Over-reporting of maladjustment by depressed subjects

Summary The extent to which patients' reports of maladjustment is influenced by depressive symptoms was estimated in 25 acute depressed patients responding to pharmacotherapy. Their social adjustment over the same four-month period immediately prior to hospitalization was assessed on two separate occasions: firstly when they were acutely depressed, and again a mean of 20 days later when clinically recovered. Significant differences between the two reports were found in mean score of maladjustment in four out of five fields of social adjustment (work, social/leisure life, family of origin, marriage, and sex). The reduction in depressive symptoms scores (of pessimism considered separately), correlated significantly with changes in the total maladjustment score. The reduction in pessimism scores correlated with changes in the scores for both work and social/leisure fields, and also accounted for 40% of the total variance in maladjustment score. These results indicate that impaired social adjustment as assessed during the height of the depressive illness arises in part from a symptom-related overreporting bias leading patients to make a harsh appraisal of themselves.     

Depressed subjects unwittingly overreport poor social adjustment which they reappraise when recovered

Potential biases due to acute depressive symptomatology on raters' assessments of social maladjustment derived from patients' reports were assessed in 25 patients responding to pharmacotherapy during medium-term hospitalization. Patients were questioned on two separate occasions about their social maladjustment covering the exact same period (the 4 months preceding hospitalization): the first was during the acute illness phase, and the second a mean of 20.5 days later, when symptoms remitted. In the second report, composite scores for all fields as a whole showed significantly fewer reports of social impairment than did the first. Significant differences from the first to the second evaluation concerning both subjective distress and observable behavior were found in four and three, respectively, of the five "fields" of social adjustment. Although subjective distress was most modified by remission of acute symptoms, even supposedly objective, observable disturbances were significantly affected. These results indicate that acutely depressed patients overreport social maladjustment, which they then more accurately reappraise when symptoms remit. Patients are completely unaware of both the initial bias and of the reappraisal.     

The relationship between depression and marital maladjustment. A descriptive study

Measures of depression and marital adjustment were completed by patients hospitalized on an inpatient psychiatric unit and their spouses. Therapists also provided ratings of the patients' depression and couples' marital adjustment. Results indicated a significant negative correlation between patient self-reports of depression and marital adjustment, which was supported by the correlation between therapist ratings. These results demonstrate generalization of the previously established depression-marital maladjustment relationship from outpatients to inpatients. Analyses of sex differences indicated that, although there were no differences between depressed men and women in the severity of the depression, depressed men rated their marriages as significantly better adjusted than depressed women. Clinical implications of these findings with respect to depression and marital maladjustment are discussed.     

Damaging backgrounds: later adjustment of international adoptees.

In this study of 2,148 international adoptees aged 10 to 15 years, the influence of early adverse experiences on later adjustment was examined. It was found that early neglect, abuse, and the number of changes of caretaking environment increased the risk for later maladjustment. The older the age of the child at placement, the greater the probability that the child had been subjected to psychosocial adversities. This association sufficiently explained the greater likelihood of later maladjustment with increasing age of the child at placement. Age at placement, as such, did not contribute to the prediction of later maladjustment, independent of the influence of early adversities. The present study underscores the importance that parents and professionals should obtain reliable and detailed information on the child's background and functioning before adoption. This study also showed that the majority of adopted children, even those with backgrounds known to be damaging, seemed to function quite well according to their parents' reports.     

Psychological Adjustment to Illness Scale (PAIS): A study of chronic hemodialysis patients

One hundred and two patients on chronic hemodialysis were studied by the self-report version of the Psychosocial Adjustment to Illness Scale (PAIS). High agreement was found between patients' total scores (global adjustment) and physicians' assessment of the patients' adjustment. High agreement was also found between patients' reports on specific aspects of adjustment, e.g. vocational rehabilitation, psychological distress and social environment, and the physicians' assessments of the same aspects of adjustment. It is suggested that the PAIS is adequate for measuring some aspects of adjustment/maladjustment and therefore large scale studies can be undertaken, aiming at filling gaps in knowledge, clarifying contradictory information, comparing adjustment in different modalities of treatment, as well as measuring the effectiveness of different psychotherapeutic interventions.     

