A taxometric analysis of the MMPI-2 Depression scales

The MMPI (Hathaway & McKinley, 1943) and MMPI-2 (Butcher et al., 2001) have long been used as measures of psychopathology. Both clinicians and researchers have noted the widespread existence of negative affectivity on the MMPI and MMPI-2 that may elevate scale scores and eclipse the tests' ability to differentiate depression from other clinical disorders. Using taxometric analyses, in this study we sought to test directly whether the MMPI-2 depression scales could differentiate patients with depressive symptoms from patients with other disorders. A large psychiatric sample (N = 2,000) was utilized and analyses were run separately for men and women. Taxometric analyses did not find a MMPI-2 Depression scale cut point that categorizes patients with depressive symptoms from other patients. Rather, these findings support previous studies finding an underlying dimensionality of depression. We discuss implications for MMPI-2 scale use and depression nosology in light of these findings.     

Diagnosis of major depression by self-report

The Symptom Checklist-90 (SCL-90), Millon Clinical Multiaxial Inventory (MCMI), and Minnesota Multiphasic Personality Inventory (MMPI) test profiles of inpatients and outpatients with DSM-III major depression (n = 48) were contrasted with the test profiles of a control group of patients with diverse psychiatric disorders (n = 68). In addition, the diagnostic efficiency of the relevant depression subscales for the diagnosis of major depression were examined. The results indicated that the three self-report tests may be used to diagnose DSM-III major depression, and that the depressed patients had characteristic test profiles.     

The Szondi Test in a Psychological Battery: Two Case Studies

This study investigated MMPI Characteristics of male and female adolescent inpatients with diagnoses of borderline personality disorder (n = 28) in contrast to adolescent inpatients receiving principal diagnoses of conduct disorder (n = 21), dysthymic disorder (n = 50), other personality disorders (n = 17), and other diagnoses (n = 30). The borderline group has significantly higher elevations than comparison groups on MMPI Scales F, Hs, D, Pd, Pa, Pt, Sc, and Ma. A stepwise discriminant analysis resulted in 82.1%. accuracy in correctly classifying borderline patients and 78.0% accuracy in identifying, nonborderline patients. Findings are discussed in terms of potential uses and limitations in identifying borderline personality disorder with the MMPI.     

Personality factors associated with psychological distress in testicular cancer survivors

The aim of this study was to investigate symptoms of anxiety and depression in testicular cancer survivors (TCSs) and to identify personality traits associated with psychological distress in these patients by means of the MMPI (Hathaway & McKinley, 1943). A total of 50 TCSs and 50 age-adjusted healthy men participated in the study, and we used the following self-report instruments: Montgomery-Asberg Depression Rating Scale (Montgomery & Asberg, 1979), Hamilton Anxiety Rating Scale (Hamilton, 1959, 1969), Spielberger's State-Trait Anxiety Inventory (Spielberger, 1970, 2005), and the MMPI. TCSs displayed higher rates on all psychopathology scales studied compared to controls, but the majority of the patients' scores were within the "normal range," indicating rather mild psychological distress. TCSs' MMPI profiles showed higher rates on Scales 1, 3, 6, and 9 compared to controls; and within the TCSs sample, symptoms of depression were most closely associated with Scales 3 and 5. Similarly, anxiety symptoms were mainly associated with Scale 3. These findings indicate that TCSs present mild symptoms of psychological distress, mainly anxiety and depressive symptoms, suggesting that careful assessment and consultation in TC patients is essential to help them deal with distress after treatment and to minimize possible risk factors.     

Psychometric features related to the acute phase and final outcome of anorexia nervosa

The MMPI responses of a poor and good final outcome group from a follow-up study of anorexia nervosa were compared with responses of a group of anorexic patients in the acute phase. The poor outcome group produced elevated scores in the psychopathological range except on scales 4, 5 and 9. No elevations occurred in the good outcome group and the MMPI thus discriminated significantly between different kinds of final outcome of anorexia nervosa. The profile of the patients in the acute phase at time of testing was not significantly different from the poor outcome group profile. In order to improve the predictive validity of the MMPI related to anorexia nervosa, the paper points to possible directions for further research.     

Measuring depressive symptomatology of patients referred to a behavioral medicine clinic: Concordance of self-report measures

We measured depressive symptomatology of 134 outpatient veterans treated within a Behavioral Medicine Clinic utilizing three reliable instruments with depression subscales: Minnesota Multiphasic Personality Inventory (MMPI), Derogatis Stress Profile (DSP), and Symptom Checklist 90—Revised (SCL-90-R). Results indicate that although the instruments correlate significantly, they differ in sensitivity to depression and are clinically discordant. The MMPI classified a substantially higher number of patients as depressed than either the DSP or SCL-90-R. The present study argues that the discrepancy in clinical concordance and sensitivity of the three depression scales has considerable implications for psychologists concerned with the assessment and treatment of depression.     

