Article Review: Marek, R. J., Heinberg, L. J., Lavery, M., Rish, J M., & Ashton, K. (2016)’s A Review of Psychological Assessment Instruments For Use in Bariatric Surgery Evaluations


Marek, Heinberg, Lavery, Rish, and Ashton (2016) offer a thorough review of psychological assessment instruments for bariatric surgery patients.  Through their literature review, they highlight the association of pre-surgical psychological factors with weight gain post-op and recurrence of behavioral problems. Additionally, they note that bariatric patients have a higher prevalence for psychological disorders compared to the general population (Kalarchian et al., 2007; Mitchell, Selzer, et al., 2012, as cited in as cited in Marek, Heinberg, Lavery, Rish, & Ashtom, 2016). Thus, and consistent with their review, the National Institute of Health (NIH) has recommend psychological assessment for bariatric surgical candidates.  The authors highlight the goals for such an evaluation are to “identify and treat preexisting psychopathology,” “identify patients who may need additional postoperative care,” and to “identify alternative treatment strategies” if a patient is deemed not appropriate for a selected procedure (Block & Sarwer, as cited in Marek et al., 2016, p. 1143).


The authors review the domains of a semi-structured interview for the assessment of bariatric surgery candidates and provide references for the clinical interview (see references for information on clinical interviews).  They indicate that though many practitioners use common broadband assessments (i.e., MMPI-2 or BID-II), the instruments used tend to vary and often lack sound psychometric properties for use with this population. In general, they recommend that the psychological domains of internalizing psychopathology, eating-related behaviors, externalizing psychopathology, and thought disorder or poor cognitive functioning be assessed.  The authors indicate that depression and anxiety are prevalent among this population, and further note that antidepressants may be inadequately absorbed after surgery (Roerig et al., 2012; as cited in Marek et al., 2016).  If left untreated, alcohol and substance use are contraindicated with this surgical procedure.  Marek et al. (2016) state that “pharmacokinetic changes following some bariatric surgery procedures further accelerate alcohol absorption, making postsurgical risk of alcohol misuse problematic” (p. 1144). Further, continued marijuana use may impact eating habits; while the effects of other substances are currently unknown.  Finally, an unstable or untreated thought disorder is considered contraindicated for bariatric procedures. Here, concerns of weight gain from psychiatric medications, side effects from anesthesia (e.g., delirium), adherence and understanding of the procedure and aftercare, and deficits in neurocognitive domains are considered to be significant factors that could lead to problems post-surgery.


The authors offer a thorough review of several common assessment instruments used in bariatric surgery evaluations. For the broadband instruments, the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) is the most widely used, and the Minnesota Multiphasic Personality Inventory, Second Edition-Restructured Form (MMPI-2-RF) also shows good reliability, validity, and predictive utility.  Marek et al. (2016) reported preference for the MMPI-2-RF with this population. The authors highlight concerns with MMPI-2 profile elevations related to underreporting as this response style may not only suppress clinical scales, but also may indicate an underreporting on other self-report measures. High scores on the hysteria, masculinity/femininity, and paranoia scales, along with elevations of Health Concerns and the Infrequency scale differentiated patients who lost less than 50 percent of their weight.  The Personality Assessment Inventory (PAI) is less commonly used, but is suggested as a viable option. The Symptom Item Checklist-90-Revised (SCL-90-R) lacks validity scales and assessment of externalizing psychopathology; yet based on past research, bariatric patients that score higher on depression, anxiety, and hostility scales were more likely to be delayed for surgery. The Million Behavioral Medication Diagnostic (MBMD) has bariatric normative data and report options, yet there is limited psychometric data published. Research with the Millon Clinical Multiaxial Inventory-II (MCMI-II) suggested patients with elevation on scales of schizoid, schizotypal, and compulsiveness had less weight loss 6 months post-surgery. However, the authors note that the MBMD and MCMI-II lack adequate research supporting the use with this population. For the Basic Personality Inventory, low alienation scores were associated with successful weight loss.


