Social comparison, self-esteem and depression in people with intellectual disability

Depression in people with intellectual disability: an evaluation of a staff-administered treatment program

The prevalence of co-morbid depression in people with intellectual disability (ID) provides a strong rationale for the early identification and treatment of individuals at risk. The aim of this study was to evaluate a staff-administered group CBT program for the treatment of depression in people with mild ID. A sample of 13 staff employed at two community-based disability agencies were trained to deliver the program to 47 individuals with mild ID and symptoms of depression. A wait list control group comprised of 27 individuals subsequently completed the program. Compared to the control group, individuals who had participated in the treatment program showed lower depression scores, and fewer automatic negative thoughts. Furthermore, these changes were maintained at a 3-month follow-up. The results indicate that staff can be trained to deliver a CBT program within community settings that is effective in the reduction of depression symptomatology in people with mild ID.

Women with and without intellectual disability and psychiatric disorders: an examination of the literature

This article examines the literature on women with and without intellectual disability and psychiatric disorders, using a gender social model of health. Relevant empirical studies, international literature reviews and policies between 1980 and 2007 were identified from electronic databases, journals and secondary sources. Three areas were examined: psychiatric disorders, their contextual background, and their clinical presentation. There are minimal levels of research into women with intellectual disability and psychiatric disorders. However, this article hypothesizes that women with intellectual disability have higher rates of psychiatric disorders than women without. This may result from greater vulnerability related both to internal factors (;intra': cognitive deficits, poorer communication skills, limited social skills) and to the external world (;inter': lack of opportunities, stigma, poor social support networks). The article argues that such women require gender-sensitive mental health services. However, more empirical evidence is required to support this claim and to inform development and delivery of services.

The effectiveness of self help technologies for emotional problems in adolescents: a systematic review

BACKGROUND

Adolescence is a transition period that involves physiological, psychological, and social changes. Emotional problems such as symptoms of anxiety and depression may develop due to these changes. Although many of these problems may not meet diagnostic thresholds, they may develop into more severe disorders and may impact on functioning. However, there are barriers that may make it difficult for adolescents to receive help from health professionals for such problems, one of which is the limited availability of formal psychological therapy. One way of increasing access to help for such problems is through self help technology (i.e. delivery of psychological help through information technology or paper based formats). Although there is a significant evidence base concerning self help in adults, the evidence base is much weaker in adolescents. This study aims to examine the effectiveness of self help technology for the treatment of emotional problems in adolescents by conducting a systematic review of randomized and quasi-experimental evidence.

METHODS

Five major electronic databases were searched: Medline, PsycInfo, Embase, Cochrane Controlled Trials Register and CINAHL. In addition, nine journals were handsearched and the reference lists of all studies were examined for any additional studies. Fourteen studies were identified. Effect sizes were calculated across 3 outcome measures: attitude towards self (e.g. self esteem); social cognition (e.g. self efficacy); and emotional symptoms (i.e. depression and anxiety symptoms).

RESULTS

Meta analysis showed small, non-significant effect size for attitude towards self (ES = -0.14, 95% CI = -0.72 to 0.43), a medium, non-significant effect size for social cognition (ES = -0.49, 95% CI = -1.23 to 0.25) and a medium, non-significant effect size for emotional symptoms (ES = -0.47, 95% CI = -1.00 to 0.07). However, these findings must be considered preliminary, because of the small number of studies, their heterogeneity, and the relatively poor quality of the studies.

CONCLUSION

At present, the adoption of self help technology for adolescents with emotional problems in routine clinical practice cannot be recommended. There is a need to conduct high quality randomised trials in clearly defined populations to further develop the evidence base before implementation.

A preliminary evaluation of the adaptation of four assessments for offenders with special needs

BACKGROUND

Appropriate assessment is an essential part of treating sexual offenders. Few assessments exist that can be used with offenders who have lower levels of intellectual functioning and/or literacy deficits.

METHOD

This study describes the adaptation of four self-report assessments for sexual offenders with special needs: (i) the Social Intimacy Scale (SIS: Miller & Lefcourt, 1982); (ii) the Relationship Scales Questionnaire (RSQ: Griffin & Bartholomew, 1994a); (iii) the Criminal Sentiments Scale (CSS: Gendreau, Grant, Leipciger, & Collins, 1979); and (iv) the Victim Empathy Distortion Scale (QVES: Beckett & Fisher, 1994). Each scale was adapted in an effort to simplify content and language and to improve readability. Preliminary data are presented on the comparability of each adapted measure to the original, as well as the internal consistency, reliability, and concurrent validity of the adapted tests.

RESULTS

The SIS and the QVES were identified as appropriate assessment measures, comparable to the original with good reliability and validity. One subscale of the RSQ had fair reliability and validity, while the remaining subscales had varied psychometric properties. The adapted CSS had poor psychometric qualities and the adaptation of this test appears not to have been successful.

CONCLUSIONS

The relevance of these findings to our understanding of offending by this population is discussed.

Early detection of depression and associated risk factors in adults with mild/moderate intellectual disability

The aim of this study was to determine the presentation and risk factors for depression in adults with mild/moderate intellectual disability (ID). A sample of 151 adults (83 males and 68 females) participated in a semi-structured interview. According to results on the Beck Depression Inventory II, 39.1% of participants evinced symptoms of depression (2 severe, 14 moderate, and 43 mild). Sadness, self-criticism, loss of energy, crying, and tiredness appeared to be the most frequent indicators of depression or risk for depression. A significant difference was found between individuals with and without symptoms of depression on levels of automatic negative thoughts, downward social comparison and self-esteem. Automatic negative thoughts, quality and frequency of social support, self-esteem, and disruptive life events significantly predicted depression scores in people with mild/moderate ID, accounting for 58.1% of the variance.

A review of the reliability and validity of Likert-type scales for people with intellectual disability

BACKGROUND

Likert-type scales are increasingly being used among people with intellectual disability (ID). These scales offer an efficient method for capturing a wide range of variance in self-reported attitudes and behaviours. This review is an attempt to evaluate the reliability and validity of Likert-type scales in people with ID.

METHODS

Fifty-one studies reporting response rates, response bias, reliability and validity of Likert-type scales among adolescents and adults with ID were reviewed.

RESULTS

Low response rates were found among adolescents and adults with moderate to profound ID, when pictorial representations of response alternatives were not employed, and for Likert-type scales with self-descriptive statements. Response bias was evident, particularly among adolescents and adults with moderate to profound ID. Likert-type scales have better reliability and validity among adolescents and adults with borderline IQ or mild ID. Pretests and clarifying questions increase reliability and validity.

CONCLUSIONS

Likert-type scales should include pictorial representations of response alternatives, a single set of one or two word response descriptors, clarifying questions, and pretests, and are best used with adolescents and adults with borderline IQ to mild ID.

Evaluating an Interpersonal Model of Depression Among Adults With Down Syndrome

The Interpersonal Model of Depression (IMD) based on the Theory of Human Relatedness (Hagerty, Lynch-Sauer, Patusky, & Bouwsema, 1993) is evaluated among adults with Down syndrome. One hundred subjects participated, with 32% having elevated depression scores and 40% stating they felt lonely. The relationship between depression, perceived social support, loneliness, and life satisfaction is statistically significant, F(6, 172) = 4.36, p < .001. Loneliness, social isolation, loss of sense of well-being, self-hate, and social withdrawal are important interpersonal manifestations and represent increasing levels of depression. Social and emotional loneliness are two dimensions of loneliness. The IMD provides a framework to assess depression in this population. Research on the efficacy of depression treatment based on the IMD is needed.

