Discriminant validity of the General Behavior Inventory: an outpatient study

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.     

Discriminant Validity of the General Behavior Inventory: An Outpatient Study

Recent studies have provided strong support for the convergent validity of the General Behavior Inventory (GBI), a case identification inventory for chronic subsyndromal affective disorders (cyclothymia and dysthymia). Fewer data are available, however, on the ability of the GBI to distinguish chronic subsyndromal affective disorders from other forms of psychopathology. In order to address this issue, outpatients with cyclothymia (n = 9), dysthymia (n = 26), nonchronic major depression (n = 16), and nonaffective psychiatric disorders (n = 30) were compared on the GBI. Diagnoses were derived blind to GBI scores using structured diagnostic interviews and DSM-III criteria. The inventory significantly discriminated cyclothymes and dysthymes from patients with nonchronic major depressions and nonaffective disorders. Using the cutoff score that maximized GBI-diagnosis concordance, the inventory correctly classified 88% of the sample. All of the cyclothymes, 92% of the dysthymes, 87% of the patients with nonaffective psychiatric disorders, and 75% of the nonchronic major depressives were correctly classified by the inventory. These data provide strong support for the discriminant validity of the GBI.     

Parent-Offspring Transmission of Internalizing and Sensory over-Responsivity Symptoms in Adolescence

Reactions to sensory experiences are an overlooked correlate of affective regulation, despite the importance of bodily states on psychological processes. Children who display sensory over-responsivity (i.e., adverse reactions to typical sensations) are at greater risk for developing affective disorders. We extended this literature to adolescents and their middle-aged parents. Participants in a birth record-based study of families of adolescent twins (N = 506 families; 1012 adolescents; 53% female) completed a subset of items from the Adult Sensory Profile. We derived adolescent self-reported internalizing disorder symptoms and parent affective diagnoses from structured diagnostic interviews. Structural equation models tested the relationship between parent sensory over-responsivity symptoms and affective diagnoses and their adolescent offspring’s sensory over-responsivity and internalizing symptoms. Adolescent sensory over-responsivity symptoms were correlated with internalizing disorder symptoms. Parents with a diagnosis of anxiety or depression (mothers only) reported more frequent SOR symptoms than parents without a diagnosis. Parent depression was significantly related to adolescent sensory over-responsivity symptoms, over and above parent sensory over-responsivity symptoms (β = 0.26, p < 0.001 for mothers; β = 0.13, p = 0.004 for fathers). Father alcohol abuse/dependency also predicted offspring sensory over-responsivity symptoms. Offspring of parents with affective disorders were at additional risk for sensory dysregulation via parents’ influence on offspring internalizing problems.     

Social Support as Predictor of Psychopathology in the Adolescent Offspring of Psychiatric Patients

The potential role of social support for the adolescent offspring of psychiatric patients has hitherto not been examined. We examined whether the adolescent's level of psychiatric symptoms is dependent on the content and the function of social support (whether direct or moderating), controlling for perceived stress. In a cross-sectional design, 40 adolescents (11–18 yrs) with a parent exhibiting an affective or personality disorder were given several questionnaires, including the Youth Self Report (Achenbach), a Social Support Inventory, and the MUSIC, an inventory assessing perceived emotional and physiological stress reactions. The social support inventory consisted of three subscales to assess the positive and negative perception of social support, and the discrepancy between demand and supply of social support. The mentally-ill parents were given the General Health Questionnaire (GHQ). Data were then analyzed using multiple linear regression analyses. Analyses showed that perceived stress and negative social support predicted the adolescent's level of psychiatric symptoms, and that social support served as a direct effect, and was independent of parental GHQ score. Results are discussed and the presently under-utilized potential of social support for this population at risk is highlighted as something warranting increased attention both in terms of research and practical preventative steps.     

The relationship of young adolescent Children's Depression Inventory (CDI) scores to their social and cognitive functioning

The relationship of young adolescents' scores on the Children's Depression Inventory (CDI) to subjective and objective indices of their social and cognitive functioning was examined. Subjects were 89 young adolescents (11–15 years old), their parents, and their social studies teachers. The correlations of adolescents' CDI scores with recent school grades, objective ratings of overt social behavior, and measures of adolescent social and cognitive competence as perceived by the adolescent, both parents, and the teacher were examined. CDI scores were significantly and negatively correlated with school grades, behavioral ratings of positive social communication, and adolescent, mother, father, and teacher perceptions of the adolescents' social and cognitive competence. The relationship of these findings to those of other CDI validity studies is discussed.This research was supported, in part, by the William T. Grant Foundation and the University of Georgia's Institute for Behavioral Research.     

