Depression research methodologies in the Journal of Personality and Social Psychology: a review and critique

Conceptualization and assessment of personality factors in depression

Research that relates personality to depression is one of the dominant themes in the clinical literature. The current paper examines this research from a critical perspective. It is argued that existing research is limited by (i) a failure to adopt a broad conceptual approach to the study of personality and depression; and (ii) the use of personality measures with questionable psychometric properties. Our observations lead us to suggest that greater adherence to established methodology and conceptual developments in the personality field will result in substantial improvements in research on personality and depression, and may ultimately provide a more accurate appraisal of the role of personality factors in depression. In addition to examining important issues, key directions for future research are discussed.

A Meta-Analysis of Observational Studies on the Association of Chronic Urticaria With Symptoms of Depression and Anxiety

Background: Chronic urticaria (CU) is a frequently occurring skin condition associated with many psychological factors, but the effect size of associations varied in literature.

Objectives: To perform a systematic review and meta-analysis on the associations of CU with the symptoms of depression and anxiety.

Methods: According to a pre-specified protocol, we systematically searched articles published in PubMed, Web of Science, CNKI, and CQVIP databases between January 2000 and January 2019. Pooled estimates in terms of odds ratios (ORs) or standardized mean differences (SMDs) were calculated according to outcome measures. Subgroup analysis by disease subtypes and tool of measurement, and sensitivity analysis were performed. Risk of bias and quality of studies were evaluated.

Results: Twelve studies were selected for the systematic review. The ORs were 3.99 [95% confidence interval (CI): 3.24–4.91, P < 0.001] for anxiety and 2.94 (95% CI: 2.42–3.58, P < 0.001) for depression. The SMDs of severity were 0.98 for anxiety (95% CI: 0.76–1.200, P < 0.001) and 0.84 for depression (95% CI: 0.59–1.10, P < 0.001). Subgroup analysis by disease subtypes and tool of measurement showed variations in effect size, where chronic spontaneous urticaria showed greater effects on anxiety (OR = 6.62, 95% CI: 3.67–11.95, P < 0.001) and depression (OR = 6.13, 95% CI: 2.31–16.31, P < 0.001). Sensitivity analysis demonstrated consistent results.

Conclusion: CU is associated with higher risks of anxiety and depression.

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low-Income Outpatients

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro-level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low-income outpatients from community mental health clinics who completed a semi-structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.

Gender-specific associations of depression and anxiety symptoms with mental rotation

BACKGROUND

Men score higher on mental rotation tasks compared to women and suffer from depression and anxiety at half the rate of women. The objective of this study was to confirm the gender-specific effects of depression and anxiety on mental rotation performance.

METHODS

We collected data in non-experimental conditions from 325 university students at three universities. Participants completed rating scales of depressive and anxiety symptoms, and then simultaneously performed a mental rotation task using tablet devices.

RESULTS

We observed no significant difference between men and women in the depressive and anxiety symptoms and task response time. Men had a significantly higher correct answer rate compared with women. The scores of depression and anxiety of all participants were positively correlated. Task response time correlated positively with intensity of depressive symptoms and anxiety in women, but not in men. Women with high depressive symptoms had significantly longer response times than did women with low depressive symptoms, while men had no differences due to depressive symptoms.

LIMITATIONS

We did not directly examine brain functions; therefore, the underlying neurobiological results are only based on previous knowledge and action data.

CONCLUSIONS

The pathology of depression and anxiety was reflected in the correct answer rate and response time in relation to the gender difference of brain function used in mental rotation.

Depressive Symptoms, Disclosure, HIV-Related Stigma, and Coping Following HIV Testing Among Outpatients in Uganda: A Daily Process Analysis