Narrowband instruments can function as a supplement to gauge eating disorder behavior or other specific domains of concern.  For depression and anxiety, the Beck Depression Inventory, Second Edition (BDI-II) is suggested to be an adequate screening measure, and per research findings (Hayden et al., 2012, as cited in Marek et al., 2016) a cutoff score of 13 should be utilized.  The authors suggest additional discriminant validity is needed for use of the BDI-II with this population. The Patient Health Questinnaire-9 (PHQ-9) is also a useful screening tool and is a strong choice with his population per Marek et al. (2016).  The authors suggest a recommended cutoff of 15 to indicate further screening for depression. The Mood Disorders Questionnaire (MDQ) has good sensitivity for assessing bipolar spectrum symptoms, with a recommended cutoff of less than 7.  The Beck Anxiety Inventory has good reliability and validity for use with this population. The Center for Epidemiologic Studies Depression Scale and the Generalized Anxiety Disorder-7 lack psychometric data for use with bariatric assessments.


For substance abuse screening, the Alcohol Use Disorders Identification Test (AUDIT) has good sensitivity and specificity for use with bariatric populations. The Michigan Alcoholism Screening Test is useful but may be more so reflective of lifetime use rather than more recent drinking patterns; furthermore, psychometric properties have not been reported with bariatric samples.  The Substance Abuse Subtle Screening Inventory-3 has shown to have low sensitivity in identifying alcohol dependence in some populations.  There also is reportedly no data relative to bariatric samples.


Instruments to assess eating behaviors are useful in identifying persistent eating disorder pathology, which may contributed to less successful weight loss post-surgery. The authors recommend that an evaluation of eating behaviors be included in bariatric assessments, as well as the need to confirm reported eating behavior through a clinical interview. The Eating Disorders Examination Questionnaire is commonly used and has strong internal consistency and validity. The Questionnaire of Eating and Weight Patterns-Revised is the most commonly utilized measure in the literature. It assesses behavioral aspects of disordered eating, as well as weight history and body image.  The Three-Factor Eating Questionnaire assesses restraint, hunger, and disinhibition. This instrument is used frequently and has shown to be able to distinguish between binge eating and non-binge eating.  The Binge Eating Scale is also commonly used and is able to distinguish between minimal, moderate, and severe binge eating problems; however, this instrument should be used with caution due to a tendency to over diagnose.  The Eating Disorders Inventory-III has been validated with obese populations, but not with bariatric populations. The 11 subscales provide assessment for drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, introceptive awareness, maturity fears, asceticism, impulse regulation, and social insecurity. The Night Eating Questionnaire assesses severity of nocturnal ingestion, evening hyperphagia, morning anorexic, and mood/sleep problems. It has also been validated with weight loss surgery candidates and the authors recommend this as a component of the assessment, though more psychometric development is needed.  To assess for loss of control related to binge eating, the Loss of Control Eating Scale has shown good psychometric properties. The concept of loss of control is noted to be predictive of psychopathology and distress rather than the amount of food consumed.


Overall, a broadband assessment appears necessary to assess and rule out existing psychopathology that either is contraindicated with weight loss surgery or to target treatment in order to maximize benefits post-surgery. Furthermore, though a clinical interview is necessary to diagnose disorders, the use of screening measures to support diagnoses or to suggest areas of intervention is recommended.  Interestingly despite recommendation by the NIH for pre-surgical evaluation, only about two-thirds of bariatric surgery clinics reportedly adhere to this recommendation (Marek et al., 2016).  The use of psychological testing helps provide normative data and additional evidence to support a diagnosis, aid in treatment planning, and assess behavioral tendencies (eating patterns, substance use).  The use of a broadband measure that assesses response styles is also necessary.  Interpretation of response styles can help guide decision making and diagnosis.  Marek et al. (2016) further indicated that a portion of bariatric surgery patients minimize psychopathology, specifically impulse-control and sensation-seeking.  Overall, Marek et al. (2016) suggest the assessment of eating, mood, and substance use is the foundation for bariatric assessments, with the overall goal to enhance the evaluation in order to inform treatment and decision making to best assist patients.


