Evidence-based assessment of depression in adults

From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and suicidality; (d) an approach to suicidality that distinguishes between resolved plans and preparations and desire and ideation; (e) assessment of the atypical, seasonal, and melancholic subtypes; (f) parameters of course and chronicity; and (g) comorbidity and bipolarity. These complexities need to be accounted for when certain assessment approaches are preferred, and when ambiguity exists regarding the categorical versus dimensional nature of depression, and whether and when clinician ratings outperform self-report. The authors conclude that no one extant procedure is ideal and suggest that the combination of certain interviews and self-report scales represents the state of the art for evidence-based assessment of depression.     

The illusion of mental health: in the mind of which beholder?

We reference self-ratings and clinician ratings of childhood anxious symptoms to a third data source well delineated with regard to the pathophysiology of anxiety. A total of 36 children with anxiety disorders and other children were administered yohimbine, an alpha-sub-2-adrenoreceptor antagonist, in response to which anxiety-prone children have blunted output of growth hormone. We assessed neuroendocrine reactions. In general, participants who claimed anxiety that was unconfirmed by clinicians displayed anxiotypic neuroendocrine profiles, whereas those who denied anxiety detected by clinicians did not, suggesting self-report may have had the advantage over clinician ratings in some instances. Nuanced and contextualized conclusions in this area of work are needed. In response to the question "the illusion of mental health: in the mind of which beholder?," we answer "it depends on the sample and the syndrome under study."     

When a compliance without pressure strategy fails due to a minority dissenter: A case of “behavioral conversion”

While a strategy of compliance without pressure (Joule, 1987) had the effect of inducing almost all of a group of smoking subjects to stop smoking first for 18 hours then for 3 days, simply observing someone (an accomplice) break his or her own initial agreement to abstain from smoking for 18 hours was enough to bring about a substantial reduction in the willingness of other subjects to later abstain for 3 days. However, subjects did not follow the lead of the accomplice immediately, and persisted in their agreement to abstain for 18 hours. This pattern of indirect, but not direct influence, suggests that there may be a type of minority influence at work here that represents a sort of behavioral conversion.     

The making of an adolescent clinic

This paper addresses the nationwide need for comprehensive health care services directed toward adolescents, outlining a multidisciplinary team program designed to provide such services. The national problem of teenage pregnancy is discussed, and the multidisciplinary team's success with family planning counseling is described. The authors strongly encourage the development of more school- or community-based clinics based on a comprehensive health care team model.     

Parent vs. Self-Report: Contributions Toward Diagnosis of Adolescent Psychopathology

Assessment of psychopathology in adolescents can be complicated due to uncertainties about who should be considered the primary informant. While a multimethod, multiinformant approach to assessment allows for a thorough assessment, it can also result in contradictory findings. The purpose of this study was to use a sample of 121 adolescents to investigate issues of parent-adolescent agreement on behavior rating scales and a structured diagnostic interview. Additionally, this study evaluated whether adolescent report offers unique information to the assessment beyond the parent's report. The sample included both normal controls and adolescents who met criteria for diagnosis of an Internalizing or Externalizing disorder based on the DSM-IV criteria. Agreement between parents and adolescents on the Diagnostic Interview for Children and Adolescents—Revised (DICA-R) was low for ADHD (39.4%) and Externalizing Disorders (41.1%) and moderate for Internalizing Disorders (56.6%). A significant difference was found between the number of ADHD symptoms reported, with parents reporting more symptoms (M = 9.42) than adolescents (M = 8.34). Regression analysis indicated that the adolescent completed Youth Self-report (YSR) contributed unique information beyond the parent completed measures in predicting both the adolescent and the parent interviews for Internalizing Disorders. This finding emphasizes the need to continue to collect self-report information, especially when assessing Internalizing disorders, which inherently contain symptoms indicating high-risk behaviors such as suicide ideation.     

Delay discounting of different outcomes: Review and theory

Steep delay discounting is characterized by a preference for small immediate outcomes relative to larger delayed outcomes and is predictive of drug abuse, risky sexual behaviors, and other maladaptive behaviors. Nancy M. Petry was a pioneer in delay discounting research who demonstrated that people discount delayed monetary gains less steeply than they discount substances with abuse liability. Subsequent research found steep discounting for not only drugs, but other nonmonetary outcomes such as food, sex, and health. In this systematic review, we evaluate the hypotheses proposed to explain differences in discounting as a function of the type of outcome and explore the trait- and state-like nature of delay discounting. We found overwhelming evidence for the state-like quality of delay discounting: Consistent with Petry and others' work, nonmonetary outcomes are discounted more steeply than monetary outcomes. We propose two hypotheses that together may account for this effect: Decreasing Future Preference and Decreasing Future Worth. We also found clear evidence that delay discounting has trait-like qualities: People who steeply discount monetary outcomes steeply discount nonmonetary outcomes as well. The implication is that changing delay discounting for one outcome could change discounting for other outcomes.     

