Two Key Studies of Classification Systems (HL IB Psychology)
Revision Note
Written by: Claire Neeson
Reviewed by: Lucy Vinson
Key Study One: Haroz et al. (2017)
Aim: To investigate the diagnostic criteria of the DSM-5 with regard to possible culture bias linked to the diagnosis of depression.
Participants: 16,130 records were used to form the basis of this research which comprised of 138 studies with data derived from 170 samples across 77 nationalities/ethnicities (the total number of participants across the sample is not stated in the original article).
Procedure:
A review of qualitative research on depression across the world conducted between August and December 2012 (updated in June 2015)
Statistics were used to compare features of depression across nationality, region, gender and context i.e. qualitative data was translated into quantitative data
Four independent experts rated the items from 1-5 on measures such as their credibility, lack of bias and transferability and these ratings were compared with the DSM-5 and other established systems for measuring depression
Results:
The DSM-5’s classification for diagnosis of depression agreed with 7 of the 15 features identified by the experts
Several other features of depression which occur frequently (e.g. poor concentration) were not given priority by the DSM-5 and thus were not included as a standard way of measuring depression
The DSM-5 model was found to not adequately reflect the experience of depression at worldwide or regional levels i.e. it is overly individualistic and westernised in its approach
Conclusion: The DSM-5 may not be applicable to a range of cultures across the world and may suffer from cultural bias which means that it may lack validity.
Evaluation of Haroz et al. (2017)
Strengths
The results of the study could be used to inform clinicians to be wary of assuming a universalist approach and to consider the role of culture carefully when forming a diagnosis
The large sample size should ensure that the quantitative results are robust which should increase the reliability of the findings
Limitations
Using secondary data means that the researchers could not be 100% confident that all the studies included in the research had been conducted with care and attention to detail which would affect the credibility of the research
Translating qualitative data into quantitative data necessarily involves sacrificing meaning, subjectivity and context so that the data’s explanatory power is lost
A review article uses the findings of previously published research.
Examiner Tip
A review article (rather like a meta-analysis) is not like most of the studies you will learn about in IB Psychology as it uses secondary data which the researchers have not collected themselves. You need to make sure that you understand the difference between secondary data and primary data (data obtained directly via testing by a researcher) as this can form key critical thinking points in your ERQ responses.
Key Study Two: Mojtabai (2011)
Examiner Tip
You can also use Mojtabai (2011) to answer a question on Normality vs Abnormality as it focuses on how the DSM-5 should exclude bereavement-related depression from its classification system. It is a good idea to use a study for more than one section of the IB specification as this is a more efficient use of your time than having to revise more studies than is necessary for the purposes of the exam.
Aim: To question whether bereavement-related depression should be excluded from the DSM-5.
Participants: A community-based sample of participants (who were taking part in the National Epidemiologic Survey on Alcohol and Related Conditions) from the USA who were tested in two phases (43,093 in phase 1; 34,653 in phase 2).
Procedure:
The participants were part of a retrospective longitudinal study into grieving and depression conducted from 2001 to 2002 and from 2004 to 2005
The researchers used structured interviews,using the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV (DSM-4) version to guide the type of questions asked
The interview schedule described above was designed to as a diagnostic tool used to diagnose mood, anxiety, substance abuse, and other related disorders
The researchers measured demographic characteristics of the participants including their age at the onset of their depression; if there was a history of depression in their family; if they had used mental health services, and any new depressive episodes they experienced during the 3-year follow up period
Major depressive episodes were defined as having a duration of at least 2 weeks, during which the participant would have experienced 5 or more of the nine DSM-IV (DSM-4) symptoms, particularly impairment and/or distress
The qualitative data collected via interview was translated into quantitative data via a specific scoring system
Results:
Participants with bereavement-related, single, brief depressive episodes tended to be older at onset, were more likely to be African-American, and were less likely to have had impairment, anxiety disorders or a previous psychiatric treatment history
These participants were also less likely than other participants with bereavement-unrelated, single, brief depressive episodes to experience fatigue, increased sleep, feelings of worthlessness, and suicidal thoughts
These participants also had a much lower risk of developing depression during the follow-up period
Conclusion: The DSM-5 should exclude bereavement-related depression from the list of depressive episodes requiring treatment as these can be explained by the bereavement itself, they are not signs that a person is prone to depression generally.
Evaluation of Mojtabai (2011)
Strengths
The use of a longitudinal design meant that the researchers were able to track depressive episodes across time which enabled them to form their conclusion that depression is a natural consequence of bereavement, thus the findings have validity
Research such as this is important as it can help to inform future revisions and reviews of the DSM-5 which shows that the findings have good application
Limitations
It is possible that participants suffering from depression may not be able to assess their feelings and mood objectively which means that the results could lack reliability
The responses of the participants may have been affected by investigator effects (i.e. they may have liked/disliked the researcher disproportionately) which would in turn decrease the validity of their response
Worked Example
The question is, ‘Discuss the use of classification systems in diagnosis’. [22]
This question is asking you to offer a considered and balanced review of the use of classification systems in diagnosis that includes a range of arguments, factors or explanations. Here is an exemplar paragraph for guidance:
Classifying mental disorders can be problematic because to do so requires using diagnostic tools that are standardised and which are in agreement as to what constitutes ‘abnormal’ behaviour. Motjabai’s (2011) research highlighted one issue with the DSM-IV (now in its fifth iteration as the DSM-5) in that it classified bereavement-related depressive episodes as evidence of abnormal behaviour. A common sense view of bereavement is that it tends to produce low mood, dysphoria, tearfulness etc. in the bereaved person, all of which are understandable features of the grieving process. To label depressive symptoms as ‘abnormal’ in the context of bereavement means that someone who is progressing through the stages of grief might be told by a clinician that they have clinical depression. This diagnosis could in turn lead to a self-fulfilling prophecy (‘They told me I’m depressed, therefore I must be’) and to treatment which is not necessarily helpful or appropriate e.g. SSRIs prescribed for long-term use.
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