Diagnosing Depression

Becky Hinchman

PSYC 3120 Abnormal Psychology

Diagnosis Paper

April 11, 2006

Diagnosing Depression

Diagnostic System 1: Depression Related to Alcoholism

The purpose of system 1 is to measure depression related to alcoholism. The mutually exclusive categories for this system include: Alcoholic & Depressed (A & D), Alcoholic & Not Depressed (A), Not Alcoholic & Depressed (D), and Not Alcoholic & Not Depressed (neither).

Diagnostic criteria for alcoholic (2 or more of the following criteria must be met to be diagnosed as an alcoholic):

- A destructive pattern of alcohol use, leading to significant social, occupational, or medical impairment

- Alcohol tolerance (need for more alcohol to achieve intoxication)

- Withdrawal symptoms (sweating or rapid pulse, increased hand tremors, insomnia, nausea or vomiting, anxiety, hallucinations)

- Unable to cut back or stop drinking

- Continued drinking despite escalating consequences

Diagnostic criteria for depression (2 or more of the following criteria must be met, however person doesn’t have to meet two criteria if suicidal, suicidal symptoms are sufficient to diagnose person as depressed):

- Depressed mood

- Significantly reduced pleasure or interest in most or all activities

- Considerable loss or gain of weight

- Difficulty falling asleep or staying asleep

- Feeling tired

- Thoughts of worthlessness or extreme guilt

The information gained by using system 1 is the relationship with alcohol and depression. System 2 does not utilize alcohol consumption or alcoholism as a factor related to or precipitating depression. I would lose information on depression related to other conditions such as loss of job, cancer, death, ageing etc.

Diagnostic System 2: Depression Known—Environmental Factors Preceding the

The purpose of diagnostic system 2 is to diagnose the preceding environmental stressor related to the depression. Depression is already known in each case. The mutually exclusive categories for this system include: Relationships, Death of someone close (Death), Diagnosed with major illness or disease (Major Illness), Losses other than death (Other Losses).

Diagnostic criteria for relationships (must meet 2 of the following criteria, divorce is sufficient to diagnose relationships):

- Conflict in a current close relationship (fighting, bickering, arguing, tension)

- Divorce

- Break up or separation from significant other

- Negative feelings towards someone close to you

Diagnostic criteria for death of someone close (must meet 1 of the following criteria):

- Recent death of a close friend or family member (with in one or two years)

- Not able to cope with the death of a close friend or family member (grieving lasts longer than two years)

Diagnostic criteria for major illness or disease (must meet 1 of the following criteria):

- Diagnosed with terminal illness such as cancer

- Paralysis

- Loss of limb or functioning of body part

- Diagnosed with a disease that will have a significant affect on normal daily life

Diagnosis of losses other than death (must meet 1 of the following criteria):

- Loss of job

- Significant loss of income

- Loss of role (transition from high school to college, empty nest, loss of pet)

The information gained by using system 2 is knowing that the person is already depressed, and knowledge of some precipitating event such as job loss, death, ageing etc. I would loose information on people who were not diagnosed as having depression and how they coped with major life changes, illnesses, relationships or transitions.

Method

The diagnostic systems were tested by 10 of my peers in the Abnormal Psychology class at Anderson University. Each peer received a packet of three case studies. Each page contained a case study, diagnostic system 1 and criteria, and diagnostic system 2 and criteria. They were instructed to read the case study and diagnose the person in the case according to both diagnostic systems.

The packets of information will be collected and the reliability and validity of the diagnostic systems will be tested. The reliability of the systems will be tested by adding up the number of responses to each case and seeing if there is a most popular answer. If there is consistently a most popular answer then the diagnostic system, for the purposes of this study will be considered reliable. The validity of the diagnostic systems will be determined by having an “expert” on depression diagnose each case. The answers this expert marks will be considered the correct diagnosis. The diagnostic systems will be considered reliable if the majority of the students answer the same as the expert did. The validity will tell people if the diagnostic systems measure what they are supposed to measure.