Life changes. Do people really remember?

The question, "How well do people remember life changes?" was approached in a longitudinal study of nearly 400 healthy men in a responsible profession. Three scales for assessing life changes were administered by questionnaire at two examinations nine months apart. The subjects were asked to report life change events occurring during a specific six-month period--that which immediately preceded the first examination. For all three life change scales there was substantial forgetting over the interval between reports, with a second report yielding total scores 34% to 46% less than those from the first report for the same period. The amount of change over time varied greatly across persons. These findings raise serious questions about the validity of retrospective studies of life change and illness when the period being reported is greater than six months in the past. They do not, however, jeopardize the potential of the method for prospective studies.     

Do premorbid impairments predict emergent ‘prodromal’ symptoms in young relatives at risk for schizophrenia?

Aims: Individuals at risk for developing schizophrenia (SZ) in the future frequently exhibit subtle behavioural and neurobiological abnormalities in their childhood. A better understanding of the role of these abnormalities in predicting later onset of ‘prodromal’ symptoms or psychosis may help in early identification of SZ. Methods: In an ongoing prospective follow‐up study of young genetically at‐risk relatives of patients with SZ, we studied the prevalence of problems in premorbid social adjustment and childhood psychopathology and examined their relationship with the presence and progression of ‘prodromal’ symptoms of SZ. Results: Growth curve analyses showed that ‘prodromal’ symptoms, as measured by the Scale of ‘Prodromal’ Symptoms, increased during follow‐up. Premorbid maladjustment and childhood behavioural disturbances were cross‐sectionally correlated broadly with ‘prodromal’ symptomatology scores. Longitudinal analyses revealed that behavioural disturbances, but not childhood maladjustment at baseline, significantly predicted increases in ‘prodromal’ symptomatology during the 2‐year study period. Conclusion: Premorbid behavioural disturbance and maladjustment may predict the later emergence of ‘prodromal’ symptoms. ‘Prodromal’ symptoms in young at‐risk relatives may define a subgroup worthy of follow‐up into the age of risk for psychosis in order to cost‐effectively characterize the predictors of psychotic symptoms and SZ.     

REM sleep,dream variables and suicidality in depressed patients

To examine the relationship between the emotional quality of dreams, REM sleep variables and suicidal tendency in depressed individuals, 26 depressed volunteers (10 males and 16 females) were assessed with the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS), and underwent 3 nights of polysomnography. There was a significant negative correlation between suicidality scores and REM latency and a positive correlation between suicidality and REM percent. Suicidal subjects had a significantly shorter mean REM latency and a higher mean REM percentage than the non-suicidal subjects. As expected in normal subjects, 20 subjects had an increase in dream-like quality (DLQ) of REM reports between the first and second halves of the night. The six subjects with a negative DLQ difference also scored as suicidal. A reduction in dream-like quality of the REM content reports between the first and second halves of the night was found to be associated with suicidal tendency. The findings may indicate that these subjects fail to self-regulate mood and integrate affect into long-term memory networks during sleep. Theoretical and clinical implications of these findings in depression are discussed.     

Variations in self-assessment of personality characteristics in depressed patients, with special reference to aspects of aggression.

30 in-patients, 14 male and 16 female, aged 24-69 years (mean age 47.1 +/- 2.7) suffering from a moderately severe or severe depressive syndrome completed a new personality inventory, the KSP, on two separate occasions. The first-when they were depressed and had just been admitted to the hospital, the second when they were at home and in their customary situation. On the same test occasions the severity of their psychopathology was rated by means of the CPRS. A significant improvement in CPRS rating was ascertained on the second test occasion. In contrast only small changes occurred in the subscales of the KSP. The score referring to 'psychic anxiety' and to 'somatic anxiety' decreased slightly but significantly (p less than 0.05). The scores referring to 'social desirability' also showed a significant (p less than 0.01) slight decrease. Of particular note is that no significant differences were found in the 6 KSP subscales concerned with aspects of aggression, or in the factors which can be obtained from these subscales. Our findings amongst this population of non-psychotic depressed patients do not support the assumption that changes in the direction of aggression occur during depression.     

