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Journal ArticleDOI

Personality, stressful life events, and treatment response in major depression.

01 Dec 2009-Journal of Consulting and Clinical Psychology (American Psychological Association)-Vol. 77, Iss: 6, pp 1067-1077
TL;DR: Self-Criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self -criticism.
Abstract: The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism.

Summary (5 min read)

Introduction

  • Ii Major Depression (MD) currently affects over 17 million individuals in North America (Greenberg et al., 2003).
  • Personality in the form of trait self-criticism, neediness, and connectedness was assessed at pre and post-treatment using the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976).
  • It is therefore critically important to identify factors that predict treatment response in MD.
  • While it is known that personality and stressful life events, as individual risk factors, predict treatment response, few investigations have examined interactions between personality and stressful life events in predicting treatment response in MD.

Self-criticism

  • Individuals high in self-criticism are characterized by excessive personal demands for goal achievement and constant needs to meet high expectations (Blatt & Zuroff, 1992).
  • These individuals are often obsessional regarding achievement-based tasks and are prone to feelings of frustration, inferiority, weakness, self-scrutiny, and guilt when they do not meet their goals.
  • When these individuals do have relationships, they tend to be superficial or materialistic in nature and limited by feelings of other-directed criticism, resentment, and competition.
  • As a result, individuals high in self-criticism typically have smaller, less supportive, and less cooperative social circles and experience less enjoyment, emotional closeness, and relationship satisfaction with romantic partners when compared to individuals low in selfcriticism (Zuroff & Fitzpatrick, 1991; Zuroff & Franko, 1986).
  • Personality, Stressful Life Events, and Depression 4.

Dependency

  • Individuals high in dependency have a deep need to be loved and to have close and protective relationships (Blatt & Zuroff, 1992).
  • Specifically, these researchers found that changes in personality occurring in the first half of treatment predicted mood change in second half of treatment.
  • And specifically interpersonal stressors, have been found to interact with dependency to provoke depressive symptomatology, it is not yet known whether a similar relationship exists for the dependency subfactors of neediness and connectedness.
  • The extant literature has therefore yielded mixed results regarding personality × stressful life event interaction effects on MD treatment response with Mazure et al. (2000) finding support, and Zuroff and Blatt (2002) finding a lack of support for this relationship.
  • (2) The second goal was to examine the main and interactive effects of self-criticism Personality, Stressful Life Events, and Depression 21 change, neediness change, and connectedness change over the course of treatment in predicting MD treatment response.

Participants

  • Individuals were recruited via community advertisements (e.g., daily newspapers, magazines) as part of a larger study conducted at the Mood Disorders Clinic at the Centre for Addiction and Mental Health in Toronto, Ontario.
  • Respondents were screened over the telephone and then, if they passed the telephone screen, again during an in-person interview.
  • Exclusion criteria included (1) a SCID-I/P diagnosis of Bipolar Disorder (past or present), Schizoaffective Disorder, Schizophrenia, Substance Abuse Disorder (current or within the past 6 months), Borderline or Antisocial Personality Disorder, or Organic Brain Syndrome; (2) Electroconvulsive Therapy (ECT) in the past 6 months; and (3) concurrent active medical illness.

Structured Clinical Interview for DSM-IV

  • The Structured Clinical Interview for DSM-IV, Patient Edition (SCID I/P; First et al., 2002) is a semi-structured diagnostic interview used to assess the presence of DSMIV symptoms and disorders.
  • Questions on the SCID I/P correspond with specific disorder criteria in the DSM-IV.
  • The SCID I/P is considered the gold standard for clinical diagnoses and has demonstrated strong reliability and validity (Fennig, Craig, Lavelle, Kovasznay, & Bromet, 1994; Williams et al., 1992).
  • Interviews were conducted by graduate level clinical psychology students trained to ‘gold standard reliability status’ on the SCID I/P.
  • Training also included detailed study and discussion of DSM-IV criteria for Axis I disorders during regular diagnostic supervision meetings.

Hamilton Rating Scale for Depression

  • The 17-item Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960) is a semi-structured interview measure used to assess the intensity and type of depressive symptomatology.
  • The questionnaire yields an overall score from 0 – 52 with Personality, Stressful Life Events, and Depression 25 higher scores indicating more intense depressive symptomatology.
  • This measure has been shown to be a reliable and valid measure of depressive symptomatology (Hamilton, 1967).
  • Interviews were conducted by graduate level clinical psychology students trained in administration of the HRSD.