Young people with intellectual disabilities attending mainstream and segregated schooling: perceived stigma, social comparison and future aspirations

BACKGROUND

Mainstream schooling is a key policy in the promotion of social inclusion of young people with learning disabilities. Yet there is limited evidence about the school experience of young people about to leave mainstream as compared with segregated education, and how it impacts on their relative view of self and future aspirations.

METHODS

Sixty young people with mild to moderate intellectual disabilities in their final year of secondary school participated in this study. Twenty-eight individuals came from mainstream schools and 32 attended segregated school. They completed a series of self-report measures on perceptions of stigma, social comparison to a more disabled and non-disabled peer and the likelihood involved in attaining their future goals.

RESULTS

The majority of participants from both groups reported experiencing stigmatized treatment in the local area where they lived. The mainstream group reported significant additional stigma at school. In terms of social comparisons, both groups compared themselves positively with a more disabled peer and with a non-disabled peer. While the mainstream pupils had more ambitious work-related aspirations, both groups felt it equally likely that they would attain their future goals. Although the participants from segregated schools came from significantly more deprived areas and had lower scores on tests of cognitive functioning, neither of these factors appeared to have an impact on their experience of stigma, social comparisons or future aspirations.

CONCLUSIONS

Irrespective of schooling environment, the young people appeared to be able to cope with the threats to their identities and retained a sense of optimism about their future. Nevertheless, negative treatment reported by the children was a serious source of concern and there is a need for schools to promote the emotional well-being of pupils with intellectual disabilities.

Effectiveness of treatment programmes for depression among adults with mild/moderate intellectual disability

BACKGROUND

The current study describes the development and evaluation of group treatment programme for people with mild/moderate intellectual disability (ID).

METHODS

A total of 34 participants (16 males, 18 females) completed the treatment programme and 15 participants (six males, nine females) comprised a control group.

RESULTS

Compared to the control group, the intervention group showed an improvement in levels of depression, positive feelings about the self, and lower levels of automatic negative thoughts after the intervention. These changes were maintained at 3-month follow-up.

CONCLUSIONS

These results demonstrate that intervention programmes are effective for the treatment of depression among people with ID.

Model Underpinning Treatment for Sex Offenders With Mild Intellectual Disability: Current Theories of Sex Offending

Although many writers have provided a theoretical framework for treatment of mainstream sex offenders, this research has not been extended to sex offenders with mild intellectual disability. My purpose here is to bring together several research strands to provide a theoretical model for working in this field, including theories of sex offending, developmental theories for offending, and work on quality of life. In addition to dealing with issues of sex offending, researchers should also investigate developmental and societal issues crucial in the genesis of sex offending and offending in general. Because societal issues are also important for treatment, engagement and identification with society are suggested. Quality of life and issues directly related to sex offending are of central importance.

Can physical training have an effect on well-being in adults with mild intellectual disability?

The aim of this study was to investigate the effect of physical training on balance, strength, and general well-being in adult people with intellectual disability (ID). This study evaluated how physical training can effect physical and psychological change among 'older' adults with mild ID. Participants consisted of non-randomly selected groups with ID (n=22), between 54 and 66 years of age. Clinical balance functional tests were measured by a modified Timed Get-up and Go test and Functional Reach test. Knee muscles strength were measured on a Biodex dynamometer. The self-concept of well-being was measured by direct interview with a questionnaire consisting of 37 structural statements. Physical training program was conducted three times a week for six consecutive months. Multiple regression analyses suggested positive relations between balance, muscle strength, well-being and physical training between the experimental and control group. This positive relation can support the role and importance of physical training to improve locomotor performance and perception of well-being among 'older' adults with ID.

Coping with social stigma: people with intellectual disabilities moving from institutions and family home

BACKGROUND

Social stigma and its impact on the life opportunities and emotional well-being of people with intellectual disabilities (IDs) are a subject of both practical and theoretical importance. The disability movement and evolving theories of self, now point to individuals' ability to develop positive identities and to challenge stigmatizing views and social norms.

