Social relationships, adversity and neurosis: a study of associations in a general population sample

Anxiety and depressive disorders in a French population: methodology and preliminary results

Preliminary results of an epidemiological study in the general population of a small town near Paris are presented. This study investigates the prevalence of depressive and anxiety states and the risk factors associated with these disorders. The study methodology is reported in detail, especially the instruments chosen (some sections of the DIS/CIDI, questionnaires on social support, life events and self-rating questionnaires). Anxiety and depressive disorders are frequent in this population: life-time prevalence of Panic Disorder in men amounted to 2.3% and in women 3.1%, Generalised Anxiety Disorder in men 5.4% and in women 13.4%, Major Depressive Episode in men 8.5% and in women 21.9%. Panic Disorder is assessed with regard to different definitions and criteria (DSM III, DSM III-R). A wide difference in results is found according to the criteria used. Specifically, when anticipatory anxiety is taken into account, this increases the frequency rate of Panic Disorder. A significant comorbidity is found between anxiety and depressive disorders.

Commonly occurring adverse birth outcomes and maternal depression: a longitudinal study

OBJECTIVES

Little is known about whether commonly occurring adverse birth outcomes have a long-term impact on the mental health of mothers. The aim of this study was to investigate whether commonly occurring adverse birth outcomes predicted mothers' depressive-symptom trajectories over a 27-year period following the birth of a baby.

STUDY DESIGN

Longitudinal study.

METHODS

Participants comprised a sub-group of women from the longitudinal cohort of the Mater and University of Queensland Study of Pregnancy. Maternal depression was measured at six time points from the first clinic visit of an index pregnancy to 27 years after birth. A semi-parametric mixture model was used to identify three symptom trajectories of low-stable, moderate-stable and moderate-rising depression. Multinomial logistic regression was then used to determine whether a number of commonly occurring birth outcomes predicted moderate-stable and/or moderate-rising depression trajectories over the subsequent 27 years. Sociodemographic and behavioural factors were used to adjust for possible confounding.

RESULTS

After adjustment for potential confounders, none of the adverse birth outcomes predicted subsequent maternal depression trajectories. Teenage pregnancy, not completing high school, low family income, obesity, poorer quality partnership and not exercising, measured at women's first clinic visit, and small social networks at three to five days after birth, were significantly associated with women's moderate-rising depressive-symptoms trajectory over 27 years.

CONCLUSIONS

Commonly occurring adverse birth outcomes do not predict long-term depressive trajectories. A number of sociodemographic and behavioural factors present at the index pregnancy predict women's long-term pattern of depression throughout their reproductive life course.

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.

Social support helps protect against perinatal bonding failure and depression among mothers: a prospective cohort study

Causal relationships between perinatal bonding failure, depression, and social support among mothers remain unclear. A total of 494 women (mean age 32.4 ± 4.5 years) completed the Mother-Infant Bonding Questionnaire (MIBQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Japanese version of the Social Support Questionnaire in early pregnancy before week 25 (T1) and 1 month after delivery (T2). Our model of recursive structured equation modeling (SEM) showed acceptable fit (CMIN/df = 2.2, CFI = 0.97, and RMSEA = 0.05). It was revealed that: (1) a lower number of supportive persons at T1 significantly predicted both MIBQ and EPDS scores at T1 and T2; (2) at T1, poorer satisfaction with the social support received significantly predicted EPDS scores; (3) both MIBQ and EPDS scores at T1 significantly predicted their respective scores at T2. Out cohort study indicates that the number of individuals who are available to provide social support and the degree of satisfaction with the level of social support received during pregnancy have a great influence on bonding failure and depression in the postpartum period. These findings suggest that psychosocial interventions that focus on these two aspects of social support during pregnancy are effective in preventing bonding failure and depression in the postpartum period.