Depressive Experiences Questionnaire

  • The Depressive Experiences Questionnaire (DEQ; Blatt, D’Afflitti, & Quinlan, 1976) is a 66-item self-report measure that assesses a broad range of feelings and thoughts about the self and others.
  • More recently, factor analytic work has identified two stable factors within the overarching dependency construct labeled neediness and connectedness (Rude & Burnham, 1995).
  • For the purposes of the current study, the 14 DEQ items representing the original self-criticism dimension (Blatt et al., 1976), and the 9 neediness and the 10 connectedness DEQ items identified by Rude and Burnham (1995) were examined.
  • Personality, Stressful Life Events, and Depression 26 analysis and reliability analyses conducted on the current sample suggested both the presence of these factors and that the each scale demonstrated adequate reliability and internal consistency.
  • Scores for each of these scales were computed using item factor weights derived from Zuroff, Quinlan, & Blatt (1990).

The Life Events and Difficulties Schedule

  • The Life Events and Difficulties Schedule (LEDS-II; Bifulco et al., 1989) is a semi-structured, contextual interview and rating system used to assess the number and severity of stressful life events experienced by an individual over a given period of time.
  • In a one-on-one setting, interviewers pose questions and probe answers regarding experiences in a number of life event domains, including health, education, and relationships.
  • Raters utilize LEDS manuals, which together contain over 5,000 case vignettes, to provide anchoring and standardization of the ratings.
  • For the current study, the time period of interest was the 16-week treatment phase (see description of the treatment procedure below).
  • Specifically, the presence or absence of at least one stressful life event experienced Personality, Stressful Life Events, and Depression 27 during treatment that was rated level 3 or higher (i.e., rated as marked, moderate, or some level of threat) was included in the analysis.

Procedure

  • Individuals meeting full study criteria after the initial telephone and in-person screening interviews were invited to participate in the study.
  • Following the Frank et al. (1991) empirically defined conceptualization of remission from MD, treatment response was operationalized as a 50% reduction in the 17-item HRSD scores from baseline to week 16 and a final HRSD score of equal to or less than 8.
  • At Personality, Stressful Life Events, and Depression 28 treatment completion, participants were interviewed with the LEDS to assess stressful life events they had experienced during treatment.
  • Furthermore, of the 140 treatment completers, personality data at both intake and extake was collected for 131 participants.
  • In addition, no significant differences were found between those who received the LEDS versus those who did not receive the LEDS on treatment response, ² (1, 131) = .95, p > .95.

Demographic and Clinical Variables

  • The demographic and clinical characteristics for the sample of treatment completers are presented in Table 1.
  • Independent sample t-tests were used examine differences on continuously defined variables while Chi-Square tests were conducted to analyze differences on categorically defined variables.
  • For cases that had missing demographic or clinical data, pair-wise deletion procedures were used.
  • No evidence for significant differences was found between treatment responders and Personality, Stressful Life Events, and Depression 31 treatment non-responders on any variable, except age of onset of first MD t(130) = 2.31, p < .05.

Treatment Type

  • To examine whether the type of treatment modality to which patients were randomized (i.e., CBT, IPT, and PT) was associated with differential rates of treatment response, a Chi Square analysis was conducted.
  • MannWhitney tests were used to further explore differences between these treatment groups on treatment response.
  • Personality, Stressful Life Events, and Depression 33.

Personality and Life Event Variables

  • Table 2 displays the means, standard deviations, and where relevant, percentages, for the personality, stressful life event, and treatment response variables of interest.
  • At step 4, the three-way interaction among these personality traits was entered.
  • At step 2, the addition of the pre-treatment personality traits did not result in a Personality, Stressful Life Events, and Depression 35 significant improvement of the model χ²(7, 131) = 3.93, p = .27, although it is noteworthy that self-criticism as a main effect did show a trend towards significance.
  • In the second analysis, treatment response was regressed onto Axis I comorbidity, age at first MD onset, HRSD at treatment intake, treatment type, self-criticism, connectedness, a coded variable representing low neediness, and all personality trait interactions.
  • On the other hand, among individuals scoring lower in neediness, higher scores on connectedness were significantly associated with superior treatment response, B = -2.19, p < .001.

