Assessing depression with the MMPI and MMPI-2

Depression and suicide after temporal lobe epilepsy surgery: A systematic review

Psychiatric comorbidities, including depression and suicide, contribute substantially to the illness burden of patients with refractory temporal lobe epilepsy (TLE). The aim of this systematic review was to synthesize the existing literature assessing the effect of TLE surgery on (1) depression prevalence and (2) severity, and estimating the incidence of (3) de novo depression and (4) attempted and completed suicide following TLE surgery. A literature search was performed using Ovid Medline, Embase, Clarivate Web of Science, Cochrane Library, and ProQuest Dissertations and Theses. Studies of patients with TLE who underwent TLE surgery and reported estimates of at least one of the following outcomes were included: pre- and postoperative depression prevalence or severity, the incidence of postoperative de novo depression, or attempted or completed suicide. The search yielded 2,127 citations related to TLE surgery and postoperative depression or suicide. After a full-text review of 98 articles, 18 met the final eligibility criteria. Most studies reported a reduced or similar prevalence (n = 12) and severity of depression (n = 5) postoperatively, compared with the preoperative period. Eleven studies reported the incidence of postoperative de novo depression, which ranged from 0 % to 38 % over follow-up periods of three months to nine years. Four studies assessed the incidence of postoperative attempted or completed suicide, with completed suicide incidence ranging from 0 % to 3 % over follow-up periods of one to four years. Overall, the effect of TLE surgery on depression and suicide remains unclear, as many studies did not assess the statistical significance of depression prevalence or severity changes following TLE surgery. Therefore, timely psychosocial follow-up for patients after TLE surgery should be considered. Future longitudinal studies with consistent measures are needed to elucidate the effect of TLE surgery on the prevalence and severity of depression and estimate the incidence of de novo depression and suicide following surgery.

Why We Need a Formal Systematic Approach to Validating Psychological Tests: The Case of the Rorschach Comprehensive System

This article documents and discusses the importance of using a formal systematic approach to validating psychological tests. To illustrate, results are presented from a systematic review of the validity findings cited in the Rorschach Comprehensive System (CS; Exner, 2003) test manual, originally conducted during the manuscript review process for Mihura, Meyer, Dumitrascu, and Bombel's (2013) CS meta-analyses. Our review documents (a) the degree to which the CS test manual reports validity findings for each test variable, (b) whether these findings are publicly accessible or unpublished studies coordinated by the test developer, and (c) the presence and nature of data discrepancies between the CS test manual and the cited source. Implications are discussed for the CS in particular, the Rorschach more generally, and psychological tests more broadly. Notably, a history of intensive scrutiny of the Rorschach has resulted in more stringent standards applied to it, even though its scales have more published and supportive construct validity meta-analyses than any other psychological test. Calls are made for (a) a mechanism to correct data errors in the scientific literature, (b) guidelines for test developers' key unpublished studies, and (c) systematic reviews and meta-analyses to become standard practice for all psychological tests.

A study of remitted and treatment-resistant depression using MMPI and including pessimism and optimism scales

Background

The psychological aspects of treatment-resistant and remitted depression are not well documented.

Methods

We administered the Minnesota Multiphasic Personality Inventory (MMPI) to patients with treatment-resistant depression (n = 34), remitted depression (n = 25), acute depression (n = 21), and healthy controls (n = 64). Pessimism and optimism were also evaluated by MMPI.

Results

ANOVA and post-hoc tests demonstrated that patients with treatment-resistant and acute depression showed similarly high scores for frequent scale (F), hypochondriasis, depression, conversion hysteria, psychopathic device, paranoia, psychasthenia and schizophrenia on the MMPI compared with normal controls. Patients with treatment-resistant depression, but not acute depression registered high on the scale for cannot say answer. Using Student's t-test, patients with remitted depression registered higher on depression and social introversion scales, compared with normal controls. For pessimism and optimism, patients with treatment-resistant depression demonstrated similar changes to acutely depressed patients. Remitted depression patients showed lower optimism than normal controls by Student's t-test, even though these patients were deemed recovered from depression using HAM-D.

Conclusions

The patients with remitted depression and treatment-resistant depression showed subtle alterations on the MMPI, which may explain the hidden psychological features in these cohorts.

2010 Bruno Klopfer Distinguished Contribution Award. Some considerations for enhancing psychological assessment

The field of psychological assessment appears to be bogged down in recent decades on refining existing measures and techniques to the detriment of real change. This article attempts to highlight some of the changes that need to take place in psychological assessment in the next few decades if real progress is to be achieved: (a) developing guidelines for psychological tests and measures; (b) establishing explicit criteria for training; (c) establishing guidelines for competencies; (d) recognizing the impact of marketing; (e) embracing electronic technology; and (f) implementing computer adaptive testing.