Somebody to lean on: Social relationships predict post-treatment depression severity in adults

Supportive social relationships can help protect against depression, but few studies have examined how social relationships influence the response to depression treatment. We examined longitudinal associations between the availability of social relationships and depression severity following a 12-week intervention. In total, 946 adults aged 18-71 years with mild-to-moderate depression were recruited from primary care centres across Sweden and treated for 12 weeks. The interventions included internet-based cognitive behavioural therapy (ICBT), 'usual care' (CBT or supportive counselling) and exercise. The primary outcome was the change in depression severity. The availability of social relationships were self-rated and based on the Interview Schedule for Social Interaction (ISSI). Prospective associations were explored using and logistic regression models. Participants with greater access to supportive social relationships reported larger improvements in depression compared to those with 'low' availability of relationships (β= -3.95, 95% CI= -5.49, -2.41, p< .01). Binary logistic models indicated a significantly better 'treatment response' (50% score reduction) in those reporting high compared to low availability of relationships (OR= 2.17, 95% CI= 1.40, 3.36, p< .01). Neither gender nor the type of treatment received moderated these effects. In conclusion, social relationships appear to play a key role in recovery from depression.

Assessing social relationships in adolescents and adults: Constructing and validating the Affective Relationships Scale

We propose an Affective Relationships Scale (ARS), specifically constructed to describe core and relatively stable social relationships among people of both genders and of a wide range of ages, from adolescents to adults. The ARS assesses the personal frameworks within which individuals organise their multiple social relationships, by assigning psychological functions to significant others. In Study 1, the ARS among 279 female college students was examined for its factorial validity, to confirm that it reflected normative trends of social relationships that had been documented by previous research(e.g. affective needs toward friends would be stronger than towards parents; “Giving nurture” would be sought more strongly than “Seeking proximity”); and to classify individual patterns of personal frameworks. Study 2 examined the ARS’s convergent and discriminant validity by correlating its scores with those of other psychological measures for 142 female college students. In Study 3, the examination of ARS among a total of 1399 participants of both genders from adolescence to middle-age showed its applicability to males and over a wide age range. Two salient characteristics of the ARS, the delineation of individual patterns of social relationships, and the applicability to different cultures, are discussed.

Trajectories and predictors of women's depression following the birth of an infant to 21 years: a longitudinal study

Little is known about the long-term mental health of women following the birth of an infant. This study describes the 21 year trajectory of women's depression following the birth of an infant and identifies early predictors of post-birth maternal depression trajectories. The sample comprises 2,991 women from the Mater and University of Queensland Study of Pregnancy. Using the Delusions-Symptoms-States-Inventory, depression was measured at 6 months, 5, 14 and 21 years after the birth. These measures were clustered and in addition bivariate and multivariate analyses were used to test for significant association between the groups and a range of maternal socio-demographic, psychological and pregnancy-related factors. Two depression trajectories were produced, a no-low depression group (79.0 %) and a high-escalating depression group (21.0 %). The strongest predictors for a high-escalating depression group were conflict in the partner-relationship (p < 0.001), anxiety (p < 0.001) and stress (p < 0.001) in the antenatal period, having many pregnancy symptoms (p < 0.001), being younger (p < 0.001) and having poorer social networks (p < 0.001). To a lesser extent not completing high school (p < 0.05), being unsure about wanting the pregnancy (p < 0.05) and not wanting contact with the infant following the birth (p < 0.05) were also predictors for high-escalating depression trajectory. Our findings suggest a sub-sample of mothers experience persistent depressive symptoms over a 21 year period following the birth of their infant. Partner conflict, inadequate social supports and poor mental health during the pregnancy, rather than factors relating to the birth event, contribute to women's depressive symptoms in the long-term. Given the identification of early markers for persistent depression, there may be opportunities for intervention for at-risk pregnant women.

Nostalgia-Evoked Inspiration

Six studies examined the nostalgia–inspiration link and its motivational implications. In Study 1, nostalgia proneness was positively associated with inspiration frequency and intensity. In Studies 2 and 3, the recollection of nostalgic (vs. ordinary) experiences increased both general inspiration and specific inspiration to engage in exploratory activities. In Study 4, serial mediational analyses supported a model in which nostalgia increases social connectedness, which subsequently fosters self-esteem, which then boosts inspiration. In Study 5, a rigorous evaluation of this serial mediational model (with a novel nostalgia induction controlling for positive affect) reinforced the idea that nostalgia-elicited social connectedness increases self-esteem, which then heightens inspiration. Study 6 extended the serial mediational model by demonstrating that nostalgia-evoked inspiration predicts goal pursuit (intentions to pursue an important goal). Nostalgia spawns inspiration via social connectedness and attendant self-esteem. In turn, nostalgia-evoked inspiration bolsters motivation.

