Psychophysiological Identification of Depression Subtypes in Older Adults: Problematic Diagnostic Heterogeneity in the DSM-III-R and DSM-IV

The DSM-IV does not subclassify patients with depression on the basis of anxiety level. Hence a significant confound may exist in all outcome studies that employ DSM definitions of depression. To establish that objectively identifiable anxious and nonanxious subtypes of depression do indeed exist, a psychophysiological assessment battery was used with 114 treatment-seeking older adults. Dichotomous criterion categorization as either Nonanxious Depressed or Anxious Depressed was based on (a) DSM-III-R/DSM-IV diagnosis, and (b) standardized questionnaires of psychopathology. Multivariate analyses revealed no differences between groups when DSM criteria were used to classify participants. However, identical analyses using phenomenological diagnostic criteria indicated that anxious and nonanxious depressed participants differed in their psychophysiological response to negative imagery. Although anxious and nonanxious depressed participants evince different psychophysiological response patterns, these differences unfortunately are obscured by the DSM. Consequently, a phenomenological classification system may be more appropriate with affective disorders.     

Depression After Traumatic Brain Injury: A Review of Evidence for Clinical Heterogeneity

Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.     

Spiritual Dark Night and Psychological Depression: Some Comparisons and Considerations

The author contends that spiritual dark night and some forms of psychological depression share commonalties yet have distinctly different features that call for different responses from caregivers. The author presents comparisons between the 2 phenomena; highlights differences between them to offer counselors guidelines for making informed responses to their clients' issues; and compares professional preparation for spiritual directors, pastoral counselors, and traditional counselors. The article focuses on effective caregiver responses to dark night challenges that may be misperceived as manifestations of depression and stresses the importance of counselors and spiritual directors knowing their limits of expertise.     

Assessment of Depression in Adolescents: Objective and Projective Measures

This study is a multimethod assessment of depressive features in a sample of 60 adolescent inpatients. The purpose of the study was to examine the relationship between self-report measures of depression and Rorschach variables commonly associated with depression. Patients represented a variety of diagnostic categories in order to determine whether information gathered through assessment instruments was related to the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III], American Psychiatric Association, 1980) diagnoses of depression. Findings indicated that this sample of adolescents was highly defensive and emotionally constricted. There were several significant relationships between self-report measures and Rorschach indicators of depression. However, in general, the Rorschach variables were not strongly related to depression. The self-report measures were more accurate than Rorschach variables in discriminating between depressed and nondepressed subjects.     

童年期抑郁情绪发展的异质性与可预测性:2年追踪研究

以儿童抑郁量表为研究工具,对小学3到4年级771名儿童进行了2年的追踪研究。采用潜类别增长模型和终端结局潜发展模型,分别考察了童年期儿童抑郁情绪发展的亚群组类型,以及儿童抑郁情绪的发展特征对观察期结束时抑郁情绪的预测作用。结果表明：（1）童年期儿童的抑郁情绪发展呈现出三种不同的亚类型,即抑郁高风险组、抑郁低风险组和抑郁自愈组,各类型组人数比例分别为9.6%、53.4%和36.8%;（2）童年期儿童抑郁情绪的初始水平及其发展变化率均可以显著预测观察期结束时的抑郁情绪状况。童年期儿童抑郁情绪的早期监测工作有着重要的实践意义。     

童年期抑郁情绪发展的异质性与可预测性:2年追踪研究

以儿童抑郁量表为研究工具,对小学3到4年级771名儿童进行了2年的追踪研究。采用潜类别增长模型和终端结局潜发展模型,分别考察了童年期儿童抑郁情绪发展的亚群组类型,以及儿童抑郁情绪的发展特征对观察期结束时抑郁情绪的预测作用。结果表明：（1）童年期儿童的抑郁情绪发展呈现出三种不同的亚类型,即抑郁高风险组、抑郁低风险组和抑郁自愈组,各类型组人数比例分别为9.6%、53.4%和36.8%;（2）童年期儿童抑郁情绪的初始水平及其发展变化率均可以显著预测观察期结束时的抑郁情绪状况。童年期儿童抑郁情绪的早期监测工作有着重要的实践意义。     

Low-End Specificity of Four Depression Measures: Findings and Suggestions for the Research Use of Depression Tests

Past research has found that very low scorers on the Beck Depression Inventory (BDI) tend to respond in a fake-good manner on the Minnesota Multiphasic Personality Inventory (MMPI) validity scales. This finding was interpreted as evidence of poor low-end specificity. This study replicated and extended this work by evaluating the low-end specificity of four popular depression measures. The evidence of problems with low-end specificity was strong for the BDI and marginal for the Profile of Mood States depression subscale. Interestingly, MMPI scores in the normal range were associated with fake-good responding, whereas very low and high scores were not. There was no evidence of an association between fake-good responding and scores on Exner's Depression Index for the Rorschach. Implications of these findings and guidelines for dealing with problems with low-end specificity in research are discussed.     