The General Behavior Inventory as an outpatient screen for dysthymic disorder

High prevalence, morbidity, and response to treatment make the detection of dysthymic disorder an important public health issue. We report our experience with the General Behavioral Inventory, a self-report questionnaire developed to detect affective illness, including dysthymic disorder. In a small sample of psychiatric outpatients the instrument yielded a sensitivity of 61% and a specificity of 88% for dysthymic disorder. These results challenge the utility of this instrument for detecting dysthymic disorder in this population.This work was supported in part by Grants MH-19069 and MH7103 from the National Institutes of Mental Health.     

Social information processing in child psychiatric populations

This study examined three kinds of social information-processing deficits in child psychiatric populations. The deficits studied were response decision biases, hostile attributional biases, and cue-utilization deficiencies. Subjects were diagnosed as hyperactive/aggressive (H/A) (n=24), exclusively hyperactive (n=14), exclusively aggressive (n=14), psychiatric control (n =23), and normal control (NC) (n=60) boys according to procedures suggested by Loney and Milich (1982). They were administered several tasks to solicit information-processing patterns. The H/A group was found to be deficient in all three areas asssessed, relative to the NC group. They were also deficient in response decisions and cue-utilization, relative to the other three groups of psychiatrically referred boys. Discriminant function analyses demonstrated that the H/A group displayed a distinct processing pattern. These results were found to be relevant to the study of behavior disorders, to social information processing theory, and to intervention efforts with these boys.This work was supported by NIMH Grant No. 32992, awarded to the first author, and NIMH Grant No. 37062, awarded to the second author.     

Family interaction and the course of adolescent psychopathology: An analysis of adolescent and parent effects

This study focused on evaluating the utility of three family measures for predicting outcome in a sample of disturbed but nonpsychotic adolescents: (a) the affective quality of the adolescents' voice tone when communicating with his/her parents; (b) the predominant affective quality of the parents' voice tones when communicating with the adolescent, and (c) the affective quality of the content of the parents' verbalizations to the adolescent. These measures were derived from 5-minute face to face discussions between parents and their disturbed adolescent. Results indicated that adolescents using positive or neutral voice tones during emotionally laden discussions with their parents tended to show relatively adequate levels of psychosocial adjustment as young adults, while adolescents using exclusively negative voice tones tended to show sufficient adjustment difficulties in early adulthood to warrant diagnoses within the extended schizophrenia spectrum. Although adolescent voice tone was associated with outcome, considering both adolescent and parent affective response led to improved prediction, with consideration of adolescent and parent variables leading to accurate prediction of outcome for 30 of the 33 sample cases.     

Family Functioning and Mental Illness: A Comparison of Psychiatric and Nonclinical Families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61 ), bipolar disorder (n = 60 ), major depression (n = 111 ), anxiety disorder (n = 15 ), eating disorder (n = 26 ), substance abuse disorder (n = 48 ), and adjustment disorder (n = 46 ). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353 ). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

Psychopathology in children of parents with recurrent depression

We examined the prevalence of psychopathology in children of parents with recurrent major depression (n=61)and children of normal control parents (n=46).Rates of psychopathology in the children of depressed parents were consistently higher when compared either with the control children or with rates of disorder reported for nonclinically referred children from other studies. Forty-one percent of high-risk children met criteria for at least one psychiatric disorder compared with 15% of low-risk children. Significant differences between groups were found for affective disorders and attention deficit disorder, and a nonsignificant trend was noted for anxiety disorder, all of which were more prevalent in the children of depressed parents.This work was supported, in part, by a W. T. Grant Foundation Faculty Scholar Award, No. 8308700.     

