Margaret P. Norris

Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients.

This study evaluated the psychometric characteristics of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in a primary care medical setting. A principal-components analysis with Promax rotation indicated the presence of 2 correlated factors, Somatic-Affective and Cognitive, which explained 53.5% of the variance. A hierarchical, second-order analysis indicated that all items tap into a second-order construct of depression. Evidence for convergent validity was provided by predicted relationships with subscales from the Short-Form General Health Survey (SF-20; A. L. Stewart, R. D. Hayes, & J. E. Ware, 1988). A receiver operating characteristic analysis demonstrated criterion-related validity: BDI-II scores predicted a diagnosis of major depressive disorder (MDD), as determined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ). This study demonstrated that the BDI-II yields reliable, internally consistent, and valid scores in a primary care medical setting, suggesting that use of the BDI-II in this setting may improve detection and treatment of depression in these medical patients.

Active and passive coping strategies in chronic pain patients

&NA; This study assessed the validity of active and passive coping dimensions in chronic pain patients (n = 76) using the Coping Strategies Questionnaire and the Vanderbilt Pain Management Inventory. The validity of active and passive coping dimensions was supported; passive coping was strongly related to general psychological distress and depression, and active coping was associated with activity level and was inversely related to psychological distress. In addition., the Coping Strategies Questionnaire was found to be a more psychometrically sound measure of active and passive coping than the Vanderbilt Pain Management Inventory.

Detecting the Malingering of Cognitive Deficits: An Update

There has recently been a dramatic increase of empirical studies that investigate methods for detecting malingering of cognitive deficits. The present review focuses on a comparison of simulated and suspected malingerers in the malingering literature, and critiques the numerous approaches to the detection of malingering. The approaches that are reviewed include detection of floor effects, discrepancies of information, response bias, neuropsychological tests and batteries, symptom validity testing, and anomalous performance on memory tests. The latter approach has only recently been proposed by researchers and may show the most promise.

Public Mental Health Care Utilization by Older Adults

The present study examined the extent to which older adults began public mental health treatment throughout Texas in 1999, the types of services they used, and how they compared on demographic and clinical variables to younger consumers. Notwithstanding recent policy and related developments, older adults were found to use public mental health services at substantially low rates, as in past decades. Significantly, older consumers tended to be relatively healthy and independent. Among younger and, even more so, older consumers, there were relatively high proportions of rural residents and minorities, groups previously found to be unlikely to utilize private mental health services. Overall, the findings urge that greater attention be devoted to public mental health outreach and service delivery with the elderly, and raise the question of what role the public mental health system should have in nursing homes and other long-term care settings.

Memory self-evaluation: The effects of age and experience

Abstract An examination of the evaluation-test relationship both before and after memory testing was carried out with older and younger adults using self-efficacy evaluations of tasks representing everyday and laboratory tasks and comparing these evaluations with performance on laboratory tests and simulated everyday tests. the results supported a framework for memory self-evaluation that considered the effects of age, memory self-efficacy beliefs, task experience (general familiarity with a task), and recent test experience. As compared to the pretest, both age groups showed reduced self-efficacy, in general, and stronger evaluation-test relationships after testing. At the same time, the younger adults showed stronger evaluation-test relationships than older adults, especially on the laboratory tests. Memory self-efficacy beliefs appear to be affected by prior task experience with similar memory activities and by actual test experience that enables individuals to reevaluate their capabilities in accordan...

Screening for malingering in a correctional setting.

This study outlines the development of the Screening SIRS, an abbreviated version of the Structured Interview of Reported Symptoms (SIRS), for use as a screening measure of malingering in a correctional setting. Seventy-five inmates complaining of psychological impairment were tested for malingering. A subset of the participants was given both the original SIRS and the Screening SIRS as a separate test with the test order counterbalanced; the remainder were given the original SIRS and a derived classification was determined by extracting the Screening SIRS scale scores. Using Receiver Operating Characteristic analyses, classification based on the Screening SIRS was significantly better than chance. With a sensitivity of 87% and specificity of 73%, the Screening SIRS was highly predictive of classifications based on the original SIRS. These findings have instrumental implications in correctional settings where identification of possible malingerers through a screening procedure may facilitate optimal allocation of resources.

Comparing student and patient simulated malingerers' performance on standard neuropsychological measures to detect feigned cognitive deficits.