Social factors associated with the decision to relinquish a baby for adoption

Little is known about the characteristics, social circumstances and mental health of women who give a child up for adoption. This paper reports data from a longitudinal study of 8556 women interviewed initially at their first obstetrical visit. In total, 7668 proceeded to give birth to a live singleton baby, of which 64 then relinquished the baby for adoption. Relinquishing mothers were predominantly 18 years of age or younger, in the lowest family income group, single, having an unplanned and/or unwanted baby and reported that they were not living with a partner. These women were somewhat more likely to manifest symptoms of anxiety and depression both prior, and subsequent to, the adoption, but the majority of relinquishing mothers were of 'normal' mental health. The decision to relinquish a baby appears to be a consequence of an unwanted pregnancy experienced by an economically deprived single mother rather than the result of emotional or psychological/psychiatric considerations. These findings document a particular dimension of the impact of poverty on health.

Independent associations of alexithymia and social support with depression in hemodialysis patients

OBJECTIVE

The influences of alexithymia and social support on depression among chronically ill patients were examined prospectively.

METHODS

The study population was 230 outpatients receiving chronic hemodialysis (HD) therapy. The Beck Depression Inventory-II (BDI-II), the 20-item Toronto Alexithymia Scale (TAS-20), and two subscales of the Social Support Questionnaire were given to the subjects. The BDI-II was readministered after a 6-month interval, and subjects who showed deterioration in their depression score above the level predicted from their baseline score were identified. Multivariate logistic analysis adjusted for age, gender, cause of dialysis, and psychosocial variables were performed.

RESULTS

Baseline depression was significantly and independently associated with alexithymia and low satisfaction with available support. Deterioration of depression after 6 months was predicted by alexithymia and poor available support.

CONCLUSIONS

Alexithymia and reduced social support might have independent associations with the presence and the prognosis of depression among HD patients.

Quality of life of elderly persons with cancer: a 6-month follow-up

The aim of this study was to investigate possible changes in quality of life (QoL) in elderly persons diagnosed with cancer (65 years and above), in relation to age, contact with the health-care system, activities of daily living, hope, social network and support. The investigation points were at time of diagnosis (baseline), and again 3 and 6 months after the diagnosis. The study also aimed to investigate which of the aforementioned factors predicted deteriorated QoL in elderly persons with cancer from baseline to the 6-month investigation. At baseline, the sample consisted of 101 individuals aged (age 65+) recently diagnosed with cancer (74 women, 27 men), but was reduced to 75 (57 women, 18 men) by the 6-month investigation point. EORTC QLQ C30, Katz ADL, Nowotny's Hope Scale and Interview Schedule for Social Interaction were used in structured personal interviews and questionnaires. Emotional function improved significantly over time, and complaints of nausea and vomiting decreased. Contact with a district nurse at baseline predicted deteriorated QoL from baseline to 6 months later. Support from grandchildren increased significantly. About 30% of the total sample deteriorated in QoL, by the significant >/=10 units, from baseline to 6-month follow-up, while about 70% remained stable in QoL from baseline. The majority of the elderly persons with cancer showed an ability to adjust to the new condition. However, in clinical practice, specific attention should be paid to the most vulnerable groups of elderly persons with cancer: those with advanced disease and decreased hope, and those with increased need of both informal and formal assistance.

Interpersonal Support Evaluation List (ISEL)--college version: validation and application in a Greek sample

OBJECTIVES

a) To validate the Interpersonal Support Evaluation List (ISEL)--college version in a Greek population sample and b) To test the hypothesis that students scoring high on the ISEL present stronger resistance to stressful experiences and fewer psychological or physical problems.

