5- are people changed by the experience of having an episode of depression a further test of the...

7/30/2019 5- Are People Changed by the Experience of Having an Episode of Depression a Further Test of the Scar Hypothesis

1/8

Journ al of Ab norm al Psychology Cop yright 1990 by the Am erican Psychological Associat ion, Inc .1990, Vol . 99, No. 3, 264--271 0021-843X/90/$00.75

Are People C hang ed by the Exper ience of Having an E pisodeo f Depress ion? A Further Test of the Scar H ypothes isPaul Rohde, Peter M. Lewinsohn, and John R. SeeleyO r e g o n R e s e a r c h I n s t i tu t e , E u g e n e , O r e g o n

The purpo se o f this study was to identify characterist ics o f individuals before and a fter their f i rstdepressive episode. Sub jects were 49 older persons a ssessed before and after th eir first depressiveepisode o n depression-related psychosoeial variables. The co ntrol group consisted o f 351 never-de-pressed individuals. Consistent with previous findings, patients were more likely to be younger,female, and mildly depressed both before and after the episode. In addition, they were more l ikelyto be em ployed. Following an ep isode o f depression, the recovered pat ients described their socialski lls and health as po orer and their interpersonal dependency as greater than the controls. How-ever, on an experiment-wise basis, the num ber o f significant differences were no greater thanexpected by chance. Th e stress act ivat ion model w as examined but did not appreciably enhance theresults. Results suggest tha t mo st of he psyeho social variables associated with depression are statedependent .

I n d i v i d u a l s w h o h a v e b e e n d e p r e s s e d i n t h e p a s t a r e a tg r e a t e r ri s k f o r d e v e l o p i n g a f u t u r e e p i s o d e o f d e p r e s s i o n c o m -p a r e d w i t h t h o s e w h o h a v e n e v e r b e e n d e p r e s s e d ( A m e n s o n &L e w i n s o h n , 1 9 8 1 ; G o n z a l e s , L e w i n s o h n , & C l a rk e , 1 9 8 5 ;K e l l er , Sha p i r o , La v or i , & Wol fe , 1982). F o r e xa m pl e , A m e n s o na n d L e w i n s o h n ( 1 9 8 1 ) f o u n d t h a t a p r e v i o u s h i s t o r y o f d e p re s -s i o n w a s a s s o c i a te d w i t h a n a p p r o x i m a t e l y t w o - f o l d i n c r e a se i np r o b a b i l i ty o f d e v e l o p i n g a f u tu r e e p i s o d e o f d e p r e s s io n d u r i n ga o n e - y e a r p e r i o d ( f r o m . 1 2 t o . 2 2 f o r w o m e n a n d f r o m . 0 5 to . 1 3f o r m e n) . The r e f o r e , i t m a y be hypo t he s i z e d t ha t ( a ) f o r m e r l yd e p r e s s e d i n d i v i d u a l s p o s s e s s d i s t i n g u i s h i n g c h a r a c t e r i s t i c st ha t c o n t r i bu t e t o t h i s i nc r e a s e d vu l ne r a b i l i ty , a nd ( b ) t ha t t he s ec h a r a c t e r i s t i c s a r e p r e s e n t e v e n w h e n t h e i n d i v i d u a l s a r e n o td e p r e s se d . A s s u m i n g t h a t t h e s e d i s t i n g u i s h in g c h a r a c t e r i s t ic sc a n b e i d e n t i f i e d , i t r e m a i n s t o b e d e t e r m i n e d w h e t h e r t h ev u l n e r a b i li t y t o b e c o m i n g d e p r e s s e d i s a c h a r a c t e r i s ti c o f t h ep e r s o n b e f o r e th e o c c u r r e n c e o f t h e i r f i rs t e p i s o d e o f d ep r e s -s i o n o r w h e t h e r t h e v u l n e r a b il i ty c o m e s i n t o e x i s te n c e d u r i n gt he f i rs t e p i s ode . I f he c ha r a c t e r i s t i c , w h i c h c ou l d be p s yc ho l og -i c a l , e nv i r onm e n t a l , o r b i o l og i c a l , i s p r e s e n t be f o r e t he f i r s tde p r e s s i ve e p i s ode , t he n i t m a y be s a i d t o be a t r a i t m a r ke r f o rb e c o m i n g d e p re s s e d . T h e t r a it m a r k e r h y p o t h e s i s re q u i r e s t h a tv a r i ab l e s t h a t d i s c r i m i n a t e f o r m e r l y d e p r e ss e d i n d i v i d u a lsf r o m n e v e r - d e p r e s s e d i n d i v i d u a l s d i s c r i m i n a t e b e t w e e n t h et w o g r o u p s e v e n b e f o r e t h e o n s e t o f t h e f i rs t d e p re s s iv e e p i s o d e .

A l t e rna t ive l y , i nd i v i dua l s m a y no t m a n i f e s t t he vu l ne r a b i l i t yb e f o r e t h e ir f i rs t e p i s o d e b u t a c q u i r e a " s c a r " d u r i n g o r a f t e r t h e

This project , which complied w ith Am erican Psychological Associa-t ion's ethical standard s in the treatment of hum an subjects, was par-t i a l ly suppor ted by Nat ional Ins t i tu te of Menta l He al th ResearchG r a n t MH 35672 .Correspondence conc erning this art icle should be addressed to PaulRohd e, Oregon Re search Institute, 171 5 Franklin B oulevard, Eugene ,Oregon 97403-1983.

26 4

f i r s t de p r e s s i ve e p i s ode , w h i c h p r e d i s pos e s t he m t o f u t u r e de -p r e s s i ve e p i s ode s . The s c a r hypo t he s i s w a s f i r s t i n t r oduc e d byL e w i n s o h n , S t e i n m e t z , L a r s o n , a n d F r a n k l i n ( 19 81 ). A s e a r isde f i ne d a s a r e l a ti ve ly pe r m a n e n t r e s i dua l de f i c it t ha t i s c r e a t e db y t h e e p i s o d e o f d e p re s s io n m u c h i n t h e s a m e w a y th a t a c u t o rs u r g i c a l ope r a t i on m a y l e a ve a phys i c a l s e a r.

T h e q u e s t i o n o f w h e t h e r a n e p i s o d e o f d e p r e ss i o n l e a ve s re l a-t i ve l y pe r m a ne n t r e s i dua l s o r de f i c i t s ( i . e , s e a r hypo t he s i s ) o rw h e t h e r p e r s o n s w h o a r e p r o n e t o b e c o m i n g d e p r e s s e d d i f f e rf r o m t h o s e w h o a r e n o t a s v u l n e r a b l e e v e n b e f o r e t h e y f i r s tb e c o m e d e p r e s s e d ( i e , t r a i t m a r k e r h y p o t h e s i s ) i s i m p o r t a n tbo t h t he o r e t i c a l l y a nd c l in i c a ll y . I de n t i f y i ng s uc h c ha r a c t e r i s -t i cs a n d t h e i r t e m p o r a l r e l a t io n s h i p t o t h e o n s e t o f d e p r e s s io nm a y p r o v i d e c l u e s a b o u t t h e m e c h a n i s m s t h a t r e n d e r p e o p l em o r e v u l n e r a b l e t o b e c o m i n g d e p r e s s e d a n d c l a r i f y t h e s e-q u e l a e o f d e p r e s s io n . C l i n i c a ll g s u c h i n f o r m a t i o n c o u l d f a c i li -t a t e t h e d e v e l o p m e n t o f i n t e rv e n t i o n s t o a m e l i o r a te c h a r a c t e r is -t i cs o r c o n d i t i o n s t h a t c o n t r i b u t e t o t h e i n c r e a s e d v u l n e r a b il i tya m o n g t h e f o r m e r l y d e p r e s se d .

R e l e v a n t t o t h e i s s u e s j u s t m e n t i o n e d i s t h e l i t e r a t u r e i nw h i c h f o r m e r l y d e p r e s s e d i n d i v i d u a l s h a v e b e e n c o m p a r e dw i t h n e v e r - d e p r e s s ed c o n t r o l s . B o t h t h e s c a r a n d t r ai t m a r k e rs u p p o s i t io n s r e q u i re t h a t t h e s e g r o u p s d i f f e r o n s o m e v a r ia b l e s.U n f o r t u n a t e l ~ n o c l e a r a n s w e r s as t o th e n a t u r e o r m a g n i t u d e o fs u c h d i f f er e n c e s h av e e m e r g e d f r o m p r e v i o u s st u d i es . O n t h eb a s i s o f th e i r r e s u l ts a n d c o n c l u s i o n s , t h e s e s t u d i e s m a y b es o r t e d i n t o t h r e e g e n e r a l g r o u p s .

