Distinguishing bipolar depression, major depression, and schizophrenia with the MMPI-2 clinical and content scales

Clinical and content scales from the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) were used to examine the capacity of these scales to assist in the differential diagnosis of a sample of 212 psychiatric patients-137 with major depression; 43 with schizophrenia; and 32 with bipolar disorder, depressed state. Consistent with the previous literature, the clinical scales Depression (D), and Schizophrenia (Sc), and the content scales Depression (DEP), and Low Self-Esteem (LSE) best distinguished major depression from schizophrenia; the content scale DEP proved to be the most powerful predictor in distinguishing bipolar depression from schizophrenia. No clinical or content scale proved to be effective in distinguishing patients with bipolar depression from patients with major depression. In general, the content scales outperformed the clinical scales.     

Sex Differences in the Relationship of Anger and Depression: An Empirical Study

A comparison of mean scores on the Beck Depression Inventory and State-Trait Anger Expression Inventory scales revealed that women scored significantly higher than men on depression, whereas there were no significant differences on any of the 6 anger scales. Separate multiple regression analyses revealed that there were statistically significant relationships between the linear combination of anger scales and depression for both groups. A comparison of zero-order correlations of depression with the anger scales revealed that Anger-In correlated significantly more highly with depression among women than men. Finally Anger-In correlated significantly with 4 of the 5 other anger scales for women, but only with one for men.     

Examination of the Hamilton Scales in Assessment of Anxious Older Adults: A Replication and Extension

This study examined the original and reconstructed Hamilton scales in the assessment of anxiety and depression in a sample of older adults diagnosed with GAD (n = 82). Internal consistency of all scales appeared adequate. Results indicated improved construct validity with the reconstructed scales, which demonstrated reduced shared variance. However, construct validity examined through intercorrelations of the Hamilton scales with self-report measures of anxiety and depression was generally poor. Discriminant function analysis indicated that the reconstructed scales might have some clinical utility in differentiation of patients with and without coexistent depressive diagnosis (67% correct classification). In addition, two items from the Hamilton rating scale for depression (Work and Activities; Hopelessness) correctly classified patients with and without depression at a similar level as the Hamilton scale total scores (64–65% correct classification). These results suggest that the Work and Activities, and Hopelessness items may provide clinicians with useful screening questions for depression in anxious older adults.     

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.     

Effect of symptom information and validity scale information on the malingering of depression on the MMPI-2

MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) data from college students who were attempting to malinger depression (199 women and 171 men) were compared to MMPI-2 data from students who responded honestly (50 women and 45 men). Mean MMPI-2 scores were compared with analyses of variance, and students' success in malingering depression was evaluated with criteria based on cutting scores for validity indexes and on the clinical scales commonly associated with depression. Students who were given information about the validity scales or about the symptoms of depression were more successful at malingering than students who received no information, indicating that malingerers of depression may be able to elude detection by the MMPI-2 if they are informed about the validity scales or the symptoms of depression.     

Utility of the SCL-90-R with depressed and conduct-disordered adolescent inpatients.

We assessed the diagnostic utility of the Symptom Checklist-90-Revised (SCL-90-R) in a sample of adolescent inpatients. In Part 1 (n = 79), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation. Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, and obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct disorder, sensitivity was low.     

Can the MMPI-2 validity scales detect depression feigned by experts?

Major depression is one of the most frequently presented disorders for claims of psychiatric disability. Evidence also suggests that many individuals making claims of disability exaggerate or even fabricate mental illness. These facts suggest that the detection of feigned depression is an important task in psychiatric disability claim assessments. In this study, the capacity of a number of MMPI-2 validity scales and indicators to detect feigned depression was examined. Twenty-three mental health professionals with specific expertise and significant experience in assessing and treating major depression were asked to complete the MMPI-2 as if they were suffering from major depression. The MMPI-2 protocols of this sample were compared to those of a sample of patients diagnosed with major depression. Results indicated that the validity scales F, back F (FB), and the Dissimulation scale (Ds) were highly successful at distinguishing MMPI-2 protocols of feigned depression from bona fide depression. Replicating results from previous studies, however, FB proved most effective, outperforming all other validity scales and indicators, including F and Ds. These findings suggest that even experts are unable to feign major depression successfully on the MMPI-2, and that the FB scale might be the most effective indicator for detecting feigned depression.     

