University of Southern California Dissertations and Theses

Physical measures of female speech and voice variables as indices of retarded clinical depression

(USC Thesis Other)

Physical measures of female speech and voice variables as indices of retarded clinical depression

PDF

Download

Open document

Flip pages

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content PHYSICAL MEASURES OF FEMALE SPEECH AND VQICE VARIABLES AS INDICES OF RETARDED CLINICAL DEPRESSION by David Irving NeWhauser A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (Educational Psychology) r j td N548 December 1975 UMI Number: DP24150 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI DP24150 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest' ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 U N I V E R S I T Y O F S O U T H E R N C A L I F O R N I A THE GRADUATE SCHOOL UNIVERSITY PARK LOS ANGELES. CALIFORNIA 00007 This dissertation, written by David Irving Newhauser _____ under the direction of hA^... Dissertation Com mittee, and approved by a ll its members, has been presented to and accepted by The Graduate School, tn partial fulfillm ent of requirements of the degree of C.(LlcC Ph.D. £dL '76> N 5 HS 43y, D O C T O R O F P H IL O S O P H Y D ate, DISSERTATION COMMITTEE ACKNOWLEDGMENTS First, I wish to thank Dr. William C. Theimer, who offered to stand by during a very bleak time and was an academic gad-fly so that schedules were met. I also wish to thank Dr. Frank H. Fox, who assisted me to strive for excellence while discouraging my efforts for perfection, and my final committee members. Dr. William H. Perkins and Dr. Paul A. Bloland, for their pertinent questions and recommendations that often caused me to question the unquestioned. To Molly Crispin, Departmental Secretary and fellow student, I extend my gratitude for both her patience and thoughtfulness midst the tense times during my doctoral pursuits. The study could not have been carried to fruition without the help of Dr. Warren A. Bradley, Chief of Psychiatry, and Joy Phillips, Nursing Supervisor of the Psychiatric Unit, both of Memorial Hospital of Long Beach, who tolerated my "unobtrusivenessn with great understand ing and kind cooperation; and the physicians, nurses, psychiatric assistants and ward clerks at Memorial whose thoughtfulness allowed me to progress at a steady and non- > discouraging pace. ii Special appreciation is extended to Dr. Peter Ladefoged and Willie Martin of the Ladefoged Linguistics Laboratory at UCLA. The technology, which now seems so simple in the final form, became so only because of their generosity and expertise. Dr. Stanley Azen, of the University of Southern California's Public Health Research group, frequently made himself available so that statis tical conundrums were readily resolved. Very special acknowledgment is also deserving to Drs. A. Kofacs, A. Bigel, B. Forer, and Ms. C. Zuckerman, who initiated me to the significance of depression. I am certain that without their help this study might never even have been initiated. I also wish to thank my parents for their help, their patience and belief in me, who encouraged me at times of little hope and have taught me the priceless value of human dignity. Finally, I wish to thank my wife, Ann Louise, for tolerating the intolerable, suffer ing the insufferable, and loving this doctoral candidate at times when I am certain I was uniquely unloveable. To all of the above, thank you for your help. TABLE OF CONTENTS Section Page I. THE PROBLEM....... ......... . 1 Introduction and Background to the Problem...• 1 Statement of the Problem. ............. 3 Purpose of the Study ......... 3 Questions to be Answered............ *........ 5 Study Rationale ...... 5 Hypotheses......... 6 Methodological Assumptions.. • ^............... 7 Delimitations of This Study........ 7 Summary.......... 8 Overview and Remainder of the Study......... 8 II. REVIEW OF RELATED LITERATURE. ....... 10 Delineation and Clinical Portrait of Unipolar Depression......• ••............ *10 Symptoms of Psychomotor Retardation and Pseudoanergia........... ................ 15 Etiological Views of Depression...............18 Speech Characteristics and Emotional Disturbances......................... ....24 Summary....................... 33 III. METHODOLOGY............... ..35 Introduction.................. 35 Population and Sample......................... 35 Instrumentation........ .37 Procedure s.................................... 41 Data Collection....... ............. 43 Research Hypotheses and Statistical Analysis..44 Summary...... 45 IV. RESULTS....... .46 Preliminary Data Reduction. ....... 46 Tests of Null Hypotheses............... 46 Summary of Results................. 47 iv Section Page V. DISCUSSION AND RECOMMENDATIONS...............49 Conclusions........................ 49 Summary.............. ......... 53 BIBLIOGRAPHY......................... 55 APPENDIX I.......... .... 67 APPENDIX II........ 68 APPENDIX III.......... ...70 v CHAPTER I THE PROBLEM Introduction and Background to the Problem There has been extensive research relating to description, etiology, treatment methods, and prognosis of clinical depression, yet relatively few studies have dealt with the severity of the phenomenon (Beck, 1967; Seligman, 1975? Zung, 1973). The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (1968) includes partially overlapping and/or conflicting categories of depression and a gross delineation of its severity. Pragmatically, the science of disease classifica tion should lead to appropriate treatment (Beck, 1967; Kielholz, 1972, 1973; Zung, 1973). Treatment modalities, such as psychotherapy, chemotherapy, and electrocon- vulsive shock, could vary as well as overlap with type, intensity, and duration of treatment. Mild depression might be treated on an outpatient basis with psycho therapy and mild mood elevators (Hill and Hollister, 1970), while at the other extreme, intense, retarded depression could require hospitalization, the major anti-psychotic tranquilizers, electroconvulsive shock - 1 therapy, intensive psychotherapy, and closely supervised institutionalization (Hill, et al., 1970; Kielholz, 1972). The varieties of depression as well as the numerous treatment modalities suggest extensive combinations of clinical approaches. Often severity is taken into consideration as where different amounts of a psycho tropic drug may be administered; however, objective measures of severity appear absent in clinical practice. It is therefore suggested that an efficient method of classification in depression implicitly demands a means and method for assessing severity. A more accurate diagnosis, which includes an evaluation of severity, followed by more appropriate treatment modalities lead ing to a more rapid disappearance of target symptoms, could hasten recovery and reduce the likelihood of suicidal behavior and sudden depression-related death (Coppen, 1970; Lester and Lester, 1971; Seligman, 1975)• Depression has been described in terms of symptomology, some of which is highly reactive in the diagnostic setting. Therefore, a non-reactive measure which allows for severity could reduce compounding of symptoms that interfere with content and thought processes, physiological responses and mood fluctuations recognized as being prevalent in clinical depression (Beck, 1967; 2 1 Hill, et al., 1970? Kiev, 1974? Mendels, 1970? Seligntan, 1975? Webb, Campbell, Schwartz, and Sechrist, 1973? Zung, 1973)* The term "clinical," as used in this study, refers to symptoms sufficiently significant to require hospitalization (Thomas, 1970). One of the major objective symptoms observed, yet minimally subjected to experimental validation, was that of speech and voice qualities (Truax, 1971). These qualities were perceived as potential measures of psycho- motor retardation (Laughlin, 1967? Linn, 1967? Zung, 1967) and fatigue (or the pseudoanergic syndrome) which in turn are symptomatic of retarded depression (Kamo and Hoffman, 1974? Kiev, 1974). Statement of the Problem There is no clear-cut, non-reactive way of classi fying severity of retarded depression available to the therapist today. It is possible, however, that by combining information known about physical symptoms of retarded depression, especially as it relates to speech and voice qualities and the content of that communication, it might be possible to develop an additional, more objective means of diagnosing retarded clinically depressive patients. Purpose of the Study It was the primary purpose of this study to relate retarded depression to physical measures of speech and voice through a comparison of retarded clinically depressed women versus other (selected) psychiatric women subjects. The speech patterns of these women were analyzed in terms of relative voice intensity or decibels (dB) and articulation rates. These variables were related to the severity of retarded depression as measured on the Zung Self-Administered Depression Scale (SDS)• These specific voice and speech parameters appeared both adaptable and acceptable for objective measurement and were broadly defined as follows: Relative Voice Intensity: The magnitude of energy, acting to produce a sound wave which is proportional to the average size of the variations in air pressure, usually measured in decibels. In this study, the dB was used as a logarithmic relationship which indicated what proportion one intensity level differed from another (Potter, Kopp & Kopp, 1966). Articulation Rate: A ratio of total recorded time and total articulated speaking time. The total articu lated speaking time is the total syllable time in the test paragraph and total recorded time is the elapsed time from beginning to end of the same test paragraph. \ The articulation rate is the total articulated syllable 4 time divided by the total elapsed time for the test paragraph (Perkins, 1975). Questions to be Answered 1. Do physical voice and speech measures differ significantly between the retarded clinically depressed versus other (selected) psychiatric women patients? 2. Do physical voice and speech measures correlate significantly with the severity of retarded clinical depression as measured by the SDS? Study Rationale There are numerous examples of retarded depressive equivalents expressed as somatic manifestations, such as those involving the gastrointestinal system (Chaplan, 1974), those affecting sleep and wakefulness (Feighner, 1974), those involving sexual dysfunctions (Renshaw, 1974), those involving pain (Kielholz, 1973, 1974; Sternbach, 1974), those involving the cardiovascular system (Reisner, 1967), and those involving respiratory disorders (Stein and Schiavi, 1967). For this study of retarded clinical depression, psychosomatic retardation and the pseudoanergic syndrome were explicitly investi gated. Clinical observations of Chan (1971) and Karno and Hoffman (1974) suggested that there appeared to be more severe retarded depression when there was reduced voiee 5 intensities with a slowing of speech, concurrent with subjective patient reports of fatigue or energy deficits* Psychosomatic retardation is defined as a general reduction in activity with a slowing drive and initiative (Kiev, 1974) . Typically, in psychomotor retardation there is apparent inhibition of all bodily movements and thinking (Linn, 1967)• Pseudoanergia is a syndrome of feelings of fatigue, weakness, and apparent loss of energy due to exclusive psychological origin (Karno, et al*, 1974; Kiev, 1974). Speech and voice production mechanisms are of a physical nature and potentially subject to somatic syndrome expression* Varying in degree, they appeared as a potential diagnostic index for severity of retarded clinical depression* Hypotheses 1* Retarded clinically depressed women patients demonstrate significantly lowered voice intensities and articulation rates than other (selected) psychiatric women patients* Specifically, decibels and articulation rates were hypothesized to be lower for the retarded clinically depressed women patients than for other (selected) psychiatric women patients* 2* The SDS scores of the retarded clinically 6 depressed women differ significantly from those of other (selected) psychiatric women patients. Methodological Assumptions 1. It was assumed that voice and speech qualities which existed in the testing-clinical situation were also existent in other clinical settings* 2. It was assumed that three two-syllable samples per subject, a two-syllable sample from the initial portion, a two-syllable sample from the middle portion, and a two-syllable sample from the ending portion of the test paragraph, provided reliable and sufficient physical speech and voice characteristic data for each subject. 