Doing right by the eyewitness evidence: a response to Berkowitz et al.

Berkowitz et al. (Berkowitz, S. R., Garrett, B. L., Fenn, K. M., & Loftus, E. F. (2020). Convicting with confidence? Why we should not over-rely on eyewitness confidence. Memory. https://doi.org/10.1080/09658211.2020.1849308) attribute to us the claim that "confidence trumps all", and the few out-of-context quotations they selected can certainly be used to create that false impression. However, it is easily disproved, and we do so here. The notion that "confidence trumps all" is the mistake that the jurors made in the DNA exoneration cases, not a position that we have ever advocated.

Comparison of DSM-IV and proposed ICD-11 formulations of PTSD among civilian survivors of war and war veterans.

The World Health Organization recently proposed a reformulation of posttraumatic stress disorder (PTSD) for the 11(th) edition of the International Classification of Diseases (ICD-11), employing only 6 symptoms. The aim of this study was to investigate the impact of this reformulation of PTSD as compared to criteria according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) on the prevalence of current PTSD as well as comorbid major depressive episode and anxiety disorders other than PTSD. Study 1 involved previously collected interviews with 560 Kosovar civilian war survivors; Study 2 employed a previously collected sample of 142 British war veterans. Results revealed no change in the diagnostic status under the criteria proposed for ICD-11 in 87.5% of civilian war survivors and 91.5% of war veterans. Participants who only met the newly proposed criteria showed lower rates of comorbid major depressive episode than participants who only met DSM-IV criteria (13.6% vs. 43.8% respectively). Rates of comorbid anxiety disorders did not significantly differ between participants who lost or gained a PTSD diagnosis under the proposed criteria.

Recognition and treatment of psychological disorders during military service in the UK armed forces: a study of war pensioners.

PURPOSE: Little is known about the detection and treatment of psychological disorders arising during military service. We investigated whether personnel who developed disorders while serving in the UK armed forces came to the attention of medical services for these problems, received corresponding diagnoses, and were treated. METHODS: For this retrospective record-based study 132 veterans in receipt of a war pension for psychological or physical problems received a lifetime diagnostic interview. Those with onsets of PTSD, depression, or alcohol abuse while in service were compared with those who never developed any condition or only developed it after discharge. Their medical records were inspected for contemporaneous contacts, diagnoses, and treatment. RESULTS: PTSD and depression, but not alcohol abuse, were independently associated with mental health contacts while in service. The median time from PTSD onset to first contact was 1 month. Under half of personnel meeting criteria for these disorders received a corresponding diagnosis, and alcohol abuse was more likely to be recognised in the context of comorbid PTSD. PTSD was as well recognised in earlier as in later years covered by the study. Most personnel with disorders received treatment, and those treated were more likely to be medically downgraded or discharged. CONCLUSIONS: War pensioners are more likely than not to have had their psychological problems acknowledged and treated while in service. The fact that these problems are still largely present 10 years later raises questions over the continuity of care associated with the transition to civilian life.

Delayed-onset posttraumatic stress disorder: a systematic review of the evidence.

OBJECTIVE: Since the diagnosis of delayed-onset posttraumatic stress disorder (PTSD) was introduced in DSM-III, there has been controversy over its prevalence and even its existence. The authors sought to resolve discrepant findings concerning the prevalence of delayed-onset PTSD by conducting a systematic review of the evidence. METHOD: A literature search was conducted for case reports and group studies with adequate measurement of delayed-onset PTSD according to DSM criteria. Studies that met inclusion criteria were examined for the defined length of delay for delayed-onset PTSD, presence of symptoms before full diagnostic criteria were met, length of follow-up, prevalence estimates, and other variables. Studies were also examined for differences between immediate-onset PTSD, delayed-onset PTSD, and no-PTSD cases. RESULTS: Ten case studies and 19 group studies met criteria for inclusion in the review. Studies consistently showed that delayed-onset PTSD in the absence of any prior symptoms was rare, whereas delayed onsets that represented exacerbations or reactivations of prior symptoms accounted on average for 38.2% and 15.3%, respectively, of military and civilian cases of PTSD. CONCLUSIONS: The discrepant findings in the literature concerning prevalence can be largely, but not completely, explained as being due to definitional issues. Little is known about what distinguishes the delayed-onset and immediate-onset forms of the disorder. Continuing scientific study of delayed-onset PTSD would benefit if future editions of DSM were to adopt a definition that explicitly accepts the likelihood of at least some prior symptoms.