Finally, for additional information on templates for a structured clinical interview and recommendations to include in the interview, see the references below:


Sogg, S., & Mori, D. L (2004). The Boston Interview for Gastric Bypass: Determining the psychological suitability of surgical candidates. Obesity Surgery, 14, 370-380.


Sogg, S., & Mori, D. L. (2009). Psychosocial evaluation for bariatric surgery: The Boston Interview and opportunities for intervention. Obesity Surgery, 19, 369-377.


Dannie S. Harris, MA
WKPIC Doctoral Intern



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Friday Factoids: Robots could help solve social care crisis, and evolutionarily destroy the function of our mirror neurons at the same time! (How wonderful?)



International teams of engineers are developing humanoid robots to deal with our ‘social care crisis’.


Tasked with the responsibility to interact with the elderly in care homes, these ‘personal social’ robots will be able to be specifically programed to match the personality type of the people they will be working with. According to a British Broadcasting Communication (BBC) article, “It is hoped the new robots will help improve the well-being of their charges by providing entertainment and enabling them to connect better, through smart appliances, with family and the outside world.”


My question to you is, what would you do if you could build yourself a robot? Posing this very question to an exceptionally scholarly and brilliant 13-year-old girl (and highly favored niece), I attempted to address this issue. According to her, if she had a clone robot, she would have the robot do all her chores and homework, so she could have the free time to, you guessed it, socialize (the sweet irony of an upcoming Generation Z’er). I suppose this is the sentiment shared by most, which is to have technology do our dirty work, like making our food, cleaning up after us, and now doing our Therapy, so we could then have the free time to do what we really want, perhaps connecting with other people.


That is the purpose of technology in theory. In practice however, I am noticing the opposite. As we progress into the information age, where the world is flat; I recognize that people are becoming less connected. Yes, we are coming into contact with more and more people, but we are ‘connecting’ with fewer. Weekly, we are adding to the already hundreds of ‘friends’ we have on Facebook, while grandpa plays chess with a robot. In the information age, our communication is becoming limited to 140 characters tweets or less and Facebook postings of the Panera sandwich and Kale smoothie we had for lunch (because our friends really want to know). Still, we wonder why we feel depressed and lonely.


I have an idea. Maybe we should give grants to engineers to program robots to do our Tweeting, so we could have more time to spend with our grandparents.


Robots could help solve social care crisis, say academics<>[×9/p04r8ghc.jpg


Dianne Rapsey-Vanburen, M.A.
WKPIC Doctoral Intern



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Friday Factoids Catch-Up: If You Want To Be An Effective Therapist, You Should Learn How To Use POTT!!!


Research findings have finally drawn our attention to something tantalizingly useful: the benefits of POTT use among therapist. Even better news, its cost effective, sharing is encouraged and it is totally legal to use in any state at any time of the day.  Now before you go running off to throw away that “medicinal” prescription sheet you have been hoarding in your nightstand and cancelling that dream vacation trip to Amsterdam; there is something you should be aware of. “POTT” stands for Person-Of-The-Therapist-Training. A unique training program offered to students, POTT was “designed to facilitate clinicians’ ability to consciously and purposefully use their selves to effectively connect, assess and intervene with clients,” within the treatment process (Nino, Kissil, Cooke, 2016.)


Building on a collective of other research that highlights the importance of the “therapeutic alliance” as being a definitive factor in most treatment successes.  Person-Of-The-Therapist-Training aims to foster the therapeutic relationship between client and clinician, by identifying and building on the therapist empathic strengths (i.e. via past personal experiences).


