Depression and General Psychopathology in University Students

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Depression and General Psychopathology in University Students. Ian H. Gotlib. University of Western Ontario. London, Ontario, Canada. The recent increased ...
Journal of Abnormal Psychology 1084, Vol 93, No 1, 19-30

Copynghi 1984 by the American Psychological Association, Inc.

Depression and General Psychopathology in University Students Ian H. Gotlib

University of Western Ontario London, Ontario, Canada The recent increased productivity of researchers in the area of depression has been accompanied by a greater reliance on student samples A number of these investigations, however, have incidentally reported significant correlations between measures of depression and several other forms of psychopathology The present study was designed to examine explicitly the relationship between self-reported depression and a number of self-report measures of other forms of maladaptive functioning in a subclimcal population. Seven questionnaires completed by 443 undergraduate students yielded 17 different pathology scales. All of the scales were found to be significantly mtercorrelated Furthermore, a factor analysis yielded a two-factor solution with the first factor, composed of all but three scales, accounting for 50% of the total variance Chi-square analyses revealed that only 5%-10% of the subjects were cross classified as high on one measure and low on another These results are discussed with reference to the ability of self-report measures to differentiate discrete forms of psychopathology in both subclimcal and psychiatric populations Finally, the present results underscore the need for caution in extrapolating findings from studies with students scoring high on the Beck Depression Inventory

The last decade has brought forth a proliferation of research examining psychological aspects of depression This growth in research productivity, however, has been accompanied by a change in subject samples. Prior to the 1970s, the majority of relevant research m this field used psychiatric patients in testing models and theories of depression (e.g, Beck & Ward, 1961; Friedman, 1964) Since that time, however, most of the studies in this area have used mildly depressed university students as subjects, selected typically on the basis of their scores on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The working assumption of most of these investigations—albeit often implicit—is that mild depression in university students serves as a useful analogue to clinical depression in psychiatric patients. Mild depressive states in persons drawn from nonclimcal populations are postulated to represent the low end of a continuum of seventy—with clinical

depression at the opposite pole, quantitatively but not qualitatively different This assumption has not gone unchallenged. Depue and Monroe (1978) summarized the results of a number of relevant studies, concluding that whereas mild depressions in otherwise normal subjects may share the subjective mood and cognitive components of more severe depressions in clinical populations, they lack the somaticized anxiety, physical complaints, and overt behaviors of clinical depression. Strengthening this observation, Gohn and Hartz (1979) factor analyzed a trait version of the BDI administered to university students and failed to find the somatic disturbance factor identified by Weckowicz, Muir, and Cropley (1967) in a sample of depressed psychiatric inpatients. More recently, Coyne and Gotlib (1983) reviewed the results of a number of studies that call into question the relationship between scores on the BDI and ratings of depression based on clinical interviews, particularly in student samples (e.g., Bumberry, Oliver, & McClure, 1978; Hammen, 1980). These concerns seem not to have had a detrimental effect on the number of published studies reporting the use of mildly depressed students as subjects. As Coyne and Gotlib go on to conclude,

I would like to express my appreciation to Mary Ellen Beatty for her help in collecting and coding the data reported in this study Requests for reprints should be sent to Ian H Gothb, Department of Psychology, University of Western Ontario, London, Ontario, Canada N6A 5C2. 19

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IAN H. GOTLIB

for reasons that likely have more to do with the isolation of researchers from clinical populations than with the viability ofthe continuity hypothesis, the bulk ofthe literature examining depression currently involves the study of mildly depressed college students, and will probably continue to do so (p 476)

Given this trend in the literature, it becomes increasingly important to delineate exactly what is being measured or assessed by the BDI in nonclimcal populations. Results from a number of studies (typically presented in footnotes) suggest that the BDI may be measuring a construct or emotional state considerably broader than depression. Craighead, Hickey, and DeMonbreun (1979), for example, reported an investigation designed to assess distortion of perception and recall of neutral stimuli in depressed university students. Recognizing that "it is essential to have a psychopathology control group in order to argue that obtained group differences may be clearly attributable to depression" (p. 292), Craighead et al. included three groups of subjects in their study: depressed anxious, nondepressed anxious, and nondepressed nonanxious, defined by scores on the BDI and on the Endler-Okada S-R Inventory of General Trait Anxiousness In a footnote, the authors explained that the reason this study was not run as a full 2 X 2 factorial design was that an adequate number of depressed nonanxious subjects could not be found, suggesting a strong relationship between depression and anxiety in university students This relationship was also found by Hollon and Kendall (1980), who attempted to examine depressogemc cognitions in depressed and anxious students. In analyzing their results, however, Hollon and Kendall found a strong correlation between the measures of depression and anxiety, and concluded that, "it was not possible to meaningfully discriminate between self-reported depression and selfreported anxiety in this sample" (p. 391). Finally, Blumberg and Hokanson (1983) assessed the responses of depressed students to confederates enacting various interpersonal roles during a laboratory interaction. The depressed students, however, differed from the nondepressed controls not only on their BDI scores but also with respect to their scores on the Psychasthenia scale of the Minnesota Multiphasic Personality Inventory (MMPI). Blumberg and Hokanson discussed this overlap,

stating that "the confound m selecting our depressed sample between depression scores and anxious rumination . . . indicates the possibility that the results may be accounted for by an anxiety variable" (p. 208). We have encountered a similar situation in our own laboratory. Our studies of psychological processes in depressed psychiatric patients have invariably included a control group of nondepressed psychiatric patients in order to assess the specificity to depression of any obtained deficits (e.g., Gotlib, 1981, 1982, 1983; Gotlib & Olson, in press; Kowalik & Gotlib, 1983). In fact, our results have indicated that very different conclusions would have been drawn concerning the relationships among depression, social skills, self-reinforcement, and recall had this control group not been included (cf. Gotlib, 1981, 1982). When we attempted to extend this methodological paradigm to the study of mildly depressed university students, however, we were consistently unable to extract two distinct psychopathology groups. Gotlib and Robinson (1982), for example, examined the responses of individuals to depressed and nondepressed students with whom they interacted A footnote m this article explained that although the study was originally intended to be run as a 2 X 2 (Depression X Anxiety) factorial design with subjects assigned to each group on the basis of their scores on the BDI and on the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970), a correlation of .73 between these two measures rendered this design impossible to implement. Similarly, Cane and Gotlib (1983) examined the effects of positive and negative feedback on the expectations, evaluations, and performance of depressed and nondepressed university students. Cane and Gotlib used the Costello-Comrey Depression and Anxiety scales to assign subjects to the four cells of the 2 X 2 design. Again, however, a footnote was required to explain that a significant correlation of .42 between these two measures precluded the use of this intended design. These studies, then, have all found a significant relationship between depression and anxiety in subclinical samples. There are a number of explanations for this finding. It may be, for instance, that depression and anxiety simply are highly interrelated emotional states.

DEPRESSION AND GENERAL PSYCHOPATHOLOGY

Individuals who are experiencing symptoms of depression, therefore, also would likely be experiencing a significant degree of anxiety, regardless of whether they comefroma clinical or from a subclinical population. This explanation is consistent with the theoretical position outlined by Wolpe (1971), who has emphasized the role of anxiety as a critical etiological factor in depression, and in fact there is considerable empirical evidence to suggest that depressed psychiatric patients report symptoms that are similar to those manifested by patients diagnosed as suffering from anxiety neurosis. Prusoffand Klerman (1974), for example, compared the self-assessment scores of 364 depressed and 364 anxious female psychiatric outpatients on the Symptom Check List Although the depressed patients scored highest on the depression factor and the anxious patients scored highest on the anxiety factor, the depressed patients were found to score higher on the anxiety factor than were the anxious patients, indicating a substantial degree of overlap in symptoms Furthermore, a discriminant function analysis indicated that the probability of patient misclassification in this study was a significant 34% In a similar study reported by Snaith, Bridge, and Hamilton (1976), patients who were suffering from endogenous depression or from anxiety neurosis completed both the Leeds Self-Assessment of Depression scale and an equivalent scale for anxiety Snaith et al. found that only 24% of the anxiety patients and 26% of the depression patients had scores that did not overlap with those of the patients in the other group. Similar findings of significant correlations between measures of depression and anxiety have been reported for samples of psychiatric patients (Davies, Burrows, & Poynton, 1975; Mendels, Weinstem, & Cochrane, 1972), alcoholic inpatients (Pachman & Foy, 1978), medical outpatients (Goldberg, Rickels, Dowmng, & Hesbacher, 1976), and students (Krantz & Hammen, 1979; Meites, Lovallo, & Pishkin, 1980; Pohvy, 1981). In fact, Goldberg et al. (1976) reported that thefirstfactor obtained in a factor analysis of the General Health Questionnaire completed by medical outpatients was concerned with depression and anxiety, and stated that "it should perhaps be emphasized that both rotated and unrotated solutions have been ex-

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amined up to the 7-factor solution . and that there is no solution which produces anxiety items on one dimension and depressive items on another" (p. 65) A second explanation to account for the finding of a strong relationship between measures of depression and anxiety m the Craighead et al. (1979) and the Gotlib (Cane & Gothb, 1983; Gotlib & Robinson, 1982) studies is that in subclinical samples, all types of psychopathology are significantly interrelated It is important to emphasize that this explanation is not presented as a rival hypothesis to thefirstalternative discussed but rather represents an extension of the position that depression and anxiety are interrelated constructs. Although no investigation has explicitly assessed this possibility, a number of studies have reported results consistent with this explanation. Strack, Blaney, Ganellen, and Coyne (1983), for example, assessed anagramsolving performance under a variety of experimental conditions in groups of depressed and nondepressed university students, defined by scores on the BDI In addition, to examine the relationship between anagram performance and test anxiety, Strack et al. also administered the Test Anxiety Inventory (TAI) to all subjects Analyses conducted comparing the depressed with the nondepressed subjects' scores on the TAI subscales yielded t values of 7 9 and greater, with all ps < .001 Reminiscent of Blumberg and Hokanson's (1983) observation, Strack et al noted that this of course reflects the high association between the BDI and test anxiety The point is that although test anxiety played no role in subject selection or assignment, the differences between groups on a measure of test anxiety were so great that it appears certain that the results would have been similar if it, rather than depression, had been the sorting variable (p 15)

Finally, depression in subclinical samples has also been found to be significantly related to measures of other forms of psychopathology. Meites et al. (1980) obtained a correlation of .63 between scores on the BDI and on the Neuroticism scale of the Eysenck Personality Inventory (EPI-N) in a sample of university students The EPI-N was also found in this study to be highly correlated (r = .53) with the Zung Self-Rating Depression Scale. Similarly, Krantz and Hammen (1979) reported that all six factors of the Profile of Mood

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IAN H GOTLIB

States—depression, anger, anxiety-tension, confusion, fatigue, and vigor—were significantly intercorrelated in a student sample, and Polivy (1981) found that the affective states of anger, depression, and anxiety tended to cooccur in both laboratory and natural settings in a sample of university students. The present study was designed to address this second explanation by examining more explicitly the relationship in a subchnical population between self-reported depression and a number of self-report measures of other forms of psychopathology. Method Subjects The subjects in the present study were 475 undergraduate students at the University of Western Ontario Subjects with any missing data were excluded from further analyses, yielding a final sample of 443 subjects (147 males and 296 females) All subjects received course credit for their participation

