Journal of Personality Assessment
ISSN: 0022-3891 (Print) 1532-7752 (Online) Journal homepage: http://www.tandfonline.com/loi/hjpa20
Selective Responsiveness of Chronically Ill Children to Assessments of Depression Frances F. Worchel , William A. Rae , T. Kent Olson & Susan L. Crowley To cite this article: Frances F. Worchel , William A. Rae , T. Kent Olson & Susan L. Crowley (1992) Selective Responsiveness of Chronically Ill Children to Assessments of Depression, Journal of Personality Assessment, 59:3, 605-615, DOI: 10.1207/s15327752jpa5903_13 To link to this article: http://dx.doi.org/10.1207/s15327752jpa5903_13
Published online: 10 Jun 2010.
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Citing articles: 22 View citing articles
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Date: 13 November 2015, At: 11:04
JOLKXALOF PERSONAL173' ASSESSMENT. 7992 59i3), 635-615 fc;2>?ight @ 1 9 2 . Lawrence Erlbaum Assoclales. h c
Downloaded by [University of Birmingham] at 11:04 13 November 2015
Selective Res~onsivenessof Chronically ill fhildren to ~ssessmex=& of Depression
William A. Rae and T. Kent Olson Scafi- and White Clinic
Manv investigators have noted that depression is a common :yxp:om among pediatric cancer patients. Picrwever, prevalence :a:s vary wideiy across studies. rates m a v be due, ;n part, to seieceive reporcng of :3 i s variation i c parien:. based on meascres used and ecvironmental cues. In :h:s s:udp, we evaluated 5: chronically ill pediatrxc patienrs (19 cancer and 31 d:abetic patients! for the:e use oi seiective reporting of dep:ession. Factors in the 2 x 2 design were Ister~:ention{disclosurevideo:ape and cartoor: videotape! an&Examiner {familiar examiner end utliamIilar examiner). In the Interventior: manipiliation, subjects were shown either a videotape prompt;.ng the chlid chat self-disclosure was appropriate or a :ape of a car:oon :control condit~on!.In the Examiner mazipuiatio~;.suh~ectswere admmstered rhe experimental measures by either a iamiiia: (perenti or unfamiliar (research assistant) examiner. Bependent variables were :he Children's Depression Inventory C D I ; Kovats, 19811, :he Depression scale of the Roberts Apperception Test fo: Chiidreri (KATC; McArrhur & Kober:s. 1982?, and a depression meassre :&en from h e Chiid Behavior Checklist tCBCL: Achenbach & Edelbrocic. 19831,As hypothesized, the Examiner x 1n:erven:ios interaction revealed tha: ch~idrenwho did not view :he disclosure ~.ideorapeand who were tested by an snfzmiiiar examiner gave sigdicandg iowe: seii-reports oi ->
depression on the CDI r'r,an chiidren in the orhe: cmditions. However, ?arm: 2nd child projective reports oi depression did not van7 as s hncticn of experlmen:al condidon. The resuits are interpreted as se'lecr:ve responding on the part 31 pediatric patients. Linitarions of assessing internal psvchoiogicai s:ares in chiidren are discussed.
Downloaded by [University of Birmingham] at 11:04 13 November 2015
606
WORCHEL, K4E, OLSON, CROWLEY
Among hospitalized pediatric patients, suspected depression constitutes the most common reason for mental health referrals (Chon et a(,, 1988). AIthwugh many investigators have noted that depression is a common symptom in peciiarric cancer patients ( H o f h a n &. Becker, 1973; KelHerman? Zeitzer, Ellenberg, Dash, t i Rigler, 1982.;Plunb Sr Holland, 1977; Taylor, I?'/?), prevalence rates vary wideiy across strlclies (Worchel et al., 1988). In facr, severai investigators have f w n d samples of pediatric pacierrts (cancer and diabedc patients) to score lower oi1 measures of depression than nonnative groups o i ch;ldrerr (Kmcher & 09Mailey. 