3. The test paragraph of low emotional loading was assumed to be at a reading level appropriate for the test population. Delimitations of This Study 1. This study did not attempt an analysis of subjective speech and voice quality evaluations but was limited to objective, measurable indices. 2. In order to obtain complete records and scores, the extremely retarded depressed subject was purposefully excluded* 3. The subject population was limited to women between the ages of 19 and 64, as it was this range in 7 which the SDS was standardized for normal subjects* 4. Retarded depressive patients were chosen as the clinically depressed group* 5* Other psychiatric patients were selected for the control group, excluding hebephrenic and catatonic schizophrenics as well as agitated clinical depressives and those with organic brain syndromes. Summary The diagnosis and treatment of depression has expanded during this century. However, in spite of advances there appear to be few objective measures of severity* It was hypothesized that physical measures in decibels and articulation rates would provide addi tional diagnostic measures of retarded depression among women, particularly data relevant to severity* Psychosomatic retardation and the pseudoanergic syndrome were perceived as overlapping symptoms expressing muscular effects of retarded clinical depression* This form of depression appeared most wide spread and typical of the general concept of depression* Overview and Remainder of the Study There are four additional chapters which provide a review of related literature, the research design, a chapter on results and one providing a discussion and recommendations• 8 Chapter II provides a clinical portrait of unipolar depression, a section on psychomotor retardation and pseudoanergia, etiological theories of depression, and a final section on speech and voice characteristics as they relate to emotional problems. Chapter III contains descriptions of population and sample, instrumentation, procedures, and research hypotheses and statistical analysis. Chapter IV contains the null hypotheses and results, while Chapter V contains the discussion and recommenda tions. Finally, there are appendices and a bibliography. 9 CHAPTER II REVIEW OF RELATED LITERATURE It was the purpose of this review to draw together sources of information and research relating to depression and speech and voice characteristics. The review of this research will initially delineate a clinical portrait of unipolar depression; secondly, describe specific symptoms of psychomotor retardation and pseudoanergia; thirdly, present etiologies of depression; and lastly, review speech and voice characteristics in relation to emotional disturbances• Delineation and Clinical Portrait of Unipolar Depression | Some of the more apparent symptoms of depression are sadness, pessimism and self-dislike, together with the loss of energy, motivation, and concentration (Mendels, 1970). Depression is often a recurrent, self- limiting condition with an average attack lasting about six months (Coppen, 1970). The disorder involves mood, thought, behavior, appearance, and somatic manifestations. In addition, depressives often exhibit anxiety features and suicidal behavior (Kielholz, 1972, 1973; Kiev, 1974; Laughlin, 1967; Mendels, 1970; Zung, 1973). Other emotional symptoms that may occur along 10 with sadness are absence of feeling tone and an apathy towards work and social life, often requiring extensive time and effort previously not required. Frequently there are feelings of failure, self-reproach, and a tendency for the patient to underestimate either the seriousness or the extent of illness or both. Numerous patients believe that there is little wrong that a strong mental effort will not cure (Coppen, 1970). This belief is viewed as a secondary defense mechanism where the symptoms themselves are defended (I«aughlin, 1967) • Other symptoms may be hypochondriacal preoccupations, disorders of behavior such as shoplifting, stealing, reckless driving, and provoking and demanding behavior. Increased irritability is not uncommon, with aggressive outbursts, especially towards other members of the family. Often, heavy alcoholic intake is both prodromal and a symptom of depressive episodes (Beck, 1970; Coppen, 1970; Grinker. Miller, Sabshin, Nunn, and Nunnaly, 1961; Kielholz, 1973; Mendels, 1970; Zung, 1965). Sexual behavior tends to be diminished, and impotence or frigidity often appear as typical features. Menstral irregularities and dysmenorrhea are often present while the time just prior to menses is one of heightened vulnerability (Coppen, 1970; Kielholz, 1972; Seligman, 1975; Zung, 1965)• 11 Therefore, there are combinations of physical and mental symptoms. These symptoms individually and con jointly affect diagnosis. The onset may begin quite slowly and so deceptively that the patient and his relatives have difficulty in ] pinpointing the time of onset (Coppen, 1970). Beck (1967) indicates that an acute onset will favor recovery and that a long prodromal phase indicates a more pro longed attack. Lundquist (1945), in a study of patients I 30-39 years of age, indicated 5.1 months as the mean t | duration of acute attacks and 27.2 months for those of ! slow onset. Among psychoneurotics. Beck (1967) gave a somewhat different picture when he indicated the median duration of an attack as 6.3 months for inpatients I | and approximately three months for outpatients. An | important feature related to duration is severity (Ayd, 1961)• Ayd indicated that those attacks which occur earlier in life tend to be relatively short, while those that occur later have a longer duration. Aydvs data pro vided a mean duration for those under 20 years of three months; 20-30 years, 6-12 months; 30-50, 9-18 months; and after 50, 3-5 years. Ayd further noted that the premorbid personality where the more neurotic or psychopathic features were displayed by the patient prior to onset, 12 the more likely the depression was to be extended. Of particular danger are the periods at the beginning of treatment and the six months following discharge. It is during these times that suicidal behavior or sudden death is likely to occur (Coppen, 1970; Leonard, 1967; Lester and Lester, 1961; Mendels, 1970; Seligman, 1975). Anxiety is often prominent and may be expressed either through emotional means or through physical symptoms. It is not uncommon for a diurnal variation or daily rhythm to exist. Typically, the feelings appear worse in the morning and improve as the day progresses. Concurrently, there are often sleep disorders. These may precede an episode, improve during treatment, and persist even after recovery and treatment cessation (Mendels, 1975). Coppen (1970) held that intelligence and memory are unimpaired. However, confusion is often a symptom which will contribute to problems relating to memory, speed of thought, or accuracy (Beck, 1967; Grinker, et al., 1961; Holliday and Devery, 1962; Zung, 1965). Therefore, Coppen*s position seems subject to question. In the seriously depressed, delusional experiences may be manifested involving feelings of guilt or general unworthiness. These delusions often seem bizarre, though 1 1 they tend to be consistent with the primary depression (Beck, 1967; Coppen, 1970; Bosenthal and Goodman, 1967)* Beck’s (1967) presentation regarded depression as a primary disorder of thought with a resultant disturbance of affect and behavior in accordance with cognitive dis tortion. He cited the tendency towards arbitrary infer ence, selective abstraction, overgeneralization, magnification and minimization, and inexact labeling as specific examples. Affect in the depressed patient is grossly reduced. Experiences such as the death of a spouse or the loss of a job, which normally might produce sadness, or even happy events that might produce joy, tend to become meaningless (Mendels, 1970; Seligman, 1975). In older patients, agitation commonly appears as a symptom exemplified by restlessness and purposeless activity (Linn, 1967)• This agitation can include frequent pacing, tearing a Kleenex, fidgeting with pencils or toothpicks, or the moving of some small item from room to room without apparent reason. Emotionally, this appears as a frantic expression of anguish and pain often accompanied with clinging behavior, personal denigration and guilt (Coppen, 1970; Linn, 1967; Zung, 1965). 14 While agitation may be seen more frequently in the elderly, retardation is far more common at all age levels* In simple depression, there is a feeling of pronounced fatigue accompanied by decreased motor activity• Great difficulty exists in initiating any activity including speech (Linn, 1967; Post, 1970; Zung, 1972). The clinical portrait of the depressive shows factors relating to pervasive affect, physiological changes, psychological distortions and psychomotor disturbances* Pervasive affective disturbances include sadness and tearfulness. The physiological disturbances are expressed as diurnal variations, sleep pattern changes, I ' appetite and weight changes, decreased libido, gastro intestinal, cardiovascular and muscular skeletal problems, explicitly fatigue. The psychological disturbances subsume confusion, emptiness, hopelessness, indecisiveness, irritability, dissatisfaction, personal devaluation and suicidal ruminations. Finally, the psychomotor disturbances appear either as agitation or retardation* The clinical portrait, however, is often confused due to the confounding of diagnoses that result from omissions, interactions and unattended symptom severity factors* Symptoms of Psychomotor Retardation and Pseudoanergia Williams, Barlow, and Agras (1972) felt that 15 anergia was often associated with other apparent physiological factors such as constipation, weight loss, and dawn insomnia. They also state that both slow, monotonous speech and psychomotor retardation could be listed as diagnostic signs of deep depression. Karno, et al. (1974) dealt with the pseudoanergic syndrome as a somatic manifestation of depressive disorders. They differentiated true anergia from pseudoanergia by relating the former to fatigue evolving from organic illness, while the latter appeared as a result of emotional experience not caused by work or exertion nor accompanied by accumulations of lactic acid. Laughlin (1967) listed depression and fatigue reactions both separately and together, and disorders of speech were noted in each area. Apparently confusion exists in both psychomotor retarda tion and pseudoanergia; however, slowed speech appears logically as a subset of each. Shands and Finesinger (1952) noted in their study of patients complaining of fatigue that although the statement, "I am tired," conveyed instantaneous meaning, no two patients described identical symptoms. Beck (1967) observed marked variability among self reports of increased fatigueability: Some symptoms appeared as a purely physical phenomenon, the limbs felt heavy 16 or the body felt as though It were weighed down; others expressed a general loss of pep and energy# indicating feelings of being worn out or run down. It should be noted that depression often coexists with medical problems# and exhaustion may exist in a number of different forms (Cassidy# Flanagan# Spellman and Cohen# 1957). Prusoff# Klerman# and Pykel (1972) commented on self reports relating to the acute episode where patients differentiated between fatigue concepts such as tiredness# sleepiness# being worn out# the lack of energy# and sloppiness or carelessness. Karno# et al. (1974)# while noting the variability of symptoms# still reflected a close relationship to psychomotor retardation. They explicitly stated that early in depression# fatigue or apathy may be only periodic or mild. As depression deepens# psychogenic fatigue or pseudoanergia becomes more constant# severe and "attendant upon a wider and wider range of activities" (p. 59). They regarded subjective complaints of slowness# difficulty in thinking and acting as equivalent reports of depressive inhibition. They thought that a measurable number of sighs would be ’ decreased as severity of depression decreases. They further contended that speed fluency and the quantity of speech# as well as other forms of behaviors would be 17 correlative signs of depression. Therefore, it is their position that pseudoanergia consists of behavioral, somatic and psychological symptoms• Beck (1967) and Mendels (1970) report that pseudoanergic symptoms are repeatedly alluded to as cardinal symptoms of depression. Kamo, et al. (1974) concurred with McClure (1970) in his estimate of 17 percent of American society demonstrating depressive. symptoms. This percentage is qualitatively supported by Hilliard (1966) and would potentially affect behavioral, psychological, and somatic symptoms* The pervasive recog nition of emotional fatigue from numerous clinical observations noted by Hilliard (1966), and psychomotor retardation and/or pseudoanergia evaluated from clinical reports by Karno, et al. (1974) indicate