Deconstructing antenatal depression: What is it that matters for neonatal behavioral functioning?

This prospective study examined the variability within clinical characteristics of antenatal maternal depression and cortisol levels for associations with newborn infant behavior using the Neonatal Behavioral Assessment Scale (NBAS; T.B. Brazelton, 1984 ). Participants were 81 pregnant women at risk for perinatal depression given their histories of depression prior to pregnancy. We took into consideration not only whether the woman experienced antenatal depression but also whether the depression met diagnostic criteria and variability in timing (onset and occurrence) of antenatal depression and symptom severity. Infants of mothers who became depressed during pregnancy scored less optimally on a subset of the NBAS scales, specifically those scales related to infant neuroregulation. Among the clinical characteristics of depression, the fetus' overall exposure to mothers' depression (reflected in the mean) was most often and most strongly associated with NBAS scales. In terms of timing, third‐trimester exposure was significantly related to newborn behavior. The findings are discussed within the S.H. Goodman and I.H. Gotlib ( 1999 ) model for transmission of psychopathology to offspring of depressed mothers.     

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.     

Adolescent suicidal behavior and popular self-report instruments of depression, social desirability, and anxiety

Popular self-report inventories of depression, hopelessness, social desirability, and anxiety, along with the Suicidal Behaviors Questionnaire, were completed by 150 college students. Tanaka-Matsumi and Kameoka (1986) had questioned the use of popular depression instruments in the assessment of this population, due to the high correlation between depression, anxiety, and social desirability scales. The present experiment also found significant correlations between the self-report instruments and suicidal behaviors. These findings may be due to the fact that anxiety and depression are often found together in clinical settings, and that the content of depression and anxiety scales is not specific to those constructs.     

Depression and bulimia: the link between depression and bulimic cognitions

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.     

Utility of the SCL-90-R With Depressed and Conduct-Disordered Adolescent Inpatients

We assessed the ciiagnosric utility of the Symptom Checklist-90-Revised (SCL-9O-R) in a sample of adolescent inpatients. In Part 1 (n = 73), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation, Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, an obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct dsorder, sensitivity was low.     

Measurement of depression: Comparison between self-reports and clinical assessments of depressed outpatients

Agreement among several depression scales was investigated as regard the relative influences of administration mode (self-rating or clinical rating) and scale content. The Beck Depression Inventory (BDI), the Self-Rating Depression Scale (SDS), the Hamilton Rating Scale for Depression (HRSD), and three corresponding scales with identical structure and content but the alternative administration mode were administered to 47 outpatients with diagnoses of DSM-III major depression disorders. Correlations between the total scores and the degrees of association between corresponding items of different scales were calculated. The results suggest that differences in content contribute more to inter-scale discrepancy than differences in administration mode. The implications for the evaluation of outpatients with major depression are discussed.     

The concepts of depression,anxiety, and neuroticism in questionnaires

In this study, the relations among depression, anxiety, and neuroticism measured by self-report questionnaires were investigated. Subjects were 207 psychiatric patients. High correlations were found among self-report scales purporting to measure depression, anxiety, and neuroticism. Results of a content analysis showed considerable overlap among these scales. A division of items into six content categories did not result in lower correlations compared to the original scales.     

Depression and decision-making among intravenous drug users

Two short scales, the TCU Depression Scale and the TCU Decision-making Scale, were psychometrically evaluated in a sample of 145 intravenous drug users. Coefficient alpha reliabilities were .78 for the 6-item TCU Depression Scale and .77 for the 9-item TCU Decision-making Scale. Concurrent validity of the former scale was assessed by correlating scores with those on the Beck Depression Inventory, r = .75. Based on the Beck Depression Inventory Clinical cutoff scores, 83% of the sample showed some depression, with 23% severely depressed, 39% moderately depressed, and 21% mildly depressed. Individuals scoring higher on depression on both tests tended to score lower on decision-making. Significant demographic associations of age, gender, education, and race-ethnicity were found for the depression and decision-making scales. More depression was noted for women, those younger, white, and having less education. Older and more educated intravenous drug users tended to score higher on decision-making. Validity for the depression and decision-making scales was assessed by examining correlations with behaviors. Significant positive correlations were found between depression scores and intravenous use of cocaine only, heroin and cocaine combined, and heroin only. Also, intravenous use of cocaine only and of cocaine and heroin combined were negatively related to decision-making. AIDS sex-risky behavior was positively correlated with depression and negatively correlated with decision-making.     