Personality Change and Treatment Response

  • Related to the study’s second goal, a reduction in neediness over the course of treatment was significant associated with superior treatment response.
  • Previous research has found that individuals low in neediness, compared to those high in neediness, demonstrate more adaptive patterns of behaviour, particularly in the interpersonal domain.
  • Therefore, it is possible adaptive interpersonal or cognitive changes associated with reduced neediness either resulted in, were the result of, or worked interdependently with changes in mood to be associated with superior treatment response.
  • This finding is consistent with previous research reporting that decreases in self-criticism over the course of various treatment modalities such as cognitive therapy predicts successful treatment response (DeRubeis & Feeley, 1990; Rector et al., 2000).
  • Therefore, the current null finding might have represented a deficiency in the instrument used to detect connectedness change rather than suggesting that connectedness change is, in actuality, not associated with treatment response.

Personality, Stressful Life Events, and Treatment Response

  • The third goal of the study was to examine whether stressful life events moderated the relationship between personality and MD treatment response.
  • It is possible, therefore, that in the present study, individuals high in self-criticism were especially vulnerable to the negative impact of a stressful life event because the event served to activate maladaptive self-critical thoughts, feelings, and behaviour patterns thereby resulting in poor treatment response.
  • It was hypothesized that neediness and connectedness, which purportedly tap into elements of MD risk and resilience, respectively, would interact with stressful life events to predict treatment response; however, evidence for these relationships was not found.
  • One possibility for these null findings is that ‘congruency’ between stressful life events and the interpersonal-based traits of neediness and connectedness was not assessed in the present study.
  • Multiple investigations have found that individuals characterized by maladaptive interpersonal-based traits such as dependency are especially prone to depression in the face of interpersonal-based life stressors, but not necessarily achievement based life stressors (Fichman et al., 1997, Robins et al., 1995, Shahar et al., 2004).

Pre-treatment Personality and Treatment Response

  • A significant self-criticism × connectedness interaction was found such that amongst individuals characterized by low self-criticism, higher scores on connectedness were associated with superior treatment response.
  • Nonetheless, the current findings suggest that low self-criticism and high connectedness augment one another to predict superior depression treatment response.
  • Individuals low in neediness tend to be independent and are generally unconcerned with approval or reassurance from others regarding their selfworth (Rude & Burnham, 1995).
  • Again, this possibility suggest that tracking the formation of relationships, both in terms of social support and the therapeutic alliance, would offer a compelling test of whether neediness X connectedness interaction on treatment response could be accounted for by either social support or the therapeutic alliance.
  • One possibility for these null main effects of personality on treatment response is that in the current study treatment response was examined by collapsing patient outcome across each of the treatment modalities of CBT, IPT, and PT.

Future Directions

  • It has been found that women tend to score higher than men on both trait neediness and connectedness (Rude & Burnham, 1995; Bacchiochi et al., 2003).
  • Therefore, it is possible that these traits, both on as independent predictors and in interaction with stressful life events, are differentially associated with treatment response for women and men.
  • Personality domains such as neuroticism and extraversion have been found to significantly predict depressive onset and treatment response in MD (Bagby et al., 1995; Ormel, Oldehinkel, & Brilman, 2001).
  • Personality, Stressful Life Events, and Depression 55.

Limitations

  • There were a few limitations associated with the current study.
  • Attachment beliefs and interpersonal contexts associated with dependency and self-criticism.
  • Personality, Stressful Life Events, Stressful Life Events, and Depression 68 SCID-I/P.

A. MOOD EPISODES

  • MAJOR DEPRESSIVE, MANIC, HYPOMANIC EPISODES, DYSTHYMIC DISORDER, MOOD DISORDER DUE TO A GENERAL MEDICAL CONDITION, SUBSTANCE-INDUCED MOOD DISORDER, AND EPISODE SPECIFIERS ARE EVALUATED.
  • MAJOR DEPRESSIVE DISORDER AND BIPOLAR DISORDERS ARE DIAGNOSED IN MODULE D.

CURRENT MAJOR DEPRESSIVE MDE CRITERIA EPISODE

  • Now I am going to ask you A. Five (or more) of the following some more questions symptoms have been present during the about your mood.
  • Often, I feel I have disappointed others.

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PERSONALITY, STRESSFUL LIFE EVENTS, AND TREATMENT
RESPONSE IN MAJOR DEPRESSION
by
Eric Lewis Bulmash
A thesis submitted to the Department of Psychology
in conformity with the requirements for
the degree of Master of Arts
Queen’s University
Kingston, Ontario, Canada
September, 2007
Copyright © Eric Lewis Bulmash, 2007

ii
Abstract
Major Depression (MD) currently affects over 17 million individuals in North America
(Greenberg et al., 2003). Identifying factors predictive of MD treatment response is
important for developing more efficacious treatments and better understanding MD
vulnerability. The goal of the present study was to examine the main and interactive
effects of personality and stressful life events as predictors of MD treatment response.
One hundred and thirty-one clinically depressed participants were randomly assigned to
either 16-weeks of cognitive behavioural therapy (CBT), interpersonal psychotherapy
(IPT), or pharmacotherapy (PT). Personality in the form of trait self-criticism, neediness,
and connectedness was assessed at pre and post-treatment using the Depressive
Experiences Questionnaire (DEQ; Blatt et al., 1976). Stressful life events experienced
during treatment were assessed using the Life Events and Difficulties Schedule (LEDS;
Bifulco et al., 1989). Results revealed that amongst individuals scoring lower in pre-
treatment self-criticism, higher pre-treatment connectedness predicted superior treatment
response. As well, amongst individuals scoring lower in pre-treatment neediness, higher
pre-treatment connectedness predicted superior treatment response. In terms of
personality change, both a reduction in neediness and a reduction in self-criticism over
the course of treatment predicted superior treatment response. A personality × stressful
life event interaction was also found such that amongst those experiencing a stressful life
event during treatment, higher scores on pre-treatment self-criticism predicted poor
treatment response. These results suggest that personality and stressful life events play an
important role in the treatment of MD. Limitations and clinical implications are
discussed.

iii
Acknowledgements
First and foremost, I would like to thank my parents who have fully supported me
throughout my life. I would especially like to thank them for encouraging my choice to
enter the field of psychology and for their love and direction. I would also like to thank
my brother and sister who have always been close to my heart.
I special thanks goes out to my close group of friends, both from Toronto and
Kingston, who have brought joy, laughter, and fulfillment to my life.
I am in deep gratitude to my advisor, Dr. Kate Harkness. Thank you for sharing
your knowledge and experience with me and guiding me through this process with
patience and encouragement. Thank you especially for keeping me focused on
completing my goals.
I would like to thank the members of my thesis committee, Dr. Ron Holden and
Dr. Leandre Fabirgar, for their contributions which greatly improved the quality of this
thesis. I wish to thank them both for their supportive attitudes and humour which made
working with them a pleasure.
Finally, I am grateful to all of the people who have contributed to the completion
of this thesis in other ways. I would like to thank Dr. R. Michael Bagby for his guidance
and each member of the Early Experience Laboratory who have been both my friends and
colleagues over the past two years.

iv
Table of Contents
Abstract ii
Acknowledgements iii
Table of Contents iv
List of Figures v
List of Tables vi
Chapter 1: Introduction 1
Chapter 2: Methods 23
Chapter 3: Results 29
Chapter 4: Discussion 46
References 57
Appendix A: Structured Clinical Interview for DSM-IV 67
Appendix B: Hamilton Rating Scale for Depression 73
Appendix C: Depressive Experiences Questionnaire 75
Appendix C: Life Events and Difficulties Schedule 80

v
List of Figures
Figure 1. Treatment response as a function of the interaction between
self-criticism and connectedness 37
Figure 2. Treatment response as a function of the interaction between
neediness and connectedness 38
Figure 3. Treatment response as a function of personality change
during treatment 41
Figure 4. Treatment response as a function of the interaction between
self-criticism and the presence or absence of a stressful life event 45

Citations
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Abstract: This book, for those who may be unfamiliar with this annual publication, is a review of the psychoanalytic literature and includes selections by a number of well-known and consistent contributors to the psychoanalytic concepts in development of children, the psychopathology of children, and the clinical problems involved in the treatment of children. It is of interest, of course, to members of related professional disciplines and will be of greatest value to those pediatricians who are somewhat familiar with the analytic approach and comfortable with the analytic terminology used. Certainly this and the other volumes do constitute an excellent sampling of the significant contributions to psychoanalytic knowledge of the child during the past 15 years. For general interest to the pediatrician in his everyday practice, one might select the first paper in this volume written by John Bowlby on Grief and Mourning in Infancy and Early Childhood . It is discussed and

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TL;DR: CFT shows promise as an intervention for mood disorders, particularly those high in self-criticism, however, more large-scale, high-quality trials are needed before it can be considered evidence-based practice.
Abstract: Background. Compassion-focused therapy (CFT) is a relatively novel form of psychotherapy that was developed for people who have mental health problems primarily linked to high shame and self-criticism. The aim of this early systematic review was to draw together the current research evidence of the effectiveness of CFT as a psychotherapeutic intervention, and to provide recommendations that may inform the development of further trials. Method. A comprehensive search of electronic databases was undertaken to systematically identify literature relating to the effectiveness of CFT as a psychotherapeutic intervention. Reference lists of key journals were hand searched and contact with experts in the field was made to identify unpublished data. Results. Fourteen studies were included in the review, including three randomized controlled studies. The findings from the included studies were, in the most part, favourable to CFT, and in particular seemed to be effective for people who were high in self-criticism. Conclusions. CFT shows promise as an intervention for mood disorders, particularly those high in self-criticism. However, more large-scale, high-quality trials are needed before it can be considered evidence-based practice. The review highlights issues from the current evidence that may be used to inform such trials. Received 21 December 2012; Revised 4 August 2014; Accepted 4 August 2014

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Cites background from "Personality, stressful life events,..."

  • ...It was observed that although these individuals were able to engage with cognitive and behavioural tasks, they still responded poorly to therapy (Rector et al. 2000; Bulmarsh et al. 2009)....

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  • ...2000; Bulmarsh et al. 2009). CFT was developed initially to help those individuals create affiliative feelings towards themselves, and to help them develop a more compassionate inner voice. CFT was based upon a growing body of neuroscientific evidence that demonstrated that affiliative motives and emotions can have a major impact on self and affect regulation (Cozolino, 2002; Depue & Morrone-Strupinsky, 2005). This research explores the interaction between three human affect regulation systems: threat protection, seeking and acquiring, and soothing. Gilbert (2014) proposes a framework of action for the biological mechanisms underpinning compassion that is based on the principles of evolutionary biology....

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  • ...2000; Bulmarsh et al. 2009). CFT was developed initially to help those individuals create affiliative feelings towards themselves, and to help them develop a more compassionate inner voice. CFT was based upon a growing body of neuroscientific evidence that demonstrated that affiliative motives and emotions can have a major impact on self and affect regulation (Cozolino, 2002; Depue & Morrone-Strupinsky, 2005). This research explores the interaction between three human affect regulation systems: threat protection, seeking and acquiring, and soothing. Gilbert (2014) proposes a framework of action for the biological mechanisms underpinning compassion that is based on the principles of evolutionary biology. A comprehensive overview of the theory and processes underpinning CFT is presented in Gilbert (2014); a brief summary of salient issues is presented below....

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TL;DR: The potential benefits of using Compassion Focused Therapy with people with eating disorders are demonstrated and the need for further research on this new approach is highlighted.
Abstract: Objective This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. Method Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). Results There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). Conclusion This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.

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TL;DR: This paper explored the benefits of a group-based compassion-focused therapy approach in a heterogeneous group of clients presenting with severe and enduring mental health difficulties to a community mental health team.
Abstract: This study explored the benefits of a group-based compassion-focused therapy approach in a heterogeneous group of clients presenting with severe and enduring mental health difficulties to a community mental health team. Seven groups with an average of five clients per group were run over 12–14 weeks. The format of the group followed the procedures of explaining the evolutionary model, formulating client problems within the compassion-focused therapy model, introducing clients to the core practices of compassionate training, and using compassion based interventions to address core difficulties. Questionnaires were completed pre- and post intervention: Self-criticism, shame, depression, anxiety, and stress. Significant reductions were found for depression, anxiety, stress, self-criticism, shame, submissive behavior, and social comparison post intervention. Of importance, at pre-intervention the majority of patients were in the severe category of depression scores. At the end of therapy the majority were in the borderline category. A combination of self-report data and client feedback suggests that compassion focused therapy is easily understood, well-tolerated, seen as helpful and produces significant changes in objective measures of mental health difficulties in naturalistic settings. Read More: http://guilfordjournals.com/doi/abs/10.1521/ijct.2012.5.4.420

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TL;DR: Women reported significantly more severe and nonsevere, independent and dependent, and other-focused and subject-focused life events prior to onset of depression than did men, and these relations were significantly moderated by age, such that gender differences in rates of most types of events were found primarily in young adulthood.
Abstract: Theoretical models attempting to explain why approximately twice as many women as men suffer from depression often involve the role of stressful life events. However, detailed empirical evidence regarding gender differences in rates of life events that precede onset of depression is lacking, due in part to the common use of checklist assessments of stress that have been shown to possess poor validity. The present study reports on a combined sample of 375 individuals drawn from 4 studies in which all participants were diagnosed with major depressive disorder and assessed with the Life Events and Difficulties Schedule (Bifulco et al., 1989), a state-of-the-art contextual interview and life stress rating system. Women reported significantly more severe and nonsevere, independent and dependent, and other-focused and subject-focused life events prior to onset of depression than did men. Further, these relations were significantly moderated by age, such that gender differences in rates of most types of events were found primarily in young adulthood. These results are discussed in term of their implications for understanding the etiological role of stressful life events in depression.

