Case Study
Patient Demographic: Client Age: 26 Sex: Male Gender: Male Sexuality: Heterosexual Ethnicity: African American Relationship Status: Single Counseling Setting: Community Mental Health Center Type of Counseling: Individual Presenting Problem: Depressive Symptoms Diagnosis: Persistent Depressive Disorder (PDD) (Dysthymia) Diagnostic Criteria 300.4 (F34.1)
Mental Status Exam: Mental Status Exam: The client is dressed in age-appropriate clothing and is well groomed. His affect is blunted and anxious at times. The client denies anxiety but discloses that he is nervous about the counseling process and doesn’t know what to expect. He is cooperative but hesitant to offer more information than is asked. The client is tearful when discussing his breakup and states that there are days when it is a struggle to get out of bed and go to work. He denies suicidal ideation, and he says that he has had no previous attempts. The client is oriented to person, place, time, and situation, and his thought content is organized. Fam
Presenting Problem: You are a counselor working in a community mental health center. Your initial intake appointment is with a 26-year-old African American male who presents with symptoms of depression. The client states that he has felt depressed since his teens, with symptoms increasing within the last couple of months. He reports feelings of worthlessness, fatigue, and occasional bouts of insomnia. In addition, the client indicates that his symptoms worsened after his girlfriend of 2 years broke things off with him. He explained that she grew tired of his low energy and pessimistic outlook on life. As a result, he has been hesitant to seek help, believing that he just needed to “man up” and handle his problems privately. The client is unsure of his insurance benefits but thinks his policy allows for a limited number of counseling sessions.
Other Contexts:    ily and Work History: The client grew up in a home with his mother, father, and maternal grandmother. He has a 22-year-old sister who he believes also experiences depression, but he is unsure if she has received treatment. The client says that he attends church “most Sundays” with his family, primarily because he knows it is important to his grandmother. The client holds an associate degree in information technology and is a computer network support specialist. He has worked for the same company for the past 4 years.  You would like to use the Beck Depression Inventory-II (BDI-II) but are concerned about the possibility of racial bias. You find a study stating, “The recommended cutoff score of 14 for screening for depression appears to be appropriate for African American patients in the primary care setting” (Dutton et al., 2004). This cutoff yielded a specificity of 84%

Question: You would like to use the Beck Depression Inventory-II (BDI-II) but are concerned about the possibility of racial bias. You find a study stating, “The recommended cutoff score of 14 for screening for depression appears to be appropriate for African American patients in the primary care setting” (Dutton et al., 2004). This cutoff yielded a specificity of 84%. How do you interpret these findings?
(A): 84% of respondents with depression scored above 14.
(B): 84% of respondents have a high probability of scoring above 14.
(C): 84% of respondents without depression scored below 14.
(D): 84% of respondents have a low probability of scoring above 14.

Correct Answer: 84% of respondents without depression scored below 14.
Explanation: The study shows a high proportion of people without depression with low scores. BDI-II scoring is as follows: A score of 0–13 is considered in the minimal range, 14–19 is mild, 20–28 is moderate, and 29–63 is severe. Specificity measures (ie, the true negative rate) are the proportion of people without depression with a low score on the BDI-II. In other words, a specificity of 84% indicates that 84% of individuals without depression did not score above a cutoff score of 14. This also means that the study yielded few false negatives. The same study yielded a sensitivity score of 88%. A sensitivity score is a true positive rate because 88% of those with depression scored above the cutoff score of 14 on the BDI-II. Probability is unrelated to specificity and sensitivity and is used to determine the likelihood or chance of an event occurring. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis