r"

Model answer
Di scuss i ssues surroundi ng t he cl assi f i cat i on and di agnosi s of
depressi on. (8 marks + 16 marks)
One ssue related to cIa~ification and diagnos:is:is:reliabili1y.Reliability refers: to the cons:istency of a
measuring ins:trurnent,such as D~M frhe Diagnos:tic and ~tatistical ManuaD which is:used when diagnosing
""
-.J Some exam questions on
depre~ion. Reliabil0' can be measured Interms: of whethertwo independent assessors @ Ves:imilarscores
...the topic of 'issues related to
Qnter-raterreliabilitY.. I-ligh reliability is:indicated by a high positive correlation.
classification and diagnosis'
are just A02. Others are
Inter-raterreliability has been assessed fordiagnoses of depression and found to be reasonable, FOrexample, AO) and A02, as is the case
Kelleret al. OQQ5)recruited 524 depressed individuals:from different clinical snes Each was interviewed here. When both AO) and
using the ~M criteria and interviewed again 6 months laterto establish reliabili1y.Results showed that inter-
A02 are required it is vital to
rsterreliability was 'fairto good'.
make the A01 component
clearly separate from the
Inter-raterreliability is po~ibly lowerthan desirable. This may be due to the fact that fora diagnosis of
A02. Many students lose
deprescion to be given on D~M, a minimum offlve out of nine symptoms mus:tbe present IN'henthe severity
A01 marks because clear
of the disorderis such that it is:at the diagnostic threshold, a disagreement between clinicians ofjus:t one item
division is missing.
(e.g. whetheran individual is wfficiently lethargic to denote a shift in activity levels) could mean the difference
between giving a diagnosis of MDD ora le~ serious disorder
There are cultural biases in diagnosis. For example, Karssz (2004) gave a vignette describing depressive
symptoms to New Vork.ers:who were ~outh Asian orEuropean Americans. Only the lattergroup identified
UThis essay requires that both
the problem as being biolOgical and requiring 'professional' help. This suggests that some cultural groups won't ""
r - - - . . classification and diagnosis
seel::help fordepression. are discussed, whereas
Reliability of diagnosis can also be assessed using the test-retsst method where the same patient is tested
some essay titles don't (they
twice overa period of time to demonstrate whetherthe scores on a c1as:sificationmeasure remain consistent
say 'and/or').
We would expect scores to remain relatively constant overa short period of time so there should be a s:trong
positive correlation between two scores from the same person - ifthe test is reliable.
In terms of diagnoses of depression test-retest results indicate low reliabili1y.For example, Kelleret al.
OqQ5)found o-rnonth test-reiest reliability was 'fair' fordysthymia. but 'poorto fair' formajordepression. It '"UYou can keep track of the
is possible that 6 months is a long period overwhich to expect scores to remain constant fora disorderlik.e
r - - - . . relative amounts of AO) and
depre~ion so the variability is not because the measurement is unreliable, it's because the persors mental
A02 by sticking to yourplan
state has changed.
- have fourAO 1 paragraphs
and eight A02 paragraphs
Test-retest reliability has also been calculated for'Becl:'s Depression Inventory (lIDD, one of the most popular each about 50-60 words.
diagnostic tools forevaluating depression. Forexample, Vi~er et a/. (2006) assessed patients:fordepresson
This ensures that youressay
using the 'BDI. producing a test-retest correlation of +M. This suggests: that the 'BDI is a reliable measure
has the right proportions of
of the severity of depre~ive symptoms.
each.
A second i~ue is validity. which concerns both claSSification and diagnOSiS. Forexample, there is the issue
of comorbidity. which is the extent that two (ormore) conditions co-occ.ur, such as different subtypes of
""
-.J Note how each paragraph
depression, and therefore the extent to which the conditions are 'real'. ...in this essay mirrors the
There is research support forcomorbldlty of different types of depression, McCullough et al. (2000
original answerplan.
compared 601 patients:who had been diagnosed with various:types of depression, including majordepressive
This use of paragraphs
disorder(MDD) and dysthymia. They found considerable overlap in theirsymptoms, responses to treatment helps you keep a track of
and othervariables that made it difficult to justity distinct forms of depressive illness. how much A01 and A02
you have covered, and also
Anotherissue concerning the validity of diagnOSisis the question of who carries out the diagnOSiS. Formost
helps the examiner to read
people, a diagnosis of depression is given bytheirlocal GP ratherthan by a psychiatrist, which may affect the youranswerbecause each
validity ofthe diagnosis.
separate point is clear.
There are arguments to explain why GP diagnoses might lad validi1y.Van Weel-'Baumgarten et al. (2006)
suggest that diagnoses made by GP s may be less objective because they are based on previous:J ::nowl~e
of the patient and fumily history ratherthan the actual presenting symptoms (necessary forD~M diagnoSiS.
There is research support forthe lad of validity of GP diagnoses. ~tirling et al. (2000 found that the avernge
consultation time fora GP to diagnose depression wasjus:t overf5 minutes, whereas forpsychiatrist it was
1hour. A 50% increase in GP consultation time resulted in a 32% increase in the accuracy of diagnosis for
depression.
This answeris just about
700 words in length,
70% of which is A02.
There are just over
200 words of AO 1 which
is sufficient content for
that skill.
'-
Chapter 10 Depr ession 105