Interview Ratings Research Articles

Can We Predict “Problem Residents”?

This study investigates whether data available at the time of residency application can be used to predict more accurately future problems of performance, both during and after residency. The authors identified all residents with reported problematic behavior across 20 years (1987-2007) at a single residency program and created a set of matched controls. Problems were further divided into "major" (leading to significant disruptions of performance and disciplinary action) and "minor" (remediable and resolved). Application materials were then reviewed for United States Medical Licensing Examination (USMLE) scores, evidence of academic failures, interviewer ratings, negative interviewer comments, negative comments in the dean's letter, and negative comments in letters of recommendation. The presence of any negative comments in the dean's letter yielded significant correlations with future problems. Further, those applicants with future major problems had significantly more negative comments in the dean's letter than did those with future minor problems. Other factors such as USMLE scores, failed courses, letters of recommendation, and interviewer ratings and comments did not predict future problems. Most of the factors the authors assessed in prospective applicants did not predict future problems, with the exception of negative (even mildly so) comments in the dean's letter. The authors suggest that more attention should be paid to the use of the dean's letter to assess risk among applicants, and prospective study of this assessment should be performed.

Narcissistic personality disorder and self-esteem: An examination of differential relations with self-report and laboratory-based aggression

A controversy exists regarding the strength and replicability of relations between self-related constructs of self-esteem and narcissism in relation to aggression. Methodological issues have been posited to be responsible for these inconsistent results including an over-reliance on self-report measures and the use of dissimilar measures of aggression. In the current study, we examined the relations among Narcissistic personality disorder (NPD), self-esteem and aggression in two samples. Both self-report and interview ratings of NPD were correlated with both laboratory-based and self-reported aggression. Alternatively, self-esteem manifested primarily nonsignificant relations with aggression, except when controlling for the variance shared with NPD. The current results add to the extant literature suggesting that narcissism may be the more powerful correlate of aggressive behavior.

Disentangling the Effects of Applicant Defensive Impression Management Tactics in Job Interviews

This study explores (1) the effects that three kinds of applicant defensive impression management (IM) tactics (apologies, justifications, and excuses) have on interviewer evaluation and (2) the moderating effects that two types of interviewer negative concerns (competence‐related and integrity‐related concerns) have on the aforementioned relationship. Two hundred and one managers from Taiwan participated in this study by watching a simulated interview. Compared with the control group, applicants using defensive IM tactics received higher interviewer ratings when negative concerns surfaced. Moreover, the type of interviewer negative concern moderated the effects of defensive IM tactics. All three tactics had similar effects on interviewer evaluation when the concern was competence related. Apology was, however, the most effective tactic when the concern was integrity related.

Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome.

Depression consistently predicts recurrent events and mortality in patients with acute coronary syndrome (ACS), but it has 2 core diagnostic criteria with distinct biological correlates-depressed mood and anhedonia (loss of pleasure or interest). To determine if depressed mood and/or anhedonia predict 1-year medical outcomes for patients with ACS. Observational cohort study of post-ACS patients hospitalized between May 2003 and June 2005. Within 1 week of admission, patients underwent a structured psychiatric interview assessing clinically impairing depressed mood, anhedonia, and major depressive episode (MDE). Also assessed were the Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, antidepressant use, and depressive symptom severity using the Beck Depression Inventory. Cardiac units of 3 university hospitals in New York and Connecticut. Consecutive sample of 453 patients with ACS (age, 25-93 years; 42% women). All-cause mortality (ACM) and documented major adverse cardiac events (MACEs)-myocardial infarction, hospitalization for unstable angina, or urgent/emergency coronary revascularization)-actively surveyed for 1 year after admission. There were 67 events (16 deaths and 51 MACEs; 14.8%): 108 (24%) and 77 (17%) patients had anhedonia and depressed mood, respectively. Controlling for sex, age, and medical covariates, anhedonia (adjusted hazard ratio, 1.58; 95% confidence interval, 1.16-2.14; P < .01) was a significant predictor of combined MACE and ACM, but depressed mood was not. Anhedonia continued to significantly predict outcomes (P < .05) when additionally controlling for MDE diagnosis or depressive symptom severity. Findings were confirmed using depressed mood and anhedonia subscores from the Beck Depression Inventory in place of clinician interview ratings. Anhedonia identifies risk of MACE and ACM beyond that of established medical prognostic indicators, including MDE and depressive symptom severity. Correlates of anhedonia may add to the understanding of the link between depression and heart disease.

Depression and oxidative damage to lipids

Depression is associated with increased morbidity and mortality from cardiovascular and cerebrovascular diseases. Oxidative damage to lipids is one of the key early events in the etiology of atherosclerosis, the pathologic condition that underlies these diseases. The current study examines the pathophysiological consequences of depression by comparing serum levels of F(2α)-isoprostanes (8-iso-PGF(2α)), a biomarker of oxidative damage to lipids, in a group of depressed individuals (n=73) and a matched comparison group (n=72). The depressed group had significantly higher levels of serum 8-iso-PGF(2α), while controlling for age, gender, race, years of education, daily smoking, number of alcoholic drinks per week, average amount of physical activity per week, and body mass index. Analyses using interviewer ratings on the Hamilton Scale revealed that, within the depressed cohort, there was no significant association between the severity of symptoms and levels of 8-iso-PGF(2α), suggesting this is a threshold rather than a dose-response relationship. Results extend on our knowledge of depression and oxidative damage to lipids. In conclusion, oxidative damage to lipid molecules may represent a common pathophysiological mechanism by which depressed individuals become more vulnerable to atherosclerosis and its clinical sequelae.

Increased plasma levels of brain-derived neurotrophic factor in patients with long-term bipolar disorder

Recent data indicate that neurotrophins may play a role in the physiopathology of bipolar disorder (BD) and may be useful as biomarkers of the disease. The aim of this study was to evaluate the plasma concentrations of brain-derived neurotrophic factor (BDNF) in BD patients, and to correlate their levels with clinical parameters. BDNF was measured in plasma from 53 BD type I subjects (34 during mania and 19 during euthymia) and 38 healthy controls by enzyme-linked immuno-sorbent assay (ELISA). Patients were assessed by a structured clinical interview (Mini-plus), Young mania and Hamilton depression rating scales. Plasma BDNF levels were significantly increased in patients with mania ( P ≤ 0.001) and euthymia ( P ≤ 0.001) when compared with controls, but did not correlate with any clinical parameters. BDNF concentration was higher in BD patients with 10 or more years of disease. BDNF plasma levels were increased in BD patients, mainly in those with a longer course of disease. In line with previous studies, it is conceivable that BDNF may play a role in the pathophysiology of BD.

Applicability of the DEPS Depression Scale: Assessing format and individual items in subgroups of patients

Background: The role of questionnaires is important in improving the recognition of major depression. Aims: Our aims were: 1) to compare the differences of structure between the Depression Scale (DEPS) and other instruments, and 2) to study whether the DEPS items function in the same way with patients grouped by gender, by age or by education, at the same time taking into account the level of depression. Methods: The item topics of the DEPS and five other self-rating questionnaires (BDI-II, CES-D, HADS-D, PHQ-9, SCL-90-D), an interviewer rating scale (HAMD-17) and two diagnostic interviews for depression (ICD-10, DSM-IV) were listed in a table. The format of the questionnaires and the rating scale were compared. Differential item functioning (DIF) analysis using empirical material (n=1522) and logistic regression models was done to predict DEPS item responses across dichotomous categories for gender, age and education. Results and conclusions: The DEPS scale items covered essential symptoms of depression. Of the instruments assessed, the DEPS seemed the most simple. DIF analyses with the DEPS scale revealed some socio-demographic variation in which symptoms were endorsed after matching for DEPS sum score. Clinically the DEPS has good applicability and accuracy for screening depression in working aged primary care patients.