The underlining theme to this body of research seems to be that the most effective asset in therapy is the human asset.  The idea that a therapist can draw from his or her past experiences, and effectively transform this energy into highly effective, empathic skills is something of a phenomenon. The concept of the “wounded healer,” has often shown up in various forms of literature, over a vast multitude of disciplines. However, Person-Of-The-Therapist-Training appears to make an effort to capture this elusive dynamic system by packaging it into neat categories, that us clinicians cannot seem to live without, testable data.  Whether or not rating and evaluating past personal experiences and training students to be empathic with clients is an actual thing (perhaps you have empathy or you don’t) one thing seems certain. Psychology (and all other related human service fields) is in the business of connecting to people and building relationships. It may not matter what theoretical orientation we come from, or what therapy language we use to convey our understanding and willingness to help someone in need. And since being human is not some part time job that can readily be dismissed, and may possibly be the most effective tool you have when trying to connect with someone in pain. Why not use it. Do we really need research and training, to confirm and teach us that?


Or maybe we could have just saved a ton of time and funding, and just watched the kids movie Kung Fu Panda:


“There is no secret ingredient in the secret ingredient soup….its just you.


Niño, A., Kissil, K., & Cooke, L. (2016). Training for Connection: Students’
Perceptions of the Effects of the Person-of-the-Therapist Training on Their Therapeutic Relationships. Journal Of Marital And Family Therapy, doi:10.1111/jmft.12167


Dianne Rapsey-VanBuren,
WKPIC Intern



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Friday Factoids Catch-Up: City Interns Have Higher Burnout!

City Interns, have higher burnout rates!


Or, one current intern’s shameful –but heartfelt-plug, to incoming interns.


Going through this stressful ordeal only one year ago, I often wondered about the creators of the psychology internship process? Obviously, self-care, mindfulness and mental health were not the cornerstones by which this gem was hatched. The process starts when you are at the final stages of finishing your academic year, in addition to practicum (thankfully no other life exists outside these two realms for us budding psychologists).


Forcefully sucking out any refreshing accomplishment air, you attempt to gasp as you scramble to get your letters of recommendations and essays written before those heart stopping due dates. And as the first official semester break (and I use the term ‘break’ very loosely) approaches, you gather with family and loved ones to celebrate Thanksgiving; those infamous letters start arriving! I mean really….Can’t we just at least enjoy a turkey leg in peace, without feeling so relentlessly pressured? I remember thinking about those sites who choose to send their rejection letters the day before, or day of Thanksgiving. Seriously? At least the pilgrims had the heart to offer corn before the big fallout. I simply emotionally bandaged myself up that day, comforted myself (CBT style), bowed my head with the rest of the family at the dinner table, and offered my own secret version of the Thanksgiving prayer:  “Dear God, thank you for a bullet well-dodged.”


It is sometimes painful to watch what we psychologist do to each other, in the name of advancement. Not to mention our statisticians and psychometricians who for some reason fail to recall that the holiday seasons usually marks the height of suicide rate among our population and possibly not the best times to send those letters. Perhaps maybe it Freudian-slipped their minds. Nevertheless, we students bear and push through the pain, adding continuous enormous debt as we optimistically back-pack across the nation (again, statistically the worse time of the year for travel) in search of that perfect internship. Relentlessly we attempt to convince ourselves that sweet, peaceful, victory is just around the turn.


And, cue Burnout.


Where does it all end, or does it ever? Here is one article to consider when deciding how much emotional stamina you have left, as you prepare to assess and ultimately rank your internship interview experience:  City interns have greater burnout rates.


Apparently the growing number of stress related symptoms reported by graduates seeking mental health services while on internship prompted Doctors in the UK to study the relationship between internship and burnout. What they found is far from any earth shattering enlightenment to our generation, which is, interns sleep less, are more sad and stressed out (simplifying the results to its bare minimum)–especially those interns living in big city, and working in high-paced environments.


Luckily, there are places that offer high quality, APA-accredited internship programs like WKPIC in Kentucky (yes, another shameless plug) that come without the high burnout price tag those big cities bring.


A small start, but definitely something to CBT about.


