Interpersonal stress and depression in women

The article presents a review and discussion of several aspects of the interpersonal context in which depression occurs that are unique to women. Women commonly experience depression in response to interpersonal life events, and also they contribute to the occurrence of stressful events and life contexts. Four key topics are reviewed: childrearing and parenting; romantic and marital relationships; generation of stressful life events; enduring social dysfunction even when not depressed. It is argued that depressed women are often locked into maladaptive interpersonal environments that contribute to the recurrence or chronicity of depression. Implications for treatment, conceptualization, and future research are noted.     

Stress generation in depression: reflections on origins, research, and future directions

Depressed individuals report higher rates of stressful life events, especially those that have occurred in part because of the person's characteristics and behaviors affecting interpersonal interactions. Termed stress generation, this phenomenon draws attention to the role of the individual as an active contributor rather than passive player in his or her environment, and is therefore an example of action theory. In this article, the author speculates about the intellectual origins of her stress generation perspective, and notes somewhat similar transactional approaches to the stress-disorder link outside of depression research. The literature on stress generation in depression is reviewed, including studies that attempt to explore its correlates and predictors, covering clinical, contextual, family, genetic, cognitive, interpersonal, and personality variables. Empirical and conceptual gaps in our understanding of processes contributing to stressors in the lives of depressed people remain. The author concludes with suggestions for further research, with the goal of furthering understanding both of mechanisms of depression and of dysfunctional interpersonal processes, as well as development of effective interventions to help break the stress-recurrence cycle of depression.     

Interpersonal Factors and Late-Life Depression

An extensive literature about young and middle-aged adults has documented that interpersonal factors increase risk for depression and that depression has deleterious effects on social and family relationships. However, social and family relationships play an important role in the depressed patient's recovery. We know much less about the interpersonal dimensions of depression in late-life than in younger age groups. In this paper, we review studies of interpersonal factors and depression in mixed-age groups. We then examine studies of late-life depression including interpersonal risk factors, daily and social functioning, family issues, interpersonal predictors of the course of illness, and interventions to improve marital and family functioning in depression. We conclude with suggestions for future research and the clinical implications of work in this area.     

Personality--life event congruence effects in late-life depression

BACKGROUND: This study examined whether specific interactions of personality and life events predicted increases in depressive symptoms over time in a late-life sample. METHOD: Participants (n=55) who were in remission from a recent episode of major depression completed a depression symptom interview and a questionnaire assessing the personality constructs sociotropy and autonomy. Six months later, they completed the same personality questionnaire and a checklist of life events experienced during the past 6 months. RESULTS: As predicted, increases in depressive symptoms were significantly predicted by the congruent interaction of sociotropy with negative interpersonal events and by the congruent interaction of autonomy with negative autonomy events, but not by either of the non-congruent interactions. LIMITATIONS: A small sample prevented examinations of important depressive subtypes based on age of depression onset and vascular status. CONCLUSIONS: These findings strongly support the personality-life event congruence model of depression in a late-life sample. Clinical implications include attending to stressful events that match an older adult's personality style, to help the older adult cope with those events that are more likely to increase his or her depression.     

Role of depression, stress, and trauma in HIV disease progression

Despite advances in HIV treatment, there continues to be great variability in the progression of this disease. This paper reviews the evidence that depression, stressful life events, and trauma account for some of the variation in HIV disease course. Longitudinal studies both before and after the advent of highly active antiretroviral therapies (HAART) are reviewed. To ensure a complete review, PubMed was searched for all English language articles from January 1990 to July 2007. We found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression in terms of decreases in CD4 T lymphocytes, increases in viral load, and greater risk for clinical decline and mortality. More research is warranted to investigate biological and behavioral mediators of these psychoimmune relationships, and the types of interventions that might mitigate the negative health impact of chronic depression and trauma. Given the high rates of depression and past trauma in persons living with HIV/AIDS, it is important for healthcare providers to address these problems as part of standard HIV care.     

