Clinical judgments of depression

Abstract

In an effort to reevaluate Gough's (1954) classic study of common misconceptions about neuroticism, an investigation was undertaken of the degree to which judges could simulate the Basic Personality Inventory (BPI) responses of a clinically depressed patient group. Judgments were recorded of the probability of responding to each of 240 BPI items by a total of 56 university student judges. Judges were assigned randomly to one of two information conditions, one that had only the label “clinical depression” and another that had, in addition, a more extensive definition. Judgmental profiles of depressed patients indicated very high reliabilities (.99) across information conditions, a high association with actual profiles of clinically depressed patients, and differentiation from other psychiatric patients and normal controls. Results were interpreted as supporting the accuracy of judgments of psychopathology, particularly when certain preconditions are met, namely, the use of a meaningful construct of psychopathology and the prediction of behavior relevant to that construct.

Clinical inferences about depression and physical disability.

“…These findings suggest that the inferences about depression by psychology graduate students in accredited programs are not likely to be adversely affected by physical stigma. In general, these results are consistent with those of Jackson et al (1986) in that the accuracy of clinical judgments is enhanced when judges have adequate information and the focus is on specific behavioral problems. Although, overall, our subjects responded more to the display of depressive behaviors than to physical disability, one notable exception did occur in the rating of patient concerns about body image.…”

“…These findings suggest that the inferences about depression by psychology graduate students in accredited programs are not likely to be adversely affected by physical stigma. In general, these results are consistent with those of Jackson et al (1986) in that the accuracy of clinical judgments is enhanced when judges have adequate information and the focus is on specific behavioral problems.…”

“…In addition, the nature of this experiment created a context in which the actual behavior of the targets was salient to the participants. These qualities have been found to improve clinical judgments of psychopathology (Jackson et al, 1986; Reed & Jackson, 1975; Strasburger & Jackson, 1977). Ideally, this experiment approximates a scenario in which a psychologist would be required to focus on actual client behavior in a highly structured context.…”

“…Because staff judgments of patient depression vary considerably across disciplines (Caplan, 1983) and are influenced by the use of subjective rather than standardized criteria (Cushman, Dijkers, & Harrison, 1985), it is premature to assume, without supportive data, that psychologists would have misperceptions of affect in persons with disabilities. Jackson has demonstrated that the accuracy of clinical judgments is enhanced when (a) the judges have adequate information about the specific behavioral disorders in question, (b) the focus is on the specific behavior, and (c) a valid measure of the target behavior is used by the judges (Jackson et al, 1986; Strasburger & Jackson, 1977). It is reasonable to assume that psychologists from accredited programs are exposed to adequate information about depression and would thus rely on standardized criteria in their assessments.…”

The Phenomenology and Course of Depression in Parentally Bereaved and Non-Bereaved Youth

“…1 However, in recognition of the wide variation of the effects of loss, clinicians since antiquity and certainly since the time of Freud have tried to differentiate between the expectable sadness associated with bereavement and true clinical depression that requires treatment. 2,3 The attempt to differentiate between an expectable response to bereavement and major depression is reflected in current DSM-IV criteria, which require a 2-month duration, or “marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation, to make a diagnosis of depression in the post-bereavement period.” 4 This additional requirement for the diagnosis of major depression after the loss of a loved one has engendered a wide range of views, ranging from concerns that diagnosing depression in bereaved individuals inappropriately “medicalizes sadness” to advocacy for dropping this exclusionary criterion completely, because it unnecessarily increases the diagnostic and therapeutic threshold for bereaved people with significant depressive symptomatology. 5–7 Although there are some data on bereavement-related depression in adults, 5,8–13 there are virtually none to inform diagnostic practices in bereaved adolescents.…”