DESIGN

Rating scale assessment and analytical cross-sectional study.

METHOD

The ISEL was translated into Greek and then back-translated into English. A random sample of 145 students of the Faculty of Medicine completed: a) the translated version of the ISEL, b) the Symptom Check List 90-R (SCL-90-R), c) the Scale of Stressful Life Events (SSLE) and d) a questionnaire about physical health problems. Comparisons were conducted between the scores on the ISEL and the scores on the other measures. Correlations were also calculated between the scores on the Global Severity Index (GSI) of the SCL-90-R and SSLE, separately for students with high, fair and low social support, in order to assess the protective role of social support. The test-retest reliability and the internal consistency of the ISEL were also investigated.

RESULTS

The students with a lower score in social support reported more psychological and somatic symptoms. The students with a higher score in social support were protected against the harmful effect of stressful events. The ISEL presents good internal consistency (Cronbach's alpha: 0.452-0.752) and test-retest reliability (intraclass correlation coefficients (ICC): 0.631-0.847).

CONCLUSIONS

The ISEL is a valid and reliable instrument for measuring social support among Greek students. A higher score on the ISEL is correlated with a significant stress-buffering effect.

Background factors related to and/or influencing occupation in mentally disordered offenders

OBJECTIVE

Knowledge of background and occupational related factors of mentally disordered offenders are missing. It is essential to understand these issues when planning discharge from forensic psychiatric hospital care to enable community dwelling.

AIMS

One aim was to investigate mentally disordered offenders' background factors, confidence in and how they value occupations. Another aim was to investigate MDOs background factors' in relation to and the influences on Occupational Performance and Social Participation.

METHOD

Data was collected with an explorative, correlative design after informed consent, from 74 mentally disordered offenders (mean age 34,2) cared for in forensic psychiatric hospitals. Assessments were Allen Cognitive Level Screen, Capability to Perform Daily Occupations, Interview Schedule of Social Interaction, Manchester Short Assessment of Quality of Life, Self-efficacy Scale and Importance scale. Eight background factors were assembled from the individual forensic psychiatric investigation.

FINDINGS

Most of the investigated background factors relate to and half of them influence occupational performance, particular the cognitive aspect of occupational performance. The influences on occupation originate from adulthood, such as suffering from schizophrenia, psycho/social problems, and having performed violent crimes. These findings indicate that staff in forensic hospital care should initiate rehabilitation with knowledge about MDOs' complex daily occupations. For avoiding information bias, information gathering preceding treatment planning should be performed in collaboration between caring staff and mentally disordered offenders.

Ovarian Cancer Patients' Psychological Distress: The Role of Physical Impairment, Perceived Unsupportive Family and Friend Behaviors, Perceived Control, and Self-Esteem

Although research has indicated that illness-related and interpersonal stress are associated with greater psychological distress among cancer patients, little empirical attention has been given to mechanisms that account for these relationships. In the present study, 2 mechanisms for the association between illness-related stress (physical impairment) and interpersonal stress (family and friend unsupportive responses) and psychological distress of 143 ovarian cancer patients were examined cross-sectionally. Separate structural equation models tested whether physical impairment impacted patients' distress via decrements in perceived control over their illness and whether unsupportive behaviors impacted patients' distress via decrements in patients' self-esteem. Results supported the proposed models and suggest that perceived control and self-esteem are 2 mechanisms for explaining how illness-related and interpersonal stress may be associated with psychological distress among women with ovarian cancer.

Quality of life of elderly persons with newly diagnosed cancer

The aim was to investigate quality of life (QoL) in elderly persons newly diagnosed with cancer (65+ years) in relation to age, contact with the health-care system, ability to perform activities of daily living (ADL), hope, social network and support, and to identify which factors were associated with low QoL. The sample consisted of 101 patients (75 women and 26 men) newly diagnosed with cancer. EORTC QLQ-C30, Nowotny's Hope Scale, Katz ADL and the Interview Schedule for Social Interaction (ISSI) were used. The analysis was carried out in four age groups and revealed no significant differences in QoL. Compared with the other age groups, those of a high age (80+ years) more often lived alone, used more home-help service and had a smaller social network. Factors associated with low QoL were 'no other incomes than retirement pension', 'low level of hope' and 'lung cancer'. In addition, 'being told that the cancer disease has not come to an end', 'needing more help in activities of daily living', 'getting help from grown-up children' and 'needing help with PADL' were associated with low QoL. Those at risk of inferior QoL, that is, having poor economy, low level of hope and lung cancer need special attendance and specific interventions to improve QoL.

