Living with a depressed person

Does Family Functioning Matter? Understanding the Relationship Between Family Interactions and Depressive Symptoms for Caregivers of Cancer Patients

BACKGROUND

Caregivers of cancer patients are at increased risk of depression and other health challenges. There is limited understanding of the role of the caregiver's own family members in promoting or discouraging mental wellbeing. Family functioning conceptualizes how family members interact to promote a positive family environment and has the potential to impact caregiver mental health. The purpose of this study is to assess the association between family interactions and depressive symptoms among family caregivers of cancer patients.

METHODS

Secondary analysis of baseline data from an NIH-funded randomized control trial of family caregivers of cancer patients recruited from academic palliative care clinics at three sites (2 Midwest, 1 East). We tested for an association between caregiver responses to the Family Quality of Life in Dementia-Family Interactions Subscale and Patient-Reported Outcomes Measurement Information System Depression Short Form 8A using a block-wise approach to linear modeling.

RESULTS

A total of 246 caregivers were included in analysis; caregivers were mostly White (82%), not Hispanic or Latina/o (96%), and female (65%), with an average age of 55 years. Overall, participants had high family interactions (mean 57.7, sd 11.7) and an average depressive symptom burden (t-score 52.4, SD 8.57). Family interactions was significantly negatively associated with depressive symptoms (b = -.163, se = .057) when accounting for relevant covariates.

CONCLUSION

Family caregivers with more positive family interactions are likely to have fewer depressive symptoms, suggesting family functioning may play a key role in bolstering family caregiver mental health and wellbeing.

Dyadic coping and mental health in couples: A systematic review

Globally, one out of three people suffer from a mental health issue during their lifetime. In romantic relationships, impaired mental health does not only affect the individual but also their partner and therefore needs to be coped with dyadically. In this systematic review, we summarize research examining dyadic coping (DC) in the context of mental health and individual and relational outcomes. We searched for peer-reviewed articles published between January 1990 and April 2023 on PsycInfo, Medline, and PSYNDEX on DC and mental health within romantic relationships. A total of 60 qualitative, quantitative, and intervention studies met the inclusion criteria, reporting on 16,394 individuals and 4,945 dyads. To synthesize the studies, we used a narrative synthesis approach. Overall, stress expression and positive DC yielded beneficial individual and relational outcomes, whereas, for negative DC, the opposite was true. Results differed between mental health clusters and context played an important role (e.g., symptom severity, life phase). Due to the great diversity of studies and variables, further research should focus on understudied mental health clusters (e.g., anxiety disorders). Clinicians are advised to view mental health issues as a dyadic rather than an individual phenomenon ("we-disease") and develop tailored couple-centered interventions.

Process-Based psychotherapy personalization: considering causality with continuous-time dynamic modeling

Psychotherapy can be improved by integrating the study of mediators (how it works) and moderators (for whom it works). To demonstrate this integration, we studied the relationship between resource activation, problem-coping experiences and symptoms in cognitive-behavior therapy (CBT) for depression, to obtain preliminary insights on causal inference (which process leads to symptom improvement?) and prediction (which one for whom?).

A sample of 715 patients with depression who received CBT was analyzed. Hierarchical Bayesian continuous time dynamic modeling was used to study the temporal dynamics between the variables analyzed within the first ten sessions. Depression and self-efficacy at baseline were examined as predictors of these dynamics.

There were significant cross-effects between the processes studied. Under typical assumptions, resource activation had a significant effect on symptom improvement. Problem-coping experience had a significant effect on resource activation. Depression and self-efficacy moderated these effects. However, when system noise was considered, these effects may be affected by other processes.

Resource activation was strongly associated with symptom improvement. To the extent of inferring causality, for patients with mild-moderate depression and high self-efficacy, promoting resource activation can be recommended. For patients with severe depression and low self-efficacy, promoting problem-coping experiences can be recommended.

Movement-based patient-therapist attunement in psychological therapy and its association with early change

Objective

Attunement is a novel measure of nonverbal synchrony reflecting the duration of the present moment shared by two interaction partners. This study examined its association with early change in outpatient psychotherapy.

Methods

Automated video analysis based on motion energy analysis (MEA) and cross-correlation of the movement time-series of patient and therapist was conducted to calculate movement synchrony for N = 161 outpatients. Movement-based attunement was defined as the range of connected time lags with significant synchrony. Latent change classes in the HSCL-11 were identified with growth mixture modeling (GMM) and predicted by pre-treatment covariates and attunement using multilevel multinomial regression.

Results

GMM identified four latent classes: high impairment, no change (Class 1); high impairment, early response (Class 2); moderate impairment (Class 3); and low impairment (Class 4). Class 2 showed the strongest attunement, the largest early response, and the best outcome. Stronger attunement was associated with a higher likelihood of membership in Class 2 (b = 0.313, p = .007), Class 3 (b = 0.251, p = .033), and Class 4 (b = 0.275, p = .043) compared to Class 1. For highly impaired patients, the probability of no early change (Class 1) decreased and the probability of early response (Class 2) increased as a function of attunement.

Conclusions

Among patients with high impairment, stronger patient-therapist attunement was associated with early response, which predicted a better treatment outcome. Video-based assessment of attunement might provide new information for therapists not available from self-report questionnaires and support therapists in their clinical decision-making.

Validation and application of the Non-Verbal Behavior Analyzer: An automated tool to assess non-verbal emotional expressions in psychotherapy

BACKGROUND

Emotions play a key role in psychotherapy. However, a problem with examining emotional states via self-report questionnaires is that the assessment usually takes place after the actual emotion has been experienced which might lead to biases and continuous human ratings are time and cost intensive. Using the AI-based software package Non-Verbal Behavior Analyzer (NOVA), video-based emotion recognition of arousal and valence can be applied in naturalistic psychotherapeutic settings. In this study, four emotion recognition models (ERM) each based on specific feature sets (facial: OpenFace, OpenFace-Aureg; body: OpenPose-Activation, OpenPose-Energy) were developed and compared in their ability to predict arousal and valence scores correlated to PANAS emotion scores and processes of change (interpersonal experience, coping experience, affective experience) as well as symptoms (depression and anxiety in HSCL-11).