A Construct Validity Study of Employment Readiness in Persons with Severe Mental Illness

This archival study examined the construct validity of rehabilitation readiness in the employment domain. Rehabilitation readiness in the employment domain is a measure of one's intent to seek employment rather than one's ability to work. A multitrait-multimethod matrix design for construct validation was used to support an inference of construct validity augmented by predictive validity assessments. Participants were 111 unemployed adults with serious psychiatric illnesses newly enrolled in supported employment programs in New Jersey who agreed to participate in the study. Data were collected on demographics, readiness, and symptoms at baseline, as well as on employment activities on a monthly basis for up to 6 months. Participants were enrolled on an ongoing basis, and not all participants reached the 6-month point before the study ended. Two methods of data collection were used: interviewer ratings and client self-report. The resultant pattern of coefficients within the multitrait-multimethod matrix su...

Developing a Predictive Model to Assess Applicants to an Internal Medicine Residency

Residency programs strive to accurately assess applicants' qualifications and predict future performance. However, there is little evidence-based guidance on how to do this. The aim of this study was to design an algorithm for ranking applicants to an internal medicine residency program. Ratings of overall performance in residency were compared to application characteristics of 230 graduating residents from 2000-2005. We analyzed 5 characteristics of the application: medical school, overall medical school performance, performance in junior medicine clerkship, United States Medical Licensing Examination (USMLE) Step 1 score, and interview ratings. Using bivariate correlations and multiple regression analysis, we calculated the association of each characteristic with mean performance ratings during residency. In multiple regression analysis, the most significant application factors (r(2) = 0.22) were the quality of the medical school and the applicant's overall performance in medical school (P < .001). This data has allowed the creation of a weighted algorithm to rank applicants that uses 4 application factors-school quality, overall medical school performance, medicine performance, and USMLE Step 1 score.

Predicting the longitudinal effects of the family environment on prodromal symptoms and functioning in patients at-risk for psychosis

The current study examined the relationship between the family environment and symptoms and functioning over time in a group of adolescents and young adults at clinical high risk for psychosis (N=63). The current study compared the ability of interview-based versus self-report ratings of the family environment to predict the severity of prodromal symptoms and functioning over time. The family environmental factors were measured by interviewer ratings of the Camberwell Family Interview (CFI), self-report questionnaires surveying the patient's perceptions of criticism and warmth, and parent reported perceptions of their own level of criticism and warmth. Patients living in a critical family environment, as measured by the CFI at baseline, exhibited significantly worse positive symptoms at a 6-month follow-up, relative to patients living in a low-key family environment. In terms of protective effects, warmth and an optimal level of family involvement interacted such that the two jointly predicted improved functioning at the 6-month follow-up. Overall, both interview-based and self-report ratings of the family environment were predictive of symptoms and functioning at follow-up; however patient's self-report ratings of criticism had stronger predictive power. These results suggest that the family environment should be a specific target of treatment for individuals at risk for psychosis.

Process and Outcome in Psychodynamic Hospitalization-Based Treatment for Patients With a Personality Disorder

This study examined the relationship between the psychotherapeutic process and outcome in 44 patients who completed hospitalization-based psychodynamic treatment for personality disorders. Using self-report and interview ratings, outcome was assessed in terms of symptoms and personality functioning, and the psychotherapeutic process in terms of self and object relations, felt safety, and reflective functioning. Symptom and process measures were administered at intake, every 3 months during treatment, and at 3 and 12 months follow-up. Personality measures were collected at intake, the end of treatment, and at 3 and 12 months follow-up. Using Piecewise Linear Growth Curve Analysis results showed improvement in symptoms, personality functioning, self and object relations and felt safety, but not in reflective functioning. Linear changes in self and object representation and felt safety, but not in reflective functioning, predicted improvement in outcome.

