Depressive symptom manifestation and help‐seeking among Chinese college students in Taiwan

One longstanding hypothesis in the research of depression among Chinese populations is that they tend to express depressive symptoms in somatic terms, which, in turn, prevent them from seeking assistance from mental health services. This study aimed to examine the manifestation of depressive symptoms and its relationship to help‐seeking attitudes among Chinese college students. The Chinese Beck Depression Inventory‐II (BDI‐II; Beck, Steer, & Brown, 1996 ) and the Attitudes Toward Seeking Professional Psychological Help: Shortened Form (ATSPPH‐SF; Fischer & Farina, 1995 ) were administered to 1039 Chinese college students in a private university in Taiwan. Factor ratio scores analyses revealed that Chinese college students generally emphasized somatic complaints compared to cognitive‐affective complaints in expressing depressive symptoms. Probably‐depressed Chinese students (BDI‐II scores?16), however, placed significantly less emphasis on somatic symptoms than did nondepressed students. Additionally, multiple regression analyses showed that while Chinese students with elevated BDI‐II scores were less likely to seek professional psychological help, neither somatic nor cognitive‐affective symptoms were correlated with their attitudes toward seeking and avoiding professional psychological help. These findings seem to run counter to the common assumption that Chinese people tend to express depression in somatic terms and that somatic complaints help to explain their reluctance to seek professional psychological assistance. The current results suggest that Chinese students with elevated depressive symptoms readily acknowledged and expressed cognitive‐affective symptoms of depression and they were likely to distance themselves from professional psychological help. However, somatic symptoms did not explain their reluctance to utilize mental health services.     

Differential functioning of the Beck depression inventory in late-life patients: use of item response theory

The present analyses examined age-related measurement bias in responses to items on the revised Beck Depression Inventory (BDI) in depressed late-life patients versus midlife patients. Item response theory (IRT) models were used to equate the scale and to differentiate true-group differences from bias in measurement in the 2 samples. Baseline BDI data (218 late life and 613 midlife) were used for the present analysis. IRT results indicated that late-life patients tended to report fewer cognitive symptoms, especially at low to average levels of depression. Conversely, they tended to report more somatic symptoms, especially at higher levels of depression. Adjusted cutoff scores in the late-life group are provided, and possible reasons for age-related differences in the performance of the BDI are discussed.     

A comparison of two online cognitive‐behavioural interventions for symptoms of depression in a student population: The role of therapist responsiveness

Objectives: The study aimed to compare the efficacy of eight weekly sessions of a self‐administered online CBT treatment (cCBT; n=51) to a therapist‐assisted email CBT treatment (eCBT; n=50) in University students. Design: The design was a randomised parallel group trial. The study randomised participants with symptoms of depression to one of two available treatments. Method: Participants were offered eight weekly sessions of either cCBT or eCBT. Participants completed the Beck Depression Inventory‐II (BDI‐II) and the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) at pre‐and post‐treatment, at weeks 16 and 32 follow‐up. The Working Alliance Inventory‐Short Form (WAI‐SR) was completed at weeks 2, 4, and 6. Results: For both groups, pre‐post within group effect sizes reported were large for the BDI‐II and the CORE‐OM and these were maintained at follow‐up. Perceptions of working alliance were similar in each group, but Bond was significantly stronger for the eCBT condition. WAI scores correlated more positively with the outcome on BDI‐II for those in the eCBT condition than the cCBT condition, but not significantly. Conclusion: There were no significant differences between the two online treatments, both reduced depressive symptoms and improved general functioning. Similarly, at post‐treatment and follow‐up, clinical improvement and recovery was demonstrated for both groups equally. The study demonstrates the possibility for cCBT in a university setting that may contribute to addressing the shortcomings in meeting increasing demands that mental health services presently face.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Perceptions Of Treatment Helpfulness And Depressive Symptomology In Psychiatric Inpatients On A Cognitive Therapy Unit

This study examined 123 psychiatric inpatients' perceptions of treatment helpfulness using the Treatment Experience Questionnaire (TEQ), a measure that includes perceived elpfulness ratings for specific cognitive and non-cognitive aspects of treatment. It was predicted that (a) the inpatients on the cognitive therapy unit would perceive the cognitive therapy components of the program as more helpful than the non-cognitive components, and that (b) the perception of the helpfulness of the cognitive and noncognitive therapy components would significantly predict discharge depression scores, as measured by the Beck Depression Inventory (BDI). The results indicated that the inpatients rated the helpfulness of both the cognitive and non-cognitive aspects of treatment highly and that there was a modest yet significant relationship between perceived helpfulness and symptom change. The BDI scores at admission explained considerably more of the variation in discharge BDI scores than the perceptions of helpfulness. These results are discussed in light of past and future research.     