MATERIALS AND METHODS

A total of 183 patient therapy videos were divided into a training sample (55 patients), a test sample (50 patients), and a holdout sample (78 patients). The best ERM was selected for further analyses. Then, ERM based arousal and valence scores were correlated with patient and therapist estimates of emotions and processes of change. Furthermore, using regression models arousal and valence were examined as predictors of symptom severity in depression and anxiety.

RESULTS

The ERM based on OpenFace produced the best agreement to the human coder rating. Arousal and valence correlated significantly with therapists' ratings of sadness, shame, anxiety, and relaxation, but not with the patient ratings of their own emotions. Furthermore, a significant negative correlation indicates that negative valence was associated with higher affective experience. Negative valence was found to significantly predict higher anxiety but not depression scores.

CONCLUSION

This study shows that emotion recognition with NOVA can be used to generate ERMs associated with patient emotions, affective experiences and symptoms. Nevertheless, limitations were obvious. It seems necessary to improve the ERMs using larger databases of sessions and the validity of ERMs needs to be further investigated in different samples and different applications. Furthermore, future research should take ERMs to identify emotional synchrony between patient and therapists into account.

Mothers' Depressive Symptoms and Children's Internalizing and Externalizing Behaviors: Examining Reciprocal Trait-State Effects from Age 2 to 15

Using a large sample from the National Institute of Child Health and Development Study of Early Child Care and Youth Development (N = 1,178, 51% were male and 80% were White), the random intercept cross-lagged panel model was employed to unpack the trait and state aspects in the relations between mothers' depressive symptoms and children's behavioral problems from age 2 to 15. The transactional predictions among mothers' depressive symptoms and children's behavioral problems were largely attributed to their correlations at the underlying trait level (rs = .458-.528). At the state level, the mutual influences among mothers' depressive symptoms and children's behavior problems occurred more often during periods of transition. With that said, the child effects hypothesis was not supported.

Equity of Dyadic Coping in Patients with Depression and Their Partners

Introduction: For couples, depression can position diagnosed partners to receive dyadic coping and mates to primarily provide support. We examine whether inequities in dyadic coping covary with depressive symptoms. Methods: Using data from 62 mixed-gender couples with one partner diagnosed with major depression (60% female), we computed differences between provided and received dyadic coping reported by both partners. With Response Surface Analyses we examined the associations with depressive symptoms. Results: In patients, lower equity of dyadic coping was associated with more depressive symptoms, regardless of whether the patient felt underbenefitted or overbenefitted. In partners, dyadic coping was negatively associated with depressive symptoms while equity of dyadic coping showed no significant associations. Patients and partners both reported providing more dyadic coping than they received. Discussion: Inequities in dyadic coping covary with depressive symptoms in patients, beyond main effects of dyadic coping, justifying the inclusion of couples in treatment for depression.

Are some therapists better at facilitating and consolidating sudden gains than others?

BACKGROUND

Changes during psychotherapy often include sudden symptom improvements, called sudden gains (SGs), which have been identified as being superior to gradual symptom change with regard to treatment success. This study investigates the role of therapists in initiating and/or consolidating SGs.

METHODS

The analyses are based on a sample of patients (N = 1937) who were seen by 155 therapists and received individual psychotherapy at a university outpatient clinic. First, the therapist effect (TE) on SG was investigated using multilevel modeling (MLM). Second, MLM was used to explore the relative importance of patient and therapist variability in SGs as they relate to outcome.

RESULTS

The TE on SGs accounted for 1.8% of variance, meaning that therapists are accountable for inter-individual differences in their patients' likelihood to experience SGs. Furthermore, results revealed a significant effect of SGs on outcome for both levels, while therapist differences regarding the consolidation of SGs were not significant.

CONCLUSIONS

The analyses indicated that some therapists are better in facilitating and initiating SGs. The process of triggering SGs seems to be a therapist skill or competence, which opens up an additional pathway to positive outcomes that could be used to improve clinical training.

Cognitive reappraisal and the association between depressive symptoms and perceived social support among older adults

OBJECTIVES

There is an association between depression and diminished social support; indeed, interpersonal dysfunction is often a central feature of depression. The purpose of this study is to examine the role that an emotion regulation (ER) strategy, cognitive reappraisal, plays in influencing the association between depressive symptoms and perceived social support in older adults.

METHOD

Data for this cross-sectional study come from a community-based survey of older adults (60+, N = 910). We examined the effects of depressive symptoms and cognitive reappraisal on perceived social support. We then examined the potential moderating role of cognitive reappraisal on the association between depressive symptoms and perceived social support.

RESULTS

Depressive symptoms were associated with lower levels of perceived social support. Cognitive reappraisal was associated with higher levels of perceived social support. Cognitive reappraisal moderated the negative consequences of depressive symptoms on perceived social support. Whereas depressive symptoms had a negative effect on perceived social support, the negative effect was greater for those with lower levels of cognitive reappraisal compared to those with higher levels of cognitive reappraisal.

DISCUSSION

ER strategies may play a role in attenuating the negative consequences of depressive symptoms on social support in older age. It may be possible to help individuals maintain social support in later life, even in the face of mental health challenges, if they cultivate ER skills.

