Life events, symptom course, and treatment outcome in unipolar depressed women.

Although a large number of studies have addressed issues of etiology associated with stressful life events and diverse forms of disorder, little attention has been focused on the importance of such psychosocial parameters for the course and remission of symptoms once the disorder has begun. The authors review research on this latter topic, with special reference to the depressive disorders. A longitudinal study of 130 22–60 yr old unipolar depressive females receiving treatment was conducted. Results indicate that life events preceding entry into treatment significantly predicted certain forms of depressive symptomatology and of clinical outcome over a 6-mo follow-up period. In contrast, events occurring during the treatment and/or posttreatment period were not related to any of the depressive symptom outcome measures. Different subclassifications of events particularly may have relevance for the course and remission of symptoms in unipolar depressives under treatment. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive styles and life events interact to predict bipolar and unipolar symptomatology.

This study examined the interaction of cognitive style (as assessed self-report and information-processing battery) and stressful life events in predicting the clinician-rated depressive and manic symptomatology of participants with Research Diagnostic Criteria lifetime diagnoses of bipolar disorder (n?=?49), unipolar depression (n?=?97), or no lifetime diagnosis (n?=?23). Bipolar and unipolar participants' attributional styles, dysfunctional attitudes, and negative self-referent information processing as assessed at Time 1 interacted significantly with the number of negative life events that occurred between Times 1 and 2 to predict increases in depressive symptoms from Time 1 to Time 2. Within the bipolar group, participants' Time 1 attributional styles and dysfunctional attitudes interacted significantly, and their self-referent information processing interacted marginally, with intervening life events to predict increases in manic symptoms from Time 1 to Time 2. These findings provide support for the applicability of cognitive vulnerability–stress theories of depression to bipolar spectrum disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and life stress predictors of relapse in remitted unipolar depressed patients: Test of the congruency hypothesis.

Longitudinally followed remitted depressed Ss (N?=?59) to determine whether dependent or self-critical persons are more vulnerable to relapse after exposure to life events that have a bearing on interpersonal or achievement concerns. Regression analyses indicated that congruency effects, as measured by the occurrence of achievement-related adversity in the lives of self-critical Ss, accounted for a significant increment in relapse variance over each variable entered singly. When data from the 2 mo just before relapse were analyzed, some evidence of congruency effects in dependent Ss experiencing interpersonal-related adversity was obtained. Findings highlight the dimensional qualities of life event impact and call for greater differentiation in modeling the activation of a diathesis and precipitation of depression after life stress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nature of life events and difficulties in depressed adolescents

OBJECTIVE: To examine the significance of acute life events and ongoing difficulties in adolescents with a recent major depressive disorder. METHOD: Adolescents (aged 13-18 years) with a recent episode of major depressive disorder based on DSM-III-R (n = 26) and normal controls free of any Axis I lifetime psychiatric disorder (n = 15) were assessed using the investigator-based Life Events and Difficulties Schedule (LEDS). RESULTS: Traditionally defined severe events were more likely to occur in the year prior to onset among depressed adolescents (46%) than in a comparable period among normal controls (20%), but these differences did not reach statistical significance. Expanding the definition of severe events to include those events focused on others important to the adolescent resulted in a significantly higher percentage of depressed adolescents having one or more refined "severe" events in the year prior to onset (62%) compared with normal controls (27%) (p < or = .02). It is interesting that one half of the depressed adolescents had two or more refined severe events occur during the year prior to onset compared with none of the normal controls (p < or = .01). Further analyses showed that depressed adolescents were significantly more likely to have a major difficulty precede the onset of their depression (27%) compared with normal controls (0%) (p < or = .04). CONCLUSIONS: The results suggest that depressed adolescents are exposed to high levels of stress prior to becoming depressed. Future investigations might benefit from using the LEDS with adolescents to assess acute and ongoing stressors.     

Life events and disorder: Event-symptom associations and the course of disorder.

74 18–58 yr old employees of a moderate size corporation were administered the Life Events Scale and the Social Readjustment Rating Scale. Once a month for 4 mo, psychological-symptom reports were assessed. Associations between event breakdowns (i.e., desirable vs undesirable events) and subsequent psychological-symptom reports were found to vary significantly as a function of Ss' initial assessment status (i.e., Ss initially presenting significant symptomatology vs those relatively free of initial symptoms). Results are discussed in terms of the methodological importance of controlling for initial symptoms or prescreening Ss in prospective life event studies on the dependent measures. The broader issues involving the conceptual importance of examining psychosocial influences on maintenance and remission of disorder as well as on disorder onset are also addressed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social-environmental factors in unipolar depression: Comparisons of depressed patients and nondepressed controls.

Examined the role of stress and coping factors in depression by comparing a group of 409 Ss (over age 18) entering psychiatric treatment for unipolar depression with a sociodemographically matched group of 409 nondepressed Ss. In addition to reporting significantly more stressful events than controls, depressed Ss also experienced more severe life strains associated with their own and their family members' physical illness, their family relationships, and their home and work situations. Depressed Ss were less likely to use problem-solving and more likely to use emotion-focused coping responses and had fewer and less supportive relationships with friends, family members, and co-workers. These group differences were consistent for both depressed women and men. Findings indicate the value of expanding the consideration of psychosocial factors in depression to include individuals' chronic strains and acute stressors as well as their coping responses and social resources. (53 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional styles and life events in the classroom: Vulnerability and invulnerability to depressive mood reactions.

A core prediction of the reformulated model of learned helplessness and depression states that when confronted with the same negative life event, people who display a tendency to attribute negative outcomes to internal, stable, or global factors should be more likely to experience a depressive reaction than people who typically attribute negative outcomes to external, unstable, or specific factors. The present study tested that prediction with 227 undergraduates by determining whether the content of Ss' attributional styles at 1 point in time predicted the severity of their depressive response (Multiple Affect Adjective Check List) to receiving a low grade on an exam at a subsequent time. Consistent with the prediction, Ss with an internal or global attributional style for negative outcomes at Time 1 experienced a depressive response when confronted with a low grade; Ss with an external or specific attributional style were invulnerable to this response. In contrast to results for the internality and globality dimensions, Ss' scores along the stability attribution dimension were not correlated with the severity of their depressive response to the low grade. In the absence of a negative life event, Ss' generalized tendencies to make internal or global attributions for negative outcomes at Time 1 were not significantly correlated with their subsequent changes in depressive mood, although there was a nonsignificant positive correlation between severity of depressive response and the tendency to make global attributions for negative outcomes at Time l. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative life events and time to recovery from episodes of bipolar disorder.

The authors of the current study examined the impact of severe negative life events on time to recovery from episodes of bipolar disorder. Although negative life events have been shown to influence relapse in bipolar disorder, research has not focused on life events and recovery in bipolar disorder. The authors recruited 67 individuals with bipolar disorder during hospitalization and conducted monthly assessments for at least 1 year. Individuals with severe negative life events took more than 3 times as long to achieve recovery as those without severe life events, and the impact of life events was not mediated by medication compliance. These results reveal that the psychosocial environment may play a much larger role in the course of bipolar disorder than previous biological models have suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations of sociotropic and autonomous personality characteristics to specific symptoms in depressed patients.

A number of writers have suggested that two sets of personality characteristics are associated both with vulnerabilities to depression in response to different classes of events and with different clinical presentations of depression. The present study examined the relations between levels of sociotropic and autonomous personality characteristics and specific, theoretically derived clusters of symptoms in 80 unipolar depressed patients. As was predicted, sociotropy was related to the cluster of symptoms associated with the concept of anxious-reactive depression and was unrelated to the autonomous symptoms cluster. In contrast, the predicted relations of autonomous personality characteristics and symptoms were not found. These results support the idea that the symptom picture in depression may be related to personality characteristics, but they also suggest that the measurement of autonomy may require revision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applied hermeneutics: Retrospective reevaluation of life course events.

Suggests that because life course narratives change over time, they generate competing accounts of the same events. The attempt to adjudicate between accounts is an empirical hermeneutic enterprise that parallels current issues in the social sciences. The problem of retrospective reevaluation is explored from the perspective of cognitive psychology and psychoanalysis. Insights gained from them are applied to the problem as conceptualized by philosophy, drawing on the similarity of retrospective reevaluation to conceptions of time. This approach is used to understand a life history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prediction of suicidal intent in depressed patients

The aim of the present study was to examine the relationships between suicidal ideation or suicidal attempts and severity of depression, presence of personality disorders, and sociodemographic factors in a population of depressed in-patients. A total of 338 adult depressed psychiatric in-patients were examined and classified according to DSM-III criteria as having major depression with or without melancholic or psychotic features, adjustment disorder with depressed mood or dysthymic disorder. Scores on the Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI) and Zung Self-Rating Depression and Anxiety Scales (SDS and SAS) were measured. We found that suicidal ideation was significantly related to severity of depression (according to the HDRS and all self-rating scales), a lower global assessment of functioning the year before hospitalization, and previous psychiatric hospitalizations. The items with the strongest predictive value for suicidal ideation were hopelessness, depressed mood, feelings of guilt, loss of interest and low self-esteem. These symptoms predicted 43% of the variance in suicidal ideation. None of the above predictors of suicidal ideation was related to suicidal attempts. Depressed patients with a personality disorder attempted significantly more suicidal attempts and showed more suicidal ideation than depressed patients without personality disorder. No significant correlations were found between suicidal ideation or suicide attempts and gender, marital status, employment status or psychosocial stressors during the previous 6 months.     

Health-related quality of life assessment in euthymic and depressed patients with bipolar disorder. Psychometric performance of four self-report measures

The aim of this study was to determine the interaction potential of the new antiepileptic drug felbamate (2-phenyl-1,3-propanediol dicarbamate) with three Ca2+ channel blockers (nicardipine, nifedipine, and flunarizine), one Ca2+ channel activator (Bay K 8644; 1,4-dihydro-2,6-dimethyl-5-nitro-4-[2-(trifluoromethyl)-phenyl]-3-pyridi ne carboxylic acid), and two methylxanthines (caffeine and aminophylline (theophylline2 . ethylenediamine)) which are all known to markedly change protective effects of conventional antiepileptic drugs. To do so, the maximal electroshock seizure test in mice (an experimental model predicting drug efficacy in the treatment of human generalized tonic-clonic seizures) was employed to (1) quantify changes in the protective efficacy and potency of felbamate produced by adjunct drugs and (2) assess the ability of aminophylline and caffeine to affect protective efficacy afforded by a submaximal protective dose of felbamate against maximal electroshock-induced seizures. Doses of adjunct drugs were selected based on their effects on the threshold for electroconvulsions and on appropriate literature. Nicardipine (10-30 mg/kg), nifedipine (5-20 mg/kg), flunarizine (2.5-10 mg/kg), Bay K 8644 (2.5-5 mg/kg), and aminophylline (50-75 mg/kg) did not change the protective efficacy and potency of felbamate against maximal electroshock-induced tonic convulsions. Aminophylline in the dose of 100 mg/kg, however, diminished the protective potency of felbamate as evidenced by a statistically significant increase in the protective ED50 value of felbamate (a dose, in mg/kg, predicted to protect 50% of mice against convulsive stimulus) from 79.6 to 118 mg/kg; P < 0.05). Aminophylline and caffeine only at high doses (100 and 161.7 mg/kg, respectively) significantly diminished the protective efficacy of felbamate (110 mg/kg) from 96% to 27% and 40% (P < 0.05), respectively. In conclusion, felbamate shows low interaction potential with Ca2+ channel modulators and methylxanthines. Such low interaction potential clearly differentiates felbamate from conventional antiepileptic drugs where protective effects are readily altered by the compounds tested in the present study.     

Psychosocial processes of remission in unipolar depression: Comparing depressed patients with matched community controls.

Investigated the posttreatment phase of unipolar depression by examining the personal and social-environmental characteristics of remitted, partially remitted, and nonremitted depressed patients. The sample was based on a 12-mo follow-up of 424 depressed persons who received psychiatric treatment and a comparable follow-up of demographically matched, nondepressed community controls. 98.8% of the Ss were located at 12-mo follow-up. Analyses were based on 380 Ss. At follow-up, the 138 Ss whose depressive symptoms remitted also reported improvement in other aspects of their adjustment as well as in personal resources such as self-esteem and coping responses to posttreatment stressors. In contrast, the 133 nonremitted Ss continued to report deficits in each of these domains. 124 Ss were categorized as partially remitted. Remitted Ss approached normal levels of life stressors and social resources, whereas nonremitted Ss continued to report heightened stressors and lower levels of support. Risk factors identified at treatment intake were predictive of these Ss' subsequent outcome at follow-up. These findings imply that many successfully treated depressed patients can resume near-normal patterns of functioning and that remission is linked to normalization of personal and social context factors. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increase in red blood cell triiodothyronine uptake in untreated unipolar major depressed patients compared to healthy volunteers

1. Kinetic parameters of red blood cell (RBC) L-triiodothyronine (T3) initial uptake (Vmax, maximal velocity and Km, Michaelis constant) were determined in 34 untreated inpatients suffering from unipolar depression and in 40 healthy volunteers. 2. Both Vmax and Km were significantly increased in depressed patients as compared to controls. The alterations in kinetic parameters were not associated with the severity of depression. 3. Out of the 19 depressed patients who were submitted to TRH test, 7 of them (36%) showed a blunted TRH-induced TSH response associated with a Vmax situated outside the control mean value +/- 1 S.D. 4. The authors found a significant positive correlation between Vmax of RBC L-T3 and L-tryptophan (TRP) uptakes which is in agreement with the assumption that L-T3 and L-TRP share a common carrier system at the erythrocyte level. 5. The results indicate that the uptake of L-T3 by RBC is increased in major depression. These transport perturbations might reflect alterations in the plasmatic metabolism of L-T3. Evaluation of RBC L-T3 uptake could be useful in a best biological characterization of the depressed patients with regard to their thyroid function.     

Generation of stress in the course of unipolar depression.

The effect of stressful events on depression has been amply demonstrated, but the opposite relation is also important. The author examined event occurrence over 1 yr in 14 women with unipolar depression who were compared with demographically matched groups of women with bipolar disorder (n?=?11), chronic medical illness (n?=?13), or no illness or disorder (n?=?22). Interview assessments of life events, severity, and independence of occurrence confirmed the hypothesis that unipolar women were exposed to more stress than the normal women, had significantly more interpersonal event stress than all others, and tended to have more dependent events than the others. The implication is that unipolar women by their symptoms, behaviors, characteristics, and social context generate stressful conditions, primarily interpersonal, that have the potential for contributing to the cycle of symptoms and stress that create chronic or intermittent depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functioning and life context among spouses of remitted and nonremitted depressed patients.

The functioning and life context of spouses of depressed patients were examined at the patients' treatment intake and again after 1 year. Three groups of spouses were defined according to their depressed partner's recovery status at follow-up: remitted (n?=?39), partially remitted (n?=?39), or nonremitted (n?=?40). These spouse groups were compared with each other and with spouses of demographically matched community control participants (n?=?157). At both assessments, the remitted and control spouses were comparable in functioning, stressors, and coping, but the remitted spouses had more social and family problems than control spouses. In contrast, nonremitted spouses had significantly more problems than control spouses on most indices, both at intake and at follow-up. There was no evidence that adaptation of remitted spouses improved or that adaptation of nonremitted spouses deteriorated. Spouse adaptation was typically unrelated to changes in the depression of the depressed partner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency, quality, and impact of life events in self-rated depressed, behavioral-problem, and normal children.

Assessed 60 self-rated depressed, behavioral-problem, and normal 3rd–6th grade children closely matched for sex, age, and socioeconomic status (SES) for the number, quality, and impact of stressful life events in the past year. Results indicate that dysphoria-reporting Ss experienced more life events and a higher qualitative index of stress than the other 2 groups. The impact of each event, however, was not greater for the depressed Ss than for the other 2 groups. The self-rated depressed Ss appeared to experience more major family disruptions than the other 2 groups of Ss. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-sectional and longitudinal comparisons of bipolar and unipolar depressed groups on the MMPI.

Compared MMPI admission and remission profiles in 34 patients (17 bipolar and 17 unipolar) hospitalized for depression. There were no significant demographic differences or difference in behaviorally rated depression between the bipolar and unipolar groups. Relatively normal profiles for the bipolar group and abnormal profiles for the unipolar group significantly differentiated the 2 groups at admission, but, with 1 exception, the differences dissipated at recovery. Thus, greater changes over time were found in the self-reported personality characteristics of unipolar Ss than in bipolar Ss. After recovery from the depressive episode, there was a significant shift within unipolar Ss from withdrawal and lack of interest in others to a greater concern for socially approved behavior. The implications of change in the unipolar group and stability in the bipolar group and the more enduring personality characteristics of the 2 groups are discussed. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)