T h e f ir s t g r o u p c o n s i s t s o f t h o s e s t u d i e s i n w h i c h n o s ig n if i-c a n t d i f f er e n c e s b e t w e e n t h e f o r m e r l y d e p r e s s e d a n d n e v e r -d e -p r e s s e d g r o u p s w e r e f o u n d a m o n g a l a r g e n u m b e r o f c o g n i ti v e( B l a c k b u r n & S m y t h , 1 9 8 5 ; H a m i l t o n & A b r a m s o n , 1 9 8 3 ; L e -w i n s o h n e t a L 1 9 8 1 ; W i l k i n s o n & B l a c k b u r n , 1 9 8 1 ) a n d b e h a v -i o ra l ( L e w i n s o h n & T a l k i n g t o n , 1 9 7 9 ; M a c P h i l l a m y & L e w i n -s o h n , 1 9 7 4 ; Y o u n g r e n & L e w i n s o h n , 1 9 8 0 ; Z e is s & L e w i n s o h n ,1 9 8 8 ) c o n c o m i t a n t s o f d e p r e ss i o n . T h e s e s t u d i e s s u g g e s t t h a tt h e p s y c h o s o c i a l v a r i a b l e s a s s e s s e d ( e . g , d y s f u n c t i o n a l a t t i -


2/8

SC A R S O F D EPR ESSIO N 26 5t ude s , i r r a t i ona l be l ie f s , f r e que n c y o f p l e a s a n t e ve n t s) a r e no tc o n t r i b u t i n g t o t h e i n c r e a s e d v u l n e r a b i l i t y t o d e p r e s s i o n r e -lapse .A s e c o n d g r o u p o f s t u d ie s h a s r e p o r t e d m o r e e q u i v o c a l r e -s u it s, w h i c h d e m o n s t r a t e d t h a t f o r m e r l y d e p r e s s e d i n d i v i d u a l sd i f f e r e d , a l b e i t i n r e l a t i v e l y s m a l l w a y s , f r o m t h e n e v e r - d e -p r e s s e d c o n t r o l g r o u p ( B i l l i n g s & M o o s , 1 9 8 5 ; H i r s c h f e l d ,K l e r m a n , C l a y t on , & K e l l e r, 1983 ; Pa yke l & We i s s m a n , 1973).F o r i n s t a n c e , B i l li n g s a n d M o o s ( 1 98 5 ) c o n c l u d e d t h a t a l t h o u g hs om e d i f f e re nc e s , p r i m a r i l y i n t he a r e a o f s oc i a l r e s ou r c e s (e .g .s m a l l e r n u m b e r o f fr i e n d s, l e s s f a m i l y su p p o r t ) , r e m a i n e d a f t e rr e co v e ry , i n m o s t r e s p e c ts t h e f o r m e r l y d e p r e s se d p a t i e n t s r e -t u r n e d t o a l ev e l o f f u n c t i o n i n g c l o s e t o t h a t o f th e n e v e r - d e -p r e s s e d c on t r o l s .

T h e t h i r d g r o u p o f s t u d i e s h a s r e p o r t e d l a rg e d i f fe r e n c e s b e -t w e e n t h e n e v e r - d e p r e s s e d a n d f o r m e r l y d e p r e ss e d g r o u p s ( e .g ,A i r m a n & W i t t e n b o r n , 1 9 8 0 ; C o f e r & W i t t e n b o r n , 1 9 8 0 ; P er r is ,E i s e m a n n , V o n K o r r i n g , & P e r ri s , 1 98 4 ). O n e s u c h s t u d y ( E av e s& R u s h , 1 9 8 4 ) f o u n d t h a t u p o n r e m i s s i o n a f o r m e r l y d e p r e s s e dg r o u p o f 2 4 w o m e n s t il l r e p o r t e d s i g n if i ca n t ly g r e a t e r u s e o fdys f unc t i ona l a t t i t ude s a nd ne ga t i ve a t t r i bu t i ona l s t y l e , w h i l et h e i r r e p o r t e d l ev e l o f a u t o m a t i c n e g a t iv e t h o u g h t s w a s c o m p a -r a b l e t o t he 17 ne ve r - de p r e s s e d c on t r o l s . Suc h s t ud i e s s ugge s tt h a t f o r m e r l y d e p r e s s e d i n d i v i d u a l s c o n t i n u e t o s h o w d i f f e r -e n c e s o n b a s i c m e a s u r e s o f s y m p t o m a t o l o g y a n d p e r so n a l it y .

T h e s e c o n t r a d i c t o r y f i n d i n g s m a k e i t d i ff ic u l t t o d r a w f i r mc o n c l u s i o n s a b o u t t h e e x i s t e n c e a n d n a t u r e o f a n y p o t e n t i a l s c a ro r t r a i t m a r k e r va r i a b l e s . Se ve r a l pos s i b l e e xp l a n a t i ons f o r t hed i s c r e p a n t f i n d i n g s m a y b e o f f e r e d . F i r s t , t h o s e s t u d i e s t h a tr e p o r t e d s i g n if ic a n t g r o u p d i f fe r e n c e s m a y h a v e i n c l u d e d f o r-m e r l y d e p r e s s e d s u b j e c ts w h o w e r e i n v a r y i n g d e g r e e s o f r e c o v -e r y , w i t h s om e s ub j e c t s s t i l l m i l d l y de p r e s s e d . Se c ond , s t ud i e st ha t r e po r t e d s i gn i f i c a n t d i f f e r e nc e s t e nde d t o a s s e s s f o r m e r l yd e p r e s s e d s u b j e c t s w h o h a d e x p e r i e n c e d m o r e s e v e r e a n d / o rm o r e n u m e r o u s p a s t e p i s o d e s o f d e p re s s io n . B o t h A n e s h e n s e l( 19 8 5) a n d D e p u e a n d M o n r o e ( 1 9 86 ) e m p h a s i z e d t h e i m p o r -t a n c e o f d i f f e r e n t ia t i n g i n d i v i d u a l s w h o a r e p e r s i s t e n t l y d e -p r e s s e d f r o m t h o s e f o r w h o m a d e p r e ss i v e e p i s o d e r e p r e s e n t s a ni s o la t e d e v e n t d i f fe r e n t f r o m t h e i r u s u a l w a y o f f u n c t i o n i n g .T h i r d , i n d i v i d u a l s w h o h a v e m o r e r e c e n t l y r e c o v e r e d f r o m ad e p r e ss i v e e p i s o d e m a y b e m o r e l i k e l y t o s h o w r e s i d u a l d e fi c it st h a n t h o s e w h o h a v e b e e n d e p r e s s i o n - f re e f o r m a n y y e a r s .F o u r t h , s c a r s m a y n o t a l w a y s b e o b s e r v a b l e ; r a th e r , t h e y b e -c o m e n o t a b l e o n l y i n t h e p r e s e n c e o f el e v a te d l e v e ls o f s tr e s s( i e , t he s t r e s s a c t i va t i on m ode l ) . F i f t h , m or e s ubs t a n t i a l s c a r sm a y h a v e e m e r g e d i n s t u d i e s i n v o l v i n g t h e s u b s e t o f d e p r e s s e di n d i v i d u a ls w h o s e e k t r e a t m e n t .

P r e s e n t S t u d yA s p a r t o f a lo n g i t u d i n a l s t u d y a i m e d a t i d e n t i f y in g t h e c h a r -

a c t e r i s t ic s o f pe o p l e a t r i s k f o r de p r e s s i on , 742 i nd i v i dua l s a ge d5 0 y e a r s o r o l d e r w e r e a s s e s s e d b y d i a g n o s t i c i n t e r v i e w a n ds e l f- r e p o rt q u e s t i o n n a i r e a t t w o t i m e p o i n t s. T h e t w o - p a n e l d e -s ig n p r o v i d e d a u n i q u e o p p o r t u n i t y t o s t u d y a g r o u p o f 49 o l d e ri n d i v i d u a l s w h o d e v e l o p e d t h e i r f i r s t d e p r e s s i v e e p i s o d e b e -t w e e n t h e t w o a s s e s s m e n t p o i n t s o f o u r s t u d y ( n e w c a se s ). W ew e r e a b le t o c o m p a r e t h i s g r o u p o f in d i v i d u a ls w i t h a n e v e r -d e -p r e s s e d c o n t r o l g r o u p o n a l a r g e a r ra y o f p s y c h o s o c i a l c h a r a e -

t e r i s t ic s r e l a t ive l y c l o s e t o t he o ns e t a nd r e m i s s i on o f t he i r f i r s te p i s ode . G i ve n t h e f a c t t ha t a l l t he s ub j e c t s w e r e o l de r, t he l i ke li -h o o d t h a t w e i n c l u d e d i n d i v i d u a l s w i t h a d e p r e s s i o n t r a itm a r k e r i n o u r n e v e r - d e p r e ss e d c o n t r o l g r o u p w a s q u i te l ow .

S e v e r a l v a r i a b l e s b r o a d l y c a t e g o r i z e d a s d e m o g r a p h i c s ,s t r e ss , s oc i a l s up po r t a nd i n t e r a c t i on , pe r s on a l i t y c ha r a c t e r i s -t i c s, c op i ng s t y le , he a l t h , a nd pa t h o l og y w e r e a s s e s s e d . V a r i-a b l e s w e re c h o s e n f o r i n c l u s io n i f th e y h a d b e e n f o u n d i np r e v i o u s c r o ss - s e c ti o n a l a n d l o n g i t u d i n a l s t u d i e s t o b e p r e d i c -t o r s o r c o n c o m i t a n t s o f d ep r e s s io n . I t w a s a m o n g t h i s se t o fm e a s u r e s t h a t t h e s c a r s o f d e p r e s s i o n w e r e t h o u g h t m o s t l i k el yt o b e f o u n d .

T h e d a t a s e t p r o v i d e d a u n i q u e o p p o r t u n i t y t o t e s t t h e s c a rhypo t he s i s i n t ha t ( a ) de p r e s s i on w a s r i go r ous l y a s s e s s e d us i ngb o t h d i a g n o s t i c i n t e r v ie w a n d s e l f - r ep o r t m e a s u r e s b e f o r e a n da f t e r t h e f i r st e p i s o d e ; (b ) t h e s t u d y w a s l o n g i t u d i n a l a n d p r o -s p e c ti v e (i .e . t h e n e w c a s e s h a d b e e n m e a s u r e d b e f o r e a n d a f t e rt h e i r f i r st e p i s o d e o n a l a rg e a r r a y o f p s y c h o s o c i a l c h a ra c t e r is -t i cs , t hus p r ov i d i ng a d i r e c t t e s t o f t he s c a r hypo t he s i s ) ; a nd (c )t h e s u b j e c t s w e r e g a t h e r e d f r o m t h e g e n e r a l c o m m u n i t y a n dt h u s w e r e m o r e r e p r e se n t a ti v e t h a n a t r e a t m e n t s a m p l e .

M e t h o dParticipants

Between M ay, 1982, and November, 1983, 4,133 individuals over theage o f 50 residing in E ugene-Springfield, Oregon, w ere random ly se-lected from a l ist of l icensed drivers and invited to part icipate in psy-cholngical research. A total ofl ,0 08 subjects completed bo th the Tim e1 (TI) self-report quest ionnaire and diagnostic interview. O f the 1,008subjects, 742 (74%) comp leted pa rticipation in the entire study (e.g,completed th e Tim e 2 IT2 ] questionnaire and interview) unti l i ts con-clusion in M arch, 1986. Th e average t ime elapsed between TI and T 2was 29 months.Inspection of the dem ographic characterist ics o f the 742 part ici-pants revealed that , com pare d with United States census data for thearea, part icipants were bet ter educa ted and m ore l ikely to he wom en.Older individuals were slightly more likely to discontinue participa-t ion; no othe r assessed dem ographic differences were associated withat tr i tion in this study. Approximately 2% of the T 2 sample reportedreceiving concu rrent counseling for s om e t ype o f problem (e.g, alcohol-ism, marital discord). Subjects received no financial reimbursementfor part icipation and signed a statement of inform ed consent, w hichensured confidentiality.

Subject FindingOu r prim ary goal was to reco rd al l fi rst episodes o f depression thatoccur red be tween TI and T2. To achieve th i s goal , subjec t s weremailed the Center fo r Epidemiolngieal Studies D epression Scale (CES-D) (Radloff , 1977), a self-report m easure o f 20 depressive symptoms,approximately every two months. Complet ion rates were high, averag-ing 80% (ofthe 1,008 TI subjects) across the n ine m ailings. An y subjectnot diagnosed as depressed at TI who scored above 11 on an y subse-quent CES -D administration was considered fo r a post-Tl follow-upinterview to determine whether he or she had b ecom e depressed. Be-cause o f adm inistrative and financ ial constraints, no t all eligible sub-jects were interviewed and higher priority was given to subjects withhigher CES-D scores. Six-huudred post-Tl interviews were conduc tedwith 386 o f the T I subjects (214, or 55.4%, o f these 386 subjects hadmultiple post-Tl interviews).


3/8

266 a . R O H D E , E L E W I N S O H N , A N D J . S E E L E YD u r i n g t h e T 2 p h a s e o f t h e s tu d y ( b e t w e e n N o v e m b e r , 1 98 4 , a n dMa rch , 1986) , 749 o f the T I sub jec ts (74%) were aga in in te rv iew ed and

a d m i n i s t e r e d t h e s e l f - re p o r t m e a s u r e s a s s e s s e d a t T I . R e s o u r c e c o n -s t r a i n ts p r e v e n t e d f o l lo w - u p o f t h e e n t i r e T I s a m p l e . H i g h e s t p r i o r i t yfo r T2 in te rv iews was the re fo re g iven to sub jec ts who (a ) had beend e p r e s s e d a t T I , ( b ) h a d b e c o m e d e p r e s s e d a t a n y t i m e d u r i n g t h epos t -T l pe r iod , (c) had a h is to ry o f depress ion , o r (d ) repor ted an e le -v a t e d l e v e l o f d e p r e s s iv e s y m p t o m s o n t h e f i n a l p o s t - T l C E S - D q u e s -t ionna i re . T hese c r i te r ia iden t i f ied 391 sub jec ts . In add i t ion , a ran doms a m p l e o f 3 5 8 ( 66 % ) o f t h e 5 4 0 T 1 s u b j e c ts w h o h a d r e p o r t e d n o e v i -d e n c e o f p a s t o r c u r r e n t d e p r e s s i o n w e r e a l s o r e i n t e r v i e w e d a s c o n t ro lsub jec ts . Da ta fo r 7 sub jec ts were exc luded f rom ana lyses because o fm i s s i n g i n f o r m a t i o n , e v i d e n c e o f o r g a n ic i ty , o r d e v i a n t o r r a n d o m r e -s p o n d i n g .A g r o u p o f 4 9 i n d i v i d u a l s ( n ew c a s es ) w e r e i d e n t i f i e d w h o w e r e d i a g -n o s e d a t t h e T I i n t e r v i e w as n e v e r h a v i n g b e e n d e p r e s s e d a n d l a t e rd i a g n o s e d a t t h e T 2 i n t e r v i e w a s h a v i n g e x p e r i e n c e d a n d r e c o v e r e df r o m t h e i r f i r s t d ep r e s s i ve e p i s o d e d u r i n g t h e c o u r s e o f t h e s tu d y. T h ef i rs t d e p r e ss i v e e p i s o d e f o r t h e n e w e a s e s h a d a m e a n d u r a t i o n o f 16 .1we eks (range: 2-1 17 weeks).

Diag nostic ClassificationsT h e d i a g n o s i s o f d e p r e s s i o n a n d o t h e r p s y c h o p a t h o l o g i c a l s y n -

d r o m e s w a s b a s e d o n i n f o r m a t i o n g a t h e r e d f r o m p a r t i c i p a n t s a t T 1a n d p o s t - T l i n t w o - h o u r s e m i s t r u c t u r e d i n t e r v i e w s u s i n g t h e S c h e d u l ef o r A f fe c t i v e D i s o r d e r s a n d S c h i z o p h r e n i a n L i f c t i m e ( S A D S - L ) ( E n d i -c o t t & S p i tz e r , 1 97 8 ) a n d C h a n g e ( S A D S - C ) ( S p i t z er & E n d i c o t t , 1 9 7 7)v e r s i o n s , w i t h d e c i s i o n r u l e s s p e c i f i e d b y t h e R e s e a r c h D i a g n o s t i cC r i t e r i a ( R D C ) ( S p i t ze r , E n d i c o t t , & R o b i n s , 1 97 8 ). A t T 2 t h e L o n g i t u -d i n a l I n t e r v i e w F o l l o w - U p E v a l u a t i o n ( L I F E ) ( S h a p i r o & K e l l e r, 1 9 79 )w a s c o n d u c te d . T h e L I F E i n t e r v i e w p r o v i d e d d e t a i l e d i n f o r m a t i o na b o u t t h e l o n g i t u d i n a l c o u r s e o f p s y c h i a tr i c s y m p t o m s a n d d i s o r d e r ss i n c e t h e l a s t i n t e r v i e w (T 1 o r p o s t - T l ) w i t h r i g o r o u s c r i t e r ia f o r r e c o v -e r y f r o m a d i s o r d e r ( i . e , s y m p t o m - f r e e f o r e i g h t o r m o r e w e ek s ).

D i a g n o s t i c i n t e r v i e w e r s w e r e a c a r e f u l l y s e l e c te d g r o u p o f g r a d u a t ea n d a d v a n c e d u n d e r g r a d u a t e s t u d e n t s e n r o l l e d i n a y e a r - lo n g d i d a c t i ca n d e x p e r i e n t i a l d i a g n o s t i c i n t e r v i e w i n g c o u rs e . I n t e r r a t e r r e l i a b i l i tyf o r t h e d i a g n o s i s o f d e p r e s s i o n a n d o t h e r p s y c h i a t ri c d i s o r d e r s w a se v a l u a t e d b y m e a n s o f t h e k a p p a s t a t i st i c ( C o h e n , 19 6 0) . O n t h e b a s i so f j o i n t r a t i n g s, t h e k a p p a c o e f f ic i e n t w a s . 8 1 f o r 1 93 T I S A D S - L i n t e r-v iews , .81 fo r 101 pos t -T l SA D S-C in te rv iews , and .82 fo r 147 T2 L IFEi n t e rv i e w s , i n d i c a t i n g a c c e p t a b l e l e v e ls o f r e l i a b i l i t y f o r t h e d i a g n o s e s .

