Issues in personality as diathesis for depression: the case of sociotropy-dependency and autonomy-self-criticism.

A congruency between personality and life stress is assumed to pose a particular risk for depression. The authors review relevant research as a way of examining broader issues entailed in diathesis-stress models of depression. Topics include the identification of distinct personality modes and the differentiation of these modes from the phenomena of depression and the influence of the social context. Diathesis-stress models face formidable conceptual and methodological challenges. More complex models are needed to accommodate the dynamics of a person's life course, involvement in significant social contexts, and fluctuations in vulnerability to depression. Base rates of key phenomena favor development of models of depression recurrence in high-risk samples rather than its onset in the general population.

Comparison of postpartum and nonpostpartum depression: clinical presentation, psychiatric history, and psychosocial functioning.

This study compared a sample of postpartum women diagnosed with depression with a nonpostpartum depressed group and 2 nondepressed control groups. Women's depressive episodes were compared to determine whether differences existed in symptomatology, previous history, or course. Results indicate that postpartum depression tends to be relatively mild. Both depressed groups had high rates of positive psychiatric history and were equally likely to have recovered at a 6-month follow-up. Groups were also compared on psychosocial variables known to covary with depression: interpersonal relations, stress, and coping. A series of multivariate analyses of covariance showed few differences between the depressed groups that were not attributable to symptom severity, although postpartum depressed women did report better marital relations than did the nonpostpartum depressed women. These findings suggest that there is little to distinguish postpartum from nonpostpartum depression beyond differences in symptom severity.

Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum.

Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors.

Depression and marital functioning: an examination of specificity and gender differences.

Recent work has emphasized the importance of assessing the marital relationships of depressed persons. The present study was designed to examine the specificity to clinical depression of problematic marital functioning and to assess potential gender differences in the marital relationships and spousal interactions of depressed persons. Depressed psychiatric patients, nondepressed medical patients, and nondepressed community control subjects and their spouses completed measures of marital satisfaction and then participated in a 20-min marital interaction task. Subjects then completed measures assessing their postinteraction mood and perceptions of their spouses, and the interactions were scored with respect to the frequency of occurrence of a number of behaviors. The depressed couples differed from the community controls on virtually every measure of marital functioning. Furthermore, although the medical patients and their spouses also reported marital dissatisfaction and exhibited dysfunctional interactional behavior, only the depressed couples were characterized by negative affect following the interactions and by negative appraisals of their spouses' behaviors. This negative affect was particularly pronounced for the depressed women. Implications of these results are discussed and directions for further research are offered.

Infants of postpartum depressed mothers: temperament and cognitive status.

This study examined the association of postpartum depression with specific infant characteristics. Twenty-five diagnosed depressed and 25 nondepressed mothers and their 2-month-old infants participated in the study. The mothers completed measures of infant temperament and difficulty associated with infant care, and the infants were assessed using the Bayley Scales of Infant Development. Group comparisons indicated that, compared with the infants of the nondepressed mothers, the infants of the depressed women were less competent cognitively and expressed more negative emotions during the testing. The depressed mothers perceived their infants as more difficult to care for and more bothersome than did the nondepressed mothers, but did not attribute these difficulties to the temperament of their infants. These findings suggest that postpartum depression is associated with an identifiable pattern of infant behavior that may exacerbate depressed women's mood.

Prospective investigation of postpartum depression: factors involved in onset and recovery.

We examined the role of a number of psychosocial variables in the onset of postpartum depression and in recovery from depression that occurs during pregnancy. Women (N = 730) were recruited during pregnancy and were followed through 1 month postpartum. They were assessed on demographic variables and on measures of depressive symptomatology and diagnostic status, perceived stress, marital satisfaction, perceptions of their own parents, dysfunctional cognitions, and coping style. Onset of depression in the postpartum was predicted by the levels during pregnancy of depressive symptomatology and perceived maternal and paternal care during childhood. In contrast, recovery in the postpartum from depression during pregnancy was not predicted by the variables examined in this study. These results are discussed with reference to previous investigations that have examined depression that occurs outside the context of childbirth.