Creating Memories for False Autobiographical Events in Childhood: A Systematic Review.

Using a framework that distinguishes autobiographical belief, recollective experience, and confidence in memory, we review three major paradigms used to suggest false childhood events to adults: imagination inflation, false feedback and memory implantation. Imagination inflation and false feedback studies increase the belief that a suggested event occurred by a small amount such that events are still thought unlikely to have happened. In memory implantation studies, some recollective experience for the suggested events is induced on average in 47% of participants, but only in 15% are these experiences likely to be rated as full memories. We conclude that susceptibility to false memories of childhood events appears more limited than has been suggested. The data emphasise the complex judgements involved in distinguishing real from imaginary recollections and caution against accepting investigator-based ratings as necessarily corresponding to participants' self-reports. Recommendations are made for presenting the results of these studies in courtroom settings.

False Memories and Free Speech: Is Scientific Debate Being Suppressed?

Commentators have raised important points, including the relative contribution of false beliefs versus false memories and the issue of how findings in the laboratory can be generalized to the real world, which we have addressed here. However, some of the commentaries misrepresent what we said, make criticisms that are unfounded, or imply that our article should not have been published in Applied Cognitive Psychology. We relate these responses to a more general literature on the suppression of unwanted scientific findings and suggest that the study of false memory would be better served by more openness to alternative perspectives.

Student anxiety and depression: comparison of questionnaire and interview assessments.

BACKGROUND: Recent reports note a reliance on self-report measures and a lack of information about diagnosable mental disorder in university students. Professional concern about perceived increases in student mental health problems raises questions about whether questionnaire assessments can provide valid approximations of such disorders in this group. The aim of this study was to validate the Hospital Anxiety and Depression Scale (HADS) against DSM-IV diagnoses in university students. METHODS: Eighty-nine students were administered with the HADS followed by the Structured Interview for DSM-IV. RESULTS: At recommended cut-offs HADS anxiety and depression scales both showed good sensitivity in detecting DSM-IV anxiety and depression disorders, and the depression scale showed good specificity and overall efficiency. The HADS anxiety scale showed poor specificity and moderate overall efficiency. In the absence of an anxiety diagnosis, high HADS anxiety scores were not significantly associated with other measured indicators of serious mental health problems. LIMITATIONS: Further research is needed to investigate whether the current findings hold for student populations with higher social diversity. CONCLUSIONS: The HADS depression scale is likely to be a reasonably accurate indicator of depressive conditions in university students at the recommended cut-off but the HADS anxiety scale overestimates the extent of clinical anxiety. Students' self-reported higher symptom levels in comparison to general population norms cannot be assumed to indicate higher levels of more serious mental health conditions. However this is not to deny the genuine distress and severe problems that some students experience.

Life goals, approaches to study and performance in an undergraduate cohort.

BACKGROUND: Two main approaches to studying have been distinguished by several researchers, the deep approach and the surface approach. In addition, an achieving or strategic approach employs either deep or surface strategies, depending on the demands of the task. AIMS: The present study investigated factors contributing to the choice of preferred study approach at university and relations between these factors and academic performance. METHOD: A questionnaire was mailed to a complete cohort of entrants in a college of London University in the UK. A further questionnaire was sent part way through the second year of the course. RESULTS: Consistent relations were found between general life goals and approaches to study, with the deep approach being associated with altruistic life goals and the surface approach being associated with wealth and status life goals. The achieving approach was related to both types of life goal, but more strongly to wealth and status life goals. Older students, those with superior results in Advanced Level examinations, those reporting more use of the achieving approach, and those with less interest in wealth and status life goals, produced better academic results. Study approaches became more surface-oriented and less deep and achieving-oriented over the first year of study, but these changes were unrelated to academic performance. CONCLUSIONS: Approaches to study form part of a wider approach to life in general. Students adopting the achieving approach to study performed better. Though the achieving approach tended to weaken as the course proceeded, this change was unrelated to performance.

