Family functioning and major depression: an overview

Article Abstract:

Family dynamics are known to play a major role in the development and course of major depression, and this role has become increasingly clear over the last 10 years. Research on the influence of family functioning in major depression has provided evidence to support family and marital interventions. This overview examines how the family is influenced by depression; the family has been found to experience substantial problems during the most acute stage of the patient's illness. One study evaluated the impact of 40 moderately to severely depressed women on their families. These women were more passive, dependent, argumentative, and less affectionate and communicative than nondepressed women. Another group of 20 depressed inpatients were found to be more hostile, tense, and preoccupied with themselves than a nondepressed inpatient group. The families of 43 depressed inpatients were more dysfunctional than 29 control families, especially in the areas of family communication and problem solving. In 64 percent of these families, the members felt that their overall functioning was impaired. Research has suggested that, in general, depressive illness is associated with more family distress and impairment than other psychiatric and medical illnesses. Family members have cited that the depressed relative's fatigue, hopelessness, worrying, and lack of interest in social life were especially disturbing. Even after the acute depressive episode passes, these families experience more dysfunction in their interrelations than nonclinical families. Also, depressed patients with fewer family problems have a quicker recovery time. Research indicates that family functioning also affects relapse rates; a three-fold relapse rate during the first nine months occurred when family members became emotionally overinvolved, hostile, or critical with the patient. Patients at high risk for relapse were those who perceived that their relatives were critical of them. Open supportive discussion of feelings and problems in a family may result in lower relapse rates. Apparently, a nonstressful, supportive environment is important in sustaining remission. Stressful life events were also associated with higher relapse rates, especially when vulnerability factors, such as lack of a support network, were present. Suicide and family functioning was also reviewed. It was found that depressed inpatient suicide attempters perceived their family functioning to be worse than the other family members. Depressed parents tended to exhibit aversive behavior and impaired parenting. Children of depressed parents were at high risk for psychopathology and functioning were negatively effected by the parents' depressed mood. These homes were characterized by parental rejection and conflict. Rates of major depression among these children range from 23 to 38 percent, and have a younger age of onset of depression, compared with 11 to 24 percent in control families. Depressed women complained of difficulties with disobedient and unruly behavior in their children, but a higher rate of disturbance in the children may be the result of a negative environment which offers them low support and high stress. It is concluded that there are a variety of factors influencing the development of depression and family dynamics, and that these factors are continually interacting with each other. Interventions must focus on both the patient's vulnerability and the family in which they must function if successful recovery is to be achieved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Mentally ill persons, Causes of, Mentally ill, Family, Parent and child, Parent-child relations

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Cognitive-behavioral treatment of depressed inpatients: six- and twelve-month follow-up

Article Abstract:

Forty-five hospitalized patients who suffered from severe depression were randomly separated into three groups. All groups were initially treated as inpatients and upon release, continued treatment as outpatients. Follow-up data was gathered at six months and again at twelve months. One group was treated by standard methods for depression, which included therapy in a hospital setting and the use of antidepressant drugs, which were monitored. The second group was treated using cognitive-behavioral therapy in addition to the standard methods. A goal of cognitive-behavioral therapy is to improve patients understanding and awareness of their behavior. The third group received social skills therapy, also in combination with standard treatment. Social skills therapy emphasizes the development or improvement of appropriate social behavior. The groups that received cognitive therapy and social skills therapy were combined for reporting purposes and measured against the group that received standard treatment alone. The conclusions were limited by the small size of the sample population, but it was concluded that this study was significant because the sampling was composed of inpatients who were severely depressed and their progress was tracked over a long period of time. This represents the first controlled observation with this particular scope. Results of this study in light of other studies suggest a distinct long-term benefit of cognitive-behavioral and social skills therapies in combination with standard treatment, as opposed to standard treatment (drugs) alone. The researchers felt that the correlation between the results of this long-term study and similar studies reinforces their conclusions. Overall, the data also suggests that the patients in this study required a greater amount of treatment when compared with outpatients treated for depression described in previous studies.

Care and treatment, Case studies, Cognitive therapy

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12-month outcome of patients with major depression and comorbid psychiatric or medical illness (compound depression)

Article Abstract:

Thirty-seven patients with major depression and 41 patients with major depression plus a co-existing psychiatric or medical condition (compound depression) were compared during the acute stage of depressive illness and during a one-year follow-up after hospital discharge. Throughout the follow-up, patients were given repeated tests to assess depression, overall functioning and social readjustment. During the acute phase of depression, no differences were found between groups in terms of psychosocial variables, depressive symptoms, suicidal thinking or functional ability. Differences between groups were not found until the third month after discharge, when the pure depression group demonstrated better overall global adjustment than the compound depressed patients. From the eighth month on, differences between groups remained consistently significant, with the pure depression group demonstrating far better scores for overall functioning and social adjustment. Approximately twice as many patients with pure depression were fully recovered by the end of the follow-up, although both groups had received similar proportions of therapy and medication management. No gender differences in recovery rates were found among patients with compound depression but, by the end of the follow-up, twice as many men as women with pure depression had recovered. Although several other studies have also found a trend for higher recovery rates for depressed males, it is not yet known whether the gender differences are related to social role phenomena or to biological differences in depressive illness between sexes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Prognosis

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