Psychosocial issues in patients with congestive heart failure

Psychosocial issues are important variables that need to be addressed in patients with congestive heart failure (CHF). Unfortunately, these issues are often overlooked. Depression and lack of social support have been shown to have a negative impact on patients with CHF. Patients with CHF who are depressed or who lack social support have been shown to have increased morbidity and hospital readmission rates, to be less adherent to their medical regimen, and to have an overall increase in cost of care. The variables are often interrelated, as high levels of social support may lessen the impact of depression on mortality. In addition, certain biologic factors may influence the impact of psychosocial factors in patients with CHF. This review addresses the effects of depression, treatment adherence, and social support in patients with CHF and suggests interventions targeted to these problems. Health care professionals must assess these issues in all patients with CHF, address their specific needs, and intervene appropriately when warranted.

Social support, depression, and mortality during the first year after myocardial infarction

BACKGROUND

We previously reported that depression after myocardial infarction (MI) increases the long-term risk of cardiac mortality. Other research suggests that social support may also influence prognosis. This article examines the interrelationships between baseline depression and social support in terms of cardiac prognosis and changes in depression symptoms over the first post-MI year.

METHODS AND RESULTS

For this study, 887 patients completed the Beck Depression Inventory (BDI) and the Perceived Social Support Scale (PSSS) at about 7 days after MI. Some 32% had BDIs > or =10, indicating mild to moderate depression. One-year survival status was determined for all patients. Follow-up interviews, including the BDI, were conducted with 89% of survivors. There were 39 deaths (35 cardiac). Elevated BDI scores were related to cardiac mortality (P=0.0006), but PSSS scores and other measures of social support were not. There was a significant interaction between depression and the PSSS (P=0. 016). The relationship between depression and cardiac mortality decreased with increasing support. Furthermore, residual change score analysis revealed that among 1-year survivors who had been depressed at baseline, higher baseline social support was related to more improvement in depression symptoms than expected.

CONCLUSIONS

Post-MI depression is a predictor of 1-year cardiac mortality, but social support is not directly related to survival. However, very high levels of support appear to buffer the impact of depression on mortality. Furthermore, high levels of support predict improvements in depression symptoms over the first post-MI year in depressed patients. High levels of support may protect patients from the negative prognostic consequences of depression because of improvements in depression symptoms.

Precedents of perceived social support: personality and early life experiences

In order to examine the effects of personality and early life experiences on perceived social support, a total of 97 young Japanese women were investigated. Current interpersonal relationships were measured by an interview modified from Henderson et al.'s Interview Schedule for Social Interaction (ISSI). Personality was measured by Cloninger et al.'s Temperament and Character Inventory. Early life experiences at home and outside of home were also identified in the interview. The number of sources of perceived support was correlated with self-directness, while satisfaction with perceived support was correlated with novelty seeking and with low harm avoidance. No early life experiences--early loss of a parent, perceived parenting, childhood abuse experiences, experiences of being bullied and/or other life events--showed significant correlations with the number or satisfaction of supportive people. The quantity and quality of perception of social support differ in their link to personality, and perceived social support may, to some extent, be explainable in terms of personality.

Testing an explanatory model of the development of depressive symptoms in young women during a life transition

Factors to explain the rising incidence of depressive symptoms among young women making the transition from home to university life were investigated. A path analysis of data from 213 18- and 19-year-old women entering a large university indicated that negative life events, interpersonally derived social support, self-esteem, and depressive symptoms were significantly related. Negative life events that affected the women's self-esteem (drawn from the women's performance in interpersonal relationships) were most strongly associated with depressive symptoms, and self-esteem derived through efficacy (i.e., taking control and acting assertively) was not associated with negative events. The women in the sample appeared to derive efficacy self-esteem from relationships. An analysis of the data supported developing interventions to improve interpersonal relationships rather than focusing on competence in gaining access to resources.

