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Psychiatric Briefs

Primary Care Companion J Clin Psychiatry 2002;4:202-206

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Background: In this study, the extent of interpersonal dysfunction in depressed women was examined, and their degree of independence of current depressive episodes or symptoms was explored. Method: Using a variety of indices of interpersonal behavior and beliefs, 812 community-dwelling women who were formerly, currently, or never depressed were compared. The spouses and adolescent children of these women, as well as raters, also provided information. The study controlled for current depressive mood and sociodemographic factors that could affect social functioning. Results: Formerly depressed but not currently depressed women showed significantly more impairment than never-depressed women on nearly all measures of interpersonal dysfunction, a finding consistent with hypotheses that interpersonal difficulties are not merely consequences of depressive symptoms. Women who had formerly been depressed were less likely to be stably married, had less marital satisfaction, were more likely to experience spouse coercion and physical injury, had more problematic relationships with children and extended family members as well as friends, reported more stressful life events that had interpersonal and conflict content, and had greater insecurity in their beliefs about other people. The spouses and boyfriends of these women reported more problems as well, and they were more likely to have diagnosable disorders. No between-group differences were found, however, in children’s perceptions of warmth or hostility on the part of the mothers. Limitations: Conclusions about the causal direction of the relationship between depressive symptoms and interpersonal difficulties are precluded by the cross-sectional design of this study. Clinical depression is usually followed by subthreshold symptoms not identified by standard diagnostic instruments; these symptoms are difficult to distinguish from preceding or co-occurring interpersonal problems. Conclusions: Interpersonal difficulties are a stable feature of depression. They pose a great challenge to treatment, and they may reflect an underlying susceptibility to both the onset and recurrence of depression.