Sex Differences on the Revised Beck Depression Inventory for Outpatients With Affective Disorders

The revised Beck Depression Inventory (BDI) was administered to 174 male and 276 female psychiatric outpatients diagnosed with affective disorders. The mean BDI scores, mean number of symptoms claimed, and corrected item-total correlations were comparable for both sexes, and the coefficients alpha for each sex was .88. Principal components analyses found four dimensions of depression underlying both sexes' BDI item-intercorrelation matrices. Although men and women had comparable dimensions with respect to weight loss, self-blame, and somatic-performance symptoms, men had affective and performance symptoms loading on the same factor, whereas women had affective and cognitive symptoms loading on the same dimension.     

Oral Pessimism and Depressive Symptoms

I examined the relation of oral optimistic and oral pessimistic personality traits to depressive symptoms to assess the psychoanalytic claim that fixation at the early phase of the oral stage of psychosexual development is related to depression. College students (N = 140) were administered the Oral Optimism Questionnaire (OOQ; Kline, 1978) and Oral Pessimism Questionnaire (OPQ; Kline, 1978) and the Beck Depression Inventory (BDI; Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961). Oral pessimism and levels of depressive symptoms were positively correlated, and a subsample of subjects with clinical levels of depressive symptoms also scored significantly higher on the Oral Pessimism Questionnaire than the rest of the sample. For the whole sample, 10 BDI items correlated significantly with the OPQ scores, and 5 OPQ items correlated significantly with the total BDI scores. The psychoanalytic claim relating fixation at the oral pessimism stage to depressive symptoms was supported.     

Double Depression in Men: Does It Exist?

Differences between male veterans diagnosed with major depression alone and male veterans diagnosed with both major depression and dysthymia (double depression) were investigated. Assessment instruments included the Structured Clinical Interview for DSM-III-R, the Beck Depression Inventory (BDI), and the Symptom Checklist-90-R (SCL-90-R). Consistent with prior literature, it was hypothesized that male veterans diagnosed with both major depression and dysthymia display more severe depressive symptomatology and other forms of psychopathology than male veterans diagnosed with major depression alone. Results did not corroborate these hypotheses. Patients with double depression (n = 17) yielded BDI and SCL-90-R scores which did not differ significantly from those of patients with major depression alone (n = 14). Our results call into question the existence of double depression among men, a disorder whose existence has been demonstrated primarily among women.     

Effects of death within 11 years on cognitive performance in old age

Six different cognitive tests and the Heck Depression Inventory (BDI) were given to 3,572 active community residents aged 49 to 93 years. Causes of death were ascertained for 443 who died between 36 and 3,903 days later. Subsequent survival predicted test scores during the 3,903 days and independently during Days 36 to 1,826 and Days 1,827 to 3,903. Scores on the BDI and cumulative verbal learning and vocabulary tests predicted mortality after demographics and performance on other cognitive tests had been considered. Predictors were similar for deaths from heart disease, malignancies, and other causes. A new finding that cognitive tests did not predict survival duration within the sample of deceased explains previous findings of greater terminal decline in performance for young than for elderly adults.     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

Depression in a Cancer Patient Population

The main goal of this study was to examine depression and its components in cancer patients as compared with healthy control subjects and psychiatric inpatients. The participants were 54 cancer patients (28 females with breast cancer, 26 males with prostate cancer), 59 healthy controls (33 females, 26 males), and 75 psychiatric patients (27 females, 48 males). Participants were administered the Beck Depression Inventory (BDI) and the State Trait Personality Inventory (STPI) Depression scales. Cancer patients had higher overall depression scores than did healthy controls as measured by BDI, but the difference was due primarily to the significantly higher scores of the cancer patients on the BDI Somatic–Performance subscale. No differences were found on the BDI Cognitive–Affective subscale. Cancer patients also scored significantly higher than healthy controls on the State-Trait Personality Inventory (STPI) State Depression (S-Dep) scale because of higher Euthymia subscale scores. The psychiatric inpatients scored significantly higher than the other groups on all measures of depression. The findings of this study suggest that cancer patients may be erroneously labeled as depressed because of somatic–performance difficulties they may experience, which are similar to symptoms of depressed individuals. In addition, it is essential to delineate the various components of depression in evaluating cancer patients.     

The relationship of marital satisfaction and social support to depressive symptomatology

The relationship between depressive symptomatology, as measured by the short-form Beck Depression Inventory (BDI), and two social support variables was assessed. Based on a sample of 131 married men and 136 married women, the results indicated that the quality of the marital relationship and the frequency of positive social contact with adults other than the spouse were significantly related to depressive symptomatology for both men and women. These two variables accounted for 16% of the variance in BDI scores. Further, analyses of risk for high BDI scores showed that individuals having the least support were 13 times more likely to be in the high-BDI group than individuals with the highest levels of social support. These results suggest that social isolation and marital discord are related to high BDI scores among married adults.     