Disability as an Interpersonal Experience: A Systematic Review on Dyadic Challenges and Dyadic Coping When One Partner Has a Chronic Physical or Sensory Impairment

Chronically disabling health impairments affect an increasing number of people worldwide. In close relationships, disability is an interpersonal experience. Psychological distress is thus common in patients as well as their spouses. Dyadic coping can alleviate stress and promote adjustment in couples who face disabling health impairments. Much research has focused on dyadic coping with cancer. However, other health problems such as physical and sensory impairments are also common and may strongly impact couple relationships. In order to promote couples' optimal adjustment to impaired health, the identification of disability-related relationship challenges is required. Furthermore, ways in which dyadic coping with these challenges may benefit couples could inform researchers and practitioners how to support couples in coping with health impairments. Accordingly, the aims of this study were to systematically review dyadic challenges and dyadic coping when one partner has a chronically disabling physical or sensory impairment. Out of 873 articles identified through database searches, 36 studies met inclusion criteria. The disability-related dyadic challenges identified in the review were changed roles and responsibilities within the couple, altered communication, compromised sexual intimacy, and reduced social participation. These challenges were reported to burden both partners and the couple relationship. Dyadic adjustment benefitted from a we-perspective, i.e., when couples viewed the disability as a shared challenge and engaged in conjoint dyadic coping. The results suggest that patient/care recipient and partner/caregiver roles should be de-emphasized and that disability should be recognized as an interpersonal experience.

Interpersonal clarification effects in Cognitive-Behavioral Therapy for depression and how they are moderated by the therapeutic alliance

BACKGROUND

Although a wide body of research links depression to interpersonal deficits, Cognitive-Behavioral Therapy (CBT), considered the gold standard in the treatment of this condition, has not been developed to specifically address interpersonal difficulties. However, cognitive changes on a relational level occurring during CBT might play an important role in the treatment of depression. Interpersonal clarification refers to the process of better understanding the nature of one's interpersonal patterns during therapy. The aim of this study is to analyze the effects of interpersonal clarification in CBT and how they are moderated by the therapeutic alliance.

METHODS

A sample of 621 patients diagnosed with depression were treated with CBT by 126 therapists in a university outpatient clinic. Patients completed measures of interpersonal problems and depression severity at baseline, measures of symptomatic evolution before each session and process measures (assessing interpersonal clarification and alliance) after each session. Multilevel models separating between-patient (BP) and within-patient (WP) effects of interpersonal clarification, and including BP and WP alliance effects as covariates and moderators of the interpersonal clarification effects were conducted.

RESULTS

Analyses showed both significant BP and WP effects interpersonal clarification, even when adjusting for alliance effects. Furthermore, significant interactive effects were found between outcome of WP interpersonal clarification with both BP alliance and WP alliance.

LIMITATIONS

Interpersonal clarification was measured with one single-item and adherence to CBT was not explicitly measured.

CONCLUSIONS

The results present preliminary evidence for considering interpersonal clarification a meaningful change process in CBT for depression, especially in the context of a stronger therapeutic alliance.

Marital Quality and Well-Being Among Older Adults: A Typology of Supportive, Aversive, Indifferent, and Ambivalent Marriages

A large body of work has linked marital quality to the health and well-being of older adults, but there is a lack of agreement on how to best measure dimensions of marital quality. Drawing on a stress-process life course perspective, we construct a typology of marriage type that captures the synergistic relationship between positive and negative marital qualities and health. Using data from Wave 1 (2005/2006) and Wave 2 (2010/2011) of the NSHAP survey from the United States, we examine the association between supportive, aversive, ambivalent, and indifferent marriages for older adults that remained married over the study period on multiple indicators of well-being (depression, happiness, and self-rated health; N = 769 males and 461 females). Results suggest that older adults in aversive marriages reported lower happiness (men and women) and physical health (men). There was less evidence that those in ambivalent and indifferent marriages reported worse well-being.

The caregivers' dilemma: Care burden, rejection, and caregiving behaviors among the caregivers of patients with depressive disorders

Taking care of depressed patients significantly impacts caregivers' lives, both objectively and subjectively. The effects of caregivers' burden on their responses to their patients has yet to be investigated. The aim of this study is to explore the relationships among caregivers' subjective and objective burden, depression, frequency of caregiving behaviors, and rejective attitude. A cross-sectional study was conducted among 134 caregivers of patients diagnosed with depressive disorders. We administered questionnaire to assess caregivers' demographics, care burden, reassurance seeking, depression, rejective attitude and caring behaviors. Both caregivers' objective and subjective burdens were associated with their depressive symptoms. Rejection towards patients was determined by the caregivers' level of depressive symptoms, subjective feeling of sadness, and anger, rather than by their objective burden. On the other hand, the frequency of caregiving behavior was determined by perceived reassurance seeking and anger, rather than by caregivers' depression or objective burden. These findings suggest that caregivers' subjective burden plays a more salient role in predicting their rejection and frequency of caregiving behaviors toward the patients than objective burden. The caregivers in this study could recognize their rejective attitude toward depressed patients but still had difficulty withdrawing their care when they were already in distress.

Latina/o and non-latina/o brain injury and dementia patients’ and caregivers’ health: An actor/partner interdependence model

Background:

The interdependence between patient and caregivers’ health, which is when the patients’ and informal caregivers’ emotion, cognition and/or behavior affects that of the other person is well documented among dyads experiencing cancer and heart disease, but scant research has assessed interdependence among those with brain injuries or dementia and Latina/o populations. This study aimed to assess the interdependence of patient and caregiver depression, patient functional independence and caregiver burden among non-Latina/o and Latina/o and patients with brain injuries and dementia and their caregivers.

