The purpose of this study was to determine whether uncooperative behavior and a quantitative measurement of depression exist in the same patient in a public health nurse's caseload. Seven full-time public health nurses were randomly selected from the San Bernardino Public Health Department staff. They reviewed their caseloads and selected all the patients who met the general criteria.

Patients were then classified as cooperative or uncooperative based on the following specific criteria: (1) gives unreliable information, (2) uses the nurse as a "buffer" between helping agencies, (3) demands immediate gratification of requests in a stressful situation, (4) makes only token provision to avoid further problems, (5) demands attention in excessive amounts and/or inappropriate ways, (6) is critical or unappreciative, (7) has "a problem for your every solution," and (8) is a visit you would like to postpone.

After the patients were classified, five cooperative and five uncooperative patients were randomly selected from each nurse's caseload. The nurse then visited her ten selected patients and administered the Zung Self-rating Depression Scale (SDS). From the sample of 70 patients, 67 were visited and correctly completed the SDS. Of the 67, 33 were classified as uncooperative and 34 as cooperative.

The uncooperative patients had a mean SDS score of 49.88. The cooperative patients had a mean SDS score of 44.24. This was significant at the 0.05 level and accepted by the investigators. The SDS is rated so that scores of 43 or below indicate little or no depression. The higher the score above 43, up to 100, the more severe the depression.

To rule out the possibility that the difference in SDS mean scores between the cooperative and the uncooperative group was due to other variables of ethnic group, crisis and no crisis, socioeconomic levels, and reason for the nurse's visit, these were tested. No significant differences were found when these variables were tested against the SDS means. It was concluded that public health patients classified as uncooperative do give more evidence of depression than those considered cooperative.

LLU Discipline





Graduate School

First Advisor

Ruth M. White

Second Advisor

Wynelle J. Huff

Third Advisor

Norma Norriss

Degree Name

Master of Science (MS)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Depression; Patient Compliance; Public Health Nursing



Page Count

viii; 69

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives