The Depressive Experiences Questionnaire: on using a student-based scoring program for a clinical sample

In both clinical and nonclinical samples, the Depressive Experiences Questionnaire is scored with a program that computes factor scores by using means, standard deviations, and item-loadings of a student sample. The underlying assumption of the use of this program in clinical samples is that factor scores computed on the basis of the student factor solution are similar to factor scores computed on the basis of a clinical factor solution. Consequently, both series of scores should lead up to the same conclusions when studying associations with theoretically related variables. This assumption has not been tested although the questionnaire has been used in research for almost 30 years. In the present paper an alternative scoring program was constructed, based on the factor solution of a clinical sample (N = 400) to assess whether scores of this clinical scoring program are associated in the same way with different types of depressive symptoms and interpersonal problems as the scores of the original (student-based) program. Analysis gave results inconsistent with the assumption and did not support the use of the student-based scoring program in the clinical sample. Further, results suggest that standards for assessing factorial similarity used in confirmatory factor analysis might be too lenient.     

Assessing risk of reoffending in adolescents who have committed a sexual offense: the accuracy of clinical judgments after completion of risk assessment instruments

As courts often rely on clinicians when differentiating between sexually abusive youth at a low versus high risk of reoffense, understanding factors that contribute to accuracy in assessment of risk is imperative. The present study built on existing research by examining (1) the accuracy of clinical judgments of risk made after completing risk assessment instruments, (2) whether instrument-informed clinical judgments made with a high degree of confidence are associated with greater accuracy, and (3) the risk assessment instruments and subscales most predictive of clinical judgments. Raters assessed each youth's (n = 166) risk of reoffending after completing the SAVRY and J-SOAP-II. Raters were not able to predict detected cases of either sexual recidivism or nonsexual violent recidivism above chance, and a high degree of rater confidence was not associated with higher levels of accuracy. Total scores on the J-SOAP-II were predictive of instrument-informed clinical judgments of sexual risk, and total scores on the SAVRY of nonsexual risk.     

THE SEARCH FOR CONFIGURAL RELATIONSHIPS IN PERSONALITY ASSESSMENT: THE DIAGNOSIS OF PSYCHOSIS vs. NEUROSIS FROM THE MMPI

In 1956 Meehl predicted that the relationships between MMPI scores and the psychosis-neurosis diagnostic classification should be highly configural in character, and therefore that no linear combination of MMPI scores should be able to differentiate neurotic from psychotic patients as accurately as either experienced clinical psychologists or configural actuarial techniques. The present paper summarizes the findings from ten years of research on this question. While the search for configural actuarial procedures has led to a moderator variable, neither clinical experts, moderated regression analyses, profile typologies, the Perceptron algorithm, density estimation procedures, Bayesian techniques, nor sequential analyses-when cross-validated-have been-able to improve on a simple linear function. The implications of these negative findings for investigations of configural relationships with other problems are discussed.     

The relationship between 16 fear factors and psychiatric status

Although originally designed as a guide to therapy, the Wolpe-Lang Fear Survey Schedule (FSS) has been the subject of increasing study of its psychometric characteristics. A recent factor analysis of the records of psychiatric patients yielded 16 fear factors. The present study attempted to evaluate the clinical relevance of these factors by comparing the factor scores of adult psychiatric outpatients (AOP) with those of parents of child psychiatry patients (CPC). On 13 of the 16 factors the AOP group scored higher (with 3 of these 13 differences modulated by sex), indicating a strikingly consistent relationship between clinical status and the fear factors. These results suggest that future research of the patterns of fear factor scores as they relate to clinically relevant variables might well be fruitful. In the present study, females scored higher than males on all 16 fear factors (with 3 of these 16 differences appearing only in the AOP group). These results suggest the importance of treating sex as a moderator variable in future research on the FSS and its factors.     