The relationship of non-disclosure in therapy to shame and depression.

OBJECTIVE: This study aimed to explore the relationship between shame-proneness, depression, and non-disclosure in therapy in 85 men and women who had received treatment for depression. METHOD: Data were collected by means of a questionnaire, which assessed depressive symptoms, shame-proneness, non-disclosure in therapy, and reasons for non-disclosure. RESULTS: In total, 54% of the respondents reported concealing depression-related symptoms and behaviours or other distressing experiences from their therapist. Shame was the most frequently reported reason for non-disclosure overall, but was a more frequent reason for non-disclosure of symptoms than experiences. Similarly, shame-proneness was significantly related to non-disclosure of symptoms but not to non-disclosure of experiences. For participants no longer in therapy, non-disclosure of symptoms made a significant independent contribution to current level of depressive symptoms after controlling for demographic variables, worst depression, and shame-proneness. CONCLUSIONS: The hypothetical model put forward in this study predicting a significant relationship between shame, non-disclosure in therapy, and current depressive symptomatology was supported. The findings suggest that encouraging and facilitating the disclosure of shameful symptoms and related behaviours has positive implications for the effectiveness of treatment.

Diagnostic overlap between acute stress disorder and PTSD in victims of violent crime.

OBJECTIVE: In a group of crime victims, the authors investigated overlap between acute stress disorder and posttraumatic stress disorder (PTSD) diagnoses and their relative ability to predict PTSD at 6 months. METHOD: A mixed-sex group of 157 victims of violent assault were interviewed within 1 month of the crime. At the 6-month follow-up, 87.9% were reinterviewed by telephone. RESULTS: At baseline the rate of acute stress disorder was 19.1%, the rate of PTSD was 21.0%, and the percentage agreement between them was 95.5%. The two diagnoses were equally effective predictors of PTSD 6 months later. CONCLUSIONS: The high level of overlap between acute stress disorder and PTSD calls into question whether, as presently formulated, they represent distinct diagnoses.

Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology.

Participants with schizophrenia (N = 59) were assessed on self-evaluation, symptomatology, and positive and negative affect (expressed emotion) from significant others. An interview-based measure of self-evaluation was used and two independent dimensions of self-esteem were derived: negative and positive evaluation of self. As predicted, negative self-evaluation was strongly associated with positive symptoms, a more critical attitude from family members was associated with greater negative self-evaluation, and analyses supported a model whereby the impact of criticism on patients' positive symptoms was mediated by its association with negative self-evaluation. The interview-based method of self-esteem assessment was found to be superior to the questionnaire because its predictive effects remained after depressed mood was accounted for.

The relationship between shame, eating disorders and disclosure in treatment.

BACKGROUND: This study considered shame in 68 women who had received treatment for eating disorders (EDs) compared to 72 non-clinical controls, and shame in relation to disclosure in treatment. METHOD: All participants completed questionnaires on ED and depressive symptoms, and bodily, behavioural and characterological shame and shame around eating. ED women also answered questions on disclosure in treatment. RESULTS: The ED group scored significantly higher than controls on all shame areas when depression was controlled. ED women who were currently symptomatic and those who had recovered scored higher than controls on bodily and characterological shame and shame around eating. Non-disclosure in treatment was reported by 42% of the ED group and was associated with higher shame in all areas except bodily shame. CONCLUSIONS: The study is the first to show a relationship between shame and ED in a clinical sample. It supports existing evidence regarding the importance of bodily shame in women with EDs, and extends the literature in terms of the importance of other shame aspects for ED symptomatology and disclosure. Implications for treatment are discussed.