the pervasiveness of depression in contemporary American society. To the degree that pseudoanergia and/or psychomotor retardation are physically manifested, they can affect speech and voice qualities as somatic manifestations of depression. Etiological Views of Depression There are three current views as to depressive etiology: Biochemical, genetic and psychological. While each of these are viewed as separate entities, all three factors coexist and interact. ; 18 Biochemical View: In the 1950*8, reserpine, widely used in the treatment of hypertension, was found to cause depression. In addition, monoamine oxidase inhibitors, which were used in the treatment of tuberculosis, were found to produce euphoric effects* The first medication seemed to deplete norepinephrine, serotonin and dopamine from the brains of medicated animals. The second medi cation was found to increase the level of norepinephrine, serotonin, and dopamine. These observations suggested that depression may result from a deficiency of one or a number of biogenic amines in the brain, while manias could result from an excess of one or a number of these amines (Schildkraut, 1970b). Haskell, Dimascio, and Pruspff (1975) investigated the effects of amitriptyline on the reduction of depressive symptoms. Their findings showed rapid improvement in suicidal feelings, insomnia, and anorexia, but slower and more gradual improvement in areas of impaired work and interests, as well as a slow transition from retardation and feelings reflecting initial pessimism and hopelessness. The average outpatients improved rapidly during the first week, moderately during the second, slightly during the third, and then with a spurt in the fourth. . . . Approximately three quarters of the total change that occurred in initial insomnia and suicidal feelings took place in the first week of treatment, while in contrast only about a quarter of the change in lack of energy and fatigue occurred in that period. (p. 27) The authors went on to say that among the various symptoms of depression, anorexia and insomnia tended to improve early, while others, such as impaired or slow work, reduced interests as well as lack of energy (pseudoanergia) tended to improve later in treatment* Steroid metabolism measured by levels in urinary output suggested that there is a definite relationship between increased steroid secretion and depression. In addition, the tricyclic anti-depressants inhibit cellular uptake of norepinephrine, increase normetanephrine, and decrease the deaminated catechol metabolites (Schildkraut, 1970a). In spite of these findings, Schildkraut cautioned that there are questions as to causality. Even high correlations only indicate concurrent change, but whether one or a number of factors was in fact the cause of a specific biochemical event Is still open to question. Genetic View: Price (1970) dealt with the genetics of depression observing that this subject area is hard to look at objectively. He based his views on depression's ubiquitous occurrence and people's "entrenched views about what ought and what ought not to be inherited" (p. 21). Empirical risk data suggests that if one parent suffers a severe depression there is a 10 to 15 percent likelihood that any one offspring would also be severely 20 depressed. If both parents were severe depressives their child would have a 50 percent chance of experiencing this affliction. Price indicated that transmission is definitely not a simple Mendelian genetic activity and suggested, though does not explicitly state, a polygenic hereditary base for depression. The polygenic base rest* ing on a review of ancestral cases was also suggested by Baker, Dorzab, Winokur and Cadoret (1972). Caramer (1969) stated explicitly, "We have no clear evidence that depressive illness is directly inherited" (p. 25), and while acknowledging the importance of susceptibilities being inherited, stressed that a suscep tibility may be modified. While he did not cite any research, he did conclude that, "The evidence seems to indicate that the environment can more than compensate for hereditary proneness to depression" (p. 25). Prone ness which cannot be directly observed is difficult to measure and contributes to the general uncertaintieis of a genetic theory of depressive etiology. Psychological Views A third view has two over lapping positions. One is the helplessness-hopelessness view, while the second is the frozen state of rage. Beck's (1970) contention, applicable to both positions, is that "depression seems to violate every principle of 21 human functioning*1 (p. 17) and is, therefore, paradoxical. He specifically cited instincts of self-preservation, the maternal instinct, biological needs such as hunger, sex and sleep, the social instincts, and Freud's pleasure principle, which are countered by depression's force. In the helplessness-hopelessness sense, the individual experiences frustration and in finding no alternatives that are acceptable, begins an emotionally downward spiral where things may only deteriorate. There is the apparent feeling of a loss of control which may negate or detract from the identity and/or self- concept of the person (Beck, 1970; Laughlin, 1967; Mendels, 1970; Seligman, 1975). The frozen state of rage appears as a redirection of aggression inward as a result of frustration which cannot be acted out due to strong internalized inhibi tions. This redirection is recognizable by certain physiological equivalents as headaches, constipation, agitation, and feelings of fatigue. The psychological equivalents are often feelings of meaninglessness, inadequacy, and self-destructive ruminations. The affective equivalents would include a dejected countenance, crying and verbal reports of sadness 22 (Kielholz, 1972, 1973; Laughlin, 1967; Mendels, 1970; Seligman, 1975). In a study of the relationship of conflict and mood in depression, Lauterbach (1975) found that personal problems had a strong influence on mood, and that these problems seemed to be more severe when the subject was depressed. He also noted in the study that # . ■ » . the proportion of conflict involved in the personal problems of neurotic and depressed inpatients was correlated with the patients9 mood over several months. He found that mood correlated highly with conflict. He noted that high conflict was correlated with feelings of depression, tenseness and fatigue. Other researchers found that the most obvious aspects of depression are a marked reduction in the frequency of certain kinds of activity and an increase in the frequency of others. Depressed persons are frequently found sitting silently for extended periods of time, and may sometimes remain in bed all day. Depressives often take longer than non-depressives in responding to questions, speaking, walking, and carrying out routine tasks at a slower than normal pace. Among such depressed patients certain kinds of verbal behavior such as telling an amusing story, writing a report or 23 letter, or simply speaking without solicitation seldom occur (Friedman and Katz, 1974)• Wittenborn (1965) chose to regard depression as a state of ambivalence, the person being neither free to assert his competitive impulses nor ready to capitulate so that he could enjoy his dependency* This state of ambivalence interferes with "purposeful effective activity and where this activity does exist, the ability to sustain it decreases" (p. 1046)• He typified the individual as experiencing vasciHating indecision or apathetic inactivity* This position is in agreement with the theoretical foundation for psycho motor retardation and pseudoanergia presented by Karno and Hoffman, 1974; Kielholz, 1972, 1973; Kiev, 1974; and Mendels, 1970* These findings provide further foundation for physical speech and voice characteristic changes as being symptomatic of depression* Speech Characteristics and Emotional Disturbances According to Eisenson, Auer, and Irwin (1963), The voice of the speaker -- the variations in loudness, quality, initial pitch and range of pitch — should reflect the thinking and feel ing of the speaker* The well adjusting speaker’s voice is under control; variations are consonant with meaning and neither the speaker nor the listener need be surprised and wonder "Just what did that voice change mean?" The voice of the well adjusting person reveals rather than betrays his intentions about what he is saying. (p. 342) 24 Potentially, the not-so-well adjusting personality would have his voice betray intentions, would be out o£ control and distort rather than reflect with accuracy the thinking and feelings of a speaker, where varia tions in loudness, quality, initial pitch and range of pitch would evoke questions in the mind of the listener* Eisenson, et al. (1963), in discussing "not-so-well adjusted personalities" (p* 347), cited problem type individuals as examples of inefficient coninunication • Examples given are the nonconsnunicative person, the logical speaker, the undertalker, the overtalker, the tangential speaker and the helpless speaker. They held with Ruesch (1957) that there is a causal relationship between disturbances of communication and those of personality. Of particular importance is the concept of selectivity in reply as a possible cause of communi cative disturbances and pathology. Conditions leading toward maladjustment may involve: Insufficiently or excessively discriminating responses, over stimulation of one function of the environment and neglect of another, grossly dissimilar value systems in the home compared to values outside of the home, and selectively not attending to developing abilities. There appears an imbalance or inaccuracy in the responder to a given stimulus situation reflecting problems in perception, 25 discrimination and levels of reactivity. Functional voice disorders which are normally characterized by marked deviations in loudness, pitch, quality, or flexibility can frequently be explained as a result of psychological disturbance or maladjustment. Here the implication was that the neurotic, psychotic or character disordered individuals may express their dysfunction through the symptom of a voice disorder (Goodstein, 1958). Numerous writers have suggested voice as a correlate of personality or personality changes. While Diehl (1960) suggested that voice may be a measure of personality, he questioned the validity of personality tests as an objective measure of voice quality. Dreher, et al. (1970) related rhythmic qualities of speech to pathology, particularly noting that structural analysis had been relatively neglected in favor of content analysis. Skinner (1958) treated verbal behavior as being subject to the same control as any other type of motor behavior. Through the writings of these men ran a common suggestion; namely, that speech and voice qualities can be used to describe personality and personality changes. The motor qualities of speech and voice may be operationally defined and are physically measurable. 26 Once measured they may be compared in reference to measures that relate to emotionality, personality and behavioral variables (Licklider and Miller, 1951). Milisen (1971) found that loudness was sensitive to situational pressures. He parenthetically stated! "It is not uncommon to have great reduction of loudness even to a point of aphonia while the speaker is under stress'* (p. 656) . He further suggested that psychological withdrawal can be deduced when the speaker uses excessively soft infantile voices* Moore, cited in Travis (1971), dealt with voice defects excluding differences due to hearing losses and stated that voices that are either too loud or not loud enough to meet present communication needs tended to be found in people who developed their voice patterns because of a functional need. He also noted that weak voices are caused by paresis, paralysis involving the larynx or muscles of respiration, or when the vocal chords are unable to interrupt the flow of breath to allow subglottal pressure to develop, or when muscles of exhalation do not provide sufficient air pressure in the trachea for vigorous activation of the chords. He further suggested that weakness is almost always accompanied by breathiness. Breathiness related to loudness was also considered as 27 being related to fatigue. He stressed that fatigued or ill persons may often have a breathy voice. Grinker, et al. (1961) and Seligman (1975) studied reduced activity of the retarded depressive patient and noted a lowered initiation of voluntary responses, characterized by a verbal behavioral manifestation exhibiting a decreased volume of voice while the patients sat alone very quietly. Fairbanks and Hoaglin (1942) studied durational characteristics of voice. Their results indicated that fear, anger and indifference differed markedly from contempt and grief and that the latter two differed further in that contempt was slower than grief in durational qualities. Pavy (1968) stated that pauses in speech were seen as one possible manifestation of the more general block ing of activity which occurs when organisms are con fronted with situations of uncertainty. He further suggested pauses such as "ahw or filled pauses were both a function of information processing delays and indicators of potential emotional disturbance. Don and Sacks (1968) studied the verbal aspects of behavior before and after the administration of anti-depressant drugs to diagnosed, clinically depressed 28 patients. The primary thrust of the study was the possible relationship between the number and length of pauses inductively related to thought processes. They found that frequency of pausing was interpretable as an index of the degree of thinking which precedes speech, thus the quality of speech is improved when sufficient thought processes/ pauses, accompany verbalization. While not explicitly stated, fewer pauses would indicate possible improvement in the agitated depressive. Conversely, a reduction in pause would indicate more assurance and less confusion for retarded depressives as suggested by Beck's (1967) cognitive theory of depression. Robinson and hewinsohn (1973) studying social skills of depressives noted that these patients seem to have a restricted interpersonal range; they talk with fewer people and therefore apparently receive fewer social reenforcements. They further stated that the timing of social responses was often inappropriate and that they exhibited a longer action latency than normals, taking significantly longer periods of time to respond to verbal stimulations. Their findings showed that the depressed emitted approximately one-half less actions, both physically and verbally, than the non depressed. 