Gender-related assessment of childhood play

Parent-report based scales for the assessment of sex-dimorphic behavior are an important tool in research on psychosexual differentiation and its disorders. This paper presents the factor analysis and corresponding scale development for the slightly expanded Child Game Participation Questionnaire (Bates & Bentler, 1973), based on the parents of a demographically diverse school sample of 355 girls and 333 boys aged 6 to 10 years. Evidence supporting each of three theoretical positions in gender assessment — unidimensional bipolar, two-dimensional unipolar, and multidimensional — was provided. Effect sizes were unusually large for gender, but small for age, socioeconomic level, and race/ethnicity.This research was supported in part by a NICHD postdoctoral fellowship (NRSA HD06726; sponsor: Dr. Meyer-Bahlburg) awarded to Dr. Sandberg, by grants to Dr. Ehrhardt and Dr. Meyer-Bahlburg from the Spencer Foundation, the William T. Grant Foundation, the Ford Foundation, and NIMH (center grant 2-P50-MH43520, Anke A. Ehrhardt, Ph.D., Principal Investigator), and by the NIMH Clinical Research Center grant MH-30906.We thank the children and parents who participated in the study. Dr. Jacob Cohen consulted on statistical matters. Ms. Patricia Connolly provided word processing services. A portion of this work was presented as a poster at the XIth Biennial Meeting of the International Society for the Study of Behavioral Development, Minneapolis, Minnesota, July 3–7, 1991 (Abstracts, p. 285).     

Operating within the mainstream: Coping and adjustment among a sample of homosexual youths

A sample (N = 37) of African American adolescent homosexual males was administered a questionnaire that focused on four areas of social psychological functioning (self‐identity, family relation, school‐work relations, and social adjustment). The findings contradicted several past studies that reported in general that homosexual males experience crippling cognitive dissonance. Even with the existence of homophobia in the society, the adolescents were found to possess an adequate social psychological attitude and survival skills. The sampled adolescents reported being comfortable with their sexual orientation even though the majority of them had not disclosed their homosexuality. The respondents reported how they managed self‐presentation among heterosexual persons. The adolescents appeared well‐adjusted and stable in their social functioning and disagreed with the idea that they needed professional counseling.     

Validity of the NIMH Diagnostic Interview Schedule for Children: A comparison between psychiatric and pediatric referrals

The NIMH Diagnostic Interview Schedule for Children (DISC) was used to evaluate 40 psychiatric referrals aged 7–11 and 40 pediatric referrals matched for age, sex, race, and socioeconomic status. Each parent and child was interviewed separately using parallel versions of the interview, DISC-P and DISC-C, and parents completed the Child Behavior Checklist (CBCL). The psychiatric referrals had more psychiatric diagnoses and higher symptom scores than the pediatric referrals. Parent reports discriminated better between the criterion groups than child reports. In both groups, mild oppositional behavior and fears were commonly reported by parents, whereas mild separation anxiety, fears, and dysthymia were commonly reported by children. Attention deficit disorder, conduct disorder, and affective disorders were much more common among psychiatrically referred children. There was an association (x²=37.1, p < 001) between abnormally high CBCL scores and diagnoses derived from the interview with the parent, but the association between the CBCL and the child interview was not significant. Over all, the results support the validity of the DISC-P, and to a lesser extent that of the DISC-C, in discriminating psychiatric from pediatric referrals, at the level of both symptoms and severe diagnoses, but not at the mild/moderate level of diagnosis.This work was supported in part by NIMH Clinical Research Center Grant No. MH30915 and by NIMH Contract No. RFP-DB-81-0027. The second author is supported by an NIMH Research Scientist Development Award No. MH00403 and by a Faculty Scholar's Award from the William T. Grant Foundation. The authors are most grateful to Noelle Conover for her assistance in data analysis.     

Predictors of Positive Outcomes in Offspring of Depressed Parents and Non-depressed Parents Across 20 Years

Understanding differences in factors leading to positive outcomes in high-risk and low-risk offspring has important implications for preventive interventions. We identified variables predicting positive outcomes in a cohort of 235 offspring from 76 families in which one, both, or neither parent had major depressive disorder. Positive outcomes were termed resilient in offspring of depressed parents, and competent in offspring of non-depressed parents, and defined by two separate criteria: absence of psychiatric diagnosis and consistently high functioning at 2, 10, and 20 years follow-up. In offspring of depressed parents, easier temperament and higher self-esteem were associated with greater odds of resilient outcome defined by absence of diagnosis. Lower maternal overprotection, greater offspring self-esteem, and higher IQ were associated with greater odds of resilient outcome defined by consistently high functioning. Multivariate analysis indicated that resilient outcome defined by absence of diagnosis was best predicted by offspring self-esteem; resilient outcome defined by functioning was best predicted by maternal overprotection and self-esteem. Among offspring of non-depressed parents, greater family cohesion, easier temperament and higher self-esteem were associated with greater odds of offspring competent outcome defined by absence of diagnosis. Higher maternal affection and greater offspring self-esteem were associated with greater odds of competent outcome, defined by consistently high functioning. Multivariate analysis for each criterion indicated that competent outcome was best predicted by offspring self-esteem. As the most robust predictor of positive outcomes in offspring of depressed and non-depressed parents, self-esteem is an important target for youth preventive interventions.     