Predicting depressive symptoms with a new measure of shame: The Experience of Shame Scale.

OBJECTIVE: To investigate whether previous findings from interview studies of a prospective relationship between shame and psychopathology (e.g. Andrews, 1995) could be replicated using questionnaires. DESIGN: A total of 163 university students participated in a longitudinal questionnaire study. METHOD: The Experience of Shame Scale (ESS), a questionnaire based on a previous interview measure, and an established shame scale (TOSCA), were considered in their relation to depressive symptoms assessed at two time points 11 weeks apart. RESULTS: Both scales made significant independent contributions to depressive symptoms at time 1. However, only the ESS predicted additional significant variance in time 2 symptoms when time 1 symptoms were controlled. CONCLUSIONS: It was concluded that the reason for the differential performance of the two scales was that the ESS, like the shame interview, assesses specific areas of shame related to self and performance, whereas the TOSCA assesses general shame and may therefore be more prone to mood-state effects.

The relation of depression and anxiety to life-stress and achievement in students.

OBJECTIVES: An apparent increase in seriously disturbed students consulting student health services in the UK has led to concern that increasing financial difficulties and other outside pressures may affect student mental health and academic performance. The current research investigated whether student anxiety and depression increases after college entry, the extent to which adverse life experiences contribute to any increases, and the impact of adversity, anxiety and depression on exam performance. METHOD: 351 UK-domiciled undergraduates completed questionnaires one month before university entry and mid-course. The Hospital Anxiety and Depression Scale (HADS: Zigmond & Snaith, 1983) was administered at both time points and a modified List of Threatening Experiences (Brugha, Bebbington, Tennant, & Hurry, 1985) was administered mid-course. RESULTS: By mid-course 9% of previously symptom-free students became depressed and 20% became anxious at a clinically significant level. Of those previously anxious or depressed 36% had recovered. After adjusting for pre-entry symptoms, financial difficulties made a significant independent contribution to depression and relationship difficulties independently predicted anxiety. Depression and financial difficulties mid-course predicted a decrease in exam performance from first to second year. CONCLUSIONS: This is the first study to confirm empirically that financial and other difficulties can increase British students' levels of anxiety and depression and that financial difficulties and depression can affect academic performance. However, university life may also have a beneficial effect for some students with pre-existing conditions. With widening participation in higher education, the results have important implications for educational and health policies.

Eating disturbances in female prisoners: the role of anger.

Women in prison have high levels of impulsive damaging behaviours, including disordered eating. In addition, they display pathological levels of the emotional precursors that have been associated with eating disorders, particularly anger. The present study examines levels of disordered eating behaviours in female prisoners, and whether those behaviours are associated with anger. The sample consisted of 91 sentenced women at a medium-sized prison in the UK. The women completed an interview-based screening tool for eating disorders, alongside a standardised measure of anger. Using the established cut-off on the measure concerned, 25% of the women were at risk for an eating disorder. This prevalence rate is exactly twice that observed in a non-eating-disordered community sample, using the same measure. Furthermore, different facets of anger were associated with different aspects of eating psychopathology. The most plausible explanation for this association appears to be that many women enter prison with high levels of anger-driven impulsivity, and that the constraints of the prison environment result in a focus on eating behaviours. Future research directions are discussed.

Comparison of immediate-onset and delayed-onset posttraumatic stress disorder in military veterans.