Methods:

Patients and caregiver dyads (n = 96) were recruited from a trauma hospital. Participants completed measures on patient and caregiver depression, patient functional independence and caregiver burden. Participants provided written informed consent. Patient inclusion criteria included: (1) diagnosis with a brain injury or dementia, (2) minimum age of 12, (3) community dwelling and (4) ability to verbally communicate and complete study measures. Caregivers were only included if they were informal, unpaid, family or a friend. Nonparametric Spearman’s Rho correlations were conducted to test the study hypotheses.

Discussion:

There was consistently a statistically significant positive relationship between caregiver depression and caregiver burden for all groups. For non-Latina/o patient and caregiver dementia dyads, there were associations between patient depression and caregiver depression. For non-Latina/o dementia dyads, functional ability was only associated with patient depression. For Latina/o patient and caregiver brain injury and dementia dyads, the only statistically significant relationship was between caregiver depression and caregiver burden. Health services should embrace family-focused mental health and respite interventions.

Enhancing Connections-Palliative Care: A Quasi-Experimental Pilot Feasibility Study of a Cancer Parenting Program

Background: In 2018, >75,000 children were newly affected by the diagnosis of advanced cancer in a parent. Unfortunately, few programs exist to help parents and their children manage the impact of advanced disease together as a family. The Enhancing Connections-Palliative Care (EC-PC) parenting program was developed in response to this gap. Objective: (1) Assess the feasibility of the EC-PC parenting program (recruitment, enrollment, and retention); (2) test the short-term impact of the program on changes in parent and child outcomes; and (3) explore the relationship between parents' physical and psychological symptoms with program outcomes. Design: Quasi-experimental two-group design employing both within- and between-subjects analyses to examine change over time and change relative to historical controls. Parents participated in five telephone-delivered and fully manualized behavioral intervention sessions at two-week intervals, delivered by trained nurses. Behavioral assessments were obtained at baseline and at three months on parents' depressed mood, anxiety, parenting skills, parenting self-efficacy, and symptom distress as well as children's behavioral-emotional adjustment (internalizing, externalizing, and anxiety/depression). Subjects: Parents diagnosed with advanced or metastatic cancer and receiving noncurative treatment were eligible for the trial provided they had one or more children aged 5-17 living at home, were able to read, write, and speak English, and were not enrolled in a hospice program. Results: Of those enrolled, 62% completed all intervention sessions and post-intervention assessments. Within-group analyses showed significant improvements in parents' self-efficacy in helping their children manage pressures from the parent's cancer; parents' skills to elicit children's cancer-related concerns; and parents' skills to help their children cope with the cancer. Between-group analyses revealed comparable improvements with historical controls on parents' anxiety, depressed mood, self-efficacy, parenting skills, and children's behavioral-emotional adjustment. Conclusion: The EC-PC parenting program shows promise in significantly improving parents' skills and confidence in supporting their child about the cancer. Further testing of the program is warranted.

General, Interpersonal, and Gender Role Specific Risk Factors of Postpartum Depressive Symptoms in Fathers

Introduction: Paternal postnatal depression has significant negative consequences for the family and child. Still, only little attention has been paid to potential unique risk factors of depression in fathers and the theoretical grounding of such research is sparse.

Method: This study examined prenatal risk factors derived from three theoretical models: the cognitive vulnerability-stress model, the interpersonal model, and the gender role risk model of paternal postnatal depression. The sample consisted of 211 expectant fathers, of whom 5.7% scored above the clinical cut-off on the Edinburgh Postnatal Depression Scale, and 235 mothers were included as a reference group. Participants filled in questionnaires during pregnancy and four months postpartum.

Results: The study results suggest that prenatal depressive score is the strongest risk factor for both paternal and maternal postnatal depressive symptoms. In addition, childhood separation from parents, unemployment, financial strain, and doubts about having the child were unique risk factors for paternal depressive symptoms, while lower marital satisfaction was a unique risk factor for maternal depression.

Discussion: These findings highlight that beyond the strong role of prenatal depressive symptoms for both genders, specific risk factors for father depression exist. This may be informative to health care professionals in increasing the reach and prevention of depression in new fathers.

Social Ties and Suicidal Ideation Among Veterans Referred to a Primary Care-Mental Health Integration Program

OBJECTIVE

This study examined associations between three indices of social ties (perceived social support, frequency of negative social exchanges, and degree of social integration) and suicidal ideation among veterans referred by their primary care provider for a behavioral health assessment.

METHODS

The sample included 15,277 veterans who completed a mental health and substance use assessment on referral to a Primary Care-Mental Health Integration (PCMHI) program. Data on sociodemographic factors, mental health and substance use conditions (e.g., depression, anxiety, and substance use), perceived general health, the three indices of social ties, and suicidal ideation were extracted from clinical interviews.

RESULTS

The mean±SD age of the sample was 51.3±15.9, most (89%) were men, and about half (48%) were white. Most met criteria for at least one mental health or substance use condition on PCMHI assessment, and 39% reported either low- or high-severity suicidal ideation, as measured by the Paykel Suicide Scale. Logistic regression analyses indicated that after adjustment for sociodemographic factors, perceived health, and comorbid mental health and substance use conditions, each of the three social tie indices was uniquely associated with higher odds of reporting suicidal ideation, compared with no ideation.

CONCLUSIONS

Findings underscore the value of assessing multiple indices of social ties when examining suicidal ideation among high-risk veterans in primary care experiencing behavioral health issues. Incorporating an assessment of the quality of patients' social interactions and level of social integration into routine PCMHI practice has the potential to enhance screening and intervention efforts aimed at reducing suicidal ideation.

