual and unusual drawings for each age group, each sex, and the GHQ-12 low score and high score groups. When the χ-squared value was significant, a residual analysis was also conducted. The effect of age group (χ 2 [3] = 18.2130, p < 0.001) on the distribution of the usual and unusual drawing patterns was significant, but significant effects of sex and mental health group were not observed. The residual analysis revealed that the unusual patterns were significantly more common in age group 4 (>50 years old) (10 of 24, 42%).

Subject Characteristics and Sex Difference in GHQ-12 Scores
This study aimed to introduce UBOM and standardize UBOM results for healthy individuals and to investigate factors that may influence these results. In D. Gotoh et al. line with this, it was necessary to closely examine whether it was valid to consider the subjects to be healthy individuals. As described in the subjects and methods section, when choosing the subjects, one of the authors, DG (with eight years of experience as a psychiatrist), confirmed through an interview that the subjects were not receiving treatment for a psychiatric disease and were leading a normal social life while either working or attending school. Subjects of various ages and occupations were selected to avoid bias in terms of age or social background. They were employed in various fields, including office work, sales, service (caregiving), safety (firefighting), construction, and student. Thus, we concluded that the subjects were healthy volunteers with no selection bias.
The distribution of the GHQ-12 scores was between 0 and 12 points. If we set a 2/3 cutoff value, 65 (43.0%) of the 149 subjects were determined to be mentally unhealthy with 3 points or above. However, in recent studies using the GHQ-12 in Japan, for example, in Senba and Shimizu [14], which used technical school students as subjects, scores ranged from 0 to 11 points, and 52.3% scored three points or above. A large-scale survey in the United Kingdom by Harrison et al.
found 28.3% of those aged 18 to 34 to be unhealthy based on GHQ-12 scores [15], and in a study by Kageyama with hospital nurses as subjects, 54.1% were found to be unhealthy [16]. Considering this, the 43.0% in this study with 3 or more points is not high.
Moreover, of all factors influencing the GHQ-12 score, only sex was found to be significant. Females have a higher score on the GHQ-12 than males, and there were more females in the GHQ-12 high score group with scores of 3 or above.
Previous studies on sex differences in the GHQ-12 reported that women have higher scores than men and that many high-scorers are women [14] [15] [17] [18] [19]. On the other hand, there are also studies that found no differences between men and women on the GHQ-12 [20] [21] [22]. The results obtained in Open Journal of Psychiatry this study are consistent with most existing findings; therefore we cannot conclude that mental health problems exist in the female participants on the basis of high GHQ-12 scores.

UBOM in the General Population-Standard Values
As described in the previous paragraph, we believe that the 149 subjects of the present study can be considered healthy. Thus, the UBOM test results obtained in this study are valid standard values for the general (healthy) population and provide a useful reference for interpreting the UBOM test results of unhealthy individuals, such as psychiatric patients, in the future. In the following, we discuss the validity of the standard values obtained in the present study, and the possible factors influencing these values. Given that we consider the present participants to be healthy individuals, we do not differentiate high and low GHQ-12 scores in the standard values obtained from this study. We also compared the means for each index obtained from this study to the means reported by Utena et al. [3] for 56 healthy individuals.

Pulse Rate Difference [PRD (UBOM-Pulse)]
As shown in Table 3 the PRD (UBOM-pulse) concordance rate was low, we hypothesized that the relationship between the examiner and the participant (pair) may affect the tension felt by the participant, which may produce a different effect on PRD (UBOM-pulse) for different pairs, resulting in a low ICC for PRD (UBOM-pulse).
In the study [25] where the examiner and participant were fixed and the PRD (UBOM-pulse) measurement was conducted three times in one session with three-minute breaks in between for four sessions, the PRD (UBOM-pulse) ICCs obtained for the second and third times through four sessions were above 0.600, with the highest ICC being 0.923. In the pairs with high ICCs, the examiner and participant knew each other well, or the examiner and participant were of the same sex. This result supports our hypothesis, and such an effect appears more likely in PRD (UBOM-pulse), because it is the first test implemented in the UBOM test. In Utena's studies, PRD (UBOM-pulse) and other tests were measured only by him, and the relationship between patients (examinees) and examiner (Utena) was well stabilized.
The finding that PRD (UBOM-pulse) is significantly affected by the relationship between the examiner and the participant suggests that the pulse rate difference test is suitable for measuring the sensitivity in stimulus reception. However, resourceful methods could be used to overcome the oversensitivity of the pulse rate difference test: 1) keep the participant's tension constant, 2) use an examiner who is familiar to the participant, 3) employ an examiner of the same sex as the participant, and 4) administer the pulse rate difference test twice, once before and once after completing the UBOM test, so as to familiarize the participant with the test setting and obtain more reliable results.

Degree of Randomness [DOR (UBOM-Random)]
As shown in Table 3, DOR (UBOM-random) for all participants was 0.94 ± 0.18 (males, 0.92 ± 0.18; females, 0.95 ± 0.18). As the main effect of sex was significant, it is necessary to set standard values separately for men and women. When D. Gotoh et al.

Limitation
UBOM-4 is a new scale originally developed in Japan and utilized only in Japan at this moment. Thus, readers outside Japan may be perplexed by unfamiliar terms used for the introduction and explanation of UBOM-4 in the present report. We apologize for this inconvenience, and we are also sorry for readers' inconvenience caused by the cited references written in Japanese. Regarding UBOM-4, literatures written in other languages than Japanese are limited as it stands.