As efforts to end the HIV epidemic accelerate there is emphasis on reaching those living with undiagnosed HIV infection. Newly diagnosed individuals face a number of psychosocial challenges, yet we know little about depressive symptoms in the weeks immediately following diagnosis and how disclosure, coping, and other factors may affect short and longer-term depressive symptoms. Purposively sampled Ugandan outpatients completed structured interviews immediately prior to testing for HIV, daily for 28 days after receiving their test results, and at 3 and 6 months post-test. The sample included a total of 244 participants: 20 who tested HIV positive at baseline and who provided 342 daily data points, and 224 who tested HIV negative at baseline and who provided 4388 daily data points. We used linear mixed effects modeling to examine changes in depressive symptom scores over the 28 day daily interview period and predictors of depressive symptom scores and changes over time. Results from the mixed modeling revealed that while those diagnosed with HIV showed initially high depressive symptoms following diagnosis, their symptoms decreased significantly and on average fell below the cutoff for possible depression approximately 15 days after diagnosis. Among those who tested HIV-negative, on average their depressive symptoms were below the cutoff for possible depression and did not change over time. Among those diagnosed with HIV, disclosure, especially to a partner, on a particular day was associated with higher depressive symptoms that day. However, those who disclosed to their partner during the 28 days after diagnosis had significantly lower depression scores by the end of the 28 days as well as lower depression scores 3 and 6 months after diagnosis than did those who did not disclose to their partner during the 28 days after diagnosis. Scoring higher on HIV-related stigma on a particular day was associated with higher depressive symptoms that day and engaging in positive coping on a particular day was associated with lower depressive symptoms that day. Positive coping also accelerated the decrease in depressive symptoms over time. These data underscore the importance of timely disclosure to partners and suggest that regular depression screening after diagnosis and provision of mental health services could improve HIV care engagement and treatment outcomes.

Factor Structure of the Depression Self-Rating Scale in an Iranian Adolescent Sample

Previous research showed concurrent validity for the Depression Self-rating Scale for Iranian adolescents, so the present purpose was to evaluate construct validity. The scale was distributed to 2,012 school students in Grades 5 to 10. Factor analysis using varimax rotation yielded four factors interpretable as depressed mood, hopelessness, lack of pleasurable activities, and physiological symptoms. These factors accounted for 44% of the variance and provide some support for construct validity of the scale in Iranian adolescents.

Classification of Psychopathology

Many have criticized the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV), and few regard it as a vehicle of truth, yet its most serious limitation is that its frank operationism in defining manifest categories has distracted attention from theories about what is going on at the latent level. We sketch a Generalized Interpersonal Theory of Personality and Psychopathology and apply it to interpersonal aspects of depression to illustrate how structural individual differences combine with functional dynamic processes to cause interpersonal behavior and affect. Such a causal account relies on a realist ontology in which manifest diagnoses are only a means to learning about the latent distribution, whether categorical or dimensional. Comorbidity of DSM diagnoses suggests that dimensionality will be the rule, not the exception, with internalization and externalization describing common diagnoses.

Cross-Cultural Comparisons and the Presumption of Equivalent Measurement and Theoretical Structure

The purpose of this article is to demonstrate, paradigmatically, the extent to which item score data can vary across cultures despite measurements from an instrument for which the factorial structure is equivalently specified in each group. Based on item scores from the Beck Depression Inventory, the authors first tested for the group invariance of factorial structure and then examined the patterns of item score distributions and response frequencies across Canadian ( n = 658), Swedish ( n = 1,096), and Bulgarian ( n = 691) high school adolescents. Findings carry important implications for multigroup comparisons research in general, and for cross-cultural research in particular, where the primary interest focuses on testing for mean group differences.

The Effects of Depression on Impression Formation: The Role of Trait and Category Diagnosticity

Two studies examined the impact of trait and category diagnosticity on the social information processing of depressed and non-depressed participants. As suggested by the Weary, Marsh, Gleicher, and Edwards model of the effects of depression on social information processing, it was predicted that depressed participants would be especially sensitive to the diagnosticity of the available information when forming an impression of another person. In Study 1, depressed participants were more sensitive than nondepressed participants to trait diagnosticity when forming an impression. In Study 2, depressed participants were more sensitive than nondepressed participants to both trait and category diagnosticity when forming an impression.

Control Motivation and Uncertainty: Information Processing or Avoidance in Moderate Depressives and Nondepressives

Two studies investigated the uncertainty orientation model of self-regulation as it relates to control motivation in moderate depressives and nondepressives. It was hypothesized that moderately depressed persons would be more likely than nondepressed persons to process information when control deprived, as opposed to nondeprived, only if they were uncertainty oriented. Certainty-oriented persons were expected to decrease information processing under these conditions. Participants differing in uncertainty orientation and depression level were assessed for information processing following control deprivation or no deprivation. In Study 1, desire for information about the deprivation task was assessed and participants were given a second performance task. In Study 2, information seeking was measured while reading about social outcomes. The expected three-factor interaction was found to be significant on measures of information seeking and performance in both studies. A model to represent these findings is proposed, as are implications for research on depression, coping, and control.