Overload (Book)

Relationships between various personality styles measured by the basic and pathological personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and mood or symptom states measured by the Profile of Mood State scales were examined. The MCMI personality scale-POMS symptom/mood scale relationships found in this study are compared with MCMI personality scale-MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual. Consistent associations of moderate strength were found between: (a) the MCMI Compulsive-Conforming and Passive-Aggressive (Negativistic) scales (negative and positive associations, respectively) and various measures of depression, anxiety and hostility: (b) the MCMI Avoidant, Schizotypal and Borderline-Cycloid scales and various measures of depression and anxiety; (c) the MCMI Schizoid-Asocial scale and various measures of depression; and (d) the Histrionic-Gregarious scale and various measures of high energy-activity. These MCMI personality scale-symptom/mood scale relationships are generally consistent both with the underlying theory of personality and psychopathology upon which the MCMI is based and with the personality-symptom scale relationships found within the MCMI.     

An examination of the relationship between personality patterns and symptom/mood patterns

Relationships between various personality styles measured by the basic and pathological personality scales of the Millon Clinical Multiaxial Inventory (MCMI) and mood or symptom states measured by the Profile of Mood State scales were examined. The MCMI personality scale-POMS symptom/mood scale relationships found in this study are compared with MCMI personality scale-MMPI and SCL-90 symptom/mood scale relationships reported in the MCMI manual. Consistent associations of moderate strength were found between: (a) the MCMI Compulsive-Conforming and Passive-Aggressive (Negativistic) scales (negative and positive associations, respectively) and various measures of depression, anxiety and hostility; (b) the MCMI Avoidant, Schizotypal and Borderline-Cycloid scales and various measures of depression and anxiety; (c) the MCMI Schizoid-Asocial scale and various measures of depression; and (d) the Histrionic-Gregarious scale and various measures of high energy-activity. These MCMI personality scale-symptom/mood scale relationships are generally consistent both with the underlying theory of personality and psychopathology upon which the MCMI is based and with the personality-symptom scale relationships found within the MCMI.     

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.     

The meaning profiles of anxiety and depression: similarities and differences in two age groups

ABSTRACT

The distinctiveness of anxiety and depression is discussed concerning their nature, definitions, uses, manifestations and determinants. The objective was to examine the difference and similarity of anxiety and depression by applying the psychosemantic approach, which is a theory and methodology based on analysing the cognitive processes applied in communicating meanings. In Study 1, there were 760 participants of both genders, 23–31 years old. They were administered the Meanings Test, which yields the respondent’s meaning profile, and one of seven anxiety scales or one of three depression scales. Significant correlations between the meaning profiles and the anxiety or depression scales were summarised and compared. In Study 2, there were 78 individuals over 65 years old who were administered the Meanings Test plus an anxiety or depression scale. The findings for anxiety and depression were compared within and across age groups. The results yielded two distinct meaning profiles for anxiety and depression in the two age groups. The anxiety profile indicated more focusing on one’s internal world. whereas the depression profile indicated focusing both on the personal and the interpersonally shared reality. The conclusion was that anxiety and depression are different constructs that need to be considered as separate theoretically and practically.     

Construction of new scales for the Multiple Affect Adjective Check List

Factor analyses were used to develop new scales for the Multiple Affect Adjective Check List (MAACL) measuring anxiety, depression, hostility, positive, and sensation-seeking affects. Anxiety, depression, and hostility scales were moderately intercorrelated and a combined score called “dysphoria” was formed from their addition. Positive and sensation-seeking affects were also correlated and combined in a summary score (PASS). The dysphoric and PASS scores were not highly correlated. The number of items checked correlated highly with the positive affect scale, moderately with sensation seeking, and relatively low with the negative affect scales. Internal reliabilities were high and retest reliabilities were low, in conformance with the model for state scales. The anxiety score increased and the positive affect score and number of items checked decreased just prior to a classroom examination. Further plans for scale development are discussed.