Self concept and object relations of patients with affective disorders--individual centered diagnosis with the repertory-grid technique

Significant dimensions of the self concept and the object relations of 127 depressive patients and 34 orthopaedic patients were investigated with the repertory-grid-technique. Self concept and object relations were compared by means of nomothethically used idiographic results after recovery from manifest depression. The object relations of the depressive sample were characterised by the dimension "symbiotic near"; "ambivalent" and "indifferent" partnership relationships were found much more frequently in the controls. The idiographic results contribute to a differentiation of the spectrum of affective disorders. They underline the importance of the interpersonal dimension of depression and may be used as a basis of a therapeutic orientation.     

Self-esteem and partner relationships of patients with bipolar affective disorder: a study of the interval personality with the Giessen-test

The self-concept and the partner relationships of patients with bipolar affective disorder in remission were investigated with the Giessen-Test (GT, Beckmann et al. ) comparing the bipolar patients with unipolar depressive patients, a control group of orthopedic patients and the standard sample of the Giessen-Test. The new dimensions "self-esteem" and "near-to-object" were developed by means of the Giessen-Test items. Self-esteem was significantly lower in bipolar patients in remission than in the controls. The bipolar patients also described themselves as "more distant to others" than the controls. Bipolar and unipolar-depressive patients had a similar self-concept and view of their partner relationships. The results underline the importance of the regulation of self-esteem and the interpersonal dimension in the long-term course of bipolar affective disorder. Therapeutic implications are discussed.     

Social Support Resources and Post-Acute Recovery for Older Adults with Major Depression

This study assessed the relationships between older patients’ social support resources and depressive symptoms and psychosocial functioning at 6 months following a psychiatric hospital discharge. The data used in this study were extracted from a prospective study titled “Service Use of Depressed Elders after Acute Care” (National Institute of Mental Health-56208). This sample included 148 older patients who participated in the initial and the 6-month follow-up assessment. Ordinary Least Squares regression (OLS) was used to examine important social support resources in relation to older patients’ depressive symptoms and psychosocial functioning. A vast majority of patients were embedded in a social support network that consisted of acquaintances and confidants. Patients’ depressive symptoms were related to availability of a confidant and the extent to which they spent time with others. However, patients’ psychosocial functioning was not related to social support resources assessed in this study.     

Gender roles, social support, and postpartum depressive symptomatology. The benefits of caring

Although women are assumed to be particularly vulnerable to depressive symptomatology after childbirth, the extent to which this symptomatology predominates over that found in men at this life cycle stage has not been addressed. This study examined gender differences in postpartum depressive symptomatology and the link between postpartum symptomatology and gender roles and relationships in a sample obtained from childbirth preparation classes. The data show no gender difference in depressive symptomatology at 2 months after childbirth. Women manifested a decrease in depressive symptomatology and men showed a slight increase from the preparenthood point. We partially link women's equivalent rather than higher distress levels to the protective effects of their varied social supports. By contrast, men depended primarily on their spouses, but both genders experienced a decrease in spouse support after childbirth. Female lack of support was more strongly associated with symptomatology in homemakers compared with employed women or women on maternity leave. Within the context of gender role changes, the data highlight benefits of female bonding in contrast to the "costs of caring" depicted by other researchers.     

Stress and night eating syndrome: a comparison study between a sample of psychiatric outpatients and healthy subjects

The Night Eating Syndrome (NES) is a disorder characterized by the clinical features of morning anorexia, evening hyperphagia, and insomnia with awakenings followed by nocturnal food ingestion. The core clinical feature appears to be a delay in the circadian timing of food intake. The diagnosis and early treatment of NES may represent an important means of prevention for obesity. Aims. The aim of the present study was to determine the vulnerability to develop NES between a clinical sample of patients with psychiatric disorders and a non clinical sample. We investigated a possible relation between stress and a dysfunctional eating behaviors as NES. Methods. The Night Eating Questionnaire (NEQ) has been administered to 147 psychiatric outpatients and to 531 subjects attending the University of L'Aquila. The NEQ is a questionnaire used to evaluate the prevalence of NES. The sample has been also evaluated through the Stress-related Vulnerability Scale (SVS) to measure both perceived stress and social support. Results. The 8.2% of patients scored above the diagnostic cut-off of the NEQ, compared to the 2.1% in the sample of healthy subjects. The majority of patients who had shown NEQ>25 had a diagnosis of major depressive disorder (MDD). The total scores on the NEQ were strongly associated with the SVS total score and especially with the "lack of social support" subscale. Conclusions. This study shows the increased vulnerability of NES in the sample of psychiatric patients compared to the sample of healthy subjects. The study further confirms the strong association between perceived stress, social support, altered eating behaviors and obesity.     