Longitudinal associations of family burden and patient quality of life in the context of first-episode schizophrenia in the RAISE-ETP study

The present study examined longitudinal associations between family member perceived burden and clinical correlates to understand potential covariation in change over time in the context of first-episode schizophrenia in the RAISE-ETP study (N = 282). Across 24 months, family burden, patient quality of life, and positive symptoms improved. Findings from the present study suggest covariation in change over time in quality of life and family burden. As patient quality of life improved, family burden decreased. However, initial levels of quality of life were not significantly associated with changes in family burden and vice versa. Initial levels of positive symptoms were significantly associated with initial levels of family burden. These findings have treatment implications by suggesting the potential for interventions aimed at improving quality of life to have a spillover effect on family burden, or alternatively, that reducing perceived family burden may improve patient quality of life.

Neuropsychodynamic Approach to Depression: Integrating Resting State Dysfunctions of the Brain and Disturbed Self-Related Processes

A mechanism-based approach was developed focusing on the psychodynamic, psychological and neuronal mechanisms in healthy and depressed persons. In this integrative concept of depression, the self is a core dimension in depression. It is attributed to negative emotions (e.g., failure, guilt). The increased inward focus in depression is connected with a decreased environmental focus. The development of neuropsychodynamic hypotheses of the altered self-reference is based on the investigation of the emotional-cognitive interaction in depressed patients. It may be hypothesized that the increased negative self-attributions—as typical characteristics of an increased self-focus in depression—may result from altered neuronal activity in subcortical-cortical midline structures in the brain, especially from hyperactivity in the cortical-subcortical midline regions and hypoactivity in the lateral regions. The increased resting state activity in depression is especially associated with an increased resting state activity in the default mode network (DMN) and a dysbalance between DMN and executive network (EN) activity. Possible therapeutic consequences of the neuropsychodynamic approach to depression involve the necessary emotional attunement in psychotherapy of depressed patients and the adequate timing of therapeutic interventions. The hypotheses which have been developed in the context of the neuropsychodynamic model of depression may be used for more specific psychotherapeutic interventions, aiming at specific mechanisms of compensation and defence, which are related to the increased resting state activity and the disturbed resting state-stimulus-interaction.

Prognostic significance of social network, social support and loneliness for course of major depressive disorder in adulthood and old age

AIMS

Poor recovery from depressive disorder has been shown to be related to low perceived social support and loneliness, but not to social network size or frequency of social interactions. Some studies suggest that the significance of social relationships for depression course may be greater in younger than in older patients, and may differ between men and women. None of the studies examined to what extent the different aspects of social relationships have unique or overlapping predictive values for depression course. It is the aim of the present study to examine the differential predictive values of social network characteristics, social support and loneliness for the course of depressive disorder, and to test whether these predictive associations are modified by gender or age.

METHODS

Two naturalistic cohort studies with the same design and overlapping instruments were combined to obtain a study sample of 1474 patients with a major depressive disorder, of whom 1181 (80.1%) could be studied over a 2-year period. Social relational variables were assessed at baseline. Two aspects of depression course were studied: remission at 2-year follow-up and change in depression severity over the follow-up period. By means of logistic regression and random coefficient analysis, the individual and combined predictive values of the different social relational variables for depression course were studied, controlling for potential confounders and checking for effect modification by age (below 60 v. 60 years or older) and gender.

RESULTS

Multiple aspects of the social network, social support and loneliness were related to depression course, independent of potential confounders - including depression severity - but when combined, their predictive values were found to overlap to a large extent. Only the social network characteristic of living in a larger household, the social support characteristic of few negative experiences with the support from a partner or close friend, and limited feelings of loneliness proved to have unique predictive value for a favourable course of depression. Little evidence was found for effect modification by gender or age.

CONCLUSIONS

If depressed persons experience difficulties in their social relationships, this may impede their recovery. Special attention for interpersonal problems, social isolation and feelings of loneliness seems warranted in depression treatment and relapse prevention. It will be of great interest to test whether social relational interventions can contribute to better recovery and relapse prevention of depressive disorder.

Depression: counting the costs

The Merck Essay Prize was inaugurated in 1993. All trainee psychiatrists (senior house officers, registrars or senior registrars) in the United Kingdom and Republic of Ireland were eligible to submit an essay on the topic: ‘Depression: Counting the Costs’. The winning essay by Dr Peter Haddad is printed here. The runners-up in Joint second place were Dr J. Bray, Lecturer, University of Leicester (Leicester General Hospital) and Dr R. Bullock, Senior Registrar, St Mary Abbots Hospital, London.

Depressive illness is the commonest form of mental disorder in the community. Its effects are far-reaching and include psychological suffering and social disruption for affected individuals and their families, increased mortality, and direct and indirect financial costs for society. Only about half of all cases of depression are recognised by doctors and not all of these receive effective treatment. The costs of depression could be reduced if detection and treatment were improved. Addressing this is a major challenge for psychiatric services.

Resilience and spirituality in patients with depression and their family members: A cross-sectional study

OBJECTIVE

The degree and quality of resilience in patients with depression have never been investigated in the context of remission status, spirituality/religiosity, and family members' resilience levels, which was addressed in this study.

METHODS

This cross-sectional study recruited Japanese outpatients with depressive disorder according to ICD-10 and cohabitant family members who were free from psychiatric diagnoses. Resilience was assessed using the 25-item Resilience Scale (RS). Other assessments included the Montgomery-Asberg Depression Rating Scale (MADRS); the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT) and Kasen et al.'s (2012) scale for spirituality/religiosity; and the Rosenberg Self-Esteem Scale (RSES).

RESULTS

One hundred outpatients with depression (mean±SD age, 50.8±14.5years; 44 men; MADRS total score 9.8±9.0) and 36 healthy family members (mean±SD age, 56.5±15.0years; 18 men) were included. Symptom severity, attendance at religious/spiritual services, and self-esteem were significantly associated with RS scores in the patient group. RS total scores were significantly higher in remitted patients compared to non-remitted patients (mean±SD, 112.3±17.1 vs. 84.8±27.7, p<0.001). No correlation was found in RS total scores between patients and their family members (p=0.265), regardless of patients' remission status.