Measures Seven Questionnaires, yielding 17 different pathology scales, were used in the present study 1 Beck Depression Inventory The BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) is a frequently used 21-Hem self-report measure of the severity of depressive symptomatology Its reliability and validity have been extensively documented (e.g. Bumberry et a l , 1978, Davies et a l , 1975, Hammen, 1980), and most important for purposes of the present study, the BDI has been reported to discriminate reliably between depression and anxiety (Beck, 1967) Further relevant investigations of the psychometric properties of the BDI are examined in detail in Coyne and Gotlib (1983) 2 D-30 Scale The D-30 Scale, developed b> Dempsey (1964), is a 30-item version of the 60-item Depression (D) scale of the MMPI The D-30 Scale eliminates the extraneous or error variation of the MMPI scale and consists of items that differentiate depressed from nondepressed individuals within both hospitalized and normal samples Dempsey has reported split-half reliability estimates for the D-30 Scale ranging from .84 to 95 and has demonstrated the psychometric superiority of this measure to the original MMPI D-scale The D-30 Scale is being used increasingly in research in depression (e g , Buchwald, 1977, Durham, 1979) and was included in the present study because it was specifically designed to measure level of depressed mood among university students (Buchwald, 1977) 3. Dysfunctional Attitudes Scale (DAS) The DAS was developed by Weissman and Beck (1978, Weissman, 1978) to measure the presence of idiosyncratic dysfunctional beliefs or assumptions postulated by Beck (1967) to characterize the thinking of depressed individuals Originally a 100-item scale, the revised version of the DAS consists

of two 40-item forms The DAS possesses both adequate test-retest reliability (.81) and high internal consistency ( 88; Weissman, 1978) Dobson and Brerter (1983) reported that the DAS correlates significantly with the BDI and with two other measures of depressive cognitions in a sample of university students, and Hamilton and Abramson (1983) found that depressed psychiatric inpatients obtained significantly higher scores on the DAS than did either nondepressed psychiatric patients or nondepressed nonpsychiatric control subjects 4. State-Trail Anxiety Inventory Form Y The STA1 (Spielberger et a l , 1970) consists of two scales developed to provide operational measures of state and trait anxiety Each scale contains 20 items that either describe symptoms of anxiety' or indicate the absence of anxiety The STAI A-State scale requires respondents to indicate the intensity of their anxiety at a particular moment, whereas the STAI A-Trait scale assesses the general frequency of specific anxiety symptoms Both the stability of the STAI A-Trait scale and the sensitivity of the STAI A-State scale to threats to self-esteem and physical safety have been examined, and the results have consistently supported the use of these scales in anxiety research (e.g, Auerbach, 1973) Levitt's (1967) review concluded that the STAI was the most carefully developed psychometric instrument available for measuring anxiety, and m fact, the STAI has been used more often in psychological research than has any other measure of anxiety (Buros, 1978) Spielberger, Vagg, Barker, Donham, and Westberry (1980) reported a psychometncally improved version of the STAI (the STAI-Form Y), and this version of the A-State scale was administered in the present study 5 Multiple Affect Adjective Check List (MAACL) The MAACL was developed by Zuckerman and Lubm (1965) It consists of 132 adjectives and yields scores on three empirically derived subscales Depression, Anxiety, and Hostility Adequate retest and split-half reliabilities (Zuckerman, Lubm, & Robins, 1965) and discriminant validity (Zuckerman, Lubin, Vogel, & Valerius, 1964) have been demonstrated for the three subscales The MAACL has been used extensively in studies with both students and psychiatric patients and has been found in a number of investigations to be sensitive to transitory mood states (e g, Buchwald, Strack, & Coyne, 1981; Gotlib & McCann, in press) 6 Svmptom Check List-revised (SCL-90) The SCL90, developed by Derogatis, Lipman, and Covi (1973), is a multidimensional symptom self-report inventory comprised of 90 items, each rated on a 5-pomt scale of distress The SCL-90 yields scores on nine primary symptom dimensions Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, PhobicAnxiety, Paranoid Ideation, and Psychoticism Internal consistency coefficients for the nine scales range from 77 to 90, test-retest reliabilities range from .78 to 90. and when compared to various scales derived from the Middlesex Health Questionnaire and the MMPI, the SCL-90 has been demonstrated to possess high convergent validity (Derogatis, Rickels, & Rock, 1976) The SCL-90 has been used to assess psychiatric symptomatology in a variety of diverse subject samples, including obese females seen in a general medical practice (Rickels, Hesbacher, Fisher, Perloff, & Rosenfeld, 1976), opiate addicts (RounsaviUe, Weissman, Cnts-Christoph, Wilber, & Kleber, 1982), hypertensives (Meyer, Derogatis, Miller, & Reading, 1978),

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DEPRESSION AND GENERAL PSYCHOPATHOLOGY and psychiatric patients (Brown, Schwartz, & Sweeney, 1978) Finally, the SCL-90 has been demonstrated to be sensitive to low levels of symptoms in normal populations (Uhlenhuth, Upman, Baiter, & Stern, 1974) 7 Rathus Assemveness Schedule (RAS) The RAS is a 30-item self-report scale developed by Rathus (1973) for the measurement of assertiveness Psychometncally, the RAS has been demonstrated to possess acceptable testretest and split-half reliability in both student and psychiatric samples (Rathus & Nevid, 1977, Rathus, 1973) In addition, the RAS has been found to correlate significantly with behavioral ratings of assertiveness (Green, Burkhart, & Harrison, 1979, Rathus. 1973), and scores on the RAS have been found to increase as a result of assertiveness and social skills training in samples of both students (Morgan & Leung, 1980) and psychiatric patients (Monti, Curran, Cornveau, DeLancey, & Hagerman, 1980)

Procedure Subjects were run in small groups of from 15 to 25 Each subject was given a booklet containing the seven questionnaires described above and was told that these measures assess people's moods and attitudes Subjects were requested to read the instructions at the top of each questionnaire and then to complete carefully each measure Two different orders of the questionnaires were used, with half of the subjects completing one version of the booklet, and half, the other

Results Means and standard deviations for each measure for males and females, and for the total sample, are presented in Table 1. Significant differences were found between males and females on four of the measures. Males obtained higher scores on the DAS, ?(441) = 2.06, p < .05, whereas females obtained higher scores on the SCL-90 Depression, ?(441) = 2.76, p < .01, Anxiety, z(441) = 2.35, p < .05, and Phobia, z(441) = 2.39, p < .05, scales. Cronbach's alpha for each scale and correlations between each measure for all subjects are presented m Table 2. As is strikingly evident from Table 2, every correlation is statistically significant Although correlation coefficients that are small in absolute value would reach statistical significance with the use of a sample size as large as that used in the present study, it is important to note that the obtained coefficients are not in general absolutely small, ranging m magnitude from 16 to 82, with a mean value of .47. Of particular interest are the correlations of the BDI with the other measures Although the highest