Depression and Interpersonal Responses to Others' Moods: The Solicitation of Negative Information about Happy People

A total of four experiments tested the prediction that social comparison concerns lead depressed individuals to solicit more negative disclosures from happy people than they otherwise would. In Experiments 1 and 2, depressed, mildly depressed, and nondepressed subjects reviewed information about another person that included ratings of that person's mood (Experiment 2 also included a control condition without mood information). After reviewing the material, subjects chose a subset of items from a list of positive, negative, and neutral questions to ask the person in an upcoming meeting. Experiment 3 replicated this procedure but used a mood manipulation to define subject groups. Experiment 4 examined the impact of subjects' line of questioning on others. Taken together; the results indicate that when they believe their partner is happy, depressed individuals are especially likely to solicit negative information about that person. This unfavorable interpersonal response increases depressed individuals' risk of social rejection.

Somatic, but not cognitive-affective, symptoms are associated with reduced heart rate variability in individuals with dysphoria

Background: Somatic, but not cognitive–affective, symptoms of depression have been associated with reduced heart rate variability (HRV), and with poor prognosis in cardiovascular patients. However, factors concomitant with cardiovascular diseases may confound the relationship between somatic symptoms of depression and reduced HRV. Therefore, this study examined whether reduced HRV was differentially associated with cognitive–affective and somatic symptoms of depression in medically healthy individuals with and without dysphoria.

Methods: Self-reported cognitive–affective and somatic symptoms as measured with the Beck Depression Inventory-II questionnaire and time and frequency domain parameters of HRV were collected in 62 medically healthy individuals, of whom 25 with and 37 without dysphoria.

Results: Somatic, but not cognitive–affective, symptoms of depression were inversely associated with SD of NN intervals (β = -0.476, p < 0.05), number of interval differences of successive NN intervals greater than 50 ms (NN50; β = -0.498, p < 0.03), and HRV total power (β = -0.494, p < 0.04) in the group with dysphoria, after controlling for sex, anxiety, and lifestyle factors. Cognitive–affective and somatic symptoms were not related to any of the HRV parameters in the group without dysphoria (all ps > 0.24).

Conclusion: By showing that the relationship between somatic depressive symptoms and reduced HRV extends to medically healthy individuals with dysphoria, the present findings suggest that this association is independent of factors concomitant with cardiovascular diseases. The present study also suggests that individuals with somatic rather than cognitive–affective subsets of depressive symptoms may be at greater risk for developing cardiovascular diseases.

Neural correlates of attention to emotional facial expressions in dysphoria

The present study investigated whether dysphoric individuals have a difficulty in disengaging attention from negative stimuli and/or reduced attention to positive information. Sad, neutral and happy facial stimuli were presented in an attention-shifting task to 18 dysphoric and 18 control participants. Reaction times to neutral shapes (squares and diamonds) and the event-related potentials to emotional faces were recorded. Dysphoric individuals did not show impaired attentional disengagement from sad faces or facilitated disengagement from happy faces. Right occipital lateralisation of P100 was absent in dysphoric individuals, possibly indicating reduced attention-related sensory facilitation for faces. Frontal P200 was largest for sad faces among dysphoric individuals, whereas controls showed larger amplitude to both sad and happy as compared with neutral expressions, suggesting that dysphoric individuals deployed early attention to sad, but not happy, expressions. Importantly, the results were obtained controlling for the participants' trait anxiety. We conclude that at least under some circumstances the presence of depressive symptoms can modulate early, automatic stages of emotional processing.

University student depression inventory (USDI): confirmatory factor analysis and review of psychometric properties

BACKGROUND

The 30-item USDI is a self-report measure that assesses depressive symptoms among university students. It consists of three correlated three factors: lethargy, cognitive-emotional and academic motivation. The current research used confirmatory factor analysis to asses construct validity and determine whether the original factor structure would be replicated in a different sample. Psychometric properties were also examined.

METHOD

Participants were 1148 students (mean age 22.84 years, SD=6.85) across all faculties from a large Australian metropolitan university. Students completed a questionnaire comprising of the USDI, the depression anxiety stress scale (DASS) and Life Satisfaction Scale (LSS).