Despite the proliferation of studies investigating methods for detecting malingering, important questions that remain unanswered. Specifically, many studies use students to simulate malingering; however, it is unclear whether this is an appropriate analog group. In addition, many studies have focused on the development of cognitive measures designed to detect malingering, rather than pursuing whether current neuropsychological measures are effective. Results of the present investigation suggest that student malingerers are significantly more difficult to detect than non-neurological patients instructed to malinger. The findings also provide further support for the recent evidence that standard neuropsychological measures are useful in detecting malingering.

Age-related differences in the frequency of personality disorders among inpatient veterans

This cross‐sectional study explored age‐related differences in the frequency of diagnosis of personality disorder (PD) among 790 veterans admitted to a psychiatric inpatient unit across three age groups: 20–39, 40–59, and 60+. Older adults obtained a lower frequency (55.4%) of PD diagnosis than middle‐aged adults (69.0%), who in turn obtained a lower frequency of PD diagnosis than young adults (75.9%). Older adults and middle‐aged adults were less likely to receive a diagnosis of Borderline PD than young adults. Older adults were also less likely to receive a diagnosis of Mixed PD than young adults, but received significantly more diagnoses of Narcissistic PD than young adults. Patients diagnosed with PD had higher rates of psychiatric hospitalization than those with no diagnosis of PD. Older adults and middle‐aged adults with PD had significantly fewer psychiatric hospitalizations than young adults with PD, whereas there were no age‐related differences in the frequency of medical hospitalizations. These findings are consistent with research suggesting an overall softening of PD features with age, particularly those characteristic of the ‘dramatic‐erratic’, Cluster B types. Copyright

Knowledge of and Attitudes Toward Nonpharmacological Interventions for Treatment of Behavior Symptoms Associated With Dementia: A Comparison of Physicians, Psychologists, and Nurse Practitioners

PURPOSE OF THE STUDY Behavior problems are common in nursing homes. Current guidelines recommend nonpharmacological interventions (NPHIs) as first-line treatment, but pharmacological regimens (PIs) continue to be used. Given differences in background and training of those who treat behavior problems in residents, we compared attitudes of physicians (MDs), psychologists (PhDs), and nurse practitioners (NPs) concerning PI and NPHI usage as well as knowledge of NPHIs. DESIGN AND METHODS One hundred and eight MDs, 36 PhDs, and 89 NPs responded to a web-based questionnaire that captured level of agreement with statements concerning treatment of behavior symptoms and familiarity with NPHIs. RESULTS NPs were the most favorable toward NPHIs. MDs were significantly more favorable to the use of PIs than were PhDs, with attitudes of NPs falling in between. All felt that NPHI usage should increase and that NPHIs should be implemented before using PIs but also believed that PIs work well for behavior problems. MDs had significantly lower knowledge of NPHIs than PhDs or NPs. Overall, NPHI knowledge was similar for PhDs and NPs, although they differed on their use of specific interventions. IMPLICATIONS As levels of knowledge and familiarity with NPHIs differed among providers, it is conceivable that all might benefit from training and experience with a wider range of NPHIs. Future studies might evaluate the impact of a uniform understanding of NPHI on communication and teamwork in nursing homes and examine ways to enhance a multidisciplinary approach that would allow for the tailoring and individualization that is required of successful interventions.

The Efficacy of Somatic Symptoms in Assessing Depression in Older Primary Care Patients

Abstract This investigation tested the hypothesis that somatic symptoms such as reduced energy, loss of interest, and sleep disturbance are accurate indices of depression in older medical patients. The Beck Depression Inventory-II (BDI-II) and the Medical Outcomes Study Short-Form General Health Survey (SF-20) were administered to 90 primary care older patients of a large HMO. Exploratory factor analysis of the BDI-II identified three factors (Cognitive/Distress, Depressed Mood, and Somatic). A second-order factor analysis confirmed that all somatic items contributed to the second-order factor of depression. Item analyses also supported the consistency, severity discrimination, and classification efficiency of somatic items. These findings suggest that somatic symptoms, including fatigue, anhedonia, loss of interest, sleep disturbance, and concentration problems should be included when assessing older primary care patients for depression. Although these symptoms may be signs of physical decline, presentation of these symptoms warrants a more complete evaluation of depression in elderly medical patients.