Running Head: DEPRESSION AND MALINGERING STUDENTS 1

Depression And Malingering Students

Hazem Amr Mohamed, Mohamed Hani

18102348, 18100537

Nile University

Presented to: Dr. Sara Kotb

English 201- Research Writing

DEPRESSION AND MALINGERING STUDENTS

Contents

1. Literature Review....................................................................................................3

1.1. Introduction..........................................................................................................3

1.2. Identification and diagnosis of depression.........................................................5

1.2.1. Scientific definition of depression.................................................................5

1.2.2. Types of depression........................................................................................6

1.2.3. Symptoms of depression................................................................................6

1.3. Causes of depression............................................................................................7

1.3.1. Post-Traumatic Stress Disorder (PTSD).....................................................7

1.3.2. Colors and neuroticism.................................................................................8

1.3.3. Stress and anxiety..........................................................................................8

1.4. Identification of fake depression (Malingering)................................................9

1.5. Effects of depression............................................................................................9

1.5.1. Academic effects.............................................................................................9

1.5.2. Health effects................................................................................................10

1.6. Conclusion...........................................................................................................10

2. Methodology............................................................................................................11

2.1. Research Design...................................................................................................11

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2.2. Research Participants...........................................................................................11

2.3. Research Instrument.............................................................................................11

2.4. Research Procedure..............................................................................................12

2.4.1. Data Collection Procedure.............................................................................12

3. References................................................................................................................12

4. Appendices..............................................................................................................14

1. Literature Review

1.1. Introduction

Depression is caused by many factors affecting college and high school students’

physical and mental health negatively, but it is becoming a trend to be depression and many

students are now claiming to be depressed, despite having many advantages socially over many

others living in the same society.

Depression is an enormous threat to our children, being a very widespread mental illness,

more than 300 million people of all ages worldwide are suffering from depression according to

the World Health Organization (WHO, 2018). WHO has stated in his research they published to

raise awareness, that depression is one of the leading causes of suicide, and more than 800,000

people aging 15 to 29 years chose to end their own lives, in other words, suicide is the second
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most common cause of death for people in this age range. In this literature review, I will be

discussing the different types of depression, their causes and how they could affect high school

and college students physically, mentally, and also how depression could be a reason of a bad

academic performance, and finally the identification and diagnosis of depression and fake

depression which is referred to as “Malingering”.

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1.2. Identification and diagnosis of depression

Depression, just like any illness needs to have proper definition and a way to be

diagnosed, because the first step to solving any given problem is to understand it. Therefore,

scientists have been trying over the years to identify, classify and understand depression, its

causes, symptoms and its effects on the patients..

1.2.1. Scientific definition of depression

Depression, according to (Busch & Kanter & Weeks, 2008), is not a syndrome and the

term depression refers to feeling sad or down. The word “depression” comes from the Latin word

“depressor” and the classical Latin word “deprimere”. The literal meaning of the classical Latin

word for depression is “press down”. This is the lingual meaning and history of the word,

moreover, it also has a scientific definition and meaning but it is way more complex to have a

simple definition like any other syndrome. To come up with a definition of any name of illness

we must understand the symptoms, and here comes the complexity. Depression is linked to states

of anxiety, loss of appetite and insomnia, and less commonly, having suicidal thoughts

(IBCCES, 2019). However, depression is also linked to increased appetite and excessive sleeping

(Busch & Kanter & Weeks, 2008), nevertheless, depression does have many symptoms that do

not vary from one patient to another, such as feeling sad, hopeless and overall down. The biggest

problem, in finding the right definition of depression is the conflicting actions that can be taken

by different patients to deal with this state. To tackle this problem, scientists have made many

different categories of depression, each with similar characteristics and/or symptoms. For

example, there is mixed state depression, Melancholic depression and minor depressive disorder

(Benazzi, 2006). Taking all of what was mentioned into account, (Busch & Kanter & Weeks,
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2008) have concluded that the best definition for depression is that it is a mood disorder that

causes a persistent feeling of sadness and loss of interest.