The Role of Lay Health Advisors in Cardiovascular Risk Reduction: A Review

Interventions are needed to reduce the negative impact of cardiovascular disease. The combination of health risks for disease, disability, and mortality, particularly among underserved populations, might be best addressed with programs designed to enhance awareness and development of resources within a context of community support. The objectives of this review were to: (1) provide a comprehensive review and evaluation of the roles, evaluation, and effectiveness of LHA in community-based programs with an emphasis on cardiovascular risk reduction; and (2) provide recommendations for future research involving LHA in such programs. Computer and manual searches were conducted of articles in the English-language literature from 1980 to 2007. Twenty articles were evaluated, which emphasized the role of the LHA in cardiovascular risk reduction. A review of research literature provides a starting point for determining salient approaches for intervention and evaluation, issues related to program implementation and sustainability, and strengths and limitations of existing approaches.     

Multicultural Counseling: A 10‐Year Content Analysis of the Journal of Counseling & Development

The emphasis on multicultural counseling during the past 20 years has influenced the increase in scholarly publications on this topic. The authors report the findings of a content analysis of 102 multicultural‐centered articles. Journal of Counseling & Development issues spanning 1990–2001 were evaluated. Findings are reported for methodology, populations discussed, applied settings, and authors' roles and institutional affiliations. Findings indicate that there has been an increase of multicultural‐focused publications since 1990 and that publications are more exploratory and developmental rather than pathology‐oriented.     

Association of Depression with Complications of Diabetic Pregnancy: A Retrospective Analysis

The goal of this study was to determine whether an association between histories of depression and adverse pregnancy outcome could be established using a retrospective analysis. Participants were a convenience sample of 152 pregnant diabetic women for whom prior pregnancy data were available. Prior pregnancy outcome, depression history, and other clinical characteristics were determined from chart review and medical history questionnaires. Logistic regression was used to determine which of the measured clinical factors, including history of depression, had a significant association with history of pregnancy complications. Thirty-nine patients (26%) had a past history of depression. Three pregnancy complications (preterm labor, pre-eclampsia, fetal prematurity) were more common in the group having a history of depression as was the proportion of participants requiring Caesarean section p( < .05 for each comparison). A history of depression was associated with prior pregnancy complications independent of the effects of parity, prepregnancy BMI, tobacco use history, diabetes type, and presence of diabetes complications (OR = 3.6; 95% CI = 1.5–9.0, p = .006). These retrospective data indicate that depression is linked to complications of diabetic pregnancy and support the need for prospective studies to clarify the effects of depression and its treatment on diabetic pregnancy.     

Preliminary exploration of secondhand smoke exposure in youth with Sickle Cell Disease: biochemical verification,pulmonary functioning,and health care utilization

Exposure to secondhand smoke (SHSe) can compound an already challenging set of health problems for youth with Sickle Cell Disease (SCD). Exposure to electronic cigarettes may also impact SCD symptomology and respiratory functioning. This study built on these previous findings by a) utilizing two objective measures of SHSe, salivary cotinine and exhaled carbon monoxide and b) examining the association of SHSe with emergency department utilization, physician-reported sickle cell crises, and pulmonary functioning. Caregivers (N = 31 dyads; M_age = 37.6 years; SD = 8.5 years) of youth with SCD (M_age = 9.0 years; SD = 4.5 years) completed self-report measures of tobacco/nicotine use. Youth provided a saliva sample to assess cotinine levels, and performed pulmonary function tests. Dyads provided breath samples for measurement of eCO. A chart review was conducted to obtain medical history and utilization. Majority of youth (88%) were exposed to SHS via salivary cotinine. Interestingly, no significant associations were observed between youth cotinine levels and emergency department utilization, physician-reported sickle cell crises, or pulmonary functioning. Present findings indicate a need to assess for SHSe using objective assessment measures. Future research should investigate which specific factors contribute to increase SHSe/SHVe in youth with SCD.