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The intent of this study was to test the hypothesis that patients with treatment-resistant depression are more likely than treatment responsive patients to suffer from sequelae of childhood trauma that may perpetuate depression despite adequate medication treatment. Twenty participants with treatment-resistant depression and 20 participants with treatment-responsive depression were administered a structured interview and a battery of psychological tests to assess levels of current depression, confirm diagnosis, and quantify childhood trauma and presence of dissociative phenomena. Tests used include the Beck Depression Inventory, the Mini International Neuropsychiatric Interview, the Minnesota Multiphasic Personality Inventory-2, the Childhood Trauma Questionnaire, and the Trauma Symptom Inventory. Compared with treatment responders, the treatment-resistant participants were significantly more depressed, had significantly more comorbid anxiety disorders, reported significantly greater levels of childhood emotional abuse, and experienced current-day sequelae of childhood emotional abuse. The hypothesis was partially supported by these results. This study suggests that reported history of childhood emotional abuse and sequelae of that abuse may be associated with treatment resistance in depressed outpatients.

The Minnesota Multiphasic Personality Inventory--Second Edition includes a new validity scale, the VRIN scale, intended to detect random responding. High scores are viewed as casting suspicion on the validity of the profile. For the present study, the authors evaluated some of the complexities of the VRIN scale including its interaction with the F scale. In particular, we tested two hypotheses. First is that among psychotically disturbed test takers, some inconsistent responding is an integral and expected mode of responding to a self-report measure. That is, in an inpatient psychiatric population increased confused responding (high VRIN score) is related in predictable ways to increased endorsement of psychotic scales and two-point codes and to increased psychotic diagnoses. The second hypothesis is a corollary--that the absence of inconsistency (low VRIN) in a protocol indicating acute distress (high F) may indicate that a respondent is being too consistent in presenting self as having severe difficulties. In this case, the rest of the protocol may be an exaggerated description of the clinical presentation. A sample of 521 psychiatric inpatients was used to evaluate these hypotheses. Some support for both hypotheses is reported. Further studies are recommended to evaluate the hypotheses.

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