1.2.2. Types of depression

Depression has been classified into different categories that each explain common

symptoms that patients could experience. According to (Benazzi, 2006), different categories of

depression have many differences and should be approached differently. For example, Bipolar

depression is linked to hypersomnia and psychomotor retardation, while major depressive

disorder is more likely to be involved with insomnia and psychomotor agitation, which are

completely the opposite. This classification will greatly help in the treatment of depression

patients and in deciding whether to use antidepressants or not. However, Benazzi mentioned that

nonbipolar depression had very low stability, meaning that the patient may jump from one type

of depression to another during the week, which makes the classification and categorization of

depression questionable, however, the study of bipolar depressive disorder showed more stability

compared to nonbipolar depressive disorder. The main types of depression, according to

Benazzi, are bipolar and nonbipolar depression, which both have subcategories, and minor and

major depressive disorder.

1.2.3. Symptoms of depression

Depression has many symptoms which can be conflicting when comparing one patient to

another. For example, some patients have shown signs of hypersomnia, while others showed

insomnia (Benazzi, 2006). However, some symptoms are more likely to be stable and common

in many different patients, such as stress, sadness, and loss of interest in previously being

interesting activities (IBCCES, 2019). Some symptoms are more common than others, for

example, some people who are suffering from depression may experience suicidal thoughts, but
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this is not as common as the other symptoms are (WHO, 2018). Depression also is linked to

anxiety and vice versa, furthermore, anxiety can greatly affect memorizing skills and thus, lead

high school and college students to have bad academic performance (IBCCES, 2019). Finally,

depression can be the underlying cause of some physical illnesses and vice versa. For example,

depression has been linked to many cardiovascular diseases (Goodwin, 2006). But the main

symptoms that are usually linked to any mood disorders are loss of appetite, insomnia and

sudden mood changes (ie. Being easily irritated or turned off) (IBCCES, 2019).

1.3. Causes of depression

Identifying the causes of depression is not as easy as it may seem. While it’s commonly

believed that depression is mainly caused by a psychological trauma like losing a loved one or by

an unfortunate event such as losing a job, this is only a brief explanation to a much bigger

phenomenon.

1.3.1. Post-Traumatic Stress Disorder (PTSD)

There is great comorbidity between Post-Traumatic Stress Disorder (PTSD) and Major

Depressive Disorder (MDD), according to (Flory & Yehuda, 2015). This study states that 50% of

the individuals that suffer from PTSD are also MDD patients. However, this paper makes it clear

that there are only two clarifications for these mutual symptoms in both disorders, and it is

having some difficulties to be a certain and precise explanation. First, the analyses of both

disorders are imprecise due to the different orders and variables that are taken into account when

analyzing both disorders. There is some information to back up the previously mention

clarification, and it is that there is a fluctuation in the comorbidity between symptoms in both

disorders according to (Flory & Yehuda, 2015). Another explanation is that the co-existence of

PTSD and MDD is often only related to “injury-related phenotype”.

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1.3.2. Colors and neuroticism

“Neuroticism is a risk factor for selected mental and physical illnesses and is inversely

associated with intelligence” (Navardy, 2017). Although scientists are not sure if neuroticism is

directly linked to Major Depressive Disorder “MDD”, there are many signs that suggest that

neuroticism might be playing a role in causing people to have a mood disorder. (Navardy, 2017)

suggests that knowledge helps alleviate the unfortunate consequences of neuroticism physically

and mentally. (Navardy, 2017) studied families that are potentially associated with neuroticism,

and others who are not, and the study showed that neuroticism is linked to increased risk of

MDD. Nevertheless, Navardy made it clear that the insight does not necessarily guarantee a

direct link between neuroticism and MDD. Further research and experimenting are required to

have a clearer conclusion on this topic. Depression was referred to as “blue”, and the color blue

and other darker colors often puts ana individual in a sad or an anxious state, therefore, the colors

that a person might see daily can eventually alter his/her mood and cause mood disorders like

anxiety, stress, and depression (Goodwin, 2006).

1.3.3. Stress and anxiety

High school and college students are constantly under pressure, for they are expected to

get high grades and their families are always optimistic and ask for better work constantly. This

much pressure causes the students to stress over their work such as assignments, quizzes, exams,

etc.…

1 in 8 teenage students suffers from anxiety according to the Anxiety and Depression

Association of America (ADAA). Anxiety is caused by constant fear and worry according to

(IBCCES, 2019). Stress, in most cases, leads to avoidance of the events that cause it, leading to

even more stress and eventually anxiety. Furthermore, (IBCCES, 2019) emphasize that anxiety
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and depression are directly linked, they both are causes for each other, also being stressed

causing anxiety is a greater risk of suffering from mood disorders like depression.

