Derrick K. Larsen

Posttraumatic Stress Disorder and Work-Related Injury

The literature indicates a substantial overlap between chronic pain and posttraumatic stress disorder (PTSD) symptoms in individuals who sustain accidental injury. To date, however, there have been no studies of PTSD symptoms in individuals who experience work-related injury. Consequently, we assessed 139 consecutive injured workers using the Modified PTSD Symptom Scale (Falsetti, Resnick, & Kirkpatrick, 1993), as well as a number of general measures of psychopathology. Most participants reported chronic pain and all were receiving workers compensation. Results indicated that 34.7% and 18.2% of the sample reported symptoms consistent with PTSD and partial PTSD, respectively. When PTSD symptom frequency and severity were considered criterion variables in multiple regression analyses, depression was found to be significantly associated with the former and anxiety sensitivity, social fears, and somatic focus with the later. Finally, these measures of general psychopathology correctly classified 78.6% of individuals with PTSD and 81.3% of those with no PTSD. These results suggest that a considerable proportion of injured workers display symptoms consistent with PTSD and that these symptoms are related to general negative affect. Implications, including the suggestion of clinical intake screening of PTSD in this population, are discussed.

Discrepancies between self and observer ratings of depression. The relationship to demographic, clinical and personality variables.

BACKGROUND The observer-rated Hamilton depression scale (HamD) and the self-report Beck Depression Inventory (BDI) are among the most commonly used rating scales for depression, and both have well demonstrated reliability and validity. However, many depressed subjects have discrepant scores on these two assessment methods. The present study evaluated the ability of demographic, clinical and personality factors to account for the discrepancies observed between BDI and HamD ratings. METHOD The study group consisted of 94 SCID-diagnosed outpatients with a current major depressive disorder. Subjects were rated with the 21-item HamD and completed the BDI and the NEO-Five Factor Inventory. RESULTS Younger age, higher educational attainment, and depressive subtype (atypical, non-melancholic) were predictive of higher BDI scores relative to HamD observer ratings. In addition, high neuroticism, low extraversion and low agreeableness were associated with higher endorsement of depressive symptoms on the BDI relative to the HamD. In general, these predictive variables showed a greater ability to explain discrepancies between self and observer ratings of psychological symptoms of depression compared to somatic symptoms of depression. LIMITATIONS The study does not determine which aspects of neuroticism and extraversion contribute to the observed BDI/HamD discrepancies. CONCLUSIONS Depression ratings obtained with the BDI and HamD are frequently discordant and a number of patient characteristics robustly predict the discrepancy between these two rating methods. The value of multi-modal assessment in the conduct of research on depressive disorders is re-affirmed.

Research reportDiscrepancies between self and observer ratings of depression: The relationship to demographic, clinical and personality variables

BACKGROUND The observer-rated Hamilton depression scale (HamD) and the self-report Beck Depression Inventory (BDI) are among the most commonly used rating scales for depression, and both have well demonstrated reliability and validity. However, many depressed subjects have discrepant scores on these two assessment methods. The present study evaluated the ability of demographic, clinical and personality factors to account for the discrepancies observed between BDI and HamD ratings. METHOD The study group consisted of 94 SCID-diagnosed outpatients with a current major depressive disorder. Subjects were rated with the 21-item HamD and completed the BDI and the NEO-Five Factor Inventory. RESULTS Younger age, higher educational attainment, and depressive subtype (atypical, non-melancholic) were predictive of higher BDI scores relative to HamD observer ratings. In addition, high neuroticism, low extraversion and low agreeableness were associated with higher endorsement of depressive symptoms on the BDI relative to the HamD. In general, these predictive variables showed a greater ability to explain discrepancies between self and observer ratings of psychological symptoms of depression compared to somatic symptoms of depression. LIMITATIONS The study does not determine which aspects of neuroticism and extraversion contribute to the observed BDI/HamD discrepancies. CONCLUSIONS Depression ratings obtained with the BDI and HamD are frequently discordant and a number of patient characteristics robustly predict the discrepancy between these two rating methods. The value of multi-modal assessment in the conduct of research on depressive disorders is re-affirmed.

Perceptions of parental bonding and symptom severity in adults with depression : Mediation by personality dimensions

Objective: An association between anomalous parental bonding experiences (lack of parental care, overprotection, or both) and depression during adulthood has been observed in several studies. The objective of the present study was to evaluate several different personality dimensions as possible mediators of the relationship between perceptions of parental bonding and depressive symptoms in adulthood. Methods: Outpatients with depression (n = 138) completed the Parental Bonding Instrument (PBI), the Beck Depression Inventory (BDI), and several measures of proposed personality vulnerabilities to depression. The conceptual and methodological criteria of Baron and Kenny (1986) were used to assess possible mediating effects of personality variables. Results: In men, overprotection by their fathers was significantly associated with depression; neuroticism, socially prescribed perfectionism, and concern over mistakes acted as mediators of this relationship. In women, lack of care by their mothers was significantly associated with depression; self-criticism, socially prescribed perfectionism, and concern over mistakes mediated this relationship. Conclusions: The present study provides evidence that personality factors may mediate the observed relationship between parental rearing style and depression. These potential causal mechanisms warrant longitudinal evaluation.

