Heightened subjective experience of depression in borderline personality disorder

Despite the frequent comorbidity of major depression and borderline personality disorder (BPD), limited research has examined what effect this comorbidity has on the severity, course, and presentation of depression. The purpose of this study was to examine whether the severity of major depressive disorder (MDD) in the context of comorbid borderline personality disorder (BPD) differs from MDD when comorbid BPD is not present and to determine whether different measures of depression yield convergent findings. Sixty patients diagnosed with DSM-IV MDD participated in this study. Twenty-nine were diagnosed with DSM-IV BPD, while the remaining 31 had no Axis II diagnosis. Depression was evaluated with both clinician (Hamilton Rating Scale for Depression) and self-report (Beck Depression Inventory) ratings. While the two groups were rated as similarly depressed by clinicians on the overall rating and the factor scores, the MDD/BPD group reported more severe depressive symptoms on the self-report measure. This difference was significant even after controlling for clinician-rated severity. Gender interacted with diagnosis, males in the BPD group showed the largest discrepancies between clinician ratings and self-reports. Posthoc analyses of HDRS factors with the BDI showed that the clinicianrated cognitive disturbance and retardation factors were correlated with self-rated severity overall. Within subgroups, only the retardation factor was correlated with the BDI. Our results suggest that while depressed individuals with and without BPD may be rated as similarly depressed when assessed with objective rating methods, the subjective experience of the depression may be rated as more intense or severe by patients with comorbid BPD. The mechanism underlying this effect remains unknown, and requires further research.     

Feigned depression and feigned sleepiness: a voice acoustical analysis

We sought to profile the voice acoustical correlates of simulated, or feigned depression by neurologically and psychiatrically healthy control subjects. We also sought to identify the voice acoustical correlates of feigned sleepiness for these same subjects. Twenty-two participants were asked to speak freely about a cartoon, to count from 1 to 10, and to sustain an "a" sound for approximately 5s. These exercises were completed three times (within the same testing session) with three differing sets of instructions to the participants. These three conditions were presented in pseudo-random order to control for any order effects, and all subjects were na?ve to the intended purpose of this study. For all three conditions, mean speaking rates and pitch ranges were calculated. A series of paired t tests showed significant differences in the speaking rates (counting numbers and free-speech exercises) between the 'normal' and feigned sleepy conditions, and between the normal and feigned depression conditions, but not between the 'sleepy' and 'depressed' conditions. The results for pitch range, for all speech exercises, were not different between the normal and either the feigned depression or feigned sleepiness conditions. These results indicate that persons feigning depression and sleepiness demonstrate some level of conscious control of their speech rate, but they did not convincingly alter their pitch ranges while feigning depression or sleepiness.     

Time trends in the effects of mindfulness-based cognitive therapy for depression: A meta-analysis

Recent studies suggest that the effects of cognitive therapies for depression show systematic changes over time. A meta-analysis was conducted to explore the temporal development of the effect of mindfulness-based cognitive therapy (MBCT) for current depression in studies that used the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HDRS) as outcome measures. A systematic search of research databases yielded 20 studies that were included in the analyses. The results showed that MBCT is effective in reducing depressive symptoms. The effect sizes of studies using the BDI or the HDRS as an outcome measure were not moderated by the time of publication. Funnel plots and the trim and fill method suggested that publication bias was low. However, the number of available studies was small, and the time period investigated relatively short. The results should therefore be considered preliminary.     

Comparison of the Hamilton Depression Rating Scale and the Geriatric Depression Scale: detection of depression in dementia patients.

The present longitudinal prospective study compared results from the Geriatric Depression Scale with those from the Hamilton Depression Rating Scale for 30 dementia patients. The criterion measure was presence of depression as indicated by the psychiatric diagnosis. The psychiatrist and physician's assistant made the Hamilton ratings while the psychology staff administered the Geriatric Depression Scale. The two measures were statistically unrelated from Times 1 and 2 (rs = .26 and .41). Eleven (37%) patients were depressed and nine received antidepressant medications. Sensitivity ratings were 82% and 9%, respectively, and specificity ratings were 88% and 92%, respectively. Possible explanations for the success of the Geriatric Depression Scale and lack of success of the Hamilton ratings in detecting depression in this population are discussed.     