Table 1

Means and Standard Deviations for Measures of Psychopathology Male

Total sample

Female

Measure

M

SD

M

SD

M

SD

DAS BDI D-30 STAI RAS SCL-Som SCL-Obs SCL-Int SCL-Dep SCL-Anx SCL-Hos SCL-Pho SCL-Par SCL-Psy MAACL-D MAACL-A MAACL-H

123 67 7 04 7 69 21 41 4.02 6 16 11 81 7 92 1199 6 29 3 76 1 13 4 60 5 39 14 59 7.33 8 20

25 09 5 88 4 93 11 55 23 69 531 641 6 84 8 05 5 22 3 65 2 19 4 19 5 82 6.31 3 78 3 81

118 86 7 68 8 38 22 39 - 0 14 6 82 11 84 8 78 14 40 7 68 3 45 1 75 4 19 5 28 15 06 744 8 16

22 04 5 90 4.99 11 31 24 09 5 74 6 70 6 39 8 93 6 14 3.63 2 75 3 73 5.52 6 10 3 94 3 46

120 45 7 47 8 15 22 06 124 661 11 83 8 50 13 60 7.22 3.56 1.54 4 32 5 31 14 91 7 40 8 17

23.18 5 89 4 98 11 39 24.01 561 6.60 6 55 871 5.88 364 2 59 3.89 5 61 6.16 3.89 3 58

Note DAS = Dysfunctional Attitudes Scale; BDI = Beck Depression Inventory; D-30 = D-30 Scale, STAI = StateTrait Anxiety Inventory, RAS = Rathus Assertiveness Schedule SCL = Symptom Check List- Som = Somatization, Obs = Obsessive-Compulsive, Int = Interpersonal Sensitivity, Dep = Depression, Anx = Anxiety, Hos = Hostility, Pho = Phobic-Anxiety, Par = Paranoid Ideation, Psy = Psychoticism MAACL = Multiple Affect Adjective Check List D = Depression, A = Anxiety, H = Hostility

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Table 2 Reliabilities and Intercorrelations of Measures of Psychopathology Measure I. 2. 3 4 5 6 7. 8. 9. 10 11 12. 13. 14 15. 16 17

DAS BDI D-30 STAI RAS SCL-Som SCL-Obs SCL-Int SCL-Dep SCL-Anx SCL-Hos SCL-Pho SCL-Par SCL-Psy MAACL-D MAACL-A MAACL-H

1 69 47 53 44 -35 28 40 46 44 39

33 28 44 40

39 36 30

2 82 76 59 -32 46 60 59 73 63 45 47 53 59 53 51 40

3

82 65 -44 45 62

63 74 63 45 43 51 56 56 56 41

4

5

6

7

8

9

10

11

12

13

49 -36 33 55 48 64 56 29 35 40 44 65 73 49

68 -23 -36 -45 -41 -36 -22 -37 -24 -36 -27 -23 -16

77 49 49 54 56 41 47 50 53 26 26 18

81 65 74 68 45 48 57 62 35 39 22

86 74 65 56 57 73 73 35 36 22

87 74 53 50 60 69 51 51 32

83 54 56 57 67 40 47 27

79 47 60 56 20 22 23

71 48 58 26 30 21

70 69 24 27 17

14

80 33

32 20

15

16

17

88 82 75

83 72

80

Note Scale reliabilities are presented along the diagonal Decimal points have been omitted DAS = Dysfunctional Attitudes Scale, BDI = Beck Depression Inventory, D-30 = D-30 Scale. STAI = State-Trait Anxiety Inventory. RAS = Rathus Assertiveness Schedule SCL = Symptom Check List Som = Somatization, Obs = Obsessive-Compulsive, Int = Interpersonal Sensitivity, Dep = Depression, Anx = Anxiety, Hos = Hostility, Pho = Phobic-Anxiety, Par = Paranoid Ideation, Psy = Psychoticism MAACL = Multiple Affect Adjective Check List D = Depression, A = Anxiety, H = Hostility

Table 3 Rotated Factor Matrix of Measures of Psychopathology Measure

Factor 1

Factor 2

DAS BDI D-30 STAI RAS SCL-Som SCL-Obs SCL-Int SCL-Dep SCL-Anx SCL-Hos SCL-Pho SCL-Par SCL-Psy MAACL-D MAACL-A MAACL-H

4419 .6443 6420 4314 -4096 6112 7272 8362 7817 7586 6493 6352 7772 .8167 1840 2083 .0813

3431 4688 5186 6759 -2168 1419 2733 1971 4049 3105 .0966 1531 1005 1592 8939 .8821 7562

Note DAS = Dysfunctional Attitudes Scale, BDI = Beck Depression Inventory; D-30 = D-30 Scale, STAI = StateTrait Anxiety Inventory, RAS = Rathus Assertiveness Schedule SCL = Symptom Check List Som = Somatization, Obs = Obsessive-Compulsive, Int = Interpersonal Sensitivity, Dep = Depression, Anx = Anxiety, Hos = Hostility, Pho = Phobic-Anxiety, Par = Paranoid Ideation, Psy = Psychoticism. MAACL = Multiple Affect Adjective Check List. D = Depression, A = Anxiety, H = Hostility

correlations with the BDI were with other measures of depression (average r = .67), the BDI was also highly correlated with the measures of anxiety (average r = .58) and with the remaining measures (average r = .49). In fact, the BDI did not correlate less than 32 with any measure, and the mean correlation coefficient of all measures with the BDI was .55. A factor analysis (principal component solution with a vanmax rotation) of scores on these measures yielded two factors with eigenvalues greater than one, together accounting for 63.2% of the total variance (50.8% and 12.4%) This analysis is presented m Table 3 The first factor (82 0% of the variance accounted for by the two factors) is composed of all of the measures except the three MAACL scales. The MAACL scales make up the second factor (18.0% of the variance), along with the STAI A-State scale, which loads on both factors Finally, to examine whether subjects who would be selected as depressed and nondepressed for one study would be the same subjects who would be selected as high and low anxious, nonassertive and assertive, high and low attitudmally dysfunctional, and so forth