1% 1; Kovacs, 198I).. There zre severzl possibiIities for this Back of uniform findings. First, children with differerect diseases (e.g., cancer and diabetes) may experience differenr levels of depression. Second, there is wide varia~ihznin pediatric mentzl health services available to medically i!I chiidren, both the specifis treatment facility and the a m o m t of time the child has been exposed to mental health support wILi influence the child's deveiopaect of adaptive coping techniques, Third, there is eviaence that coping with chronic iiiness ioEiows cyclical patterns whereby various rypes and levels of ernoticnal 5~nctioningoccur at different stages of one's disease. Fourth, it is weli known that seif-reports ci depression c o d a t e poorly with other reports of depressicn, Thus, cbscrepant findings may resuit from different types of measures being used. Finally, pediatric patients may denv emotional distress as a function of individual differences and context variabks, prticularly on seif-report measures. Although certainly noi a8 inclusive, the iorego.oing outlines possibiikies behirid discrepant literature findings on the prevaienze of Jepressiorr n chrcnicaily i';I children. It suggests that the field needs to advance beyond a mere comparison of healthy and iii chil&en based en a scandard battery of psychoiogica; tests. Many studies document discrepant reporting between patients and other sources. Jsy: Green, Johnson, CaldweU, and Nitschke (1987)found chat patients were Hesc likely than contrcis to ackncswiedge the possibility of their own death‘. Levensor., Copeland, h.iorrowt Eeiferbaum, and Silberberg (1983) found that adolescents reporied significantly iess fear and discomfor:: regarding medical treatments tharr their parents reported them to have. Jarison, Lewis? and Burish (1 986) fsund that patients generally perceived cancer as being less severe than did healthy controls. ~ o r c h e l Gopeland, ; and Sarker (1987)reported on twc instances of discrepant reporting. First, :Ire cancer parient.5 in their study reported themseives tc! be signikantly Jess depressed than indicated by parenr and nurse ratings. Seccnd, these patients' self-reports of their iilness status were much less severe than the reports given by their physicians. Worchei (1989) suggested that pediatric patients quickly learn the roucine of k i n g 21, and that: although many of them demonstrate some emotional distress, this is much more l:kelp to occcr in specific settings i,e.g., group therapp) or with specific people ie.g., parent or favorite xxsej. She hypothesized that chiicfren who must cope with iliness on a daily basis quickly iearn that they cannot: be sad all the time;
Downloaded by [University of Birmingham] at 11:04 13 November 2015
thus, seEdisciosure of emotisnal distress becomes adapti\.ei\- resericred tc ~pecific si:ua:ions. Focusing primarily o n depressmn, B'orchei er a;. (i98,: suggested that children ~ s t cancer h were iess iikei,: to ;;nderreport symptons of depression m rhe presence ci ianiliar persons and wirh specific c:ies prompting for seif-disciosure. Olrr st& ;\-as designed :s evaluate the use of seiecnve reporting 5 v chrcrni. caliy 1Ii cktldren, weh an emphasis on reports of ciepressicn. W e hvpor5esi:ed . . that child self-reports of depression co:rjd be e ~ p e r i m e n r a i l mampniateci. ~ Specifically, chiidren were expected :o be more self-disclosing when iz the presence oi faxiliar individuals and when external cues proxpted fc: sel6 true Ievei ZC ( l i e ~ r e s s i 3Thus1 a ~ e dix the following ways: '
.
I
.
I. ChJJ seli-reports of depression on objectil+,e tests were compared to , chiidrex's scores on projecti\-e measxres 0: aepressicn. \Ye 1:ypothezizeJ :ha: rhe .. ,. c~jec:iw self-reports would vary across experizenta! condition, whereas the wcxld no: vary. depression scores from the projec:ive -.7 p~ I .i ~- se!f-reports ld of depressrox were ccxpared to paren: repxrs of t i e child's ievei of depression. Agair,, :he child report, no: the parem report, was expected co vary across expcrimentai condition. , . 3. Chiidreri with cancer were compared to chiidrer: with diibetcs to e v a i ~ a r e
.
the effect oT ri-pc of iZIness o n selective responciing,
Subject:; were 5C pediatric oztparienrs drawn from the hematoIogy.:oncoiog?- ir; -.. = 1 9 and diabeces in = 3 ! t services of a prwace medical hospital.. hli patients from these services beween the ages of 6, and Ii were recrui:eJ for the stuciy if they and 2ne parent were English-speaking and if the c h i l ~ r e nciisplsyed nc . . is IS. riot srancirard procedure and shouid he cons~ieredas a swrce i.lipotential b:as. Finalit-, a broad age range was used in rhis study. Further k~vestigatiocc:with a large enmglr saxpi:: to anaiyze effect: by age are desirabie.
