Studies: One contemporary study on another disorder, from the following: Depression — Edexcel A-Level Psychology
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Studies: One contemporary study on another disorder, from the following: Depression explained
The eight item Patient Health Questionnaire is the depression module with the self harm item removed, each symptom rated from not at all to nearly every day over the past fortnight, and this paper asks whether it still measures current depression once that ninth item is dropped so the scale can be used over the telephone. Using close to two hundred thousand adults interviewed in a national United States health surveillance survey, the authors compared a simple cut point, a total of ten or more, with a diagnostic algorithm requiring five symptoms present more than half the days including low mood or loss of interest. The two routes gave very similar prevalence, and rates were far higher among people unemployed, unable to work, uninsured or living with chronic illness.
5.3.4 Williams et al. (2013) Combining imagination and reason in the treatment of depression: a randomised control trial of internet based cognitive bias modification and internet-CBT for depression.
This trial tested whether a week of computerised imagery training, in which ambiguous everyday scenarios are repeatedly resolved positively so that the habit of imagining the worst is retrained, adds anything to therapy delivered over the internet. Sixty nine adults meeting the criteria for major depressive disorder were recruited online in Australia, randomly allocated to the imagery condition or to a matched control training, and all then worked through the same online cognitive behavioural lessons over the following weeks, with standard depression and distress scales taken at each stage. Symptom scores fell substantially across the combined programme, with large effect sizes, so the interesting question is what the training week itself contributed and how far volunteers recruited online stand for patients in a clinic.
Your focus
- 5.3.3 Kroenke et al. (2008) The PHQ-8 as a measure of current depression in the general population.
- 5.3.4 Williams et al. (2013) Combining imagination and reason in the treatment of depression: a randomised control trial of internet based cognitive bias modification and internet-CBT for depression.
Studies: One contemporary study on another disorder, from the following: Depression exam tips
Marking Points
- Describe the measure precisely: eight symptoms taken from the diagnostic criteria for major depression, each scored from zero to three for the last two weeks, giving a maximum of twenty four, with a total of ten or more treated as current depression.
- Explain why the ninth item was left out, because the question about self harm is rarely endorsed and cannot be followed up safely in an anonymous telephone interview, and say that the paper shows removing it makes almost no difference to who is classified as depressed.
- Report both scoring rules and the comparison between them, since the point of the study is that a quick cut point and a criteria based algorithm agree closely enough for population use.
- Use the demographic pattern as evidence of validity: the scale picks out exactly the groups independently known to carry more depression, which is the argument for criterion validity in a study with no clinical interview of its own.
- Evaluate the method: an enormous sample gives population validity and standardised wording gives reliability, but self report by telephone invites social desirability, symptoms are counted rather than understood, and the design is nomothetic, so no individual case is explained.
- Describe the design as a randomised controlled trial with two allocated conditions followed by a shared phase of internet delivered cognitive behavioural therapy, and name the outcome measures as standardised self report scales of depression and distress taken before, between and after the two phases.
- Explain the rationale for cognitive bias modification: depression is maintained by interpreting ambiguous events negatively and by a shortage of vivid positive imagery, so training people to complete ambiguous scenarios positively should shift mood as well as interpretation.
- Report the outcomes in the terms the paper uses, that the combined programme produced large reductions in depressive symptoms which were retained at follow up, and that the imagery training is presented as a possible preparation for therapy rather than as a treatment on its own.
- Evaluate the controls: random allocation and computer delivery remove therapist differences and make the procedure highly replicable, but the control condition is an active comparison rather than no treatment, which changes what the comparison can show.
- Give the limits: self selected internet volunteers, diagnosis established remotely, drop out in online trials, and no long term follow up, alongside the genuine applied strength that online therapy is cheap, private and reaches people who would never attend a clinic.
Examiner Tips
- 💡This is a favourite vehicle for research methods credit, so be ready to explain the difference between reliability and validity for a questionnaire and how test retest reliability and concurrent validity would be established.
- 💡If asked to compare contemporary studies, the useful axes are sample size, self report against objective measurement, and breadth against depth.
- 💡In an extended answer, include one methodological strength, one weakness and one wider issue such as cultural bias in how low mood is expressed, because a list of weaknesses alone caps the marks.
- 💡Usefulness questions want a concrete application, so say that a short scale lets health services track depression across a population and screen quickly in primary care.
- 💡Use it in an essay on treatments for depression as the evidence base for computerised therapy, stating what the trial shows about effectiveness and what it leaves untested.
- 💡Review questions in the skills paper reward specific methodology, so write about randomisation, the active control, attrition and self report rather than a generic complaint about laboratory settings.
- 💡If the command word is compare, choose a study with a genuinely different method, and structure the answer as similarities then differences with a point about each one.
- 💡Keep one sentence ready on the ethics of online trials, including how consent and risk monitoring work when the researcher never meets the participant.
Common Mistakes
- Treating a score of ten or more as a diagnosis. It is a screening threshold, and a clinician still has to interview before anyone is diagnosed or treated.
- Describing the study as a trial of a treatment. Nothing was administered and nobody was randomised; this is a study of measurement.
- Forgetting the time frame. The scale asks about the last two weeks, so it measures current depression and says nothing about lifetime history or about how long an episode has lasted.
- Calling the sample a clinical sample. These were members of the general population, which is what makes the prevalence figures meaningful.
- Writing that self report is unreliable and stopping there, instead of saying what specifically threatens the data, such as denial of symptoms to an interviewer or cultural differences in reporting physical rather than emotional complaints.
- Describing cognitive bias modification as a form of talking therapy. It is a repetitive computer task built from ambiguous scenarios, with no therapist in the room.
- Calling the control group a no treatment group. It received matched training and then the same online therapy, so nobody in the study went untreated.
- Claiming the study proves imagery training cures depression, when every participant also received the therapy, so the contribution of the first week cannot be fully isolated.
- Saying only that participants improved, without naming a measure. Credit follows the operationalisation, so name the depression inventory and say scores fell.
- Ignoring who was excluded. Trials of this kind screen out people at immediate risk, so the result does not speak for the most severely ill.