Differences in symptoms, trauma exposure, dissociative and emotional reactions to trauma, and subsequent life stress in war veterans reporting immediate-onset or delayed-onset posttraumatic stress disorder (PTSD) or no PTSD were investigated. The role of life stress in delayed-onset PTSD was also studied. Retrospective interviews were conducted with 142 United Kingdom veterans receiving a war pension for PTSD or physical disability. Immediate-onset and delayed-onset PTSD were similar in the number and type of symptoms reported at onset, but the delayed-onset group differed in showing a gradual accumulation of symptoms that began earlier and continued throughout their military career. They were more likely to report major depressive disorder and alcohol abuse prior to PTSD onset. Both groups described similar amounts of trauma exposure, but those in the delayed-onset group reported significantly less peritraumatic dissociation, anger, and shame. Veterans with delayed onsets were more likely than veterans with no PTSD to report the presence of a severe life stressor in the year before onset. In conclusion, the results suggest that delayed onsets involve a more general stress sensitivity and a progressive failure to adapt to continued stress exposure.

Relations between life difficulties, measures of working memory operation, and examination performance in a student sample.

This study investigated the hypothesis that the negative effect of life difficulties on examination performance in university students (Andrews & Wilding, 2004) can be explained by impairment of working memory efficiency. UK-based students were given an extensive interview covering recent life stressors, and carried out a task testing working memory span, in which they had to judge the truth of arithmetic expressions while retaining words. Students reporting one or more life difficulties in the preceding 12 months recalled significantly fewer words than those reporting no such difficulties, but showed no difference in processing time on the task. However, while the number of words recalled was unrelated to examination performance at the end of the year, students who took longer on the task did significantly less well in the examination. This relation was more marked in Science than in Arts students. A number of possible explanations for this pattern of results are considered, which need to be explored in further research. In particular it is suggested that the number of words retained in the working memory span task reflects current state, and is reduced by intrusive thoughts provoked by current life difficulties, while time on the task reflects more permanent efficiency of the processing system and, therefore, efficiency in study and examinations.

Risk of non-fatal suicide ideation and behaviour in recent onset schizophrenia--the influence of clinical, social, self-esteem and demographic factors.

BACKGROUND: Suicide rates amongst schizophrenic patients are high. There are disadvantages in investigating successfully completed suicides which make suicidal ideation and previous attempts important proxy measures of suicidal risk. The aim of this study was to investigate factors associated with these risk measures. METHOD: Fifty-nine patients suffering recent onset schizophrenia were assessed for suicidal ideation and history, and a range of demographic, clinical, social (including relatives' Expressed Emotion) and self-esteem measures. Univariate comparisons were made between those with and without suicide ideation and previous attempts. Path analysis was conducted to identify factors directly or indirectly associated with a composite scale of risk (low, medium or high). RESULTS: Approximately 25% of the sample reported a current desire to kill themselves and 47% had made one or more previous attempts. There were numerous significant univariate differences between those with or without ideation or history. Path analysis indicated that greater hopelessness (OR 1.22) and longer duration of illness (OR 1.13) increased risk. Hopelessness was associated with higher negative self-evaluation and social isolation. Negative self-evaluation was associated with more relatives' criticism which was associated with more negative symptoms. Being a male, unmarried and unemployed were all significantly associated with an increase in negative symptoms. Social isolation was associated with being unemployed, older, more positive symptoms and longer illness duration. Duration of illness was not itself predicted by any other variables. CONCLUSION: Non-fatal suicide ideation and behaviour are significantly associated with an array of demographic, clinical, interpersonal and psychological factors. To reduce risk of suicide, these factors need to be assessed and methods developed to reduce their influence.

Gender, social support, and PTSD in victims of violent crime.

Gender differences in social support levels and benefits were investigated in 118 male and 39 female victims of violent crime assessed for PTSD symptomatology 1 and 6 months postcrime. Within 1 month postcrime both genders reported similar levels of positive support and support satisfaction, but women reported significantly more negative responses from family and friends. Women also reported an excess of PTSD symptoms that was similar at 1 and 6 months postcrime, and negative responses mediated the relationship between gender and later symptoms. Overall negative response and support satisfaction, but not positive support, were significantly associated with PTSD symptoms. However, the effects of support satisfaction and negative response on 6-month symptoms were significantly greater for women than men. The findings are consistent with previous studies of predominantly female assault victims concerning the stronger impact of negative over positive support, and might help explain women's higher PTSD risk in civilian samples.