CONCLUSIONS

Resilience may be influenced by individual characteristics rather than familial environment; furthermore, self-esteem or spirituality/religiosity may represent reinforcing elements. While caution is necessary in extrapolating these findings to other patient populations, our results suggest that resilience may be considered a state marker in depression.

"Family Matters": A Systematic Review of the Evidence For Family Psychoeducation For Major Depressive Disorder

The first aim of this systematic review was to evaluate the evidence for family psychoeducation (FPE) interventions for major depressive disorder (MDD). A second aim was to compare the efficacy of different modes of delivering face-to-face FPE interventions. Ten studies (based on nine distinct samples) were identified comprising four single-family studies, four multifamily studies, one single versus multifamily comparative study, and one peer-led, mixed-diagnosis study. Seven studies measured patient functioning and six reported positive outcomes. Six studies measured carer's well-being and four reported positive outcomes. Results provide preliminary evidence that FPE leads to improved outcomes for patient functioning and family-carer's well-being for persons with depression. The implications for future development and delivery of FPE interventions for MDD are discussed.

User value and usability of a web-based mindfulness intervention for families living with mental health problems

Mental health problems affect the patients and their families, who may also need therapeutic interventions. Mindfulness interventions have shown beneficial health effects for clinical and healthy populations. A web-based mindfulness intervention was tailored to address families' needs of support and tested in a pilot intervention study. The aim of this study was to explore the participants' experiences of using an 8-week web-based mindfulness programme in terms of user value and usability. Qualitative semi-structured interviews were carried out over the phone (Spring 2015, Sweden) with 15 randomly selected participants after the 3-month follow-up as part of the pilot study. Data were also collected through usability surveys online post intervention and at the 3-month follow-up. Qualitative data were analysed with content analysis and quantitative data with descriptive statistics. The analysis of the interviews resulted in four categories describing the participants' experiences of the programme's usability and value: A valuable and flexible tool that requires time and discipline, New perspective and coping strategies for an enhanced well-being, I'm important too - my limits, my responsibility, and Taming the inner critic. The programme's usability was satisfactory and largely corroborated by the surveys. The programme was experienced as a valuable tool to cope with stress in both private and professional contexts, making it a viable option to support families living with mental health problems. Time for self-care, a widened perspective, a less judgmental and more accepting attitude, deterring automatic reactions and setting limits helped the participants to deal with their situation and health. The programme's ease and flexibility of use were major advantages, although the training requires discipline. Motivators and barriers to use were illuminated, which should be considered in the development of further online services and study designs.

Psychosocial Assessments and Outcomes in Organ Transplantation

A qualitative review was conducted to define the term psychosocial as applied to transplant patients and to summarize evidence regarding the role and impact of psychosocial assessments and outcomes across the transplant process. English-language case series and empirical studies from January 1970 through April 1990 that were abstracted in Medline and Psychological Abstracts or listed in publications' bibliographies were used as data sources. A qualitative analysis was performed to determine the depth of the case reports and whether the empirical reports obtained statistically reliable, clinically significant findings. The authors conclude that psychosocial assessments differ in content and application to candidate selection depending on the transplant program. Psychosocial status before transplant does not consistently affect medical outcomes after transplant. Psychosocial status generally improves with transplant, although difficulties are prevalent in psychological adjustment and in compliance with medical regimens. Psychiatric history can predict psychological outcomes after transplant but does not consistently predict compliance. Social supports and coping strategies strengthen psychosocial outcomes. Posttransplant psychosocial outcomes may predict physical morbidity and mortality.

Depressive Disorders: Treatment with Nonpharmacological Alternatives

The purpose of this article is to provide a review of current social psychology theories explaining depressive disorders and to describe selected nonpharmacological approaches that may be useful in treating disorders related to these causes. It is essential that providers of health care are alert to the signs and symptoms of depression. For many cases of depression, the presentation is not straightforward. Early recognition by both provider and client is important to the successful treatment of depressive disorders. The cognitive-behavioral and interpersonal therapies discussed in this article may be useful to augment other types of alternative and complementary healing modalities or for clients who prefer nonpharmacological treatment.

Family psychoeducation for major depressive disorder - study protocol for a randomized controlled trial

Background

Major depressive disorder has been shown to affect many domains of family life including family functioning. Conversely, the influence of the family on the course of the depression, including the risk of relapse, is one reason for targeting the family in interventions. The few studies conducted within this area indicate that family psychoeducation as a supplement to traditional treatment can effectively reduce the risk of relapse in patients with major depression as well as being beneficial for the relatives involved. However, the evidence is currently limited. This study will investigate the effect of family psychoeducation compared to social support on the course of the illness in patients with major depressive disorder.

Method/design

The study is designed as a dual center, two-armed, observer-blinded, randomized controlled trial. Relatives are randomized to participate in one of two conditions: either four sessions of manualized family psychoeducation or four sessions in a social support group led by a health care professional. Patients will not participate in the groups and will continue their treatment as usual. A total of 100 patients, each accompanied by one relative, will be recruited primarily from two outpatient clinics in the Capital Region of Denmark.

The primary outcome is the occurrence of depressive relapse at 9-month follow-up defined as a score ≥7 on the Hamilton six-item subscale. Secondary outcomes will include time to relapse.

Discussion

It is hoped that the results from this study will help to clarify the mechanisms behind any beneficial changes due to family psychoeducation and provide information on the long-term effect of this intervention for both patient and relatives. If the results are positive, the family psychoeducation program may be suitable for implementation within a clinical setting.

Trial registration

ClinicalTrials.gov Identifier: NCT02348827, registered 5 January 2015.

