Depression Studies

This covers studies relevant to the following 24 mark questions:

Issues related to Classification and Diagnosis

Biological Explanations

Cognitive Explanations

Behavioural Explanations

Psychodynamic Explanations

Biological Treatments

Psychological treatments

Unfortunately the spell checker wont work on my laptop- so I'm apologising in advance for any typos you may find.

I made this resource while listening to the album Pretty Odd by Panic! At The Disco- so if there are random P!ATD lyrics in the text, that will be why ;)

Beck

Inter-rater reliability: 54% in 154 cases

Quite low

Implications:- many researchers (46%) don't agree with one another when it comes to diagnosing an individual with depression.

Keller

Inter-rater relaibility- fair to good

Implications:- Keller argued that the subtleties of the symptoms and needing 5 out of the 9 symptoms leads to a subjective judgement

Test-retest (6 months apart)- fair

Moca

Use to argue against Beck and Keller

88% concordance inter rater

78% concordance test retest

Implications- The relaibility is higher than originally believed

Inter-rater: It can be difficult to reliably diagnose MDD. Reliability is defined as data consistency. If an individual is diagnosed with depression by one specialist but as healthy by another, this is an example of low inter-rater reliability. The notion that diagnosis of MDD has low inter-rater reliability was supported by Beck; Beck found for only 54% of 154 cases diagnoses agreed between raters. This poses the issue that some suffering from MDD may not be successfully diagnosed and therefore be left without treatment, putting their mental health in jeopardy.

Keller argued that the reason inter-rater reliability is so low is due to subtleties in diagnosis criteria, thus leading to a subjective interpretation. He supported this further by finding inter-rater reliability as fair to good.

Moca disputed this- finding inter-rater reliability was in fact at an 88% concordance rate, much higher than first believed .

Test retest: Another issue with reliability is test-retest reliability. As many with MDD may experience spontaneous recovery and other may have their symptoms change bi annually- SAD- this could lead to low test-retest reliability. Indeed, Keller supported this, arguing that when tested 6 months apart an individual’s test-retest reliability was merely ‘fair’. Alternatively, Moca opposed this, finding in their own research that it was much more reliable, at 78%.

Kessler

Those suffering from MDD have a 74% chance of having another disorder as well

Implications- we cannot accurately measure one distinct disorder when multiple disorders are present.

Van Weel Baumgarten

Clinicians (GPs) were able to correctly identify 28 of 33 depressed patients.

Implications- despite argued weaknesses with GPs, they appear to have high diagnositic validity

Validity is a key problem in defining mental illness, particularly depression, as many suffer co-morbidity, or in other words, exhibiting more than one mental illness at once. This leads to the overlapping of symptoms meaning it can be difficult to measure exactly what we intend to measure, leading to low validity. The validity of MDD diagnosis was questioned by Kessler, who found that those that suffered had a 74% chance of being diagnosed with another disorder. Therefore it may not be possible to accurately measure a distinct disorder with the DSM-IV, meaning it has low validity.

Another issue with the DSM’s validity is that many are diagnosed by their own GP. Therefore this may not give an objective measure of symptoms due to knowledge and opinions on a patient’s history. Also, the fact that GPs are not specialised in mental health may lead to inaccurate interpretations of symptoms. In contrast to this, Van Weel Baumgarten actually found that patients were successfully identified as having MDD in 28 out of 33 cases, suggesting validity is actually higher than originally expected. This has the positive implication of meaning- if this is practically the case- many depressed individuals are accurately identified and receive the correct treatment when going through their GP.

This question is challenging, the important thing to remember is to continually refer to the question and how it relates to validity or reliability- otherwise it is very easy to get bogged down in detail and stray from the topic. Even if you are evaluating reasearch (e.g Van Weel Baumgarten only using 33 patients) remember to say how this affects the conclusion (in this example, small sample means low population validity so may not represent the accuracy of GPs across the areas where the DSM-IV is used, so we cannot say surely the majority of GP diagnoses are valid)

McGuffin

Concordance rates for unipolar depression:

46% MZ twins

20% DZ twins

Wender

Adoption study. Eight fold increase in likelyhood of having depression if a biological parent was depressed.

Kety

High levels of noradrenaline in the urine of manic people.

(Also see Permissive Amine theory A01)

Schildkraut

Too much noradrenaline at certain sites causes mania.

Too little causes depression

Thase

Depressed patients had INCREASED levels of noradrenaline

Cochrane

Women are two to three times more likely to suffer from depression than men. (oestrogen levels)

Abramson

Hopelessness theory.

Internal, stable and global negative views of failure increase chances of being depressed.

Peterson and Seligman

People prone to depression explained negative events as being due to these factors as were more likely when stressed.

Beck

All depressed patients experience similar cognitions. they develop negative schemas which lead to cognitive biases, this results in a negative view of oneself, the future and the world.

Sasito

Expectant mothers who indulged in negative thinking patterns showed increased depressive sy.mptoms

Seligman

Students who make global stable attributions remained depressed for longer after examinations had finished suggesting negative thinking is the stimulus for depression.

Lewinsohn

Poor social skills make one more vulnerable to depression as social ineptness is unlikely to bring reinforcement from others.

Maier and Seligman

Tested Seligman's learned helplessness theory with humans, Subjected people to inescapeable noise and shocks and found that later they failed to escape the situation even when possible.

Peterson

Depessed people report having fewer pleasureable experience than the non-depressed and greater depression correlates with fewer pleasant experiences.

Crook and Elliot

There is little evidence of a direct connection between early loss and risk of adult depression

Shah and Wall

Deppressives describe their parents as affectionless

ECT

Effective- 60-70%

However found 53% of patients relapsed regardless

Drug Therapy

Effective in 65-75% of cases

Kuyken

Literature review and meta analysis CBT on its own was more effective than medication or psychotherapy. And the effects were maintained for several years after. However CBT was much more effectibe when patients fully engaged witrh the homework and those suffering from depression alone, being less effective for those with co-morbidity.

Keller

Recovery rates were:

55% for drug therapy alone

52% for for CBT alone

85% for CBT and drug therapy combined

Eysenk

66% of the control group improved spontaneously

44% of psychoanalysis patients improved

Bergin

Used to oppose Eysenk

Found Eysenk report stuied the control group in a hospital and psychoanaylsis group with the GP.

By selecting different criteria the psychoanalysis group rose to 83% improvement and the control group 30% improved.

Brown and Harris

61% of depressed participants had recently experienced a stressful life event, compared to 19% non depressed.

Of those that experienced the life event but had a friend only 10% had depression in comparison to 37% that did not have a close friend.