RESULTS

The three correlated factor model was shown to be an acceptable fit to the data, indicating sound construct validity. Internal consistency of the scale was also demonstrated to be sound, with high Cronbach alpha values. Temporal stability of the scale was also shown to be strong through test-retest analysis. Finally, concurrent and discriminant validity was examined with correlations between the USDI and DASS subscales as well as the LSS, with sound results further supporting the construct validity of the scale. Cut-off points were also developed to aid total score interpretation.

LIMITATIONS

Response rates are unclear. In addition, the representativeness of the sample could be improved potentially through targeted recruitment (i.e. reviewing the online sample statistics during data collection, examining the representativeness trends and addressing particular faculties within the university that were underrepresented).

CONCLUSIONS

The USDI provides a valid and reliable method of assessing depressive symptoms found among university students.

The effect of depression on physician-patient communication among Hispanic end-stage renal disease patients

End-stage renal disease is associated with increased level of depression. Depression is associated with a reduction in the ability of people to effectively communicate in interpersonal settings. The interaction between end-stage renal disease patients and their physicians has important implications for the course of the treatment of this disease; however, there is limited research examining the influence of depression on general patient-physician communication. This study examines the association between depression and physician-patient communication in a sample of Hispanic end-stage renal disease patients. Participating patients filled out the Beck Depression Inventory and self-reported their feelings about meeting with physicians. Patients then met with a physician, and a nurse practitioner observed the interaction. Results indicate that depression was negatively associated with patients' self-reported perceptions of their readiness for the appointment (r =-.20) and with self-reported communication efficacy (r =-.19). Moreover, the nurse practitioner rated patients with depression as being significantly less likely (a) to ask for clarification (r =-.40), (b) to be engaged in the conversation (r =-.46), and (c) to be forthcoming with the physician (r =-.37). Results of this study have significant implications for communication between physicians and end-stage renal disease patients and for the influence of depression on patient-physician communication.

Construction and preliminary validation of a dictionary for cognitive rigidity: linguistic markers of overconfidence and overgeneralization and their concomitant psychological distress

Fanaticism and extremism are increasingly recognized as seminal to psychopathology and distress, especially considering the increase in political unrest and violence over the last decade. In the psychopathological literature, however, the cognitive style associated with extremism and overgeneralization has long been recognized as a risk factor for emotional distress, leading to both externalizing behavior (e.g. aggression) and internalizing pathology (e.g. depression). Despite its recognized importance, however, virtually no standardized measures of this cognitive style exist. Since direct inquiry about a respondent's Cognitive Rigidity, is likely to be biased, a text-analytical measure of extremism in spontaneous autobiographical narratives is proposed. In contrast to self-reports, naturally occurring speech often suggests cognitive proclivities towards overgeneralization, overconfidence or extremization. In this study, spoken autobiographical narratives were elicited from 483 participants, and contrasted with extensive mental health information using a hierarchical concordanced-keyword technique. The resulting corpus-based dictionary is context-sensitive, and exhibits significant correlations with measures of negative emotionality, with minimal association with response bias measures.

The role of rumination in affective distress in people with a chronic physical illness: a review of the literature and theoretical formulation

The role of maladaptive cognitive content among individuals with chronic physical illness has been acknowledged in cognitive models. Rumination has been documented as a key predictor of depression, and to a lesser extent of anxiety, in non-clinical samples. This paper provides a preliminary discussion of the potential role of rumination as a causal and maintaining factor for emotional distress in the setting of chronic physical illness. Although a number of methodological limitations exist, the current research on rumination may provide a useful framework for the extension of existing cognitive models in chronic illness.

A context-informed approach to the study of negative-feedback seeking in depression

The purpose of the current study was to examine the link between negative-feedback seeking (NFS) and depression using a behavioural task that addressed many of the limitations of existing measures of NFS, to use a remitted-depressive design to determine whether NFS is a temporary or stable feature of depression, and to examine the role of personality and contextual variables (e.g., marital quality, spousal characteristics) in NFS. Using a sample of 59 couples (12 wife currently depressed, 20 wife remitted-depressed, and 27 wife never-depressed), we designed a task that correlated with an established measure of NFS and was able to distinguish between non-depressed and currently depressed wives. Using this behavioural task, we found that NFS is stably associated with depression and that relationship and partner characteristics may protect depressed individuals from engaging in destructive interpersonal patterns.