Dispositional Optimism, Role-Specific Stress, and the Well-Being of Adult Daughter Caregivers

The present investigation examined the effects of role stress and dispositional optimism on the well-being of 296 adult daughter caregivers who simultaneously occupied mother, wife, and employee roles. It was predicted that dispositional optimism would buffer the effects of stress in each of the fourroles on psychological well-being (depressive symptoms and life satisfaction). Results provided some evidence to support the stress-buffering hypothesis. Dispositional optimism buffered (i.e., moderated) the effects of wife stress on depressive symptoms and life satisfaction. In addition, main effects of dispositional optimism on the psychological well-being were found, even after considering stressful experiences in particular social roles (e.g., caregiver). Findings suggest that dispositional optimism can serve as a beneficial resource that reduces the negative effects of wife stress on psychological well-being and contributes to adult daughter caregiver’s well-being, irrespective of stress experienced in specific social roles, including caregiving.

Understanding variations in exposure to social stress

Although exposure to stress is a central component of the stress process paradigm, little research has explicitly sought to identify antecedents of stress exposure. Based on a probability sample of 1393 adults aged 18-55 residing in Toronto, Canada, this research examines the effects of social status, past adversity, social and personal resources and history of mental disorder on recent exposure to stress. Consistent with earlier findings, results indicate that younger adults, divorced individuals and those with lower socioeconomic status, experience greater levels of social stress. Although respondent’s history of major depressive disorder was related to all types of stress exposure, past cumulative adversity was the most powerful predictor of both total current stress (operant burden) and the subsequent onset of life events, independent of other antecedents. Findings suggest that the onset of chronic stress is more affected by personal characteristics, such as emotional reliance and disorder history, than is onset of life events. Implications of these findings are discussed.

Body Weight and the Quality of Interpersonal Relationships

We investigate whether underweight, normal-weight, overweight, and obese Americans differ in their evaluations of positive and negative aspects of their interpersonal relationships. Analyses are based on data from the Midlife Development in the United States (MIDUS) study, a survey of more than 3,000 adults ages 25 to 74 in 1995. We find no significant differences across the body mass index (BMI) categories in the quality of relationships with friends, coworkers, and spouses. Severely obese persons report significantly higher levels of strain and lower levels of support in their family relationships. This pattern, however, is contingent upon one's adolescent body weight. Among persons who were of “normal” weight at age 21, current BMI is not associated with relationship quality. For persons who were overweight at age 21, the level of social support received from family during adulthood declines as adult BMI increases. Implications for stigma theory are discussed.

Outcome of a web-based mindfulness intervention for families living with mental illness - A feasibility study

BACKGROUND

Families living with a person with mental illness can experience distress requiring therapeutic interventions. Web-based mindfulness interventions have shown beneficial health outcomes for both clinical and healthy populations, and may help families cope and overcome barriers that can otherwise hinder a help-seeking process.

AIMS

To develop and assess outcomes of a web-based mindfulness intervention for families living with a person with mental illness.

METHODS

A pilot study investigating an 8-week web-based mindfulness intervention with a pre-post design and follow-up after 3 months, with mindfulness as the primary outcome and perceived stress, caregiver burden and self-compassion as secondary outcomes. The study included a sample of 97 persons approached by advertisement in newspapers, newsletters, and online.

RESULTS

The study showed significant improvements in levels of mindfulness post-intervention and at follow-up as well as significant improvements in levels of perceived stress, caregiver burden, and self-compassion both post-intervention and at follow-up.

DISCUSSION

Acceptability and feasibility of the intervention were high, outcomes were relevant, and the intervention showed positive and significant results supporting the hypothesis that the intervention may help families cope with a stressful situation.

CONCLUSION

Further randomized controlled studies of the intervention are needed to investigate the intervention's effectiveness, including dose-effect studies.

Confusing acceptance and mere politeness: Depression and sensitivity to Duchenne smiles

BACKGROUND AND OBJECTIVES

Whereas the association between depression and the perception of emotions has been widely studied, only few studies have examined the association between depression and the ability to discriminate genuine (Duchenne) from fake (non-Duchenne) smiles. The present study examined this by comparing currently depressed, previously depressed, and healthy control individuals. Guided by recent theory, the present study also investigated the effect of depression recurrence on smile identification.

METHODS

Participants were 27 healthy controls, 33 with past depression (51% with recurrent depression), and 22 with current depression (77% with recurrent depression). Participants were presented with a series of 20 videos depicting smiling individuals, and were asked to indicate whether each smile was genuine or fake.

RESULTS

Having (or having had) a first episode of depression was associated with more mistakes in categorizing smiles as genuine or fake compared to having recurrent depression or to having no history of depression.

LIMITATIONS

Cross sectional design and a (relatively) small sample size.

CONCLUSIONS

Our results show that an impaired ability to differentiate between markers of affiliation and politeness is specific to first-episode depression, even after the depression has remitted.

Experiences of adults providing care to a partner or relative with depression: A meta-ethnographic synthesis

BACKGROUND

International interest in the informal carer role has grown in part because of the relationship between caring and caregiver burden. It has been suggested that living with someone with depression is comparable to that of other serious mental health problems, such as schizophrenia or dementia.

METHODS

This meta-ethnography included 15 studies exploring experiences of living with a relative or partner with depression. Studies were heterogeneous regarding types of relationship with the depressed individual.

RESULTS

The synthesis revealed a cyclical, psychosocial process that family caregivers undergo whilst providing care to a person with depression. The process consists of four phases: making sense of depression; changes in family dynamics; overcoming challenges; and moving forward. The findings illustrate that care giving is not a static process and that the needs of the depressed person are constantly changing.

LIMITATIONS

Some of the studies presented in the review represent caregivers recruited via support groups and so the person cared for may not have had professional diagnoses of depression.

