Objective: Axis V, which uses the Global Assessment of Functioning Scale in the multiaxial system of DSM-III-R, is under review for DSM-IV. This article examines what is known about axis V and selectively reviews the literature on measures of social functioning to identify potential alternatives to the Global Assessment of Functioning Scale. Method: About 25 studies on the use, reliability, and validity of axis V in DSM-III and DSM-III-R are reviewed. In addition, nearly 30 measures of social functioning are reviewed and analyzed as potential substitutes for the Global Assessment of Functioning Scale. The analysis focuses on the strengths and weaknesses of each measure for assessing functioning on axis V. Results: Axis V measures are modestly reliable and valid but not widely used. The authors identify and discuss two particular limitations on the Global Assessment of Functioning Scale: 1) the combination of measures of symptoms and measures of social functioning on a single axis and 2) the exclusion of physical impairments from the rating of functioning. Conclusions: None of the measures of social functioning reviewed is clearly superior to the Global Assessment of Functioning Scale for use on axis V. A modified version of the Global Assessment of Functioning Scale, separating the measures of social and occupational functioning from the measures of symptoms and psychological functioning, is proposed for field testing, along with a new set of instructions permitting the rating of limitations due to both physical and mental impairments.

Revising Axis V for DSM-IV: A Review of Measures of Social Functioning

In this article we attempt to distinguish empirically between psycho-social variables that are concomitants of depression, and variables that may serve as antecedents or sequelae of this disorder. We review studies that investigated the relationship between depression and any of six psychosocial variables after controlling for the effects of concurrent depression. The six variables examined are attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The review suggests that whereas there is little evidence in adults of a cognitive vulnerability to clinical depression, disturbances in interpersonal functioning may be antecedents or sequelae of this disorder. Specifically, marital distress and low social integration appear to be involved in the etiology of depression, and introversion and interpersonal dependency are identified as enduring abnormalities in the functioning of remitted depressives. We attempt to integrate what is known about the relationships among these latter variables, suggest ways in which they may influence the development of depression, and outline specific issues to be addressed in future research.

https://psych.unl.edu/psyc451_2015/ashby/barnett_gotlib.pdf

Psychosocial Functioning and Depression: Distinguishing Among Antecedents, Concomitants, and Consequences

ContextMajor depressive disorder (MDD) that arises in
adolescence impairs functioning and is associated with suicide risk,
but little is known about its continuity into adulthood.ObjectiveTo describe the clinical course of adolescent-onset MDD
into adulthood.Design and ParticipantsProspective case-control study.
Seventy-three subjects had onset of MDD based on systematic clinical
assessment during adolescence (Tanner stage III-V) and 37 controls had
no evidence of past or current psychiatric disorders, and also were
assessed in adolescence (assessment years: 1977-1985). Follow-up was
conducted 10 to 15 years after the initial assessment by an independent
team without knowledge of initial diagnosis (follow-up years:
1992-1996).SettingCases were identified at Columbia Presbyterian Hospital,
New York City, NY; controls were recruited from the community.Main Outcome MeasuresSuicide and suicide attempts, psychiatric
diagnoses, treatment utilization, and social functioning.ResultsClinical outcomes of adolescent-onset MDD into adulthood
compared with control subjects without psychiatric illness include a
high rate of suicide (7.7%); a 5-fold increased risk for first suicide
attempt; a 2-fold increased risk of MDD, but not other psychiatric
disorders; an increased occurrence of psychiatric and medical
hospitalization; and impaired functioning in work, social, and family
life. Thirty-seven percent of those with adolescent MDD survived
without an episode of MDD in adulthood vs 69% of the control
participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7;
P<.05]).ConclusionThere is substantial continuity, specificity,
morbidity, and potential mortality from suicide into adulthood in
adolescent-onset MDD patients. Now that empirically based guides to
their treatment are becoming available, early identification and
treatment seems warranted.

