published_or_final_version / Psychology / Doctoral / Doctor of Philosophy

The recognition and diagnosis of elderly depression has been the focus of much research over the last 20 years (Brink, 1982; Goodstein, 1985; Klerman, 1983). One problem in diagnosing depression in the elderly has been adequate assessment devices that are sensitive, specific, and predictable with this population (Yesavage et al., 1983). One assessment device developed specifically for the elderly is the Geriatric Depression Scale (GDS) (Brink et al., 1982;Yesavage et al., 1983). This depression scale has yielded high reliability and validity with other self-rating depression scales. In recent research a Short Form Geriatric Depression Scale was produced containing 15 items, all from the original Long Form GDS. A problem with the Short Form involves the lack of research concerning its construct validity. The purpose of the present study was to demonstrate that the Short Form Geriatric Depression Scale does measure depression in the elderly, and therefore, does possess construct validity. To accomplish this task, it was believed that if significant correlations could be identified between various psychosocial variables highly associated with depression in the elderly and the Short Form GDS, validity could be established. The five psychosocial variables chosen: gender differences, physical/health problems, insufficient social support, marital status, and socioeconomic status (finances), have all been shown to be highly related-to depression in the elderly.The information used for this project was gathered from a survey questionnaire developed by the Institute of Gerontology at Ball State University in Muncie, Indiana. The survey questionnaire was sent to over 5,000 randomly selected elderly in the state of Indiana ranging in age from 60 to 85. Of the approximately 5,000 surveys, 2,979 were completed and returned. The survey incorporated questions concerning the five psychosocial variables reviewed and a modification of the Short Form GDS.In order to test the various hypotheses of the study, several analyses were conducted. Based upon the outcome of these analyses, it was concluded that the Short Form Geriatric Depression Scale does possess construct validity. It was also concluded that the Short Form Geriatric Depression scale does assess depression in the elderly and thus is a valid instrument to use in the assessment of depression with the elderly adult.Based upon the information obtained from the survey following hypotheses were supported:a. Elderly individuals with physical disabilities and/or health related problems had higher total GDS scores on the Short Form. b. A positive relationship was found between physiological problems in the elderly and total GDS score.c. Elderly individuals having no social support system had higher total GDS scores on the Short Form.d. A negative relationship existed between an elderly individual's social support system and total GDS score.e. Elderly widows and widowers produced higher total GDS scores than married elderly.f. Elderly individuals with low economic status had higher total GDS scores than elderly individuals with high economic status. / Department of Counseling Psychology and Guidance Services

The concept of subcortical dementia predicts higher rates of depressive symptomatology in dementia syndromes with predominant subcortical pathology. This hypothesis was evaluated by comparing the frequency and severity of depressive symptomatology in three diagnostic conditions: Alzheimer's disease (AD) (n=30) I subcortical vascular disease (SVD) (n=30), and Parkinson's disease (PD) (n=30). While AD and PD are prototypical exemplars of cortical and subcortical dementia syndromes respectively, SVD provides a test of the generality of the hypothesis as a subcortical neurodegenerative condition whose pathology is not confined to a single subcortical nucleus. A secondary aim of the study was to compare assessment methods for the ascertainment of depressive symptomatology. Assessment methods included the Hamilton Rating Scale for depression derived from interview with the patient's primary caregiver (HRSCG) and from interview with the patient (HRSEX), and the self-report Geriatric Depression Scale. The severity of current depressive symptomatology across the three neurodegenerative disorders followed a consistent pattern across each method of assessment. Specifically, scores on self-report (GDS) , examiner ratings (HRSEX), and caregiver ratings (HRSCG) of depression were most severe in patients with Parkinson's disease (PD), intermediate in subcortical vascular disease (SVD), and least severe in Alzheimer's the ascertainment of depressive symptomatology. Assessment methods included the Hamilton Rating Scale for depression derived from interview with the patient's primary caregiver (HRSCG) and from interview with the patient (HRSEX), and the self-report Geriatric Depression Scale. The severity of current depressive symptomatology across the three neurodegenerative disorders followed a consistent pattern across each method of assessment. Specifically, scores on self-report (GDS), examiner ratings (HRSEX), and caregiver ratings (HRSCG) of depression were most severe in patients with Parkinson's disease (PD) , intermediate in subcortical vascular disease (SVD), and least severe in Alzheimer's / Ph. D.