Life events,number of social relationships,and twelve-month naturalistic course of major depression in a community sample of women

Research suggests that negative life events and social support are associated with the course of major depressive episodes. However, the manner in which these variables may be specifically interrelated remains unclear. The present study compared two models of the relation among life events, number of social relationships, and the naturalistic course of major depression in a community sample of women. The life event profiles of 32 women were assessed during their index episode of major depression (T1) and again 1 year later (T2). Measures included the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Life Events and Difficulties Schedule. Data analysis focused on whether life events and social relationships were independent predictors of depressive symptomatology (i.e., "main effects" model) or whether social relationships moderated the influence of life events on the naturalistic course of participants' major depressive episodes (i.e., "stress buffering" model). The results only partially supported the main effects model and failed to support the buffering model of the relation among life events, social relationships, and naturalistic depression course. In particular, the present findings indicated that number of social relationships was a significantly stronger predictor of naturalistic depression course than were life events. These findings suggest that insufficient social support is a particularly strong prospective predictor of elevated depressive symptomatology. Determining the quality of patients' social support networks should be a regular part of clinical assessment, and efforts should be made to help depressed patients establish supportive relationships both in the therapeutic environment and in their personal lives.     

The relationship between the perception of social support and post-stroke depression in hospitalized patients

In our study we examined the relationship between the perceived adequacy of social support and post-stroke depression in 76 hospitalized Australian patients. Social support or the perception of its lack, particularly from a spouse care-giver, was associated significantly with both the presence and severity of depressive disorder. Furthermore, depressed patients who perceived their support to be inadequate had a longer duration of depressive illness than depressed patients who perceived their support in a more favorable light. We conclude that following stroke, perception of social support from key relationships may mediate the emotional response to this life crisis. The implications of these findings are discussed.     

Psychogenic pain conditions. Defense structure and taxonomic subgroups]

According to the results of the prospective Grant-Study the maturity of the individually available defence mechanisms has an essential influence on both physical and psychic well-being. Psychogenic pain patients are characterized by a "turning against self": an immature defense mechanism. By means of a cluster analysis, three taxonomic subgroups (types A, B, C) were defined. Type A is characterized by immature defense mechanisms (projection, turning against self and against object) and type C by neurotic defances (reaction formation and intellectualization), whereas type B manifests both intellectualization and a turning against self. Raised scores for anxiety, abnormal illness behaviour, depressive self-image, depressive mood and suicidal ideas are additional features which distinguish types A and B from type C. In contrast to type B, type A shows a negative social resonance, "doctor shopping" and drug abuse. The diagnostic differentiation of types A, B and C could be the basis of a differential indication to the different psychotherapeutic treatment approaches to chronic pain patients.     

Personal constructs in anorexia

A repertory grid of 12 elements and 12 constructs was presented to 15 female subjects suffering from primary anorexia nervosa and 15 matched control subjects. Cluster analysis, as used by Makhlouf-Norris and Norris (1973) revealed that the anorexic group had a prevalence of segmented and monolithic structures and the normal group a prevalence of articulated structures. The relationships between the elements was examined and the anorexic group showed significantly more "ideal self" isolation, "social" and "present self" alienation than the control group. The average distance between the elements was significantly greater in the anorexic group than in the control group. Analysis of the first two components showed that the first component accounted for more variance than the second when compared to the normals. It is concluded that the repertory grid is a valid method of investigating the conceptual disturbance in anorexia nervosa.     

Deliberate self-harm in female patients with affective disorders: investigation of personality structure and affect regulation by means of operationalized psychodynamic diagnostics

This study investigated psychodynamically relevant dimensions in female depressive patients with and without deliberate self-harm (DSH). DSH is often observed in depressive patients and frequently shows a correlation with personality disorders. Forty female depressive patients with and without DSH were investigated after recovery from acute depressive pathology by means of "operationalized psychodynamic diagnostics" (OPD). Patients with DSH had a significantly lower level of integration in the OPD dimension "structure," and their "interpersonal relationships" showed dysfunctional interaction patterns. They also had a significantly higher rate of personality disorders. These results underline the significance of aspects of personality structure in female depressive patients with DSH, and enable a deeper understanding of their dysfunctional defense strategies, the connections with underlying disturbed affect regulation, and vicious circles in the therapeutic transference-countertransference relationship. OPD has been shown to be a useful tool for empirical research into therapeutically relevant dimensions of personality.     

