Paul L. Merrick

Subjective Cognitive Complaints and Objective Cognitive Function in Aging: A Systematic Review and Meta-Analysis of Recent Cross-Sectional Findings.

Research investigating how subjective cognitive complaints (SCCs) might reliably indicate impairments in objective cognitive functioning has produced highly varied findings, and despite attempts to synthesise this literature (e.g., Jonker et al. International Journal of Geriatric Psychiatry, 15, 983–991, 2000; Reid and MacLullich Dementia and Geriatric Cognitive Disorders, 22(5–6), 471–485, 2006; Crumley et al. Psychology and Aging, 29(2), 250–263, 2014), recent work continues to offer little resolution. This review provides both quantitative and qualitative synthesis of research conducted since the last comprehensive review in 2006, with the aim of identifying reasons for these discrepancies that might provide fruitful avenues for future exploration. Meta-analysis found a small but significant association between SCCs and objective cognitive function, although it was limited by large heterogeneity between studies and evidence of potential publication bias. Often, assessments of SCCs and objective cognitive function were brief or not formally validated. However, studies that employed more comprehensive SCC measures tended to find that SCCs were associated independently with both objective cognitive function and depressive symptoms. Further explicit investigation of how assessment measures relate to reports of SCCs, and the validity of the proposed ‘compensation theory’ of SCC aetiology, is recommended.

Using Homework Assignments in Psychotherapy: Differences by Theoretical Orientation and Professional Training?

Prior research has shown that psychology-trained practitioners use homework assignments, but no prior research has sought to survey the clinical practice of other mental health professionals. Three hundred and thirty-three mental health professionals from counselling, medical, nursing, psychology, and social work training backgrounds were surveyed regarding their use of homework assignments in psychotherapy. The vast majority of the sample (83%) reported the use of homework assignments, and those practising cognitive-behavioural therapy indicated a greater frequency and degree of specificity in assigning homework. However, it was noteworthy that all theoretical and professional groups in the present study reported some use of homework assignments.

Assessing subjective memory complaints: a comparison of spontaneous reports and structured questionnaire methods

BACKGROUND Subjective memory complaints (SMCs) are a common occurrence for adults, which increase with age, and cause considerable distress. Traditionally SMCs have been assessed by either questionnaires, which ask whether a person has experienced given examples of SMCs, or open-ended questions which elicit spontaneous reports of SMCs. However, little is known about how these methods of assessment might influence reporting of SMCs. METHODS Four hundred and twenty one adults aged 40 years and above were surveyed about SMCs using spontaneous report and questionnaire methods. RESULTS As expected, spontaneously reported SMCs were fewer in number and rated more distressing overall than SMCs endorsed on a questionnaire. However, comparison of individual SMCs revealed that distress ratings tended to be higher when assessed in a questionnaire than spontaneously reported, which may be due to the context of a questionnaire causing inflated ratings. Participants also reported SMCs which were not well assessed by the questionnaire, including some which were among the most distressing SMCs overall. Conversely, other SMCs were over-sampled by the questionnaire and did not feature in spontaneous reports. CONCLUSIONS Implications for clinical assessment of SMCs are that open-ended questioning might be preferable to initial use of prescriptive questionnaires, in order to elicit SMCs that are most distressing. While use of questionnaires may reveal endorsement of a wider range of SMCs than are spontaneously reported, they can take focus away from, or even fail to assess, those SMCs which cause most subjective distress (and therefore should be the target of interventions).

The validity and clinical utility of the hospital anxiety and depression scale (HADS) with older adult New Zealanders.

BACKGROUND The Hospital Anxiety and Depression Scale (HADS) has established use with older adult populations in New Zealand but few studies have evaluated its psychometric properties. Research with the psychometric properties of the HADS in elderly populations has primarily used correlational methods that do not allow for the effects of measurement error to be observed. The hypothesized tripartite model of anxiety and depression within the HADS was evaluated using confirmatory factor analysis (CFA) methods. METHODS Overall, 203 community-dwelling older adults who were recruited from older adult community groups completed the HADS. Competing two- and three-factor structures were trialled using CFA. RESULTS A three-factor model indicated a lack of differentiation between factors and poor clinical utility and was rejected in favor of a two-factor model. Significant correlations were observed between the anxiety and depression factors on the two-factor model, but it was considered to have validity for older adult samples. Good internal consistency was found for the HADS. CONCLUSIONS A two-factor model of the HADS was favored due to the lack of differentiation between factors on the three-factor model, and the higher clinical utility of a two-factor solution. The validity of the HADS may be limited by over-diagnosing anxiety in non-clinical populations. It is recommended that the HADS be used to measure change over time through treatment and not be used as a diagnostic tool until future research establishes appropriate norms and cut-offs.

Influence of Assessment Methods on Subjective and Objective Memory Impairment

Evidence regarding the relationship between subjective memory complaints (SMCs) and objective memory functioning remains mixed; assessment methods may underlie this inconsistency. In this study, 94 participants aged 40 and above completed two measures of SMCs (open-ended self-reports, and a questionnaire) and memory tests (Rey Auditory Verbal Learning Test and Rey Complex Figure Test). Canonical correlation analysis showed no significant associations between any measures of memory and SMCs, regardless of the assessment method employed. Possible explanations for this result and the influence of study limitations are discussed.