A randomized clinical trial of a brief, mailed intervention for symptoms of depression

This research evaluated the efficacy of a brief, mailed personalized feedback intervention designed to alleviate depressed mood and antecedents (ineffective coping and hopelessness). College students (N = 177) were randomly assigned to intervention or control group following a baseline assessment. A week after completing the baseline assessment, participants in the intervention condition were mailed feedback and information detailing their mood, coping strategies, as well as suggestions for enhancing mood. Results indicated that feedback was effective in reducing depressive symptoms, hopelessness, and among men, increasing willingness to use coping strategies at the 1-month follow-up. Hopelessness mediated reductions in depressive symptoms. Results support the use of personalized feedback as a low-cost, initial intervention for college students suffering from symptoms of depression.

Effects of depressive symptoms and experimentally adopted schemas on sexual arousal and affect in sexually healthy women

The present study examined the effects of depressive mood symptoms and experimentally adopted sexual schemas on women's sexual arousal and affect. Women's vaginal response, subjective sexual arousal, and affect were measured in response to sexually explicit visual material in a laboratory setting. At baseline on a self-report measure, women with depressive mood symptoms (n = 28) reported significantly lower sexual desire than women with normal mood (n=28), but no significant differences in arousal, orgasm, satisfaction, or pain. Participants were asked to adopt both a positive and negative sexual self-schema prior to viewing erotic stimuli. Women in both mood groups demonstrated significantly greater subjective sexual arousal, vaginal response, and positive affect in the positive schema condition than in the negative schema condition when controlling for anxiety. There were no main effects for mood symptoms. These findings support an information processing conceptualization of sexual arousal and suggest that an acute dose of cognitive sexual schemas can significantly impact subsequent sexual and affective responses. Implications of findings for the assessment and treatment of sexual dysfunction are noted.

A depressive symptom scale for the California Psychological Inventory: construct validation of the CPI-D

To facilitate life span research on depressive symptomatology, a depressive symptom scale for the California Psychological Inventory (CPI) is needed. The authors constructed such a scale (the CPI-D) and compared its psychometric properties with 2 widely used self-report depression scales: the Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale. Construct validity of the CPI-D was examined in 3 studies. Study 1 established content validity, classifying CPI-D items into Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition depressive symptoms. Study 2 used 3 large samples to gather evidence for reliability and validity: correlational analyses demonstrated alpha reliability and convergent and discriminant validity; factor analysis provided evidence for discriminant validity with anxiety; and regression analyses demonstrated comparative validity with existing standard PI scales. Study 3 used clinician ratings of depression and anxiety as criteria for external validity.

Factor structure of the Zung Self-rating Depression Scale in first-year university students in Japan

The Zung-Self-rating Depression Scale (SDS) was distributed to 28,588 first-year university students. Factor analysis using PROMAX rotation revealed three factors interpretable as affective, cognitive, and somatic symptoms. The confirmatory factor analysis showed a goodness-of-fit index of 0.976 and an adjusted goodness-of-fit index of 0.967. The two sexes exhibited virtually the same factor structure. The result suggests that studies with this scale should use these three subscales rather than a total score.

Depression burden, psychological adjustment, and quality of life in women with breast cancer: Patterns over time

The purpose of this study was to examine how level of depression burden influences women's psychological adjustment and quality of life over time and how depression burden interacted with a community-based oncology support program to influence psychological adjustment and life quality. Participants were 169 women who completed a side effects checklist at three data collection points. Women were divided into two groups based on their depression burden scores: 123 women reporting no burden, and 46 women reporting high depression burden. For psychological adjustment, there were significant interaction effects for intervention by time and for intervention by depression burden by time and significant main effects for depression burden. For life quality, there was a significant interaction effect for intervention by time and a significant main effect for depression burden. The findings document the negative impact of depression burden on psychological adjustment and life quality. Oncology support interventions can be effective in reducing this negative impact.

