Psychological Testing- Sadness - Case Study Example

 «Psychological Testing Sadness» Introduction The Internet / world Wide Web has not only changed the way that we communicate, but has also created opportunities for a wide range of various testing and analysis options. This is true in both the medical and psychiatric professions. The validity and usefulness of this testing has been under constant debate for many years, and while no consensus has yet been reached, there are certainly guidelines that may or may not be in place. The purpose of this study is to examine a site that is not necessarily academic or professional in nature, a “pop” site that contain a test for sadness and/or depression. This test is taken from the site, “HealtyPlace.com” and is reproduced in its entirety in the appendix (Depression Quiz, 2006). The test will undergo a thorough analysis. This analysis will include a review of the validity of the test as well as the reliability of the results. Whether or not the questions are appropriate to the purpose of the test or whether they are questions that could be misinterpreted and lead to false results and conclusions. This is particularly important since many of these online tests are for self-diagnoses and are often taken as valid by the site visitor regardless of the site’s credentials. After this review this writer will construct a test correcting or improving upon the initial test by utilizing the results gained from the review. This test will attempt to more closely follow some of the guidelines already in place for such tests and hopefully eliminate false indications by tests that are either too vague or sim0ple not well thought out. It is hoped that the results will benefit not only the client seeking psychiatric help online but also the practitioner who may be considering utilizing such a format for his or her practice. Literature Review Sadness / Depression and Mood Disorders To study or measure any psychological construct, one must first start with a clear definition of that which is to be measured (Anastasi, A. & Urbina, 1997). The most predominant feature of any mood disorders is the experience of dysphoric and/or euphoric states that depart considerably from social norms and mores. These deviations create significant distress or impairment in the daily functioning and well being of the individual. Depressive disorders are a subset of the mood disorders and include major depression, dythymia, and depressive disorder (not otherwise specified [NOS]). The prevalence and functional impact of depressive disorders are substantial, necessitating an implementation of primary and secondary prevention (or assessment) strategies that facilitate efficient and effective recognition of clinical depression, assist in the selection of appropriate target behaviors, and help in designing intervention programs. (Hopko, Lejuez, Armento & Bare, 2004, p. 85) The authors go on to say that accurate detection of depressive symptoms and disorders requires a comprehensive assessment process that is “based on awareness of diagnostic criteria, knowledge of risk factors, and utilization of a multimethod assessment strategy” ( 2004, p. 85). There are many factors that influence depression and its assessment, gender, economic status and perhaps most importantly, age. Depression is a common accompaniment of old age. Estimates of the prevalence of depression in older persons vary widely, depending on the diagnostic criteria and measures used, and the population tested, however, prevalence rates of between 10% and 19.5% for persons over the age of 75 have been reported in the UK and are likely to be similar in New Zealand. (Knight, Mcmahon, Green & Skeaff, 2004) It is important to understand some of the background of the patient when attempting a diagnosis for depression, otherwise symptoms may be misunderstood and answers to question about their condition may need further analysis to be relevant. Religion, unemployment, race, age, intoxication, impulsivity, rigid thinking, stressful event, health status, indirect statement and other behavioral signs are all relevant factors in evaluating the condition. Depression can also lead to other actions that have severe consequences so an accurate diagnosis is critical. For instance it has been found that the rates for suicide for those with clinical depression may be as much as twenty time higher that that of the general population (Koocher, Norcross, & Hill, 2005). The accompanying sense of hopelessness appears to be the major indicator of suicidal tendencies (Koocher, Norcross, & Hill, 2005). Therefore these warning signs must be adequately assessed to prevent further complication from this mood disorder. Psychological Testing Psychological test for psychiatric conditions is nothing new and has been part of the practitioner’s regime almost since the discipline was created. The difference between the past practice and this current venue of online testing is that, in the past the patient and clinician were in the same room while the questions were being asked. Body language and voice all play a part in that evaluation and is one of the main topics of concern for opponents to online testing, especially in the realm of “pop’ psychology. Online text completely isolate the doctor and patient from each other and the test answers are often merely yes or no questions which leave wide room for interpretations. In order to understand these types of question an overview of the realm of psychological testing is in order. First of all, as Rowe we points out there is often a great difference in the psychiatric diagnosis as compared to a medical one (2003). While medical doctors often come to a valid consensus based on x-rays, pet scans, etc, psychiatrist have to rely on a great deal of personal