Thesis (M.S.W.)--University of Hong Kong, 1991.

Thesis (M. Ed.)--University of Hong Kong, 1993.

Thesis (M.Ed.)--University of Hong Kong, 1993. / Also available in print.

Depression is a major public health problem. Decades of research have been conducted to create a classification system aligned with the complex phenomenological features of depression. The dominant classification system for depression is the latent paradigm, which conceptualizes observable symptoms of depression as effects of an underlying disorder. There is increasing evidence, however, that the latent model is inadequate to inform the prognosis and treatment of depression. Specifically, evidence is accumulating that symptoms of depression do not necessarily arise due to an underlying condition, but that symptoms occur as a network in which each one is causally related to a previous symptom. This dissertation critically evaluated the underlying assumptions of this “network paradigm,” one of the frameworks which had been proposed as an alternative to the traditional latent paradigm, as an appropriate model for studying depression. The first chapter systematically evaluated empirical depression network studies regarding whether the study design included an examination of the paradigm’s assumptions. In the second chapter, I investigated the relationships among depressive symptoms and determined whether causal relationships among depressive symptoms, a key assumption underlying this paradigm, could be a plausible explanation. The last chapter investigated a central controversy within the network literature regarding consistent findings and measurement error. The first chapter found that the majority of depression network studies published in the literature were not capable of providing empirical support of symptom causal relationships and often neglected to investigate the impact of measurement error. The second chapter estimated a significant relationship between two depressive symptoms - sadness and anhedonia, using an inverse probability treatment-weighted regression estimation approach in the context of longitudinal data. Causal relationships among symptoms, a key assumption underlying the network paradigm, may be a plausible explanation for the depressive symptom relationships. The third chapter found that statistical network models are not robust to measurement error through a series of simulation studies. Measurement error remained a general threat against the network paradigm, and existing network findings should be interpreted with caution. Overall, the network paradigm may be appropriate for study depression, but existing findings should be interpreted with caution. There is a need to explore the fundamental assumptions of paradigms prior to widespread application.

Human faces provide a rich source of behavioral data. Following acute, potentially traumatic events, manual and automated coding systems of facial behavior may help identify individuals at risk for developing psychopathology. In the present study, OpenFace, an automated system, and FACS, a manual method, were compared as predictors of long-term functioning using facial behavioral data from clinical interviews collected one-month after a potentially traumatic event that brought participants into the emergency department of a Level-1 Trauma Center in New York City. We evaluated similarities and differences in facial emotions identified by FACS and OpenFace to determine their predictive accuracy in capturing Depression and PTSD 6-months and 12-months later. The findings suggest OpenFace is a more sensitive and precise measure of facial behavior than FACS.

