Non-melancholic depression: the contribution of personality, anxiety and life events to subclassification

BACKGROUND: We sought to develop a clinically useful subtyping system for the non-melancholic depressive disorders, and here we assess one weighted to central aetiological factors. METHODS: We studied 185 patients meeting DSM-III-R and/or clinical criteria for non-melancholic depression. Data were obtained by self-report, interview of patients and from corroborative witnesses. We developed a set of variables for class definition, assessing: (i) 'P', disordered personality as a vulnerability factor; (ii) 'A', meeting criteria for a lifetime anxiety disorder or positive on probe questions about trait anxiety characteristics, so assessing anxiety as a vulnerability factor; and (iii) 'L', psychiatrist and consensually-rated life event stress prior to depression onset. RESULTS: A latent class analysis generated a four-class solution for the P-A-L variables. Life event stressors had similar item probabilities across all four classes, and did not influence the four-class 'P-A' solution when deleted from the analysis, suggesting that life event stress may act more as a general provoking agent, rather than constituting any distinct 'reactive' or 'situational' depression class. Three classes generated clinically meaningful groupings, reflecting varying contributions of anxiety and disordered personality functioning, and with evidence of differential outcome over the following 12 months. CONCLUSIONS: We suggest that a refined aetiologically-weighted model may assist definition of the non-melancholic depressive disorders, and provide the logic for exploring the comparative utility of differing treatments to identified vulnerability-based classes.     

A social-cognitive theory of depression in reaction to life events.

Presents a theory of reaction to life events based on epidemiological evidence. Depression occurs with events that disrupt roles by which people define their worth, if these people lack alternative sources of self-definition. A disruption has its effect when there is a major discrepancy between the perceived actions of a role other and the cognitive representation of that other. Symptoms of reactive depression occur in 3 sets: a set of cognitive symptoms due to loss or damage of the sense of self, a set of intense emotions, and a set of interpersonal strategies. Data from a study by G. W. Brown and T. Harris (1978) of the link between depression and a provoking agent in the presence of a vulnerability factor are reviewed. Other retrospective and prospective studies of depression and triggering events are also noted. It is proposed that provoking agents increase the risk of depression by posing threats to selfhood, when the sense of self is realized in a role. (105 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality, stressful life events, and treatment response in major depression.

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive–behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal study of cognitions, life events, and depression in psychiatric inpatients.

Administered the Beck Depression Inventory, Attributional Style Questionnaire, Social Readjustment Rating Scale and an irrational beliefs inventory to 47 psychiatric inpatients (mean age 32 yrs) when they were admitted to the hospital, to 32 of them when they were discharged, and to 20 of them 7 mo later. The study tested the models of depression of A. T. Beck (1972) and of L. Y. Abramson et al (see record 1979-00305-001) that predict that stressful life events interact with certain types of cognitions (irrational beliefs in Beck's model; attributions in the Abramson et al model) to produce clinical depression. Results of multiple regression analysis show that severity of depression was related to irrational beliefs, attributions, the interaction of Attributions and Life Events, and the interaction of Attributions and Session. There was no relationship between depression and the interaction of Irrational Beliefs and Life Events. The Attributions?×?Session interaction indicated that the relationship between attributions and depression changed over the period studied; the relationship between irrational beliefs and depression was stable over time. Attributions and irrational beliefs changed over the period studied, indicating that they are not stable, unchanging aspects of personality. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic and population perspectives on life events and depression

Population comparisons of epidemiological surveys using the same investigator-based measures suggest that large differences are possible in the experience of clinically relevant depression and of life events capable of provoking such episodes. It is argued that, given the great majority of onsets in the various populations were provoked by a life event, the differences in the experience of depression are likely to have been largely the result of psychosocial factors. Moreover, this interpretation would still be likely to hold even if heritability (h2) coefficients for depression within the component populations were substantial. The same argument would hold for the interpretation of the across-population differences in the experience of life events. New material concerning the differing experience across populations of humiliation/entrapment events, known to be particularly depressogenic, is also presented and the implications of the findings for future aetiological research discussed.     

Can personality explain genetic influences on life events?