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DEPRESSION AND GENERAL PSYCHOPATHOLOGY

in other studies, a quartile-split procedure was used to assign subjects to high, medium, and low groups on each measure. For each measure high scorers were denned as subjects composing the top quartile of scores, low scorers as the bottom quartile, and medium scorers as the middle 50%. Chi-square analyses indicated a significant tendency for subjects to fall in the same category on each of the 17 scales Chi-square values, with four degrees of freedom, ranged from 19.24 (p < .001) between the RAS and MAACL-Depression scales, to 297.87 (p < .0001) between the MAACL-Depression and the MAACL-Anxiety scales These analyses revealed that no more than 20% of the subjects classified as high scorers on one measure were ever classified as low scorers on another, and more often, only 5%—10% of subjects were cross classified as high on one measure and low on another. As a representative example, the chisquare analysis of scores on the BDI and on the STAI A-State scale is presented in Table 4. Discussion The present study was designed to examine the relationships in a nonclinical population among a number of self-report measures of various types of psychopathology. Moderate to strong correlations, all significant, were obtained for every measure administered in this study. Furthermore, a factor analysis of these 17 scales yielded only two coherent factors, with the first accounting for 50% of the total variance. Finally, and not surprising, given the strong correlations and the two-factor solution, chi-square analyses indicated that most often only 5%— 10% of subjects who scored in the top quartile on one measure obtained a score in the bottom quartile on any other scale Thefindingof high correlations among various measures of psychopathology in a student sample is not completely unexpected. Although no study has examined simultaneously all of the measures used in the present study, a number of investigations have reported results with subclinical samples that, although more limited in scope, are nonetheless similar to those found in the present study. The STAI, for example, has been found to correlate significantly with the UCLA Loneliness Scale

Table 4 Number and Percentage of Subjects Classified on the BDI and the STAI bv a Quartile Split BDI STAI A-State Low (0-13) n % Medium (14-28) n % High (29 and over) n %

Low (0-3)

Medium (4-10)

High (11 and over)

57 129

44 99

7 16

60 13 5

137 30 9

32 7.2

7 1 6

38 86

61 138

Note BDI = Beck Depression Inventory, STAI = StateTrait Anxiety Inventory TV = 443

(Russell, Peplau, & Cutrona, 1980) and with the RAS (Fiedler & Beach, 1978) Similarly, the RAS has been demonstrated to be significantly correlated with the Fear Survey Schedule (Hollandsworth, 1976), the Endler-Okada S-R Inventory of General Trait Anxiousness (Burkhart, Green, & Harrison, 1979), Rotter's (1966) I-E scale (Replogle, O'Bannion, McCullough, & Cashion, 1980), and with 9 of the 11 scales of the Personality Research Form (Green et al, 1979). Finally, the SCL90 has been found to correlate significantly with the UCLA Loneliness Scale (Baum, 1982) The finding of a single major factor accounting for 50% of the total variance clearly warrants comment. This factor is made up of all of the questionnaires except the three MAACL subscales and appears to represent nonspecific or general distress There have been previous studies of symptomatology in psychiatric patients which have reported a major factor similar to that found in the present study. Welsh (1956) defined two major dimensions obtained m factor analyses of the MMPI and noted that the first factor represented general psychiatric distress or disturbance More recently, Mendels et al. (1972) administered 11 self-report measures of depression and anxiety, including the BDI, MAACL, and Costello-Comrey Depression and Anxiety scales, to female psychiatric inpatients. A factor analysis yielded a two-factor solution similar to that obtained in the present

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study. Mendels et al.'s first factor, which ac- draw conclusions about the relationship becounted for 53% of the total variance, was tween cognition and depression on the basis made up of all but 2 of the 11 measures used either of differences between these two groups in the study. These authors discuss the diffi- or of correlations between cognitive measures culties in empirically separating depression and BDI scores. Dobson and Breiter (1983), and anxiety in psychiatric patients and suggest for instance, correlated scores on three cogthat self-report measures of anxiety and nitive measures with the BDI and concluded depression do not measure independent con- that the Automatic Thoughts Questionnaire structs but rather appear to assess general psy- (ATQ; Hollon & Kendall, 1980) "would be chiatric disturbance. Virtually identical results the instrument of choice for assessing cogniwere obtained in the present study with a sub- tions in depression" (p. 108, italics added). It clinical population and with constructs in ad- is interesting that Hollon and Kendall found dition to depression and anxiety. It appears, that the ATQ actually correlated more highly then, that self-report measures of a number with scores on the STAI A-Trait scale than of types of maladaptive functioning may all with either the BDI or the MMPI D-scale. essentially assess one construct, which might Similarly, Krantz and Hammen (1979) found best be labeled dysphoria, malaise, or general that although degree of cognitive distortion psychological distress was correlated with scores on the depression The present results have important impli- factor of the Profile of Mood States, distortion cations for psychological models of depression. was also significantly correlated with each of To consider but one example, the postulation the other five mood factors derived from this of learned helplessness as a model of depres- questionnaire. It is of paramount importance sion (cf. Abramson, Sehgman, & Teasdale, that future studies using student samples to 1978) was derived in part from observations examine psychological factors in depression of similarities between helplessness-induced attempt to include some form of psychopathiosubjects and depressed individuals, typically logical control group. Unfortunately, the presuniversity students selected on the basis of their ent results suggest that this paradigm may scores on the BDI (cf. Miller & Sehgman, prove extremely difficult to implement with a 1975). The present results suggest that the de- subclinical population. pressed students m these studies would have It is also important that the present study been caught in the pathology net of any num- be conducted with psychiatric patients. Given ber of measures of different types of mal- the substantial effort dedicated to training cliadaptive functioning and would consequently nicians to make reliable differential diagnoses, have been labeled anxious, unassertive, atti- one would want to argue ideally that the prestudinally dysfunctional, and so forth, rather ent results would not be replicated in such than depressed Had these measures been used samples. It is interesting that there is evidence instead of the BDI, learned helplessness might to suggest that similar results might in fact be originally have been postulated as a model of obtained. Studies demonstrating a strong reanxiety or unassertiveness. In fact, following lationship between self-reported depression a similar line of reasoning, Lavelle, Metalsky, and anxiety in psychiatric patients have been and Coyne (1979) produced helplessness def- reviewed earlier in this article. Other studies icits in students manifesting high levels of test converge with these investigations, however, in anxiety and, in a subsequent study, alleviated suggesting that a number of self-report meahelplessness deficits through an attentional re- sures of psychopathology in addition to deployment procedure typically used to treat depression and anxiety may be highly interanxiety (Coyne, Metalsky, & Lavelle, 1980). related in patient samples. Blatt, Quinlan, Similar cautions are in order for investi- Chevron, McDonald, and Zuroff (1982), for gations that make frequent use of student example, found that the BDI correlated sigsamples in examining other psychological as- nificantly with 9 of the 10 clinical scales of pects of depression. For example, studies of the MMPI in a sample of psychiatric inpacognition and depression frequently use only tients. Similarly, Serra and Pollitt (1975), Masamples of depressed and nondepressed stu- thew, Largen, and Claghorn (1979), and Wildents, defined by their scores on the BDI, and kinson and Blackburn (1981) all obtained sig-

