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Objective: A substantial number of patients with major depressive disorder (MDD) do not respond to treatment, and recurrence rates remain high. The purpose of this study was to examine a history of severe childhood abuse as a moderator of response following a 16-week acute treatment trial, and of recurrence over a 12-month follow-up. Method: Participants included 203 adult outpatients with MDD (129 women; age 18-60). The design was a 16-week single-center randomized, open label trial of interpersonal psychotherapy, cognitive-behavioral therapy, or antidepressant medication, with a 12-month naturalistic follow-up, conducted at a university psychiatry center in Canada. The main outcome measure was Hamilton Depression Rating Scale scores at treatment end point. Childhood maltreatment was assessed at the completion of treatment using an interview-based contextual measure of childhood physical, sexual, and emotional abuse. Multiple imputation was adopted to estimate missing values. Results: Patients with severe maltreatment were significantly less likely to respond to interpersonal psychotherapy than to cognitive-behavioral therapy or medication (OR = 3.61), whereas no differences among treatments were found in those with no history of maltreatment (ORs less than 1.50). Furthermore, maltreatment significantly predicted a shorter time to recurrence over follow-up across treatment conditions (OR = 3.04). These findings were replicated in the sample with complete case data. Conclusions: Patients with a history of childhood abuse may benefit more from antidepressant medication or cognitive-behavioral therapy than from interpersonal psychotherapy. However, these patients remain vulnerable to recurrence regardless of treatment modality. (Contains 3 footnotes, 2 figures and 2 tables.)

In the current investigation, the authors examined the diagnostic construct validity of the "Minnesota Multiphasic Personality Inventory-2-Restructured Form" (MMPI-2-RF) in a patient sample. All participants were diagnosed via the "Structured Clinical Interview" for DSM-IV Axis I Disorders (SCID-I/P). The data set used in this study was composed of 544 patients--67 with bipolar disorder, 407 with major depressive disorder, and 70 with schizophrenia. Multivariate analyses revealed a pattern of mean scale differences among patient groups that was mostly consistent with the prominent features of each diagnostic group; logistic regression analyses identified a number of scales that were strong, unique predictors in the differentiation between pairs of diagnostic groups. The higher order scales (H-O)--the Emotional/Internalizing Dysfunction (EID) and Thought Dysfunction (THD) scales were most useful in differentiating between patient groups. For differentiating bipolar disorder patients from the other diagnostic groups, the Activation (ACT) Specific Problem scale was most useful. Although not all hypothesized scale differences emerged; overall, the pattern of results provides support for the diagnostic construct validity of the MMPI-2-RF scales. (Contains 4 tables and 6 notes.)

We examined the utility of the validity scales on the recently released Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF; Ben-Porath & Tellegen, 2008) to detect overreported psychopathology. This set of validity scales includes a newly developed scale and revised versions of the original MMPI-2 validity scales. We used an analogue, experimental simulation in which MMPI-2 RF responses (derived from archived MMPI-2 protocols) of undergraduate students instructed to overreport psychopathology (in either a coached or noncoached condition) were compared with those of psychiatric inpatients who completed the MMPI-2 under standardized instructions. The MMPI-2 RF validity scale Infrequent Psychopathology Responses best differentiated the simulation groups from the sample of patients, regardless of experimental condition. No other validity scale added consistent incremental predictive utility to Infrequent Psychopathology Responses in distinguishing the simulation groups from the sample of patients. Classification accuracy statistics confirmed the recommended cut scores in the MMPI-2 RF manual (Ben-Porath & Tellegen, 2008). (Contains 7 footnotes, 4 tables, and 1 figure.)

The Beck Depression Inventory-II (BDI-II) is a self-report instrument frequently used in clinical and research settings to assess depression severity. Although investigators have examined the factor structure of the BDI-II, a clear consensus on the best fitting model has not yet emerged, resulting in different recommendations regarding how to best score and interpret BDI-II results. In the current investigation, confirmatory factor analysis was used to evaluate previously identified models of the latent symptom structure of depression as assessed by the BDI-II. In contrast to previous investigations, we utilized a reliably diagnosed, homogenous clinical sample, composed only of patients with major depressive disorder (N = 425)--the population for whom this measure of depression severity was originally designed. Two 3-factor models provided a good fit to the data and were further evaluated by means of factor associations with an external, interviewer-rated measure of depression severity. The results contribute to a growing body of evidence for the Ward (2006) model, including a General (G) depression factor, a Somatic (S) factor, and a Cognitive (C) factor. The results also support the use of the BDI-II total scale score. Research settings may wish to model minor factors to remove variance extraneous to depression where possible. (Contains 2 figures and 3 tables.)