Psychological problems among patients attending an infertility clinic

Ten couples presenting at an infertility clinic for the first time, and ten couples already undergoing treatment, all with a complaint of primary infertility, were seen by a clinical psychologist, and interview and questionnaire data gathered. Nine patients complained of significant emotional disturbance; nine showed evidence of impaired social adjustment; five individuals reported sexual dysfunction secondary to their infertility, with a primary sexual dysfunction found in a further couple; and a deterioration in the marital relationship was reported by seven couples. Overall, nine women and four men showed signs of current emotional disturbance, social maladjustment or secondary sexual dysfunction. Psychological problems were not generally reported by the partner in whom the aetiological factor for the infertility was found. The results are thought to confirm previous clinical reports suggesting a high incidence of psychological problems in this population, with implications for their management.     

Psychological adjustment in adult adoptees: assessment of distress, depression, and anger

Psychological adjustment was assessed in a sample of 525 female and 191 male adoptees. Analyses were conducted by gender; by search status, i.e., those who had never searched, those who were searching, and those who had made contact with their biological parents; and by history of mental health service utilization. Compared to normative data, the sample reported significantly higher levels of psychological maladjustment; only women adoptees scored higher on a scale measuring anger. Overall, adoptees' scores were elevated but did not approach levels typical of outpatient populations.     

Patients' Understanding of and Adjustment to Epilepsy: Interim Findings from a European Survey

Summary: The purpose of the study was to discover how much European patients with epilepsy and their carers understand about epilepsy. This article reports the interim results for the first four European countries recruited to the study and includes data collected from 1,920 people with epilepsy and 2,136 carers. Clinical and demographic details and data on understanding of epilepsy were collected using self-completed questionnaires mailed to members of epilepsy support groups. There were no significant differences between people with epilepsy and carers for scores on the Epilepsy Knowledge Questionnaire, although people with epilepsy were more likely to score in the higher ranges. Higher scorers on the questionnaire were more likely to be better educated, to have lower scores on the impact of epilepsy scales, to have higher scores on the adjustment to epilepsy scale, and were less likely to report feeling stigmatized. The study confirms the findings of previous studies that people with epilepsy are reasonably well informed, although some gaps in their knowledge were evident. A comparison of country differences will be made and multivariate statistical analysis will allow a better understanding of the contribution of knowledge to people's overall adjustment to their condition.     

Depressive disorders among somatizing patients in primary health care

Unrecognized, untreated and undertreated depressive disorders incur inordinate human and economic costs, despite the availability of an exclusive array of clinical interventions. The aim of this study was to identify cases of masked depression in primary health care, employing a two-stage design. In the first stage, involving a study of 442 patients, the prevalence of recognized depression was 1.8%. In the second step, 62 patients from stage 1 were investigated further because of their high score on somatization tendency. In total, 41 of the 62 patients were found to have a mood disorder according to DSM-III-R, i.e. a major depressive disorder or dysthymia. Two patients were found to have already had a diagnosis of major depression assigned to them in stage 1, but they were joined by 13 more patients. A further 26 patients were found to be suffering from dysthymia, nine had adjustment disorders with depressed mood, and 12 patients showed no signs of depressed mood. For the group suffering from a current episode of major depression or dysthymia, the prevalence rate increased to 11.7% in the initial total population after stage 2. The diagnostic category with the highest rate of depressed patients was ‘musculoskeletal diseases’. Patients with masked depression had higher scores for alexithymia and psychasthenia than depressed patients who were directly diagnosed.     

Social maladjustment and severity of depression

This paper is one of a series dealing with social adjustment and depression.^1–4 In previous reports, we have described the social maladjustments of 40 depressed women who received detailed initial ratings, were followed over 8 months treatment, and were compared with matched controls from the general population. A wide range of maladjustments were present, and factor analysis indicated that these could be described through six dimensions. Follow-up over 8 months showed substantial but incomplete remission, with differential patterns in the six dimensions.In this paper we are concerned with the correlation between social adjustment and symptom ratings. Findings in the earlier sample suggested that although much of the social maladjustment improved after symptomatic recovery and appeared to be a consequence of the depression, during the acute episode there was little correlation between the two domains.³ However, the sample was too small for this aspect of analysis to be entirely satisfactory. This paper will extend the findings to a much larger sample of patients, rated since the earlier study. Our aims are to examine relationships between the degree and patterns of social dysfunction on one hand, and the symptoms of depression on the other.     

