We describe a new self-report instrument, the Inventory of Depression and Anxiety Symptoms (IDAS), which was designed to assess specific symptom dimensions related to major depression and related anxiety disorders. We created the IDAS by conducting principal factor analyses in three large samples (college students, psychiatric patients, community adults); we also examined the robustness of its psychometric properties in five additional samples (high school students, college students, young adults, postpartum women, psychiatric patients) that were not involved in the scale development process. The IDAS contains 10 specific symptom scales: Suicidality, Lassitude, Insomnia, Appetite Loss, Appetite Gain, Ill Temper, Well-Being, Panic, Social Anxiety, and Traumatic Intrusions. It also includes two broader scales: General Depression (which contains items overlapping with several other IDAS scales) and Dysphoria (which does not). The scales (a) are internally consistent, (b) capture the target dimensions well, and (c) define a single underlying factor. They show strong short-term stability, and display excellent convergent validity and good discriminant validity in relation to other self-report and interviewbased measures of depression and anxiety.

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.

We describe a new self-report instrument, the Inventory of Depression and Anxiety Symptoms (IDAS), which was designed to assess specific symptom dimensions related to major depression and related anxiety disorders. We created the IDAS by conducting principal factor analyses in three large samples (college students, psychiatric patients, community adults); we also examined the robustness of its psychometric properties in five additional samples (high school students, college students, young adults, postpartum women, psychiatric patients) that were not involved in the scale development process. The IDAS contains 10 specific symptom scales: Suicidality, Lassitude, Insomnia, Appetite Loss, Appetite Gain, Ill Temper, Well-Being, Panic, Social Anxiety, and Traumatic Intrusions. It also includes two broader scales: General Depression (which contains items overlapping with several other IDAS scales) and Dysphoria (which does not). The scales (a) are internally consistent, (b) capture the target dimensions well, and (c) define a single underlying factor. They show strong short-term stability, and display excellent convergent validity and good discriminant validity in relation to other self-report and interview-based measures of depression and anxiety.

Objective-Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a 20-week manual-based group treatment program for outpatients with borderline personality disorder that combines cognitive behavioral elements and skills training with a systems component. The authors compared STEPPS plus treatment as usual with treatment as usual alone in a randomized controlled trial.Method-Subjects with borderline personality disorder were randomly assigned to STEPPS plus treatment as usual or treatment as usual alone. Total score on the Zanarini Rating Scale for Borderline Personality Disorder was the primary outcome measure. Secondary outcomes included measures of global functioning, depression, impulsivity, and social functioning; suicide attempts and self-harm acts; and crisis utilization. Subjects were followed 1 year posttreatment. A linear mixed-effects model was used in the analysis.Results-Data pertaining to 124 subjects (STEPPS plus treatment as usual [N=65]; treatment as usual alone [N=59]) were analyzed. Subjects assigned to STEPPS plus treatment as usual experienced greater improvement in the Zanarini Rating Scale for Borderline Personality Disorder total score and subscales assessing affective, cognitive, interpersonal, and impulsive domains. STEPPS plus treatment as usual also led to greater improvements in impulsivity, negative affectivity, mood, and global functioning. These differences yielded moderate to large effect sizes. There were no differences between groups for suicide attempts, self-harm acts, or hospitalizations. Most gains attributed to STEPPS were maintained during follow-up. Fewer STEPPS plus treatment as usual subjects had emergency department visits during treatment and follow-up. The discontinuation rate was high in both groups.Conclusions-STEPPS, an adjunctive group treatment, can deliver clinically meaningful improvements in borderline personality disorder-related symptoms and behaviors, enhance global functioning, and relieve depression.The treatment of patients with borderline personality disorder is challenging (1, 2). The use of medication has increased, but while several drugs have proven useful, their benefit has been modest (3-4). A range of psychotherapies has been developed and several have NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript garnered empirical support (5-12), including dialectical behavioral therapy (5-7, 12), mentalization-based therapy (8, 9), cognitive behavioral therapy (10), schema-focused therapy (11), and transference-focused therapy (12).In 1995, Blum et al. developed Systems Training for Emotional Predictability and Problem Solving (STEPPS) based on a program introduced by Bartels and Crotty (13). STEPPS is a group treatment that combines cognitive behavior elements and skills training with a systems component for individuals with whom a patient regularly interacts (14,15). STEPPS is easily learned and efficiently delivered by therapists of varying educational and professional backgroun...