Gender differences in clinical characteristics in a naturalistic sample of depressive outpatients: The Leiden Routine Outcome Monitoring Study

BackgroundNo previous large scale studies have assessed gender differences in naturalistic samples of major depressive disorder (MDD) outpatients. We therefore determined gender differences in comorbidity, symptom patterns and subjective health status in these outpatients in a mental healthcare setting. MethodsOf 3798 consecutive adult patients (age range: 18–65), 1131 (65.1% women) fulfilled DSM-IV criteria of current MDD on the Mini-International Neuropsychiatric Interview (MINI-Plus). Patients were routinely assessed with Routine Outcome Monitoring (ROM), including the Montgomery–Äsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI) and Short Form-36 (SF-36). ResultsNo gender differences were found in disease severity using the clinician-rated MADRS. However, women showed a significant higher depression severity measured with the self-report BDI-II. Also, psychopathological symptoms self-reported with the BSI were higher, and reported health status on the SF-36 was lower in women. In men with MDD, social phobia, attention deficit hyperactivity disorder, and alcohol and drug misconduct were more common comorbid disorders, while in women with MDD posttraumatic stress disorder and bulimia nervosa were more common, as well as atypical features of depression. LimitationsThe use of retrospective reports of lifetime psychopathology might have led to recall bias. 20% of subjects were excluded from ROM due to language problems or logistical reasons. ConclusionsAlthough women self-reported higher depression severity, more severe general psychopathological symptoms and lower health status, no differences in disease severity were found on interviewer ratings. These findings could have implications for clinical decision making and treatment.

Versão brasileira da Escala de Avaliação da Cognição em Esquizofrenia (SCoRS-Br): validação em contextos clínicos sem informantes

OBJETIVO: A SCoRS é uma medida coprimária de avaliação da cognição na esquizofrenia, baseada em entrevista, relacionada à performance cognitiva e ao funcionamento no mundo real. Em sua versão original, envolve entrevistas com pacientes e informantes. O objetivo do presente trabalho foi buscar evidências de validade de construto convergente e de fidedignidade da versão brasileira da SCoRS (SCoRS-Br) em contextos sem disponibilidade de informantes qualificados. MÉTODO: Foram incluídos 49 pacientes com diagnóstico de esquizofrenia, segundo o DSM-IV. A validação de construto convergente foi realizada utilizando-se o teste R1 e o Miniexame do Estado Mental (MEEM) como instrumentos-padrão. Estimativas de correlação foram avaliadas pelo método de Pearson. Avaliou-se, ainda, a consistência interna da SCoRS. RESULTADOS: A correlação de Pearson entre os resultados da SCoRS sob a perspectiva do entrevistador e os resultados do teste R1 mostrou-se baixa, mas significativa. O coeficiente de Cronbach foi de 0,8829 para a SCoRS examinador e 0,8468 para a SCoRS paciente e o split-half foi de 0,811 e 0,806, respectivamente. CONCLUSÕES: Os resultados evidenciam a validade convergente e fidedignidade da SCoRS, mesmo empregada sem a utilização de informantes. Estudos são necessários para a investigação dos demais critérios de validação.

S22-01 - Preventive monitoring of psychiatric patients at risk for compulsory readmission: preliminary results of a multi-center RCT

ObjectivesThis study aims at reducing the risk for compulsory readmission in psychiatric patients by a comprehensive intervention comprising psychoeducation on warning signs, crisis cards and a continuous telephone monitoring of the patients‘ mental health status and health care utilization over a two-year period. Beyond reducing involuntary admissions, further objectives of the intervention are to reduce number and duration of inpatient stays and to result in a more cost-effective service provision.MethodsPsychiatric inpatients suffering from schizophrenia or an affective disorder were randomly allocated to the intervention group or the control group (treatment as usual). Risk for compulsory readmission was defined by a current involuntary treatment episode or involuntary treatment within the previous 24 months. Both groups are assessed at baseline, at 12-month and 24-month follow-up. Interviewer ratings cover psychopathology (Positive and Negative Syndrome Scale, Young Mania Rating Scale, Hamilton Depression Sale, Global Assessment of Functioning), psychopathy (Hare Psychopathy Checklist Screening Version) and risk for violence (HCR 20). Treatment satisfaction, empowerment and quality of life is measured by self-report questionnaires. Health care utilization and prescription of psychotropic medication is recorded continuously in the intervention group and over a 3-month period in the control group.ResultsPreliminary results of this ongoing study will be presented, illustrating sample characteristics and first results of the one year follow-up. Focusing on data of type, number and duration of inpatient stays, the potential of the intervention to reduce the risk for involuntary readmission to psychiatry will be discussed.