Teacher assessment of behaviour in children with new-onset seizures.

RATIONALE: Recent data suggest that children with new-onset seizures may be at increased risk for behaviour problems. Teachers are an excellent source of data about such problems. They do not have the potential bias that a parent worried about a new onset of seizures might have and, furthermore, they are accustomed to comparing performance of children and work in an environment in which the behavioural problems associated with epilepsy may be quite evident. We obtained teachers' reports of behaviour problems in children in the 2 months prior to their first recognized seizure. We also obtained similar data on children with new-onset, moderate severity asthma. In addition to comparing behavioural scores between children with seizures and children with asthma, we compared teachers' assessments of behaviour in children with no prior seizures to those of children with previously unrecognized seizures.METHODS: We evaluated 192 children with new-onset seizures, including 129 children with no prior episodes and 63 children with recognized prior seizure-like episodes. The comparison group consisted of 78 children with new-onset, moderate severity asthma. Behaviour was assessed by the teacher's report form (TRF) of the child behaviour checklist (CBCL) or the caregiver-teacher report form for ages 2-5 (C-TRF). Mean scores were compared by two-sample t -tests and analysis of variance (ANOVA).RESULTS: The children with new-onset seizures had more thought problems than children with asthma. In comparison to children with no prior seizures, the children with prior unrecognized seizures had higher scores in total behaviour problems, internalizing problems, somatic complaints, anxious/depressed, thought problems, and attention problems.CONCLUSIONS: In this sample, children with prior unrecognized seizures were already at increased risk of teacher-rated behaviour problems before starting medication and before any possible stigma effects related to seizures. This sequence suggests underlying neurological problems causing both behavioural problems and seizures.     

Social adjustment and the course of affective illness: A one-year controlled longitudinal study involving bipolar and unipolar outpatients

The association between social adjustment and recurrent affective episodes was examined in 27 recovered bipolar patients and 24 recovered unipolar patients who had been receiving maintenance treatment for at least 1 year. Social adjustment variables and psychiatric status were assessed by bimonthly interviews over the 1-year period using the Social Adjustment Scale (SAS) and the Research Diagnostic Criteria (RDC). Variations in the social adjustment scores were analyzed in the 2 months preceding the onset of a recurrent affective episode. Furthermore, social adjustment variables at entry into the study were assessed to investigate whether there was any association between these and the potential timing of a recurrent episode. Results revealed no significant deterioration in social adjustment during the 2 months preceding a recurrent affective episode. However, it was demonstrated that there was a relationship between a patient's overall social adjustment score at entry into the study and the onset of recurrent affective episodes, independent of any residual depressive symptomatology. Specifically, impaired work adjustment in bipolar and unipolar patients was associated with recurrent episodes. Impaired social and leisure activities adjustment in bipolar patients was also associated with recurrent episodes, and impaired marital adjustment in unipolar patients was associated with recurrent episodes. These results suggest that social maladjustment could be a risk factor for both unipolar and bipolar recurrent affective episodes and that impairment in specific areas of social functioning could be used to predict outcome. Depression and Anxiety 8:50–57, 1998. © 1998 Wiley-Liss, Inc.     

Early and late improvement in a two-year out-patient alcoholic treatment programme

The process of improvement was studied in a 2-year out-patient programme for alcoholics. The drop-out rate was 16%. The analysis was based on recurrent evaluations of treatment contracts including both drinking pattern and psycho-social treatment objectives. Background data were related to the alcohol adjustment during the first but not during the second year of treatment. Subjects with favourable background characteristics showed an early improvement of drinking pattern but few psycho-social changes. In contrast, subjects whose improvement in drinking behaviour occurred during the second year of treatment showed improvement in their psycho-social adjustment already during the first year. All subjects with an early stable improvement were type 1 alcoholics according to the Cloninger-Bohman typology while the majority of those who improved during the later part of the treatment period were type 2 alcoholics.     

