Perfectionism, efficacy, and daily coping and affect in depression over 6 months.

OBJECTIVE: This study examined how perfectionism and efficacy impacted the maintenance of daily coping and affect in depression over six months. METHOD: Forty-six depressed patients (69.6% female, mean age = 41.11 years) completed measures of perfectionism dimensions (self-critical, personal standards), efficacy, and depressive severity at Time 1. Participants then completed daily diaries of stress appraisals, coping, and affect for 7 consecutive days at Time 1 and Time 2, 6 months later. RESULTS: Perfectionism dimensions and efficacy were differentially correlated with appraisals, coping, and affect across Times 1 and 2. Behavioral disengagement tendencies mediated the relation between self-critical perfectionism and daily negative affect over 6 months, controlling for depressive severity. Efficacy was related to daily positive affect over 6 months through problem-focused coping tendencies. CONCLUSIONS: Results highlight the importance of addressing perfectionism, efficacy, and daily coping tendencies to more effectively reduce distress and bolster resilience in people with depression.

Self-critical perfectionism and depression maintenance over one year: The moderating roles of daily stress-sadness reactivity and the cortisol awakening response.

This study of depressed outpatients (N = 43) examined daily stress-sadness reactivity and the cortisol awakening response (CAR) as moderators of the relationship between self-critical (SC) perfectionism and depression over one year. Participants completed perfectionism measures at baseline (Time 1), daily diaries and salivary sampling six months later (Time 2), and an interviewer-rated depression measure at Time 1, Time 2, and one year after baseline (Time 3). Hierarchical multiple regression analyses of moderator effects demonstrated that patients with higher SC perfectionism and higher levels of daily stress-sadness reactivity (i.e., greater increases in daily sadness in response to increases in daily stress) had less improvement in depressive symptoms at Time 3 relative to those of other patients, adjusting for the effects of Time 1 and Time 2 depression. Furthermore, higher SC perfectionism in conjunction with an elevated CAR predicted higher levels of depression at Time 3. In addition, lower SC perfectionism in combination with higher levels of stress-sadness reactivity/CAR was associated with the lowest levels of depression at Time 3. These findings highlight the importance of targeting dysfunctional self-critical characteristics that exacerbate the impact of heightened stress-sadness reactivity and CAR to generate better treatment outcomes for patients with higher SC perfectionism. (PsycINFO Database Record

Daily Stress, Coping, and Negative and Positive Affect in Depression: Complex Trigger and Maintenance Patterns.

Major depressive disorder is characterized by emotional dysfunction, but mood states in daily life are not well understood. This study examined complex explanatory models of daily stress and coping mechanisms that trigger and maintain daily negative affect and (lower) positive affect in depression. Sixty-three depressed patients completed perfectionism measures, and then completed daily questionnaires of stress appraisals, coping, and affect for 7 consecutive days. Multilevel structural equation modeling (MSEM) demonstrated that, across many stressors, when the typical individual with depression perceives more criticism than usual, he/she uses more avoidant coping and experiences higher event stress than usual, and this is connected to daily increases in negative affect as well as decreases in positive affect. In parallel, results showed that perceived control, less avoidant coping, and problem-focused coping commonly operate together when daily positive affect increases. MSEM also showed that avoidant coping tendencies and ongoing stress, in combination, explain why people with depression and higher self-critical perfectionism maintain daily negative affect and lower positive affect. These findings advance a richer and more detailed understanding of specific stress and coping patterns to target in order to more effectively accomplish the two predominant therapy goals of decreasing patients' distress and strengthening resilience.

Chronic Stress and Attenuated Improvement in Depression Over 1 Year: The Moderating Role of Perfectionism.

This study of depressed outpatients (N=47) examined self-criticism (SC) and personal standards (PS) dimensions of perfectionism as moderators of the relation between chronic stress and depression over 1year. Participants completed personality measures (SC, PS, neuroticism, conscientiousness) at baseline (Time 1), a chronic stress interview 6months later (Time 2), and self-report and interviewer-rated depression measures at Time 1, Time 2, and 1year after baseline (Time 3). Hierarchical multiple regression analyses of moderator effects demonstrated that patients with higher SC or PS and higher achievement-related chronic stress had higher levels of both self- and interviewer-rated depressive symptoms at Time 3 relative to those of other patients, adjusting for the effects of Time 1 and Time 2 depression scores. SC also interacted with interpersonal chronic stress to predict attenuated improvement in both self- and interviewer-rated depression at Time 3. The broader traits of neuroticism and conscientiousness did not interact with chronic stress to predict depression at Time 3. Our results highlight the importance of targeting perfectionists' dysfunctional characteristics (e.g., contingent self-worth, coping, interpersonal functioning) that perpetuate a chronic sense of hopelessness in the context of chronic stress in order to produce a better treatment response for these individuals.