Social stress and women's risk for recurrent depression

Summary The lives of depressed women appear to be stressful. Based on data from a community sample of women with histories of depression, support for an interpersonal stress perspective on women's depression is presented. Women often find themselves embedded in environments with high levels of chronic stress and negative life events. Compared to never-depressed women, those who are currently depressed, and even those with prior but not current depression, are relatively more likely to experience divorce and marital difficulties, spouses with psychiatric disorders, problematic relationships with their children, children with high rates of disorder, and recent elevated rates of personal stressful life events. Such life challenges may increase the likelihood of further depressive experiences. While both psychosocial and genetic factors may contribute to the interpersonal vulnerabilities, once caught up in depression-maintaining environments, treatments for women may require intervention in the family and interpersonal domains. Received October 15, 2002; accepted November 17, 2002 Published online January 17, 2003 RID="*" ID="*"  Presented at the First World Congress on Women's Mental Health, Berlin, March, 2001; Symposium: Understanding the interaction of stress and gender in the prediction of major depression and treatment response. Correspondence: Constance Hammen, Ph.D., Department of Psychology, University of California, Los Angeles, 405 Hilgard Ave., Los Angeles, CA 90095, U.S.A.; e-mail: hammen@psych.ucla.ed     

Sex differences in event-related risk for major depression

BACKGROUND: This study sought to determine if women are more likely than men to experience an episode of major depression in response to stressful life events. METHOD: Sex differences in event-related risk for depression were examined by means of secondary analyses employing data from the Americans' Changing Lives study. The occurrence and time of occurrence of depression onset and instances of stressful life events within a 12-month period preceding a structured interview were documented in a community-based sample of 1024 men and 1800 women. Survival analytical techniques were used to examine sex differences in risk for depression associated with generic and specific stressful life events. RESULTS: Women were approximately three times more likely than men to experience major depression in response to any stressful life event. Women and men did not differ in risk for depression associated with the death of a spouse or child, events affecting their relationship to a spouse/partner (divorce and marital/love problems) or events corresponding to acute financial or legal difficulties. Women were at elevated risk for depression associated with more distant interpersonal losses (death of a close friend or relative) and other types of events (change of residence, physical attack, or life-threatening illness/injury). CONCLUSION: Stressful life events overall, with some exceptions among specific event types, pose a greater risk for depression among women compared to men.     

The origins of cognitive vulnerability in early childhood: mechanisms linking early attachment to later depression

This paper examines the theory and research linking attachment relationships to cognitive vulnerability to depression and assesses evidence that early attachment experiences contribute to the development of these cognitive processes. Most research in this area has involved adult participants using self-report measures of both attachment and depressive vulnerabilities and thus cannot convincingly speak to the existence of such a developmental pathway. Several studies, however, have followed individuals from infancy and examined the emergence of self-esteem and responses to failure throughout childhood and adolescence. These studies suggest that early experiences in non-secure attachment relationships place an individual at-risk for developing a cognitive framework that increases their vulnerability to depression following stressful life events. The paper concludes with a discussion of how future research might best explore specific mechanisms through which distinct attachment relationships may lead to divergent developmental pathways sharing the common outcome of cognitive processes that place individuals at risk for depression.     

Exogenous corticosteroid exposures are associated with increased recollection of traumatic life events.