Derivation and Implications of MMPI Cluster Groups in Clinically Depressed Inpatient Females

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.     

Derivation and implications of MMPI cluster groups in clinically depressed inpatient females.

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.     

MMPI Characteristics of Drug Abusers With and Without Histories of Suicide Attempts

Compared to drug addicts without histories of suicidal attempt (n = 50), drug addicts who have attempted suicide (n = 50) were characterized by higher levels of maladjustment—particularly in the areas of depression, feelings of alienation, and use of projection and externalization—and were more emotionally withdrawn. Certain Minnesota Multiphasic Personality Inventory (MMPI) codetypes appeared in the attempt group that were not present in the no history group. Drug addicts with suicidal ideation but no history of attempt (n = 13) were not significantly different from the other two groups, and their inclusion as a comparison group masked the real differences between the other two groups. The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group. Treatment implications are considered.     

MMPI characteristics of drug abusers with and without histories of suicide attempts

Compared to drug addicts without histories of suicidal attempt (n = 50), drug addicts who have attempted suicide (n = 50) were characterized by higher levels of maladjustment--particularly in the areas of depression, feelings of alienation, and use of projection and externalization--and were more emotionally withdrawn. Certain Minnesota Multiphasic Personality Inventory (MMPI) codetypes appeared in the attempt group that were not present in the no history group. Drug addicts with suicidal ideation but no history of attempt (n = 13) were not significantly different from the other two groups, and their inclusion as a comparison group masked the real differences between the other two groups. The MMPI results suggest it may be possible to identify a suicide attempt group in substance abusers but not when contrasted with a suicidal ideation group. Treatment implications are considered.     

The Utility of MMPI–2–RF Scale Scores in the Differential Diagnosis of Schizophrenia and Major Depressive Disorder

This study was designed to determine whether scores on selected Minnesota Multiphasic Personality Inventory–2–Restructured Form (MMPI–2–RF) scales could be used to differentiate between individuals diagnosed with schizophrenia (SCZ) and major depressive disorder (MDD). The sample was drawn from 2 psychiatric inpatient hospitals and included data from 199 individuals with SCZ and 808 individuals with MDD. A series of multivariate analyses of variance, analyses of variance, and odds ratios were calculated to determine which MMPI–2–RF scales provide the best differentiation between individuals presenting with these 2 disorders. Results indicated scales assessing internalizing dysfunction, including Emotional/Internalizing Dysfunction (EID), Restructured Clinical Scales Demoralization (RCd), Low Positive Emotions (RC2), Suicidal/Death Ideation (SUI), and Self Doubt (SFD) best discriminated MDD from SCZ. Scales assessing thought dysfunction, incluidng Thought Dysfunction (THD), Restructured Clinical Scales Ideas of Persecution (RC6) and Aberrant Experiences (RC8), and Psychoticism-Revised (PSYC-r) were demonstrated to best identify SCZ. Comparisons of the examined MMPI–2–RF scales to MMPI–2 scales assessing similar constructs suggested scales from the MMPI–2–RF perform similarly to their MMPI–2 counterparts in detecting MDD or SCZ, but might have increased ability to discriminate SCZ from other conditions. Overall, results of this study suggest that scores on the examined MMPI–2–RF scales provide important information about the differential diagnosis of MDD and SCZ to clinicians working in inpatient settings.     

Diagnosis of posttraumatic stress disorder with the MMPI: PK scale scores in somatization disorder

Clinic patients with diagnoses of either major depression or somatization disorder were given the MMPI. Women with somatization disorder had high scores on Keane's MMPI scale (PK) for posttraumatic stress disorder. Following the procedure for the MMPI-2 (46 of the 49 PK items and MMPI-2 norms), 59% of the women with somatization disorder and 21% of the women with major depression would have T scores > or = 65 on the MMPI-2 scale although none of them were known to have developed psychiatric disorder after exposure to a life threatening event. The PK scale has little use in the differential diagnosis of women patients with somatization disorder.     

Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence

It is not clear whether specific target groups for psychotherapies in adult depression benefit as much from these treatments as other patients. We examined target groups that have been examined in randomized trials, including women, older adults, students, minorities, patients with general medical disorders, and specific types of depression, and we examined where patients were recruited. We conducted subgroup and multivariate metaregression analyses in a sample of 256 trials (with 332 comparisons) comparing psychotherapy with an inactive control condition. Only 22% of the studies had low risk of bias (RoB), heterogeneity was high and there was a considerable risk of publication bias. A meta-regression analysis among low RoB studies showed that effect sizes found for studies among women, older adults, patients with general medical disorders, patients recruited from primary care, and patients scoring above a cut-off on a self-rating depression scale, did not differ significantly from effect sizes from other studies. For other target groups, the number of low RoB studies was too small to draw any conclusion. We found few indications that psychotherapies for adult depression are more or less effective in women, older adults, patients with comorbid general medical disorders, and primary care patients.     