CONCLUSIONS

This synthesis indicated the need for professional support to be available to caregivers for their own mental health needs. The model put forward suggests that different types of support may be useful for caregivers at different stages of the process including couples or systemic therapy at the initial stages of management, addressing stigma to help those overcoming challenges of caring for their partner or relative and self-compassionate approaches for caregivers who may need support to look after themselves, avoid feelings of guilt and move forward towards acceptance.

Too Much to Bear: Psychometric Evidence Supporting the Perceived Burdensomeness Scale

BACKGROUND

People who feel they have become a burden on others may become susceptible to suicidal ideation. When people no longer feel capable or productive, they may assume that friends and family members would be better off without them.

AIM

The present study was designed to assess preliminary psychometric properties of a new measure, the Perceived Burdensomeness (PBS) Scale.

METHOD

Depressed psychiatric patients (N = 173) were recruited from a veterans affairs medical center. Patients were assessed with a structured diagnostic interview and self-report measures assessing perceived burdensomeness, depression severity, hopelessness, and suicidal ideation.

RESULTS

The present study supported preliminary evidence of reliability and concurrent validity of the PBS. Additionally, perceived burdensomeness was significantly associated with higher levels of hopelessness and suicidal ideation.

CONCLUSION

It is hoped that with the aid of the PBS clinicians may be able to intervene more specifically in the treatment of suicidality.

Relationship dynamics around depression in gay and lesbian couples

Research on intimate relationship dynamics around depression has primarily focused on heterosexual couples. This body of work shows that wives are more likely than husbands to offer support to a depressed spouse. Moreover, when wives are depressed, they are more likely than husbands to try and shield their spouse from the stress of their own depression. Yet, previous research has not examined depression and relationship dynamics in gay and lesbian couples. We analyze in-depth interviews with 26 gay and lesbian couples (N = 52 individuals) in which one or both partners reported depression. We find evidence that dominant gender scripts are both upheld and challenged within gay and lesbian couples, providing important insight into how gender operates in relation to depression within same-sex contexts. Our results indicate that most gay and lesbian partners offer support to a depressed partner, yet lesbian couples tend to follow a unique pattern in that they provide support both as the non-depressed and depressed partner. Support around depression is sometimes viewed as improving the relationship, but if the support is intensive or rejected, it is often viewed as contributing to relationship strain. Support is also sometimes withdrawn by the non-depressed partner because of caregiver exhaustion or the perception that the support is unhelpful. This study points to the importance of considering depression within gay and lesbian relational contexts, revealing new ways support sustains and strains intimate partnerships. We emphasize the usefulness of deploying couple-level approaches to better understand depression in sexual minority populations.

Does Comorbid Anger Exacerbate the Rejection of Children with Depression by their School Peers?

Depression in childhood and adolescence is often accompanied with social rejection by peers, which accentuates the course of that emotion. Despite the documented association between anger and depression, little is known about the impact of the interaction of both emotions on peer relations. The main objective of this study is to explore the interpersonal implications of depression with comorbid anger in a pediatric sample. The sample consisted of 466 participants; the mean age was 11.45 (SD = 1.55). There were 231 females (49.6 %) and 235 males (50.4 %). ANOVAs revealed significant differences between boys and girls in depression, aggression, anger experience/explosive anger and internalized responses to anger. There were no significant differences between the correlations computed with the data from boys and girls for the hypothesized associations among anger, aggression, depression, and peer acceptance/rejection. Both Anger-Out and Depression were significantly associated with perceived unpopularity. Additionally, the interaction of Anger-Out and Depression added significantly to the prediction of perceived unpopularity.

The Enhancing Connections Program: a six-state randomized clinical trial of a cancer parenting program

OBJECTIVE

The purpose of this study was to test the efficacy of a cancer parenting program for child rearing mothers with breast cancer, the Enhancing Connections Program. Primary goals were to decrease maternal depressed mood and anxiety, improve parenting quality, parenting skills and confidence, and enhance the child's behavioral-emotional adjustment to maternal breast cancer.

METHOD

A total of 176 mothers diagnosed within 6 months with Stage 0 to Stage III breast cancer and their 8- to 12-year-old child were recruited from medical providers in 6 states: Washington, California, Pennsylvania, Minnesota, Arizona, and Indiana. After consenting and obtaining baseline measures, study participants were randomized into experimental or control groups. Experimental mothers received 5, 1-hr educational counseling sessions at 2-week intervals; controls received a booklet and phone call on communicating and supporting their child about the mother's cancer. Outcomes were assessed at 2 and 12 months.

RESULTS

Compared to controls, at 2 months experimental mothers significantly improved on depressed mood and parenting skills; experimental children improved on behavioral-emotional adjustment: total behavior problems, externalizing problems, and anxiety/depressed mood significantly declined. At 1 year, experimental children remained significantly less depressed than controls on both mother- and child-reported measures. The intervention failed to significantly affect parenting self-efficacy or maternal anxiety.

CONCLUSIONS

The Enhancing Connections Program benefitted mothers and children in specific areas and warrants refinement and further testing.

Parental Depression and Child Behaviour Problems: Implications for Behavioural Family Intervention

This report explores the role of parental depression in the adjustment of children and discusses its implications for behavioural family intervention. Within a social interactional perspective, depression is conceptualised as a class of behaviours that is under the control of the social environment and at the same time operates as a context for other social agents. The presence of this class of behaviours in parents is postulated to precipitate developmentally determined psychological problems, that is based on a child's age and sex, such that younger boys and adolescent girls would be most at risk. The results of two longitudinal studies are presented showing a significant relation between fluctuations in mothers' depressive symptoms and similar symptoms in their adolescent daughters. Weaker effects are seen between fathers' and sons' depressive levels. The implications for behavioural family therapy are discussed in relation to depression in adolescent girls.