Thesis (MSc)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: Malingering is the intentional production or exaggeration of symptoms for personal gain in the context of external incentives. Due to the absence of objective symptoms, depression may represent a relatively attractive option for malingerers. Existing approaches to distinguish between depressive symptoms and possible malingering often use time-consuming psychometric tests or unreliable interview techniques. Short screening tests for malingering may be a practicable alternative and recently South African cut-off scores on tests for malingering were determined for a student sample. The purpose of this study was to establish South African cut-off scores for persons with a diagnosis of depression on screening instruments for malingering. Fifty-one subjects with a diagnosis of depression (measured by the Zung Depression Scale) were randomly ascribed to one of two groups: an experimental group of 25 subjects (instructed to simulate symptoms based on a malingering case scenario) and a control group of 26 subjects (instructed to do their best in the tests). No incentive was provided to the subjects. Each subject completed the 21-item verbal memory forced choice test (FCT), the Rey IS-item test (Rey IS-item), the dot-counting test (DCT), the Word Recognition test (WR) that is part of the Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) and the Structured Inventory of Malingered Symptomatology (SIMS). The WR test correctly classified 74.5% of subjects with a sensitivity of 93%. The FCT, with a cut-off of> 15.5, correctly classified 72.5% of subjects. A regression equation was computed by combining the FCT, DCT and SIMS. This correctly classified 74.5% of patients with a sensitivity of 69%. The DCT accurately identified 64% of the malingerers using a cut-off score of> 65.57. The Rey15-item test showed poor results and does not seem to be useful as a screening instrument. The WR test shows promise as a screening instrument for malingering. Combining tests when screening for malingering proved to be an effective way to distinguish between malingering of depressive symptoms and real symptoms. The results of this study will help provide guidelines to mental health workers on how to diagnose malingering in patients with depression more objectively. / AFRIKAANSE OPSOMMING: Malingering is die opsetlike nabootsing of oordrywing van simptome vir persoonlike gewin in die konteks van eksterne vergoeding. As gevolg van die subjektiewe aard van simptome, kan depressie 'n relatief aantreklike opsie wees wanneer psigiatriese kondisies gesimuleer word. Bestaande maniere om te onderskei tussen werklike depressiewe simptome en moontlike malingering, gebruik tydrowende psigometriese toetse of onbetroubare onderhoudstegnieke. Kort siftingstoetse vir malingering kan 'n praktiese altenatief wees en onlangse Suid-Afrikaanse afsnypunte op toetse vir malingering is bepaal vir 'n studentesteekproef. Die doel van hierdie studie was om Suid-Afrikaanse afsnypunte te verkry vir malingeringstoetse vir mense met 'n diagnose van depressie. Een en vyftig subjekte met 'n diagnose van depressie (gemeet deur die Zung Depressieskaal) is ewekansig toegewys aan een van twee groepe: 'n eksperimentele groep van 25 subjekte (met die opdrag om simptome te simuleer op grond van 'n malingering-scenario) en 'n kontrolegroep van 26 subjekte (met die opdrag om hulle bes te doen in die toetse). Geen vergoeding is aan proefpersone gebied nie. Elke subjek het die 21-item verbal memory forced choice test (FfC), die Rey 15-item test (Rey IS-item), die dot-counting test (DCT), die Word Recognition test (WR) wat deel vorm van die Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) en die Structured Inventory of Malingered Symptomatology (SIMS) voltooi. Die WR het 74.5% van die subjekte korrek geklasifiseer met 'n sensitiwiteit van 93%. Die FCT, met 'n afsnypunt van <15.5, het 72.5% van die subjekte korrek geklassifiseer. 'n Regressie-vergelyking is bereken deur 'n kombinering van die FCT, DCT en SIMS. Dit het 74.5% van die subjekte korrek geklassifiseer met 'n sensitiwiteit van 69%. Die DeT kon 64% van die malingeerders akkuraat identifiseer deur gebruik te maak van 'n afsnypunt van> 65.57. Die Rey IS-item toets het swak resultate getoon en blyk nie bruikbaar te wees as 'n siftingstoets nie. Die WR toon potensiaal as In siftingstoets vir malingering. Die kombinering van toetse wanneer pasiënte gesif word vir malingering blyk 'n effektiewe manier te wees om te onderskei tussen die malingering van depressiewe simptome en werklike simptome. Die resultate van hierdie studie kan help om riglyne te skep vir geestesgesondheidswerkers oor hoe om malingering van depressie meer objektief te diagnoseer.

Previous research suggests that marital problems, inhibited communication, social rejection, and mutual hostility characterize the interpersonal behavior of depressed patients. The specificity and external validity of these results is questionable since most of this research used analogue designs or lacked important control groups necessary to separate the effects of depression from psychological disturbance in general. This study examined interpersonal aspects of depression within the context of the marital relationship. A battery of standardized and original questionnaires was administered to couples in three comparison groups defined by the wife's level of depression and psychotherapy patient status: a depressed patient group, a non-depressed patient group, and a normal control group. Results of planned comparisons revealed that, relative to the married couples with nondepressed patients and normal control wives, the depressed patients and their husbands saw their marriages as more maladjusted with less open communication. Husbands of the depressed patients also reported feeling more anxiety and acting less honestly or supportively specifically when interacting with their spouses. Husbands in the depressed patient group also rated their wives more negatively in terms of their overall interpersonal impact and saw their own actions as more generally negative when interacting with the depressed spouse. Both spouses in the depressed patient group rated themselves as feeling more hostile generally, while the husbands saw the depressed patients as specifically impacting them in a hostile manner. These results were seen as consistent with Coyne's interpersonal model of depression which suggests that depressed behavior and affect may be maintained by the responses it evokes from interacting others. The finding of greater hostility in both the depressed patients and their husbands replicates previous controlled research but contradicts most psychological theories of depression which predict lowered hostility in depression. Implications for further research and therapy with depressed patients are also discussed.

published_or_final_version / abstract / Humanities / Doctoral / Doctor of Philosophy

published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Anatomy / Doctoral / Doctor of Philosophy