Objective: We sought to evaluate two approaches with varying time and complexity in engaging adolescents with an Internet-based preventive intervention for depression in primary care. We conducted a randomized controlled trial comparing primary care physician motivational interview (MI, 10–15 minutes) + Internet program versus brief advice (BA, 2–3 minutes) + Internet program. Setting: Adolescent primary care patients in the United States, ages 14–21. Participants: 83 individuals (40% non-white) at increased risk for depressive disorders (sub-threshold depressed mood > 3–4 weeks) were randomly assigned to either the MI group (n=43) or the BA group (n=40). Main Outcome Measures: Patient Health Questionnaire (PHQ-A) – Adolescent and Center for Epidemiologic Studies Depression Scale (CES-D). Results: Both groups substantially engaged the Internet site (MI, 90.7% versus BA 77.5%). For both groups, CES-D-10 scores declined (MI, 24.0 to 17.0 p < 0.001; BA, 25.2 to 15.5, p < 0.001). The percentage of those with clinically significant depression symptoms based on CES-D-10 scores declined in both groups from baseline to twelve weeks, (MI, 52% to 12%, p < 0.001; BA, 50% to 15%, p < 0.001). The MI group demonstrated declines in self-harm thoughts and hopelessness and was significantly less likely than the BA group to experience a depressive episode (4.65% versus 22.5%, p = 0.023) or to report hopelessness (MI group of 2% versus 15% for the BA group, p=0.044) by twelve weeks. Conclusions: An Internet-based prevention program in primary care is associated with declines in depressed mood and the likelihood of having clinical depression symptom levels in both groups. Motivational interviewing in combination with an Internet behavior change program may reduce the likelihood of experiencing a depressive episode and hopelessness.

Clinical researchers have recently begun to explore differences between psychotherapy outcome studies that focus on efficacy and those that focus on effectiveness. The authors provide concise descriptions of these research models, followed by more extended consideration of the most important conceptual and empirical distinctions between the two. Research on the efficacy/effectiveness distinction is then put into context: The common treatment variables that also influence treatment outcomes are reviewed. Fifty years of research on psychotherapy outcomes are next considered; contemporary research on the efficacy and effectiveness research models is emphasized. A description and evaluation of current efforts to heighten the value of technique-focused research to clinicians follow. The authors conclude by anticipating some promising future directions in this research domain.

We explicated the validity of the Inventory of Depression and Anxiety Symptoms (IDAS; Watson et al., 2007) in two samples (306 college students, and 605 psychiatric patients). The IDAS scales showed strong convergent validity in relation to parallel interview-based scores on the Clinician Rating version of the IDAS (IDAS-CR); the mean convergent correlations were .51 and .62 in the student and patient samples, respectively. With the exception of Well-Being, the scales also consistently demonstrated significant discriminant validity. Furthermore, the scales displayed substantial criterion validity in relation to DSM-IV mood and anxiety disorder diagnoses in the patient sample. We identified particularly clear and strong associations between (for a recent review, see Joiner, Walker, Pettit, Perez, & Cukrowicz, 2005). At the same time, however, the accumulating research also has exposed some limitations of these instruments, thereby establishing the need for alternative measures (Joiner et al., 2005). Watson et al. (2007) created the Inventory of Depression and Anxiety Symptoms (IDAS) to complement these traditional measures and to address their limitations.The IDAS differs from these older instruments in two basic ways. First, these traditional measures originally were created to yield a single overall index of symptom severity. These total scores are valuable in many contexts; nevertheless, this focus on global dysfunction ignores the heterogeneous and multidimensional nature of depressive symptoms, and it hampers the identification of meaningful subtypes (Ingram & Siegle, 2002;Joiner et al., 2005). In contrast, the IDAS was specifically designed to contain multiple scales assessing specific symptoms of depression (e.g., insomnia, suicidality, appetite loss).Second, extensive evidence has established that these depression measures are very strongly associated with symptoms of anxiety (e.g., Clark & Watson, 1991;Mineka, Watson, & Clark, 1998;Watson, 2005). Consequently, the original IDAS item pool contained a broad range of anxiety-related symptoms. The inclusion of these items facilitated the development of depression scales with good discriminant validity, and also eventually led to the creation of complementary anxiety scales (e.g., social anxiety, panic). Development and Preliminary Validation of the IDAS Further Validation of the IDAS 4 Development of the IDASAn initial pool of 180 items was subjected to a series of analyses in a large undergraduate sample (see Watson et al., 2007, Study 1); this yielded a revised pool of 169 items. Next, this revised set of items was administered to large samples of college students, psychiatric patients, and community adults (Watson et al., 2007, Study 2). Data from these three samples were subjected to separate series of principal factor analyses. Ten specific content factors emerged in all three samples and were used to create corresponding scales. Five of these scales represent specific symptoms of major depression: Insomnia, Lassitude (which includes items refle...

Summary Background The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods. Methods Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19–40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes. Findings Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe. Interpretation Our findings show that there might be different types and severity of perinatal depression with varying time of onset throughout pregnancy and post partum. These findings support the need for tailored treatments that improve outcomes for women with perinatal depression. Funding Janssen Research & Development.