Anxiety and depression: Why and how to measure their separate effects

It is well recognized that depression and anxiety are closely associated, but nonetheless, they may be associated with distinct causes and consequences. For example, anxiety and depression are associated with different effects on information processing. This paper argues that experiments should not study anxiety or depression in isolation, but should measure both variables. It is argued that this methodological step is both important and commonly overlooked. Even when both depression and anxiety are measured, methodological difficulties can confuse their effects. Common difficulties in choice of measures and in participant selection criteria are discussed, and recommendations are made for overcoming them. The argument is made drawing from illustrations within the experimental cognitive literature, but conclusions and recommendations are equally applicable outside this area.

Looking at facial expressions: Dysphoria and facial EMG

Previous research on interpersonal deficits among dysphoric individuals has been equivocal, with some studies finding that dysphoric persons show an increase in negative behavior and other studies finding no group differences. Most studies in this area have employed self-report instruments and behavioral coding systems to examine interpersonal displays. Using a different approach, we examined facial electromyography (EMG) reactivity to pictures of happy and unhappy expressions among dysphoric persons. Dysphoric and non-dysphoric persons viewed happy and unhappy facial expressions while zygomatic EMG and corrugator EMG activity was recorded. Results indicated that both groups showed the appropriate increase in corrugator EMG to unhappy expressions; however, dysphoric persons did not show the expected increase in zygomatic EMG activity to happy expressions while the control participants did show this response. Unexpectedly, the dysphoric group displayed an increase in corrugator EMG activity (e.g. frown response) to the happy facial expressions. These findings indicate that dysphoric persons have impaired interpersonal reactivity that is specific to happy facial displays.

The latent structure of analogue depression: should the Beck Depression Inventory be used to classify groups?

Research on depression is often conducted with analogue samples that have been divided into depressed and nondepressed groups using a cutoff score on the Beck Depression Inventory (BDI). Although the relative merits of different cut scores are frequently debated, no study has yet determined whether the use of any cut score is valid, that is, whether the latent structure of BDI depression is categorical or dimensional in analogue samples. The BDI responses of 2,260 college students were submitted to 3 taxometric procedures whose results were compared with those of simulated data sets with equivalent parameters. Analyses provided converging evidence for the dimensionality of analogue depression, arguing against the use of the BDI to classify analogue participants into groups. Analyses also illustrated the notable impact of pronounced skew on taxometric results and the value of using simulated comparison data as an interpretive aid.

Anxiety and depression in mothers of children undergoing bone marrow transplant: symptom prevalence and use of the Beck depression and Beck anxiety inventories as screening instruments

This study examined anxiety and depressive symptoms among 115 mothers of children undergoing bone marrow transplant and evaluated the ability of the Beck Anxiety Inventory (BAI; A. T. Beck, N. Epstein, et al., 1988) and the Beck Depression Inventory (BDI; A. T. Beck, 1978) to serve as screening tools for assessing generalized anxiety disorder (GAD), panic disorder (PD), and major depressive disorder (MDD). Mothers with BAI or BDI scores greater than or equal to 14 were administered a structured clinical interview. An additional 20% was randomly selected for interview to determine whether the scale cutoff was an accurate screening method. Among the 64 mothers interviewed, 20% received at least I of the 3 diagnoses. Although the BAI did not demonstrate predictive accuracy in assessing GAD and PD, the BDI did in assessing MDD. The results suggest that a subset of mothers may have an anxiety or depressive disorder and that investigators should use caution before using the BAI as a screening instrument for anxiety disorder.

Correlates of analogue and clinical depression: a further test of the phenomenological continuity hypothesis

BACKGROUND

The use of college students with high scores on a depression rating scale as analogues for depression by psychological researchers has generated controversy. Critics of analogue research argue that depression is qualitatively different in analogue and clinical samples.

OBJECTIVE

To conduct a further comparison of the phenomenology of clinical and analogue depression to determine if the differences between these groups are best understood as quantitative (consistent with the continuity hypothesis) or whether these forms of depression are qualitatively distinct.

METHOD

This study compared 161 outpatients with major depressive disorder to 148 "analogue" subjects (college students with a Beck Depression Inventory score > or =9) and 141 non-distressed controls. Study measures included several proposed personality vulnerability factors for depression, a measure of developmental experiences that may confer vulnerability to adult depression, and family history of emotional disorders.