Depressive personality disorder (DPD) was included in the appendix of the "Diagnostic and Statistical Manual of Mental Disorders", Fourth Edition ("DSM-IV") for further study. Questions abound regarding this disorder in terms of its distinctiveness from extant diagnostic constructs and clinical significance.This study examines the interrelations between three assessments of DPD and their relations to pathological personality traits and disorders in a sample of undergraduates (N = 182). The DPD indices evinced adequate convergence with each other (mean r = 0.60) and similar pathological personality profiles. The authors also tested the incremental validity of the DPD scores in relation to psychological functioning, after controlling for depressive symptoms and the "DSM-IV" personality disorders (PDs). The DPD scores manifested limited incremental validity, mainly in the form of predicting lower levels of positive affectivity. Our results suggest that this is not specific to DPD, however, as the official PDs also manifested limited incremental validity. (Contains 4 notes and 4 tables.)

Although pathological gambling (PG) is regarded in the 4th edition of the "Diagnostic and Statistical Manual of Mental Disorders" (American Psychiatric Association, 1994) as a unitary diagnostic construct, it is likely composed of distinct subtypes. In the current report, the authors used cluster analyses of personality traits with a non-treatment-seeking community sample of gamblers and identified 3 PG subtypes. Gamblers partitioned into a simple PG cluster, characterized by low rates of comorbid psychopathology and trait scores near the normative mean; a hedonic PG cluster, characterized by moderate rates of comorbid psychopathology and a proclivity for excitement seeking and positive affect; and a demoralized PG cluster, characterized by high rates of comorbid psychopathology and a propensity toward negative affect, low positive emotionality, and disinhibition. The findings provide preliminary support for an empirically based typology of gamblers, distinguishable in terms of personality structure, which may reflect different etiologies. (Contains 5 footnotes and 5 tables.)

In the current investigation, the authors examined the validity of the L-r and K-r scales on the recently developed Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; Y. S. Ben-Porath & A. Tellegen, in press) in measuring underreported response bias. Three archival samples previously collected for examining MMPI-2 validity scales were reanalyzed in 2 studies. In Study 1 L-r and K-r significantly differentiated 2 groups of participants (patients with schizophrenia and university students) who had been instructed to underreport on the MMPI-2 from participants who took the test under standard instructions. L-r and K-r also added incremental predictive variance to one another in differentiating these groups. In Study 2 a similar set of outcomes emerged through the use of a differential prevalence design in which L-r and K-r significantly differentiated a group of child custody litigants who were administered the MMPI-2 from university students taking the test under standard instructions. (Contains 4 tables and 3 footnotes.)

The authors examined the comparative predictive capacity of the Trauma Symptom Inventory (TSI) Atypical Response Scale (ATR) and the standard set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) fake-bad validity scales (i.e., F, F[subscript B[prime]], F[subscript p[prime]], FBS) to detect feigned posttraumatic stress disorder (PTSD). Remitted trauma victims (n = 60) completed the TSI and MMPI-2 under standard (honest) instructions and then were randomly assigned to 1 of 2 experimental conditions (noncoached/validity scale coached) in which they were administered these instruments again with instruction to fake PTSD. These test protocols were compared with TSI and MMPI-2 results from workplace injury claimants with PTSD (n = 84). The ATR and FBS were able to distinguish only the noncoached participants instructed to fake from the PTSD claimants; in contrast, the F, F[subscript B[prime]], and F[subscript p[prime]] scales were able to distinguish both the noncoached and the validity-scale-coached participants from the PTSD claimants. F, F[subscript B[prime]], and F[subscript p[prime]] always outperformed the ATR and FBS; neither the ATR nor the FBS was able to add incremental predictive variance to that of F, F[subscript B[prime]], or F[subscript p[prime]]. (Contains 5 tables and 8 footnotes.)

Schinka, Kinder, and Kremer developed "validity" scales for the "Revised NEO Personality Inventory" (NEO PI-R; Costa & McCrae) to detect underreporting--the Positive Presentation Management (PPM) Scale and overreporting--the Negative Presentation Management (NPM) Scale. In this investigation, the clinical utility of these scales was examined using the established validity scales from the "Minnesota Multiphasic Personality Inventory-2" (MMPI-2; Butcher et al.) as the referent. The sample was composed of 370 psychiatric patients who completed the NEO PI-R and the MMPI-2 as part of a routine evaluation. Results indicated that response distortion compromised the utility of the NEO PI-R domain scales. Moreover, the PPM and NPM scales and an NPM-PPM index significantly differentiated invalid under-and overreporting groups from a valid responding group. The PPM and NPM-PPM index were adequate in classifying under- and overreporters, respectively. (Contains 5 tables and 4 notes.)

An eight-subtest short form (SF8) of the Wechsler Adult Intelligence Scale, Third Edition (WAIS-III), maintaining equal representation of each index factor, was developed for use with psychiatric populations. Data were collected from a mixed inpatient/outpatient sample (99 men and 101 women) referred for neuropsychological assessment. Psychometric analyses revealed an optimal SF8 comprising Vocabulary, Similarities, Arithmetic, Digit Span, Picture Completion, Matrix Reasoning, Digit Symbol Coding, and Symbol Search, scored by linear scaling. Expanding on previous short forms, the current SF8 maximizes the breadth of information and reduces administration time while maintaining the original WAIS-III factor structure.

The Personality Psychopathology Five (PSY-5) is a model of personality psychopathology assessed in adult populations with a set of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales. The authors examine the reliability and validity of recently developed lower-order facet subscales for each of these five domains, with an emphasis on structural invariance, using both confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). MMPI-2 protocols completed by psychiatric patients (N = 693) served as the data source. The reliability and discriminant validity of the subscales were mostly inadequate. Results from the CFAs reveal universally poor statistical fits. Subsequent EFAs extracted alternate latent structures, which also demonstrate mostly inadequate reliability and validity. Overall, results suggest that the item pool that forms the MMPI-2 PSY-5 domain scales may not be able to sustain meaningful facet subscales. (Contains 4 tables and 6 notes.)

Anxiety and avoidance dimensions of adult attachment insecurity were tested as moderators of treatment outcome for interpersonal psychotherapy (IPT) and cognitive-behavioral therapy (CBT). Fifty-six participants with major depression were randomly assigned to these treatment conditions. Beck Depression Inventory-II, Six-Item Hamilton Rating Scale for Depression scores, and remission status served as outcome measures. Patients higher on attachment avoidance showed significantly greater reduction in depression severity and greater likelihood of symptom remission with CBT as compared with IPT, even after controlling for obsessive-compulsive and avoidant personality disorder symptoms. Results were replicated across treatment completers and intent-to-treat samples. These results suggest that it is important to consider the interaction between attachment insecurity and treatment type when comparing efficacy of treatments.

Structural, mean- and individual-level, differential, and positive personality continuity were examined in 599 patients treated for major depression assigned to 1 of 6 forms of a 6-month pharmacy-psychotherapy program. Covariation among traits from the Five Factor model remained invariant across treatment, and patients described themselves as slightly more extroverted, open to experience, agreeable and conscientious, and substantially more emotional stable after treatment. Trait changes were only to a small extent explained by changes in depression severity. There was evidence for differential, individual-level, and positive stability, with stable personality profiles in terms of shape and to a lesser extent in terms of scatter and elevation. Traits remain relatively stable, except for emotional stability, despite the depressive state and the psycho pharmacological interventions.

The incremental validity and clinical utility of the recently developed Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency Posttraumatic Stress Disorder Scale (Fptsd) was examined in relation to the family of MMPI-2 F scales in distinguishing feigned post-traumatic stress disorder (PTSD) from disability claimants with PTSD. Research participants instructed to feign PTSD when completing the MMPI-2 scored significantly higher on the MMPI-2 family of F scales and the Fptsd scale compared with their responses when completing the MMPI-2 under standard instructions and the sample of claimants with PTSD. Although comparable in magnitude, effect sizes derived from mean group differences and hierarchical logistic regressions for the Fptsd scale never exceeded those for F[B], and F[P], F, F[B], and F[P] added incrementally to Fptsd in the prediction of feigned PTSD. These results suggest that the Fptsd scale does not afford any incremental predictive utility for detecting feigned PTSD relative to the complement of the existing family of F scales. (Contains 6 tables, 3 figures and 3 notes.)