A differential diagnosis between head injury and depression is critical to ensure proper treatment and appropriate interventions. Knowledge about this can only aid counseling psychologists' work with this population and, identifying a measure that can assist in this process is essential. The purpose of this study is to measure the utility of the Dean — Woodcock Neuropsychological Assessment System (D-WNAS) in distinguishing individuals with head injury from those who have a primary diagnosis of depression, and general neurological impairment. Participants included 433 adults (222 males, 211 females) between the ages 20-55 years of age (mean = 35.3 years, SD = 10.97 years) from the Midwestern United States. During the individual's treatment in the neuropsychological laboratory, each person was administered the following: the Dean-Woodcock Structured Interview (Dean & Woodcock, 1999), mental status exam, the Woodcock Johnson — Revised Tests of Cognitive Ability (WJ-R COG; Woodcock & Johnson, 1989b), the Woodcock Johnson — Revised Tests of Achievement (WJ-R ACH; Woodcock & Johnson, 1989a), and the Dean-Woodcock Sensory Motor Battery (DWSMB; Dean & Woodcock, 1999). This study indicates that responses to D-WNAS can be used to reliably classify adults into groups of depression, head injury, and general neuropsychological impairment. In particular, responses to the D-WSMB portion of the D-WNAS can be used to reliably classify adults into groups of depression, head injury, and general neuropsychological impairment. Classification results revealed that the original grouped cases were classified with 62.6 % (p < .001) accuracy and with 73.2% overall accuracy when the head injury and general neurological impairment groups were combined and compared to depression and normative groups. The WJ-R COG and WJ-R ACH were not as reliable as the D-WSMB at predicting group membership. / Department of Counseling Psychology and Guidance Services

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The Beck Depression Inventory (BDI) is a popular screening and research instrument for measuring severity of depression. The instrument was translated to Portuguese for use in Brazil in 1979; however, it was not until recently that its psychometric properties have been tested empirically for the Brazilian population. The purpose of the present study was to explore the BDI's psychometric properties in a northern region of Brazil and to test for possible relationships between certain demographic variables and BDI outcomes. Samples used in this study were from an urban area in Roraima, the northernmost state of Brazil. The BDI showed adequate levels of internal consistency in nonclinical and clinical samples. Female respondents had significantly higher scores than male respondents. Those who had lower levels of education, income, or occupational status had significantly higher scores than those with higher levels of these variables. Adolescents had significantly higher scores than adults from all age groups except those from age 19 to 22. No significant difference was found between those who identified themselves as “indigenous” and those who identified themselves as “non-indigenous.” Regression analysis results showed that the combination of gender, education, and age best accounted for the variance in BDI scores. An ANCOVA revealed that clinically depressed adults had significantly higher BDI scores than nonclinically depressed adults. Factor analysis results showed that there were two main factors in the item structure for both female respondents and male and female respondents combined: one factor of mainly cognitive-affective items and the other factor of mainly somatic items. The results were discussed in terms of the future use of the BDI in Brazil.