BACKGROUND: Exogenous corticosteroid exposures are associated with depression in clinical samples, however, the mechanisms underlying this association are unknown. Recent animal studies have shown that corticosteroids enhance conditioning in stressful learning paradigms. It has been hypothesized that corticosteroids may enhance the recollection of stressful experiences in humans, potentially contributing to the etiology of corticosteroid induced depression. This hypothesis has not been evaluated in human subjects. METHODS: The first phase of the Canadian National Population Health Survey collected data from a probability sample of 17626 members of the general Canadian population over the age of 12. The data set included measures of drug exposure (including corticosteroid exposures) and childhood and adult psychosocial stressors, including traumatic life events. In this study, self-reported traumatic life events were cross-tabulated against corticosteroid exposures in order to evaluate whether these variables were associated. RESULTS: 52% of subjects treated with corticosteroids in the month prior to the interview, as compared to 41% of non-exposed subjects reported one or more of the following stressors: parental divorce, long term parental unemployment, a "frightening" event that was "thought about for years after", being sent away from home for doing something wrong, parental drug or alcohol abuse, or physical abuse. This difference was statistically significant at the 5% level of confidence. LIMITATIONS: The use of cross-sectional survey data in this study precluded confirmation that changes in the pattern of trauma recollection followed exposure to corticosteroids. Also, the study relied on unconfirmed self reported medication exposure data, and ratings from brief survey instruments concerned with life events, stress levels and traumatic experiences. CONCLUSIONS: What we report is consistent with, but not confirmatory of, the hypothesis that increased recollection of stressful events may be a mechanism underlying associations between corticosteroids and depression. Additional research is needed in order to determine whether the basis for this association is an altered recollection of life events, or in a differing pattern of life experiences.     

Predictors of work adjustment in bipolar I patients: a naturalistic longitudinal follow-up

This study explored the clinical and psychosocial predictors of work adjustment in 52 Bipolar I patients over a 2-year longitudinal period and examined associations between work functioning and social relationships, personality features, stressful life events, and clinical variables. Analyses indicated that psychosocial variables (personality disorder symptoms and social functioning) added significantly to prediction of work functioning after clinical variables were entered. Stressful life events were not associated with work adjustment. Overall, presence of a good quality supportive relationship was the strongest unique predictor of work. The results highlight the need to study functional outcomes in patients, especially because they appear only modestly associated with clinical status.     

The relationship between stressful life events, the serotonin transporter (5-HTTLPR) genotype and major depression

BACKGROUND: Serotonin is a good candidate for major depression. We attempted to replicate the study by Caspi and colleagues [Science (2003) 301, 386-389] which reported a significant interaction between serotonin transporter (5-HTTLPR) genotype and stressful life events when predicting major depression. METHOD: We typed the serotonin promoter 5-HTTLPR gene in 1206 male and female twins aged 19-78 years (mean = 39, S.D. = 11). A DSM-IV diagnosis of major depression was available for 1199 twins. Most of these twins had participated in a 1988-1990 study which included a stressful life events inventory and self-report measure of depression based on the SCL-90 and DSSI/sAD. Complete 5-HTT genotype and life events data, self-report symptoms and major depression diagnoses were available for 1091 subjects. We regressed categorical and ordinal measures of depression onto stressful life events and genotype. RESULTS: There were significant main effects for stressful life events but there was no evidence for any effect of 5-HTT genotype, nor a genotype x stressful life event interaction. CONCLUSIONS: Regardless of whether our results were based on binary logistic or ordinal regression analyses we found no evidence to support a main effect of 5-HTTLPR, or an interaction between the 5-HTTLPR genotype and stressful life events on major depression, Only 20 % of our subjects were aged below 30 years. It is possible that the effect reported by Caspi and colleagues is specific to young people, in which case our study has much less power in this age group.     

The Type A belief system: relationships to hostility, social support, and life stress.

Certain core beliefs may underlie the Type A behavior pattern, predisposing individuals to health problems and impaired interpersonal relationships. Previous studies have revealed that the Type A Cognitive Questionnaire (TACQ), a self-report measure reflecting these beliefs, is indeed related to emotional distress. The current study assessed the TACQ's relationship to aspects of the interpersonal environment, including perceived social support and stressful events. It also investigated the TACQ's relationship to subtypes of hostility (ie, cynicism and paranoid alienation). Subjects were 111 college undergraduate volunteers. As hypothesized, the TACQ was significantly related to poor quality of social support and to greater perceived life stress. The TACQ appeared more strongly related to cynicism than to paranoid alienation. Findings were generally more pronounced for males. The discussion suggests that Type A beliefs may predispose individuals to health problems through impaired interactions with their interpersonal environment.     