Social support and pregnancy: I. Factorial structure and psychosocial correlates of perceived social support

In a questionnaire survey among 1329 first-trimester pregnant women, social support providers were divided by factor analysis into husband, 'premarital network' (parents and friends) and 'postmarital network' (children and mother-in-law), while social support contents were divided into 'given' (emotional, informational and instrumental support) and 'giving' (nurturing opportunity and general confiding). The husband was most frequently nominated by the woman as the support provider in both of these categories. Multiple regression analyses revealed that a husband's poor 'given' support was predicted by the presence of premenstrual irritability, a lower level of the woman's own education, her smoking habits and past experience of pregnancy termination, while a husband's poor 'giving' support was predicted by current older age, smoking habits and past experience of delivery.

Social support and adjustment to a novel social environment

The present article aims to examine the ways in which social support may affect the adaptation of individuals to a novel social environment. A distinctive feature of this research was the assessment of social support both before and after entering a completely new network of social relationships. A cohort of international exchange high school students (N = 242) was administered a battery of self-report questionnaires dealing with personality traits, perceived social support, coping behaviors and emotional distress before leaving Japan and six months after living with a host family in a foreign community. Perceived social support abroad contributed to less emotional distress. This health-promoting effect of social support was found to be mediated by adaptive coping behaviours, and was not due to confounding by personality traits. Perceived social support at home was predictive of more emotional distress abroad. Subjects who reported high levels of social support at home were particularly vulnerable when they entered the completely new environment and found that such support was no longer available.

Supportive and negative responses in the partner relationship: their association with psychological adjustment among individuals with cancer

This study examined the association between positive and negative aspects of spouse responses and psychological adjustment among 158 individuals with cancer. Two contextual variables, gender and disease-related functional impairment, were taken into account when examining the association between spouse responses and patient psychological distress and well-being. Results indicated that negative aspects of close relationships played a comparatively stronger role than positive aspects in their associations with both psychological distress and well-being. For negative spouse responses, patient gender did not moderate the effects of these responses upon psychological outcomes. For positive aspects of spouse support, both gender and functional disability moderated the association between spouse support and psychological outcomes. These findings are integrated with the general literature on positive and negative aspects of close relationships. Implications for clinical interventions are also discussed.

Marital relationships and somatic and psychological symptoms in pregnancy

The relevance of marital relationships to somatic and psychological symptoms in late pregnancy was examined. Fifty-four primiparae at the 7th month of pregnancy completed the General Health Questionnaire (GHQ-28) and the Ryle Marital Patterns Test (RMPT), which was also completed by their husbands. Multiple regression analyses identified the husbands' ratings of nurturance behaviour as the best predictors of somatic and social dysfunction symptoms in late pregnancy. Higher perception of care by the husband was associated with a higher number of symptoms in wives. A high level of exchanged affection reported by wives is associated with lower levels of symptoms of anxiety and insomnia. The implication of these findings is discussed.

Psychological and social correlates of the onset of affective disorders among pregnant women

One hundred and twenty women recruited from attenders at the antenatal clinic of the Obstetrics Department of a general hospital were asked to complete ad hoc questionnaires during pregnancy; they were then interviewed by psychiatrists using a structured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia (SADS). Nineteen (16%) women were identified as having an onset of an affective disorder during the period of pregnancy, mainly (68%) during the first trimester. As compared with the women without any such onset (controls), the women with pregnancy-related affective disorder (PRAD) were characterized by (1) it being their first pregnancy or first delivery with past termination of pregnancy, (2) early loss of either parent by death, (3) high Eysenck Personality Questionnaire (EPQ) Neuroticism (N) and Psychoticism (P) scores, (4) living in a flat with either a plan to stay there after the forthcoming childbirth or an expectation that their accommodation would be crowded, and (5) negative response to the news of the pregnancy by the husband with low intimacy. The effects of these factors were additive since the probability of developing a PRAD episode was highly correlated with the number of factors reported.