1.4. Identification of fake depression (Malingering)

A new tool has been come up with, that can help in the identification of “Malingering” or

fake depression. An experiment was done on 2 groups of people, one group is identified as the

“liar” group which was asked to lie about their current psychological condition, and the other

group was asked to answer the questions honestly. A new tool is used to identify a malingering

person by the analysis of their hand movements on the mouse. The experiment was successful

and scientists were able to have a clear difference between malingering and true patients.

(Monaro, 2018).

1.5. Effects of depression

Without a doubt depression has many devastating effects on the people who suffer from

it, however, on the contrary to public belief, the effects of depression are not only psychological,

it can have also many physical effects that could increase its severity..

1.5.1. Academic effects

As previously discussed, depression and anxiety cause a loss of interest in previously

considered important activities and an escape of a certain challenge or problem (IBCCES, 2019).

Furthermore, patients of depression have shown a decline in memory forming skills according to

(Kizilbash & Curtiss & Vandeploeg, 2002), therefore making it harder for students to maintain

good grades and good academic performance. Also, the feeling of carelessness and loss of

interest makes students not get involved and work on their grades to make their academic

performance better (IBCCES, 2019). In case of depression and anxiety that are caused due to
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stress, it is even worse for the students who suffer from these mood disorders experience the

previously mentioned symptoms but even more severe, because stress over time gets worse

(IBCCES, 2019). Depression, as previously discussed, can have some conflicting symptoms,

nevertheless, symptoms like hypersomnia and insomnia (Benazzi, 2006), will both negatively

affect the academic performance for both high school and college students (IBCCES, 2019).

1.5.2. Health effects

It is proven that various types of depression are associated with physical consequences

(Goodwin, 2006). Some of the depression patients have suffered from certain cardiovascular

diseases according to (Goodwin, 2006). Also, some symptoms that may affect the lifestyle of the

depressed individuals may severely affect their overall wellbeing, symptoms like insomnia,

hypersomnia, lack of appetite and increased appetite (Benazzi, 2006) can all lead to some

complications in the patients like cardiovascular diseases, obesity and more (Goodwin, 2006).

1.6. Conclusion

In conclusion, depression is a very common disorder that affects individuals of all ages,

yet it is also very complex and complicated and very hard to understand due to the conflicting

effects, symptoms, and causes. The understanding of depression, its causes, effects, symptoms,

and types would be of great help for a better diagnosis, identification, and treatment. However,

up to this point, scientists have only been able to identify malingering and differentiating it from

real depression patients by their rely on newly developed technology that might not be available

everywhere. The question here is, is it possible to be able to identify fake depression or

malingering solely based on our background information of the patient and our knowledge of the

mood disorder, taking into account its great complexity and the common symptoms with other

common disorders?
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If it is possible to identify malingering, how could it be done? It is logical to research this

topic and to further enlighten ourselves and have more efficient psychotherapy to help treat such

an unfortunate disorder.

2. Methodology

2.1. Research Design

The objective of this research is to differentiate amongst the real depressed students and

the malingering, and to come up with an accurate statistical results that shows the percentage of

the malingering from the total students who claim to be depressed. To achieve these objectives,

we will use both qualitative and quantitative research. Qualitative research will help in the

differentiation of the malingering and the quantitative research will be used to make an accurate

statistical result.

2.2. Research Participants

40 students will be taken as our sample, and they will be of both genders and age range

from 17 to 25 years old. The sample will be high school, Nile University or students from other

universities to insure that the sample is from diverse environments. All the 40 students will

participate in the quantitative research and 8 of them will be chosen for the qualitative research.

2.3. Research Instrument

In this research, a survey will be used as the quantitative research tool to identify the

amount of people (out of 40) who claim that they are depressed, moreover, it will give us an

insight for what the symptoms that they experience that makes them think that they are

depressed. This is a fast way to collect as much data as possible and will help in the data

collection process and the categorization of the sample. Second part of the research is the
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qualitative, and in this part we will interview 8 students from the 40 (they should be from the

students who claim that they are depressed), and we will ask them open-ended question based on

our knowledge of the symptoms of depression. This interview will help us understand the current

state of the students deeply and identify whether they are actually depressed or faking it.

2.4. Research Procedure

2.4.1. Data Collection Procedure

The survey will be conducted using “Google Forms”, because it helps in the data

retrieving process and categorization. The survey link will be posted on Facebook and WhatsApp

groups for more spread and will be out for a week to allow to gather enough responses. The

information from the interview will retrieved, processed and categorized manually, for it will be

a face to face interaction and there will not be any software to help in this process.

3. References

Benazzi, F. (2006). Various forms of depression. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181770/.

Depression. (2018, March 22). Retrieved from https://www.who.int/news-room/fact-

sheets/detail/depression.

Flory, J., & Yehuda, R. (2015, June). Comorbidity between post-traumatic stress disorder and

major depressive disorder: alternative explanations and treatment considerations.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518698/.

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Goodwin, G. (2006). Depression and associated physical diseases and symptoms. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181771/.

Impact of Anxiety and Depression on Student Academic Progress. (2019, May 16). Retrieved

from https://ibcces.org/blog/2019/05/01/impact-anxiety-depression-student-progress/.

Kanter, J. W., Busch, A. M., Weeks, C. E., & Landes, S. J. (2008). The nature of clinical

depression: symptoms, syndromes, and behavior analysis. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2395346/.

Kurt, S., & Osueke, K. K. (2014, February 28). The Effects of Color on the Moods of College

Students - Sevinc Kurt, Kelechi Kingsley Osueke, 2014. Retrieved from

https://journals.sagepub.com/doi/full/10.1177/2158244014525423.

Kizilbash, A., Curtiss, G., & Vanderploeg, R. (2002, January 1). Effects of depression and

anxiety on memory performance. Retrieved from

https://academic.oup.com/acn/article/17/1/57/2143.

Navrady, L. B., Ritchie, S. J., Chan, S. W. Y., Kerr, D. M., Adams, M. J., Hawkins, E. H., …

McIntosh, A. M. (2017, June). Intelligence and neuroticism in relation to depression and

psychological distress: Evidence from two large population cohorts. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486156/.

Monaro, M., Toncini, A., Ferracuti, S., Tessari, G., Vaccaro, M. G., De Fazio, P., … Sartori, G.

(2018, June 8). The Detection of Malingering: A New Tool to Identify Made-Up

Depression. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002526/.

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4. Appendices

The first part of the research is the survey, and the following are the questions that we

will include.

1. Which color do you prefer?

 Male  Female

2. How old are you?

• (17-19) • (20-22) • (23-25)

3. On the scale of 1 to 10, 1 being the least and 10 being the most, how energetic do you

feel on a daily basis.

•1 •2 •3 •4 •5 •6 •7 •8 •9 •10

4. How do you think the people around you perceive you as?

•Very useful •A little useful •I don’t know • Not useful • Totally useless

5. What is your academic level?

•High school •Freshmen •Sophomore •Junior •Senior

6. How long do you sleep every day?

•less than 3 hours • 3-5 hours • 6-8 •9 or more hours

7. If you are in a situation where everyone counts on you to do good work how well will

you perform (from 1 to 10, 10 is the best)?

•1 •2 •3 •4 •5 •6 •7 •8 •9 •10
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8. If you have a large assignment due after 1 hour how well would you perform? (from 1 to

10, 10 is the best)

•1 •2 •3 •4 •5 •6 •7 •8 •9 •10

9. How useful do you think you are in society? (from 1 to 10, 10 is the best)

•1 •2 •3 •4 •5 •6 •7 •8 •9 •10

10. If there were no legal or religious constrains for an hour, what would you do?

11. Do you think that you are depressed?

Yes No

The second part of the research is the interview and these are the questions that will

include.

1. How do you feel when you wake up first thing in the morning and why?

2. What is your eating habit?

3. How do you enjoy yourself in your free time and why?

4. We will show you a sequence of numbers and you have to say it out loud in the

correct order. (5 levels)

5. What do you think of the student who jumped off of Cairo tower this month?

6. What makes you think that you are depressed?

7. How is your academic performance?

8. If you can be anywhere right now, where would you prefer to be, with who, why?

9. Describe your dream significant other.

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10. Describe life from your perspective. (more potential follow-up questions

depending on his/her response)