29 Seligman (1975) discussed the slowness of the depressive to answer when asked questions* He found that psychomotor retardation and intellectual slowness were pervasive in learned helplessness and depression* Pauses were seen as frequent and few voluntary responses were initiated* Hinchliffe, Lancashire and Roberts (1971), studying speech defense mechanisms in depression, investigated quantity of speech, pauses and silences, rate of speech in words per minute, personal and non-personal references, negators, direct references, expressions of feeling and evaluators* They used depressed patients whom they compared to minor surgery control patients* The groups were matched for age and socio-economic status. All subjects were screened to exclude organic brain damage and schizophrenia. All subjects were interviewed and samples of speech were tape recorded. These samples were obtained by requesting subjects to speak on topics of their own choosing for five minutes* All sample records of 400 words or less were excluded. Their study demonstrated significance at the .025 level between their depressed patients and their control groups with respect to rate of speech in words per minute. The researchers used the Wilcoxon Rank Sum test 30 to determine the significance of their results* Subjects had been categorized as both retarded and agitated depressives. It may be that the failure to find signifi cant differences in paused was due to the confounding affect of including both retarded and agitated depressives in the study. However, the number of negatives expressed were significant at the .005 level. Expressions of feelings were also significant at the .005 level* The mean score and range indicated two separate populations corresponding to the specifications of the study* In 1929 Dawson investigated the vocal articulation of pupils to determine whether the rate of articulation develops after children entered school. If so, the study would focus on some of the factors which poten tially related to it, i.e., age, sex and intelligence. Pupils1 scores were the actual number of sounds articulated in 15 seconds. He found that articulatory ability develops during the entire period of school attendance* A correlation was noted between intelligence quotient and articulation rate. Girls1 articulation rates were faster than boys in the early grades, but boys had a greater articulation rate in the later grades* He concluded that articulation skills which develop in the school environment follow the general rule of motor 31 learning. The rate of motor learning was rapid at the beginning of school attendance but slow as the indi vidual reached a state of satisfaction. Articulation was seen as a motor ability and it was suggested that factors affecting motor skills would affect the rate of articulation. Weintraub and Aronson (1967) related speech characteristics to clinically meaningful behavior. They selected groups of patients sharing identifiable behavior patterns observing manners of behavior as reflected in their speech. All patients exhibited similar depressive behaviors such as sadness, hopelessness, guilt and other depressive-related symptoms. The subjects were sub divided into two groups of retarded depressives and agitated depressives. Agitated depressives exhibited a significantly larger number of speech sounds as compared to the retarded depressives whose speech was slow and yielded fewer speech sounds. They noted that as a change in depression occurred production in both groups converged and as depression became more severe there was great divergence in production. Truax (1971) also investigated depression by measuring verbal output. He hypothesized that a change in depression would affect verbal productivity, since, 32 as individuals experienced more severe depression, verbal productivity diverged from normal productivity and converged as individuals experienced less severe depression. He sought to determine whether psycho* therapeutic improvement in depression in a schizophrenic patient would be indicated as the patient approached normal speech. He hypothesized that verbal productivity would provide an objective measure of improvement or unimprovement and that this data would be obtainable from tape recordings. Results of the study indicated that a marked decrease in abnormality of verbal productivity was found in those schizophrenics exhibiting either average symptoms of depression or those who showed some improvement in depression. Those patients who showed no improvement or greater depression exhibited a significant increase in abnormality of verbal productivity. Verbal productivity, words per minute, syllables per minute or per finite time span have been and may be clinical measures of severity in depression and by inference potential measures of effectiveness of therapeutic intervention. Summary The literature suggests that in addition to speech 33 content, there are voice and speech parameters which may be used to diagnose neurotic and psychotic personalities and behavior, character disorders and normalcy. It also suggests physical measures such as decibels and articula tion rates can provide objective physical information to evaluate severity, particularly in depressive illness. 34 CHAPTER XII METHODOLOGY Introduction This study compared, through appropriate statistical methods, retarded clinically depressed women versus the other psychiatric women subjects to determine the inter relatedness of depression as measured on the Zung Self- Administered Depression Scale (SDS) and voice and speech parameters: Specifically, relative voice intensity in decibels (dB) and articulation rate. It was expected that additional diagnostic information would be provided by an analysis of these voice and speech parameters. The procedures needed to answer the questions posited in Chapter 1 will be presented in this Chapter. Population and Sample The population consisted of patient subjects from a hospital located in a large metropolitan area in Southern California. These patients had been referred by their doctors or had voluntarily sought treatment at the hospital, and were primarily from lower and low-middle social and economic levels. Patients were accepted in the hospital regardless of race or place of birth. However, all subjects were native born Americans who spoke ________________________________________ : _______________: ____________________3£ the English language. No attempt was made to standardize level of literacy or educational background. When these patients entered the hospital for the first visit, each patient was required to have had a standard psychiatric evaluation prior to or within 72 hours after admittance. Based on this diagnostic evaluation, patients were classified into those who had been diagnosed as either retarded clinically depressed or other acceptable psychiatric patients. From this patient population, 60 female subjects between 19 and 64 years of age were selected. All subjects were screened to exclude organic brain syndromes, as well as agitated clinical depressives and hebephrenic and catatonic schizophrenics. This screening was intro duced to provide control related to emotional, behavioral and motor changes that could have presented symptoms similar to retarded clinical depression or confound the retarded depressive category. The retarded depressed group and the other acceptable psychiatric group were selected from a grossly similar population. The other acceptable psychiatric patients, who comprised the control group, were similarly screened as were the retarded depressives. These two groups were matched as to sex, age and similar socio-economic background. 36 In strumentation Depres sIon Test " The Zung Self-Administered Depression Scale contains 20 items based on clinical diagnostic criteria most commonly characterizing depressive disorders in terms of affective, biological, and psychological disturbances* These items are in sentence form and are based upon material selected and validated as most representative for each of the particular symptoms within the depressive syndrome* In using the SDS, the subjects are asked to rate each of the 20 items in one of four quantitative terms indicating how it applies to them at the time of testing. Each item is numerically valued from one to four. The scale is devised so that of the 20 items used, 10 are worded symptomatically negative and 10 are worded symptomatically positive. An index for the SDS is derived by dividing the sum of the raw score values obtained on the 20 items by the maximum possible score of 80. This score is then converted to a decimal and multiplied by a hundred to obtain the final score. Final scores below 50 indicate a normal range of responses; 50-59 indicate the presence of minimal to mild depression; 60-69 indicate the presence of moderate to marked depression; and 70 and over, the 37 presence of severe to extreme depression (Zung, 1974)* A recent study by Zung (1973) to demonstrate the reliability of the SDS found that split-half reliability test correlations yielded an r of .73 (p < .01). Brown and Zung (1972), in a study of 65 depressive inpatients, found that the Zung SDS and Hamilton Depression scales correlated with an r of .79 (p < .01). These findings agree with two previous studies by Zung. His 1965 study dealt with 52 outpatients of a psychiatric clinic with respect to their scores on the SDS, MMPI, clinical diagnosis, and correlations between, the various scales. He found that the SDS was able to differentiate between the same groups as the MMPI D scale, and obtained a correlation of r ~ .70 (p < .05). An analysis of variance of the mean MMPI D scale scores and the SDS scores differentiated depressives and anxiety reaction groups at the .05 level and .01 level, respectively. Zung's 1967 study found an r of .59 between the SDS and MMPI D scale scores. These results, while lower than the previous study, were explained by the higher percentage of younger patients in the latter study. By combining all data obtained from the two studies, a correlation coefficient between the SDS and 38 MMPI yielded an r of .65 (p < *05), which compares favorably with results obtained in all the studies above. McNair (1974) considered the SDS superior to other self-evaluation forms in use for evaluating depression because of its wide coverage of symptoms, its conciseness, and finally because more data and experience exist with the SDS than was presently available for any other scale of its type and use. Test Paragraph The test paragraph is a paragraph of 133 syllables and was chosen because it had low emotional loading. A trial reading was performed on a group of 18 fifth grade students reading at fourth and fifth grade levels in the Southern California area. These children indicated that they understood the paragraph and all were either able to paraphrase or repeat from memory all portions cumulatively of the paragraph. While these children would not have been comparable to the test population, they did establish that the reading level for this test instrument was low enough that