Attachment and Loss

Examines whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (1) whether a measure assesses support structure (the existence of relationships) or function (the extent to which one's interpersonal relationships provide particular resources) and (2) the degree of specificity (vs globality) of the scale. Special attention is given to methodological characteristics that are requisite for a fair comparison of the models. It is concluded that there is evidence consistent with both models. Evidence for the buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person's degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications for theories of social support processes and for the design of preventive interventions are discussed.

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Stress, social support, and the buffering hypothesis.

The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

1. An Overview 2. The Role of Emotions in Cognitive Therapy 3. The Therapeutic Relationship: Application to Cognitive Therapy 4. Structure of the Therapeutic Interview 5. The Initial Interview 6. Session by Session Treatment: A Typical Course of Therapy 7. Application of Behavioral Techniques 8. Cognitive Techniques 9. Focus on Target Symptoms 10. Specific Techniques for the Suicidal Patient 11. Interview with a Depressed Suicidal Patient 12. Depressogenic Assumptions 13. Integration of Homework into Therapy 14. Technical Problems 15. Problems Related to Termination and Relapse 16. Group Cognitive Therapy for Depressed Patients Steven D. Hollon and Brian F. Shaw 17. Cognitive Therapy and Antidepressant Medications 18. Outcome Studies of Cognitive Therapy Appendix: Materials *The Beck Inventory *Scale for Suicide Ideation *Daily Record of Dysfunctional Thoughts *Competency Checklist for Cognitive Therapists *Possible Reasons for Not Doing Self-Help Assignments *Research Protocol for Outcome Study at Center for Cognitive Therapy *Further Materials and Technical Aids

Cognitive Therapy of Depression

• The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessivecompulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's α coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/494743/archpsyc_46_11_007.pdf

The Yale-Brown Obsessive Compulsive Scale: I. Development, Use, and Reliability

AN extensive literature exists regarding the relationship of life events and depression. The largest group of studies has concerned the descriptive characterization of those events occurring at the onset of depression. There has been particular emphasis on actual or symbolic losses, 1-4 including loss of self-esteem. 5 Others have been concerned with the general presence or absence of stress at onset and have attempted to define a group of endogenous depressions, occurring in the absence of stress, and showing characteristic clinical features. 6-8 Although it has been generally assumed that most depressions are reactions to events, some dissent has been expressed. Hudgens 9 and his colleagues found events uncommon in the six months prior to onset of illness in 40 patients hospitalized with affective disorders. Winokur and Pitts 10 reported reactive depressions to be infrequent and threw doubt on the validity of

Life Events and Depression: A Controlled Study

This paper draws attention to an important adverse outcome in depression, the occurrence of residual symptoms after partial remission. Among patients with definite major depression followed every 3 months to remission and thereafter, residual symptoms reaching 8 or more on the Hamilton Depression Scale 17-item total were present in 32% (19) of the 60 who remitted below major depression by 15 months. The pattern was of mild but typical depressive symptoms. Residual symptoms were more common in subjects with more severe initial illness, but were not related to any other predictors, including longer prior illness, dysthymia, or lower dose of drug treatment during the illness episode. There were weak associations with personality that might have been consequences of symptom presence. Residual symptoms were very strong predictors of subsequent early relapse, which occurred in 76% (13/17) of those with residual symptoms and 25% (10/40) of those without.

Residual symptoms after partial remission: an important outcome in depression

Varied subjects were asked to judge, on a 0 to 20 scale, the degree to which 61 life events were upsetting. Mean event scores covered almost the entire scale range and ranked in a meaningful way. At the top end of the scale were catastrophic and highly distressing events such as deaths of child or spouse. At the bottom of the scale were events which were either trivial, or important but desirable and not distressing. Consistency of the scaling indicated acceptable interrater reliability. Individual variability reflected in standard deviations was moderate. Agreement across groups was high, although there were small differences due to sociodemographic group, item order, and recent experience of the event. Consensus scaling of events may facilitate use of a quantified methodology in empirical studies of life stress.

Scaling of Life Events

A 20 per cent prevalence of mild clinical depression was found in 120 women assessed at about six weeks postpartum. The strongest associated factor was occurrence of recent stressful life events. Previous history of psychiatric disorder, younger age, early postpartum blues, and a group of variables reflecting poor marital relationship and absence of social support were also notable. Poor marital support acted as a vulnerability factor, only producing an effect in presence of stressful life events. Previous psychiatric history produced a strong independent effect, both with and without life events. Postpartum blues were only associated with depression in the absence of life events, suggesting a small hormonal sub-group. Overall the findings indicate the importance of social stress in puerperal depression.

Life events and social support in puerperal depression.

Seven hundred and twenty subjects from a general population survey were interviewed as to the occurrence of suicidal feelings of five different degrees. A total of 8.9 per cent reported suicidal feelings of some degree in the past year. Responses ranged along a continuum such that subjects reporting more intense feelings also reported the less intense. For 3.5 per cent the maximum intensity consisted only of feelings that life was not worth while; 2.8 per cent reached the point of wishing themselves dead, 1 per cent the point of having thought of taking their lives, 1 per cent seriously considered suicide or made plans, and 0.6 per cent made an actual suicide attempt.

Subjects experiencing suicidal feelings in the last year reported more minor psychiatric symptoms, particularly of depression, were more socially isolated, less religious, and to a lesser extent had experienced more stressful events and more somatic illness. In these respects they resembled descriptions of completed suicides. Unlike suicides, however, they were more likely to be female and did not show any other specific demographic characteristics.

Eugene S. Paykel

Papers

Life Events and Depression: A Controlled Study

Residual symptoms after partial remission: an important outcome in depression

Scaling of Life Events

Life events and social support in puerperal depression.

Suicidal feelings in the general population: a prevalence study.