Dimensionality of depression in acute schizophrenia: a methodological study using the Bech-Rafaelsen Melancholia Scale (BRMES)

Despite the great clinical importance of depressive symptoms in schizophrenia there is a lack of studies on the assessment and evaluation of depression in acutely psychotic patients. For the Bech-Rafaelsen Melancholia Scale (BRMES), among other advantages, the concept of unidimensionality was confirmed in patients with major depression by different methodological approaches including Rasch analysis. The present evaluation was designed to investigate the scale properties of the BRMES in acutely schizophrenic patients with particular emphasis on the dimensionality of the scale. Three different statistical approaches were used: principal component analysis in combination with computer simulation, polytomous Rasch analysis using advanced latent trait and latent class models and confirmatory factor analysis (CFA) by means of linear structure model approaches. The statistical methods were applied to BRMES baseline data of 132 acutely schizophrenic patients with predominantly positive symptoms participating in a multi-center pharmacological trial. The different methodological approaches revealed converging results indicating: (1) a substantial proportion of acutely ill schizophrenic patients showed depressive symptoms; (2) the hypothesis of unidimensionality of the BRMES had to be rejected for the sample of acutely schizophrenic patients and (3) a three-factorial model of depressive symptoms as measured by the BRMES (retardation, depressive core symptoms, unspecific depressive symptoms) yielded the best fit of the present data. Depression in acutely psychotic patients has to be considered rather as a heterogeneous construct than as a well-defined syndrome. The differentiation of depressive symptomatology should facilitate treatment evaluation and help to clarify relationships between different symptom classes in further studies.     

Depressed patients and non-psychiatric controls: discriminant analysis on social environment variables

A set of variables from the social environment (e.g. social contacts, confiding relationships, leisure activities, loneliness) was used to differentiate between a consecutive series of 111 patients diagnosed as having a depressive illness and a sample of 98 non-psychiatric controls. The function derived from the discriminant analysis correctly classified 83% of the subjects. The results indicate shortcomings in the social environment of depressives and point to the discriminating power of such variables.     

The mediating role of self-criticism and dependency in the association between perceptions of maternal caring and depressive symptoms

Background: This study examined a theoretically based mediation model including participants' perceptions of early relationships with their mother, self‐criticism, dependency, and current depressive symptoms. We expect that (a) early relationships characterized by low levels of care and high levels of overprotection will be positively associated with both current depressive state and self‐criticism and dependency; (b) high levels of self‐criticism and dependency will be positively associated with depressive symptoms; and (c) self‐criticism and dependency will play a mediating role in the association between participants' perceptions of early relationships characterized by low levels of care and high levels of overprotection and their current depressive symptoms. Methods: A nonclinical community sample of 200 Portuguese adults participated in the study. Perceptions of early relationships were measured using the mother scales of the Parental Bonding Instrument (Parker et al. [1979: Br J Med Psychol 52:1–10]), levels of self‐criticism and dependency were measured using the Depressive Experiences Questionnaire (Blatt et al. [1976: J Abn Psy 6:383‐389]), and depressive symptoms were measured using the Center for the Epidemiological Studies of Depression Scale (Radloff [1977: Appl Psychol Meas 1:385–401]. Results: Structural equation modeling showed that the link between participants' perceptions of early caretaking relationships with their mothers and their current depressive symptoms is mediated by high levels of self‐criticism—a personality trait associated with vulnerability to depression—but not Dependency. However, an ancillary analysis indicated that the link between participants' perceptions of early maternal overprotective relationships and their current depressive symptoms is mediated by high levels of Neediness. Conclusions: Findings underscore the role of perceived early relationships in psychological vulnerability to depression among highly self‐critical and among highly needy individuals and highlight the negative role played by perceived mothers' early dysfunctional practices, characterized by low levels of caring and high levels of overprotection, for the self‐critical vulnerability to depression and by perceived mothers' high levels of overprotection, for the neediness vulnerability to depression. These potential causal mechanisms warrant longitudinal evaluation. Theoretical and clinical implications of the findings are discussed. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Social relationships and mortality in patients with congestive heart failure

The present study was undertaken to evaluate the possible effects of social relationships (perceived social support, and perceived social isolation) upon mortality risk among patients with congestive heart failure (CHF). Proportional hazard models were used to evaluate the effects of different social factors on mortality among 119 clinically stable patients (71.4% men; mean age 65.7+/-9.6 years) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the 24-month period of data collection, all from cardiac causes. Results indicated that social isolation was a significant predictor of mortality (relative risk, 1.50, confidence interval (CI), 1.00 to 2.19; P<.038), controlling for depressive symptoms, heart failure severity, and functional status and age. Perceived intimate network support was marginally significantly associated with increased risk of mortality in this population of CHF patients (relative risk, 0.60, CI, 0.35-1.02; P<.06). However, the sample is small and caution in drawing conclusions should be exercised. Further research is required in order to either deny or confirm these findings, and to illuminate the mechanisms behind the relationships between social isolation and mortality.     