DEPRESSION AND GENERAL PSYCHOPATHOLOGY

nificant correlations in psychiatric patients between scores on the BDI and on the EPIN, which suggested a strong general neuroticism component of the BDI. Zuckerman et al. (1965) reported that the three MAACL subscales of Depression, Anxiety, and Hostility were all highly intercorrelated m a patient sample and, furthermore, that all three scales correlated positively and significantly with the Depression, Paranoia, Schizophrenia, and Hypochondnasis scales of the MMPI. Finally, the SCL-90 has been found to correlate significantly in a sample of psychiatric inpatients with the BDI, the STAI, and 8 of the 10 MMPI clinical scales (Dinning & Evans, 1977). Additional evidence of significant relationships among various measures of maladaptive functioning in nonstudent samples comes from studies examining cognitive, affective, and behavioral effects of various therapy approaches. Sanchez and Lewinsohn (1980), for example, reported that training m assertive behavior was effective in lowering patients' self-reported levels of depression. Hammen, Jacobs, Mayol, and Cochran (1980) found that assertion training with commumty residents resulted not only in increased scores on the RAS but also in decreased scores on the DAS. Similarly, social skills training has been found to result both in increased RAS scores (Monti et al., 1980) and in decreased BDI scores (cf. Lewinsohn, Biglan, & Zeiss, 1976) Finally, Rounsaville et al. (1982) reported a significant decrease on the BDI and on all of the SCL-90 scales in opiate addicts as a function of a program of psychotherapy, reflecting what these investigators refer to as pansymptomatic improvement. The results of these studies are consistent with a more general form of Leff's (1978) suggestion that psychiatrists tend to make more clear-cut distinctions among unpleasant affects than do psychiatric patients. Leff had 20 psychiatric inpatients and outpatients complete a questionnaire containing 22 items (e.g., "I feel like crying," "I feel shaky inside"), each rated on a 5-point scale. Three copies of the questionnaire—with the different headings, "When I am Depressed," "When I am Anxious," and "When I am Irritable"—were answered by each patient. Ten psychiatrists also completed the questionnaires "as they imagined a typical neurotic patient would do."

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When the three questionnaires were correlated within each of the two subject groups, Leff found that whereas the psychiatrists were able to make significant distinctions among depression, anxiety, and irritability (correlations ranged from 0 to 28), the patients conceived of these emotions as overlapping to a considerable degree (correlations ranged from .49 to .62). On the basis of these data, Leff concluded that "psychiatrists hold concepts of anxiety, depression and irritability that are much more differentiated than the corresponding concepts held by patients suffering from neurosis" (p. 310) The present results extend Leff's findings and suggest that individuals in nonchmcal populations, too, do not make clear distinctions among negative affects. A final concern involves the argument that the high correlations obtained in the present study among the various measures of psychopathology do not reflect the individuals' actual perceptions of the relationships among these various constructs but rather are a function of a global response bias to present oneself in a negative light. Although this issue was not addressed directly, there is empirical evidence to suggest that this may not be the case. Reynolds and Gould (1981), for example, assessed the relationship between scores on the BDI and the Marlow-Crowne Social Desirability Scale and found a nonsignificant correlation between these two measures Similarly, Appelbaum (1976) found that scores on the RAS m a student sample did not correlate significantly with scores on the Marlow-Crowne scale. Conflicting results, however, have been reported by Rock (1981) and Hoffman (1970) in samples of students and of hospitalized male alcoholics, and further research needs to be conducted to assess this possibility more adequately. In sum, the present study highlights a major difficulty in using self-report measures to assess various forms of maladaptive functioning in subchnical samples Significant mtercorrelations were found among all scales examined in this study, and a factor analysis indicated that these scales measure a unitary factor of general distress Future research might be addressed to an examination of more qualitative distinctions among psychological disorders in subchnical populations In the interim, caution must be exercised in extrapolating empirical