Relationship between depressive severity and demographics in youth with Inflammatory Bowel Disease

There is a higher prevalence of depression in youth with inflammatory bowel disease (IBD), compared to healthy controls and to those with other chronic illnesses. 1) Confirm the association between depression and IBD activity; 2) Investigate relationship between demographic factors and depression in youth with inflammatory bowel disease. 358 youths (aged 9-17 years) with IBD were assessed consecutively for depression and disease activity in gastroenterology clinics over a one year period at the Children's Hospitals of Pittsburgh and Boston. Disease activity was measured by the PCDAI (Crohn's Disease; CD) or PUCAI (ulcerative colitis,) and depression identified with a self-report screen, the Children's Depression Inventory (CDI). Youth with CDI scores≥9 (n= 92) underwent a structured psychiatric interview (KSADS) and objective clinician rating of depressive severity (CDRS). Demographics were collected in the depressed populations which included: patient gender, age, and race, as well as caregiver age, education, income, employment status and marital status. The relationship between depressive severity and these demographics were assessed in the total screened and depressed cohorts. Of the total sample, 74% had CD, 49% were male, 89% were Caucasian, and mean age was 13.8 years. In the total population (n= 358), there was a significant positive correlation of depressive severity with patient age (r= 0.126, p= 0.05). There was a significant inverse correlation between depressive severity and both caregiver education (r= -0.125, p= 0.05) and income (r= -0.153, p= 0.01). Non-Caucasian youth had significantly greater depressive severity (p= .025). No differences were seen in gender, or caregiver employment status. In the CD patients, a strong correlation was again seen between depressive severity and disease severity (r= 0.324, p= 0.01). In a regression model, the variables with significant correlations above explained 15% of the variance in depressive severity, with IBD severity and child's age having largest unique contributions. Of the total sample 26% screened positive for depression; of these, 93.9% had syndromal depression. In the syndromal depression cohort (n= 92), the mean age was 13.6 years, 52% male, and 85% were Caucasian. The only significant positive correlation was between depressive severity and patient age (r= 0.254, p= 0.05). These data suggest that IBD severity, child's age and race, caregiver education level and family income serve as predictors of depression in children and adolescents with inflammatory bowel disease. The overwhelming majority of patients who screen positively for depression met criteria for major or minor depression. Within the depressed cohort, patient age is the only the demographic factor that has a significant association with depressive severity. These data support screening for depression during medical visits, particularly in youth with active IBD and those who are older and have lower socio-economic class.

Randomized Controlled Trial of Illness Management and Recovery in Multiple-Unit Supportive Housing

This study evaluated the effects of the illness management and recovery program on mental illness and functional outcomes of persons with serious mental illness who were receiving supportive housing services. A randomized controlled trial was conducted with 104 persons with serious mental illness who were assigned either to illness management classes for six months or to a waitlist control group, with follow-up assessments conducted six months posttreatment. Assessments included self-reports, nonblinded clinical ratings, and blinded interview ratings and included the domains of illness management, symptoms, psychosocial functioning, hospitalizations, and substance abuse and dependence. Participants assigned to the program showed significantly greater improvements than the control group in self-reported and clinician ratings of illness management, interview-based ratings of symptoms on the Brief Psychiatric Rating Scale, and interview-based ratings of psychosocial functioning on the abbreviated Quality of Life Scale. Participants in both groups improved in self-ratings of symptom distress and had low rates of hospitalization and substance abuse over the course of the study. The results suggest that the program was effective at improving illness management and functional outcomes for persons with serious mental illness who were receiving supportive housing services.