Factors associated with the mental health of adolescents when a parent has cancer

This study explored factors associated with the mental health in adolescents (ages 11-17; n = 54) within 12 months after a parent had been diagnosed with cancer. A control group was included (ages 11-17; n = 49). A demographic questionnaire, the SF-8 Health Survey, the Youth Self Report and the McMaster Family Assessment Device were used. Similar levels of psychological distress and healthy family functioning were reported in the clinical and the control group. No effect of gender of the ill parent and that of the adolescent was found. A negative correlation was found between the physical health of the ill parent and the mental health of the adolescent. Healthy family functioning correlated with less psychological distress in adolescents with a parent with cancer. Open communication, flexible problem solving and appropriate affective involvement were significant predictors for less psychological distress in the adolescents. The study concludes that a healthy family functioning facilitated the adolescent's adjustment to parental cancer.     

Group therapy as an adjunct to medication in the management of bipolar affective disorder

This paper asserts that, contrary to the beliefs of many clinicians, patients with bipolar affective disorder often experience a deteriorating course characterized by pervasive social dysfunction. It reviews the literature, identifying a rationale for group psychotherapy as an adjunct to medication in the management of these chronic patients. It outlines a theoretical approach to bipolar group therapy, and presents a retrospective study comparing the course of 43 lithium-treated bipolar patients before and after entering bipolar groups. During the year in group therapy, bipolar patients displayed significant improvements in symptom relief as well as social functioning. It is proposed that group process enhances treatment with medication, providing benefits not evident with medication alone.     

A goal-striving life event and the onset of hypomanic and depressive episodes and symptoms: perspective from the behavioral approach system (BAS) dysregulation theory

On the basis of the behavioral approach system (BAS) dysregulation theory of bipolar disorder, this study examined the relation between occurrence of a BAS activation-relevant life event--goal striving--and onset of hypomanic and depressive episodes and symptoms. In particular, the authors examined the relation between preparing for and completing final exams (a goal-striving event) and onset of bipolar spectrum episodes and symptoms in college students with bipolar II disorder or cyclothymia (i.e., "soft" bipolar spectrum conditions). One hundred fifty-nine individuals with either a bipolar spectrum disorder (n=68) or no major affective psychopathology (controls; n=91) were further classified on the basis of whether they were college students (i.e., completed final exams). Consistent with the BAS dysregulation theory, preparing for and completing final exams was associated with an increase in hypomanic but not depressive episodes and symptoms in individuals with a soft bipolar spectrum diagnosis. Furthermore, self-reported BAS sensitivity moderated the presence of certain hypomanic symptoms during final exams.     

Diagnostic accuracy of the Millon test computer reports for bipolar affective disorder

The diagnostic accuracy of the Millon Clinical Multiaxial Inventory (MCMI) computer reports was assessed for the sample of 48 patients reliably identified as having bipolar affective disorder. Only 13 of the 48 reports were accurate in classifying the patients as having bipolar affective disorder, and this was significantly (p < .01) less than 50% of the cases. The diagnostic accuracy clearly left much to be desired. Additional research is needed to assess the validity of MCMI diagnostic suggestions for other patient groups.     

Cross-validation of a minnesota multiphasic personality inventory (MMPI) subscale for the assessment of combat-related post-traumatic stress disorder

We have examined the Minnesota Multiphasic Personality Inventory (MMPI) scores of 80 carefully diagnosed veterans with post-traumatic stress disorder (PTSD) in an attempt to cross-validate the PTSD subscale and three-point MMPI code of Keane, Malloy, and Fairbank (1984). In general, although we replicated Keane and co-workers'cutoff scores, our hit rates were slightly lower than those reported originally.This research was supported in part by NIMH Grant MH-37839 to Dr. Kolb.