METHOD

This paper presents findings from a phenomenological study of 10 individuals making the transition from their family home to live more independently and 18 individuals moving from a long-stay hospital to live in community housing. It builds on an earlier data set obtained from people living at home with their families and examines: (1) people's awareness of stigma, and (2) their modes of adaptation to stigma.

RESULTS

The participants all believed that they faced stigmatized treatment and were aware of the stigma associated with ID. They presented a range of views about self in relation to disability and stigma. These views included regarding themselves as part of a minority group who reject prejudice, and attempts to distance themselves from stigmatizing services and from other individuals with IDs.

CONCLUSIONS

The findings are discussed in relation to theories of self and the importance of considering psychosocial factors is stressed in clinical work with people who have IDs.

Measurement of mood in adolescents with intellectual disability

To date, there has been limited research into mood responses among adolescents with intellectual disability. One reason for this is the absence of a reliable and valid measure for the assessment of mood among this population. The present study evaluated such a measure among a sample of 135 adolescents with mild intellectual disability. Results supported the factorial validity of a 12-item derivative of the Profile of Mood States, referred to as the Intellectual Disability Mood Scale (IDMS). Convergent and divergent validity was also supported. Overall, the IDMS showed encouraging psychometric characteristics as a measure of mood among adolescents with intellectual disability. It is hoped that the results of this study will stimulate further research to expand our knowledge of mood responses among this population.

Psychosocial Theories of Depression for Individuals With Intellectual and Developmental Disabilities: A Historicist Perspective

The mental health care system has historically marginalized individuals with intellectual and developmental disabilities (I/DD). Until the mid-1980s, many clinicians doubted that individuals with I/DD were capable of depression (Sovner & Pary, 1993). Although it is now generally accepted that individuals with I/DD do have depression, they may not be treated or may be inappropriately treated (Matson et al., 2000). A historicist perspective takes into account the effect of marginalization on science and practice. Depression has both biological and psychosocial aspects. Key groups of theories regarding the psychosocial aspects of depression include psychodynamic/psychoanalytic, behavioral, cognitive, and ecological/interpersonal theories (Clark, Beck, & Alford, 1999; Joiner, Coyne, & Blalock, 1999). The application of psychosocial theories of depression to individuals with I/DD continues to reflect their marginalization and oppression. Behavioral theories of depression are limited in their conceptions for research, identification, and treatment of depression but continue to be used widely with individuals with I/DD. Cognitive theories of depression are widely used in research and treatment of depression in the general population, but have limited usage among individuals with I/DD. Interpersonal theories of depression are used in the general population and have many benefits, but are only now being investigated for use with individuals with I/DD. In this article, theories of depression as applied to individuals with I/DD are discussed from a historicist perspective.

Depressive symptoms in intellectual disability: does gender play a role?

BACKGROUND

Gender issues remain largely unaddressed in the dual diagnosis arena, even in the area of depression where there is a 2:1 female to male ratio in the general population. This paper argues that women with intellectual disability (ID) report higher levels of depressive symptoms than men with ID and that risk factors for depression identified for women in the general population are relevant to this group.

METHOD

Findings are based on structured interviews with 99 men and women with ID, with corroborative information provided from caregivers and casebook reviews.

RESULTS

Overall, women reported higher levels of depression than men. Individuals with higher depression scores were more lonely and had higher stress levels than individuals with lower scores. Women with higher depression scores were more likely to report coming from abusive situations, to have poor social support from family and to be unemployed when compared to women with lower scores, but similar differences were not found when comparing men with higher and lower depression scores.

CONCLUSION

Men and women who report experiencing these psychosocial correlates of depression should be a target group for future prevention efforts, taking gender specific concerns into consideration.

