Brigitte A. Prusoff

Social adjustment by self-report in a community sample and in psychiatric outpatients.

Data are presented on social functioning derived from a self-report social adjustment scale (SAS-SR) administered to 774 subjects including a community sample and three psychiatric outpatient populations: acute depressives, alcoholics, and schizophrenics. This self-report scale derives from an interview form and was developed and tested on depressed outpatients. Since its publication, it has been used in populations other than depressives including other psychiatric patients, nonpsychiatric patients, and nonpatients.The purpose of this paper is to make data available to other investigators on results of this self-report social adjustment scale in a broad range of subjects and to describe further the psychometric properties, limitations, and utility of the scale. Findings show that the scale has wide applicability in a range of subjects but that certain cautions should be followed in using it with chronically impaired psychiatric populations who may not be involved in the major roles assessed by the scale.

Psychopathology in the Children (Ages 6–18) of Depressed and Normal Parents

Data from a pilot family-history study of 194 children (ages 6–18) of probands with major depression compared with the children of normal controls showed children of depressives were at increased risk for psychological symptoms, treatment for emotional problems, school problems, suicidal behavior, and DSM-III diagnoses. The magnitude of the risk was increased 3-fold for any DSM-III diagnosis in the children of depressed probands. Major depression was the most common psychiatric disorder, followed by attention deficit and separation anxiety. The risk to children of major depression and of any DSM-III diagnosis increased linearly if both parents were psychiatrically ill than if only one or neither parent had psychiatric illness. Other significant predictors of risk to children were early onset of the probands depression, an increased number of the probands first-degree relatives who were ill with any psychiatric disorder and/or major depression, and if the proband was divorced, separated or widowed. While diagnoses were based on multiple informants and were made by a psychiatrist who was blind to the clinical status of the probands, the absence of direct interviews with the children make these findings preliminary. A direct interview study is under way.

Comparison of the family history method to direct interview factors affecting the diagnosis of depression

This study compares information on the diagnosis of depression obtained by family history reports with the formation obtained by direct interview. Reports were obtained from family members on the psychiatric status of 696 individuals for whom direct SADS-L interviews were also available. The effects on family history reports of subjects characteristics, treatment status, age of onset of depression, and endogenous symptoms were examined. Sensitivity and specificity for family history reports on the specific symptoms of depression are also reported. The specificity of family history reports for the diagnosis of depression was consistently high but sensitivity varied as a function of subject and illness characteristics. Sensitivity was somewhat higher for females than males and appreciably higher for probands than for their first-degree relatives and spouses. Sensitivity was increased whenever treatment, hospitalization or endogenous symptoms were present in the subject, indicating that family history reports are most accurate for detecting the severest cases of depression. Finally, the symptoms of depression that are least accurately reported by relatives are identified and suggestions for modifying the family history criteria for depression are proposed.

Effects of maintenance amitriptyline and psychotherapy on symptoms of depression.

Depressives responding to initial treatment were maintained on amitriptyline for eight months, withdrawn double-blind to placebo after two months, or withdrawn overtly onto no medication. In each group half the patients received weekly psychotherapy and half were seen once monthly. Effects on symptom ratings were examined. Maintenance amitriptyline gave a significant advantage over early withdrawal in preventing symptom recrudescence. There were no differences between double-blind or overt withdrawal. There were no interactions between drug withdrawal and psychotherapy. Psychotherapy produced no significant advantages over low contact on symptoms, although it did improve social adjustment ratings reported elsewhere.

Early-onset major depression in parents and their children

In a study of 6-23-year-old offspring of depressed and of normal parents, an inverse relationship between the rates of major depression among the children and the age of onset of major depression in their proband parents was found. The children of parents who had an onset of major depression that was younger than age 20 years overall had the highest risk of major depression. There was specificity in the findings in that these higher rates were nearly all accounted for by prepubertal onsets of major depression in their children. There was a 14-fold increased risk of onset of depression before age 13 in the children of probands who had onset less than age 20. These results were not confounded by the current age of the proband or the children, by interview status (children were interviewed), by comorbidity in the parents or by assortative mating. Future family genetic studies should examine the rates and patterns of illness of the biological relatives of probands with prepubertal-onset major depression.

Marital disputes and treatment outcome in depressed women.

Abstract This study assesses the relationship between improvement of marital disputes and other treatment outcomes. The subjects are 76 women who received 8 months of individual psychotherapy as part of a controlled clinical trial testing the efficacy of various outpatient maintenance treatments for depression. The presence or absence of marital disputes was rated at the beginning of treatment, and improvement or failure to improve was noted at the end of treatment. Three marital groups (no marital disputes, marital improvement, and no marital improvement) were compared in terms of symptom status and overall social adjustment at the beginning and end of treatment. The results reveal that depressed women with marital disputes at the onset of treatment have a generally poorer treatment outcome than women who are single or in supportive relationships. Only a minority of women with marital disputes effected an improvement in the relationship during the course of treatment. Those who improved their marriages also experienced an improvement in depressive symptoms, while those whose marriages did not improve experienced less improvement or a worsening of symptoms.

Dimensions of social adjustment in depressed women.

