URGENT--Due 5/10 by 10PM (EST) APA Format *Topic: Depression* (Advanced Test & Measures PhD Coursework)

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Week Three Written Assignment Grading Criteria Content Criteria (6 Points) Points Content includes a discussion of the construct of interest.

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Content includes an evaluation and critique of 5-7 instruments that measure a construct of interest. Content includes a summary of the strengths and weaknesses of 5-7 instruments and whether they adequately assess the construct of interest. Content adequately assess the reliability and validity of the 5-7 instruments. Content includes a summary of the areas that are not adequately addressed in instruments. Writing and Organization Criteria (3 Points ) Writing style is clear and concise.

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Tone is academic and appropriate for the content and assignment. Thesis statement is clearly articulated. Structure is logical, including an introduction, body, and conclusion. Flow is maintained by effective transitions. Rules of grammar, punctuation, and spelling are followed. Adherence to APA formatting requirements is evident. Research Criteria (3 Points) Sources are credible (preferably peer-reviewed), varied, relevant, and current (published within past five years); use of seminal work (e.g. Freud) is encouraged.

3 Sources inform analysis, evaluation, problem-solving and decision-making. Includes required number of professional/scholarly sources. Addresses ethical considerations in research when appropriate. Information used is supported appropriately by references. Total Possible Points (12 Points) 10.5

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Test Development Proposal: Step Two

Athenia L. Adams

The University of Arizona Global Campus

RES7402: Advanced Tests & Measurements (QAH114DS)

Dr. Malcolm Whitehead

April 19, 2021

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Test Development Proposal: Step Two

Depression Disorder is a common mental health problem whose symptoms can vary

from mild to severe. Some of the common symptoms of mood disorder include loss of interest,

persistent feelings of sadness, appetite changes, sleeping too little or too much, fatigue, feelings

of guilt or worthlessness, difficulty in making decisions, thinking, or concentrating, and

recurrent suicidal thoughts. Depression disorder is twice as common among women as men.

Women predominantly suffer two types of disorders, namely, premenstrual dysphoric disorder

and postpartum depression (Dauphin, 2020). According to the Center for Disease Control and

Prevention (2018), 8.1% of Americans above 20 suffer depression at least once on average

within a two-week period. If not well treated, depression is one of the most serious medical

conditions that can harm an individual's everyday life. Depression disorder has different

symptoms in college students, teens, and children. In college students, the most notable include

insomnia, avoiding social activities, and persistent lack of interest and concentration in

schoolwork. Symptoms in teens include withdrawing from family and friends, feeling guilty,

worthless, and helpless, and restless. In children, the symptoms include vocal outbursts, crying,

clinginess, and defiant behavior (Dauphin, 2020, p.122). Therefore, depression disorder may

have different symptoms depending on a person's age, gender, and profession.

While many researchers focus on symptoms and treatment, Bushnell et al. 2019 focus on

depression causes. Some of the causes include genetic features, environmental factors,

conditions such as bipolar disorders, changes in the brain's neurotransmitter levels. However,

other symptoms may be triggered by a combination of various factors such as social and

psychological factors. Depression can be treatable by managing symptoms through

psychotherapy, support, and drug treatment. Support includes discussing possible causes and

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practical solutions. Additionally, support can be through educating family members and friends.

Psychotherapy may include cognitive behavioral therapy and one-on-one counseling. Some of

the medication’s doctors prefer for treatment include antidepressants, such as atypical and

tricyclic, and selective serotonin reuptake inhibitors. However, researchers have invested their

energy and resources in developing tests and instruments for measuring depression disorder for

effective treatment. Tests and instruments will assist in successfully handling the condition.

According to Sugishita et al. 2017, The 15-Item Geriatric Depression Scale is the most

used screening instrument to measure depression among older adults. The scale consists of

fifteen questions where the older adults must answer in a "Yes/No" format. Initially, GDS

consisted of thirty questions, but later it was reduced to fifteen because of the high correlation

with depression disorder symptoms in various validation studies. According to Sugishita et al.

2017 of the fifteen items, five are indicative of depression when answered negatively, while ten

is indicative of depression if answered positively. If the patient gets a score above five, they will

need to be evaluated further. According to Stone et al. 2019, GDS was invented in response to

the poor applicability of existing depression screeners favorable for the elderly. One of the

advantages of the 15-Item Geriatric Depression Scale is that it is formatted straightforwardly,

which is likely to take the respondent 5-7 minutes, making it ideal for people who have limited

ability to concentrate for longer periods of time and who are easily fatigued. Some of the

questions may include, "Do you feel that your life is empty? Do you feel like your situation is

hopeless? A score of 0-5 is normal, which means the patient does not have depression disorder.

In terms of psychometric properties, the 15-Item GDS is relatively reliable. The study

conducted by Stone et al. 2019, results containing the findings of 338 published studies on GDS

showed an 85% accuracy level, with the Japanese version of GDS being rated at 94% reliable.