Three sub jec t g roups were o f in te res t in the p resen t s tudy : (a ) 49i n d i v i d u a l s c o m p r i s i n g t h e n e w c a s e s g r o u p , ( b ) 7 3 i n d i v i d u a l s d i a g -nosed as depressed a t T I , and (c) 351 never -depresse d con t ro l g roupi n d i v i d u a l s w h o r e p o r t e d n o p a s t o r c u r r e n t d e p r e s s i v e e p i s o d e s a tb o t h T 1 a n d T 2 . T a b l e 1 c o n t a i n s d e m o g r a p h i c i n f o r m a t i o n f o r t h eth ree g roups .

Assessment o f Independent VariablesT h e f o l l o w i n g m e a s u r e s w e r e c o n t a i n e d i n t h e s e l f - r e p o rt q u e s t i o n -

n a i r e s a d m i n i s t e r e d a t T 1 a n d T 2 .Demographic variables. Subjec ts repor ted the i r gender , age , ma r i ta ls t a t u s ( m a r r i e d , d i v o r c e d / s e p a r a t e d , w i d o w / w i d o w e r , n e v e r m a r r i e d ) ,e d u c a t i o n a l l e v e l ( g r a d e s c h o o l , 8 t h g r a d e , h i g h s c h o o l , s o m e c o l l e g e /v o c a t i o n a l s c h o o l , c o l l e g e d e g r e e , p r o f e s s i o n a l d e g r e e) , a n d e m p l o y -m e n t s t a t u s ( e m p l o y e d, u n e m p l o y e d , r e t i r e d ) .Self-rated hea lth. T e n i t e m s a s s e s s i n g o v e r a l l s e l f - p e r c e iv e d h e a l t hs ta tus as w e l l a s spec i f ic i tems regard in g v is ion , hea r ing , phys ica l d is -a b i l it i e s, t h e o c c u r r e n c e o f a s e r i o u s i l ln e s s d u r i n g t h e p a s t s i x m o n t h s ,a n d t h e u s e o f m e d i c a t i o n s . T I a l p h a w a s .7 1 a n d t h e T I - T 2 c o r r e l a t i o nwas .69 (p < .001).

T a b l e 1Demographic I n format ion fo r N ew Cases, Sub jec t s Depres sed a tTim e 1, an d Never-Depressed Control Subjects

D e p r e s s e d a t N e v e r - d e p r e s s e dV a r i a b le N e w c a s e s T i m e I c o n t r o l sn 49 73 351Wo men 71 .4% 61 .6% 49 .0%AgeM 61 .7 62 .9 64 .9SD 8.3 7.9 7.050-5 9 years 49 .0% 38 .4% 22 .8%60--69 yea rs 32.7% 42.5% 53.0%70- 79 years 14.3% 15.1% 21.9%80+ years 4 .1% 4 .1% 2 .3%M a r i t a l s t a t u sMa rr ied 79 .6% 65 .8% 82 .5%Div orced /separa ted 6 .1% 19 .2% 4 .3%Wid ow /wido wer 14 .3% 15 .1% 11 .7%Nev er ma rr ied 0 .0% 0 .0% 1 .4%E d u c a t i o n l e v e l

8th grad e 8.1% 8.2% 4.2%High schoo l 14 .3% 26 .0% 22 .6%S o m e c o l l e ge /voca t iona l schoo l 40 .8% 38 .4% 41 .1%Col leg e degree 22 .4% 19 .2% 19 .4%Profess io na l degree 14 . 3% 8 .2% 12 .6%E m p l o y m e n t s t a t u sEm ployed 45 .8% 26 .4% 25 .7%Un em ploy ed 6 .3% 12 .5% 7 .8%Re tire d 47.9% 6 I . 1% 66.5%

Macrostress. T w o m e a s u r e s p r o b i n g f o r t h e o c c u r r e n c e o f m a c r o -s t r e ss o r s w e r e a s s e s s e d o n t h e b a s i s o f a s u b s e t o f l 8 n e g a t i v e / u n d e s i r e di t e m s f r o m t h e S o c i a l R e a d j u s t m e n t R a t i n g S c a l e ( H o l m e s & R a h e ,1 9 67 ). S u b j e c t s ra t e d t h e t o t a l n u m b e r o f e v e n ts t h a t o c c u r r e d d u r i n gt h e p a s t s i x m o n t h s t o t h e m ( st re ss t o s e l f ) a n d t o t h e i r s p o us e , c l o s ere la t ive , o r f r iend ( s tress to o thers ). The T I -T 2 co r re la t ions fo r s t ress tose l f and s t ress to o the rs were .09 (nons ign i f ican t ) and .21 (nons ign i f i -cant), respectively.Microstress. F o r t y - f o u r i t e m s w e r e u s e d f r o m t h e M o o d - R e l a t e dE v e n t s s c a l e o f t h e U n p l e a s a n t E v e n t s S c h e d u l e ( L e w i n s o h n , M e r m e l -s te in , Alexa nder , & MacP hi l lamy, 1983) desc r ib ing avers ive exper i -e n c e s f r o m e v e r y d a y l i f e s u c h a s h a v i n g a r g u m e n t s w i t h o n e ' s sp o u s e o rh a v i n g t o d o t h i n g s o n e d o e s n o t e n jo y . I t e m s w e r e r a t e d o n a 3 - p o i n ts c a l e f o r f r e q u e n c y o f o c c u r r e n c e d u r i n g t h e p a s t 3 0 d a y s. C o e f f i ci e n ta lpha a t T I was .85 and th e T I - T2 co r re la t ions was .68 (p < .001).Social support network. The s u b j e ct ' s s o c i a l s u p p o r t n e t w o r k w a sa s s e s s e d w i t h t h r e e i t e m s d e a l i n g w i t h t h e f r e q u e n c y o f c o n ta c t s b y t h es u b j e ct s w i t h t h e m e m b e r s o f t h e i r n e t w o r k ( e .g ., " H o w m a n y c l o s ef r iends do y ou have?") . T I coe f f ic ien t a lpha w as .60 and te s t - re tes tre l iab i l i ty was .70 (p < .001) .Perceived social support-fam ily and friends. A b b r e v i a t e d v e r s i o n so f t w o s c a l e s f r o m t h e P e r c e i v e d S o c i a l S u p p o r t Q u e s t i o n n a i r e ( P r o c i -dan o & H el le r , 1983) assessed th e degree to w hich sub jec ts fe l t tha t theyw e r e s u p p o r t e d b y f a m i l y m e m b e r s ( 1 0 it e m s ) a n d b y f r i e n d s ( I 0 i te m s )( e. g, " M y f r i e n d s g iv e m e t h e m o r a l s u p p o r t I n e e d " ). T I c o e f f ic i e n ta lphas w ere .87 and .90 and T1 -T2 c o r re la t ions we re .45 and .55 , re spec-t ive ly (p < .001 fo r bo th ) .Satisfaction w ith relationships. S e v e n i t e m s a s c e r t a i n e d t h e s u b j e c t 'ss a t i sf a c t io n w i t h t h e q u a l i t y a n d t h e q u a n t i t y o f t h e i r i n t e r a c t io n s w i t hr e l a ti v e s a n d f r i e n d s (e .g , " W o u l d y o u l i k e t o s e e y o u r f r i e n d s m o r eof ten th an you do?"). Coef f ic ien t a lpha a t T1 was .68 and th e T I -T 2cor re la t io n was .60 (p < .001 ) .


4/8

S C A R S O F D E P R E S S IO N 267Availabi li ty of help. S i x i t e m s a s s e s s e d t h e p o t e n t i a l a v a i l a b i li t y o f

h e l p f r o m m e m b e r s o f t h e s u b j e c t ' s s o c i a l n e t w o r k ( e .g ., " I s t h e r e s o m e -o n e w h o c o u l d t a k e c a r e o f y o u w h e n e v e r y o u n e e d e d h e l p ? " ) . T I c o e f fi -c i e n t a l p h a w a s .7 0 w i t h T I - T 2 c o r r e l a t i o n o f . 4 6 ( p < . 00 1 ).Helping others . E l e v e n i t e m s a s s e s se d w h e t h e r t h e s u b j e c t p r o v i d e dh e l p t o t h e i r c h i l d r e n a n d / o r g r a n d c h i l d r e n ( i f p r e s en t ) i n a n u m b e rw a y s (e .g , " h e l p o u t w i t h m o n e y " ) . T I c o e f f ic i e n t a l p h a w a s . 7 4 a n dtes t - re tes t re l iab i l i ty was .61 (p < .001).Social skill. Subjec ts ra ted them se lves , u s ing a 6 -po in t sca le , on 16ad jec t ives (e.g , "popu la r" ) des ign ed to e l ic i t the sub jec t ' s se l f - ra ted so -c i a l c o m p e t e n c e . T h e s e i t e m s w e r e s e l e c t e d f r o m a p r e v i o u s s t u d y ( L e -w i n s o h n , M i s c h e l , C h a p l i n , & B a r t o n , 1 9 8 0 ). T I c o e f f ic i e n t a l p h a w a s.86 and te s t - re tes t re l iab i l i ty was .80 (p < .001) .Recreationalactivity. F i v e i te m s w e r e i n c l u d e d t o p r o v i d e a m e a s u r eo f e n g a g e m e n t i n r e c r e a t i o n a l a c t i v i t i e s . B e c a u s e o f l o w c o e f f i c i e n ta lpha ( .30 ) , each i tem was examined separa te ly . The i tems inc ludedcar in g fo r p lan ts (T I -T 2 r = .59 , p < .001) , wa tch ing te lev is ion (T1-T2r = . 76 , p ~ .001) , hobb ies (T I -T2 r = .57 , p < .001) , educa t iona l o rrec rea t io na l ac t iv i t ie s (T I -T2 r = .42 , p < .001), an d exerc is ing regu la r ly(TI-T2 r = .47, p < .001).