Previous research in the Swedish Adoption/Twin Study of Aging (SATSA) has found genetic influences on life events (R. Plomin et al, see record 1990-14029-001). The present study extends this finding by examining sex differences in genetic and environmental contributions to life events and by examining personality as a mediator of genetic influences on life events in SATSA. Analyses were based on 320 twin pairs, including identical and fraternal twins reared together and apart (mean age 58.6 yrs). Controllable, desirable, and undesirable life events revealed significant genetic variance only for women. There was no significant genetic variance for either sex for uncontrollable events. Multivariate analysis of personality (as indexed by Neuroticism, Extraversion, and Openness to Experience) and life events suggest that all of the genetic variance on controllable, desirable, and undesirable life events for women is common to personality. Thus, in this sample of older adult women, genetic influences on life events appear to be entirely mediated by personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressful life events, personality, and health: An inquiry into hardiness.

Studied personality as a conditioner of the effects of stressful life events on illness onset. Two groups of middle- and upper-level 40–49 yr old executives had comparably high degrees of stressful life events in the previous 3 yrs, as measured by the Schedule of Recent Events. One group of 86 Ss suffered high stress without falling ill, whereas the other group of 75 Ss reported becoming sick after their encounter with stressful life events. Illness was measured by the Seriousness of Illness Survey (A. R. Wyler et al 1970). Discriminant function analysis, run on half of the Ss in each group and cross-validated on the remaining cases, supported the prediction that high stress/low illness executives show, by comparison with high stress/high illness executives, more hardiness, that is, have a stronger commitment to self, an attitude of vigorousness toward the environment, a sense of meaningfulness, and an internal locus of control. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lymphocyte response to mitogens: influence of life events and personality

Several patients with 'progressive loss of speech output' or 'progressive anarthria' of degenerative origin have been reported in the literature. We report 5 clinical cases with slowly progressive loss of speech output and initially no deficit in other cognitive domains. The early clinical features were analysed in an attempt to identify the anatomo-functional systems implied in the degenerative process. The first phase of the disorder was characterised by impaired articulation consistent with speech apraxia, telegraphic style and a difficulty to elaborate a series of orofacial or hand movements. It is argued that these symptoms result from an impairment of complex motor processing due to dysfunction of the ventral premotor system. In the second phase, a decrease in spontaneous speech and self-initiated action was combined with exaggerated dependency on external stimuli, interpreted as dysfunction of the dorsal premotor system. We suggest that the neuropsychological profile of the disorder may result from progressive degeneration of the premotor cortex.     

Clinical risk factors for the generation of life events in major depression.

This study examines the relationship of anxiety disorder and dysthymia comorbidity to the generation of life events prior to major depression episode onset in a cross-sectional community sample of 76 women. Those with comorbid anxiety and dysthymia experienced higher rates of events that were at least partly dependent on their own behavior but did not differ from those without these clinical risk factors on independent life events outside of their control. This relationship remained significant even after controlling for overall severity of depression and demographic covariates. The implications of these results for understanding the increased rates of major depression onset and recurrence among those with comorbid anxiety and dysthymia are discussed as avenues of future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of stressful life events and depression: A test of attributional models.

Tested the attributional models of depression proposed by L. Y. Abramson et al (see record 1979-00305-001), using 278 undergraduates who had recently experienced a stressful event and 51 55–79 yr old adults who sought treatment for problems with depression. Three questions were addressed: (a) the validity of the hypothesized independent and direction relation between each of the dimensions of internality, stability, controllability, intentionality, and globality and depression; (b) the causal relation between attributions and depression in a 2-mo prospective study; and (c) evaluation of the model on the 2 disparate samples. Ss were administered a battery of depression measures; students completed an attribution questionnaire, while adults completed a measure of life stress attributions. Causal modeling statistical procedures were applied to both the question of concurrent relations and causal relations between cognitions and depression. Results suggest minimal support for the attributional model: The dimensions were not each independently and directly associated with depression in the manner predicted, and the model that best fit the data was generally congruent for both the normal and clinical samples. In terms of direction of causality, the data were more consistent in indicating that depression causes cognitions than in indicating the reverse. (45 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributions for negative life events and depression: The role of perceived control.

Although perceptions of control occupied a central role in the development of learned helplessness theory, recent helplessness research has not considered controllability judgments when relating attributions to depression. Supporting the importance of this construct, the research discussed in this article found evidence that judgments of control interact with other attributions in predicting depression. Specifically, in a prospective study of stress and well-being in adolescence, internal, stable, and global attributions for negative events attributed to uncontrollable causes were found to be positively related to increases in depression (as predicted by the reformulated helplessness theory), but internal and global attributions for negative events attributed to controllable causes were found to be inversely related to increases in depression. The discussion considers the implications of the findings for understanding the nature of the relation between attributions for naturally occurring life events and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pleasant events, unpleasant events, and depression.

A review of previous research on P. M. Lewinsohn's (1974) model of depression shows that the causal link between a lack of response-contingent positive reinforcement and subsequent depression remains unsubstantiated. The present study tested this causal relationship through the use of cross-lagged panel correlation. 197 undergraduates completed a battery of measures of depression and pleasant events (including the Beck Depression Inventory and the Pleasant Events Schedule, respectively) twice, 1 mo apart. Results reveal that the null hypothesis of spuriousness could not be rejected, suggesting that the relation often found between a lack of pleasant events and depression is probably due to some unmeasured 3rd variable. Results also indicate that there was no causal relation between unpleasant events and depression. Possible 3rd-variable explanations are discussed. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognition and life stress in depression: Cognitive factors and the definition, rating, and generation of negative life events.

The relationship between cognitive factors and different conceptualizations and measures of life stress poses important questions for contemporary theories of depression. The authors examined whether cognitive factors (dysfunctional attitudes and attributional style) are related to the definition, rating, and generation of negative life events. Life events were assessed with both subjective self-report and more objective interview-based methods in endogenously depressed outpatients. The results partially support the hypothesis that cognitive factors are related to definition and severity ratings of self-report measures of particular types of life events. These relationships held primarily for achievement, as compared with interpersonal, events. The results also support the hypothesis that elevated scores on measures of cognition are associated with the number of objectively defined events occurring prior to the onset of depression, suggesting that some patients may generate the life events that in turn may initiate a depressive episode. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression.

This study examined the role of childhood abuse and neglect in sensitizing adolescents to the effects of proximal stressful life events in a cross-sectional sample of 103 depressed and nondepressed adolescents. Consistent with hypotheses, adolescents with a history of childhood abuse and/or neglect reported a lower level of threat of stressful life events prior to episode onset than that reported by those without. This effect was specific to those on their 1st episode of depression and was specific to independent events (i.e., stressors outside of adolescents' control). Further, this effect was robust when controlling for level of chronic difficulties, which was higher in those with childhood abuse and/or neglect. The authors suggest that childhood abuse and/or neglect may be an important risk factor that sensitizes individuals to the effects of acute independent life events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociotropy/autonomy and vulnerability to specific life events in patients with unipolar depression and bipolar disorders.

Followed samples of unipolar and bipolar patients for a 6-month period, with independent assessment of symptoms and life events. Patients were initially categorized into subtypes using Beck's Sociotropy/Autonomy Scale, with the prediction that onset or exacerbation of symptoms, as well as more total symptoms, would occur for sociotropic individuals experiencing more negative interpersonal events than achievement events, and for autonomous-achievement patients experiencing more achievement events than interpersonal events. Results were confirmed for unipolars, indicating that the course of disorder was associated with the occurrence of personally meaningful life events, but not for bipolars. Further research is recommended to examine whether the effect is equally robust for both subtypes of unipolars, whether longer study duration may be required for bipolars, and whether a cognitive self-schema mechanism may account for the specific vulnerability to a subset of stressful events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective evaluation of life events.

Surveyed 50 medical/surgical patients (mean age 59.6 yrs) concerning the occurrence of life events during the preceding year. Their subjective evaluations of the events were obtained for the dimensions of desirability, adjustment, anticipation, and control. (Psychosocial adjustment was measured by a modification of the Profile of Adjustment and Role Skills.) Substantial overlap was found among the 4 dimensions, with the degree of overlap varying as a function of whether persons or events were taken as the units of observation. Overlap was greater when events rather than persons served as the units of observation. This finding has implications for the choice of normative versus idiographic approaches to weighting events. Regarding the evaluative dimensions themselves, overlap was greatest for desirability and least for control. Psychological impairment was the area of psychosocial adjustment primarily associated with subjective evaluations, specifically with desirability and adjustment. It is concluded that results are not promising for the inclusion of anticipation and control as major dimensions of stressfulness. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Momentous events and the life story.

Memories of specific life episodes, termed personal event memories, have only recently become a focus of systematic research. In this article, memories of momentous events are analyzed from a functional perspective. First, personal event memory is defined. Second, research on the temporal organization of specific memories across the life span is described. Third, psychological functions served by remembering momentous events are illustrated. Fourth, variations in the structure and content of autobiographical memory are identified. Finally, potential connections to clinical and educational practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)