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GDS is rated at 91% in terms of validity, which makes it ideal for proper self-assessment among

older adults. From research, GDS has 89% specificity and 92% sensitivity when evaluated

against diagnostic criteria. GDS’s reliability has been supported through research and clinical

practice, emerging as the best depressing screening tool for older adults. However, the only

weakness of the GDS is that it does not assess for suicidality. Also, when a responder is naïve or

not concentrating, the GDS scale misleads the physician, leading to a wrong diagnosis.

PHQ-9 is a criteria-based 9-item depression scale for depression assessment. It is the

most validated tool in mental health, especially in diagnosing depression (Bushnell et al. 2019).

Clinicians also use it to monitor mental health treatment responses. PHQ-9 score is obtained by

developing total points by adding the score for the nine questions. Some of the questions asked

include little interest or pleasure in doing things, feeling tired or having little energy, and poor

appetite or overeating. A PHQ-9 Score of 0-4indicates none or minimal depression severity, 5-9

indicates mild depression, 10-19 indicates moderate, while the 20-17 scale indicates severe

depression severity. According to research, PHQ-2 has 67% specificity and 97% sensitivity;

thus, clinicians can use it first. If the outcome is positive, PHQ-9 can be conducted, which has

94% specificity and 61% sensitivity in adults. The Patient Health Questionnaire, which Pfizer

initially developed, has high reliability and validity of around 88% in both cases.

According to Levis et al., 2019, Clinicians have preferred the PHQ-9 for more refined

results. This is because the 9 DSM-5 criteria of "3" which mean nearly every day, and “0”

means not at all. Therefore, unlike GDS, PHQ-9 can be used to assess the extent of the response.

One of the advantages of PHQ-9 is that it is short, it can give finer details, and it has a higher

rate of true positives. Clinicians may find the tool useful when assessing anxiety and disorder

since they can be able to evaluate the depression severity as either none, mild, moderate, and

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severe due to the scores depending on everyday responses. However, some of the PHQ-9

assessment tool weaknesses include a high rate of "false negatives" and "false negatives," and it

does not test the suicidality scale. When there are too many outcomes, treating patients with

depression must always be followed with a more comprehensive diagnostic assessment to

establish the main symptoms.

According to Keum et al. 2018, the Hamilton Rating Scale is a depression screening tool

which was written by a psychiatrist at Leeds University, Max Hamilton, to evaluate the

effectiveness of the first group of antidepressants. A questionnaire was developed for use by

clinicians with an already identified depressed patient. Therefore, the tool is used to measure the

rigorousness of the illness at any point in time. The questionnaire interview typically takes 15-

20 minutes, and the tool's reliability depends on the interviewing skills of the clinician. The total

score is established when all the scores have been summed up. “The HRSD has demonstrated

reliability, validity, and efficiency in older adults. It contains 17 items, and it is rated on a 3- or

5-point Likert type scale with the sum of all the items summed to make up the total score"

(Nixon et al., 2020, p.6). A patient can score between 0-61, and clinical cutoff scores range from

14-20. An outcome of between 0-7 is considered normal, while anything above 14 is considered

mild and moderate, while anything above 23 is severe and requires further medical attention.

The Hamilton Rating Scale has 71-83 reliability, which in most cases depends on the

clinician's questioning capability (Bushnell et al. 2019 p. 907.). The validity of the Hamilton

scale comprises factorial, convergent, content discriminant, and predictive validity. The

researchers found the average validity to vary between 79-91%. One of the advantages of the

Hamilton Depression scale is that it focuses on core symptoms to the exclusion of psychomotor

and somatic items (Bushnell et al. 2019). Another advantage is that the scale has adequate

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internal reliability, convergent and discriminant validity. However, Hamilton Depression Scale

has been criticized, with studies showing that the scale was not developed for TBI. The scale's

content validity is poor, and many items are poor contributors to the assessment of depression

severity while others have poor retest and interrater reliability. Additionally, the study has

shown that the Hamilton Depression scale is conceptually and psychometrically flawed. Finally,

the scale can exclusively be used by clinicians, and it places more emphasis on insomnia other

than self-destructive thoughts, feelings of hopelessness, and suicidal cognitions.

Bender et al. 2018 used the Journal of Personality Assessment to prove the DSM-5

Manual is a handbook used by psychiatrists and clinicians as an authoritative guide to the

diagnosis of depression, especially depression, and is sometimes referred to as the psychiatrist

bible. It is reliable to patients of all age groups, and the manual contains symptoms,

descriptions, and diagnosis methods for other mental disorders. According to the APA,

Dauphin (2020) suggests the manual has been revised many times to increase the validity.

