Feeling unsupported? An investigation of depressed patients' perceptions.

BACKGROUND: Much is known about the importance of social support for psychological health and general coping. While several measures exist to assess social support as a construct, less attention has been given to assessing the clinical and demographic factors associated with perceptions of low social support from multiple sources in clinically depressed patients. METHODS: Data on social support and depression history and severity were collected from a sample of 218 outpatients with major depression. Patients were assessed with clinical assessment interviews and self-report measures including the Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: More than half of the patients sampled believed that a lack of social support was instrumental in maintaining their depressive condition. Perceptions of low social support, particularly that provided by the family, were significantly associated with objective markers of lifetime depression chronicity. CONCLUSION: Clinicians interested in assisting patients' recovery cannot afford to overlook the potential role played by interpersonal factors in maintaining depression. Patients with more chronic lifetime depression histories require psychotherapeutic assistance for coping with interpersonal stressors and maintaining or building supportive relationships.

Is behavioral inhibition a risk factor for depression?

BACKGROUND: Several studies have reported an observed relationship between a behaviorally inhibited temperament early in life and subsequent clinical anxiety, but few have explored the relationship between early inhibition and depression. METHODS: In a cross-sectional survey of non-clinical adults we examined the relationship between retrospectively reported childhood behavioral inhibition and lifetime depression. We then examined the mediating role of social anxiety and childhood relational stress factors. RESULTS: Subjects who qualified for a lifetime episode of depression also reported significantly more childhood inhibition, particularly if they had a juvenile onset depression (i.e., by age 16). Further analyses revealed that social anxiety mediated the link between reported childhood inhibition and later depression, and highlighted the additional meditating effect of parental influences. CONCLUSION: Any relationship between an early inhibited temperament and later depression, may in fact be dependent upon the presence of clinically meaningful social anxiety.

Do bullied children become anxious and depressed adults?: A cross-sectional investigation of the correlates of bullying and anxious depression.

There is little empirical research examining the historical and clinical correlates of exposure to childhood bullying in adult clinical subjects. Using structured clinical assessments, the authors studied a group of adult males and females presenting to an outpatient depression clinic, to examine the childhood risk factors and the distinguishing comorbid features associated with those reporting exposure to bullying. Just over a quarter of both men and women reported having experienced bullying that was severe and traumatic. More of these subjects also reported several other well studied childhood risk factors. Childhood correlates that were particularly relevant for exposure to bullying were parental overcontrol, illness or disability, and the tendency to have an inhibited temperament early in life. The experience of childhood bullying was strongly related to high levels of comorbid anxiety, both in terms of greater levels of state anxiety and a higher prevalence of both social phobia and agoraphobia. Independent of other childhood risk factors, exposure to bullying was especially predictive of subjects' higher levels of general state anxiety and the tendency to express anxious arousal externally when under stress. These results are compatible with both cross-sectional and prospective studies of child and adolescent samples, and highlight the potential etiological significance of early peer victimization experiences for a percentage of adults suffering from depression with comorbid anxiety.

A Brief Measure of Worry Severity (BMWS): personality and clinical correlates of severe worriers.

This report describes the development of a brief and valid self-report measure to assess severe and dysfunctional worry (the Brief Measure of Worry Severity or BMWS). Using three independent subject groups (clinical and non-clinical), the measure was used to examine the differential severity of worry in depression and anxiety and to examine the clinical and personality correlates of severe worriers. Preliminary psychometric evaluation revealed that the BMWS possesses good construct and clinical discriminant validity. Subjects reporting greater worry severity tended to be more "introverted" and "obsessional," but less "agreeable" and "conscientious." Subjects with depression only, reported less problems with worrying compared to those with co-morbid anxiety disorders. However, among the anxiety disorders, severe and dysfunctional worry was not exclusively experienced by subjects with generalized anxiety disorder (GAD). This study suggests that pathological worry is not only relevant for patients with GAD, but may be an equally detrimental cognitive activity for patients with panic disorder and obsessive-compulsive disorder.

Relationship between self-reported childhood behavioral inhibition and lifetime anxiety disorders in a clinical sample.

To examine the association between an early inhibited temperament and lifetime anxiety disorders, we studied a sample of patients with major depression who were not selected on the basis of comorbid axis I anxiety disorders. One-hundred eighty-nine adults (range = 17-68 years) referred to a tertiary depression unit underwent structured diagnostic interviews for depression and anxiety and completed two self-report measures of behavioral inhibition, the retrospective measure of behavioural inhibition (RMBI) [Gladstone and Parker, 2005] and the adult measure of behavioural inhibition (AMBI) [Gladstone and Parker, 2005]. Patients' scores were classified into "low," "moderate," or "high" inhibition. While groups did not differ in terms of depression severity, there were differences across groups in clinically diagnosed nonmelancholic status and age of onset of first episode. Those reporting a high degree of childhood inhibition were significantly more likely to qualify for a diagnosis of social phobia, and this association was independent of their scores on the AMBI. Findings are discussed in light of the existing risk-factor literature and support the hypothesis that an early inhibited temperament may be a significant precursor to later anxiety, especially social anxiety disorder.

Implications of childhood trauma for depressed women: an analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization.

OBJECTIVE: Data from depressed women with and without a history of childhood sexual abuse were used to characterize clinical features that distinguished the two groups and to examine relationships of childhood sexual abuse to lifetime deliberate self-harm and recent interpersonal violence. METHOD: One hundred twenty-five women with depressive disorders were interviewed and completed self-report questionnaires. Path analysis was used to examine relationships of several childhood and personality variables with deliberate self-harm in adulthood and recent interpersonal violence. RESULTS: Women with a childhood sexual abuse history reported more childhood physical abuse, childhood emotional abuse, and parental conflict in the home, compared to women without a childhood sexual abuse history. The two groups were similar in severity of depression, but the women with a childhood sexual abuse history were more likely to have attempted suicide and/or engaged in deliberate self-harm. The women with a history of childhood sexual abuse also became depressed earlier in life, were more likely to have panic disorder, and were more likely to report a recent assault. Path analysis confirmed the contributory role of childhood sexual abuse to deliberate self-harm and the significance of childhood physical abuse for recent interpersonal violence. CONCLUSIONS: Childhood sexual abuse is an important risk factor to identify in women with depression. Depressed women with a childhood sexual abuse history constitute a subgroup of patients who may require tailored interventions to combat both depression recurrence and harmful and self-defeating coping strategies.

Severity of stressful life events in first and subsequent episodes of depression: the relevance of depressive subtype.

BACKGROUND: Recent studies have reignited debate concerning the relationship between stressful life events and depressive subtypes, particularly in relation to first versus subsequent episodes. AIMS: To investigate the relationship between stressful life events and variably defined melancholic/non-melancholic depressive subtypes, and the import of such life events to first compared with subsequent episodes across those subtypes. METHOD: Acute and chronic stressful life events were rated in 270 patients with DSM-IV Major Depressive episodes who were allocated to melancholic and non-melancholic groups separately as defined by DSM-III-R, DSM-IV, the Newcastle criteria and the CORE system. RESULTS: Severe stressful life events (both acute and chronic)-as defined by DSM-III-R axis IV-were more likely to occur prior to first rather than subsequent episodes, particularly for those with non-melancholic depression. LIMITATIONS: Dependence or independence of life events was not assessed. Genetic vulnerability to depression was not determined. Life events in first and subsequent depressive episodes were compared cross-sectionally between groups, not prospectively in the same cohort of patients. There were no differences in the number of severe life events-as defined by clinician consensus-between the first and subsequent episodes. CONCLUSIONS: These findings are consistent with other studies in suggesting an enhanced sensitisation of depressed patients to subsequent episodes of depression, but suggest that any such phenomenon is specific to non-melancholic depression, in comparison to one key previous study.