In-Home Parent-Child Interaction Therapy: Clinical Considerations

ABSTRACT

Parent-Child Interaction Therapy (PCIT) is an empirically-supported behavioral parent training program designed to be administered in a clinic or laboratory-based setting. Recently, an empirical investigation revealed that in-home PCIT produced comparable results as the PCIT trials conducted in more controlled environments (this issue). Administering PCIT in a home setting carries both drawbacks and advantages. This article provides an overview of both the positive and negative clinical aspects of conducting in-home PCIT and presents effective solutions to potential treatment barriers.     

Personality Traits in Clinical Depression and Remitted Depression: An Analysis of Instrumental-Agentic and Expressive-Communal Traits

The present study evaluated levels of instrumental and expressive traits and vulnerability to severe depression. A sample of 44 depressed psychiatric patients (i.e., 22 currently depressed patients and 22 remitted depressed patients) completed the Beck Depression Inventory and the Personal Attributes Questionnaire, a well-known personality measure that assesses masculinity (i.e., instrumentality) and femininity (i.e., expressivity). Analyses revealed that currently depressed patients, relative to the remitted depressed patients, had significantly lower levels of both instrumental and expressive traits. Overall, most currently depressed patients were characterized by unhealthy, undifferentiated sex-role self-concepts (i.e., low levels of masculinity and femininity) while the sex-role self-concepts of remitted depressed patients closely resembled those found in nonclinical populations. The current results qualify recent research on the impact of depression on personality ratings by suggesting that severe depression may contribute by lowering scores on self-report assessments of socially desirable personality traits reflecting agentic, instrumental characteristics, and communal, expressive characteristics.     

Locating Ruptures Encrypted in Gender: Developmental and Clinical Considerations

The purpose of this article is to encourage reflection about children and adolescents who are expanding gender expression in this contemporary cultural moment. More specifically, to consider how relational rupture and its affective counterpart, grief, may become encrypted in gender. Attachment theory’s articulation of the intricacies of loss, in combination with psychoanalytic and systems theories, will serve to parse out the complex and paradoxical communications within this potentiality. Toward this end, my clinical process with five gender nonconforming children and adolescents will be discussed. The clinical section forms a tapestry weaving between similarities and differences in the expression of gender within the fabric of an attachment relationship. To link the clinical process to a larger cultural discourse, this article brings literary voices into the conversation, including Carson McCullers’s in Member of the Wedding and Jennifer Boylan’s memoirs of life in two genders and other writings. These sources crisscross/queer developmental time lines, disciplinary mediums, culture, and family dynamics to open up an inclusive conversation about gender subjectivity. The therapeutic process, with particular emphasis on the importance of play, is linked to advances in developmental science. Thinking with the children who vary the expression of gender can potentially inform our conceptualization of gender development, more generally.     

Using Self-Report Measures to Corroborate Theories of Depression: The Specificity Problem

Depression scales tend to correlate highly with measures of anxiety and other negative emotional states. If the same is true of scales measuring constructs from depression theories such as negative cognitions and anaclitic depression, it brings into question the specificity Of these models to depression. The overlap has been attributed to the common role of negative affect in depression and anxiety. Using a sample of college students, our study investigated the relationships among measures of depression, anxiety, positive and negative affect, and theory-relevant constructs. Theory-relevant scales related no more strongly to depression than anxiety measures. Furthermore, they related strongly either with negative or positive affect but usually not with both. These findings bring into question the specificity of depression models corroborated through the available self-report measures.     

The Holtzman Inkblot Technique Content Measures of Depression and Suspiciousness

Using free response reports of preferences for books and movies that are presumed to be an index of subjects' fantasy interests, content codes for these materials were developed that successfully discriminated adolescent boys and girls. In two samples boys preferred stories about (1) sports, (2) adventure themes, (3) stories of man-machine relationships. Girls preferred stories of (1) suffering, hardship, overcoming personal and interpersonal obstacles, (2) romance, (3) teenage life, and 4) religious and inspirational themes. Stories about family life, nurturance, sex, and aggression were among the codes that did not discriminate the sexes. Implications of the findings and suggestions for further development of the instrument are discussed.     