it should not cause any problems for the patient population in terms of difficulty level. Recording Equipment The Sony TC-355 tape recorder and ECM-200S condenser microphone were used to record the voice of the subject as she read the test paragraph. It also recorded her name 29 and index number. This instrument: was chosen since it did not contain an automatic volume control and would record from 20 Hz to 22,000 Hz at 7-1/2 inches per second. It was also portable and had a high-low pass filter which enabled recording of a broad spectrum of speech frequencies. The ECM-200S condenser microphone required modification to single electrode mini-jack which provided a continuous-on mode of operation and allowed an alternate on-off remote capability at the power source. Oscillomink All recordings were processed by the Siemans Oscillomink, an ink writing oscillograph, which provided visual information for each subject's speech sample. Intensity was graphically written as a continuous measure through progressive time frames. Intensity was measured by degree of deflection from the base line on the instrument. For relative voice intensity a sampling method was employed using the sixth and seventh syllables, the 62nd and 63rd syllables, and the 122nd and 123rd syllables in the 133-syllable test paragraph for each subject. Articulation rate was extracted from the Oscillomink recording as a linear quotient according to the opera tional definition presented in Chapter I. Total time for 40 the test paragraph was read with an accuracy to a fiftieth of a second. Each syllable was cumulatively measured yielding a total syllable articulation record. When this sum was divided by the total time for reading the test paragraph, an individual articulation rate was derived for each subject. Reliability of the Oscillomink was demonstrated by taking pre-calibration and post-calibration recordings of a 1000-cycle per second input at various dB ratings. There was no visual difference noted between the pre calibration and post-calibration recordings. Procedures Patient subjects arrived by either the emergency room or through the admitting office. All patients were required to have either a physician's recommendation or the recommendation for admittance by a member of the hospital's psychiatric staff who observed and spoke to the patient. Non-psychiatrically referred patients were required to have a psychiatric consultation completed within 72 hours after they had entered the hospital. Therefore, within 72 hours all patients were diagnosed by a psychiatrist and then completed clerical admission procedures. These patients were then officially admitted to the psychiatric ward. 41 Upon admission# both patient groups, the retarded clinically depressed and the acceptable other psychiatric subjects, entered the testing situation in a quiet room on the ward and were asked to seat themselves at the testing table. They were then presented with an Informal tion and Consent Form (Appendix 111) requiring their signature. Upon completion of this form, each patient was consecutively numbered and tested individually. Each patient was so positioned that she was one-half meter from a microphone resting on the table in front of her. There was the test paragraph (Appendix I) typed on an 8-1/2" x 11” sheet of paper, placed face down on the table, as well as a copy of the SDS (Appendix II) laying face down on the table. In addition, there was the recording equipment and a supply of extra pencils in the testing room. The experimenter sat across the table from the subject and gave the following instructions to her: Please be seated; placing your knees against the table. State your name aloud. (Pause) . Read the paragraph on the paper. (Point) Please speak as clearly as possible. When finished, you will be asked to respond to 20 statements that relate to you. Recording began as soon as the experimenter terminated the instructions to the subject. Upon completion of the subject's reading of the test paragraph, the experimenter said: 42 Thank you. Now, please turn over the other sheet of paper in front of you. It la a short list of statements. Your responses will help us to better understand your condition. Please read each item, and check the appropriate box for each. Please do not omit any statement. When the subject indicated she did not know if she should check a given item, the experimenter clarified by reading the statement aloud, and saying, "Now, do you understand?" If further questioned, he responded, "Respond to each one the way you really feel." When the subject had completed the SDS, the experimenter checked to see that all statements had responses. If there were omissions, the subject was asked to complete the unanswered item(s). Any subject who refused to complete the SDS was excluded from the sample, and her slot was filled by the next individual classified for her group. Upon completion of the testing, the sub ject was thanked for her cooperation, and returned to the ward for appropriate therapies. Data Collection All demographic data was extracted from hospital forms completed prior to the diagnostician's evaluation. Data included name, age, place of birth, questions relating to socio-economic status, and language(s) spoken in the home. Conditions of present or prior physical and mental health were taken from records of the diagnosti cian. 43 All $DS tests were scored at the end of each testing day in the absence of any subject. If a subject inquired as to the results of her score, she was informed that her score and its evaluation would be made available through her physician. Research Hypotheses and Statistical Analysis This depression/voice parameter study was an investigation into the physical voice and speech charac teristics of retarded clinically depressed female versus other psychiatric female patients. The dependent variables were scores on the SDS (Zung); and voice variables, dB and articulation rate. The following hypotheses were tested: 1. H^: The mean dB rating is significantly lower for the retarded clinically depressed group than for the other psychiatric group. HjS The mean articulation rate is significantly lower for the retarded clinically depressed group than for the other psychiatric group. These two hypotheses were tested with the Student's t-ratio with * at the .05 level. 2. H^: There is a significant negative correlation between dB and SDS scores for the retarded clinically depressed group. 44 H^: There is a significant negative correlation between articulation rate and SDS scores for the retarded clinically depressed group* Pearson Product Correlation tests were used to test the two preceding hypotheses and the correlations were tested for significance with Fisher's test* For statistical significance « was set at the *05 level* Summary The thrust of this study was to determine if an sanalysis of voice and speech characteristics of retarded depressive women would provide assistance in the I |determination of a diagnosis of retarded depression and |what correlation, if any, existed between such voice and speech analysis and scores obtained from the Zung Self-Administered Depression Scale* A5. CHAPTER IV RESULTS Preliminary Data Reduction Initially it was necessary to answer some questions about the data before the main relationships could be examined. The retarded clinically depressed (R) group yielded a mean Zung Self-Administered Depression Scale (SDS) score of 64.60 with a s.d. — 8.41. For other {psychiatric patients (C) the mean SDS was 42.20 and the s.d. — 6.37. A t-ratio yielded a t — 11.60 where 11.60 >1.67. The groups were significantly different at « — .05. Tests of Hull Hypotheses The null hypothesis that there is no significant difference between the mean decibel (dB) ratings for the R group as compared to the C group was tested with the Student's t-ratio. The mean for the R group was -17.37 and the s.d. — 1.99* The mean for the C group was -13.48 and the s.d. — 2.77. Pooled variance equalled 5.83. The Student's t-ratio yielded a t — -5.95 where -5.95 < -1.67 at « — .05. Therefore, the null hypothesis was rejected. The null hypothesis that there is no significant difference between the mean articulation ratings (AR) for 46 the R group as compered to the C group, again was tested with the Student’s t-ratio. Here, the mean for the R group was .635 and the s.d. — .064. Pooled variance equalled .00411. The Student’s t-ratio yielded a — -7.00 where -7.00 < -1.67 at * — .05. Therefore, the null hypothesis was rejected. The null hypothesis that there is a non-significant correlation between the dB ratings and the SDS scores for the R group was tested with a Pearson Product Correlation. Significance of this correlation was tested with the Fisher Z test. The correlation rqnq^ — -.42 (Fisher Z — -2.32; p < .05). Therefore, the null hypothesis was rejected. The null hypothesis that there is a non-significant correlation between the SDS scores and the articulation ratings for the R group was tested with a Pearson Product Correlation. Significance of this correlation was tested with the Fisher Z test. The correlation rsos-AR "" ~#^7 (Fisher Z — -2.02? p < .05). Therefore, the null hypothesis was rejected* Summary of Results The results of the first experimental hypothesis were significant and the direction of the significance was also demonstrated. Therefore, both dB rating and 47 articulation rate were significantly lower for the retarded clinically depressed group as compared to the other selected psychiatric group. In addition, the results of the second hypothesis were significant* yielding negative correlations between the SDS scores and the dB ratings, and the SDS scores and the articulation rates• Therefore, all experimental hypotheses were demon* strated as tenable. Physical voice and speech character* istics as measured in this study differentiated the retarded clinically depressed female from other selected psychiatric female patients. In addition, physical voice and speech characteristics as measured in this study correlate with severity as measured on the Zung Self* Administered Depression Scale. 48 CHAPTER V DISCUSSION AND RECOMMENDATIONS Conclusions The present study has shown statistically significant relationships between retarded clinical depression and two physical measures of speech and voice among hospitalized female patients. In addition, it lends support to the positions of Friedman, et al. (1974) who observed the slower than normal aspect of depressed patients, Dreher, et al. (1970) who favored a structural analysis of verbal behavior, and Milisen (1971) who observed great reduction of loudness while a speaker was in a stressful situation. A decreased volume of voice, as noted by Grinker, et al. (1961) and Seligman (1975), was also noted in this study< Robinson, et al. (1973) found a 50% reduction in both the physical and verbal actions of the depressed as compared to the non-depressed subjects which coincides with this study if not in absolute quantity at least in direction. This study also lends support to the position of Hinchliffe, et al. (1971) who noted reduced verbal output of depressed patients as compared to surgical controls. The Truax 1971 study, which measured verbal output in schizophrenic depressives, observed depressive symptom intensity varying with quantity and speed of 49 speech sounds. These findings are again supported by this study. Both relative voice intensity and the articulation rates were negatively correlated with severity as measured on the Zung Self-Administered Depression Scale (SDS). As noted in the results, these relationships were at the .05 level of significance. In spite of the significance of these correlations, relative voice intensity left 82.4% of the correlation unexplained and articulation rate left 88.3% of the correlation,unexplained. Considering the extent of the unexplained measures for the retarded depressed group, speech and voice analysis appear as potentially poor scales for evaluating severity. However, since the sample excluded outpatients experiencing depressive neurosis exhibiting retarded features, a wider patient spectrum could potentially yield a higher, albeit negative, correlation and could therefore justify speech-voice scales to evaluate severity of depression. Though the study was a be tween-subject design, side comments from many patients indicated that they had noticed a change in their speech or voice quality. It is suggested, therefore, that a longitudinal within- subject design could yield information which could argue for voice or speech analysis as a means for evaluating severity during a course of treatment. 