Involvement in Special Olympics and its relations to self-concept and actual competency in participants with developmental disabilities

The current study examined the relations among components of a physical activity program, Special Olympics (SO), and the self-concepts (i.e., perceived physical competence, social acceptance, and general self-worth) and adaptive behaviors of individuals with developmental disabilities. This research can assist in the development of theoretical models of how physical activity programs can be implemented to effect psychological change. Participants consisted of a randomly selected group of 97 individuals with developmental disabilities, between 9 and 43 years of age, and their parents. Participants' self-concepts and adaptive behaviors were measured both by direct interview and parental report. Examined program components consisted of the length of time affiliated to the organization, number of competitions attended, of hours spent in training, of sports, and of medals obtained. Multiple regression analyses suggest relations between specific components of SO and participants' self-concepts and adaptive behaviors. These relations highlight the importance of competition and sport for individuals with developmental disabilities.

Beyond the disability: recognizing mental health issues among persons with intellectual and developmental disabilities

Current societal changes mean increased possibilities for individuals with I/DD to participate in work, family, and community life. However, as individuals with I/DD have at least the same prevalence of mental health disorders as the general population and possibly an increased susceptibility to some mental health disorders, their ability to participate in work, housing, and social opportunities is hampered. It is important to improve nursing education about the specific issues of mental health care of individuals with I/DD. An important area for nursing research and education are improved clinical and practice guidelines. Research on medications and other therapies in mental health care of individuals with I/DD is limited and has methodological limitations. Nursing education and training are holistic, and nursing has the potential of positive impact on practice, education, and research that will improve the mental health care of individuals with I/DD.

Assessment and diagnosis of depression in people with intellectual disability

BACKGROUND

Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic.

METHOD

The present paper reviews the progress in this field since three reviews, all published in the mid-1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales.

RESULTS

Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID.

CONCLUSIONS

It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large-scale, collaborative, prospective studies are called for.

Depressive mood in students with mild intellectual disability: students' reports and teachers' evaluations

The present study examined 310 students with mild intellectual disability (ID) who attended special schools and self-contained classes in mainstream schools with regard to their reports of depressive mood, and loneliness and social skills, and teachers' perception of the students' academic, social and behavioural competencies. A multivariate analysis of variance (MANOVA) revealed that: students in special schools reported higher levels of depression and felt lonelier than mainstream school students; girls exhibited a greater sense of depressive mood than boys; teachers assessed boys as having higher academic competencies than girls; and boys were considered more easily distracted and less independent. However, teachers considered girls to have more adequate social adjustment, and be more task-oriented and more independent. For both groups, depressive mood can be predicted by distractibility and loneliness; by gender and lower academic competencies for special school students; or mainly by difficulties in social adjustment in the case of mainstream school students.

Methodological issues in interviewing and using self-report questionnaires with people with mental retardation

In this article the authors review methodological issues that arise when interviews and self-report questionnaires are used with people with mental retardation and offer suggestions for overcoming some of the difficulties described. Examples are drawn from studies that use qualitative methodology, quantitative studies assessing different question types, and studies reporting on the development of instruments measuring psychiatric symptoms, self-concept, and quality of life. Specific problems that arise with respect to item content (e.g., quantitative judgments, generalizations), question phrasing (e.g., modifiers), response format (e.g., acquiescence, multiple-choice questions), and psychometric properties (factor structure and validity) are discussed. It is argued that because many self-report questionnaires include questions that have been found to be problematic in this population, more attention needs to be paid to establishing the validity of such measures and to clearly defining the population for which the instrument is designed.

Association between perceived social support and strain, and positive and negative outcome for adults with mild intellectual disability

Social strain has been identified as a trigger for both depression and physical health problems, but has not been well researched in people with intellectual disability (ID). The present study contrasted the effects of social support with social strain on depressive symptoms, somatic complaints and quality of life over time in adults with mild ID. The level of social support explained a significant proportion of variance in quality of life 6 months later, but not depressive symptoms or somatic complaints. In contrast, the level of social strain accounted for a significant proportion of variance in depressive symptoms and somatic complaints 6 months later, but not quality of life. The results suggest that interpersonal relationships can be both positively and negatively associated with physical and mental health for people with ID.