Argumentation and Debate in Foreign Language Instruction: A Case for the Traditional Classroom Facilitating Advanced‐Level Language Uptake

In response to a growing demand for highly proficient speakers of foreign languages, both from private and government sectors, an added emphasis has been placed on immersion‐type programs that offer extensive contact time in a target language. Although time in a target language certainly plays a valuable and needed role, this research demonstrates that innovative curricular design and development in the university foreign language classroom can equal if not exceed uptake that occurs in extended immersion environments. A thorough description of the research design is provided, including the application of “memory box” items, laboratory self‐recordings, listening, reading, and written exercises, and in‐class practicum in the target language involving British parliamentary‐style debate and Model United Nations. Preliminary findings based on certified pre‐ and post‐Oral Proficiency Interview and Written Proficiency Test ratings suggest that such an approach yields significant gain. Vygotsky's (1978) idea of the Zone of Proximal Development serves as a useful framework for explaining a high percentage of gain at the Advanced‐high/Superior threshold in oral proficiency, whereas native‐speaker written corrective recasts followed by revision and resubmission of written assignments offer a useful paradigm for facilitating threshold gain across a range of proficiency levels for all participants involved.

Obesity and eating disturbances are common in 15-year-old adolescents. A two-step interview study

A two-step interview study of eating disorders (EDs) and sub-clinical EDs in 15-year-old adolescents was carried out in western Finland. The sample consisted of all ninth graders in a well-defined catchment area (n=606, 98.2% of eligible students). In the first step, a self-report questionnaire was administered at schools regarding mental health problems and life circumstances. The questions concerning anorectic and bulimic eating pathology were formulated according to the DSM-IV diagnostic criteria of EDs. The second step consisted of a semi-structured interview Rating of Anorexia and Bulimia-Teenager version (RAB-T) to which 128 subjects were invited, on the basis of their answers to questions about eating pathology in the questionnaire. The participation rate in the interview was 88.3%. The lifetime prevalence rate for anorexia nervosa (AN) in 15-year-old girls was 1.8% and the point prevalence rate 0.7%. No cases of AN were found among the boys. All criteria fulfilling cases of bulimia nervosa (BN) were not found in our sample. High rates of AN not otherwise specified (AN-NOS; 4.9%) and sub-clinical EDs (4.9%) were found among the girls; 6.7% of girls and 0.6% of boys were regarded as being “at risk” of developing EDs. Data on height and weight are based on current measurements taken at school healthcare; 22% of boys were overweight or obese compared with 16% of girls.

What you see may not be what you get: Relationships among self-presentation tactics and ratings of interview and job performance.

The image candidates portray in the interview, via appearance, impression management, and verbal and nonverbal behavior, has been hypothesized to influence interviewer ratings. Through the lenses of social influence and interdependence theories, this meta-analysis investigated (a) the magnitude of the relationship between these 3 self-presentation tactics and interviewer ratings, (b) whether these tactics also are correlated with later job performance, and (c) whether important theoretical moderators (e.g., the level of interview structure, the rating source, the use of field or experimental designs) affect these relationships. Results reveal that what you see in the interview may not be what you get on the job and that the unstructured interview is particularly impacted by these self-presentation tactics. Additionally and surprisingly, moderator analyses of these relationships found that the type of research design (experimental vs. field) does not moderate these findings.

Correspondence of perceptions about centenarians’ mental health

Objectives: The goals of this study were to uncover the criteria by which centenarians, proxy/caregivers, and interviewers rated centenarians’ mental health. Often proxy and interviewer reports are obtained in studies of the oldest-old and become a primary source of information. Methods: Data were from a population-based sample of mentally competent US centenarians in northern Georgia. The dependent variables were based on alternative reports for the centenarians’ mental or emotional health. Regression analysis was used to predict each source's rating of mental health separately with the same set of variables. These variables included information obtained from the centenarians and proxies about their distal experiences, demographics, and proximal resources including Mini-Mental Status Examination (MMSE), health, personality, socioeconomic resources, and coping behaviors. Results: Examination of mean-level differences between sources revealed similarity across mental health ratings. For centenarians and proxies, perceived economic status was a very important predictor of mental health. For centenarians and interviewers, personality (neuroticism and extraversion) was an important common predictor. The interviewer and proxy mental health ratings were strongly associated with MMSE, but that was not the case for centenarians. Conclusion: Mean-level findings and the comparative regression results provide corroborating evidence that centenarians’ self-reports of mental health are similar based on average ratings and presence of common associations with other raters (i.e., perceived economic status and personality). Implications of differences across rater pairs are discussed as guidance about the comparative value of substitution of proxies as informants for addressing specific influences on mental health.