50 For all the unobtrusiveness of the speech and voice attending qualities of the study, the fact that patients were required to read aloud a given paragraph called attention to speech and voice mechanisms* The previously noted side comments only underlined their awareness and could have contributed to some confounding of the results. Potentially this confounding feature could be avoided through the use of free speech elicited by recorded questions of low emotional loading or the reading of a series of numbers over a finite or indefi- * nite period of time. While all subjects understood the paragraph, reading abilities did not appear overly relevant to educational level. The experimenter noted that more than one college-educated subject read very poorly, and one woman stated, "I’ve always read poorly aloud." A few subjects commented at the end of the study that they seemed to be speaking lower and slower; these remarks were usually expressed while the subjects were being escorted back to their rooms. Their suggestions could well imply consideration of frequency as well as an analysis of pauses as further measures of voice and speech production as related to retarded depression. As the results indicated, both the articulation 51 rate and voice intensity were significantly lower for the retarded clinically depressed group compared to the other psychiatric group. Both of these measures would indicate a redirection, different utilization, or simply reduced energy in the total system. Though not explicitly examined in this study, it is suggested that the agitated depressive- 9 in accordance with the Weintraub, et al. (1967) study, could show, under a similar testing situation, a higher than normal articulation rate and an increased decibel (dB) score which would again indicate a redirection, different utilization, but in this instance, increased energy within the total system. It is suggested that if these results were obtained in an agitated study that they would argue against a change in the total energy of the system for the depressive syndrome and would argue for redirection or reutilization of energy. This position, relevant to energy direction or utilization, would appear more in line with a sub-set of the psychological view related to etiology. A redistribution of energy model does not appear in conflict with the biochemical view. In fact, chemotherapeutic agents may well function not only in the production of intermediary neurochemicals but could also act to redirect energy in the total system or within segments of the system. 52J It would be contrary to the evidence to deny there Is a change in the energy level in retarded depressives and possibly among those within the entire depressive syndrome. Therefore, neurologically speaking, there is a justification for investigating activating and inhibiting systems in the depressive. Here attention may be directed toward the reticular activating system and semi-specific brain areas related to muscular activity on the motor homunculous, particularly areas 4 and 4S and Broca*s area, gungnary While the results of this study significantly differentiated retarded clinical depressives as compared to other selected psychiatric patients, and there was a significant correlation between the physical measures and severity of depression as measured by the SDS, it is suggested that there is not sufficient justification at present to consider voice or speech variables as adequate measures of severity. This position is maintained on the basis of the large unexplained portion of the corre lation . The study does suggest that a redefinition of the experimental situation to a within-subject design could lead to a more efficient measure of severity. It also suggests that other voice and speech measures as frequency 53 and pauses could be studied as other means for segregating patients as to severity in depression* Finally, the significant changes in physical measures suggest an energy-based etiological view of the depressive syndrome that does not appear in conflict with either the biochemical or psychological etiological views. 54 BIBLIOGRAPHY American Psychiatric Association. Diagnostic arid Statistical Manual of Mental Disorders. 1968. Ayd, F. Recognizing the Depressed Patient. New York: Grune & Stratton, 1961. Baker, M., Dorzab, J., Winokur, C., & Cadoret, A. J. Depressive Disease: Life Events and Onset of Illness. Archives of General Psychiatry, February 1972/ Vol. 2£, 133-136. Baker, M., Dorzab, J., Winokur, C., & Cadoret, A. J. Depressive Disease: Evidence Favoring Polygenic Inheritance Based on an Analysis of Ancestral Cases. Archives of General Psychiatry, September 1972, Vol. 27, 320-327. Barbara, D. A. Psychological and Psychiatric Aspects of Speech and Hearing. Illinois: Bannerhouse, 1962. Beck, A. T. Depression: Clinical Experimental and Theoretical Aspects. New York: Harper and Row, jwrr.— Beck, A. T. Suicide. In Hill, D., & Hollister, L. E. The Medical Management of Depression. New York: Medcom, 1970. Brackett, I. P. Parameters of Voice Quality. In Travis, L. E. Handbook of Speech Pathology and Audiology. New York, New York: App1eton-Century- Crofts, Educational Division, Meredith Corporation, 1971. Burton, R. The Anatomy of Melancholia. In Hill, D., & Hollister, L. E. The Medical Management of Depression. New Yorlcl Medcom, 1970. 55 Buss, A. H., Weiner, M., Durkee, A., & Baer, M. The Measurement: of Anxiety in Clinical Situations. Journal of Consulting Psychology, 1955, Vol. 19, 12, 125-1129.--------- ---------- Cammer, L. Up From Depression. New York, New York: Simon and Schuster, 1^69. Campbell, D. T., & Stanley, J. C. Experimental and Quasi-Experimental Designs for Research. Chicago, Illinois: Rand McNally and Company, 1972. Cassidy, W. L., Flanagan, N. B. , Spellman, B. A. , & Cohen, M. E. Clinical Observations in Manic-Depressive Disease; A Quantitative Study of One Hundred Manic-Depressive Patients and Fifty Medically Sick Controls. Journal of the American Medical Association, 1967, Vol. 164, 1535-1545. : ' Cattell, R. B., & Scheier, I. H. Handbook for the IPAT Anxiety Scale QuestionnaireT champaign, Illinois: Institute for Personality and Ability Testing, 1963. Chan, R. Personal Communication, 1971. Chaplan, A. A. The Gastrointestinal Tract. In Kiev, A. Somatic Manifestations of Depressive Disorders. Princeton, New Jersey: Excerpta Medica, T974. Clark, F. R., & Bilger, R. D. Theory of Signal Detectability and the Measurement of Hearing. In Jerger, M. Modern Developments in Audlology. New York: Academic Press, 1963. Cohen, J. The IPAT Anxiety Scale Questionnaire. In Buros, 0. K. Sixth Mental Measurement Yearbook. Highland Park, New Jersey: Gryphon Press, 1965, 121-122. Committee on Nomenclature and Statistics of the American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders^ American Psychiatric Association: Wa shington> D. C., 1968. 56 Coppen, A. Depression: A Clinical Portrait. In Hill, D., & Hollister, L. E. The Medical Management of Depression. New York: Medcom, 1970. Dawson, L. A Study of the Development of the Rate of Articulation. Elementary School Journal, 1929, Vol. 29, 610-615. Denes, P., & Pinson, E. The Speech Chain. New York: Garden State/Novo, 1970. Deutsch, F., & Murphy, W. The Clinical Interview, Vol. 1^ Diagnosis International Universities Press, Inc., 1961. Diehl, C. F. Voice and Personality. Psychological and Psychiatric Aspects of Speech and HearingT Illinois: Bannerhouse, 1960. : Don, A. M., & Sacks, L. Language Measurements - A Further Approach. Psychopharmacological Research. South African Medical Journal, September 1968, Vol. 42, 926-928. ” Dreher, J. J. Personal Communication, 1974. Dreher, J. J., & Bachrach, A. J. Power Spectral Density: A Methodology for the Rhythm Analysis of Speech. Reprint from Schizophrenia Current Concepts and Research. Hicksville, New York: PJD Publications, Ltd., 1970. Eisenson, J., Auer, J. J., & Irwin, J. V. The Psychology of Communication. New York, New York: Meredith Publishing Company, 1963. Endres, W., Bambach, W., & Flosser, G. Voice Spectro grams as a Function of Age, Voice Disguise, and Voice Imitation. Journal of the Acoustical Society of America, 1971, Vol. 49, # 6(2), 1842-1848. Fairbanks, G. Voice and Articulation Drillbook. New York, Evanston and London: Harper and Brothers, 1960. Fairbanks, G., Everitte, E., & Jaeger, R. P. Method for Time or Frequency Compression of Speech. In Fairbanks, G. Experimental Phonetics: Selected Articles. Urbana,' Illinois: University ot Illinois Press, 1966. 57 Fairbanks, G. , & Hoaglin, L. An Experimental Study of the Durational Characteristics of the Voice During the Expression of Emotion. Speech Monographs, 1941, Vol. 8, 85-90. Fairbanks, G., & Provonost, W. An Experimental Study of the Pitch Characteristics of the Voice During the Expression of Emotion. Speech Monographs, 1939, Vol. 6, 87-104. Farberow, N. L., & Shneidman, E. S. The Cry for Help. New Yorks McGraw Hill Book Company, 1965. Feighner, J. P. Sleep and Depression. In Kiev, A. Somatic Manifestations of Depressive Disorders. Princeton, New Jersey: Excerpta Medica, 1974. Felstein, S., & Jajje, J. Schizophrenic Speech Fluency: Partial Replication and Hypotheses. Psychological Reports, 1963, Vol. 13, 775-780. Freedman, A. M., & Kaplan, H. I. Comprehensive Texbook of Psychiatry. Baltimore, Maryland: Williams an<l Wxtkxns Company, 1967. Friedman, G., & Katz, B. The Psychology of Depression: Contemporary Theory and Research. New Yorks John Wiley and Sons, 1974. ~ Garside, R. F., Kay, D. W. K., Wilson, I. C., Deaton, I. D., & Roth, M. Depressive Syndromes and the Classification of Patients. Psychological Medicine, 1971, Vol. 1, 333-338. Goldman-Eister, F. Speech Production and the Predictability of Words in Context. Quarterly Journal of Experimental Psychology, 1958, Vol. 10, 96-lb6. Goodstein, L. D. Functional Speech Disorders and Person ality. A Survey of the Research. Journal of Speech and Hearing Research, 1958, Vol. 1, 359-376. Goodstein, L. D. Self Rating Depression Scale. In Buros, O. K. Seventh Mental Measurement Yearbook. Highland Park, New Jersey: Gryphon Press, 1972, Vol. JL, 136-137. Grinker, R., Miller, J., Sabshin, M., Nunn, R., & Nunnaly, J. The Phenomena of Depression. New York: Paul B. Hoeber^ Inc., 1961. 58 Hamilton, M. A Rating Scale of Depression. Journal of Neurology, Neurosurgery, and Psychiatry, 1960, Vol. 23, 56—62• Hanley, T. D., & Peters, R. The Speech and Hearing Laboratory. In Travis, L. E. Handbook of Speech Pathology and Audiology. New York, New Yorks Appleton-Century-Crofts, Educational Division, Meredith Corporation, 1971. Haskell, D. S., Dimascio, A., & Prusoff, B. A. Rapidity of Symptom Reduction in Depressions Treated With Amitriptyline. Journal of Nervous and Mental Diseases, 1975, Vol. 160, 24-33. Hill, D. , & Hollister, L. E. The Medical Management of Depression. New Yorks Medcom, 1970. Hilliard, M. Women and Fatigue - A Woman Doctor's Answers. New Yorks Doubleday, 1966. Hinchliffe, M. K., Lancashire, M., & Roberts, F. J. Depressions Defense Mechanisms in Speech. British Journal of Psychiatry, 1971, Vol. 118, 471-4771 Hoch, P. H., 6 Zubin, J. Anxiety. New York: Grune 6 Stratton, 1964. Holliday, A., & Devery, W. Effects of Drugs on the Performance of a Task by Fatigued Subjects. Clinical, Pharmacology and Therapeutics, 1962, voT. i/Tirs-fs. --------- -------- Isaac, S., & Michael, W. B. Handbook in Research and Evaluation for Education and the Behavioral Sciences. San Diego, California: R. A. Knapp, 1971. James, J. , & James, R. C. Mathematics Dictionary. (2nd Ed.) Princeton, New Jerseys. D. Van Nostrand and Company, Inc., 1959. Johnson, W. Speech Handicapped School Children. New Yorks Harper and Row, 1956. Karno, M., & Hoffman, R. The Pseudoanergic Syndrome. In Kiev, A. Somatic Manifestations of Depressive Disorders. Princeton, New Jerseys Excerpta Medica, 1974. 59 Kielholz, P. Depressive Illness. Baltimore: Williams and Witkins, 1972. Kielholz, P. (Ed.) Masked Depression. Vienna: Hans Berber, 1973. Kiev, A- Somatic Manifestations of Depressive Disorders. Princeton, New Jersey: Excerpta Medica, 1974. Kraepelin, E. Manic-Depressive Insanity and Paranoia. Textbook of Psychiatry. Edinbourogh: Livingstone, 1913. Kubie, L. S. The Neurotic Potential, the Neurotic Process and the Neurotic State. Armed Forces Medical Journal, January 1951, Vol. 2 _, 1-1TI Lachman, .S. J. Psychosomatic Disorders. New York: John Wiley and Sons, Inc., 1972. Ladefoged, P. A Course in Phonetics, in press. Ladefoged, P. Some Physiological Parameters in Speech. Language and Speech, 1963, Vol. £,109-119. Laughlin, H. P. The Neuroses. Washington, D. C.: Butterworth, Inc., 1967. Lauterbach, W. Covariation of Conflict and Mood in Depression. British Journal of Social and Clinical Psychology, 1975, Vol. 14~ 49-53. Leonard, C. Understanding and Preventing Suicide. Springfield, Illinois: Chas. C• Thomas, i967. Lester, G. , & Lester, D. Suicide: The Gamble With Death. Englewood Cliffs, New Jersey: Prentice- Hall, Inc., 1971. Licklider, J. C. R. Basic Correlates of the Auditory Stimulus. In Stevens, S. S. Handbook of Experi- mental Psychology. New York: John Wiley and Sons, Inc., 1951.