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Selective responsiveness of chronically ill children to assessments of depression
F F Worchel1, W A Rae, T K Olson
1Texas A&M University.
Insights
Pediatric cancer patients may underreport depression when prompted to disclose information and tested by unfamiliar examiners. This selective reporting impacts depression prevalence rates in children with chronic illnesses.
Area of Science:
- Pediatric Psychology
- Child Psychiatry
- Clinical Psychology
Background:
- Depression is common in pediatric cancer patients, but prevalence rates vary.
- Selective reporting due to measures and environment may explain rate variations.
Purpose of the Study:
- To evaluate selective reporting of depression in chronically ill pediatric patients.
- To examine the influence of disclosure videotapes and examiner familiarity on depression self-reports.
Main Methods:
- 50 chronically ill children (19 cancer, 31 diabetic) participated in a 2x2 factorial design.
- Intervention: disclosure videotape vs. cartoon videotape. Examiner: familiar (parent) vs. unfamiliar (researcher).
- Depression assessed using Children's Depression Inventory (CDI), Roberts Apperception Test for Children (RATC), and Child Behavior Checklist (CBCL).
Main Results:
- Children not viewing disclosure tape and tested by unfamiliar examiners reported lower depression on CDI.
- No significant differences in depression on parent/child projective measures across conditions.
- Results suggest selective responding in pediatric patients.
Conclusions:
- Examiner familiarity and intervention type influence pediatric depression self-reporting.
- Selective responding complicates accurate assessment of depression in children.
- Limitations in assessing children's internal psychological states are highlighted.
Abstract:
Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies. This variation in prevalence rates may be due, in part, to selective reporting of patients based on measures used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the Intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression Inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x Intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.