Athletic trainers (ATs) are professionals who are most directly responsible for athletes’ health care in a sport environment. ATs work with athletes on prevention, diagnosis, and treatment of athletic injury; it is through these interactions that put ATs in an ideal position to recognize the psychological and emotional distress that athletes may suffer. Consequently, the National Athletic Trainer’s Association (NATA) has called for ATs to be competent in implementing psychosocial strategies and techniques (e.g., goal-setting, imagery, positive self-talk), recognizing basic symptoms of mental disorders, and identifying and referring athletes in need of psychological help. I explored ATs’ ability to recognize, diagnose, and provide a referral for collegiate athletes who were presenting with symptoms of depression across three different scenarios. The study examined factors that may impact ATs’ abilities in these areas, including AT gender, athlete gender, and type of presenting problem (e.g., athletic injury, romantic relationship, or sport performance issue). Overall, female ATs were better at recognizing depressive symptoms than male ATs, though both were equally proficient at diagnosing depression. Regardless of gender of the AT, gender of the athlete, and presenting problem, ATs were most likely to refer the athletes to a counselor/psychologist, and to a lesser extent sport psychology consultant (SPC). ATs viewed referrals to an SPC as most appropriate for presenting problems related to sport (i.e., performance problem or injury). The results highlight a possible bias in referrals to an SPC, in that SPCs may not be considered an appropriate referral source for romantic relationship problems. Implications for ATs and recommendations for future research are discussed.

The focus of the research study is to explore chronically ill African American, Latino, and White patients' causal attributions of symptoms of depression and factors that predict depression care treatment preferences among these groups. Research has demonstrated that perception of illness impacts what treatments a person will deem appropriate for their mental health problems and from whom they will seek treatment. Research also indicates that certain ethnic groups are more likely to seek treatment for their symptoms of depression in the primary care setting. Yet, it is unclear how they actually perceive their symptoms and what best predicts the treatments that they are likely to consider acceptable. A convenient sample of 109 HIV+ adults, 79 diabetic adults, and 3 adults with both conditions were recruited for this study. Participants had to be receiving services for either HIV, diabetes, or both conditions in one of the three central Austin facilities and be a representative from one of three racial/ethnic groups: African Americans, Latino, and White. Differences were found across ethnicity with regard to causal beliefs and treatment preferences for the symptoms of depression both among the HIV and the diabetic subgroups. Latinos in both groups were more likely than Whites to prefer counseling or a single form of treatment over combined treatment methods. Diabetic Latinos were more likely to prefer counseling for symptoms of depression. HIV seropositive individuals who reported the least number of symptoms of physical illness were more likely to attribute their symptoms of depression to stressful life events, whereas those who reported the greatest number of symptoms of physical illness were more likely to attribute their symptoms of depression to their medical illness. Additionally among the HIV subgroup, individuals who reported high stress tended to predict the preferences for treatment provided by a psychiatrist/psychologist and Whites scored highest on this factor. Finally, differences in depression scores across race/ethnicity were also revealed. The utility of assessing a patient's understanding of symptoms of depression in order to determine how personal illness models impact treatment preferences and knowledge of patient's causal attributions can aid medical social workers and physicians in collaborative management of chronic illness and depression are discussed.