Gallagher, P. (2013). City interns ‘are at greater risk of Burnout’. The Independent Retrieved from


Dianne Rapsey-VanBuren,
WKPIC Intern


(Director’s Note: We at WKPIC approve this shameless plug!)


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Friday Factoids Catch-Up: CBT, Anxiety Reduction, and First Episode Psychosis


Did you know that teaching a single day CBT workshop on anxiety reduction techniques and interventions, can significantly help clients with First Episode Psychosis?


A study conducted with clients experiencing First Episode Psychosis with co-morbid anxiety symptoms who were offered a single day CBT workshop on anxiety reduction techniques yielded the following results:

1) Participants reported a lessening of anxious symptoms following intervention; and

2) Participants reported that they “felt they were more likely to make use of the skills in the future.”


This study seems to once again reiterate both the effectiveness and ‘cost benefits’ of CBT, within an ever-shrinking pool of resources within the health care field.


Maybe it is true what they say after all, “teach a man how to fish….”


Welfare-Wilson, Alison; Jones, Amy (2015). A CBT-based anxiety management workshop in first-episode psychosis. British Journal of Nursing, 24(7): 378-382. doi:


Dianne Rapsey-VanBuren
WKPIC Doctoral Intern



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Friday Factoids Catch-Up: Kids and Coping

Coping skills are important not only because they allow children to manage their social emotional challenges, they may also contribute to their feelings of connectedness. Success for Kids (SFK) is a program that provides a curriculum for children’s social emotional learning (PR, 2011). Thought this Friday factoid is not an advert for program,  programs like SFK bring to the forefront the importance of teaching children, early in life, how to manage the day to day stressors we can encounter, in hopes that it will contribute to their positive decision making later in life.


Programs like SFK highlight the needs for children to learn that coping skills also include facets of communication, problem solving, responsibility, empathy, respect for others, etc.… and cannot be reduced to a simplistic list of tasks like take ten deep breaths or walk away. We have to teach our children the how difficult and nuanced coping can actually be.


Puskar, Sereika and Tusaie-Mumford (2003) explored the effects of another program, Teaching Kids to Cope (TKC).  Considering the amount of children that present with signs and symptoms of social emotional challenges, attention to how children are learning to cope in important.  This study noted that children enrolled in this program, over time, began not only to identify strategies “to decrease the intensity of emotional reactivity and depressive thoughts” (p. 78) they also began to explore and openly discuss other related issues that emerged.


Though these are two of the many programs that are available across our country, the take home message is that being proactive in teaching our children how to cope may have a positive effect in their overall ability to manage stressors as they transition from childhood in to adolescence and adulthood.





PR, N. (2011, January 26). Social Emotional Learning Key to Helping Children and Adolescents Develop Purpose, Connectedness and Coping Skills. PR Newswire US.


Puskar, K., Sereika, S., & Tusaie-Mumford, K. (2003). Effect of the Teaching Kids to Cope (TKC) program on outcomes of depression and coping among rural adolescents. Journal Of Child And Adolescent Psychiatric Nursing: Official Publication Of The Association Of Child And Adolescent Psychiatric Nurses, Inc16(2), 71-80


Jennifer Roman, M.A.
WKPIC Doctoral Intern



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Friday Factoids Catch-Up: Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) has been a hot topic for some time now and more and more children are being diagnosed with ADHD than ever before. Lunau (2014) quoted Enrico Gnaulati by writing that an ADHD diagnosis is “as prevalent as the common cold.” If this is the case, how do we, as clinicians, respond to this phenomena?


Lunau noted that more than one in ten children are diagnosed, typically, boys. (Lunau 2015) In her research, she look at various states and how each approached the diagnosis and subsequent treatment of ADHD.  She brought forward information regarding North Carolina and California to elucidate the vast differences how one can approach ADHD. She noted a 16 % diagnosis rate for children in North Carolina, whereas California has a 6%; she also discovered that children in North Carolina were 50% more likely to receive medications as treatment for ADHD symptoms.  Lunau looked to the work of Hinshaw and Scheffler (reference information not provided in Lunau’s work) who explore the multiple variables that may impact these statistics, including demographics cultural influences, and health care policy. Ultimately, they discovered that school policy has the largest impact.