Enjoyment of act iv i t ies . Seven p lea san t ac t iv i t ie s (e .g, "be ing wi thf r i e n d s " ) f r o m t h e M o o d - R e l a t e d s c a l e o f t h e P l e a s a n t E v e n t s S c h e d u l e(M acPh i l lam y & Lew insohn , 1982) were ra ted fo r en joyab il i ty . Coef f i -c ien t a lpha wa s .76 and te s t - re tes t re l iab i l i ty was .67 (p < .001) .

Life sat is fact ion. T e n i t e m s a s s e s se d o n a 5 - p o i n t s c a l e t h e s u b j e c ts 'd e g r e e o f s a t is f a c t io n w i t h t h e f r e q u e n c y a n d q u a l i t y o f t h e i r a c t i v i ti e s ,a c c o m p l i s h m e n t s , f a m i l y l if e , m a r i t a l i n t e r a c t io n , a n d r e c r e a t i o it ( e. g." H o w d o y o u f e e l a b o u t h o w m u c h f u n y o u a r e h a v i n g? " ) . T h e s e i t e m sw e r e c h o s e n f r o m t h e i t e m s u s e d b y A n d r e w s a n d W i t h e y (1 9 76 ) a n dCam bel l , Co nverse , and Rogers (1976) . T1 coef f ic ien t a lpha w as .88a n d T I - T 2 c o r r e l a t i o n w a s .7 6 ( p < . 00 1 ).

Emotional rel iance and social se l f -conf idence. Th e E m o t i o n a l R e l i-a n c e a n d S o c i a l S e l f - C o n f i d e n c e s c a l e s o f t h e I n t e r p e r s o n a l D e p e n -d e n c y Q u e s t i o n n a i r e ( H i r s c h f e ld , K l e r m a n , C h o d o f f , K o r c h in , &B a r r e t , 1 9 7 6) w e r e i n c l u d e d . T h e E m o t i o n a l R e l i a n c e s c al e i s a s s u m e dt o m e a s u r e t h e n e e d f o r a t t a c h m e n t a n d d e p e n d e n c y ( e. g, " I w o u l d f e e lh e l p l es s i f d e s e r t e d b y s o m e o n e I l o v e " ) . T I c o e f f i ci e n t a l p h a w a s . 83a n d t h e T I - T 2 c o r r e l a t i o n w a s .7 1 ( p < . 00 0 ). T h e S o c i a l S el f - C o n fi -d e n c e s c a l e i s a s s u m e d t o m e a s u r e t h e w i s h f o r h e l p in d e c i s i o n m a k i n ga n d i n t h o s e s i t u a ti o n s r e q u i r i n g i n i t ia t i v e ( e. g, " I w o u l d r a t h e r b e af o l l o w e r t h a n a l e a d e r " ) . T I c o e f f ic i e n t a l p h a o f t h i s s c o r e w a s . 7 9 a n dt h e T I - T 2 c o r r e l a t i o n w a s .8 0 ( p < . 00 1 ).

P e r c e i v e d ma s t e ~ T h r e e i t e m s a s s e s s e d p e r c e p t i o n s o f c o n t r o l o v e rs o c i a l o u t c o m e s ( e& , " I n m y e x p e r i e n c e , l o n e l i n e s s c o m e s f r o m n o tt r y i n g t o b e f r i e n d ly " ) . T h e s e i t e m s h a d b e e n u s e d i n a p r e v i o u s s tu d y( A m e n s o n & L e w i u s o h n , 1 9 81 ). T I c o e f f i ci e n t a l p h a w a s . 64 a n d t h eT1-T 2 cor re la t ion was .49 (p < .001) .

Sel f-control scale . Th e S e l f - C o n t r o l S c a l e ( R o s e n b a n m , 1 9 80 ) w a si n c l u d e d a s a m e a s u r e o f l e a r n e d r e s o u r c e f u l n e s s ( M e i c h e n b a u m ,1 9 77 ; R o s e n b a u m , 1 9 80 ). L e a r n e d r e s o u r c e f u l n es s r e f e r s t o t h e r e p e r -t o i r e o f c o g n i t i v e a n d b e h a v i o r a l s k i l l s u s e d t o r e g u l a te o n e ' s t h o u g h t sa n d f e e l i n g s . T l c o e f f ic i e n t a l p h a w a s . 80 a n d t e s t - r e t e s t r e l i a b i l i t y w a s.76 (p < .001).

Effect ive and inef fect ive ant idepressive behaviors . T w e n t y - t h r e ei t e m s f r o m m e a s u r e s d e v e l o p e d b y R i p p e r e ( 1 9 76 , 1 97 7 ) a n d P a r k e ra n d B r o w n ( 1 9 7 9) , w h i c h d e s c r i b e b e h a v i o r s u s e d b y p e o p l e t o d e a lwi th s t ress fu l l i fe s itua t ions , w ere inc lude d to rep res en t "e f fec t ive" an -t i d e p r e ss i v e b e h a v i o r s ( N = 1 2) (e .g , " P l a n s o m e t h i n g p l e a s a n t " ) a n d" i n e f f e c t iv e " a n ti d e p r e s s iv e b e h a v i o r s ( N = 1 1) ( e. g, " D o s o m e t h i n gr a t h e r d a n g e r o u s " ) . F o r t h e e f f e ct i v e a n t i d e p r e s si v e b e h a v i o r s T I c o e f -f ic ien t a lpha was .79 and te s t - re tes t re l iab i l i ty was .53 (p ~ .001) , andf o r t h e i n e f fe c t i ve a n t i d e p r e s s iv e b e h a v i o r s T I c o e f f ic i e n t a l p h a w a s.81 and te s t - re tes t re l iab i l i ty was .58 (p < .001) .

Passivity behaviors. S i x i t e m s i n d i c a t i v e o f p a s s i v i t y i n t h e f a c e o f

s t r e ss ( e ~ , " W a i t t o s e e w h a t w i l l h a p p e n ~ ) w e r e s e l e c t e d f r o m t h e W a yso f C o p i n g Q u e s t i o n n a i r e ( F o i k m a n & L a z a r u s , 1 9 8 0 ). T h e T I c o e f fi -c ien t a lpha w as .50 and te s t - re tes t re l ia b i l i ty was .48 (p ~ .001) .Cognitive dysfunction. S i x i t e m s w e r e s e le c t e d f r o m t h e I n v e n t o r y o fP s y c h i c a n d S o m a t i c C o m p l a i n t s -E l d e r l y S c a l e ( R a s k i n , 1 9 79 ) t o m e a -s u r e t h e p e r c e i v e d p r e s e n c e o r a b s e n c e o f d i ff i c u lt i e s w i t h m e m o r y ,c o n f u s i o n , c o n c e n t r a t i o n , a n d t h i n k i n g ( e . g , " D o y o u h a v e tr o u b l e r e -m e m b e r i n g t h i n g # ' ) . T I c o e f f i c i e n t a l p h a w a s .7 1 a n d t e s t - r e t e s t r e li -ab i l i ty was .68 (p < .001) .Dysphoria. U s i n g f o u r i t e m s f r o m a p r e v i o u s l y d e v e l o p e d s c a l e ( L e -wi nsoh n e t a l , 1980) , the sub jec ts ra ted th e i r nega t ive a f fec t leve l . T Icoef f ic ien t a lpha w as .67 and the T I -T 2 co r re la t io n was .75 (p ~ .001) .Use o f caf fe ine, tobacco, andaicohol . T h r e e i t e m s w e r e u s e d t O a s s e s st h e p r e v i o u s ly m e n t i o n e d a d d i c t i v e b e h a v i o r s . T I c o e f f ic i e n t a l p h awas .37 and the te s t - re tes t co r re la t ion was .83 (p ~ .001) .Social desirability. T e n i t e m s f r o m t h e C r o w n e - M a r l o w e S o c i al D e -s i rab i l i ty Sca le (Crowne & Mar lowe , 1960) were inc luded . T l coef f i -c ien t a lpha w as .68 and te s t - re tes t re l iab i l i ty was .74 (p ~ .001) .ln frequency. F i v e it e m s w e r e i n c l u d e d f r o m t h e I n f r e q u e n c y s c a l e(e .g , "At t im es w hen I w as i l l o r t i red , I have fe l t l ike go ing to bed ea r ly" )o f t h e P e r s o n a l i t y R e s e a r c h F o r m ( J a c k so n , 1 9 7 4) t o i d e n t i fy s u b j ec t sw h o m i g h t h a v e r e s p o n d e d r a n d o m l y t o t h e q u e s t i o n n a i r e .Interview Measures

