The bias in regression-based indices of premorbid IQ.

Formulas for premorbid intelligence estimates are typically derived by linear regression and are therefore biased in individual cases because of regression to the mean. It is shown that it is inappropriate to compare such IQ estimates with current IQ scores to determine whether a decline from premorbid levels has occurred. This widespread practice grossly overestimates the probability of an IQ decline in the below-average range and grossly underestimates it in the above-average range, with serious implications for clinical practice. The authors present a formula for computing unbiased estimates of IQ decline as well as a test of the null hypothesis of no decline. Corresponding tables for several combinations of test indices and estimation methods are included for practical reference.

Biased estimators, biased experts, and the Ivory Tower: a reply to Grove (2001).

This reply responds to W. M. Grove's (2001) critique of H. O. F. Veiel and R. F. Koopman's (2001) article on bias in widely used methods of estimating premorbid IQ. In this reply, the authors show that Grove is misrepresenting part of Veiel and Koopman's arguments, extend them to show that the proposed adjustment to regression estimates of IQ not only is unbiased but also is the maximum-likelihood estimate of the true IQ, and argue that Grove's notion of the acceptability of biased methods in judicial proceedings reflects a fundamental misapprehension of their nature and purpose.

Measuring unfitness to stand trial: psychological analysis of a legal issue.

The structure of the legal concept of unfitness to stand trial and how it corresponds to psychometric concepts is examined. We conclude that psychometric attempts at quantification and measurement are logically flawed, because they inappropriately treat fitness/unfitness as an individual trait rather than as situation-specific conjunctive/disjunctive concepts. It is argued that, whereas psychometric approaches may be suitable for measuring single components of unfitness, an overall "fitness" score is meaningless and that the assessment should focus on elements of unfitness. The determination of unfitness requires the simultaneous consideration of several different individual capabilities in reference to the demands of a specific trial. The quantification of these specific capabilities by psychologists can assist psychiatrists and the court, but the evaluation of their influence on unfitness in the instant case must be left to the court.

A preliminary profile of neuropsychological deficits associated with major depression.

A profile of neuropsychological deficits of clinically depressed (major depression) but otherwise unimpaired individuals is presented, based on a meta-analysis of all studies published since 1975 and meeting stringent methodological and sample selection criteria. Deficits are discussed separately for different cognitive areas in terms of mean size of deficit, variability between studies, variability of individual scores in depressed populations relative to that of controls, and expected proportion of depressed individuals scoring two standard deviations or more below the mean of controls. The neuropsychological deficits of individuals with major depression are shown to be consistent with a global-diffuse impairment of brain functions with particular involvement of the frontal lobes. Recent neuro-imaging studies also indicating frontal dysfunction in clinical (functional) depression are referred to. Both the severity and the profile of cognitive deficiencies in depression are postulated to be similar to those seen in moderately severe traumatic brain injury.

CVLT recognition-recall discrepancies and retrieval deficits. A comment on Wilde et al (1995)

The methodological procedures employed by the authors are inappropriate for their data. Even when the results of the statistical analyses are taken at face value, the interpretation that there is no difference between the Discrepancy and Nondiscrepancy group is unsustainable, and the authors' conclusions that retrieval deficits do not underlie recognition-recall discrepancies is unwarranted. Therefore, the Wilde et al. study can not be taken as an adequate test of this issue. The interpretation of recall-recognition discrepancies as retrieval deficits should continue to be regarded as very plausible. What stands out as a robust result of the Wilde et al. study is the significantly greater heterogeneity of the Nondiscrepancy group as compared with the Discrepancy group, although this may well be a selection artifact, given a similar difference in the grouping variables. Regardless of whether this is the case, it underscores the necessity of greater attention to distributional problems, either by applying more stringent selection criteria or by using nonparametric statistical methods.

Detrimental effects of kin support networks on the course of depression.

On the basis of preliminary findings that, for recovered depressed patients, a good family support network is associated with a subsequent increase in depressive symptoms, a prospective study is presented which examines the specific conditions under which this counterintuitive effect is present. A sample of 168 depressed psychiatric inpatients was assessed 1 and 7 months after discharge from hospital regarding, among other variables, depressive symptomatology, diagnostic status, and the composition and supportive functions of their social networks. The detrimental effect was restricted to female patients who were recovered at discharge and who were homemakers, and it involved supportive relatives, in particular relatives providing close psychological and emotional support in crises. Possible psychological and psychosocial mediators as well as implications for research and intervention are discussed.

Psychosocial correlates of clinical depression after psychiatric in-patient treatment: methodological issues and baseline differences between recovered and non-recovered patients.

General methodological and design issues in research on psychosocial outcome predictors of clinical depression are discussed, and the first stage of a study of discharged depressed in-patients is presented. It involved 115 recovered and 75 non-recovered such patients who were compared regarding stress factors, social support, personality and coping styles. While there were few differences between recovered and non-recovered patients with respect to stable personality traits, recovered patients were less likely to have had severe long-term life difficulties, and their coping style differed: it was characterized by more negative appraisals of stressful situations, greater problem avoidance, less palliative activities, and a lesser inclination to solicit social support. Whereas among women without partners, as well as men, non-recovery was also associated with less support from friends, in particular psychological-emotional support in crises, non-recovered women with partners had much more such support. The results are discussed with reference to the existing literature on outcome correlates of clinical depression.