Specifically, school mandates in North Carolina for higher test scores may have impacted the perceived need for some children to receive additional services and, in some cases, children receiving academic based services are not included in the test score average (Lunau, 2015).


So, given the significant difference between the incidences of ADHD across state, are we witnessing an epidemic or a cultural phenomena that carries with it a secondary gain of medication management to attempt to manage behaviors or increase school testing scores. Taking a step back and looking at ADHD from a global perspective, Lunau noted other countries are not experiencing a similar increase in the onset of ADHD in their children and briefly explored how other factors may mimic ADHD symptoms, like sleep deprivation.  Though briefly mentioned, Lunau indicated the need for further exploration into how ADHD is assessed and diagnosed.


When looking at the high rates of ADHD, we must also begin to consider how this diagnosis is treated. Is medication the ideal treatment?  The CDC published a study (PR, 2015) which looked at the various types of treatment our children are exposed to.  Results indicated 1 in 10 children, ages 4-17, diagnosed with ADHD received behavioral therapy, 3 in 10 received medication and therapy, and 1 in 10 received no treatment. When looking at preschool aged children, 1 in 4 received medication alone and 1 in 2 received both medication and therapy.  This begs the question of whether or not we are over medicating our children so early in life. What are the long term implications of medication only interventions on the overall development of the child?


The CDC study highlighted that states which provided increased amounts of behavioral therapy also experienced lower rates of medication management for the treatment of ADHD, and vice versa. Bell and Efron (2015) briefly explored the impact of tri-cyclic antidepressants as a possible treatment for children with ADHD and noted tricyclic outperformed, in one trial, clonidine in the reduction of symptoms.  The information in these three articles is obviously not exhausted, however, it does highlight the need for continued research in the assessment, diagnosis and treatment of ADHD and an active re-evaluation of how cultural/social influences can impact the national conversation of how we understand ADHD.



Bell, G., & Efron, D. (2015). Tricyclic antidepressants – third-line treatment for attention deficit hyperactivity disorder in school-aged children. Journal Of Paediatrics & Child Health51(12), 1232-1234. doi:10.1111/jpc.13031


Lunau, K. (2014). Giving ADHD a Rest. Maclean’s127(8), 48-50.


PR, N. (2015, April 1). CDC publishes first national study on use of behavioral therapy, medication and dietary supplements for ADHD in children. PR Newswire US.


Jennifer Roman, M.A.
WKPIC Doctoral Intern


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Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

The role of psychologists is changing as overall mental health service needs and service systems change. Separating medical health from mental health is not always so clear cut. With advances in the medical fields, psychologists must also embrace a new way of looking at overall mental health.  Wahass (2005) noted that health was “seen as the absence of diseases or injury and their presence meant ill health.” This approach was suggestive of there being a solution to the malady. However, over time, the connection between the mind and body began to shift the traditional medical model (illness and its corresponding cure) to a more dynamic view, a biopsychosocial perspective on approaching maladies.


The biopsychosocial model integrates the biological, psychological and social factors that interact independently or in concert with each other to sustain a healthy or unhealthy status. (Wahass, 2005)  This is particularly important to keep in mind as we encounter clients from culturally, linguistically, and socioeconomically diverse background.  As psychologist we must have an awareness of and become champions of not only serving in a clinical role, but advocating for it as well.  Our work is not limited to assigning diagnoses; rather, our responsibility to is act as a liaison between our clients and their communities.


Wahass identified several areas of focus, including clinical, health/medical, counseling, rehabilitation and community psychology. Many of the quotidian responsibilities may overlap; however, each has distinct demands and expectations, which not only allow for a more robust treatment of our clients presenting problems, they also encourage a more meaningful understanding of the person behind the list of concerns.