A n u m b e r o f o t h e r m e a s u r e s w e r e a d m i n i s t e re d a t t h e T l , p o s t - T l ,a n d T 2 i n t e rv i e w s . T h e f o l l o w i n g it e m s w e r e o f i n t e r e s t in t h e p r e s e n tstudy.Health screening quest ionnaire . A b r i e f i n t e r v i e w a s s e s se d t h e p r e s -e n c e a n d s e v e r i ty o f s i g n i f i c an t h e a l t h p r o b l e m s ( e. g, i n f l a m m a t o r Yj o i n t d i s e a s e , l u n g d i s e a s e , t h y r o i d o r g l a n d u l a r d i s ea s e ) . T h e t o t a ln u m b e r o f h e a l t h p r o b l e m s s u b j e c t s h a d e x p e r i e n c e d , l a b e l e d " d i s -eases , " had a T1-T 2 cor re la t ion o f .62 (p ~ .001) . In add i t ion , th ei n t e r v i e w e r r a t e d " g l o b a l h e a l t h " o n a 6 - p o i n t s c a l e ra n g i n g f r o m e x c e l -l e n t t o t o t a l l y i m p a i r e d . T h i s r a t i n g w a s b a s e d o n o v e r a l l p a t t e r n a n dsever i ty o f i l lness , l imi ta t io ns on ac t iv i ty , am oun t o f exerc ise , and de -g r e e o f d i s a b i l i t y o r f u n c t i o n a l i m p a i r m e n t . T h e T I - T 2 c o r r e l a t i o n o fth is second va r iab le was .46 (p ~ .001) .Brown ln t ima cy Sca le . This sca le (B rown & H arr i s , 1978) assessedt h e p r e s e n c e o f a c l os e a n d c o n f i d i n g r e l a t io n s h i p i n t e r m s o f d e g r e e o fi n t im a c y , p h y s i c a l p r o x i m i t y , a n d f r e q u e n c y o f c o n t a c t . S u b j e c t s w e r ea s k e d t h r e e q u e s t i o n s r e g a r d i n g w h o t h e y w o u l d f i r s t d i s c u s s a p r o b -l e m w i t h , a d d i t i o n a l c o n f i d i n g r e la t i o n s hi p s , a n d t h e e x t e n t a n d e a s e o fc o m m u n i c a t i o n w i t h t h e s e i n d i v i d u a l s . R a t i n g s w e r e m a d e o n a 4 -p o i n t s c a l e a n d t h e T 1 - T 2 c o r r e l a t i o n w a s . 47 ( p ~ . 00 1 ).Interpersonal At traction Measure. Th e s o c i a l i m p a c t o f t h e s u b je c ti n f a c e - t o - fa c e i n t e ra c t i o n w a s a s s e s s e d b y h a v i n g t h e i n t e r v i e w e r c o m -p l e t e t h e I n t e r p e r s o n a l A t t r a c t i o n M e a s u r e ( M c C r o s k e y & M c C a i n ,1 9 74 ). T h i s i n s t r u m e n t c o n s i s t e d o f 17 i t e m s t h a t m e a s u r e d p h y s i c a la t t r a c t io n , t a s k a t t r a c t io n , a n d f r i e n d s h i p a t t r a c t i o n ( e. g , " I t h i n k h e /s h e c o u l d b e a g o o d f r i e n d o f m i n e " ) r a t e d o n a 7 - p o i n t s ca l e . T 1 c o e f fi -c i e n t a l p h a w a s .9 4 a n d t h e T I - T 2 c o r r e l a t i o n w a s . 20 ( p ~ . 00 1 ).M enta l S ta tus Ques t ionna ire . T h i s s t a n d a r d b r i e f m e n t a l s t a t u ss c r e e n i n g ( K a h n & M i l l e r, 1 9 7 8) a s s e s s e d o r i e n t a t i o n f o r p l a c e a n dt i m e , r e c e n t a n d r e m o t e m e m o rY , a n d g e n e r a l i n f o r m a t i o n . T w o s u b-j e c t s w e r e d e s e l e c t e d b a s e d o n p e r f o r m a n c e o n t h e M e n t a l S t a t u sQ u e s t i o n n a i r e a n d t h e H a l s t e a d - W e p m a n A p h a s i a S c r e e n in g T e s t .Halstead-Wepman /4~hasia Screening Test . T h i s s t a n d a r d 6 - p o i n ta p h a s i a s c r e e n i n g i n s t r u m e n t ( H a l s t e a d & W e p m a n , 1 9 4 9 ) a s s e s s e dt h e p r e s e n c e o f a p r a x i a s a n d a g n o s ia s .

ResultsOverview o f Analyses

D a t a a n a l y s e s w e r e s e q u e n t i a l . T o i d e n t i f y t h e s e t o f d e p r e s -s i o n - r e la t e d v a r i a b l e s a m o n g w h i c h s c a r s o r t r a i t m a r k e r s w o u l d


5/8

268 P. ROHDE, P. LEWINSOHN, AND L SEELEYmost likely be found, the correlation of all variables with theCES-D score at T1 and a dummy variable (0,1) based onwhether a subject was never depressed (n = 351) or depressed atTI (n = 73) was computed. The new cases (n = 49) and thenever-depressed group were then compared on demographicvariables, self-reported depression levels at TI and T2, an d onall depression-related variables at T2 (controlling for age,gender, and self-reported depression level). Because of the possi-bility that scars or trait markers would be measurable only inthose subjects experiencin g high levels of stress, the depression-related variables were ex amined for both significant main ef-fects and interactions with stress in predicting diagnosticgroup. Because of m issin g data, grou p size varied slightly acrossanalyses.

The abs ence of a significant difference between the newcases and the never-depressed group at T2 on a depression-re-lated variable would be inconsiste nt with both the scar and thetrait marker hypotheses. All v ariables that significantly differ-entiated between the two diagnostic groups at T2 were thenexamined at TI. In addition, variables that distinguished thetwo diagno stic groups at T2 were investigated using repeated-measures analysis of covariance to note whether a significantchange in the characteristic had occu rred from T1 to T2. Theo-retically, a scar should not disting uish he new cases from never-depressed controls at T1, should distinguish the two groups atT2, and shoul d significantlychange in individuals as a result ofbeing depressed (i.e., the variable should show significantchange from T1 to T2 for the ne w cases). O n the ot her han d, atrait ma rker shou ld significantly disti nguis h new cases fromnever-depressed controls at both T1 and T2.Selec t ion o f Variab les for Fur the r Ana lys i s a ndDemograph ic Di f f erences

All variables were first correlated with CES-D at T1 and witha d ummy variable based on diagnostic status at TI (never de-pressed = 0, depressed at TI = 1). These correlatio ns are shownin Table 2.

To be included for further consideration, the variable had tobe significantly p < .05) correlated with both CES-D and diag-nosis at T1. As expected, almost all of the variables met thiscriterion. The exceptions were occurrence of major stressfulevents to significant others, pr ovidi ng assistance to one's chil-dren and grandchildren, caring for houseplants, amou nt of tele-vision viewing, number of hobbies, reported use of effectiveantidepressant behaviors, and use of cigarettes, alcohol, andcaffeinated beverages. A set o f 26 depression-related variablesrema ined available for further study.

Next, the new cases and never-depressed groups were com-pared on demographic variables and the CES-D at both TI andT2. The new cases tende d to be young er (61.7 vs. 64.9), F(I,398) = 8.64, p < .004, and were more likely to be w ome n (71.4%vs. 49.0%) 2(1, N = 400) = 7.79, p < .005. The ne w cases werealso more likely than the never-depressed controls to be em-ployed r ather th an retir ed (45.8% vs. 25.7%), 2(1, N = 400) =7.46, p < .01. This e mplo ymen t status difference was signifi-cant even after cont rollin g for the effects of age (partial r, con-trollin g for age = -. 09 , p < .040).