Affect Labeling to Facilitate Inhibitory Learning: Clinical Considerations

Exposure-based treatments known to be effective for a wide range of psychopathology are thought to work via inhibitory learning, where new learning acquired during exposure exercises inhibits previously learned fear and avoidance responses. One way in which this inhibitory learning may be enhanced is through affect labeling, during which clients verbalize their internal emotional experiences. Theoretically, affect labeling may be a subtle, implicit form of emotion regulation and may facilitate more explicit forms of extinction learning. Experimental research suggests that affect labeling may lead to attenuated fear responses to emotionally evocative stimuli in healthy samples and may be a helpful strategy in reducing physiological arousal experienced during exposure tasks, particularly for clients with inhibitory deficits. Research with clinical samples is limited and mixed, at best. Case examples illustrate how affective labeling may help get a client “unstuck” from unproductive processing loops, can contribute to shifts in perspective and meaning making, and may modulate distress and promote distress tolerance. We argue that routine use of affect labeling in clinical care is premature. When used, it should be employed strategically within a broader case conceptualization and may be of a limited benefit beyond what is already employed in quality exposure therapy.     

Hopelessness,Depression, Suicidal Ideation,and Clinical Diagnosis of Depression

The relevance of a clinical diagnosis of depression for explaining the discrepant relationships of hopelessness and depression with suicidal ideation was studied. The Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered to 1,306 (72.8%) patients with at least one DSM-III-R mood disorder and 488 (27.3%) patients without any mood disorders. A multiple regression analysis was conducted, and hopelessness was 1.3 times more important than depression was for explaining suicidal ideation. The interactions of the BDI and BHS with diagnostic group were not significant.     

Psychophysiological effects of noxious imagery: Prevalence and prediction

Research suggests that people who generate psychophysiological arousal in emotive imagery therapies are likely to show the largest therapeutic gains. This study investigated the frequency of occurrence and methods of predicting this imagery skill. The effects of five fearful imagery themes on 95 undergraduate volunteers were evaluated in individual sessions by psychophysiological (SRL, EKG and EMG), self-report (anxiety and clarity ratings) and behavioral (motoric expression) measures. Additionally, four questionnaires (Betts, Gordon, APQ and STAI) were administered in a group session. EKG arousal occurred in 66% of our subjects, SRL arousal in 38% and EMG arousal in 16%. Only 9% of our subjects experienced arousal in all three psychophysiological responses and 24% experienced arousal in neither. Motoric expression (overt behavioral emoting) best predicted psychophysiological arousal, self-report ratings were a distant second, and the questionnaires were worthless in this regard. Imagery-induced psychophysiological arousal appears to be a fairly common phenomena, though it eludes convenient prediction. Some training strategies were discussed, (response proposition instructions, biofeedback and motoric coaching), which could be employed with persons deficient in psychophysiological imagery skills prior to their commencing an emotive imagery therapy.     

Use of Self-Report Measures of Anxiety and Depression in Outpatients with Schizophrenia: Reliability and Validity

The psychometrics of many self-report measures of anxiety and depression have been established for patients with anxiety disorders, but little is known about use of these measures in patients with psychotic disorders. This study examined psychometrics of commonly used self-report measures. Self-report measures and interviewer ratings were collected on 33 outpatients diagnosed with schizophrenia disorders. A sample of 46 patients with anxiety disorders completed the same self-report measures. Internal consistency was high for the self-report measures in both samples. Test-retest reliability was moderate to high. Scores on self-report measures were correlated with interviewer ratings and with scores on other self-report measures of similar constructs, supporting the convergent validity of the measures. Reliable and valid information about anxiety and depression can be obtained through administering the self-report measures to outpatients diagnosed with psychotic disorders. There was more overlap among measures than was expected, possibly because of poor discriminant validity. One explanation of this may be that anxiety constructs overlap more in patients with schizophrenia or related disorders than in non-psychotic populations.     

Self-Report,Peer-Report,and Teacher-Report Measures of Childhood Depression: An Analysis by Item

We explored the low correlation among different types of childhood depression measures at the item level. The items from the Children's Depression Inventory (CDI), Peer Nomination Inventory of Depression (PNID), and the Child Behavior Checklist-Teacher Report Form (CBCL-T) were combined, and both first- and second-order factor analyses were conducted. Results indicate that self-report, peer-report, and teacher-report assessments of depression measure generally uncorrelated constructs. Second-order analysis suggests that depression as a global construct is being measured to some degree by items from all three instruments. Canonical analysis was employed to identify items that best predicted CDI, PNID, and CBL-T summary scores simultaneously. Also, the relationship between specific items with similar content was investigated. Results from these analyses generally supported a conclusion that the three types of measures yield scores that are primarily independent and that the use of summary scores is not masking stronger relationships within measures. These findings have implications for clinical practice and construct elaboration.