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findings from students obtaining high scores on the BDI to the discrete phenomenon of depression References Abramson, L Y, Sehgman, M E P., & Teasdale, J D (1978). Learned helplessness in humans Critique and reformulation Journal of Abnormal Psychology, 87, 4 9 74 Applebaum, A S (1976) Rathus Assertiveness Schedule Sex differences and correlations with social desirability Behavior Therapy, 7, 699 Auerbach, S M (1973) Emotional reactions to surgery Journal of Consulting and Clinical Psychology, 40, 264271 Baum, S K (1982) Loneliness in elderly persons A preliminary study Psychological Reports, 50, 1317-1318 Beck, A T (1967) Depression Causes and treatment Philadelphia University of Pennsylvania Press Beck, A T , & W a r d , C H (1961) Dreams of depressed patients' Characteristic themes in manifest content Archives of General Psychiatry, 5, 561-571 Beck, A T, Ward, C H , Mendelson, M , Mock, J , & Erbaugh, J (1961) An inventory for measuring depression Archives of General Psychiatry, 12, 57-62 Blatt, S J , Quinlan, D M , Chevron, E S., McDonald, C , &Zuroff, D (1982) Dependency and self-criticism Psychological dimensions of depression Journal oj Consulting and Clinical Psychology, 50, 113-124 Blumberg, S R , & Hokanson, J E (1983) The effects of another person's response style on interpersonal behavior in depression Journal of Abnormal Psychology, 92, 196-209 Brown, S L , Schwartz, G E , & Sweeney, D R (1978) Dissociation of self-reported and observed pleasure in depression. Psychosomatic Medicine, 40, 536-548 Buchwald, A M (1977) Depressive mood and estimates of reinforcement frequency Journal of Abnormal Psychology, 86, 443-446 Buchwald, A M , Strack, S , & Coyne, J C (1981) Demand characteristics and the Velten mood induction procedure Journal of Consulting and Clinical Psychology, 49, 478-479 Bumberry, W, Oliver, J M , & McClure, J (1978) Validation of the Beck Depression Inventory in a university population using psychiatric estimate as a criterion Journal of Consulting and Clinical Psychology, 46, 150— 155 Burkhart, B R . Green, S B . & Harrison, W H (1979) Measurement of assertive behavior Construct and predictive validity of self-report, role-playing, and in-vivo measures Journal of Clinical Psychology, 35, 376-383 Buros, O K (1978) The eighth mental measurements yearbook Highland Park, NJ Gryphon Cane, D. B , & Gotlib, 1 H (1983) Depression and the effects of positive and negativefeedback on expectations, evaluations, and performance Manuscript submitted for publication Coyne, J C , & Gotlib, 1 H (1983) The role of cognition in depression A critical appraisal Psychological Bulletin, 94, 472-505 Coyne, J C , Metalsky, G I , & Lavelle, T L (1980)

Learned helplessness as experimenter-induced failure and its alleviation with attentional redeployment Journal of Abnormal Psychology, 89, 350-357 Craighead, W E , Hickey, W., & DeMonbreun, B. G. (1979) Distortion of perception and recall of neutral feedback in depression. Cognitive Therapy and Research, 3, 291-297 Davies, B , Burrows, C , & Poynton, C A (1975) Comparative study of four depression rating scales Australian and New Zealand Journal of Psychiatry, 9, 21-24 Dempsey, P (1964) A unidimensional depression scale for the MMPI. Journal Consulting Psychology, 28, 364370 Depue, R A , & Monroe, S M (1978) Learned helplessness in the perspective of the depressive disorders Conceptual and definitional issues Journal of Abnormal Psychology, 87, 3-20 Derogatis, L R , Lipman, R S , & Covi, L (1973) The SCL-90 An outpatient psychiatric rating scale Psychopharmacology Bulletin, 9, 13-28 Derogatis, L R., Rickels, K , & Rock, A (1976) The SCL-90 and the MMPI A step in the validation of a new self-report scale British Journal of Psychiatry, 128, 280-289 Dinning, W D ,& Evans, R G (1977) Discriminant and convergent validity of the SCL-90 in psychiatric mpatients Journal of Personality Assessment, 41, 304-310 Dobson,K S,&Breiter,H J (1983) Cognitive assessment of depression Reliability and validity of three measures Journal of Abnormal Psychology, 92, 107-109 Durham, R C (1979) Lewmsohn's behavioral measures of social skill Their stability and relationship to mood level and depression among college students Journal of Clinical Psychology. 35, 599-604 Fiedler, D , & Beach, L R (1978) On the decision to be assertive Journal of Consulting and Clinical Psychology, 46, 537-546 Friedman, A S (1964) Minimal effects of severe depression on cognitive functioning Journal of Abnormal and Social Psychology, 69, 237-243 Goldberg, D P , Rickels, K , Downing, R , & Hesbacher, P (1976) A comparison of two psychiatric screening tests British Journal of Psychiatry, 129, 61-67 Gohn, S, & Hartz, M (1979) A factor analysis of the Beck Depression Inventory in a mildly depressed population Journal of Clinical Psychology, 35, 322-325 Gotlib, I H (1981) Self-reinforcement and recall Differential deficits in depressed and nondepressed psychiatric inpatients Journal of Abnormal Psychology, 90, 521-530 Gotlib, I H (1982) Self-reinforcement and depression in interpersonal interaction The role of performance level Journal of Abnormal Psychology, 91, 3-13 Gotlib, I H (1983) Perception and recall of interpersonal feedback Negative bias in depression Cognitive Therapy and Research, 7, 399-412 Gotlib, I H , & McCann, C D (in press) Construct accessibility and depression An examination of cognitive and affective factors Journal of Personality and Social Psychology, Gotlib, I H , & Olson, J M (in press) Depression, psychopathology, and self-serving attributions British Journal of Clinical Psychology Gotlib, I H., & Robinson, L A (1982) Responses to