Does victimization account for sex differences in depressive symptoms?

Women are more depressed than men, and more frequently victimized. We explored the possibility that childhood sexual abuse (CSA) and adult victimization account for the higher levels of depression in women. Depressive symptoms and victimization histories were compared in a sample of 91 men and 76 women seeking out-patient psychotherapy. The women were more depressed, and more likely to have a history of CSA than the men. CSA accounted for a significant proportion of the sex difference in depression levels. The women also were more likely to have been victimized as adults than were the men. However, adult victimization was not associated with higher depression levels, and, therefore, did not account further for the sex difference.

Discriminant validity of the TSC-40 in an outpatient setting.

This study examines the discriminant validity of the Trauma Symptom Checklist (TSC-40) in a clinical sample. The TSC-40 was developed as a research instrument for assessing the impact of a history of sexual victimization. Previous validity studies used nonclinical samples of women (Elliott & Briere, 1992; Gold, Milan, Myall, & Johnson, 1994). In the present study, the TSC-40 was administered to 103 men and 79 women requesting services at two outpatient clinics. Information about sexual victimization was collected from the client during intake and from the therapist after the client had received 6 months of therapy. A history of CSA was associated both with high symptom levels across symptom dimensions, and, specifically, with elevation on the trauma subscale of the TSC-40. The findings support the view that, in a clinical setting, CSA is associated both with generalized distress and with PTSD symptoms.

Maternal depressed mood and perceptions of child temperament.

Research has suggested that women who experience postpartum depression are subsequently more likely to perceive their preschool-aged children as temperamentally difficult and maladjusted. However, previous studies have not controlled for the effects of concurrent depression levels on maternal ratings of child temperament or evaluated the accuracy of maternal reports. In the present study we assessed maternal and paternal ratings of child temperament 2 years after subjects had participated in a study of postpartum depression. The findings indicate that correlations between postpartum depression and subsequent child temperament ratings were accounted for statistically by concurrent levels of depression. Although fathers' ratings corroborated some aspects of maternal perceptions, levels of parental agreement were only moderately high. Moreover, discrepancies between the parents' reports were significantly associated with maternal depression, indicating that parental disagreement is more likely when the wife is dysphoric.

Screening for postpartum depression: a methodological note.

This research evaluated the convergence of Beck Depression Inventory (BDI) classifications with Research Diagnostic Criteria diagnoses of depression in a sample of postpartum women (N = 120). The BDI demonstrated good specificity, but poor sensitivity; it detected fewer than half of the diagnosed cases. This finding was attributed to the high rate of minor depression found among postpartum women, to which the BDI is particularly insensitive. Results indicate that the BDI is not a satisfactory screening instrument in postpartum depression research.

The comparison of postpartum with non-postpartum depression: a rose by any other name.

A strong tradition exists in the psychiatric literature to consider postpartum depression a distinct diagnosis. However, the empirical evidence indicates that, in terms of etiology and relapse rates, postpartum depression is indistinguishable from non-postpartum depression. Symptomatically, postpartum depression seems to involve a milder disturbance, suggesting that it is best seen as an adjustment disorder. This paper summarizes the empirical evidence relevant to the distinct diagnosis question, and considers the benefits to be derived from challenging the traditional view of postpartum depression.

Depression and perceptions of early parenting: a longitudinal investigation.

It has been suggested that the quality of early parenting received by depressed adults is more negative than that received by non-depressed people. Since perceptions of parenting are usually examined only when subjects are depressed, depressed subjects' negative reports may be distortions due to their depression, rather than accurate recollections. In the present study, both depressed and remitted women reported experiencing greater parental overprotection than did non-depressed women, but only depressed subjects also reported less parental caring. The results are discussed with respect to the early experiences of depressed individuals, the distinction between parental caring and overprotection, and the importance of interpersonal factors associated with depression.