Differences in CES-D scores between the two diagnostic

Table 2Correlation of Variables With C ES-D Score at T ime 1 an d theDiagnosis of Depression at Tim e IVariable CES-D Diagnosis

S t r e s sStress to self .16"** .14*Stress to others .02 .004Microstress .17*** .27***Social support and interactionSocial support network - . 19*** -.20"**Support from family - . 17*** -.20"**Support from friends -.10.** -. 10 .Relationship satisfaction - . 19*** -.22"*Availability of help - . 13*** - . 17"**Helping others -.03 -.01Social skill -.25*** - . 10.Brown Intimacy Scale .21"** .32***Interpersonal attractiveness - . 13*** -.09*Recreational activityCare for plants .03 -.03Time spent watching television .06" -.01Hobbies .03 .10.Educational/recreational activity .12*** .10"Regular exercise .06* .10.PersonalityPerceived mastery .16"** .15***Emotional reliance .29*** .24***Social self-confidence -.35"** - . 16***Life satisfaction -.48"** -.51"**Enjoyment of activities -.21 *** - . 17***Social desirability .14*** .14**Coping styleSelf-control scale - . 18*** - . 17***Effective behaviors -.05* .01Ineffective behaviors -.20*** - . l 7***Passive behaviors -.22*** - . 16***Health and pathologySelf-rated health -.33*** -.32***Diseases .12*** .18***Global health .24*** .18***Caffeine, tobacco, and alcohol use -.03 .08Dysphoria .44*** .37***Cognitive dysfunction -.34*** -.33***

Note. CES-D = Center for Epidemiological Studies Depression Scale.*=p~.05. **=p


6/8

SCARS OF DEPRESSION 269p o s s i b i l i t y t h a t T 2 d i f f e r e n c e s b e t w e e n t h e n e w c a s e s a n dn e v e r - d e p r e s s e d c o n t r o l s m i g h t b e o b s e r v a b l e o n l y i n t h o s e s u b -j e c t s e xpe r i e nc i ng h i gh l e ve l s o f s t r es s , a s ing l e c om p r e he n s i vem e a s u r e o f s t re s s w a s c o m p u t e d f o r e a c h s u b j e c t b y s t a n d a r d i z -i n g a n d s u m m i n g m e a s u r e s a s s es s in g m a c r o s t r e ss a n d m i c r o -s t r e s s ; t h e m e d i a n w a s u s e d t o d e f i n e h i g h - a n d l o w - s t r e s sg r o u p s . N o s i g n i fi c a n t d i f fe r e n c e w a s p r e s e n t i n t h e p r o p o r t i o no f h i g h - s tr e s s i n d i v i d u a ls w i t h i n t h e n e w c a s e s v e r s u s n e v e r- d e -p r e s s e d g r oups , x2 (l , N = 4 00 ) = 2 .43 ns . Tw o ( N e w C a s e s ,N e v e r D e pr e s s e d ) t w o ( H i gh , L ow s t r es s ) AN CO VA Sw e r e c o m -p u t e d ; a g e , g e n d e r, a n d T 2 C E S - D w e r e e n t e r e d a s c o v a r ia t e s.

Fo r t h r e e va r i a b l e s a s i gn i f i c a n t m a i n e f f e c t f o r d i a gnos t i cg r o u p w a s p r e s e n t , a n d o n e o f t h e v a r i a b l e s a l so h a d a s ig n i fi -c a n t D i a g n o s t i c G r o u p S t r e s s i n t e r a c t i o n . C o m p a r e d w i t ht h e n e v e r - d e p r e s se d c o n t r o l s , n e w c a s e s a t T 2 r a t e d t h e m s e l v e sa s l ow e r on he a l t h , F ( 1 ,360 ) = 7 .01 , p = . 008 , a nd s oc i a l s k i l l,F ( I , 3 7 6 ) = 4 . 4 5 , p = . 0 3 6 , a n d h i g h e r o n e m o t i o n a l r e l ia n c e o no t he r s , F ( I , 376 ) = 4 .94 , p = . 027 . Th e on l y in t e r a c t i on w i t hs t r e s s t ha t a t t a i ne d s t a t i s t i c a l s i gn i f i c a nc e w a s e m ot i ona l r e l i -a nc e o n o t he r s , F ( I , 3 76 ) --- 6 . 71 , p = . 010 . Ex a m i na t i o n o fg r o u p m e a n s i n d i c a t e d t h a t i n t h e l o w - s tr e ss c o n d i t i o n t h e n e wc a s e s a n d n e v e r - d e p r e s s e d c o n t r o l s h a d s i m i l a r e m o t i o n a l r e l i-a n c e s c o re s , b u t i n t h e h i g h - st r e ss c o n d i t i o n t h e n e w c a s e s a t -t a i n e d h i g h e r s c o re s c o m p a r e d w i t h t h e n e v e r - d e p r e s s e d g ro u p .

G i v e n t h e n u m b e r o f c o m p a r i s o n s a n d t h e T y p e I e r r o r ra t ep e r c o m p a r i s o n (17 < . 0 5) , o n e o r m o r e s i g n i f ic a n t f in d i n g sw e r e e x p e c t e d s o l e ly b y c h a n c e . U s i n g t h e B o n f e r r o n i c o r r e c -t i o n f o r a n e x p e r i m e n t - w i d e T y p e I e r r o r r a t e o f . 0 5 , e a c h c o m -p a r i s o n w o u l d n e e d t o b e s i g n if i ca n t at a p p r o x i m a t e l y p < . 0 0 2.W i t h t h i s m o r e r e s tr i ct iv e c r i t e ri o n , n o n e o f t h e v a r i a b l es w o u l dbe c ons i de r e d t o s i gn i f i c a n t l y d i f f e r e n t i a t e be t w e e n t he ne wc a s e s a n d t h e n e v e r - d e p r e s s e d c o n t r o l s a t T 2 . C o n s e q u e n t l y ,w h i l e w e c h o s e t o p r o c e e d w i t h f u r t h e r a n a l y s e s , t h e f i n d in g sn e e d t o b e i n t e r p r e t e d w i t h c a u t i o n p e n d i n g c r o s s - v a li d a ti o n .D i f fe r e n ce s B e t we e n t h e Ne w C a s e s a n d Ne v e r - D e pr e s se dCo n t r o l s a t T1 o n P o t e n t i a l S c a r s o r Tr ai t M a r k e r s a n dCh ang e in Var iab les Across T i m e

T o d i s c r i m i n a t e s c a r s f r o m t r a i t m a r k e r s , t h e t h r e e v a r i a b le st ha t s i gn i f i c a n t l y d i f f e r e n t i a t e d t he ne w c a s e s f r om ne ve r - de -p r e s s e d c o n t r o l s a t T 2 w e r e e x a m i n e d a t T I , a g a i n u s i n g A N -COVAc o n t r o l l i n g f o r T1 C E S - D , a g e , a n d g e n d e r. T h e s e a n a l y s e ss u g g e s t t h a t s e l f - p e r c e i v e d s o c i a l s k i ll f i t t h e s c a r p a t t e r n ,w he r e a s s e l f - r a t e d he a l t h a nd e xc e s s i ve e m ot i ona l r e l i a nc e f i tt h e t r a i t m a r k e r p a t t e r n . A t T I , n e w c a s e s d i d n o t s i g ni f ic a n tl yd i f f e r f r om ne ve r - de p r e s s e d c on t r o l s on s e l f - pe r c e i ve d s oc i a l

s k i l l, e i t he r a s a m a i n e f f ec t , F ( l , 3 87 ) = . 5 l , n s , o r i n i n t e r a c t i onw i t h s tr e ss , F ( I , 3 8 7 ) = 2 . 3 4 , n s . O n t h e o t h e r h a n d , t h e n e wc a s e s a t T l r e po r t e d p oo r e r s e l f -r a t e d he a l t h , F ( l , 387 ) = I 1 .27 ,p = . 0 0 1 , a n d g r e a t e r e m o t i o n a l r e l i a n c e o n o t h e r s , F ( I , 3 8 7 ) =8 . 5 3 , p = . 0 04 . T h e i n t e r a c t i o n b e t w e e n e m o t i o n a l r e li a n c e a n ds t r e s s l e ve l a ga i n a t t a i ne d s i gn i f i c a nc e , F ( l , 387 ) = 5 .79 , p =. 0 1 7 , s u g g e s t i n g t h a t n e w c a s e s a t T 1 e x p e r i e n c i n g l o w s t r e ssw e r e s i m i l a r t o t h e n e v e r - d e p r e s s e d c o n t r o l s, w h e r e a s h i g h -s t r e s s ne w c a s e s r e po r t e d a s i gn i fi c a n t l y g r e a t e r ne e d f o r a t t a c h -m e n t a n d d e p e n d e n c y o n o t h e r s c o m p a r e d w i t h t h e h i gh - st re s sn e v e r - d e p r e s s e d c o n t r o ls . G r o u p ( N e w C a s e s, N e v e r D e -p r e s s e d ) T i m e ( TI , T2 ) r e pe a t e d - m e a s u r e s A N CO VA Sw i t h a ge ,

g e n d e r , a n d C E S - D a s c o v a r i a t e s e x a m i n e d w h e t h e r t h e v a r i -a b l e s s i g n i f i c a n t l y c h a n g e d a c r o s s t i m e . A s e x p e c t e d , t h eG r o u p T i m e i n t e ra c t i o n w a s n o n s i g n i f i c a n t fo r b o t h s e lf -r a t e d h e a l t h , F ( I , 3 8 5 ) = . 1 8 , n s , a n d e m o t i o n a l r e l ia n c e , F ( 1 ,387 ) = . 41 , n s , w h i l e t h i s i n t e r a c t i on a t t a i ne d s i gn i f i c a nc e f o rs e l f -pe r c e i ve d s oc i a l sk i l l, F ( 1 ,3 84 ) = 4 .07 , p = . 044 . V i s ua le x a m i n a t i o n o f t h e g r o u p m e a n s i n d i c a t e d t h a t t h e n e v e r- d e -p r e s s e d i n d i v i d u a l s w e r e e s se n t ia l ly u n c h a n g e d a c r o s s ti m e a n ds i m i l a r t o t h e n e w c a s e s at T I , w h i l e t h e n e w c a s e s t e n d e d t or a t e t he m s e l ve s a s l e s s s oc i a l l y c om pe t e n t a f t e r t he de p r e s s i vee p i s ode .