Relative contributions of relationship distress and depression to communication patterns in couples

Researchers have long been interested in the relationship between marital distress and depression. Empirical findings from investigations into the relative contributions of marital distress and depression to marital communication have been inconsistent, and some communication behaviors, such as the demand/withdraw interaction pattern, have yet to be examined. The ability of depression to predict major types of communication (positive communication, negative communication, problem-solving, and demand/withdraw) was analyzed after controlling for the shared variance between marital distress and depression. Across two studies of couples beginning therapy and one study of couples beginning an enhancement program, results failed to provide support for a unique contribution of depression to couples' communication behaviors.

Evidence-based assessment of depression in adults

From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and suicidality; (d) an approach to suicidality that distinguishes between resolved plans and preparations and desire and ideation; (e) assessment of the atypical, seasonal, and melancholic subtypes; (f) parameters of course and chronicity; and (g) comorbidity and bipolarity. These complexities need to be accounted for when certain assessment approaches are preferred, and when ambiguity exists regarding the categorical versus dimensional nature of depression, and whether and when clinician ratings outperform self-report. The authors conclude that no one extant procedure is ideal and suggest that the combination of certain interviews and self-report scales represents the state of the art for evidence-based assessment of depression.

Severity of depressive symptoms, hippocampal sclerosis, auditory memory, and side of seizure focus in temporal lobe epilepsy

The relationship between severity of depressive symptoms and performance on three Wechsler Memory Scale-III auditory memory and learning subtests was examined in 84 inpatients diagnosed with medically intractable seizures of left (n=46, LTLE) or right (n=38, RTLE) temporal lobe origin. Depressive symptom severity was associated with auditory recall test performance in individuals with LTLE, but not RTLE. Multiple regression analyses indicated that severity of depressive symptoms, hippocampal sclerosis, and naming ability were significant predictors of auditory memory test performance in LTLE; however, hippocampal sclerosis was the only significant predictor of auditory memory in RTLE. Results demonstrate the importance of hippocampal sclerosis, greater self-report of depressive symptoms, and poor naming ability as independent predictors of poor auditory memory and learning abilities. Results suggest that a complex relationship exists among multiple risk factors that combine to influence performance on auditory memory tests as a function of side of seizure focus.

The Zung Self-Rating Depression Scale: convergent validity and diagnostic discrimination

This study examined the concurrent validity of the Zung Self-Rating Depression Scale (SDS) in relation to the Depression (D) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and addressed a gap in the literature with respect to diagnostic discrimination. The participants were persons on probation or parole. Although women were more depressed than men on the SDS, gender did not interact with SDS as a predictor in a logistic regression analysis. The SDS was found to be the primary discriminating variable in distinguishing depressed from nondepressed participants. In addition, the SDS contributed significant incremental validity over the D scale and showed greater accuracy in identifying nondepressed individuals.

The hard science of Rorschach research: what do we know and where do we go?

As the final article in the Special Series on "The Utility of the Rorschach for Clinical Assessment," the authors provide an overview of this instrument's current status. They begin with a thorough review of global and focused meta-analyses, including an expanded analysis of K. C. H. Parker, R. K. Hanson, and J. Hunsley's (1988) data set, and conclude that Rorschach, Minnesota Multiphasic Personality Inventory, and IQ scales each produce roughly similar effect size magnitudes, although all tests have greater validity for some purposes than for others. Because this evidentiary foundation justifies addressing other issues, the authors build on contributions to the Special Series to identify 11 salient theoretical and empirical gaps in the Rorschach knowledge base and make recommendations for addressing these challenges to further the evolution of the Rorschach and document its strengths and inherent limitations.

The MMPI-A and 13-year-old inpatients: how young is too young?

This study examined two questions in the use of the MMPI-A with 13-year-old inpatients: (a) are the profiles of 13-year-old inpatients markedly different from those produced by 14-year-old inpatients, and (b) what is the effect of scoring with standard MMPI-A norms versus Archer MMPI-A norms for 13-year-olds. Protocols from 56 13-year-old and 85 14-year-old psychiatric inpatients were analyzed. No significant differences were found for age in mean T scores, and no clear pattern of differences was found in percentage of elevations into the clinical range (T 65) for validity, clinical, content, or supplemental scales. A strong multivariate effect was found with the use of Archer MMPI-A norms resulting in lower T-score values than when standard MMPI-A norms are used. However, univariate differences based on norms were not routinely found with statistically significant differences in only 2 of the 38 scales for males and 7 of the 38 scales for females. The two major exceptions to this finding were that the use of Archer norms versus standard MMPI-A norms resulting in significantly higher mean T scores and a significantly higher percentage of cases falling within the clinical range for Scale 1 and the depression content scale.