Diminished effect of age and education on neuropsychological test performances of older children with learning disabilities

Previous research has shown that age and education have a significant effect on neuropsychological test scores among normals, but that these effects are sharply diminished, or perhaps totally obliterated, among adults with brain damage and children with brain damage. These findings would have their major practical clinical significance in limiting the use of age and/or education adjustments of raw scores for subjects with brain damage, especially if the adjustments were based on data derived from the study of normal subjects. The present investigation studied the effects of age and education on the Neuropsychological Deficit Scale (NDS) for Older Children scores of children with learning disabilities, aged 9 through 14 years. No significant effects among age and education variables and NDS scores were found. In fact, younger and older subgroups as well as lower- and higher-educated subgroups earned mean NDS scores that were not significantly different. It appears that the neuropsychological consequences of learning disabilities override the effects of age and education in the 9- through 14-year age range.     

A balanced time perspective: Is it an exercise in empiricism,and does it relate meaningfully to health and well‐being outcomes?

Time perspective research assesses the degree to which thoughts and feelings about the past, present and future influence behaviour, and a balanced time perspective profile has been posited as being ideal. Although this area of research has seen a move towards person‐centred analyses, using either cluster analyses or a deviation from balanced time perspective (DBTP) approach, there are a number of theoretical and methodological issues that must be addressed. Using data from diverse samples in four countries, the present study used both cluster analyses and the DBTP approach to assess how cluster membership and DBTP scores related to a range of health and well‐being outcomes. As in previous studies, a balanced profile only emerged once in cluster analyses, and positive‐oriented profiles were associated with optimal outcomes. The study also found evidence of a relationship between DBTP scores and scores on well‐being indicators. However, results gained after manipulating the DBTP equation in two different ways again indicated that higher than expected positive past and present or past and future scores were responsible for the positive outcomes. As such, these findings raise concerns regarding the use of the DBTP construct within clinical settings.     

Sex-role orientation and attachment styles of sex offenders

Given the increase of individuals who have a history of sexual offenses, there has been an increase in research on the etiology of sex-offending behavior. The present purpose was to evaluate the relationship between sex-role orientation and attachment styles of males who were sex offenders. Analysis yielded statistically significant differences between comparison (n = 22) and clinical groups (n = 21) in gender roles, with little sign of the androgynous gender type for sex offenders. The offender group showed significantly lower frequency of androgyny scores and significantly higher scores on feminine and undifferentiated orientations, supporting the theoretical view of sex offenders as being "cross-sex-typed." In addition, the sex offender group had a significantly higher mean score on anxious-avoidant relationship attachment. Based on the present findings, there appears to be a need to help sex offenders explore how their gender roles may relate to their sex-offending behavior and assist sex offenders in the development of adaptive relationships with reduced anxiety and ambivalence.     

Cognitive Fusion Questionnaire—Body Image: Psychometric Properties and Its Incremental Power in the Prediction of Binge Eating Severity

Given the clinical usefulness of the CFQ-BI (Cognitive Fusion Questionnaire—Body Image; the only existing measure to assess the body-image-related cognitive fusion), the present study aimed to confirm its one-factor structure, to verify its measurement invariance between clinical and non-clinical samples, to analyze its internal consistency and sensitivity to detect differences between samples, as well as to explore the incremental and convergent validities of the CFQ-BI scores in Brazilian samples. This was a cross-sectional study, which was conducted in clinical (women with overweight or obesity in treatment for weight loss) and non-clinical samples (women from the general population). The one-factor structure was confirmed showing factorial measurement invariance across clinical and non-clinical samples. The CFQ-BI scores presented an excellent internal consistency, were able to discriminate clinical and non-clinical samples, and were positively associated with binge eating severity, general cognitive fusion, and psychological inflexibility. Furthermore, body-image-related cognitive fusion scores (CFQ-BI) presented incremental validity over a general measure of cognitive fusion in the prediction of binge eating symptoms. This study demonstrated that CFQ-BI is a short scale with reliable and robust scores in Brazilian samples, presenting incremental and convergent validities, measurement invariance, and sensitivity to detect differences between clinical and non-clinical groups of women, enabling comparative studies between them.     