My estimates of reliability and validity of each system and why…

I thought that both systems would be pretty reliable and valid for a few reasons. I thought the diagnostic criteria was short enough everyone would read through it and specific enough they would have enough direction to know which diagnostic category to mark. I also thought each possible diagnosis was mutually exclusive for the first system. However I thought the second system there could be some overlap. Someone could have divorced their spouse, lost a parent, be diagnosed with cancer and lost their job. With some of the case studies I could understand how they might mark different answers because the diagnosis could be more than one. So the diagnosis criteria were not as mutually exclusive as I thought they’d be. I thought the systems validity is wrapped up in who I choose to be the expert on diagnosing depression. I choose an expert who I thought was competent in these areas, however, validity cannot be based off of one person’s answers to the packet of material. Therefore, I do not think any of these results can truly be valid, however for the purposes of this study I think most answers will be valid because I think my peers will check the same answers as did the expert.

Case Studies

Case #1: M is a 24-year-old American Indian. One year ago her paternal grandfather died. Although M had been sober and drug free for three years prior to the death, she relapsed nine months following his death. M experienced frequent crying and rage. She had great difficulty keeping a daily routine.

Case #2: L is a 30-year-old man living with his parents following a separation from his second wife. He describes crying easily, feeling depressed and hopeless and having low energy for the past 4-5 months. He has had trouble falling asleep and has lost his appetite. He’s lost 35 pounds over the past 4 months. He engaged in daily drinking for a two-month span after he left his second wife. He had since stopped drinking on the weekdays and started binge drinking every weekend and smoking marijuana.

Case # 3: P is a 53-year old Caucasian woman who drinks a half gallon of vodka per week. She drank at home, alone or with her husband. Her tolerance increased and so did the frequency of her drinking. The business she worked for failed so she declared personal bankruptcy for tax purposes and later divorced her husband then remarried. P was treated for depression 5 years ago for suicidal ideations and after taking Prozac she had significant improvements in her mood.

Case 1	System	# 1			System # 2
	A & D	A	D	Neither	Relationship	Death	Major Illness	Other Losses
1	X					X
2	X					X
3			X			X
4	X					X
5	X					X
6	X					X
7	X					X
8				X		X
9	X					X
10			X			X

Case 2	System	# 1			System # 2
	A & D	A	D	Neither	Relationship	Death	Major Illness	Other Losses
1	X				X
2	X				X
3	X				X
4			X		X
5	X				X
6	X				X
7	X				X
8	X				X
9	X				X
10			X		X

Case 3	System	# 1			System # 2
	A & D	A	D	Neither	Relationship	Death	Major Illness	Other Losses
1		X					X
2	X							X
3		X						X
4	X							X
5		X			X
6	X							X
7	X							X
8		X						X
9		X			X
10		X						X

		Case 1	Case 2	Case 3
	A & D	7	8	4	Reliability
System	A	0	0	6	21/30
# 1	D	2	2	0	Validity
	Neither	1	0	0	21/30
System	Relationship	0	10	2	Reliability
# 2	Death	10	0	0	27/30
	Major Illness	0	0	1	Validity
	Other Losses	0	0	7	27/30
	Reliability	17/30	18/30	13/30
	Validity	17/30	18/30	13/30

What I learned by doing the Diagnostic Paper…

I learned that it is difficult to design a diagnostic system that is reliable and valid without losing some important information. I also learned it is impossible to include every aspect you want to into a diagnostic system. If I included every aspect I wanted to include in my diagnostic system no one would want to read the entire system, it would be too long and detailed. Therefore, diagnostic systems should be used as a guideline but not as an absolute because they lack completeness.

I also learned that diagnostic systems could be created out of thin air. It is possible to pick something you want to diagnose (depression) and pick what you want to base your diagnosis off of (life circumstances) and then make a diagnosis based solely on one aspect when you leave out other factors such as biology (which is most of the time impossible or too expensive to measure). Which leads me to think that our current diagnostic system is incomplete and flawed.

I also learned that validity is skewed. A diagnostic system is only valid if it measures what is supposed to measure, but who determines that it does in deed measure what it is supposed to measure. One expert could say it does another could say it doesn’t. Granted I know the DSMV-IV TR has validity and reliability, however I see where it could be and probably is flawed. I’m not sure that it will ever be possible to make a diagnostic system that is completely reliable and valid.