Chronic idiopathic urticaria and anxiety symptoms

Chronic idiopathic urticaria (CIU) is a frequently disabling disease with a negative influence on the quality of life, and can cause psychopathological symptoms, such as anxiety. Our aim is to study further anxiety symptoms on CIU patients. Both CIU patients and the control group were studied by means of validated scales for psychopathology symptoms, psychological variables and quality of life. In this study, we reported high levels of anxiety symptoms. We found statistically significant correlations between anxiety symptoms, some personality dimensions, insecure attachment styles, alexithymia and with some quality of life dimensions. CIU patients exhibit high levels of psychological distress that could potentiate difficulties at several domains, namely social, emotional, general health perception and interpersonal relationships.     

Psychological aspects of Crohn's disease

This is a critical review of 16 studies reporting a relationship between Crohn's disease and psychological variables. The studies reviewed indicate a relationship between the psychological variables of stressful life events, personality characteristics, and psychopathology and the onset and/or exacerbation of Crohn's symptoms. Personality characteristics such as depression, anxiety, and dependency are frequently reported as are the occurrence of stressful life events and the presence of psychopathology. The nature of the relationship is not explained by the research to date; however, the findings summarized in this report indicate that additional investigation into this association is warranted. A plan for such research is suggested.     

Stressful life events and depressive problems in early adolescent boys and girls: the influence of parental depression, temperament and family environment

BACKGROUND: Stressful life events increase the probability of depressive problems in early adolescence. Several genetic and environmental risk factors may change individual sensitivity to the depressogenic effect of these events. We examined modification by parental depression and gender, and mediation of the former by temperament and family environment. METHODS: Data were collected as part of a longitudinal cohort study of (pre)adolescents (n = 2127). During the first assessment wave at approximately age 11, we assessed parental depression, family functioning, perceived parenting behaviours, and temperamental frustration and fearfulness. At the second wave, about two and a half years later, stressful life events between the first and second assessment were assessed. Depressive problems were measured at both waves. RESULTS: Adolescents with parents who had a (lifetime) depressive episode were more sensitive to the depressogenic effect of stressful events than adolescents without depressed parents. Furthermore, girls are more sensitive to these effects than boys. The modifying effect of parental depression was not mediated by temperament, family functioning and perceived parenting. LIMITATIONS: Life events were assessed without consideration of contextual information. Depressive problems were measured by questionnaires that did not directly represent DSM-IV criteria. The measure of parental depression was unspecific regarding severity and timing of depressive episodes. CONCLUSION: The results suggest that gender and parental depression are associated with increased sensitivity to depression after experiencing stressful life events during adolescence.     

Stressful life events as a link between problems in nonverbal communication and recurrence of depression

BACKGROUND: Interpersonal difficulties and stressful life events are important etiological factors in (recurrence of) depression. This study examines whether stressful life events mediate the influence of problems in nonverbal communication on recurrence of depression. METHODS: We registered nonverbal expressions of involvement from videotaped behavior of 101 remitted outpatients and their interviewers. During a 2-year follow-up, we assessed stressful life events and recurrence of depression. RESULTS: The less congruent the levels of nonverbal involvement behavior of participants and interviewers, the higher the incidence of stressful life events, and -via these - the risk of recurrence. LIMITATIONS: Nonverbal behavior was measured in an experimental setting. CONCLUSIONS: The results suggest that lack of nonverbal congruence during social interaction contributes to the occurrence of stressful life events, which in turn may trigger depression.     