training. There are also differing schools of thought, therefore, Rowe concludes that “Psychiatric diagnoses are simply a matter of opinion, and psychiatrists rarely agree on a diagnosis” (Rowe, 2003, p. 259). He goes on to say that, in reality, “Psychiatrists have no way of testing their diagnoses except by asking the patient questions, and thus the process becomes circular, and hence very different from diagnosis in physical medicine” (Rowe, 2003, p. 260). This is why testing is a crucial component of any psychiatric diagnosis and not to be taken lightly. Touma further elaborates that, “the core issue in testing and assessment is not whether tests are used as an adjunct to psychotherapy, but rather under what circumstances and for what purpose” (2004, p. 25). He also believes that it is crucial for the clinician that is conducting the testing and assessments should be very aware that the response to specific questions have a valid format and basis in the research in order to aid in making relevant decisions for the patient. To fulfill this role, clinicians must integrate a wide range of data and bring diverse areas of knowledge into focus. Thus they are not merely administering and scoring tests… the psychological assessment attempts to evaluate an individual in a problem situation so that information derived from assessment can somehow help with the problem. (Touma, 2004, p. 25) Testing in all its forms is part of a multiaxial, multidimensional system that enhances the practitioner’s capacity for assessment, planning, and remedy. In addition to its clinical utility, it needs to be designed to be reliable and consistent with as well as suitable for research studies (Koocher, Norcross, & Hill, 2005). “In practice, most clinicians want a practical and succinct approach to arrive at a working DSM-IV diagnosis. It must include both childhood and general diagnosis, since almost all diagnoses are applicable to a child or adolescent population” (Koocher, Norcross, & Hill, 2005 p. 42). There are many standards for testing criteria as well as many standard tests that have been developed over time. The National Board for Certified Counselors (NBCC) has developed a set of standards that test must meet in order to be certified by them for use in a practice. They have also developed criteria for web counseling and testing services that will be reviewed in the following section (Heinlen, Welfel, Richmond & Rak, 2003). Among the standard test this research review the Beck Depression Inventory-FastScreen (BDI-FastScreen) seemed to have valuable criteria to assist in more accurate diagnoses and assessment of depression (Maruish, 2002). Rather than simple yes or no answers to questions it evaluates responses on a range of intensity from zero to three for each question and then further analyzes the resultant numerical outcome adjusted for either the general population or those which have been previously diagnosed with clinical depression. For the general population, a score of 21 or over represents depression. For people who have been clinically diagnosed, scores from 0 to 9 represent minimal depressive symptoms, scores of 10 to 16 indicate mild depression, scores of 17 to 29 indicate moderate depression, and scores of 30 to 63 indicate severe depression. The BDI can distinguish between different subtypes of depressive disorders, such as major depression and dysthymia, a less severe form of depression (Beck & Steer, 1984). This will be used when developing a revised online test later in this research. Online Testing Managed Health care has also had a tremendous impact on testing in clinical settings. It has reduced and limited the number of test that can be preformed as well as the criteria under which they are allowed. Consistent with policies surrounding the cost-effectiveness of psychotherapy, managed care organizations (MCOs) have limited the reimbursement and subsequent use of psychological assessment procedures (Ficken, 1995; Werthman, 1995). Clinicians are consequently engaging in fewer testing procedures and are more restricted in their use of assessment instruments (Piotrowski, 1999). (Hopko, Lejuez, Armento & Bare, 2004, p. 100) Over the past decade, managed health care has undoubtedly had a profound effect on the mental health field. This new practice has severely restricted a wide range of services to clients, including psychological testing and assessment. “This devaluation of clinical assessment has had a deleterious impact on psychological assessors and the assessment field in general” (Piotrowski, Belter & Keller, 1998, p. 441). This has certainly been another contributory factor to the increased use of online tests for Sadness / Depression. The advocates of online testing have cited the potential utility in reaching populations that may no longer have access to traditional mental health services. This coupled with the convenience of the service, the ease of record keeping, and the possible reduced costs associated with providing these services have gone a long way to increase the use of online texting for depression (Rochlen, Beretvas & Zack, 2004). However, Rochlen, Beretvas and Zack reviewed studies that indicate some resistance to this online form of testing: In all three studies, participants consistently expressed attitudes that were more favorable, in regard to perceived value and level of discomfort, toward face-to-face counseling services than toward online counseling services. The more favorable review of face-to-face counseling than to online counseling may be due to lower levels of familiarity with online counseling as well as to some of the concerns about the modality of online counseling that have been noted in the literature (Rochlen, Beretvas & Zack, 2004, p. 98) There are also other concerns for online testing. The quality of these products and services varies widely and it is important for the consumer to be wary. It is certainly not surprising given the cost savings that some counseling practitioners have begun to use the Web to offer higher levels of professional services to clients. Although accurate estimates of the number of WebCounseling sites or their rate of growth are difficult to obtain, current evidence suggests that there are several thousand mental health professionals with some Web-based dimension to their practice (Bloom & Walz, 2000; Grohol, 1998). Most seem to use the Web to advertise their office practices or to communicate with current clients or colleagues. However, the number of those who offer WebCounseling as an exclusive treatment intervention for clients seems to be relatively small and may number no more than several hundred (Heinlen, Welfel, Richmond & Rak, 2003, p.67) Screening for potential abuse is a must and the NBCC has done so. They have sampled 136 such sties and noted that, …not a single site was in full compliance with the NBCC The highest percentage of compliance was with the standard for provision of contact information for times when the WebCounselor was off-line. The standard for identifying a counselor-on-call received the lowest percentage of compliance; that is, none were in compliance. When WebCounselors who claimed professional credentials were compared with those who made no such claims, professional WebCounselors showed higher levels of compliance across virtually every standard. (Heinlen, Welfel, Richmond & Rak, 2003, p. 71) This brings us to the investigation of our “pop” depression online test. Discussion Analysis of an online test The depression quiz taken from the site, “HealtyPlace.com” and which is reproduced in its entirety in the appendix (Depression Quiz, 2006) was analyzed for validity as well as the potential reliability or unreliability of the results returned. Also, whether or not the questions are appropriate to the purpose of the test or whether they are questions that could be misinterpreted and lead to false results and conclusions. As stated previously, this is particularly important since many of these online tests are for self-diagnoses and are often taken as valid by the site visitor regardless of the site’s credentials or any adherence to National Board for Certified Counselors (NBCC) standards. This test is composed of twelve yes or no questions most of which are quite general in nature. Furthermore, there is no initial overview of the visitor’s status, not even the very basic questions of age or gender that, as has been stated, can be significant in evaluating the results. Several of the questions are not only general, but can be applied to many other diagnoses the symptoms of which can mimic depression. For example these two questions: Do you feel tired all the time? Do you sleep more than usual or have insomnia? Do you feel like eating all the time, especially sweets, or has your appetite decreased significantly? (Depression Quiz, 2006) Both of these questions more often than not can have organic components that can cause the symptomology, thus giving misleading and potentially harmful information. The authors attempt to avoid misinterpretation with the disclaimer: If you answer yes to one or more of the questions, see your physician right away to: Determine if there is a physical problem that needs attention; and, To plan an appropriate course of treatment. Your physician can make a referral to other health care professionals as necessary. (Depression Quiz, 2006). The fact that even answering yes to just one question should be important enough to seek medical attention is also a flag as to the validity of this test and its results. Furthermore, there is a rather shameless promotion built into the end of the disclaimer that also raises questions of bias in creating and utilizing this test: “In addition, refer to the self help resources by Mary Ellen Copeland including her books, video tape and audio tape” (Depression Quiz, 2006). This leads one to the conclusion that for clinical, therapeutic or even research purposes this test is not reliable from the outset. Creation of A More Useful Online Test After reviewing the previous online test several shortfalls have been detected overall. Simple yes or no responses can in no way help gauge the client’s true state of mind. By necessity there needs to be some evaluation of degree in the responses to any questions. This is apparent in the Beck Depression Inventory-FastScreen (BDI-FastScreen) test (Beck & Steer, 1984), which has a scale range of zero to three points in answer to any of its questions. A level of intensity is especially important in an online test since the client is isolated from the practitioner and there is no way to gauge what he or she is truly feeling, other than a range of value imposed on the answer. This multi-level value scale should be incorporated into any online test. There is also a necessity to take at least minimal demographic information such as age and gender. While other information would certainly be useful, given the limited space and time one devote to online information this simple information should give some basic understanding when evaluating results. It would of course be helpful to know whether or not the client has been previously diagnosed with depression or other mood disorders as this would certainly influence the results of the test. However this is impractical in this situation. Using the above criteria and a review of the Beck Depression Inventory-FastScreen (BDI-FastScreen) test (Beck & Steer, 1984) and the relevant literature as discussed the following test has been developed: Using the BDI-FastScreen as a guide, which has 21 questions and state that