https://jamanetwork.com/journals/jama/articlepdf/189858/joc81650.pdf

Depressed Adolescents Grown Up

Objective:Several recent studies have documented that substantial functional impairment is associated with many of the mental disorders seen in primary care. However, brief measures of mental health-related functional impairment are not commonly applied in primary care settings. The Sheehan Disability Scale (SDS), a three-item instrument for assessing such impairment, is evaluated in this study. Method: A psychometric analysis of the SDS was conducted with a sample of 1001 primary care patients at Kaiser Permanente in Oakland, California. The SDS and the Symptom Driven Diagnostic System for Primary Care assessments were completed.Results:The internal consistency reliability of the SDS is high, with coefficient alpha of 0.89. The construct validity was substantiated in two ways. A one-factor model fit the data quite well. Furthermore, patients with each of six psychiatric disorders had significantly higher impairment scores than those who did not. Finally, over 80 percent of the patients with mental disord...

Assessing Psychiatric Impairment in Primary Care with the Sheehan Disability Scale

Many lay persons and professionals believe that child sexual abuse (CSA) causes intense harm, regardless of gender, pervasively in the general population. The authors examined this belief by reviewing 59 studies based on college samples. Meta-analyses revealed that students with CSA were, on average, slightly less well adjusted than controls. However, this poorer adjustment could not be attributed to CSA because family environment (FE) was consistently confounded with CSA, FE explained considerably more adjustment variance than CSA, and CSA-adjustment relations generally became nonsignificant when studies controlled for FE. Self-reported reactions to and effects from CSA indicated that negative effects were neither pervasive nor typically intense, and that men reacted much less negatively than women. The college data were completely consistent with data from national samples. Basic beliefs about CSA in the general population were not supported.

Content Notes Appendix References: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A Meta-Analytic Examination of Assumed Properties of Child Sexual Abuse Using College Samples

Current emphasis on early case finding, outpatient care, and on longitudinal studies of asymptomatic patients has focused attention on the community adjustment of psychiatric patients. Thus, simple and inexpensive methods such as self-report scales, which allow the routine assessment of patient adjustment, are potentially useful. The derivation and testing of such a method, the Social Adjustment Scale Self-Report, is described. This scale covers the patient's role performance, interpersonal relationships, friction, feelings and satisfaction in work, and social and leisure activities with the extended family, as a spouse, parent, and member of a family unit. Self-report results based on 76 depressed outpatients were comparable to those obtained from relatives as well as by a rater who interviewed the patient directly.

Assessment of Social Adjustment by Patient Self-Report

Social functioning of 40 depressed women was studied four years following the acute episode, and compared with 40 normal community subjects. Results show that the social impairments of depressed patients persist well beyond the acute episode, particularly in marital and close interpersonal relations. Clinical and public health implications are discussed.

Social impairments four years after an acute depressive episode

The results of a double-blind trial of a tetracyclic antidepressant, maprotiline (Ludiomil®) and a conventional tricyclic, amitriptyline (Elavil®), in 67 ambulatory depressives are reported. hamilton's Rating Scale for Depression was the main outcome criterion.



No statistically significant differences were found between the drugs in onset of action, efficacy, side effects or predictors of response. Patients on either drug showed a significant reduction in symptoms after 1 week of treatment and at the end of the trial. Both drugs were tolerated well. A review of double-blind comparisons of maprotiline and tricyclic antidepressants, spanning 13 countries, and including over 900 patients, both ambulatory and inpatient, shows essentially similar results. The main outcome criterion in all these studies was manifest psychopathology assessed on the Hamilton Rating Scale for Depression by the treating physician. The absence of additional types of outcome criteria or assessment techniques, which may have detected differences in motor activity or drive as originally postulated, may have obscured results which were expected to be subtle.

Sallye Bothwell

Papers

Assessment of Social Adjustment by Patient Self-Report

Social impairments four years after an acute depressive episode

A double-blind trial of maprotiline (Ludiomil) and amitriptyline in depressed outpatients.