Personality and the experience of environmental adversity

BACKGROUND: While psychiatric epidemiology often focuses on the causal relationship between environmental adversity and the individual (e.g. environment to person), individuals probably make important contributions to the quality of their environments (person to environment). METHOD: In a population based sample of > 7000 male and female adult twins, we examined the relationship between the personality trait of neuroticism (N) and the occurrence of stressful life events (SLEs) and the quality of interpersonal relationships (IPR). We compared the magnitude of the prediction of twin 1's self-reported SLEs and IPR from: (i) twin 1's self-reported N; (ii) twin 2's report of twin 1's N; and (iii) twin 2's report of twin 2's N in monozygotic pairs. RESULTS: In our entire sample, self-report N significantly predicted the occurrence of most SLEs and all dimensions of IPR. Using the co-twin's report of N produced associations that were of the same magnitude for SLEs and modestly weaker for IPR. In monozygotic pairs, the level of N in one twin predicted SLEs and IPR in the co-twin at levels similar to those found for the co-twin's report of N. Repeating these analyses with a prospective subsample produced similar results. CONCLUSION: An individual's personality in adulthood plays a significant role in influencing exposure to some forms of environmental adversity and this association is not the result of reporting bias. Furthermore, this relationship is largely mediated by a common set of familial factors that predispose both to a 'difficult' temperament and to environmental adversity. Developmental models of psychiatric illness should adopt an interactionist view of individuals and their environment (person and environment).     

Interpersonal psychotherapy for borderline personality disorder

This paper outlines an approach to the treatment of borderline personality disorder (BPD) based on principles of interpersonal psychotherapy. The rationale for using a modified version of interpersonal psychotherapy (IPT) is described-BPD is a disorder of attachment, depression is commonly associated with BPD and the primary symptoms of BPD such as rapid mood fluctuations, impulsivity and cognitive distortions are manifested within interpersonal relationships. A focus on interpersonal dysfunction between self and others may improve the quality of relationships for these patients and improve their capacity to manage the instability engendered by depressed mood. It is argued that the normal structure of IPT meets the basic requirements of any psychotherapy for BPD but that the current four foci of IPT are inadequate to address the complexity of the problems of the person with BPD. A case is made to extend the focal areas of IPT to increase the specificity of treatment tailoring it to the core pathology of the disorder. It is suggested that consideration of regulation of the self within interpersonal interactions becomes the primary focus for treatment. KEY PRACTITIONER MESSAGE: Borderline personality disorder is manifested through problems on interpersonal relationships. Interpersonal psychotherapy may be a useful treatment for BPD. Interpersonal psychotherapy uses a focus for treatment. A new focus of problems of self/other regulation is suggested. Further research is needed to determine if this approach is effective.     

Rumination,goal linking,daily hassles and life events in major depression

Background: Rumination in response to stressful events and depressed mood leads to harmful outcomes. In addition to intra‐psychic processes, depression is also associated with daily hassles and major life events. Self‐regulatory beliefs such as goal linking could mediate the link between life events, daily hassles, rumination and major depression. Method: The relationships between depressed mood, rumination, goal linking, life events and daily hassles were investigated in a between‐groups design. Standardized questionnaire measures of these constructs were used to compare depressed participants with a group of people experiencing psychological distress, but not major depression, and a never‐depressed group. Results: Participants with major depression experienced similar numbers of life events as the other groups, though the impact of these was greater for the depressed group than either the psychological distress group or the healthy controls. Depressed participants also experienced greater daily hassles than either of the other two groups. Depressed participants were also higher in goal linking and rumination. Regression analysis demonstrated that neither life events nor goal linking predict rumination or depressed mood. Rumination appears to moderate the relationship between daily hassles and depressed mood. Discussion: Theoretical and clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Chronic Minor Stressors and Major Life Events Experienced by Low-Income Patients Attending Primary Care Clinics: A Longitudinal Examination

Chronic minor stressors and major life events were assessed from 129 randomly selected low-income patients attending primary care medical clinics. Participants reported experiencing an average of 15 chronic minor stressors in a 12-month period. The most common chronic minor stressors were reported in the areas of finances and domestic activities. Participants also reported these stressors as the most intense. The t tests revealed that female participants reported significantly (p = .05) more chronic events than males. The most common major life events were reported in the areas of vegetative symptoms (i.e., major change in sleeping and eating habits), financial status, illness, and interpersonal relationships. The most stressful life events were changes in vegetative symptoms, family illness, and interpersonal relationships. The t tests revealed that employed participants reported significantly (p < .05) more positive life events than did unemployed participants. Implications of the findings are discussed.