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References
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Reference EntryDOI
11 Jun 2013

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TL;DR: The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type, used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information.
Abstract: Types of Rating Scale The value of this one, and its limitations, can best be considered against its background, so it is useful to consider the limitations of the various rating scales extant. They can be classified into four groups, the first of which has been devised for use on normal subjects. Patients suffering from mental disorders score very highly on some of the variables and these high scores serve as a measure of their illness. Such scales can be very useful, but have two defects: many symptoms are not found in normal persons; and less obviously, but more important, there is a qualitative difference between symptoms of mental illness and normal variations of behaviour. The difference between the two is not a philosophical problem but a biological one. There is always a loss of function in illness, with impaired efficiency. Self-rating scales are popular because they are easy to administer. Aside from the notorious unreliability of self-assessment, such scales are of little use for semiliterate patients and are no use for seriously ill patients who are unable to deal with them. Many rating scales for behaviour have been devised for assessing the social adjustment of patients and their behaviour in the hospital ward. They are very useful for their purpose but give little or no information about symptoms. Finally, a number of scales have been devised specifically for rating symptoms of mental illness. They cover the whole range of symptoms, but such all-inclusiveness has its disadvantages. In the first place, it is extremely difficult to differentiate some symptoms, e.g., apathy, retardation, stupor. These three look alike, but they are quite different and appear in different settings. Other symptoms are difficult to define, except in terms of their settings, e.g., mild agitation and derealization. A more serious difficulty lies in the fallacy of naming. For example, the term "delusions" covers schizophrenic, depressive, hypochrondriacal, and paranoid delusions. They are all quite different and should be clearly distinguished. Another difficulty may be summarized by saying that the weights given to symptoms should not be linear. Thus, in schizophrenia, the amount of anxiety is of no importance, whereas in anxiety states it is fundamental. Again, a schizophrenic patient who has delusions is not necessarily worse than one who has not, but a depressive patient who has, is much worse. Finally, although rating scales are not used for making a diagnosis, they should have some relation to it. Thus the schizophrenic patients should have a high score on schizophrenia and comparatively small scores on other syndromes. In practice, this does not occur. The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type. It is used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information. The interviewer may, and should, use all information available to help him with his interview and in making the final assessment. The scale has undergone a number of changes since it was first tried out, and although there is room for further improvement, it will be found efficient and simple in use. It has been found to be of great practical value in assessing results of treatment.

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  • ...However, in the present sample, no evidence was found for a relation of selfcriticism to baseline HRSD scores, and all models were robust when controlling for baseline depression severity....

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  • ...The 17-item HRSD measures the presence and severity of depressive symptoms....

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  • ...I/P, HRSD, DEQ, and a number of other measures not relevant to the present study....

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  • ...Potential participants were required to meet the following inclusion criteria: (a) current DSM–IV–TR (American Psychiatric Association, 2000) diagnosis of nonpsychotic major depression; (b) score of at least 16 on the 17-item Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960); (c) between 18 and 70 years of age; (d) free of antidepressant medication for a minimum of 2 weeks prior to study entry; and (e) minimum Grade 8 education and fluency in reading English....

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  • ...Depression and Anxiety, 24, 586–596....

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Abstract: Introduction Interactions between Continuous Predictors in Multiple Regression The Effects of Predictor Scaling on Coefficients of Regression Equations Testing and Probing Three-Way Interactions Structuring Regression Equations to Reflect Higher Order Relationships Model and Effect Testing with Higher Order Terms Interactions between Categorical and Continuous Variables Reliability and Statistical Power Conclusion Some Contrasts Between ANOVA and MR in Practice

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TL;DR: This is an account of further work on a rating scale for depressive states, including a detailed discussion on the general problems of comparing successive samples from a ‘population’, the meaning of factor scores, and the other results obtained.
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"Personality, stressful life events,..." refers background in this paper

  • ...This measure has been shown to be a reliable and valid measure of depressive symptomatology (Hamilton, 1967)....

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Frequently Asked Questions (1)
Q1. What future works have the authors mentioned in the paper "Personality, stressful life events, and treatment response in major depression" ?

One direction for future research would be to examine whether gender moderates the effects of personality and stressful life events on MD treatment response.