Prepararion af this article 11'3s suppcrced by Scot: and White X4emo:ial Hospj:ai hesearch Fund Granr 2%-106-C t c Frances Worchel, W'illiam A. Rae, and P. Kent QIscn. We thank tarry Frznkel: ME, Pediatric Kenatciogyi3ncoiogv Depsrtrent: Pediatric Eriocrinoiog-s Deparmerit, for the:: rechanti William A i l e ~ h4D. :
7
;
nical assistance, advice, and support of this prcject. RTe also thank Sally Kerr, research assstant, for her help in gathering data and Mark Riggs, PhD, and the Scotr and W h t e hlernoria: b s F i t d Biostatrst~csDeparrrnent for their aid in stariscical anaIysisc
Downloaded by [University of Birmingham] at 11:04 13 November 2015
REFERENCES Acher~bach,T. M., 6r Edelbrock, C. S. (1983). M a n m i JOT cite C:".iid Behavior Checitlzst cnd Iieoised Cr.ilc! Behavim Pnjiie. Biiriingtor., VT: University of Vermont, Depa~rmcnrof Psychiamy. Allen, L., & Zigler, E. iISL86). Psychoiogical adjustment of serioas!~ili chiidren. .iotma! 0;' Anmicat: Academy of Chiid Pqchiatq, 25, ?G8-7iZ. Averill. .:. (1973). Personal connoi over aversive s:irnilii and its reiationship to stress. Rychoiogtwi
buIlethl 80. 286-333. Delamater, A. M., Kurtz. S. A/:.: Bu'sb: J., White, N.E,:&Santiago, J. V. (i9E7). Stress and coping in relatior, to rne:abolic controi of adoiescents UX:?Tvpe I diabe:es. Deveiopmer;~iand Behavioml
Pediatrics, 8, 13&l4O. Heisel, W.I., & Matsos, 3. k. (:?84). Assessment of depiessiori in chiidren: T h e internal structure of the Chiid Depression Inventory (CDI;. Behavior Therapy a d Research, 22, 289-298. Hoffman, M. D., &. Eecker? .4. M. (19731. Psvchotherapeutic approaches tr, the plzysicaily i!i adoiescent, Intemcrtiomi journal of Child Psyciwtherafpy, 2. BciZ-512. .&xison, R. K., Lewis, S., & B~l~ish, T.G. (i986j. Psychoiogicai impact of cancer on adolescen:~: Self-image. iocils of controi, perception of i':!ness, and knowledge of cancer. .ioumai oj Cfironzc Diseizses, 39, 5%-617. Jay, S. M., Seen, Johnson, S., Caidweli: S., ti Kitschkc R. (1957). Differences ir, death concepts between c h i l d ~ eu
ISSN: 0022-3891 (Print) 1532-7752 (Online) Journal homepage: http://www.tandfonline.com/loi/hjpa20
Selective Responsiveness of Chronically Ill Children to Assessments of Depression Frances F. Worchel , William A. Rae , T. Kent Olson & Susan L. Crowley To cite this article: Frances F. Worchel , William A. Rae , T. Kent Olson & Susan L. Crowley (1992) Selective Responsiveness of Chronically Ill Children to Assessments of Depression, Journal of Personality Assessment, 59:3, 605-615, DOI: 10.1207/s15327752jpa5903_13 To link to this article: http://dx.doi.org/10.1207/s15327752jpa5903_13
Published online: 10 Jun 2010.
Submit your article to this journal
Article views: 8
View related articles
Citing articles: 22 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hjpa20 Download by: [University of Birmingham]
Date: 13 November 2015, At: 11:04
JOLKXALOF PERSONAL173' ASSESSMENT. 7992 59i3), 635-615 fc;2>?ight @ 1 9 2 . Lawrence Erlbaum Assoclales. h c
Downloaded by [University of Birmingham] at 11:04 13 November 2015
Selective Res~onsivenessof Chronically ill fhildren to ~ssessmex=& of Depression
William A. Rae and T. Kent Olson Scafi- and White Clinic
Manv investigators have noted that depression is a common :yxp:om among pediatric cancer patients. Picrwever, prevalence :a:s vary wideiy across studies. rates m a v be due, ;n part, to seieceive reporcng of :3 i s variation i c parien:. based on meascres used and ecvironmental cues. In :h:s s:udp, we evaluated 5: chronically ill pediatrxc patienrs (19 cancer and 31 d:abetic patients! for the:e use oi seiective reporting of dep:ession. Factors in the 2 x 2 design were Ister~:ention{disclosurevideo:ape and cartoor: videotape! an&Examiner {familiar examiner end utliamIilar examiner). In the Interventior: manipiliation, subjects were shown either a videotape prompt;.ng the chlid chat self-disclosure was appropriate or a :ape of a car:oon :control condit~on!.In the Examiner mazipuiatio~;.suh~ectswere admmstered rhe experimental measures by either a iamiiia: (perenti or unfamiliar (research assistant) examiner. Bependent variables were :he Children's Depression Inventory C D I ; Kovats, 19811, :he Depression scale of the Roberts Apperception Test fo: Chiidreri (KATC; McArrhur & Kober:s. 1982?, and a depression meassre :&en from h e Chiid Behavior Checklist tCBCL: Achenbach & Edelbrocic. 19831,As hypothesized, the Examiner x 1n:erven:ios interaction revealed tha: ch~idrenwho did not view :he disclosure ~.ideorapeand who were tested by an snfzmiiiar examiner gave sigdicandg iowe: seii-reports oi ->
depression on the CDI r'r,an chiidren in the orhe: cmditions. However, ?arm: 2nd child projective reports oi depression did not van7 as s hncticn of experlmen:al condidon. The resuits are interpreted as se'lecr:ve responding on the part 31 pediatric patients. Linitarions of assessing internal psvchoiogicai s:ares in chiidren are discussed.