Predictive and incremental validity of the Violence Risk Appraisal Guide scores with male and female jail inmates

The present study examines the predictive and incremental validity of Violence Risk Appraisal Guide scores in a sample of 328 male and 145 female jail inmates held on felony charges. Significant gender differences were observed in VRAG item and total score means, as well as in correlations between the VRAG and concurrent measures of aggression. VRAG scores significantly predicted institutional misconduct during incarceration and recidivism in the first year postrelease for male inmates but not for female inmates. In terms of incremental validity, VRAG scores predicted institutional misconduct and recidivism beyond that accounted for by psychopathy for male inmates but not for female inmates. Implications for clinical practice and future research are discussed.     

Emotion recognition in schizophrenia: further investigation of generalized versus specific deficit models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.     

Psychometric evaluation of the eating disorder inventory (edi) in a clinical group

Abstract

This study examined the psychometric properties of the Eating Disorder Inventory (EDI) with a clinical sample of 79 female clients seen at an outpatient eating disorder program. The means and standard deviations for the bulimia nervosa subgroup in this study (n = 48) compared favorably with the bulimia group in the EDI Manual Supplement (1986) on all eight subscales, except Drive for Thinness. The present non-student sample had significantly lower scores on this particular subscale than did the norm group (mostly students). Another difference was that the local bulimic subgroup had significantly higher present and minimum weights (as a percentage of the expected average weight according to height). The EDI subscales also displayed respectable internal consistency reliability with this sample. In contrast to previous research, however, only five factors were found in a factor analysis rather than eight corresponding to the original subscales for the EDI. Differences between bulimic and a not-otherwise-specified (NOS) diagnostic groups were also found on both the EDI Ineffectiveness and Bulimia subscales (NOS had lower scores). The results of this study are discussed in terms of the importance of undertaking local standardization of tests in clinical settings.     

Psychosis proneness and clinical psychopathology: examination of the correlates of schizotypy

The present report examined the associations between the Perceptual Aberration Scale (PAS), a prominent psychometric index of hypothetical psychosis proneness, and several measures of clinical psychopathology in a nonpsychotic psychiatric sample (N = 101). Patients were examined by experienced clinicians using structured psychiatric interviews to assess DSM-III-R Axis I and II conditions and rated for anxiety, depression, severity of illness, and current adult social competence. Elevated scores on the PAS were most closely associated with anxiety and depression as well as schizotypal, schizoid, avoidant, and obsessive-compulsive personality disorder symptomatology. Hierarchical regression analysis identified schizotypal symptoms and anxiety as the two underlying psychopathological processes most useful in explaining variance in PAS scores. Results are interpreted as supporting both the clinical relevance and research utility of the PAS and enhancing the construct validity of Meehl's model of schizotypy.     

A comparison of working memory profiles in children with ADHD and DCD

The main objective of present study was to investigate whether the patterns of working memory performance differ as a function of attention and motor difficulties, and whether children with ADHD and DCD could be reliably discriminated on the basis of their memory deficits. A related aim was to investigate the link between their working memory profiles and academic attainment. Fifty children with ADHD-Combined, 55 children with DCD, and an age-matched group of 50 typically developing children with average working memory were assessed on standardized measures of working memory, IQ, and academic attainment (reading, spelling, comprehension, and math). The normal controls performed significantly better than both clinical groups on all working memory tests. Specific patterns emerged in the memory profile of the clinical groups: The children with DCD had a depressed performance in all working memory tests, with particularly low scores in visuospatial memory tasks; children with ADHD performed within age-expected levels in short-term memory but had a pervasive working memory deficit that impacted both verbal and visuospatial domains. The clinical groups could reliably be discriminated on the basis of their short-term memory scores. Their learning profiles were similar. It is possible that the working memory profiles of the children with ADHD and DCD are influenced by distinct underlying cognitive mechanisms, rather than a general neurodevelopmental delay. Despite these distinctive patterns of memory performance, both clinical groups performed similarly on academic attainments, suggesting that memory may underlie learning difficulties, independent of related clinical disorders.     

Therapeutic progress and symptom elevation in treating dismissive attachment: A case study

A dismissive or avoidant attachment style can present clinical challenges in psychotherapy as the attachment style may interfere with the development of a constructive therapeutic alliance and impact the level of disclosure, expressions of distress, and risks for premature drop-out. This paper reports a naturalistic case study and offers an in-depth examination of a treatment with a client with dismissive attachment, including a detailed examination of relational interventions and countertransference struggles. Furthermore, this paper considers the notable differences between quantitative scores on a well-validated, practice-based clinical symptom inventory and the qualitative outcomes for this client to offer clinical and research implications in treatment with dismissive attachment.     

