Evaluation of the internal consistency, factor structure, and validity of the Depression Change Expectancy Scale

The reliability and validity of the depression change expectancy scale in college students: a cross-sectional study in China

With the rising prevalence of mental health issues, depression not only causes significant psychological distress and severely impairs social functioning and quality of life but also heightens the risk of suicide. The Depression Change Expectation Scale (DCES) is an assessment tool designed to evaluate the attitudes of individuals exhibiting depressive tendencies or symptoms regarding their anticipated future changes in depression. Understanding adolescents' expectations about changes in depression can enable timely and targeted interventions before their mental health deteriorates. However, a Chinese version of the DCES is yet to be developed. This study aimed to translate the DCES, cross-cultural adaptation, and validate the Chinese version of the DCES among college students. Following the Brislin translation model, the initial draft of the DCES was translated and back-translated. The Chinese version was refined through expert localization and a preliminary survey. Using a convenience sampling method, 1,138 students from various universities in Anhui province were surveyed from September to December 2023. Among these, 481 students exhibiting depressive symptoms and tendencies, as identified by the Beck Depression Inventory, were selected for the reliability and validity analysis of the Chinese version of the DCES. The Chinese version of the DCES demonstrated a robust two-factor model fit (Chi-square/degrees of freedom = 2.604; comparative fit index = 0.973; Tucker-Lewis index = 0.970; goodness of fit index = 0.912; normed fit index = 0.958; root mean square error of approximation = 0.058). The scale-level content validity index was 0.898, and item-level content validity indices ranged from 0.830 to 1.000. The internal consistency, as measured by Cronbach's alpha, was 0.910 for the entire scale and ranged from 0.888 to 0.980 for individual dimensions. The test-retest reliability was 0.985 for the total scale, with individual dimensions' test-retest reliability ranging from 0.982 to 0.985. This study, supported by previous evidence, indicates that the Chinese version of the DCES possesses excellent validity and reliability. It is a valuable tool for measuring expectations regarding changes in depression and has the potential to predict future trends in depressive symptoms.

Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)

BACKGROUND

About one third of patients with depression are in a condition that can be termed as "difficult-to-treat". Some evidence suggests that difficult-to-treat depression is associated with a higher frequency of childhood trauma and comorbid personality disorders or accentuated features. However, the condition is understudied, and the effects of psychotherapy for difficult-to-treat depression are currently uncertain. The aim of this trial is to investigate the beneficial and harmful effects of 30 sessions of individual schema therapy versus treatment as usual for difficult-to-treat depression in the Danish secondary, public mental health sector.

METHODS

In this randomized, multi-centre, parallel-group, superiority clinical trial, 129 outpatients with difficult-to-treat depression will be randomized (1:1) to 30 sessions of individual schema therapy or treatment as usual; in this context mainly group-based, short-term cognitive behaviour or psychodynamic therapy. The primary outcome is the change from baseline in depressive symptoms 12 months after randomization, measured on the observer-rated 6-item Hamilton Rating Scale for Depression. The secondary outcomes are health-related quality of life assessed with the European Quality of Life 5 Dimensions 5 Level Version, functional impairment assessed with the Work and Social Adjustment Scale, psychological wellbeing assessed with the WHO-5 Well-being Index, and negative effects of treatment assessed with the Negative Effects Questionnaire. Exploratory outcomes are improvement on patient self-defined outcomes, personal recovery, anxiety symptoms, anger reactions, metacognitive beliefs about anger, and perseverative negative thinking. Outcomes will be assessed at 6, 12, and 24 months after randomization; the 12-month time-point being the primary time-point of interest. Outcome assessors performing the depression-rating, data managers, statisticians, the data safety and monitoring committee, and conclusion makers for the outcome article will be blinded to treatment allocation and results. To assess cost-effectiveness of the intervention, a health economic analysis will be performed.

DISCUSSION

This trial will provide evidence on the beneficial and harmful effects, as well as the cost-effectiveness of schema therapy versus treatment as usual for outpatients with difficult-to-treat depression. The results can potentially improve treatment for a large and understudied patient group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05833087. Registered on 15th April 2023 (approved without prompts for revision on 27th April 2023).