Downloaded by [University of Birmingham] at 11:04 13 November 2015
606
WORCHEL, K4E, OLSON, CROWLEY
Among hospitalized pediatric patients, suspected depression constitutes the most common reason for mental health referrals (Chon et a(,, 1988). AIthwugh many investigators have noted that depression is a common symptom in peciiarric cancer patients ( H o f h a n &. Becker, 1973; KelHerman? Zeitzer, Ellenberg, Dash, t i Rigler, 1982.;Plunb Sr Holland, 1977; Taylor, I?'/?), prevalence rates vary wideiy across strlclies (Worchel et al., 1988). In facr, severai investigators have f w n d samples of pediatric pacierrts (cancer and diabedc patients) to score lower oi1 measures of depression than nonnative groups o i ch;ldrerr (Kmcher & 09Mailey. 1% 1; Kovacs, 198I).. There zre severzl possibiIities for this Back of uniform findings. First, children with differerect diseases (e.g., cancer and diabetes) may experience differenr levels of depression. Second, there is wide varia~ihznin pediatric mentzl health services available to medically i!I chiidren, both the specifis treatment facility and the a m o m t of time the child has been exposed to mental health support wILi influence the child's deveiopaect of adaptive coping techniques, Third, there is eviaence that coping with chronic iiiness ioEiows cyclical patterns whereby various rypes and levels of ernoticnal 5~nctioningoccur at different stages of one's disease. Fourth, it is weli known that seif-reports ci depression c o d a t e poorly with other reports of depressicn, Thus, cbscrepant findings may resuit from different types of measures being used. Finally, pediatric patients may denv emotional distress as a function of individual differences and context variabks, prticularly on seif-report measures. Although certainly noi a8 inclusive, the iorego.oing outlines possibiikies behirid discrepant literature findings on the prevaienze of Jepressiorr n chrcnicaily i';I children. It suggests that the field needs to advance beyond a mere comparison of healthy and iii chil&en based en a scandard battery of psychoiogica; tests. Many studies document discrepant reporting between patients and other sources. Jsy: Green, Johnson, CaldweU, and Nitschke (1987)found chat patients were Hesc likely than contrcis to ackncswiedge the possibility of their own death‘. Levensor., Copeland, h.iorrowt Eeiferbaum, and Silberberg (1983) found that adolescents reporied significantly iess fear and discomfor:: regarding medical treatments tharr their parents reported them to have. Jarison, Lewis? and Burish (1 986) fsund that patients generally perceived cancer as being less severe than did healthy controls. ~ o r c h e l Gopeland, ; and Sarker (1987)reported on twc instances of discrepant reporting. First, :Ire cancer parient.5 in their study reported themseives tc! be signikantly Jess depressed than indicated by parenr and nurse ratings. Seccnd, these patients' self-reports of their iilness status were much less severe than the reports given by their physicians. Worchei (1989) suggested that pediatric patients quickly learn the roucine of k i n g 21, and that: although many of them demonstrate some emotional distress, this is much more l:kelp to occcr in specific settings i,e.g., group therapp) or with specific people ie.g., parent or favorite xxsej. She hypothesized that chiicfren who must cope with iliness on a daily basis quickly iearn that they cannot: be sad all the time;
Downloaded by [University of Birmingham] at 11:04 13 November 2015
thus, seEdisciosure of emotisnal distress becomes adapti\.ei\- resericred tc ~pecific si:ua:ions. Focusing primarily o n depressmn, B'orchei er a;. (i98,: suggested that children ~ s t cancer h were iess iikei,: to ;;nderreport symptons of depression m rhe presence ci ianiliar persons and wirh specific c:ies prompting for seif-disciosure. Olrr st& ;\-as designed :s evaluate the use of seiecnve reporting 5 v chrcrni. caliy 1Ii cktldren, weh an emphasis on reports of ciepressicn. W e hvpor5esi:ed . . that child self-reports of depression co:rjd be e ~ p e r i m e n r a i l mampniateci. ~ Specifically, chiidren were expected :o be more self-disclosing when iz the presence oi faxiliar individuals and when external cues proxpted fc: sel6 true Ievei ZC ( l i e ~ r e s s i 3Thus1 a ~ e dix the following ways: '
.