Relatives and depressive relapse: the critical period after discharge from in-patient treatment.

In a sample of 60 remitted depressed in-patients, the power of three basic parameters of the social support network--Kin Support Network Size; Non-kin Support Network Size; and Satisfaction with Support--to predict depressive symptom levels seven months after discharge was examined. The results suggest that even positive, supportive family relationships can have a distinctly detrimental effect, and that a depressed in-patient's return to his or her family represents a crucial period for the further course of the disorder. The findings are discussed with respect to the social support literature and the 'Expressed Emotion' concept. It is held that neither paradigm provides an adequate explanation, and alternative mediating mechanisms are suggested.

Self-esteem and depression. II. Social correlates of self-esteem.

The Self-Evaluation and Social Support Schedule (SESS), an interview-based instrument, is described, which aims to give a comprehensive description of a person's social milieu in terms of 'objective' and 'subjective' measures. On the basis of a population survey of 400 largely working-class women, a tentative causal model is developed which relates both the quality of current interpersonal ties and childhood experiences to current negative and positive measures of self-esteem. A major purpose of the exercise is to develop positive and negative indices of the social environment that can be used to elucidate the aetiological role of self-esteem in the development of depression. This is the task of a third paper.

The Mannheim Interview on Social Support. Reliability and validity data from three samples.

Social support questionnaires usually provide scant information about the members of supporting networks, while network-analytical approaches often fail to sufficiently detail the functional aspects of social support available to an individual. A structured interview, the "Mannheim Interview on Social Support" (MISS) is presented which combines the advantages of both approaches by mapping an individual's social resources in a "support matrix" of [network members] * [relationship characteristics + support functions]. Stability and validity data collected in three different samples (discharged depressed in-patients, university students, and parents of children afflicted with cancer) are reported. Test-retest correlations are compared with alternative measures of stability, and the relationship of various MISS scores to scores based on conceptually related instruments is explored. The results indicate good test-retest stability of the main functional and structural MISS scores rtt = 0.66 to 0.88 for a four-week interval, and rtt = 0.42 to 0.79 for a six-month-interval). It is shown that the MISS captures several dimensions of a person's social support environment not covered by questionnaires targeting subjective perceptions of support.

Depressed mood and major depressive episodes: differential responsiveness to psychosocial experiences.

In a sample of 64 remitted and discharged depressed in-patients the structure and quality of their social environment was examined in relation to the subsequent development of depressive symptoms. It is shown that mood-related symptoms were influenced by psychosocial factors, whereas vegetative and non-specific symptoms were not. Since the latter are rather more heavily weighted in the DSM-III criteria for Major Depressive Episode than in typical symptom sum scores, psychosocial variables did not predict DSM-III-defined clinical relapses. Possible implications for conceptualizing depressive disorders are discussed.

The social supports of suicide attempters: the different roles of family and friends.

The social support patterns of a sample of 101 suicide attempters were compared with the patterns of a control sample on the basis of structured interview data. Network characteristics and the extent of support in different functional categories were examined as to their absolute and relative power to discriminate between the suicide attempters and the controls. A clear separation of the functions of kin and of friends/acquaintances emerged. The crucial difference between the attempters and the controls lay in the number of friends with whom the subjects had agreeable everyday interactions and in the number of kin that provided crisis support, both psychological and instrumental. Other support differences between the two groups were of secondary importance. While there was no overall difference in the frequency of social interactions between the two groups, the size of the social network differed greatly. Consequences for the conceptualization and measurement of social support as well as for the prevention of suicidal behavior are discussed.

Base-rates, cut-points and interaction effects: the problem with dichotomized continuous variables.

On the background of the recent discussion about the appropriateness of linear difference and ratio models for testing interaction effects of social support and stress, it is argued that interaction effects are basically unstable when dichotomized continuous variables are analysed. A data set with known interrelationships of the continuous variables 'stress', 'social support', and 'depression' was simulated and analysed in tabular format. It is shown that the choice of cut-points for the independent variables crucially determines the size and presence of interaction effects in ratio analysis models.

Buffer effects and threshold effects: an alternative interpretation of nonlinearities in the relationship between social support, stress, and depression.

The common interpretation of statistical interactions of global measures of social support and stress in their effects on depression (the "buffer effect" of social support) as reflecting interactive processes within individuals was examined. It was argued that its adequacy depends on incorrect assumptions about the distribution of depressive symptoms within individuals over time and/or different levels of psychosocial adversity. With hypothetical data sets generated under the assumption of a threshold effect in the development of depression and of additive, rather than interactive, effects of social support and stress, it was demonstrated that spurious "buffer effects" of social support can appear in analyses of cross-sectional data. Methodological and substantive implications are discussed, and strategies for study design and data analysis are proposed that allow to assess whether empirical deviations from linearity are more adequately interpreted as a buffer or as a threshold effect.

Psychopathology and Boolean Factor Analysis: a mismatch.

It has recently been claimed that Boolean Factor Analysis (BFA) is superior to more traditional approaches to empirical syndrome identification in psychopathology (Weber & Scharfetter, 1984). This paper examines the underlying assumptions and the empirical basis of this claim. A hypothetical data set, with a more complex structure than the examples used by Weber & Scharfetter to support their claim, is analysed by means of both BFA and Ordinary Factor Analysis (OFA). It is shown that, as data sets resemble empirical conditions more closely, BFA may break down completely while OFA continues to yield adequate results.