Panic disorder and vestibular disturbance: An overview of empirical findings and clinical implications

The purpose of this article is to provide a general overview of the growing literature on the relationship between panic disorder and vestibular disturbance. This relationship has been examined from two distinct perspectives, including: (a) the assessment of vestibular dysfunction in patients with panic disorder; and (b) the evaluation of panic symptomatology in patients with vestibular disturbance. Consequently, this review focuses primarily on the literature pertaining to vestibular symptoms in patients with panic disorder and panic symptomatology in patients with vestibular complaints. Subsequent to this review we discuss clinical implications suggested by the data, outline recommendations for treatment, and highlight some directions for future investigation.

Neurotic butterflies in my stomach: the role of anxiety, anxiety sensitivity and depression in functional gastrointestinal disorders.

This study examined the prevalence of functional gastrointestinal (FGI) disorders, and the association between FGI disorders and measures of affective distress, among a sample of 127 university students. Subjects completed a questionnaire battery including Research Diagnostic Questions for Functional Gastrointestinal Disorders, the Beck Anxiety Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, and a medical utilization questionnaire. FGI disorders were diagnosed in 51.2% of the sample. Functional dyspepsia (22.8%), dyschezia (20.5%), functional heartburn (19.7%), functional chest pain (18.1%), and globus (12.6%) were the most frequently diagnosed disorders. Participants experiencing globus, functional dyspepsia, or functional heartburn showed significant differences in terms of anxiety, anxiety sensitivity, depression, and/or physician visits, when compared with participants without these disorders. Our results suggest that FGI disorders are strikingly prevalent among young adults, and specific FGI disorders are associated with affective distress. Implications of the observed association between psychological factors and FGI disorders are discussed.

Exploratory factor analysis of the Pain Anxiety Symptoms Scale in patients with chronic pain complaints.

Abstract The Pain Anxiety Symptoms Scale (PASS) is a 40‐item self‐report measure that consists of four subscales measuring aspects of pain‐related anxiety and avoidance. Despite its growing popularity, there have been few studies of its psychometric properties. The primary purpose of this study was to determine the factor structure of the PASS in a sample of 259 chronic pain patients. Principal component analysis with oblique (Oblimin) rotation provided partial support for the factorial validity of the PASS. Five factors were extracted: (1) catastrophic thoughts, (2) physiological anxiety symptoms, (3) escape/avoidance behaviours, (4) cognitive interference, and (5) coping strategies. The use of analgesic medication did not influence the factor solution. The factors were characterised by correlating them with pain‐related measures, and with measures of mood state. Implications are considered for revising the PASS subscales to provide a more comprehensive and factorially valid assessment of pain‐related fear and avoidance.

Analysis of Startle Responses in Patients with Panic Disorder and Social Phobia

The startle reflex can be modified by cognitive and affective variables. The present study investigated startle responses in 12 patients with panic disorder, 22 patients with social phobia and 15 healthy controls. The eye-blink component of the acoustic startle reflex was measured during baseline, pulse-alone, pre-pulse and fear-potentiated startle to disorder-specific threat words. Results indicated that patients with panic disorder exhibited significantly larger startle response amplitudes during baseline, pulsealone, pre-pulse and fear-potentiated trials than did healthy controls. Startle response amplitudes of patients with social phobia differed from healthy controls at effects of similar magnitude as the effects seen for patients with panic disorder, for all types of startle trials. During fear-potentiated trials, all groups exhibited largest startle amplitudes following the presentation of physical threat-related words, second largest magnitude to social threat-related words and the smallest to non-threatening words. It is recommended that future studies further examine startle response parameters in all forms of anxiety disorders.

Cardiovascular reactivity in nonclinical subjects with infrequent panic attacks

Abstract The present study examined the role of biological factors that may pre-dispose to panic by investigating cardiovascular reactivity among nonclinical subjects who report having occasional panic attacks. Twenty-four student volunteers with a recent history of unexpected panic attacks were compared to 24 nonpanicking control subjects on measures of cardiovascular response to psychological stress and physical exercise. The results showed that subjects with and without panic attacks had similar resting heart rates and blood pressures, and comparable patterns of task-induced cardiovascular reactivity. These findings suggest that the heightened level of autonomic activation that is often observed in patients with panic disorder is not characteristic of nonclinical subjects who have infrequent panic attacks. Rather, it may arise as a consequence of the development of anticipatory anxiety and generalized apprehension, which does not necessarily occur among nonclinical subjects.