Major Depressive Disorder (MDD) is exceedingly prevalent and considered to be one of the leading cause of disability worldwide. Depression is also a heterogeneous disorder characterized by complex diagnotic approaches with a lack of diagnostic biomarker, an inconsistent response to treatment, no established mechanism, and affecting multiple physiological systems such as endocrine, immunological and cardiovasular as well. <p><p>The growing impact of the analysis of complex signals on biology and medicine is fundamentally changing our view of living organisms, physiological systems, and disease processes. In this endeavour, the basic challenge is to reveal how the coordinated, dynamical behavior of cells and tissues at the macroscopic level, emerges from the vast number of random molecular interactions at the microscopic level. In this way, the fundamental questions could be: (i) how physiological systems function as a whole, (ii) how they transduce and process dynamical information, (iii) how they respond to external stimuli, and mostly (iv), how they change during a pathological processus.<p><p>These challenges are of interest from a number of perspectives including basic modeling of physiology and practical bedside approaches to medical and risk stratification. <p><p>The general purpose of this thesis, therefore, is to study physiological time series to provide a new understanding of sleep dynamics in health, specifically as they apply to the pathological condition of MDD. More precisely: (1) to quantitatively characterize the complex, nonlinear behaviour of cardiovascular (ECG) and electroencephalographic (EEG) time series during sleep, in health and in MDD. This project will test the hypotheses that both the sleep EEG and ECG detects reorganization in the system dynamics in patient suffering from depression. (2) To develop new diagnostic and prognostic tests for MDD, by detecting and extracting “hidden information” in the ECG and EEG datasets.<p><p>Three different methods are introduced in this thesis for the analysis of dynamical systems. The first one, detrended fluctuation analysis, can reveal the presence of long-term correlations ("memory" in the physiological system) even when embedded in non-stationary time series. Graph theoretical measures were then applied to test whether disrupting an optimal pattern ["small-world network"] of functional brain connectivity underlies depression. Finally, multiscale entropy method, which is aimed at quantifying the complexity of the systems' output resulting from the presence of irregular structures on multiple scales, was applied on the ECG signal.<p><p>The results indicate that healthy physiologic systems, measured through the EEG and the ECG signals, are the most complex. According to the decomplexification theory, the depressive disease model exhibits a loss of system complexity, with potential important applications in the development and testing of basic physiologic models, of new diagnostic and prognostic tools in psychiatry, and of clinical risk stratification. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The aim of this study was to determine the usefulness of the following instruments for the diagnosis of depression among Africans: The Beck Depression Inventory (2nd Edition) (BDI-II), the Minnesota Multiphasic Personality Inventory (Revised) (MMPI-2) and the Rorschach Inkblot Test (scored in terms of Exner's Comprehensive System). With regard to the MMPI-2, the focus was on the Depressed Suicidal Ideation Critical Item Scale, but the following Critical Item Scales were also examined: Acute Anxiety State, Somatic Symptoms and Family Conflict. With regard to the Rorschach, the Depression Index (DE PI) and the Suicide Constellation (S-CON) were examined. A Structured Questionnaire was used to obtain background information on the patients. The sample consisted of 162 African patients between the ages of 18 and 50 years that were seen in a private practice in Pretoria, Gauteng. All the patients had an educational level of at least Grade 12. The patients were diagnosed according to DSM-IV criteria as suffering from Dysthymia, Major Depression or Adjustment Disorder with Depressed Mood. The personal background information about the patients that was examined included: sources of and reasons for referral, presenting symptoms, views about the causes of depression, and experience of the self. Relevant statistical analyses were done to investigate the reliability and validity of the measurement instruments and to determine if there were any gender or age biases in the results. In contrast to the findings of earlier research that depressed African patients mainly present with physical complaints, the patients who participated in the study predominantly presented with emotional and cognitive symptoms similar to what is found in Western countries. Only a few patients referred to traditional African beliefs such as witchcraft, and most of them interpreted their illness in terms of interpersonal problems, especially in their relationships with other family members. The BDI-II was found to be a reliable and valid instrument that could be used for the diagnosis of depression among African patients. Of the 162 MMPI protocols, 46.3% were invalid. It was especially on the L, F, F(B) and Cs scales that large numbers of patients obtained scores higher than the cut-off scores. The reliabilities of the Critical Item Scales were acceptable, except for the Family Conflict scale, and these scales thus generally appear to be useful for diagnostic purposes in an African context. The mean score on the Depressed Suicidal Ideation Scale was, however, relatively low. The MMPI-2 rendered a large number of misdiagnoses of Schizophrenia and Personality Disorder and only a few of the patients obtained a diagnosis of a depressive disorder. Although the patients found the MMPI-2 too long and the language too complex, they generally experienced the test positively. The DEPI and S-CON rendered a large number of false negatives which indicates that if these indeces are used for assessing depression, it should be done in conjunction with other diagnostic methods. The Rorschach nevertheless proved to be useful for identifying psychodynamic processes that could be used therapeutically. A low and statistically non-significant positive correlation was found between the BDI-II and the DEPI. Both the BDI-II and the DEPI correlated positively with the Depressed Suicidal Ideation scale. The S-CON did not correlate significantly with any of the other scales. / Thesis (DPhil (Psychology))--University of Pretoria, 2006. / Psychology / unrestricted