Purpose: The long-term goal of this study is to develop a clinical and research tool to help identify patients suffering from depression and/or anxiety who are difficult to screen for in primary care settings due to their subtle and complex presentations of emotional problems. The aim of the tool is to better understand the mental status of individual patients based on the way they talk about their emotions. The short-term learning objectives were to test and validate this tool by comparing the results from patients who screened as either depressed or non-depressed when using standard self-report checklists such as the Patient Health Questionnaire-9 item (PHQ-9).
- Clinicians without specialty in mental health training often report difficulty identifying patients in need of mental health treatment, such as psychotherapy.
- Dr. Yarns and his lab previously developed a clinical and research tool for identifying patients with subtle and complex presentations of emotional problems. This tool involves identifying three categories of emotional words in patients’ spontaneous speech—specific feeling words, vague feeling words, and physical words. The usage of these words can be quantified to define a measurable pattern for each participant.
- The tool was developed using interview data from four chronically depressed participants in a large clinical trial of depression (Partners-in-Care).
- The tool now needs to be validated in other samples.
- Sample: Partners-in-Care (PIC), randomized clinical trial of quality improvement (QI) for depression. Out of >800 10-year follow-up interviewers, we randomly selected 5 non-depressed patients (categorized by only screening depressed at ONE time point (baseline) during PIC) and age 65 years and older.
- Each participant had 3 interviews, each roughly one month apart, focusing on the subjective experience of living with depression and the long-term effects of the QI interventions.
- We coded each interview by quantifying the usage of the 3 the word categories, namely specific feeling words, vague feeling words, and physical words, as defined by the protocol.
- We compared the final patterns from non-depressed to depressed participants.
Results: We were able to code the 3 categories in the non-depressed participants as we had been able to do in the depressed participants. Those who screened as depressed with the PHQ-9 used less specific feeling words and physical feelings words on average throughout the interviews (0.315 and 0.322 words per 100 words respectively in each of those word categories) than those who did not screen as depressed (0.426 and 0.401 words per 100 words respectively). Furthermore, depressed participants use vague feelings words more frequently (0.203 words on average) than non-depressed participants (0.195 words on average).
Conclusions: This preliminary data suggests that patients suffering from depression are more likely to express their emotions using vague feeling words (i.e. upset) than specific-feeling words (i.e. angry) or physical words (i.e. tired) when compared to their non-depressed counterparts. This could be due to a general inability to clearly process and express their own emotions, which would ultimately be at the root of their depressed state. Nevertheless, a greater sample is needed to verify this claim and to understand its practical implication for the application of this novel screening tool. The main goal here was to validate the technique in the non-depressed sample as it had been done with the depressed sample. Individuals should also be analyzed in an individual basis to gain better insight into the subtleties of their emotional problems, such as if they mostly use physical words when asked about their emotional experiences. This would also indicate a blockage in the healthy processing of emotion. Ultimately, once a better understanding of what specific word patterns translate to, clinicians could be trained to identify these categories of words in the context of a discussion of feelings to better detect and understand subtle emotional problems in patients who have difficulty speaking openly about their feelings. Next steps include furthering face and construct validity and test-retest reliability, examining the prevalence of these patterns in a larger sample, and assessing correlates of patterns.