---- Licklider, J. C. R., & Miller, G. A. The Perception of Speech. In Stevens, S. S. Handbook of Experimental Psychology. New York: John Wiley and Sons, Inc., 60 Linn, L. Clinical Manifestations of Psychiatric Disorders. In Freedman, A. M. , & Kaplan, H. 1. Comprehensive Textbook of Psychiatry. Baltimore, Maryland: Williams and Witkins Company, 1967. Lubin, B. Fourteen Brief Depression Adjective Checklists. Archives of General Psychiatry, 1966, Vol. 15(2), 205-208. Lundguist, G. Prognosis and Course in Manic Depressive Psychoses. ACTA Psychiatric Neurology, 1945, Suppl. 35^ 7-96. Market, N. N., Bein, M. F., & Phillis, J. A. The Relationship Between Words and Tone of Voice. Language and Speech, January-March, 1973, Vol. 16, # 1, 15-21. Martin, B. Anxiety and Neurotic Disorders. New York, New York: John Wiley and Sons, Inc., 1971. McClure, J. Pharmacotherapy. In Hill, D., & Hollister, L. E. The Medical Management of Depression. New York: Medcom, 1970. McNair, D. Self-Evaluations of Anti-Depressants. Psycho- ' pharmacologies, Berlin, 1974, Vol. 57, 282-302. McReynolds, P. Advances in Psychological Assessment, Vol. 2. Palo Alto, California: Science and Behavior Books, Inc., 1971. Mendels, J. Concept of Depression. New York: John Wiley and Sons, Inc., 1970. Mendels, J. The Psychobiology of Depression. New York: Spectrum Publications, SP Book Division, Halstead Press, 1975. Michel, J., Hollien, H., & Moore, G. Speaking Fundamental Frequency Characteristics of 15, 16, and 17 Year Old Girls. Language and Speech, 1966, Vol. £, 46-51. Mikesell, R. H., & Calhoun, L. G. Faking on the Zung Self-Rating Depression Scale. Psychological Reports, 1969, Vol. 25, 173-174. 61 Mikesell, R. H., & Calhoun, L. G. Response Set on the Zung Self-Rating Depression Scale. Perceptual and Motor Skills, 1970, 22. Milisen, R.. Parameters of Voice Quality. In Travis, L. E. Handbook of Speech Pathology and Audiology. New York, New York: Appleton-Century-Crofts, Educational Division, Meredith Corporation, 1971. Moore, G. P. Voice Disorders Organically Based. In Travis, L. E. Handbook of Speech Pathology and Audiology. New York, New York: Appleton-Century— Crofts, Educational Division, Meredith Corporation, 1971. Moses, J. The Voice of Neurosis. New York: Grune & Stratton, 1954. Moses, J. Emotional Causes of Vocal Pathology. In Barbara, D. A. Psychological and Psychiatric Aspects of Speech and Hearing. Illinois: Bannerhouse, 1962. Muma, J. R. , Leader , R. L., & Webb, C. E. Adolescent Voice Quality Aberrations: Personality and Social Status. Journal of Speech and Hearing Research, 1968, Vol. 11, 576-582. Murstein, B. I. Handbook of Projective Techniques. New York: Basic Books, 1965. Nie, N., Bent, D., Hull, C. Statistical Package for the Social Sciences. New York: McGraw-Hill, 1976. Ostwald, P. F., & Peltzman, P. The Cry of the Human Infant. Scientific American, March 1974, Vol. 230, # 3, 84-90. Pavy, D. Verbal Behavior and Schizophrenia: A Review of Recent Studies. Psychological Bulletin, 1968, Vol. 70, 164-178. Perkins, W. H. Speech Pathology: An Applied Behavioral Science. St. Lours, Missouri: C. V. Mosby Company, 1971. Perkins, W. H. Personal Communication, 1974. 62 Perkins, W. H. Personal Communication, 1975* Pike, K. L. The Intonation of American English, . Ann Arbor, Michigan: University of Michigan Press, 1945. Popov, V. A., Simonov, P. V., Frolov, M. V., & Khachaturyants. Frequency Spectrum of Speech as an Indication of Degree and Nature of Emotional Stress. Zhurmal Vysshey Nhervnoy Deyatel-most, 1971, No. 1, 104-109. . ~ - Post, F. The Older Depressed Patient. In Hill, D., & Hollister, L. E. The Medical Management of Depression. New York: Medcom, 1970. Potter, R., Kopp, G. , & Kopp, H. Visible Speech. New York: Dover, 1966. Price, J. Genetics of Depression. In Hill, D», & Hollister, L. E. The Medical Management of Depression. New York: Medcom, 1976. Prusoff, B* A., Klerman, G. L., & Pykel, E. S. Pitfalls in the Self-Report Assessment of Depression. Canadian Psychiatric Association, 1972, Vol. 17, 546-552. “ Reisner, M. Cardiovascular Disorders. In Freedman, A. M., & Kaplan, H. I. Comprehensive Textbook of Psychiatry. Baltimore, Maryland: Williams and ” Witkins Company, 1967. Renshaw, D. C. Sexual Dysfunctions. In Kiev, A. Somatic Manifestations of Depressive Disorders. Princeton, New Jersey: Excerpta Medica, 19*74. Robinson, J. C. , & Lewinsohn, P. M. Experimental Analysis of a Technique Based on the Premack . Principle Changing Verbal Behavior of Depressed Individuals. Psychological Reports, February 1973, Vol. 32, 199-210. Rosenthal, S., & Goodman, J. The Indogenous Depressive Pattern: An Empirical Investigation. Archives of General Psychiatry, 1967, Vol. 16, 241-249. Rowe, C. J. An Outline of Psychiatry. (5th Ed.) Dubuque, Iowa: William C. Brown Company, 1970. Ruesch, J. Disturbed Communication. New York: Norton, 1957. 63 Schildbrant, J. Neuropsychopharmacology and the Affective Disorders. Boston: Little, Brown & Co., 1970(a). Schildbrant, J. Pharmacology. In Hill, D., & Hollister, L. E. The Medical Management of Depression. »New York: Medcom, 1970 (b) . ’ Seligman, M. E. P. Helplessness: On Depression^ Development, and Death. San Francisco, California: Wl H. Freeman & Co., T975. Shands, H. C., & Finesinger, J. E. A Note on the Significance of Fatigue. Psychosomatic Medicine, 1952, Vol. 14, 309-314. Simonov, P. V., & Frolov, M. V. Utilization of Human Voice ‘ for Estimation of Man's Emotional Stress and State of Attention. Aerospace Medicine, March 1973, 256-258. Skinner, B. R. * Verbal Behavior. New York, New York: Appleton-Century-Crofts, Educational Division, Meredith Corporation, 1957. . Smith, R. P. , McGuire, R. J., & Fox, K. Aspects of Personality and Depression. Psychological Medicine, 1971, Vol. 1, 239-246. Snidecor, J., & Isshiki, N. Vocal and Air Use Charac teristics of a Superior Male Esophageal Speaker. Folia Phoniatica, 1965, Vol. 17, 217-232. Stein, M., & Schiavi, R. Respiratory Disorders. In Freedman, A. M., & Kaplan, H. I. Comprehensive Textbook of Psychiatry. Baltimore, Maryland: Williams and Witkins Company, 1967. Sternbach, R. A. Pain and Depression. In Kiev, A. Somatic Manifestations of Depressive Disorders. Princeton, New Jersey: Excerpta Medica, 19^4. Stevens, S. S. Handbook of Experimental Psychology. New York: John Wiley and Sons, Inc., 1951. Sugar, M. Disguised Depressions in Adolescence. In Usdin, B. Adolescence Care and Counseling. Phila delphia, Pennsylvania: J. J. Lippincott Co., 1967. 64 Thomas, C. H. Taber"s Cyclopedic Medical Dictionary. (12th Ed.) Philadelphia, Pennsylvania: F. A. Davis Company, 1970. Townsend, M. Personal Communication, 1974. Travis, L. E. Handbook of Speech Pathology and Audiology^ New York, New York: Appleton-Century-Crofts, Educational Division, Meredith Corporation, 1971. Truax, C. B. Normalization of Verbal Productivity and Improvement in Depressive Status in Schizophrenics. Journal of Clinical Psychology, October 1971, Vol. 27, 537-539. Usdin, B. Adolescence Care and Counseling. Philadelphia, Pennsylvania: J. J. Lippincott Co., 1967. Von Leden, H. Conservation Surgery of Laryngeal Carcinoma. International Surgery, 1966, Vol. £5, 261-271. Webb, E. J., Campbell, D. T., Schwartz, H., & Sechrist, L. Unobtrusive Measures: Non-Reactive Measures in the Social Sciences. Chicago, Illinois: Rand McNally and Company, 1973. Weintraub, W., & Aronson, H. The Application of Verbal Behavior Analysis to the Study of Psychological Defense Mechanisms. Journal of Nervous and Mental Disease, January 1967, Vol. 144, 22-28. ' Williams, J. G., Barlow, D. H., & Agras, W. S. Behavioral Measurement of Severe Depression. Archives of General Psychiatry, September 1972, Vol. 27^ 330-333. Wittenborn, J. Depression. In Wolman, B. B. Handbook of Clinical Psychology. San Francisco, California: McGraw Hill Book Company, 1965. Wolman, B. B. Handbook of Clinical Psychology. San Francisco, California: McGraw Hill BookCompany, 1965. Zung, W. W. K. A Self-Rating Depression Scale. Archives of General Psychiatry, 1965, Vol. 12, 63-70. Zung, W. W. K. A Cross-Cultural Survey of Symptoms in Depression. American Journal of Psychiatry, 1967, Vol. 126, 177-183. 65 Zung, W. W. K. Factors Influencing the Self-Rating Depression Scale. Archives of General Psychiatry, 1967, Vol. 16, 543-547. Zung, W. W. K. Evaluating Treatment Methods for Depressive Disorders. American Journal of Psychiatry, 1968, Vol. 624 (Suppl.), 40-48. Zung, W. W. K. Depression in the Normal Adult Population. Psychosoma tics, 1971, Vol. 12^, 164-167. Zung, W. K. A Cross-Cultural Survey of Depressive Symptomology in Normal Adults. Journal of Cross- Cultural Psychiatry, 1972, Vol. TJ 177-183. Zung, W. W. K. How Normal is Depression? Psychosoma tics, May-June 1972, Vol. 13, # 3, 174-178. Zung, W. W. K. From Art to Science. Archives of General Psychiatry, 1973, Vol. 2£, 328-337. Zung, W. W. K. Personal Communication, 1974. Zung, W. W. K., Richards, C. B., & Short, M. J. Self- Rating Depression Scale in an Outpatient Clinic. Further Validation of the SDS. Archives of General Psychiatry, 1965, Vol. 13, 508-5X5: Zung, W. W. K. , & Wonnacott, T. H. Treatment Prediction in Depression Usinq a Self-Rating Scale. Biological Psychology, 1970, Vol. 2, 321-329. 66 APPENDIX I Test Paragraph This easy going footpath is rightly named Meadow Trail. It winds through rich stands of pine, fir and oak with a grand view over the thick wooded valley to the stony spurs of the nearby ridge. In spring wild flowers add a beautiful dash of color* A gentle blue stream runs through waist-high grasses where the flap of wings tells of birds moving from meadow to woods or back again. The footpath reaches an old stone bridge that crosses the stream and continues on through the meadow meeting other trails. It is a lovely gateway to a lovely park-like country. 67 APPENDIX II Self-Administered Depression Scale Statements I. I feel down-hearted, blue and sad* |2. Morning is when I feel the best* . 3* I have crying spells or feel like it. 4. I have trouble sleeping through the night* 5* I eat as much as I used to* 6. I enjoy looking at, talking to and being with attractive women/men. 7. I notice that I am losing weight. 8. I have trouble with constipation. 9. My heart beats faster than usual* 10. I get tired for no reason* II. My mind is as clear as it used to be. 12. I find it easy to do the things I used to. 13. I am restless and can't keep still* 14. I feel hopeful about the future. 15. 1 am more irritable than usual. 16. I find it easy to make decisions. 17. I feel that I am useful and needed. 18. My life is pretty full. 19. I feel that others would be better off if I were dead. 68 20. I still enjoy the things X used to do. Each statement has four possible response columns: "None OR a Little of the Time," "Some of the Time," ".Good Part of the Time," or "Most OR All of the Time." Each subject responds to each statement by checking one of these four columns. 69 APPENDIX III Information and Consent Form . | You have been asked to participate in a study jwhich will involve reading a paragraph aloud and responding t to some statements that relate to you* In addition, to guarantee privacy of the information, you will be given a ; number which will be entered on all forms of this study* The information gathered here will be available to your attending physician who may pass this information on to you at a later time* It is explicitly stressed that all of your responses will be maintained in the strictest confidence* If you are willing to participate in this study, please print and sign your name and enter the date where indicated below* PRINT NAME Signature (SIGN) Index Number DAVID IRVING NEWHAUSER 1931 1949 1957-58 1958 1961-62 1962 1965-66 1967-75 1969 1969-70 1970 1970-71 1971-72 1972-73 1972- 1973- Born in Chicago, Illinois Graduated from James Madison High School, Brook lyn, New York Teaching Assistant, University o f California, Los Angeles, California B.S., Business Administration, University o f Cali fornia, Los Angeles Graduate Student, University of Southern California, Los Angeles M.B.A., Industrial Management, University o f South ern California Teaching Assistant, California State University, Los Angeles Graduate Student, University o f Southern California Departmental Appointee, National Institute on Com m unity Police Relations, University of Southern Cali fornia Research Fellowship, University o f Southern Cali fornia — Rancho Los Amigos Hospital, Los Angeles M.S., Counselor Education, University of Southern California Pre-doctoral Intern, Orange County Department of Mental Health, Santa Ana, California S ta ff Psychotherapist, Institute of Therapeutic Psychology, Santa Ana Principal, Barbara Sterling School, Garden Grove, California Staff Psychotherapist, Interpersonal Institute, Los Angeles Member, Board of Directors, Educational Guidance Foundation, Garden Grove

