Objective: The aim of this paper is to describe an approach to sub-typing non-melancholic depression and to determine which raters from a variety of backgrounds provided the most valid information on study variables.
Method: A sample of non-melancholic depressed patients is described. Multiple raters (i.e. patients, psychiatrists, referrers and corroborative witnesses) completed measures of the patient's trait anxiety levels, severity of recent life event stressors and personality functioning.
Results: The study and representative data are reported. Congruence between several measures employed indicated that psychiatrist rating of disordered personality was superior to corroborative witness report. Assessment of anxiety traits indicated reasonable agreement between referrers and corroborative witnesses but poor agreement between those ratings and interview-elicited ratings. There were also discrepancies in quantifying “severity” of life event stress, with patients and their corroborative witnesses rating such events as more severe than either the interviewing psychiatrist or psychiatrists involved in consensus rating sessions. Importantly, the psychiatrists' capacity to quantify the relative contribution of disordered personality, anxiety and life-event stress to the particular depressive episode was supported.
Conclusions: Results indicate some of the difficulties in operationalising determinants that may contribute to and sub-type the non-melancholic depressions, and demonstrate the advantages of using a range of rating strategies and raters. In this study, psychiatrist-generated judgements are clearly favoured, although the advantages of also assessing trait anxiety and life-event stress impact by self-report strategies are conceded. Some techniques for estimating the contribution of disordered personality function, anxiety and life-event stress are offered for both their research and their clinical utility.
WinokurG.The validity of neurotic-reactive depression: new data and reappraisal. Archives of General Psychiatry1985; 42:1116–1122.
2.
ParkerGHadzi-PavlovicD.Melancholia: a disorder of movement and mood. A phenomenological and neurobiological review. New York: Cambridge University Press, 1996.
3.
ParkerGHadzi-PavlovicDBoyceP.Endogenous depression as a construct: a quantitative analysis of the literature and a study of clinician judgements. Australian and New Zealand Journal of Psychiatry1989; 23:357–368.
4.
AkiskalHSRosenthalTLHaykalRFLemmiHRosenthalRHScott-StraussA.Characterological depressions: clinical and sleep EEG findings separating ‘subaffective dysthymias’. Archives of General Psychiatry1980; 37:777–783.
5.
OldhamJMSkodolAEKellmanHDComorbidity of Axis I and Axis II disorders. American Journal of Psychiatry1995; 152:571–578.
6.
WolpeJ.The renaissance of neurotic depression: its varied dynamics and implications for outcome research. Journal of Nervous and Mental Disorders1988; 176:607–613.
7.
RothMBarnesTREThe classification of affective disorders: a synthesis of old and new concepts. Comprehensive Psychiatry1981; 22:54–77.
8.
OverallJEHollisterCEJohnsonMPenningtonJ.Nosology of depression and differential response to drugs. Journal of the American Medical Association1966; 195:946–948.
9.
DavidsonJWoodburyMAPeltonSKrishnanR.A study of depressive typologies using grade of membership analysis. Psychological Medicine1988; 18:179–189.
10.
GlassRMSituational and neurotic-reactive depression. Archives of General Psychiatry1985; 42:1126–1127.
11.
HamiltonM.Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology1967; 6:278–296.
12.
BeckATWardCHMendelsonMMochJEErbaughJKAn inventory for measuring depression. Archives of General Psychiatry1961; 4:561–571.
13.
ParkerGHadzi-PavlovicDSengozAA brief self-report depression measure assessing mood state and social impairment. Journal of Affective Disorders1994; 30:133–142.
14.
American Psychiatric Association.Diagnostic and statistical manual of mental disorders. 4th ed.American Psychiatric Association: Washington, DC. 1994.
15.
World Health Organization.Composite International Diagnostic Interview. Version 1.2. Sydney: World Health Organization Research and Training Centre, 1993.
16.
CarneyMWPRothMGarsideRFThe diagnosis of depressive syndromes and the prediction of ECT response. British Journal of Psychiatry1965; 111:659–674.
17.
MillonT.A theoretical derivation of pathological personalities. In: MillonTKlermanGL, eds. Contemporary directions in psychopathology: toward the DSM-IV. New York: Guilford Press, 1986:639–669.
18.
PreskornSHFastGABeyond signs and symptoms: the case against a mixed anxiety and depression category. Journal of Clinical Psychiatry1993; 54(Suppl. 1):24–32.
19.
TennantCAndrewsG.A scale to measure the cause of life events. Australian and New Zealand Journal of Psychiatry1977; 11:163–167.
20.
BrownGHarrisT.Social origins of depression. London: Tavistock, 1978.
21.
PilkonisPAHeapeCLRuddyJSerraoP.Validity in the diagnosis of personality disorders: the use of the LEAD standard. Journal of Consulting and Clinical Psychology1991; 3:46–54.
