UIUC PSYC 238 - Joiner (2000) - Depression’s Vicious Scree (16 pages)

Previewing pages 1, 2, 3, 4, 5 of 16 page document View the full content.
View Full Document

Joiner (2000) - Depression’s Vicious Scree



Previewing pages 1, 2, 3, 4, 5 of actual document.

View the full content.
View Full Document
Unformatted text preview:

Depression s Vicious Scree Self Propagating and Erosive Processes in Depression Chronicity Thomas E Joiner Jr Florida State University Depression is remarkably persistent and recurrent Why Although several predictors of depression chronicity have been identi ed a conceptual framework regarding mechanisms whereby depression chronicity occurs is lacking The goal of this article is to explain depression chronicity at least in part with reference to processes mostly interpersonal in nature that serve to extend and reestablish depression Several such processes are described and available empirical evidence regarding each is reviewed Clinical and research implications of the present conceptualization are elucidated To the degree that these processes receive continued empirical support as mechanisms whereby depression persists they represent leverage points to combat the vexing problem of depression chronicity Key words depression chronicity interpersonal explanation self propagatory factors Clin Psychol Sci Prac 7 203 218 2000 Depression persists and recurs Average length of major depressive episodes is approximately 8 months in adults Shapiro Keller 1981 and 9 months in children Kovacs Obrosky Gatsonis Richards 1997 Incredibly mean length of dysthymic episodes may be as much as 30 years in adults Shelton Davidson Yonkers Koran 1997 the corresponding gure for children is 4 years Kovacs et al 1997 Emslie Rush Weinberg and Guillon 1997 found that 61 of depressed children experienced recurrence of depression within 2 years similar Address correspondence to Thomas E Joiner Department of Psychology Florida State University Tallahassee FL 323061270 Electronic mail may be sent to joiner psy fsu edu 2000 AMERICAN PSYCHOLOGICAL ASSOCIATION D12 2 year relapse rates have been reported among adults Belsher Costello 1988 Bothwell Scott 1997 In studies with follow ups of 10 years or more Coryell and Winokur 1992 found that 70 of people with one depressive episode subsequently experienced at least one more In the DSM IV Mood Disorders Field Trial Keller et al 1995 the most frequent course among several hundred patients with current major depression was recurrent with antecedent dysthymia without full interepisode recovery Depression is thus persistent within acute episodes and recurrent across substantial portions of people s lives Why is depression so remarkably persistent and recurrent Several clinical descriptive predictors of depression chronicity have been identi ed e g longer duration of previous episodes severity of previous episodes younger age at rst episode neuroticism Bothwell Scott 1997 Maier 1996 Miller Ingham Kreitman Surtees 1987 Unless couched in a broader conceptual framework however such predictors elucidate the who but not the why of depression chronicity THE EROSIVE PERSPECTIVE One attempt to explain depression chronicity derives from conceptual and empirical work on the scarring e ects of a depressive episode The central idea of this perspective is that a depressive episode erodes personal and psychological resources such that episodes may be lengthened and upon recovery the formerly depressed individual is left with fewer bu ers to protect against future depression This view referred to here as the erosive perspective has received some attention with varying degrees of support Personality has received the most empirical attention and ndings in this domain are unsupportive of the erosive 203 perspective For example Shea Leon Mueller and Solomon 1996 conducted a 6 year study of an originally depression free group of participants Those who experienced their rst episode of depression during the 6 year study were compared to those who remained well Personality change did not di er between the groups see also Rohde Lewinsohn Seeley 1990 Zeiss Lewinsohn 1988 Depression apparently does not erode personality strengths It may however erode cognitive and attributional resources such as the ability to maintain optimism or to explain the causes of life events in optimistic ways This appears to be particularly the case among children but is less clear regarding adults cf Hamilton Abramson 1983 In the most comprehensive studies on this issue Nolen Hoeksema Girgus and Seligman 1986 1992 found that the attributional styles of depressed children deteriorated and did not later ameliorate even upon remission of symptoms The erosive perspective may hold some promise with regard to explaining depression chronicity and guiding clinical interventions e g rehabilitating eroded domains of functioning However there are features of depressive chronicity that the perspective may not fully explain For example why is it that interpersonal factors arguably above all others e g Hooley Teasdale 1989 comprise very strong predictors of episode duration and relapse I N T E R P E R S O N A L FA C T O R S A N D S E L F P R O PA G AT O RY PROCESSES IN DEPRESSION CHRONICITY Interpersonal factors are among the strongest predictors of depression chronicity Hooley and Teasdale 1989 reported that perceived criticism was a powerful predictor of relapse Brown and Moran 1994 found that interpersonal problems predicted episode duration Lara Leader and Klein 1997 found that social support was predictive of recovery from depressive episodes even controlling for common clinical variables such as episode severity and presence of dysthymia In this article I argue that there are features of depression s aftermath that appear to be active motivated and interpersonal processes that propagate life problems and depression and that are not best described as mere diminutions of resources cf the erosive perspective above These processes are in the main actively performed by the depression prone person whereas erosion happens to the person a passive process Interestingly as will be CLINICAL PSYCHOLOGY SCIENCE AND PRACTICE shown one set of processes may lay the groundwork for development of the other Depression may not only erode existing resources then but may also build up processes that serve to maintain depression vulnerability It is the purpose of this article to argue a that a set of such processes referred to here as self propagatory processes exists and b that these processes explain aspects of depression chronicity not fully accounted for by the erosive perspective Erosive and self propagatory factors however are not viewed as exclusive but rather as complementary working in tandem to encourage depression chronicity It should be


View Full Document

Access the best Study Guides, Lecture Notes and Practice Exams

Loading Unlocking...
Login

Join to view Joiner (2000) - Depression’s Vicious Scree and access 3M+ class-specific study document.

or
We will never post anything without your permission.
Don't have an account?
Sign Up

Join to view Joiner (2000) - Depression’s Vicious Scree and access 3M+ class-specific study document.

or

By creating an account you agree to our Privacy Policy and Terms Of Use

Already a member?