Association between quality of life and self‐stigma,insight, and adverse effects of medication in patients with depressive disorders

Background: The aims of this study were to examine whether different domains of quality of life (QOL) are differently affected by depressive disorders by comparing QOL of subjects with and without depressive disorders, and to examine the association of QOL with self‐stigma, insight and adverse effects of medication among subjects with depressive disorders. Method: The QOL on the four domains of the WHOQOL‐BREF Taiwan version were compared between the 229 subjects with depressive disorders and 106 control subjects. Among the depressive subjects, the association between the four QOL domains and subjects' self‐stigma, insight, and adverse effects of medication were examined using multiple regression analyses by controlling for the influence of depression, socio‐demographic and clinical characteristics and family function. Results: Depressive subjects had poorer QOL on the physical, psychological and social relationship domains than the non‐depressive control group. The depressive subjects who had more severe self‐stigma had poorer QOL on all four domains. The depressive subjects who perceived more severe adverse effects from medication had poorer QOL on the physical, psychological and environmental domains. However, insight was not associated with any domain of QOL in patients with depressive disorders. Conclusions: The results of this study demonstrate that different domains of QOL are differently affected by depressive disorders, and that clinicians must consider the negative influences of self‐stigma and adverse effects from medication on QOL of subjects with depressive disorders. Depression and Anxiety 26:1033–1039, 2009. © 2009 Wiley‐Liss, Inc.     

Risk-taking among adolescents: associations with social and affective factors

The research investigated the associations of social and affective factors with risk-taking in male and female adolescents. A sample of 269 Israeli adolescents completed questionnaires measuring frequency of involvement in risk-taking behaviours, relationships with parents, orientation towards peer group, depressive mood, and aggressive behaviour. Correlations and multiple regression analyses showed that risk behaviour among male adolescents was mainly related to orientation towards peer group, while for female adolescents relationships with parents was the prominent factor in risk behaviour. The parental factor also contributed to the depressive mood of both genders in the sample. However, depressive mood showed only a weak association with risk taking. These results underscore the differential associations of relationships with parents vs. peers among adolescent boys and girls, respectively, in regard to risk taking.     

Social comparison in Chinese older adults

Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the role of social comparison in the relationship between depressive symptoms and four key life domains including: physical health, financial situation, relationships with adult children, and social support from friends. The respondents were 411 people aged 60 years or older from a survey of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that social comparison mediated the effect of support from friends on depressive symptoms and social comparison was the partial mediator in the linkage between financial strain and depressive symptoms. Moreover, social comparison also moderated the effect of physical health and support from friends on depressive symptoms. Lastly, we found that self-efficacy and self-esteem were moderators in the relationship between depressive symptoms and all four key life domains including physical health, financial situation, relationship with adult children, and social support from friends, whereas sense of control over physical health and sense of control over support from friends moderated the effect of social comparison on physical health and support from friends, respectively, on depressive symptoms.     

Contact difficulties and experience of loneliness in depressed patients and non-psychiatric controls

Contact difficulties and the experience of loneliness have been studied in a sample of 110 depressed patients and in non-psychiatric controls (n = 98). The results indicate significant differences between these groups. Furthermore, significant correlations between loneliness, contact difficulties and social network variables occurred. The patient sample showed relationships between loneliness and severity of the depressive syndrome.     

The relationship of social support,social networks and negative events with depression in patients with coronary artery disease

This study examined the relationship of social relationships and negative life events with major depression among 335 inpatients with coronary artery disease (CAD) who were free of neurological illnesses. Depression was assessed using the Duke Depression Evaluation Schedule, a structured psychiatric interview which included the Diagnostic Interview Schedule depression sub-scale, two scales for measuring instrumental and self-maintenance activities of daily living, a measure of negative events and four dimensions of social support. Twenty-seven subjects met DSM-IV criteria for major depression. Examination of the bivariate relationships indicated that being younger, having at least one problem with an ADL and/or one IADL, being non-white, experiencing a greater number of negative events, lack of perceived social support and a lack of social interactions were significantly related to an increased likelihood of being depressed. In multivariate analyses depressed subjects were significantly more likely to report a greater number of negative events than non-depressed individuals after adjusting for sociodemographic and ADL measures. A lack of perceived social support and increased number of negative events increased the likelihood of reporting major depressive symptoms among CAD patients. Understanding the causes of depression in CAD patients may have clinical utility in that reduction in depression may lead to a decreased risk of future CAD events.