Scholastic achievement among children enrolled in the Seychelles Child Development Study

The Seychelles Child Development Study is a longitudinal cohort study following a group of 779 children exposed prenatally to methyl mercury (MeHg) through a maternal diet high in fish. The cohort has been examined six times beginning in infancy with no consistent evidence of adverse effects. In fact, their performance resembles what would be expected from normal children of comparable ages growing up in western cultures. During a neurodevelopment assessment at 66 months, the children were tested for scholastic achievement using the Woodcock Johnson Tests of Achievement. Their reading scores were depressed relative to US norms while arithmetic scores were within normal limits. This disparity was not evident at 107 months; in fact, reading achievement scores far exceeded expected performance relative to US norms, with over 75% of the cohort obtaining scores at or above the 90th percentile. This study reports a secondary analysis of the scholastic achievement data to test the hypothesis that the results obtained in the primary analysis were probably due to the onset of the primary school curriculum between the first and second testing, and not to inherent cognitive deficits among the children at 66 months. The results suggest that a combination of reading instruction and characteristically consistent letter-sound relationships in Creole, the language spoken at home by the majority of Seychellois families, probably accounted for the high achievement scores at 107 months.     

Social readjustment and illness patterns: Comparisons between first, second and third generation Italian-Americans living in the same community

After about 80 yr as a fairly stable society Roseto, over the past seven to ten years, has been undergoing a rapid acculturation into the conventional American pattern. Formerly close family and community ties have been weakened and the self-contained, self-sufficient character of the society has been eroded as the oldest inhabitants have died and the youngsters of ten years ago have come into a position of social influence. To document the changes as they have affected individuals, the Holmes Social Readjustment Rating Questionnaire was given to 204 Italian-Americans living in Roseto, Pennsylvania to ascertain what differences, if any, existed in the Life Charge Unit scores of first, second and third generation groups and to determine the degree of association between LCU scores and illness experience in these three groups. The LCU scores were found to increase with acculturation, i.e. the first generation had the lowest and the third generation had the highest LCU scores. The generational groups also differed with respect to the type of life change they experienced. The first generation reported more changes in family life, the second generation experienced more change in their personal lives and third generation reported more changes with respect to work and financial matters. LCU was found to be significantly related to illness experience. The majority of the first generation reported no illnesses, while the second and third generation were more similar than different both the number and types of illness experienced. The results were discussed in terms of the social and cultural changes that have occured in the community during the past ten years it has been undergoing study by our group.     

Depression: its trajectory and correlates in mothers rearing children with intellectual disability

BACKGROUND: Rearing a child with an intellectual disability (ID) is a lifelong activity, and research needs to reflect the extended nature of the task as well as its complexity. The present longitudinal study reports on an 11-year follow-up of adoptive and birth families rearing children with ID. Its focus was on depressive symptoms and how these changed over time in a sample of 187 mothers. In particular, the authors were interested in whether initial differences in depression between adoptive mothers who knowingly and willingly decided to rear their children with disabilities, and birth mothers for whom the diagnosis of disability was unexpected and frequently crisis-inducing, would persist over time. METHODS: A longitudinal method with three times of measurement provided data which were analysed with analysis of variance and regression techniques. Moreover, several other individual and family adjustment measures were examined with respect to their correlations with depression and an outcome variable that measured subjective well-being with regard to the child. Furthermore, mothers were classified as typical or atypical for their adoptive/birth group based on their depression scores at the first time of measurement. The authors predicted that later depression would be different based on the earlier scores. RESULTS: Both adoptive and birth mothers reported low depression, not significantly different from each other, at the 11-year follow-up. The personality variable of neuroticism was the strongest predictor of depression for both adoptive and birth mothers, accounting for 24% and 23% of the variance, respectively, but it did not predict the mother's subjective well-being with regard to the child. Mothers classified as typical or atypical for their groups at initial measurement continued to report significantly different depression scores 11 years later. CONCLUSIONS: The low depression scores, not significantly different for birth and adoptive mothers, portray the long-term prognosis for adjustment to rearing children with disabilities as primarily positive. Moreover, the predictive value of neuroticism suggests that general mental health is an important component influencing this adjustment. Nevertheless, a different pattern for a different outcome variable suggests that multiple measures are necessary to portray accurately the complexity of reaction over time.