RESULTS

Most comparisons of personality vulnerability factors, developmental experiences and family history information followed a pattern of greatest risk in the clinical group, intermediate risk in the analogue group and lowest risk in the non-distressed group. Noteworthy exceptions included several aspects of perfectionism and a number of childhood experiences reflecting parental over-control, which appeared to be more strongly associated with analogue depression than clinical depression.

IMPLICATIONS

Several personality and developmental variables could represent important areas of discontinuity between clinical and analogue depression. However, the overall results were consistent with a growing body of literature suggesting continuity between subthreshold depression symptoms and syndromal depression.

Evaluating the continuity of symptomatology between depressed and nondepressed individuals

Debate is contentious concerning whether depression should be viewed as a distinct category or as a continuum including overlapping normal and clinical phenomena. A nonparametric item response model was used to evaluate whether the probability of expressing individual symptoms differed between nondepressed and clinically depressed adults experiencing similar levels of overall severity. Even though depressed and nondepressed individuals were equated in terms of overall severity, differences on specific symptoms emerged. Depressed mood, anhedonia, and suicidality were more likely to be expressed in depressed than in nondepressed individuals, whereas hypochondriasis and middle insomnia were more likely to be expressed in nondepressed individuals at similar levels of severity. Such differences are inconsistent with the view of depression as a simple continuum.

Depression measures in outcomes research

OBJECTIVE

To review critically the measures used to screen for depression for disability outcomes research and to recommend measures and needed research.

DATA SOURCES

Review of literature pertaining to the development, testing, and use of depression measures for outcomes research.

STUDY SELECTION

English language literature from scientists from a broad range of disciplines and research settings, focusing mainly on the Brief Symptom Inventory and the Center for Epidemiology Study-Depression scale.

DATA EXTRACTION

A literature review was completed through MEDLINE. Based on the review, instruments were selected according to their use among people with disability and the reliability and validity of the instrument. Two instruments were selected for a complete review, and 5 instruments were selected for a brief review.

DATA SYNTHESIS

A critical review of measures that have been and may be used to measure depressive symptomatology among people with disability.

CONCLUSIONS

Screening measures of depression are easy to administer and score. Almost all have low respondent burden and good face validity, thereby contributing to a high participation rate for most studies. Some problems exist with the application of these instruments to people with disability (ie, overlap of symptoms of depression and indicators of physical impairment).

Depression after alcohol treatment as a risk factor for relapse among male veterans

We examined the association between relapse-to-drinking and depressive symptomatology measured during inpatient treatment for alcohol disorder and 3 months posttreatment. Data were obtained from 298 veterans who completed 21-day inpatient treatment. Follow-up interviews were conducted at 3, 6, 9, and 12 months posttreatment. We used multiple logistic regression to assess the association between relapse and baseline/3-month posttreatment measures of depression (Beck Depression Inventory; BDI), controlling for important covariates. Our results showed that (a) the mild-to-moderately symptomatic participants (BDI = 14-19) at 3 months posttreatment were on average 2.9 times more likely than the nondepressed to have relapsed across follow-ups, and (b) the severely symptomatic participants (BDI = 20+) at 3 months posttreatment were on average 4.9 times more likely to have relapsed across follow-ups. Other analyses revealed that those with persistent depressive symptomatology reported at both baseline and 3 months posttreatment did not experience worse outcomes that those who reported symptomatology at 3 months posttreatment alone.

Screening for depression in stroke: Relationship to rehabilitation efficiency

Depression is common after stroke but is often not diagnosed. Its presence may impair progress during rehabilitation and limit functional improvement after discharge. We investigated the use of the Geriatric Depression Scale (GDS) to screen for depression among acute stroke patients. All stroke patients in an acute rehabilitation hospital who were referred for assessment of cognitive deficits were also screened for depression with the GDS. By using a modified cutoff score to account for items that could reflect physical effects of the stroke rather than depression, 22% of patients screened were classified as depressed. The rate of depression was higher among women (36%) than men (10%). Patients with elevated GDS scores (> or =15) stayed in the hospital an average of 5.76 days longer than patients whose scores fell below this cut-off. Higher GDS scores were also associated with less efficient use of rehabilitation services as measured by the Functional Independence Measure. Screening stroke patients for depression at the time of admission to rehabilitation may identify individuals at risk to progress more slowly, may initiate more comprehensive assessment, and, if appropriate, may initiate rapid intervention.