There have been relatively few empirical investigations of the dimensions underlying rating of social and interpersonal functioning. Most social adjustment scales have evaluated functioning in terms of role areas such as work adjustment, marital adjustment, social and leisure adjustment. These ignore the possibility of consistent patterns of abnormality across roles. In this investigation a semistructural interview scale measuring social adjustment was administered to 40 female depressed patients and 40 normal women from the general population. Ratings were made on 48 items covering detailed aspects of social functioning. Internal consistencies of two alternative theoretical systems of grouping items were first explored by examining correlations of items with total scores for the group of items. The first system grouped items into six role areas of work, social and leisure, extended family, marital as spouse, parental,and family unit. The second system grouped items, irrespective of role,into five qualitative categories: satisfactions and feelings, global judgments,and ratings of actual behavior, further divided into performance,interpersonal relations, and friction. Both theoretical systems, and particularly that by role area, were found to include items that were heterogeneous in terms of shared variance. A factor analysis with varimax rotation was then performed. The social functioning of these subjects was adequately described by six orthogonal factors. These were easily interpretable and corresponded to work performance, interpersonal friction, inhibited communication,submissive dependency, family attachment and anxious rumination. Patients were significantly distinguished from normal controls by scores on all six factors, which appeared to summarize a diverse range of social maladjustments of depressed patients. These factors cut across role areas such as marital, or work, indicating important systematic elements which may be ignored if social functioning is evaluated solely in terms of such areas. The factor dimensions provide an alternative conceptual framework for describing the social maladjustment of depressed patients which may be more suitable for observing patterns of change and measuring the effects of psychotherapyor other treatments.

Parental concordance for affective disorders: psychopathology in offspring

This paper examines the effects of parental concordance for affective disorders and psychopathology among the 219 offspring of probands with major depression and normal controls. The lifetime prevalence of psychiatric disorders was significantly higher among the spouses of depressed probands as compared to those of normal controls. The spouses of 37% of the normals and 69% of the depressed probands met criteria for a diagnosis of major depression, an anxiety disorder, or alcoholism. Parental concordance for diagnoses, particularly for anxiety disorders, substantially increased the risk of major depression and anxiety disorders in their children. Moreover, the marital relationship, some aspects of family adjustment and severity of current symptoms were significantly worse among the couples who exhibited diagnostic concordance for anxiety, alcoholism and/or depression. The major implication of these findings is that the diagnostic status of both parents should be considered in the design and analysis of studies of children. The findings of the present study also underscore the importance of assessment of comorbid disorders in parents and offspring. Although the original study design focused on the risk of depression in children of parents in treatment for major depression, stronger transmissibility was found for anxiety disorders plus depression than for major depression alone. However, the exclusion criteria of a lifetime history of mania or hypomania led to an extremely low proportion of probands with pure major depression without concomitant anxiety disorders. These findings confirm the results of previous studies which have demonstrated a strong degree of overlap between affective and anxiety syndromes. The increased risk of anxiety disorders in the offspring of parents who had sought treatment for non-bipolar major depression suggests that anxiety may constitute an early form of expression of affective disorders. Confirmation of the finding of age-dependent expression of anxiety and depression in prospective longitudinal studies of children is indicated.

Lifetime prevalence and age of onset of psychiatric disorders: Recall 4 years later

The blind test-retest reliability of lifetime prevalence and age of onset of psychiatric diagnoses, based on the SADS-L interview and RDC over a three-to-five year period, was examined in 143 probands and their relatives. Reliability of lifetime prevalence of major depression was excellent; reliability of antisocial personality, panic disorder, drug abuse, GAD, depressive personality, and alcoholism was good; reliability of obsessive-compulsive disorder and phobia was acceptable but lower. The reliability of hyperthymia or cyclothymia was not acceptable. Reliability for major depression did not vary substantially by age or sex of the informant, but recall of major depression was significantly higher in the probands than in their relatives. The test-retest reliability for the age of onset of major depression and panic disorder was excellent, and for phobia, GAD and alcoholism, was acceptable. Both probands and relatives recalled the age of onset of their depression fairly accurately. However, there was a reduction in agreement over time. Recall after 3-4 yr was better than 5-6 yr. There was a tendency for older respondents to systematically increase the age of onset of their depression across the two interviews, although the increase was only a few years. Recall of age of onset did not differ significantly by sex of respondent or whether the respondent was a proband or relative. These findings are discussed in light of several available studies of reliability of lifetime prevalence of psychiatric diagnoses.

The course of marital disputes in depressed women: A 48-month follow-up study ☆

A LTHOUGH there is controversy as to the sequence of marital problems and depression in women,‘,’ their relationship has been recognized and well-documented. For example, Paykel et al.3 found that increases in marital difficulties, particularly arguments, were the most frequent events reported by depressed women in the 6 months prior to coming for treatment. Weissman and Paykel-’ found that marital relationships were the most impaired areas of functioning of acutely depressed women when compared to their normal neighbors, and that their impairments were slow to resolve and persisted long after the women were symptomatically recovered. The marriages of depressed women were characterized by disengagement, poor communication, friction, and sexual problems.” Also, Brown. et al.” in a community study of Camberwell in London, found that the presence of an intimate, confiding relationship with the spouse protected a woman against depression in the face of life stress. Taken together, these studies highlight the importance of the marital relationship in the development and course of depression in women. Following Klerman’s concept that marital disputes serve as a central feature in the development of symptoms of many depressed women,” we have studied the relationship between these disputes and the course of treatment. In a study of 76 depressed women who received eight months of maintenance psychotherapy and/or antidepressant drugs for their depression, we have shown that women who present to treatment with marital disputes differ from those without disputes in the process and outcome of individual psychotherapy.‘.* Women with marital disputes showed less improvement in their symptoms and social functioning and had a greater tendency to relapse. However, within the marital dispute group. those women. who were able to effect an improvement in their marital relationships in the course of treatment showkd an improvement in depression and social adjustment equal to that of the group who had no marital disputes at the onset of treatment. Thus, we demonstrated that there was a