The cues and care randomized controlled trial of a neonatal intensive care unit intervention: effects on maternal psychological distress and mother-infant interaction.

OBJECTIVE: This study tested the efficacy of a brief intervention (Cues program) with mothers of very low birth weight (VLBW <1500 g) infants. The primary hypothesis was that mothers in the Cues program would report lower levels of anxiety compared with mothers in the control group. Secondary hypotheses examined whether Cues mothers would report less stress, depression, and role restriction, and exhibit more sensitive interactive behavior, than control group mothers. METHODS: A total of 121 mothers of VLBW infants were randomly assigned to either the experimental (Cues) intervention or an attention control (Care) condition. The Cues program combined training to reduce anxiety and enhance sensitivity. The control group received general information about infant care. Both programs were initiated during the neonatal intensive care unit stay. Maternal anxiety, stress, depression, and demographic variables were evaluated at baseline, prior to randomization. Postintervention outcomes were assessed during a home visit when the infant was ∼6 to 8 weeks of corrected age. RESULTS: Although mothers in the Cues group demonstrated greater knowledge of the content of the experimental intervention than mothers in the Care group, the groups did not differ in levels of anxiety, depression, and symptoms of posttraumatic stress. They were similar in their reports of parental role restrictions and stress related to the infant's appearance and behavior. Cues and Care group mothers were equally sensitive in interaction with their infants. CONCLUSION: Nonspecific attention was as effective as an early skill-based intervention in reducing maternal anxiety and enhancing sensitive behavior in mothers of VLBW infants.

The evidence base for the cues program for mothers of very low birth weight infants: an innovative approach to reduce anxiety and support sensitive interaction.

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant's hospitalization in the neonatal intensive care unit and to promote sensitive mother-infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.

The Cues and Care Trial: a randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants.

BACKGROUND: Very low birthweight infants are at risk for deficits in cognitive and language development, as well as attention and behaviour problems. Maternal sensitive behaviour (i.e. awareness of infant cues and appropriate responsiveness to those cues) in interaction with her very low birthweight infant is associated with better outcomes in these domains; however, maternal anxiety interferes with the mother's ability to interact sensitively with her very low birthweight infant. There is a need for brief, cost-effective and timely interventions that address both maternal psychological distress and interactive behaviour. The Cues and Care trial is a randomized controlled trial of an intervention designed to reduce maternal anxiety and promote sensitive interaction in mothers of very low birthweight infants. METHODS AND DESIGN: Mothers of singleton infants born at weights below 1500 g are recruited in the neonatal intensive care units of 2 tertiary care hospitals, and are randomly assigned to the experimental (Cues) intervention or to an attention control (Care) condition. The Cues intervention teaches mothers to attend to their own physiological, cognitive, and emotional cues that signal anxiety and worry, and to use cognitive-behavioural strategies to reduce distress. Mothers are also taught to understand infant cues and to respond sensitively to those cues. Mothers in the Care group receive general information about infant care. Both groups have 6 contacts with a trained intervener; 5 of the 6 sessions take place during the infant's hospitalization, and the sixth contact occurs after discharge, in the participant mother's home. The primary outcome is maternal symptoms of anxiety, assessed via self-report questionnaire immediately post-intervention. Secondary outcomes include maternal sensitive behaviour, maternal symptoms of posttraumatic stress, and infant development at 6 months corrected age. DISCUSSION: The Cues and Care trial will provide important information on the efficacy of a brief, skills-based intervention to reduce anxiety and increase sensitivity in mothers of very low birthweight infants. A brief intervention of this nature may be more readily implemented as part of standard neonatal intensive care than broad-based, multi-component interventions. By intervening early, we aim to optimize developmental outcomes in these high risk infants. TRIAL REGISTRATION: Current Controlled Trials ISRCTN00918472. The Cues and Care Trial: A randomized controlled trial of an intervention to reduce maternal anxiety and improve developmental outcomes in very low birthweight infants.

Factors associated with depression in pregnant immigrant women.

This study examined psychosocial risk factors for depressive symptomatology in a community sample of pregnant immigrant women in Montreal, Canada. One hundred and nineteen participants were recruited through hospitals and responded to questionnaires assessing depression, somatic symptoms, functional status, social support, stressful life events and marital adjustment. Forty-two percent of participants scored above the cut-off for depression. Depressive symptoms were associated with poorer functional status and more somatic symptoms. Depressed women reported a lack of social support, more stressful life events and poorer marital adjustment. Transitions associated with migration may place pregnant immigrant women at high risk for depression.