Emotionally conditioning the target-speech voice enhances recognition of the target speech under “cocktail-party” listening conditions

Under a noisy “cocktail-party” listening condition with multiple people talking, listeners can use various perceptual/cognitive unmasking cues to improve recognition of the target speech against informational speech-on-speech masking. One potential unmasking cue is the emotion expressed in a speech voice, by means of certain acoustical features. However, it was unclear whether emotionally conditioning a target-speech voice that has none of the typical acoustical features of emotions (i.e., an emotionally neutral voice) can be used by listeners for enhancing target-speech recognition under speech-on-speech masking conditions. In this study we examined the recognition of target speech against a two-talker speech masker both before and after the emotionally neutral target voice was paired with a loud female screaming sound that has a marked negative emotional valence. The results showed that recognition of the target speech (especially the first keyword in a target sentence) was significantly improved by emotionally conditioning the target speaker’s voice. Moreover, the emotional unmasking effect was independent of the unmasking effect of the perceived spatial separation between the target speech and the masker. Also, (skin conductance) electrodermal responses became stronger after emotional learning when the target speech and masker were perceptually co-located, suggesting an increase of listening efforts when the target speech was informationally masked. These results indicate that emotionally conditioning the target speaker’s voice does not change the acoustical parameters of the target-speech stimuli, but the emotionally conditioned vocal features can be used as cues for unmasking target speech.     

Variability in fundamental frequency during speech in prodromal and incipient Parkinson's disease: a longitudinal case study

Nearly two centuries ago, first observed that a particular pattern of speech changes occur in patients with idiopathic Parkinson's disease (PD). Numerous studies have documented these changes using a wide variety of acoustic measures, and yet few studies have attempted to quantify any such changes longitudinally, through the early course of the disease. Moreover, no attempt has been made to determine if speech changes are evident during the prodromal period, prior to the onset of clinically noticeable symptoms. This case-control pilot study is a first attempt to determine if changes in fundamental frequency variability during speech, an acoustic measure known to be affected later in the course of the disease, are evident during the prodromal period. A retrospective analysis of videotape footage recorded and made available by a leading national television news service. Videotape samples were obtained for a single individual (and a well-matched control subject) over an 11-year period of this individual's life (7 years prior to diagnosis of PD, and 3 years post-diagnosis). Results suggest that changes in F0 variability can be detected as early as 5 years prior to diagnosis (consistent with findings from other laboratories that have relied on cross-sectional study approaches). This pilot study supports the utility of such a design approach, and these results warrant continued effort to better understand the onset of PD and sensitivity of measurement of voice acoustical changes during the prodromal period.     

Selective responsiveness of chronically ill children to assessments of depression.

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies. This variation in prevalence rates may be due, in part, to selective reporting of patients based on measures used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the Intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression Inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x Intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.     

Psychometric properties of the Hamilton Depression Rating Scale and other physician-rated psychiatric scales for the assessment of depression in ESRD patients undergoing hemodialysis in Turkey

This study aimed to examine the reliability and validity of clinician-rated psychiatric scales for end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) treatment in Turkey. For this, the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Global Assessment of Functioning (GAF) Scale, Clinical Global Impression (CGI) Scale, and Mini Mental State Exam (MMSE) were administered to 45 ESRD outpatients undergoing HD treatment. Regarding the reliability of HDRS and HARS, internal consistency and split-half reliability analyses revealed acceptable coefficients. The test - retest reliability coefficients were also examined for all measures after a period of a month, and despite this relatively long time interval, test - retest reliability coefficients were above .60 for all measures. Concerning the validity studies, all these scales revealed suitable convergent, discriminant, and criterion validity outcomes. A cut-off point of 10 for HDRS is suggested for the identification of depression in this population. In general, the findings of this study indicate that HDRS, HARS, CGI, GAF, and MMSE are reliable and valid instruments that can be used among ESRD patients undergoing HD.     

Selective Responsiveness of Chronically Ill Children to Assessments of Depression

Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies This variation in prevalence rates may be due, in part, to selective reporting of patients based on measure, used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checktist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.     

Correlates of depressed mood in normal children

Two instruments which have been proposed as measures of clinical depression in children and an ad hoc teacher rating were given to a group of 109 normal children. The Children's Depression Inventory (CDI), the Peer Nomination Inventory for Depression (PNID), and a teacher rating of depression were given along with the Conner s Teacher Rating Scale (TRS), teacher ratings of somatic complaints, peer popularity, and absenteeism, and peer ratings of popularity to examine the behavioral correlates of depressed mood in normal children. While few sex differences were found on mean depression scores, different patterns of correlations were found for the two sexes. For males, there were no significant correlations among the three depression measures, but all three depression measures were correlated with unpopularity and conduct problem ratings on the TRS. For females, the three depression measures were adequately intercorrelated. The teacher rating of depression was correlated with general deviance as measured by the TRS, but the CDI and PNID were correlated with TRS ratings of conduct problems, with peer ratings of unpopularity, and with teacher ratings of somatic complaints. Implications for the issue of the possible existence of a clinical syndrome of depression in children were discussed.     