The MMPI‐2 in chronic psychiatric illness

While previous studies on the MMPI‐2 in patients with schizophrenia and depression have used mixed samples of both early stage and chronic psychiatric patients. Here, it is investigated whether chronicity itself might have a differential effect on the MMPI‐2 profiles of these patients and whether demoralization ‘associated with long‐term illness’ affects the scales of the MMPI‐2. Thirty long‐term patients with schizophrenia, 30 long‐term patients with depression, and 30 healthy participants completed the MMPI‐2. Groups were compared on Clinical Scales and on the Restructured Clinical (RC) Scales. Patients with schizophrenia differed from patients with depression on 14 MMPI‐2 scales and from healthy controls on 10 scales, generally showing mean UT‐scores < 65, indicating a subjective experience of (near) normal functioning. Patients with depression differed from healthy controls on 17 scales mostly with UT‐scores > 65, indicating impaired functioning. Demoralization was higher in patients with depression than in patients with schizophrenia and both psychiatric groups differed from the healthy control group. It is concluded that long‐term patients with depression show impaired functioning and high demoralization, while long‐term patients with schizophrenia surprisingly show near normal functioning and less demoralization.     

Personality disorders and the duration of depressive episode: a retrospective study

In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project we examined the relationship between chronicity of depression and personality disorders. Three hundred and eighty-five depressed outpatients were evaluated with semi-structured interviews. Duration of depression was analyzed as a continuous variable, and by subdividing patients by the DSM-IV (APA, 1994) chronic specifier (i.e., more or less than 2 years). Two separate regression analyses addressed the association between major depressive episode duration and each of the ten personality disorders found on Axis II. Although there was some difference between particular personality disorders associated with the two indicators of depressive duration, the results of the regression analyses indicate that the chronicity of depression is associated with personality disorders.     

Clinical Correlates of MMPI Depression Scales

We investigated whether Scale 2 (Depression [D]) and the Wiggins Content Scale of Depression (DEP) of the Minnesota Multiphasic Personality Inventory (MMPI) have different clinical correlates when only one of these two scales is elevated. According, a group of patients who elevated DEP higher than Scale 2 (DEP > 2) were compared with a group of patients who elevated Scale 2 higher than DEP (2 > DEP). The patients with DEP > 2 were rated as being less severe than the patients with 2 > DEP on the following Brief Psychiatric Rating Scales: Somatic Concern (SOM), Emotional Withdrawal (WDRA), Depressive Mood (DEP), and Blunted Affect (AFF). The patients with DEP > 2 were rated as more severe on Excitement (EXC). The patients with DEP > 2 were more likely to receive the Axis I diagnoses of: bipolar disorder, manic, and alcohol abuse. Schizophrenia was equally probable for patients in the two groups. It appears that these two MMPI scales of depression have different clinical correlates when either one scale or the other is elevated.     

A study of temperament and personality in anorexia and bulimia nervosa

Although temperament and personality traits could influence the development and course of eating disorders, only a few studies examined the similarities and differences in personality between anorexia and bulimia nervosa. We compared 72 patients with DSM-IV eating disorders and 30 healthy controls. Dimensions of personality and personality disorders were evaluated with the Eysenck's EPQ, Cloninger's TCI, and the SCID-II questionnaires. The rates of impulsivity and clinical features were evaluated using specific rating scales. A comorbid personality disorder was found in 61.8% of patients with eating disorder. Avoidant personality disorder appeared was relatively common in anorexia nervosa restricting type; borderline personality disorder was most frequent in bulimia nervosa and the binge eating-purging type of anorexia nervosa. From a dimensional perspective, anorexic patients presented high scores in the dimension of persistence. Higher harm avoidance and impulsivity was found in bulimic patients. The overall eating disorders group presented high scores in neuroticism and low scores in self-directedness. Eating disorder patients have heterogeneous features of temperament and personality traits. Cluster C personality disorders seem more common in anorexia nervosa restricting type and impulsive personality features are associated with bulimic symptoms. Impulsivity seems to be a key aspect of temperament of bulimic patients, whereas anorexic symptoms are linked to persistent temperament traits.     

Affect and depression in the elderly

Depression is considered one of the most complex mental disorders in the elderly. The diagnostic difficulties due to comorbidity, especially, with somatic diseases, have cast doubt on the use of diagnostic instruments for the elderly. In the present study, we try to determine the existence of differences in affect of third-age depression with respect to adult-age depression. For this purpose, the PANAS-X scale was administered to 120 subjects (30 depressive patients over 65 years old, 30 depressive patients between 25 and 50, and two control groups of 30 people each). The data allow us to establish two major differences of depression in the elderly compared to depression in adults: a lower intensity of negative affect and a lower intensity in the affects of fear, hostility and guilt. We can also conclude that sadness is not a differentiating element between both depressive groups.