Chang, Ling and Hargreaves explored the relationship between scientist and practitioner and the effectiveness of graduate programs in preparing psychology students for the real life demands of the various roles psychologists assume. Results revealed that there is not one predominant stance, in part because depending on the setting (e.g. hospital, private practice, community bases setting, etc…) there are distinct demands on a psychologist.


As the approach to medical and mental health issues evolves, we must also look to our training program to ensure that developing clinicians are able to respond to the demands placed on psychologists in the real world.



Chang, K., I.-Ling, L., & Hargreaves, T. A. (2008). Scientist versus Practitioner-An abridged meta-analysis of the changing role of psychologists. Counselling Psychology Quarterly21(3), 267-291. doi:10.1080/09515070802479859


Wahass, S.H. (2005) The Role of Psychologists in Health Care Delivery. Journal of Family and Community Medicine, 12(2)), 63-70


Jennifer Roman, M.A.
WKPIC Doctoral Intern


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Friday Factoids Catch-Up: Bilingualism, Biculturalism and Personality

There is plenty of research dedicated to the topics of bilingualism and biculturalism, but they may often be lumped together and defined as one in the same. Grosjean (2015) attempts to describe how a bicultural bilingual can take on different meanings.  He highlights the plethora of research dedicated to bilingualism and how the topic of biculturalism is, at times, less explored. A simple internet search of bilingualism will yield countless articles on the relationship of bilingualism and cognition, education, and the various types of bilingualism. Grosjean proposes that this difference is to the distinct nature of how each is studied and how those researchers tend not to overlap in their work; in essence, linguists study bilingualism and biculturalism is studied by social psychologists. Grosjean highlights that one can not only be bilingual and bicultural, they can also be bicultural and monolingual or monocultural and bilingual, and monolingual and monocultural.


Grosjean explored the various ways in which one can become bilingual, learning a home language and later learning a host language at different points in life,  or bicultural, the byproduct of migration to another region.  Of interest is the individualist process by which a person identifies as bicultural, independent of their bilingual status, however, proficiency in an alternate language can impact how they view themselves.


Grosjean highlights an experiment conducted with bilinguals where participants were administered the TAT (Thematic Apperception Test) or sentence completion task. In each experiment, there were significant qualitative differences in the responses given in English and responses in their home or base language (French and Japanese).  For example, with a TAT stimulus card, a response in English highlighted a man going to college at night and having a supportive wife whereas the response in French indicated a man wanting to separate from his wife.  A similar pattern emerged with Japanese/English bilingual participants.


Another experiment mentioned in Grosjean’s article reveals parallel results several years later. A group of bilingual/bicultural Hispanic, Spanish speaking women were asked to interpret advertisements with women as the protagonist in English at one time and in Spanish some months later. Result revealed participants viewed the women in the advert as more independent and intelligent when interpreting in Spanish, whereas they viewed the women in the advert as adhering to more traditional roles when interpreting the ad in English.


Chen (2015) noted differences on some personality traits when assessing native English vs native Chinese speakers, specifically, native English speakers were “perceive to be higher on extraversion and openness to experience” (p. 5) when compared to native Chinese speakers.  Chen also explored if a bilingual individual behaves differently depending on whom they are speaking with.  Her work reveals that language, activated “normative traits of that culture and shifted bilinguals’ expression of personality” (p.5).


Studies, like the ones mentioned above, highlight the complex nature of the interplay that bilingualism and biculturalism can have on our personality development. This research highlights need for further exploration culture and language, not just specifically English/other language, but also the nuanced differences between how we each define culture within the context of bilingualism and vice versa.