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

The effects of subliminally presented same and opposite-gender stimuli on anaclitic and introjective depressed males and females

PDF

Physiological, emotional, and self-reported indices of stress response for women in dual-career marriages

PDF

Family-of-origin intervention as a therapeutic resource in enhancing marital adjustment: An intergenerational approach

PDF

Intravenous drug use among women and men addicts and psychosocial and health belief correlates of AIDS risk reduction

PDF

Self-efficacy, job/home attitudes and career concept relationships in pairs of mothers and undergraduate daughters

PDF

The good child as the unidentified patient in the family system: A study of childhood antecedents of adult alienation from self

PDF

Religiosity, social support, meaning of life, and mental health in Indonesian Christians

PDF

The construct of integrative cognitive style and its measure as an indicator of advanced ego development

PDF

Adult attachment styles and relationship satisfaction

PDF

Memory complaints and neuroticism in older adults

PDF

Paths to sex role redefinition in dual-career women

PDF

Counseling and counselor training of the American rabbinate

PDF

Burnout among psychotherapists: Effects of work environment, stressful life events, coping, and social support

PDF

The war in El Salvador: The child as witness, participant, casualty, survivor, a phenomenological study

PDF

Difference on measures of ability, encouragement, sex role identity, and values among gifted males and gifted females subgrouped by career role performance

PDF

Effects of separation for divorce of adoptive parents on the adopted child

PDF

Christian counselors: A descriptive study of their counseling practices

PDF

Personality and demographic variables in mid-life career changers and non-changers

PDF

The Grief Therapy Project: The effects of group therapy with bereaved surviving spouses on successful coping with grief

PDF

Attitudes toward achieving peace : a measure of "peace through strength" and "peace through cooperation" and the relationship of these attitudes with affective, coping, personality, and gender co...

Asset Metadata

Creator Newhauser, David Irving (author)

Core Title Physical measures of female speech and voice variables as indices of retarded clinical depression

Contributor Digitized by ProQuest (provenance)

Degree Doctor of Philosophy

Degree Program Education (Counseling Psychology)

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-446858

Unique identifier UC11245242

Identifier usctheses-c26-446858 (legacy record id)

Legacy Identifier DP24150.pdf

Dmrecord 446858

Document Type Dissertation

Rights Newhauser, David Irving

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA