RESUMO
BACKGROUND: The biological mechanism by which social support influences the course of a depressive episode may involve the stress response which is reflected and/or mediated by cortisol. The study took advantage of the weekend leave that inpatients receive towards the end of an admission to investigate the inter-relationship between social support, cortisol secretion, and the severity of depression. METHOD: For 23 inpatients with a major depressive episode (DSM IV) differences between ward and home in social support, depression ratings, and cortisol secretion were compared. The effect of hassles on cortisol secretion was also assessed. RESULTS: An inverse linear relationship was found between changes in social support and depression ratings across the two settings. No relationship was found between changes in the other two sets of variables. Hassles resulted in increased cortisol secretion. LIMITATIONS: The small sample limits the analysis of hypotheses of interest. Findings are restricted to an inpatient tertiary referral sample. CONCLUSIONS: Weekend leave is an appropriate paradigm to study the effect of social influences on cortisol secretion, and the severity of depression. It is feasible for depressed inpatients to accurately collect timed saliva samples both on the ward and when at home, and for research workers to measure social support provided by a ward. The relationship between social support and depression has clinical implications in terms of interpreting mood changes following weekend leave. Hassles are associated with increased secretion of cortisol in depressed patients, which extends similar previous findings in normal subjects.