I
.
I. ChJJ seli-reports of depression on objectil+,e tests were compared to , chiidrex's scores on projecti\-e measxres 0: aepressicn. \Ye 1:ypothezizeJ :ha: rhe .. ,. c~jec:iw self-reports would vary across experizenta! condition, whereas the wcxld no: vary. depression scores from the projec:ive -.7 p~ I .i ~- se!f-reports ld of depressrox were ccxpared to paren: repxrs of t i e child's ievei of depression. Agair,, :he child report, no: the parem report, was expected co vary across expcrimentai condition. , . 3. Chiidreri with cancer were compared to chiidrer: with diibetcs to e v a i ~ a r e
.
the effect oT ri-pc of iZIness o n selective responciing,
Subject:; were 5C pediatric oztparienrs drawn from the hematoIogy.:oncoiog?- ir; -.. = 1 9 and diabeces in = 3 ! t services of a prwace medical hospital.. hli patients from these services beween the ages of 6, and Ii were recrui:eJ for the stuciy if they and 2ne parent were English-speaking and if the c h i l ~ r e nciisplsyed nc . . is IS. riot srancirard procedure and shouid he cons~ieredas a swrce i.lipotential b:as. Finalit-, a broad age range was used in rhis study. Further k~vestigatiocc:with a large enmglr saxpi:: to anaiyze effect: by age are desirabie.
Prepararion af this article 11'3s suppcrced by Scot: and White X4emo:ial Hospj:ai hesearch Fund Granr 2%-106-C t c Frances Worchel, W'illiam A. Rae, and P. Kent QIscn. We thank tarry Frznkel: ME, Pediatric Kenatciogyi3ncoiogv Depsrtrent: Pediatric Eriocrinoiog-s Deparmerit, for the:: rechanti William A i l e ~ h4D. :
7
;
nical assistance, advice, and support of this prcject. RTe also thank Sally Kerr, research assstant, for her help in gathering data and Mark Riggs, PhD, and the Scotr and W h t e hlernoria: b s F i t d Biostatrst~csDeparrrnent for their aid in stariscical anaIysisc
Downloaded by [University of Birmingham] at 11:04 13 November 2015
REFERENCES Acher~bach,T. M., 6r Edelbrock, C. S. (1983). M a n m i JOT cite C:".iid Behavior Checitlzst cnd Iieoised Cr.ilc! Behavim Pnjiie. Biiriingtor., VT: University of Vermont, Depa~rmcnrof Psychiamy. Allen, L., & Zigler, E. iISL86). Psychoiogical adjustment of serioas!~ili chiidren. .iotma! 0;' Anmicat: Academy of Chiid Pqchiatq, 25, ?G8-7iZ. Averill. .:. (1973). Personal connoi over aversive s:irnilii and its reiationship to stress. Rychoiogtwi
buIlethl 80. 286-333. Delamater, A. M., Kurtz. S. A/:.: Bu'sb: J., White, N.E,:&Santiago, J. V. (i9E7). Stress and coping in relatior, to rne:abolic controi of adoiescents UX:?Tvpe I diabe:es. Deveiopmer;~iand Behavioml
Pediatrics, 8, 13&l4O. Heisel, W.I., & Matsos, 3. k. (:?84). Assessment of depiessiori in chiidren: T h e internal structure of the Chiid Depression Inventory (CDI;. Behavior Therapy a d Research, 22, 289-298. Hoffman, M. D., &. Eecker? .4. M. (19731. Psvchotherapeutic approaches tr, the plzysicaily i!i adoiescent, Intemcrtiomi journal of Child Psyciwtherafpy, 2. BciZ-512. .&xison, R. K., Lewis, S., & B~l~ish, T.G. (i986j. Psychoiogicai impact of cancer on adolescen:~: Self-image. iocils of controi, perception of i':!ness, and knowledge of cancer. .ioumai oj Cfironzc Diseizses, 39, 5%-617. Jay, S. M., Seen, Johnson, S., Caidweli: S., ti Kitschkc R. (1957). Differences ir, death concepts between c h i l d ~ eu
