The purpose of this study is to increase knowledge about the psychopathology of depression, anxiety, and suicide by means of a detailed longitudinal assessment of the cognitive aspects of these syndromes in a psychiatric outpatient population.
The specific aims of the study are (I) to evaluate existing clinical measures, (II) to determine whether the addition of cognitive measures adds to the differentiation of individuals with clinical diagnoses of depression and anxiety from each other and from medical and psychiatric controls and to investigate the association of these cognitive factors in depression and anxiety disorders, (III) to extend the knowledge of the association between suicidal intent and hopelessness and cognitive rigidity, and (IV) to determine whether certain cognitive variables show residual elevations that relate to the prediction of relapse. Cognitive and clinical factors that are expected to differentiate depression and anxiety from each other will be examined by studying 650 outpatients, 325 drawn from eight (8) nosological categories, including a group of 50 psychiatric controls without anxiety or depression. In addition, comparisons will be made with a group of 50 medical controls and 50 outpatients (25 depressed and 25 anxious) treated with pharmacotherapy alone. The test- retest reliability of diagnoses will be examined. The assessment battery will include a measure of overall impairment, self-report, ad clinician-rated measures of depression, anxiety, and suicidal ideation, and measures of specific cognitive constructs. All participants will be administered the assessment battery at intake and after 6, 12, and 18 weeks of treatment, and at one year after intake. All patients will receive standard cognitive therapy. Multivariate analyses will be used to test the ability of the cognitive measures to discriminate depression and anxiety, and repeated-measures analyses of variance will be used to test for changes in measures of depression, anxiety, suicide, and cognitive phenomena, over the course of therapy.
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