DSM-5 consists of three sections; the first section deals with the introduction and manual

information, the second section deals with diagnostic criteria and codes, and the third section

deal with glossary measures and conditions requiring an additional review. DSM-5 is the most

effective tool in depression diagnosis and treatment because it has been upgraded multiple times

due by skilled professionals. Therefore, it is a work in progress. The strengths of DSM-5 include

standardization, it helps guide research in the field of mental health, and it plays a bigger role in

therapeutic guidance by eliminating guesswork. Some of the weaknesses of DSM-5 include it

oversimplifies human behavior, does not provide treatment, engenders stigma, and increases the

risk of overdiagnosis or misdiagnosis.

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According to Dauphin (2019), the American Psychological Association Depression

Guideline is a new depression screening guideline that APA has proposed in American

hospitals. The manual provides research-based recommendations for treating subsyndromal

depression, major depression, and persistent depressive disorder in people of all ages using

methods such as Pharmacotherapy, psychotherapy, and alternative treatments. The guidelines

were developed by very effective researchers with a view of developing a screening tool that is

effective across all ages. According to research, the scientists consider factors such as patient

values versus preferences, treatment benefits versus burdens or harms, the strength of evidence,

and applicability of treatment. The main strength of the American Psychological Association

Depression Guideline is that it is a progressive assignment that tends to incorporate many

psychiatrists' professional's views (Kirsten, 2019). Furthermore, just like the DSM-5 manual, the

guidelines provide a standardized treatment and helps eliminate guesswork. However, one

weakness is that the guidelines are only for use by clinicians only, denying individual patients

the privilege of self-diagnosis., also they increase the risk of misdiagnosis. Conclusively,

researchers have recommended an increase in depression disorder research for older adults.

The gap in the existing tests and instruments for diagnosing depression disorder includes

a lack of a standardized screening tool, with reliability and validity of above 95% that can be

used for all age groups. Another gap is a highly reliable tool that individual patients can use to

self-assess without necessarily visiting healthcare facilities. To address the gap, my proposed

test will enable depression patients to self-assess their conditions and have the privilege to

understand the best treatment mechanisms for the disorder. However, because most of the

current tests and screening tools are subject to unreliable results due to repetition of questions,

my proposed test will have only six questions, with a percentage-point Likert-type scale. The

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scale will be based on the extent of the patient’s condition from "0%' denotes none, "50%"

indicates moderate, while "100%" indicates severe depression. This will enable the patient and

the clinician to know the severity of the extent of the condition. Besides, the proposed test will

give treatment conditions for every average percentage mark given. The average percentage of

the depression will be getting the mean average of all the six questions answered, which will

typically take between 5-10 minutes depending on the patients' age. For young and older adults

who cannot compute the average, they can be assisted by close guardians. The test can be

repeated several types a day according to the patient's mood changes. Furthermore, the test will

have a standardized treatment recommendation in conformity with the APA’s DSM-5 and the

American Psychological Association Depression Guideline.

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References

Bender, D. S., Zimmermann, J., & Huprich, S. K. (2018). Introduction to the Special Series on

the Personality Functioning Component of the Alternative DSM-5 Model for Personality

Disorders. Journal of Personality Assessment, 100(6), 565–570. https://doi-org.proxy-

library.ashford.edu/10.1080/00223891.2018.1491856

Bushnell, D. M., McCarrier, K. P., Bush, E. N., Abraham, L., Jamieson, C., McDougall, F.,

Trivedi, M. H., Thase, M. E., Carpenter, L., & Coons, S. J. (2019). Symptoms of Major

Depressive Disorder Scale: Performance of a Novel Patient-Reported Symptom

Measure. Value in Health : The Journal of the International Society for

Pharmacoeconomics and Outcomes Research, 22(8), 906–915. https://doi-org.proxy-

library.ashford.edu/10.1016/j.jval.2019.02.010

Dauphin, V. B. (2020). A critique of the American Psychological Association Clinical Practice

Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults.

Psychoanalytic Psychology, 37(2), 117–127. https://doi-org.proxy-

library.ashford.edu/10.1037/pap0000253

Keum, B. T., Miller, M. J., & Inkelas, K. K. (2018). Testing the factor structure and

measurement invariance of the PHQ-9 across racially diverse U.S. college

students. Psychological Assessment, 30(8), 1096–1106. https://doi-org.proxy-

library.ashford.edu/10.1037/pas0000550

Kirsten, W. (2019). APA offers new guidance for treating depression.

https://www.apa.org. https://www.apa.org/monitor/2019/09/ce-corner-depression

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Stone, L. E., Granier, K. L., & Segal, D. L. (2019). Geriatric depression scale. Encyclopedia of

Gerontology and Population Aging, 1-8. https://doi.org/10.1007/978-3-319-69892-

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Sugishita, K., Sugishita, M., Hemmi, I., Asada, T., & Tanigawa, T. (2017). A Validity and

Reliability Study of the Japanese Version of the Geriatric Depression Scale 15 (GDS-15-

J). Clinical Gerontologist, 40(4), 233–240. https://doi-org.proxy-

library.ashford.edu/10.1080/07317115.2016.1199452