Depression Outcome Expectancy in Primary Care in Singapore: Symptom Severity as a Mediating Determinant

BACKGROUND

Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity.

METHODS

One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants' medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy.

RESULTS

Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy.

CONCLUSIONS

Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression.

The role of outcome expectancy in therapeutic change across psychotherapy versus pharmacotherapy for depression

BACKGROUND

Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy.

METHODS

A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II.

RESULTS

Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response.

LIMITATIONS

The sample size limited statistical power and the complexity of models that could be explored.

CONCLUSIONS

Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation.

Reducing the Stigma of Depression Among Asian Students

In North America, Asians reliably report higher levels of stigma toward people with depression than do Europeans. Possible methods of reducing this discrepancy have rarely been explored. Asian undergraduate students ( n = 132) were presented with one of four antistigma videos with two actresses: one portraying a student with depression and the other a professor. The videos used the concept of social proof, presenting either positive or negative descriptive norms, to effect change in stigma, measured by social distance. It was hypothesized that the positive descriptive norms intervention would show significantly greater positive change in social distance compared with the negative descriptive norms intervention. All videos were effective in reducing preferred social distance toward people with depression relative to the control condition. The effectiveness of the positive descriptive norm video was mediated through descriptive norms and self-efficacy. The effectiveness of the negative descriptive norm video was mediated through injunctive norms and perceived value of support. The findings can help guide interventions that aim to encourage social engagement with people with depression among Asian student populations. Manipulating social norms and increasing self-efficacy may be especially effective.

Individual Differences in Expectancies for Change in Depression: Associations with Goal Pursuit and Daily Experiences

More optimistic expectations for change in patients entering treatment often predict more favorable outcomes. However, our understanding of the nature and function of those expectancies is limited. The current study tested the proposal that optimistic expectancies among patients seeking outpatient psychotherapy for major depressive disorder may be explained in part by having a more adaptive self-regulatory style. A sample of 56 adults (78.6% female; mean age 36.5) completed measures of expectancies, depressive symptoms, and aspects of self-regulation. Participants also completed a week of experience sampling using a cell phone system that signaled them 8 random times per day for 7 days. Results were largely consistent with hypotheses. Depressed participants with more optimistic expectancies had a stronger promotion goal orientation, higher goal re-engagement, and reported greater progress on their most important personal goals; daily positive affect and positive situational appraisals were also higher. Findings may suggest a possible self-regulatory mechanism underlying optimistic expectancies for change.

Treatment expectations for cognitive-behavioral therapy and light therapy for seasonal affective disorder: Change across treatment and relation to outcome

OBJECTIVE

To examine the dynamic relationship between treatment expectations and treatment outcome over the course of a clinical trial for winter seasonal affective disorder (SAD).

METHOD

Currently depressed adults with Major Depression, Recurrent with Seasonal Pattern (N = 177) were randomized to 6 weeks of group-delivered cognitive-behavioral therapy for SAD (CBT-SAD) or light therapy (LT). The majority were female (83.6%) and white (92.1%), with a mean age of 45.6 years. Treatment expectations for CBT-SAD and LT were assessed using a modification of the Treatment Expectancy and Credibility Survey (Borkovec & Nau, 1972). Depression severity was assessed using the Beck Depression Inventory-Second Edition (Beck, Steer, & Brown, 1996). All measures were administered at pretreatment, midtreatment, and posttreatment.

RESULTS

As treatment progressed, expectations for the treatment received increased across time steeply in CBT-SAD patients and moderately in LT patients. Collapsing across time, patients with higher treatment expectations had lower depression severity than those with lower treatment expectations. In a cross-lagged panel path analysis, there was a significant effect of treatment expectations at midtreatment on depression severity at posttreatment among CBT-SAD patients.

CONCLUSIONS

Treatment expectations changed across treatment, affected outcome, and should be assessed and monitored repeatedly throughout treatment. Findings suggest that treatment expectations at midtreatment are a mechanism by which CBT-SAD reduces depression, which should be replicated in SAD samples and examined for generalizability to nonseasonal depression. These findings underscore the importance of further research examining treatment expectations in mediating CBT's effects in depression and other types of psychopathology. (PsycINFO Database Record