Housing stressors, social support and psychological distress

This paper explores the links between housing stressors, social supports and psychological distress. It was hypothesised that exposure to housing stressors would be significantly related to psychological distress, but that the adverse effects of housing stressors would be moderated by perceptions of social support resources. In other words, the stress/symptom relationship would be attenuated for individuals who believe that they have active and supportive social relationships. The results of a study conducted in the two New Zealand cities of Auckland and Christchurch partially confirmed this hypothesis, indicating that social support plays a role in mitigating the adverse effects of housing stressors. However, this relationship depends on the severity of the housing stressors. Among our respondents, the presence of social support was indeed associated with reduced symptom levels for those exposed to moderate housing stressors. However, among respondents subjected to high levels of housing stressors, social support was not associated with reduced psychological distress, indicating the need for a more specific policy response to the issue of seriously deficient housing.

An empirical typology of seriously and persistently mentally ill patients using symptom and social functioning factors

This study generated an empirical, statistically based typology that used both symptom data and social functioning dimensions to define subtypes of seriously mentally ill patients. The intent of using social functioning information was to explore the degree to which it improves clinicians' understanding of and treatment planning for diverse subgroups of patients. Social functioning dimensions and symptom data collected on a group of SPMI (seriously and persistently mentally ill) patients were factor analyzed and then submitted to a cluster analysis that yielded five meaningful patient subtypes. Demonstrations of the usefulness of this classification included significant subgroup differences on clinically important external variables, including needs for specific types of treatment and service consumption. For comparison purposes, the failure of the DSM-III diagnostic classification to distinguish patients on the clinically relevant criteria also was demonstrated.

The relationship between parenting stress and social support in mothers of children with learning disabilities: a Chinese experience

This study examined the relationship between parenting stress and social support in a random sample of 100 mothers with children at a school for children with learning disabilities, and a control group of 75 mothers with similarly aged non-handicapped children. Mothers of children at Zhi Ling school were found to have significantly more stress and significantly less support than those in the control group. Parenting stress in the control group was also found to be relatively high when compared with what are considered to be normal levels in the West. No significant correlation was found between total parenting stress and social support. It is suggested that further studies need to differentiate between satisfaction with support that is actually received and the perceived quality of available support.

Early parental death: relation to electrodermal orienting response and gender in schizophrenia

The aim of the present study was to examine age at parental loss by death and its relation to electrodermal orienting response and sex in schizophrenia. Forty-four DSM-III schizophrenic inpatients were exposed to a series of moderately intense tones in a standard orienting habituation paradigm, while skin conductance was recorded. The twenty-three patients who failed to respond to any of the first two tones were found to be younger when they lost their first parent compared to the 21 responders. When the 44 patients were divided according to sex, the females were found to be younger than the males when parental loss occurred. Finally, when multivariate analyses were performed, it was found that both responding/nonresponding and sex provided almost equally large independent contribution to the prediction of parental loss.

The Ryle Marital Patterns Test as a predictor of symptoms of anxiety and depression in couples in the community

The associations between marital relationships, as measured by the Ryle Marital Patterns Test, and symptoms of anxiety and depression as measured by the Interval General Health Questionnaire (I-GHQ), were assessed in 98 married couples in the community. Logistic regression analyses showed that symptoms of anxiety and depression in wives were best predicted by low ratings of affection exchange. Occupational class interacted with husbands' affection ratings, suggesting that in the nonmanual class only lower affection ratings were significantly associated with more symptoms. Anxiety in men was best predicted by low affection ratings while depression was best predicted by unemployment, by an affection discrepancy score indicating that more affection is given than received, and by a marriage which was rated as relatively more wife-dominated by wives and as relatively more husband-dominated by husbands.

Social network and social support deficits in depressed patients: a result of distorted perception?

