Allen is a 70-year-old male that is dealing with his wife’s death that happened last year. He came into counseling presenting some symptoms of depression such as: not getting adequate sleep, loneliness, lack of energy, etc. When the learner first read his case study, her first thought was: Assess his strengths, weaknesses, and coping skills. What is clear in Allen’s case is that he has been having trouble coping with his wife’s death.
To serve clients especially different populations, the HDI needs to be able to assess depression levels. In fact, the HDI is derived from the Hamilton Depression Rating Scale. Santor, Debrota, Engelhardt, & Gelwicks (2008) says that the Hamilton Rating Scale for Depression is considered the best assessment that is used to measure depression severity (Santor, Debrota, Engelhardt, & Gelwicks, 2008). The HDI is not supposed to be a diagnostic tool for depression. The HDI should be able to see the severity of the client’s depression symptoms (Fernandez, n.d). We will not be able to effectively help the client if we are not able to assess their severity level. Whenever we are trying to pick an assessment we need to ask if it is appropriate to use with the client and what it actually measures.
Description of the HDI
The HDI is a self-report assessment tool that is designed to assess the severity of depression in an individual. Mottram, Wilson, & Copeland (2000) states that the Hamilton Depression Rating Scale (HDRS) has good sensitivity and specificity (Mottram, Wilson, & Copeland, 2000). The learner mentions this because the HDRS was given the stamp of approval for measuring depression severity. Fernandez (n.d) declared that the HDI is the most current version and is easy to score and administer. It is important to note that the HDI is not meant to diagnose depression. It has different questions that aims to look at the different aspects of depression.
The HDI has different scales that are used to measure depression severity. Carneiro, Fernandes, & Moreno (2015) says, “The use of clinical rating scales is required to improve diagnosis quality, to reduce bias caused by physical symptoms, to assess prognosis during treatment, and to evaluate outcomes” (Carmeiro, Fernandes, & Moreno, 2015, p. 1). The HDI is very thorough in regards to assessing different aspects of depression. However, that runs the risk of there being some redundancy. Some of the test items might repeat themselves which could frustrate the client. The HDI is quick to administer, as it usually takes about 10 minutes. This is great for the clinician and for the client. This is wonderful for clients that gets bored easily or if the counselor only has a limited amount of time to work with the client. It was strongly emphasized that the HDI is not meant to diagnose depression, and the learner noticed that point being emphasized throughout the research she had conducted for this assignment.
The psychometric properties for the HDI was excellent. The learner acknowledges that no assessment tool is perfect and while the HDI might have limitations, that this assessment has earned a lot of respect from reviewers. Fernandez (n.d). stated that test-retest reliability was .95 and internal consistency is .89 (Fernandez, n.d). One thing the learner has learned in this class and will carry with her throughout the mental health counseling program is that the closer to 1.00 that assessment tools measure or score as, the better reliability and validity that the test will have. Test-retest reliability is important because if it is administered twice within a short time period and shows completely different numbers, then it indicates that the assessment might not be very reliable. Internal consistency is stellar at .89, which indicates that the test is reliable regarding the test items are related to assessing depression severity in this case, the internal consistency could be considered too high. Fernandez (n.d) stated that the HDI is too narrow (Fernandez, n.d). Some of the test questions could also appear to be repetitive for clients, and it might be helpful for the clinician to explore the clients’ feelings about taking the HDI. If the client is taking the longer version of the HDI and notices that some of the test items are repetitive, then they might get frustrated and it could potentially skew the results.
It is important to understand the psychometric properties of the HDI so that clinicians will know if this assessment is appropriate for use. Dozois (2003) says that psychometric properties are important because assessments affect treatment planning and other aspects of the client’s case (Dozois, 2003). If the test is not reliable or valid, then it lessens credibility from the client and insurance companies’ standpoints. There are 2 versions of the HDI. Dozois (2003) says that there is a version with 23 items that are broken down into 38 questions and a short version of the HDI that only has 9 items (Dozois, 2003). This is a great tool for clinicians to have during the therapeutic process. The learner wonders in what situations would the clinician end up using the short form of the HDI. She is also curious to wonder if the short version of the HDI has the same issue as the longer version in regards to some of the test items being repetitive. She would hypothesize that the shorter version might eliminate or severely cut down on that issue of question repetition.
Another concern with the HDI is construct validity because of some of the criteria that is included as depression symptoms. Construct validity is asking whether the HDI measures the construct (depression symptoms) that it is supposed to measure. Dozois (2003) finds that the HDI is a good assessment instrument to utilize for depression severity (Dozois, 2003). Ironically, Licht, Ovitzau, Allerup, & Bech stated that the rating scales of the HDI does not fit the criteria for unidimensionality (Licht, Ovitzau, Allerup, & Bech, 2005). It is important to recognize that every assessment has positive and negative aspects associated with it. When deciding whether to utilize this assessment or another depression assessment tool, the learner must remember to account for culture and diversity aspects of the client. Some assessment tests are not appropriate for some populations because the normed sample has only been used on Caucasians for certain instruments. Therefore, those assessments results would be inaccurate for diverse populations.
How the HDI is Scored and Linked to Counseling
The HDI is easy to score and administer. This is one of the strongest aspects of this assessment, and it has been given very positive reviews in the Mental Measurement Yearbook. Dozois (2003) says that the HDI is scored by adding all the items up within each scale (Dozois, 2003). When the learner read the review about the HDI in the Mental Measurement Yearbook, they said it was easy to score and administer but failed to give much insight about how the test itself is scored. The HDI is used to assess depression severity so that the clinician could accurately make a treatment plan. At that point in the process, it would be wise for the clinician to start collaborating with the client so that they can feel like they are a part of the therapeutic process. The results of the HDI could help give the clinician an idea of where the client is at, especially if they are not especially talkative about what is going on with them. Some clients find it easier to take an assessment than to verbally express their problems or symptoms in counseling. This could go back to the shame or stigma that is common about mental health and it is the counselor’s job to build the therapeutic alliance and try to help the client feel more comfortable. The HDI could also be used in conjunction with an assessment that diagnoses depression. Like most self-report assessments, there is the likelihood that the client lies or exaggerates on the instrument. However, that could be a problem for a lot of assessment tests and possible bias or exaggerations should always be accounted for when interpreting and applying the test results.
How the HDI can be Used with Clients
The HDI can be used to collaborate with clients on a treatment plan. Clients tend to be more engaged in the therapeutic process when they are allowed to take an active role in the counseling process. This can also help build trust with the client and make it easier to help them meet their own treatment goals. The HDI can also be used to answer client questions and give a starting point for the counselor and client to start at. When a client comes into counseling and expresses depression symptoms, sometimes it is not something that a client will always readily admit to. Sometimes the clinician will need the HDI to help see where the client is at currently so that they can help develop a plan that can be useful for the client in that moment and adapt it for future sessions as well. The results of the HDI can encourage a discussion about the symptoms that the client was reluctant to talk about in the first place, and it gives them a chance to see the clinician expressing empathy and positive regard for where they are at in that moment. If they do not feel judged by the counselor and the counselor displays patience with the client while explaining the results, then it can be a useful part of the counseling process.
Ethically, we are mandated to do no harm to clients. Section A.4 in the ACA Code of Ethics says that we need to avoid harming clients in the counseling process (ACA, 2014). If Allen is in a crisis state, then it probably is not a good idea to have him take the HDI until he is in a calm state. If he goes into a crisis state after taking the HDI, then it would be wise to wait on going over the results.
We also must obtain informed consent and give them a through explanation about the assessment and answer any questions that the client might have. The Code of Ethics (2014) says in section E.3.a that we must explain the assessment and why we are giving them that assessment (ACA, 2014). Clients have the right to be fully informed about the assessment, and to get the results unless it would be harmful for them to know the results. It is very important that we remain sensitive to the client’s feelings, especially when we are assessing an aspect about a possible psychological disorder.
HDI in Allen’s Case
The HDI would be used to help assess Allen’s level of depression severity. This will be important in regards to treatment planning. Helping to eliminate Allen’s depression symptoms is important, but we must also consider his goals for treatment. Zimmerman, Martinez, Attiullan, Friedman, Toba, & Boeresa (2012) says that treating eliminating depression symptoms might not be the main goal for clients (Zimmerman, Martinez, Attiullah, & Borescu, 2012). The results of the HDI could give a starting point for the counselor and Allen to collaborate on treatment goals.
Along that same train of thought, it will be important to ask Allen what does he want to get out of counseling, and what goals does he have? The case study states that he is showing signs of being lonely but that cannot be automatically assumed. It would be important for the clinician to ask him if he has felt lonely and if so what changes would he like to make about that? One aspect that can be helpful with depression, is finding ways to help the client regain control of their lives. Asking them questions to explore changes that they would like to make helps them regain control of their lives and feel more powerful and optimistic about their life.
It is crucial that we take Allen’s culture into consideration. For the sake of this case study, the learner will say that Allen is an African-American Christian male. The study says that he is 70 years old, which would place him in the elderly population. The ACA (2014) says in section E.8 of the Code of Ethics that counselors must select assessment tools that are culturally appropriate (ACA, 2014). Cultural aspects can affect treatment goals and solutions. Most suggestions will be considered as viable solutions when their culture is taken into account. For example, telling Allen to go to a nightclub to meet new people would be highly unlikely to be successful. On the other hand, if he was encouraged to attend church events or social events involving things that Allen enjoys doing, then it is more likely to help him meet his treatment goals.
In conclusion, the learner had the opportunity to analyze Allen’s case study and apply the HDI as an assessment tool. She had the opportunity to learn about the HDI and how it can be helpful in the counseling field. The learner appreciated analyzing the ethical side of assessments because this is an aspect that is commonly overlooked. This assignment was an excellent learning tool that helped apply the usefulness of assessments in a counseling setting...
ACA (2014). ACA Code of Ethics. Retrieved from Capella Library
Carmeiro, A., Fernandes, F., & Moreno, R. (2015). Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale in depressed and bipolar I patients: Psychometric properties in a Brazilian sample. . Retrieved from Capella Library
Fernandez, E. (n.d). Review of the Hamilton Depression Inventory. Mental Measurements Yearbook. Retrieved from Capella Library
Licht, R., Ovitzau, S., Allerup, P., & Bech, P. (2005). Validation of the Bech-Rafaelsen melancholia Scale and the Hamilton Depression Scale in patients with major depression; is the total score a valid measure of illness severity? . Retrieved from Capella Library
Mottram, P., Wilson, K., & Copeland, J. (2000). Validation of the Hamilton Depression Rating Scale and Montgomery and Asberg Rating Scales in terms of AGECAT depression cases. International Journal of Geriatric Psychiatric. Retrieved from Capella Library
Santor, D., Debrota, D., Engelhardt, N., & Gelwicks, S. (2008). Optimizing the ability of the Hamilton Depression Rating Scale to discriminate across levels of severity and between antidepressants and placebos. Depression and Anxiety. Retrieved from Capella Library
Zimmerman, M., Martinez, J., Attiullah, N., & Borescu, D. (2012). Why do some depressed outpatients who are not in remission according to the Hamilton Depression Rating Scale nonetheless consider themselves to be in remission? . Retrieved from Capella Library