DEPRESSION AND GENERAL PSYCHOPATHOLOGY depressed individuals: Discrepancies between self-report and observer-rated behavior Journal of Abnormal Psychology. 91, 231-240 Green, S B., Burkhart, B R., & Harrison, W H (1979) Personality correlates of self-report, role-playing, and m-vivo measures of assertiveness Journal of Consulting and Clinical Psychology, 47 16-24 Hamilton, E W, & Abramson, L Y (1983) Cognitive patterns and major depressive disorder A longitudinal study in a hospital setting Journal of Abnormal Psychology, 92, 173-184 Hammen, C L (1980) Depression in college students Beyond the Beck Depression Inventory Journal of Consulting and Clinical Psychology, 48, 126-128 Hammen, C L , Jacobs, M , Mayol, A , & Cochran, S D (1980) Dysfunctional congitions and the effectiveness of skills and cognitive-behavioral assertion training Journal of Consulting and Clinical Psychology, 48, 685-695 Hoffman, H (1970) Depression and defensiveness in selfdescriptive moods of alcoholics Psychological Reports, 26. 23-26 Hollandsworth, J G (1976) Further investigation of the relationship between expressed social fear and assertiveness Behaviour Research and Therapy, 14, 85-87 Hollon, S D , & Kendall, P C (1980) Cognitive selfstatements in depression Development of an Automatic Thoughts Questionnaire Cognitive Therapy and Research, 4, 383-395 Kowahk,D.,&Gothb,I H (1983) Depression and marital interaction Concordance between intent and perception of communications Unpublished manuscript, University of Western Ontario Krantz, S, & Hammen, C (1979) Assessment of cognitive bias in depression Journal ofAbnormal Psychology, 88, 611-619 Lavelle, T L , Metalsky, G 1, & Coyne, J C (1979) Learned helplessness, test anxiety, and acknowledgment of contingencies Journal of Abnormal Psychology', 88. 381-387 Leff, J P (1978) Psychiatrists' versus patients' concepts of unpleasant emotions British Journal of Psychiatry, 133. 306-313 Levitt, E E (1967) The psychology ofanxiety Indianapolis, IN Bobbs-Mernll Lewinsohn, P M , Biglan, A , & Zeiss, A M (1976) Behavioral treatment of depression In P O Davidson (Ed), The behavioral management of anxiety, depression and pain New York Brunner/Mazel Mathew, R J , Largen, J , & Claghorn, J L (1979) Biological symptoms of depression Psychosomatic Medi-

cine. 41, 439-443 Mates, K., Lovallo, W, & Pishkm, V (1980) A comparison of four scales for anxiety, depression, and neuroticism Journal of Clinical Psychology, 36, 427-432 Mendels, J., Wemstein, N , & Cochrane, C (1972) The relationship between depression and anxiety Archives of General Psychiatry, 27, 649-653 Meyer, E , Derogatis, L R , Miller, M., & Reading, A (1978) Hypertension and psychological distress Psychosomatics, 19, 160-168 Miller, W R , & Sehgman, M E P (1975) Depression and learned helplessness in man Journal of Abnormal Psychology, 84, 228-238

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Monti, P M., Curran, J P., Cornveau, D. P., DeLancey, A L , & Hagerman, S M (1980) Effects of social skills training groups and sensitivity training groups with psychiatric patients Journal of Consulting and Clinical Psychology; 48, 241-248 Morgan, B , & Leung, P (1980) Effects of assertion training on acceptance of disability by physically disabled university students Journal of Counseling Psychology, 27, 209-212 Pachman, J S, & Foy, D W (1978) A correlational investigation of anxiety, self-esteem and depression New findings with behavioral measures of assertiveness Journal of Behavior Therapy and Experimental Psychiatry, 9, 97-101 Pohvy, J (1981) On the induction of emotion in the laboratory Discrete moods or multiple affect states9 Journal of Personality and Social Psychology, 41, 803-817 Prusoff, B , & Klerman, G (1974) Differentiating depressed from anxious neurotic outpatients Archives of General Psychiatry, 30, 302-309 Rathus, S A (1973) A 30-item schedule for assessing assertive behavior Behavior Therapy, 4, 398-406 Rathus, S A,&Nevid, J S (1977) Concurrent validity of the 30-item assertiveness schedule with a psychiatric population Behavior Therapy, 8, 393-397 Replogle, W H , O'Banmon, M , McCullough, P W, & Cashion, L N (1980) Locus of control and assertive behavior Psychological Reports, 769-770 Reynolds, W M , & Gould, J W (1981) A psychometric investigation of the standard and short form Beck Depression Inventory Journal of Consulting and Clinical Psychology, 49, 306-307 Rickels, K , Hesbacher, P , Fisher, E , Perloff, M M., & Rosenfeld, H (1976) Emotional symptomatology in obese patients treated with fenfluramme and dextroamphetamine Psychological Medicine, 6, 623-630 Rock, D L (1981) The confounding of two self-report assertion measures with the tendency to give socially desirable responses to self-description Journal of Consulting and Clinical Psychology, 49, 743-744 Rotter, J B (1966) Generalized expectancies for internal versus external control of reinforcement Psychological Monographs. 80. (Whole No 609) Rounsaville, B J., Weissman, M M , Cnts-Christoph, K., Wilber,C,&Kleber,H (1982) Diagnosis and symptoms of depression in opiate addicts Archives of General Psychiatry, 39, 151-156 Russell, D , Peplau, L A , & Cutrona, C E (1980) The Revised UCLA Loneliness Scale' Concurrent and discriminant validity evidence Journal of Personality and Social Psychology, 39, 472-480 Sanchez, V , & Lewinsohn, P M (1980) Assertive behavior and depression Journal of Consulting and Clinical Psychology, 48, 119-120 Serra, A , & Polhtt, J (1975) The relationship between personality and the symptoms of depressive illness British Journal of Psychiatry, 127, 211-218 Snaith, R P , Bridge, G W K., & Hamilton, M (1976) The Leeds scale for self-assessment of anxiety and depression. British Journal of Psychiatry, 128,156-165 Spielberger, C D , Gorsuch, R C , & Lushene, R F (1970) Manual for the State-Tatt Anxiety Inventory, Palo Alto, CA Consulting Psychologists Press Spielberger, C D., Vagg, P R , Barker, L R., Donham,

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Received June 29, 1983 Revision received September 22, 1983

New Journal on Aging- Call for Nominations By action of APA's Publications and Communications Board and Council of Representatives, the APA is publishing a quarterly journal called Psychology and Aging, thefirstissue of which will appear in 1985. Psychology and Aging will contain original articles on adult development and aging The articles may be reports of research or applications of research, and they may be biobehavioral, psychosocial, educational, methodological, clinical, applied, or experimental (laboratory, field, or naturalistic) studies For more information about the new journal, see the November 1983 issue of the APA Monitor. Nominations for the editor of Psychology and Aging are now open Candidates must be members of APA and should be available to start receiving manuscripts in mid-1984 to prepare for issues published m 1985. To nominate candidates, prepare a statement of one page or less in support of each candidate. Submit nominations no later than April 2, 1984, to: Martha A. Storandt Department of Psychology Box 1125 Washington University St. Louis, Missouri 63130 (314)889-6508