a score of 21 or over for the general population may be a sign of depression, this test will set the mark at 12 or over as a sign for depression. It will also suggest that the test taker see his or her medical professional should these feeling have persisted for more than a month (Rowe, 2003). This avoids the knee jerk reaction of the other test, especially when asking the suicidal ideation question. That question is avoided here since there is no way to guarantee that the test taker will take the advice and seek help immediately. Or, moreover, be influenced by the suggestion and begin to wonder about suicide. Either way, without a clinician being present the question should not be asked. Conclusion The world of online testing for many conditions has grown by leaps and bounds, this is particularly true in the mental health field. There is a certain anonymity that attracts a client when initially wanting to find out what is “wrong” with them. But there is also the current status of managed care requirements, which now make clinical testing difficult to prescribe. (Piotrowski, Belter & Keller, 1998). This has led to a proliferation of online testing web site, many of which do not meet the criteria of the National Board for Certified Counselors (NBCC) standards. While the debate continues as to the real value of these tests, they seem to be here to stay. The evaluation of one such “pop” online test for depression (Depression Quiz, 2006) has led to specious results at best. The poor generality and viability of the questions and the possibility of a panicked test taker misdiagnosing an organic issue was found to be very high. The creation of a test that follows more standardized criteria was certainly in order and has been presented here for review. It is believed that by allowing for a range of response, rather than a simple yes or no will be invaluable in correctly assessing mood disorders such as depression. Also gather a certain amount of demographic information was also found to be relevant in evaluating the results of the questing for research purposes. References Anastasi, A. & Urbina, S. (1997). Psychological Testing (7th Ed.) Engelwood Cliffs N.J.: Prentice Hall. Beck, A. T., and R. A. Steer. (1984) Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology 40, 1365-1367. “Depression Quiz.” (2006) HealthyPlace.com Retrieved on January 1, 2009 from http://www.healthyplace.com/Communities/Depression/mhrecovery/quiz.asp Heinlen, K. T., Welfel, E. R., Richmond, E. N., & Rak, C. F. (2003). The Scope of WebCounseling: A Survey of Services and Compliance with NBCC Standards for the Ethical Practice of WebCounseling. Journal of Counseling and Development, 81(1), 61-77. Hersen, M. (Ed.). (2004). Psychological Assessment in Clinical Practice: A Pragmatic Guide. New York: Brunner-Routledge Knight, R. G., Mcmahon, J., Green, T. J., & Skeaff, C. M. (2004). Some Normative and Psychometric Data for the Geriatric Depression Scale and the Cognitive Failures Questionnaire from a Sample of Healthy Older Persons. New Zealand Journal of Psychology, 33(3), 163-179 Koocher, G. P., Norcross, J. C., & Hill, S. S. (Eds.). (2005). Psychologists' Desk Reference (2nd ed.). New York: Oxford University Press Maruish, M. E. (2002). Psychological Testing in the Age of Managed Behavioral Healthcare. Mahwah, NJ: Lawrence Erlbaum Associates Piotrowski, C., Belter, R. W., & Keller, J. W. (1998). The Impact of "Managed Care" on the Practice of Psychological Testing: Preliminary Findings. Journal of Personality Assessment, 70(3), 441-447. Possel, P., Seemann, S., Ahrens, S., & Hautzinger, M. (2006). Testing the Causal Mediation Component of Dodge's Social Information Processing Model of Social Competence and Depression. Journal of Youth and Adolescence, 35(5), 849-861. Rochlen, A. B., Beretvas, S. N., & Zack, J. S. (2004). The Online and Face-to-Face Counseling Attitudes Scales: A Validation Study. Measurement and Evaluation in Counseling and Development, 37(2), 95-109 Rowe, D. (2003). Depression: The Way out of Your Prison. New York: Routledge. Touma, S. G. (2004). Psychological Testing and Psychotherapy. Annals of the American Psychotherapy Association, 7(4), 24-38 Appendix Depression Quiz Take the following Quiz to see if you might be depressed: Do you have persistent thoughts of death, dying, or suicide? Do you have a plan to end your life? (If you do, contact your physician or a health care professional immediately.) Are you feeling hopeless and worthless, like it's not worth living? Are you unable to go to work or keep up with responsibilities that are part of your daily life because you feel bad and don't know why? Are activities that you have always found pleasurable, no longer enjoyable? Do you feel tired all the time? Do you sleep more than usual or have insomnia? Do you feel like eating all the time, especially sweets, or has your appetite decreased significantly? Are you having a hard time concentrating? Are you having a hard time remembering simple things like appointments and people's names? Do tasks that used to seem simple now seem very difficult? Are you avoiding friends and crowds? Are you having a very hard time getting over a loss or trauma in your life? If you answer yes to one or more of the questions, see your physician right away to: 1. determine if there is a physical problem that needs attention; and, 2. to plan an appropriate course of treatment. Your physician can make a referral to other health care professionals as necessary. If you cannot take this action on your own behalf, get a family member or friend to do it for you. If you need more information after you have taken this quiz, take the Next Step. In addition, refer to the self help resources by Mary Ellen Copeland including her books, video tape and audio tape. Read More