Chen, S. X. (2015). Toward a social psychology of bilingualism and biculturalism. Asian Journal Of Social Psychology18(1), 1-11. doi:10.1111/ajsp.12088


Grosjean, F. (2015). Bicultural bilinguals. International Journal Of Bilingualism19(5), 572-586. doi:10.1177/1367006914526297


Jennifer Roman, M.A.
WKPIC Doctoral Intern



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Article Review: Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample (Kodish, Herres, Shearer, et al, 2016)

Kodish, Herres, and Shearer, et al’s Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample seeks to explore what, if any, causal relationship there may be between bullying and the prevalence of suicide among youth aged 14 to 24 years.  Uniquely, their study seeks to identify not only the relationship between bullying and suicide among youth, but also to distinguish between the different types of bullying and their associated effects on suicidal ideation, as well as to explore what role depression may have as a moderating factor between bullying and suicide risk.  Kodish, et al, derived their cohort for study from ten primary care practices located in rural and semi-urban Northeastern Pennsylvania,and used the Behavioral Health Screen (BHS) to arrive at a sample of 5,429 participants.


By using the DSM in conjunction with the BHS, the surveyors were able to assess risk for bullying by type (verbal, physical, and/or cyber) as well as the presence of depressive symptoms (using five factors gauged over a two week period), and also included a four item mean from the lifetime suicide scale that included questions to determine if the participant had felt life to be not worth living; had considered suicide; planned to commit suicide; or had attempted suicide.  Controlling for depression and demographics, the collected data was then analyzed to determine what relationship, if any, existed between the types of bullying and suicidal risk levels, as well as testing the interactions between each bullying type and incidences of depression (Kodish, et al, 2016).  It was determined that there is a statistically significant relationship between risk of suicide and all three types of bullying, with a cumulative bullying experience also associated with a heightened risk of suicide.  It should also be noted that significance was recognized between all four bullying factors (verbal, physical, cyber, cumulative) and incidences of depression, with a stronger link between bullying occurrences and suicide severity among patients with depressive symptoms.  While the effects of physical, cyber, and cumulative bullying experiences were found not to be statistically significant with regard to suicide attempts, patients who experienced verbal bullying were shown to be 1.5 times more likely to report a suicide attempt (Kodish, et al, 2016).


Overall, it was discovered that all three forms of bullying were linked to suicide risk severity, with the effect being acutely heightened when symptoms of depression were present.  Of the three forms of bullying assessed, it was discovered that verbal bullying had, by far, the most impact, which may be due to it being the most common type reported (25% of the sample cohort reported verbal abuse in bullying situations).  This may be due to the fact that it is usually delivered publicly and in person.  By contrast, physical bullying, which may be painful and socially humiliating, may have a lesser psychological impact than other forms of bullying.  This could be due to any number of factors (“David v Goliath”-type situation, physical confrontation being motivated by racism, etc).  In regards to cyber bullying, the fact that it is usually done anonymously as well as the fact that the Internet is impersonal in nature may have a curtailing effect on the impact of this particular type of bullying.  Depression has been shown in this particular study to definitely be a moderator between bullying and suicide risk, but further study is warranted to determine the overall extent to which this relationship exists, as well as determining the extent of moderation for each type of bullying.


Looking at the relationship between bullying, suicidal ideation and the relevance of associated depression provides insight into developing appropriate and effective treatment protocols for those who are most at-risk.  By establishing a solid connection between bullying, suicidal ideation, and depression, the authors have furthered insight into a serious issue facing our youth, and it should be noted that not only does this research benefit those who are bullied, but also those who do the bullying; youth who bully others have been found to be at significantly increased risk for suicide and depression as well.


Delving further into these issues will help to improve not only the understanding necessary for addressing the victims of bullying but also to understand what it is that causes a bully to victimize others, thus allowing earlier interventions for prevention of escalation, and ultimately the reversal of those trends that lead to bullying, depression, and suicidal ideation.  The authors note that assessing for these issues during primary care visits is warranted.  Going forward, improving the assessment for these issues through clinical interviews should be a priority for those not only in healthcare occupations, but also those who are likely to have the most social non-parental contact with children (teachers, clergy, etc).


Kodish, T., Herres, J., Shearer, A., Atte, T., Fein, J., & Diamond, G. (2016). Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample. Crisis, 37(3), 241-246. doi:10.1027/0227-5910/a000378



Teresa King
PMHC Doctoral Intern


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