Recent studies have demonstrated that personality disorders (PDs) can be assessed via a prototype-matching technique, which enables researchers and clinicians to match an individual's five-factor model (FFM) personality profile to an expert-generated prototype. The current study examined the relations between these prototype scores, using interview and self-report data, and PD symptoms in an outpatient sample (N = 115). Both sets of PD prototype scores demonstrated significant convergent validity with PD symptom counts, suggesting that the FFM PD prototype scores are appropriate for use with both sources of data.

The goal of the present investigation is to compare the factor structure of the revised NEO Personality Inventory (NEO PI-R; P. T. Costa & R. R. McCrae, 1992) in samples of respondents differentially motivated to respond in a socially desirable manner. In the French sample, the authors compared the NEO PI-R structure of job applicants (N=12,631) subgrouped by relative degree of socially desirable responding with that of a normative sample (N=801). In the Belgian sample, the authors compared the NEO PI-R structure in naturally occurring groups, including job applicants (N=3,028), individuals receiving career counseling (N=221), and a normative sample (N=549). Results indicate that the NEO PI-R factor structure remained stable across all samples.

The current study compares the use of two alternative methodologies for using the Five-Factor Model (FFM) to assess personality disorders (PDs). Across two clinical samples, a technique using the simple sum of selected FFM facets is compared with a previously used prototype matching technique. The results demonstrate that the more easily calculated counts perform as well as the similarity scores that are generated by the prototype matching technique. Optimal diagnostic thresholds for the FFM PD counts are computed for identifying patients who meet diagnostic criteria for a specific PD. These threshold scores demonstrate good sensitivity in receiver operating characteristics analyses, suggesting their usefulness for screening purposes. Given the ease of this scoring procedure, the FFM count technique has obvious clinical utility.

Objective: The authors explored practice characteristics, activities, and career satisfaction of male and female psychiatrists. Method: A questionnaire was mailed to all practicing psychiatrists in Ontario, Canada, to which 52% responded. Results: More women specialized in child, women's mental health and geriatrics than did men, while men specialized more in forensics and psychosomatics. Women saw fewer patients for pharmacotherapy than did men. Women spent more time in session with their patients than did the men. Women were less involved in research, less likely to hold pharmaceutical funding, and less likely to have published within the last 5 years than men. Women described their careers as less successful than men but felt less regret in choosing psychiatry as a career. Conclusions: Men and women practicing psychiatry in Canada show similar differences to that reported in the U.S., although women report more satisfaction with their careers than men in Canada, a finding not reported in the U.S.

The authors assess the replicability of the two-factor model of underreporting response style. They then examine the relative performance of scales measuring these styles in analog (ARD) and differential prevalence group (DPG) designs. Principal components analysis produced a two-factor structure corresponding to self-deceptive (SD) and impression management (IM) response styles. The IM factor scale and related individual validity scales were elevated among research participants instructed to fake good on the MMPI-2 as compared with participants who completed the MMPI-2 under standard instructions (ARD) and among individuals evaluated in real-life assessment contexts where underreporting is expected (DPG). Participants in DPG samples produced significantly higher SD factor and related individual scale scores than did the ARD participants instructed to fake good. These findings confirm that the MMPI-2 validity scales measure two types of underreporting styles and that these styles may operate differently in ARD versus DPG designs.

Confirmatory factor analysis was used to test the theoretical structure of the revised Personal Style Inventory (PSI) (C. Robins and others, 1994) with 869 nonclinical adults and 101 outpatients with depression. PSI items and subscales decomposed into factor structures that were fair to good representations of the theoretical model. (SLD)

Receiver operating characteristic (ROC) analysis was used to evaluate 11 Minnesota Multiphasic Personality Inventory-2 (MMPI-2) indicators of response distortion using 343 college students, some of whom simulated malingering or defensive responding, 181 forensic psychiatric patients, and 95 other psychiatric patients. Results show the usefulness of ROC analysis. Detecting faking is discussed. (SLD)

The effects of knowledge of psychiatry and psychological testing on the ability to feign schizophrenia on the Minnesota Multiphasic Personality Inventory were studied with 54 clinically trained participants, 24 undergraduates with no clinical training, and 51 patients. Results suggest that even mental health professionals have difficulty feigning schizophrenia. (SLD)

The ability of the "fake good" indicators on the Personality Diagnostic Questionnaire-4 (PDQ-4) (S. Hyler, 1994) for "Diagnostic and Statistical Manual of Mental Disorders" Axis II disorders was studied with 99 college students. Overall classification rates of the validity scales of the PDQ-4 were too low for clinical use. (SLD)