THE COMPREHENSIVE SYSTEM FOR THE RORSCHACH:

The Comprehensive System (Exner, 1993) is widely accepted as a reliable and valid approach to Rorschach interpretation However, the present article calls attention to significant problems with the system First, contrary to common opinion, the interrater reliability of most scores in the system has never been demonstrated adequately Second, important scores and indices in the system are of questionable validity Third, the research base of the system consists mainly of unpublished studies that are often unavailable for examination Recommendations are made regarding research and clinical use of the Comprehensive System     

Global Assessment of Relational Functioning Scale (GARF): II. Reliability and Validity in a Sample of Families of Bipolar Patients

The companion article by the Group for the Advancement of Psychiatry (GAP) Committee on the Family (see p. 155, this issue) describes the development of the Global Assessment of Relational Functioning (GARF) scale. The present study evaluated the reliability and concurrent validity of a manualized version of the GARF in recently episodic bipolar patients (N = 73 ) participating with family members in laboratory interaction tasks. The GARF was applied with high reliability by raters with little clinical experience. GARF ratings discriminated between families rated high and low in expressed emotion, with families rated as high in emotional overinvolvement showing the lowest relational functioning scores. GARF scores also correlated with affective negativity scores derived from the interactional task-based affective style and coping style coding systems. However, relational ratings were independent of levels of concurrent symptoms or illness chronicity among individual patients. GARF ratings may inform the treatment plans for patients with psychiatric disorders, but the optimal methods of data collection and rater training must be determined.     

Patient personality and mortality: a 4-year prospective examination of chronic renal insufficiency.

The present study examined the role of personality as a predictor of mortality among patients with chronic renal insufficiency. A prospective evaluation of the influence of personality on patient survival was conducted over an average 49-month period. Cox regression was used to evaluate the effects of 5 dimensions of personality in a sample of 174 patients (100 male and 74 female). At follow-up, 49 patients had died. Significant demographic and clinical predictors of survival included age, diabetic status, and hemoglobin level. After these predictors were controlled for, 2 personality traits, conscientiousness and neuroticism, predicted patient mortality. Patients with high neuroticism scores had a 37.5% higher estimated mortality rate. Patients with low conscientiousness scores had a 36.4% increased mortality rate.     

Variations of Bender-Gestalt constriction and depression in adult psychiatric patients.

The present study explored variations of Bender-Gestalt constriction and their relation to depression. 20 Ss showing constriction of drawings on the upper half-page and 20 Ss showing constriction of drawings on the left half-page were compared with regard to MMPI Depression scores. No significant difference was found between these groups. However, when the constricted groups were combined and then compared with 40 Ss who did not show constriction of Bender drawings, the constricted group had significantly higher (p less than .05) MMPI Depression scores. Thus, variations in Bender constriction are not differently related to depression, but presence of constriction is an indicator. However, its rate of occurrence is so infrequent, appearing in only 5% of the records examined, that its clinical usefulness in the detection of depression is quite limited.     

Interpretation of the personality inventory for children-revised (PIC-R): Influence of cognitive impairment

The Personality Inventory for Children-Revised (PIC-R) is a parent-report measure of social-emotional adjustment for children 3 to 16 years of age. The present study examined the clinical value of the PIC-R by exploring the impact of age and developmental status on PIC-R profiles, particularly on the Psychosis (PSY) scale, within a sample of preschool and school-age children referred for assessment of suspected cognitive impairment and learning problems. Compared to school-age children, significantly more preschoolers obtained elevated scores on the Psychosis scale; those preschoolers with cognitive impairments were even more likely to obtain significantly elevated Psychosis scale scores, despite the absence of diagnosed childhood psychosis. No significant relationship was found between Psychosis scale elevations and cognitive impairment in the school-age group. The PIC-R was moderately accurate in identifying cognitively impaired preschoolers but only minimally accurate in identifying cognitively impaired school-age children.