Predictors of suicidal thoughts: Mood instability versus neuroticism

The personality trait neuroticism predicts depression and suicidal thoughts. Neuroticism is also linked to mood instability (MI)¹ that is common in patients with depression. This study investigated (a) whether MI predicts suicidal thoughts in depressed patients and (b) the relationship of MI to neuroticism. All 129 patients with Major Depression (MINI interview) were assessed on MI (Affective Lability Scale), neuroticism (Short Eysenck Neuroticism Scale), depression (Beck Depression Inventory), and suicidal thoughts (Beck Scale for Suicidal Ideation). Participants also completed the Perceived Stress Scale, Mood Disorder Questionnaire and five clinical questions on MI. Factor analysis of the Eysenck Neuroticism Scale revealed unstable moods as one of three main factors. Only depression severity and MI predicted suicidal thoughts once other variables including neuroticism were controlled. Mediation analyses showed that MI mediated the relationship between neuroticism and suicidal thoughts. These results suggest that MI as measured by the Affective Lability Scale typifies the type of depression that predicts suicidal thoughts and that MI may be more directly associated with suicidal thoughts than neuroticism. This demonstrates the clinical value of assessing MI rather than neuroticism in the treatment of patients with depression with suicidal thoughts.     

Depression, anxiety, and the MCMI-III: construct validity and diagnostic efficiency

This study aimed to enhance knowledge of the construct validity and diagnostic efficiency of the depression- and anxiety-related scales of the MCMI-III (Millon, 1994). The MCMI-III, various concurrent depression and anxiety measures, and an Axis I structured diagnostic interview were administered in a total sample of 696 outpatients with depressive disorders, anxiety disorders, or both. Sound construct validity was found for the Dysthymia and Major Depression clinical syndrome scales and the Avoidant and Depressive personality disorder scales. The validity of the Anxiety scale was poor, showing moderate convergence with panic and worry-related anxiety measures, but problems discriminating from depression. Operating characteristics for discriminating depressed patients from anxious patients were fair for the Major Depression scale, but poor for the Anxiety and Dysthymia scales.     

Cognitive and Behavioral Contributions to Depression Severity,Quality of Life,and Functioning Among People Living With HIV in South Africa

Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale—Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment.The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.     

Fatigue estimation using voice analysis

In the present article, we present a means to remotely and transparently estimate an individual's level of fatigue by quantifying changes in his or her voice characteristics. Using Voice analysis to estimate fatigue is unique from established cognitive measures in a number of ways: (1) speaking is a natural activity requiring no initial training or learning curve, (2) voice recording is a unobtrusive operation allowing the speakers to go about their normal work activities, (3) using telecommunication infrastructure (radio, telephone, etc.) a diffuse set of remote populations can be monitored at a central location, and (4) often, previously recorded voice data are available for post hoc analysis. By quantifying changes in the mathematical coefficients that describe the human speech production process, we were able to demonstrate that for speech sounds requiring a large average air flow, a speaker's voice changes in synchrony with both direct measures of fatigue and with changes predicted by the length of time awake.     

Prevalence and correlates of self-reported depressive mood among seriously emotionally disturbed adolescents.

This study examined self-reported depression on the Reynolds Adolescent Depression Scale among 45 seriously emotionally disturbed adolescents. Scores of one-third of the sample exceeded the cut-off score, which indicated the need for further diagnostic study to assess the possible presence of depression. Significant positive correlations included an association with school attendance, a relationship with scores on the Revised Children's Manifest Anxiety Scale, and an association with teachers' ratings on two subscales of the Revised Behavior Problem Checklist. Also, the Depression scale's negative association with the Lie subscale of the Manifest Anxiety Scale is interpreted as indicative of seriously emotionally disturbed adolescents' response style on self-reported measures of depression.     

Reliability and validity of the Yale Global Tic Severity Scale

To investigate the reliability and validity of the Yale Global Tic Severity Scale (YGTSS), 28 youth aged 6 to 17 years with Tourette's syndrome (TS) participated in the study. Data included clinician reports of tics and obsessive-compulsive disorder (OCD) severity, parent reports of tics, internalizing and externalizing problems, and child reports of depression and anxiety. All children participated in a 2nd YGTSS administration by the same rater 48 days later. Good internal consistency and stability were found for the YGTSS scores. YGTSS scores demonstrated strong correlations with parent-rated tic severity (r = .58-.68). YGTSS scores were not significantly related to measures of clinician ratings of OCD severity (r = .01-.15), parent ratings of externalizing and internalizing behavior (r = -.07-.20), and child ratings of depression (r = .02-.26) and anxiety (r = -.06 -.28). Findings suggest that the YGTSS is a reliable and valid instrument for the assessment of pediatric TS.     

Verbal indicators of depression.

Speech content, voice quality, and temporal pacing of speech were evaluated for 11 well and 11 depressed women. Sadness was the dominant mood of the depressed women's speech, whereas happiness and mood neutrality characterized the well women's speech. The well women's tone of voice changed with the content of their speech. The well women spoke with a wide range of fundamental frequency, and the average fundamental frequency of their voices changed according to speech content. In contrast, the depressed women spoke with a narrow range of fundamental frequency, and the average fundamental frequency of their speech was unaffected by speech content. The depressed women spoke with longer pauses than the well women did. The results of this study contribute to the understanding of measures for assessing depression.     

Child,mother, and father evaluations of depression in psychiatric inpatient children

The agreement among children and their parents in evaluating the children's depression was examined in 48 families. Newly admitted inpatient children (ages 6–13) and their mothers and fathers independently completed selfreport and interview measures to assess severity and duration of the children's depression. The results indicated that different measures of depression completed by the same rater (child, mother, or father) were highly intercorrelated. Yet there was little or no relationship between childmother and child-father ratings of the children's depression for the same or related measures of depression. Children independently diagnosed (DSM III) as depressed rated themselves and were rated by their parents as more depressed than nondepressed children. Even so, children consistently rated themselves as less depressed across the measures than did their parents. Parent ratings of the children's depression and the correspondence of child-parent ratings varied as a function of several child and family variables, including child IQ, gender, race, and family welfare status.This investigation was supported in part by a Research Scientist Development Award (1 K02 MH00353) to the first author from the National Institute of Mental Health and by a Clinical Research Center Grant for the Study of Affective Disorders (5 P50 MH30915-05) from the National Institute of Mental Health. The authors are grateful to the clinical research team of the Child Psychiatric Treatment Service.     

Relationships between the Beck Depression Inventory and the Hamilton Psychiatric Rating Scale for Depression in depressed outpatients

The Beck Depression Inventory (BDI) and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were used with 300 outpatients diagnosed with DSM-III major depression disorders. A principal-components analysis was performed on the intercorrelations among the 21 BDI and 24 HRSD symptoms. Three orthogonal components were found and interpreted as reflecting differences in self-report and clinical rating methods for measuring the severity of depression. The importance of using both self-reports and clinical ratings for evaluating depression in psychiatric outpatients was discussed.     

Measuring depression in children: a multimethod assessment investigation

The present investigation examined measures for the assessment of depressive symptomatology in children, as well as two related constructs (self-esteem and anxiety). The sample consisted of 166 elementary school children from grades 3 through 6. Two self-report depression measures, the Children's Depression Inventory (Kovacs, 1979) and the Child Depression Scale (Reynolds, in press), as well as anxiety and self-esteem scales, were completed by the children. Parents (mothers and fathers) evaluated their children on the depression and anxiety scales from the Personality Inventory for Children (Wirt, Lachar, Klinedinst, & Seat, 1977), and teachers provided global ratings of depression and academic performance. The results support the reliability and validity of both self-report children depression measures. Data obtained on the parent report measure do not recommend its use at this time for assessing depression in children, while results on teachers' global ratings of depression provide some evidence that teachers may be a good source of information regarding depression in children.The authors gratefully acknowledge the generous assistance provided by Al Holmquist, principal of Mazomanie Elementary School, and James Clark, principal of Oregon Elementary School, and their teachers. This research was funded in part by a Spencer Foundation Grant to the first author, through the School of Education, University of Wisconsin-Madison. The writing of this article was facilitated by a Wisconsin Alumni Research Foundation grant (135–1503) to the first author.