Many studies have indicated that depressed individuals show deficits in social network/social support. However, little attention has been paid to the extent to which the illness itself causes these deficits that, owing to the distortion of perception of depressed patients, might be experienced subjectively, but do not necessarily exist objectively. To examine this question, a prospective study was conducted with hospitalized depressed patients. In accordance with the assumption that the duration of illness has a special impact on social resources, the sample was divided into two groups: individuals with single episodes of depression (n = 25) and with recurrent depression (n = 25). At the beginning of hospitalization both groups showed massive deficits in social network/social support. Depressed individuals with single episodes showed fewer deficits, the more the depression improved. In contrast, such a covariation of severity of depression and the amount of experienced deficits was not found among the individuals with recurrent depression.

Social network, social support and acute chest complaints among young and middle-aged patients in an emergency department--a case-control study

The risk of developing non-specific chest complaints was higher among young and middle-aged persons with a weak social network and low social support, when comparing cases with controls at a hospital emergency department (ED). The study was comprised of 62 cases; two different control groups were recruited from other patients at the medical ED (n = 67) and from patients at the surgical ED with urolithiasis or cholecystitis (n = 31). Relative risks for non-specific chest complaints were 2.3-3.4 for patients with a low score on two of the social network factors (an overall index and social anchorage) and two social support factors (emotional esteem support and support by a confidant). These results could be used for developing guidelines for a more adequate clinical management of these patients, as well as for the prevention of stress-related conditions in general. An analysis was made of the conceptual validity of the instrument used for assessing social network and social support. It was concluded that structural elements, such as social network factors, represented a more valid measurement that was less affected by subjectivity. Future research is of importance for finding overbridging concepts, rather than to further continue the dissection of presently used indices into even more 'specific' variables.

Supportive interactions, negative interactions, and depressed mood

Research on the association between social relationships and emotional functioning has emphasized the health-promoting effects of social support. Yet there is reason to believe that the absence of negative social interactions may be more important for mental health than the presence of supportive interactions. In this investigation we clarify important characteristics concerning the source, the recipient, and the combined influence of support and negativity. Data are presented regarding supportive and negative interactions with spouse, relatives, and friends; regression analyses suggest that negative interactions are more predictive of depressed mood than supportive interactions (specifically with spouse and friends). We also document several specifications suggesting directions for future research on the special importance of interactions in intimate relationships and the synergistic effects of situations in which supportive and negative interactions both occur.

The etiology of nonpsychotic emotional illness

Two hundred and fifty couples in the general population completed self-report questionnaires which measured life events, personality, marital intimacy, and symptoms of nonpsychotic emotional illness. Path analysis was utilized to explain the development of symptoms of nonpsychotic emotional illness. Personality traits of neuroticism and extroversion explained most of the variance of symptoms of nonpsychotic emotional illness. Life events played a much smaller but significant role and marital intimacy was a nonsignificant factor. The data support a proneness model for the etiology of nonpsychotic emotional illness.

Sex difference in prevalence of minor psychiatric morbidity: a social epidemiological study in Taiwan

The female excess in prevalence of minor psychiatric morbidity (MPM) evident in a community study in Taiwan (n = 1023) was further investigated in terms of demographic variables, socioenvironmental risk factors and psychosocial stresses. It was suggested that a stronger effect of chronic psychosocial stressors accounted for the higher prevalence of MPM in women. Further analysis has revealed a longer mean duration of MPM in women and an incidence ratio close to unity between the sexes. These retrospective findings were further examined in a small one-year prospective outcome study; a poorer outcome was found among older subjects and female subjects. It is suggested that more females have MPM because chronic psychosocial stressors more adversely affect the course of such morbidity. These results are discussed in a cross-cultural context.

Psychosocial stress and minor psychiatric morbidity: a community study in Taiwan

The relationship between acute life events, chronic psychosocial stressors, sociodemographic variables, and minor psychiatric morbidity (MPM) was investigated in a community sample (n = 489) in Taiwan. A higher risk of MPM was found among women with chronic stressors and respondents with both events and stressors. There was no sex difference over the impact of events on such morbidity. The relative odds of MPM for respondents exposed to event(s) was found to be 8.9.