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7–18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

Sex differences on the revised Beck Depression Inventory for outpatients with affective disorders

The revised Beck Depression Inventory (BDI) was administered to 174 male and 276 female psychiatric outpatients diagnosed with affective disorders. The mean BDI scores, mean number of symptoms claimed, and corrected item-total correlations were comparable for both sexes, and the coefficient alpha for each sex was .88. Principal components analyses found four dimensions of depression underlying both sexes' BDI item-intercorrelation matrices. Although men and women had comparable dimensions with respect to weight loss, self-blame, and somatic-performance symptoms, men had affective and performance symptoms loading on the same factor, whereas women had affective and cognitive symptoms loading on the same dimension.     

The cognitive-somatic anxiety questionnaire: Psychometric and validity data

The Cognitive-Somatic Anxiety Questionnaire (CSAQ) is a 14-item self-report inventory that is divided into two 7-item scales (Cognitive and Somatic) that appear to reflect cognitive or somatic anxiety. In an attempt to evaluate the construct validity of this multidimensional instrument, the CSAQ was administered to 109 college students along with several other measures of physical and psychological symptoms. The results suggest that (a) despite considerable overlap between the Cognitive and the Somatic scales (r=.62), an exploratory factor analysis is able to identify a single large somatic factor along with three lesser cognitive-appearing factors, and (b) the correlations with concurrent measures of related constructs provide some limited evidence of the construct validity of the CSAQ. For males, both the Cognitive and the Somatic scales of the CSAQ correlated significantly with several anxietyrelated measures. However, for females CSAQ scores correlated less consistently with the other test scales, although Somatic scale scores for females were positively related to measures of health and exercise involvement. Suggestions for improving the CSAQ are offered.     

Cognitive trait anxiety,stress and effort interact to predict inhibitory control

Few studies have focussed on the link between anxiety and inhibitory control in the absence of stimulus-driven external threat. This two-part experiment examined the interactions between (1) somatic trait anxiety, somatic situational stress (i.e. threat of electric shock), and effort, and (2) cognitive trait anxiety, cognitive situational stress (i.e. ego-threat instructions), and effort, on inhibitory processes using a Go-No-Go paradigm. Trait anxiety was operationalised using questionnaire scores and effort was operationalised using a visual analogue scale. Performance effectiveness was measured using the d′ parameter from signal detection theory and processing efficiency was indexed by the ratio of d′ to response time on correct trials. Results indicated that somatic trait anxiety and stress did not predict effectiveness or efficiency. Cognitive trait anxiety and stress were associated with both inhibitory effectiveness and efficiency deficits; however, contrary to expectations these deficits were evident at higher rather than lower mental effort. Results suggest a distinction between how somatic and cognitive anxiety manifest on tasks involving inhibitory control.     

An examination of the relationships among emotion management,interpersonal hassles,and depressive symptomatology

This study extended previous research by testing three models predicting depressive symptoms from emotion management (EM) and interpersonal hassles in a sample with a wide range of depression scores. Adults (n = 218) from sources including a depression internet site completed measures of interpersonal hassles, depression, and three aspects of EM (attention to, clarity of, and repair of emotions). Regression analyses supported a model in which lower clarity and repair scores and greater frequency of interpersonal hassles each contributed directly to depression scores. While lower attention to emotions was associated with fewer interpersonal hassles, it did not correlate significantly with depression scores. Moderation analyses did not support a model of EM components acting on depression by buffering effects of interpersonal hassles. A model of depression and hassles predicting EM difficulties was also considered; when both hassles and depression scores were entered to predict EM, only depressive symptoms uniquely predicted clarity and repair.     

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.     

Depression and cognitive style: comparisons between measures

Several instruments have been developed recently to measure cognitive styles associated with depression. At least four of them appear to have an underlying similarity. Each appears to reflect a tendency for respondents to infer a general lack of self-worth (or a continued likelihood of bad events) on the basis of a single discrete failure. The present research was a comparative test of one of these scales against the other three in terms of associations with Beck Depression Inventory (BDI) scores. Though all instruments were significantly correlated with BDI, partial correlations revealed that our generalization scale was a more robust predictor of BDI than were (a) a measure of characterological self-blame, (b) a measure of cognitive bias, and (c) a measure of attributional style.     

The stability of depressive symptoms in college students: An empirical demonstration of regression to the mean

In a recent paper, Vredenburg, Flett, and Krames (1993) hypothesized that the apparent instability of depressive symptom scores in college students may be due, in part, to the phenomenon known as statistical regression to the mean. This statistical principle was demonstrated in the current study. A sample of 183 university students completed the Beck Depression Inventory (BDI) at two timepoints separated by a 3-month interval. Consistent with past results, analyses revealed substantial changes in symptom scores over time with decrements being evident among many subjects with elevated symptom scores at Time 1. Examination of the amount of change over time in BDI scores indicated a pattern of findings that approximated the regression to the mean phenomenon. Statistical tests confirmed that regression to the mean accounted for a significant amount of the change in symptom scores over time. The implications of these findings are discussed in terms of the nature of depressive symptoms in students and the inappropriateness of assigning subjects to depressed or nondepressed groups on the basis of elevated scores on a self-report measure.