D i s c u s s i o nT h e p r e s e n t s t u d y e x a m i n e d t h e s e q u e l a e o f d e p re s s i o n , a t-

t e m p t i n g t o d i s t i n g u i s h c o n s e q u e n c e s o f d e p r e s s i o n f r o m c o n -c o m i t a n t s i n a s a m p l e o f o l d e r i n d i v id u a l s f r o m t h e g e n e r a lc o m m u n i t y . W e r e a s o n e d t h a t d i f fe r e n c e s b e tw e e n f o r m e r l y d e -p r e s s e d a n d n o n d e p r e s s e d i n d i v i d u a l s c o u l d r e p r e s e n t e i t h e rs c a r s ( no t p r e s e n t be f o r e t he f i r s t e p i s ode a nd t he r e f o r e i n t e r -p r e t e d a s a r e s u l t o f h a v i n g b e e n d e p r e s s e d ) o r t r a it m a r k e r s( p r e s e n t be f o r e t he f i r s t de p r e s s i ve e p i s ode ) . A s e xpe c t e d , t hem a j o r i t y o f a s s es s e d v a r i a b le s d i s c r i m i n a t e d b e t w e e n c u r r e n t l yd e p r e s s e d a n d n o n d e p r e s s e d i n d i v id u a l s ; h o w e v er , o n l y t h r e eo f t h e s e v a r i a b l e s c o n t i n u e d t o d i f f e r en t ia t e i n d i v i d u a l s w h oh a d r e c o v e r e d f r o m t h e i r f i rs t d e p re s s iv e e p i s o d e f r o m n e v e r -de p r e s s e d c on t r o l s .

B e f o r e r e v i e w i ng t he s e f i nd i ngs i n g r e a t e r de t a i l , a s pe c t s o ft h e s t u d y t h a t l i m i t t h e g e n e r a l iz a b i l it y o f t h e f i n d in g s s h o u l db e n o t e d . T h e p r i m a r y d i a g n o s t i c g r o u p o f in t e r es t , t h e n e wc a s e s, w a s c o m p r i s e d o f i n d i v i d u a ls w h o d e v e l o p e d t h e i r f i rs te p i s od e o f de p r e s s i on r e l at i vel y la t e i n l if e. Th i s s a m p l e t hu sr e p r e se n t s a r e l at iv e ly u n i q u e g r o u p i n t h a t m o s t d e p r e s s e d i n d i -v i d u a l s e x p e r i e n c e t h e i r f i rs t e p i s o d e b e t w e e n t h e a g e s o f 2 0a n d 4 0 ( L e w i n s o h n , H a u t z i n g e r , & D u n c a n , 1 9 84 ). I n c o n t r a s tt o t he p r e s e n t f i nd i ngs , f o r m e r l y de p r e s s e d a d o l e s c e n t s w e r ef o u n d t o d i f f e r f r o m n e v e r - d e p r e ss e d c o n t r o l s o n a n u m b e r o fp s y c h o s o c i a l c h a r a c t e r is t i c s ( L e w i n s o h n , H o p s , R o b e r t s , &Se el ey , 1988). I t i s pos s i b l e t ha t , c om pa r e d w i t h yo ung e r i nd i v i d -ua l s , t he t r a i t m a r k e r s f o r de p r e s s i on i n o l de r ind i v i dua l s w hobe c om e de p r e s s e d f o r t he f i r st t i m e l a t e r i n l i f e a r e l e s s e v i de n to r e v e n a b s e n t .

A n o t h e r a s p e c t o f t h e s t u d y t h a t p o t e n t ia l l y l im i t s g e n e r a l iz -a b i li ty i s t h e l e s s t h a n o p t i m a l r e li a b il it ie s o f s o m e o f t h e m e a -s u r e s de ve l op e d s pe c i f i c a l ly f o r t h i s s tudy . Thu s , ou r p r e d om i -na n t l y ne ga t i ve r e s u l t s m a y be pa r t i a l l y a t t r ibu t a b l e t o p s yc h o-m e t r i c l i m i t a t io n s o f th e m e a s u r e s . N o n e t h e l e s s , i t s h o u l d b ee m p h a s i z e d t h a t t h e s t u d y w a s r e s t r ic t e d t o o n l y v a r i a b le s t h a tw e r e f ir s t fo u n d t o b e a s s o c i a t e d w i t h c o n c u r r e n t d e p r e s s io n . I na dd i t i on , w h i l e a va r i e t y o f de p r e s s e d - r e l a te d v a r i a b l e s w e r ee x a m i n e d , o t h e r p o s s i b le c o n s t r u c t s c o u l d h a v e b e e n a s s e ss e da s po t e n t i a l s c a r s .

A s e x p e c t e d , t h e n e w c a s e s w e r e m o r e l ik e l y t o b e y o u n g e r ,f e m a l e , a nd a l r e a dy m i l d l y dys phor i c . The s e d i f f e r e nc e s r e p l i -c a t e d e a r li e r f in d i n g s ( A m e n s o n & L e w i n s o h n , 1 9 8 1 ; A n e s h e n -s el, 1 9 8 5 ; D e p u e & M o n r o e , 1 9 8 6 ; L e w i n s o h n , H o b e r m a n , &R os e nba um , 1988 ; R ohde , I . ~w i ns ohn , T i l s on , & Se e l e y , 1990)a n d a r e c o n c e p t u a l i z e d a s r i s k f a c t o rs f o r d e p r e s s io n . T h e f i n d -i n g t h a t t h e n e w c a s e s r e p o r t e d s i g n i f i c a n t l y h i g h e r C E S - D


7/8

270 P. ROHDE, P. LEWINSOHN, AND J . SEELEYs c o r e a t b o t h T I a n d T 2 e m p h a s i z e s t h e i m p o r t a n c e o f c a r e f u lm e a s u r e m e n t a n d c o n t r o l o f d e p r es s i o n i n " r e c o v e r e d " su b -j e c ts . A n e w r i s k f a c to r - -- - e m p l o y m e n t a s o p p o s e d t o r e t i re m e n t- - w a s i d e n ti f ie d i n t h e p r e s e n t s tu d y , s u g g e s t i n g th a t b e i n g e m -p l oye d p l a c e s t he e l de r l y a t g r e a t e r r i s k f o r be i ng de p r e s s e d .B e i n g e m p l o y e d i n t h e e l d e rl y c o u l d b e e i t h e r c a u s a ll y r e l a te d t od e p r e s s io n o r a s s o c i a te d w i t h a n t h i r d f a c t o r t h a t c o n t r i b u t e sb o t h t o b e f u t u r e d e p r e s s io n a n d b e i n g e m p l o y e d ( e.g . f i n a n c ia lnecess i ty) .

A l a r g e n u m b e r o f st a ti s ti c a l c o m p a r i s o n s w e r e m a d e , a n dt h e m o s t c o n s e r v a t iv e i n t e r p r e ta t i o n o f t h e r e s u l ts i s t h a t o n c et h e e f f ec ts o f ag e , g e n de r , a n d m i l d d e p r e s s i o n a r e c o n t r o l le d n op s y c h o s o c i a l s c a r s a r e p r e s e n t a s a c o n s e q u e n c e o f b e i n g d e -p r e ss e d . C o m p a r e d w i t h t h e n e v e r d e p r e s s ed , t h e f o r m e r l y d e -p r e s s e d g r o u p d i d n o t d i f f e r o n s u c h d e p r e s s io n - r e la t e d p s y c h o -s oc i a l va r ia b l e s a s s t re s s , s oc i a l s up por t a n d s oc i a l ne t w or k , a ndc op i ng s ty le . W hi l e t h i s i s c ons i s t e n t w i t h ou r p r e v i ous f i nd i ngs( e .g , Le w i ns ohn e t a l ~ 1981 ; Ze i s s & Le w i ns ohn , 1988) t ha tf o r m e r l y d e p r e ss e d i n d i v i d u a ls d o n o t d i ff e r f r o m n o n d e -p r e s s e d c on t r o l s , a s i nd i c a t e d e a r l ie r , t he i n t e r p r e t a t i on o f t he s en e g a ti v e r es u l ts n e e d s t o b e t e m p e r e d b y t h e c h a r a c t e r i s ti c s o ft h e s a m p l e a n d t h e n a t u r e o f t h e m e a s u r es . H o w e v e r , it a l s on e e d s t o b e e m p h a s i z e d t h a t i n c o r p o r a t i n g t h e s t r e ss a c t iv a t i o nm o d e l i n t o t h e a n a l y s e s h a d l it tl e i m p a c t o n t h e f i n d i n g s, w i t ho n e e x c e p ti o n .

A l e s s c ons e r va t i ve i n t e r p r e t a t i on o f ou r f i nd i ngs i s t ha t on ec o n s e q u e n c e o f h a v i n g b e e n d e p r e s s e d i s th a t i n d i v i d u a l s v i e wt he m s e l ve s a s l e s s s oc i a l l y s k i l le d . I n a d d i t i on , t he n e w c a s e sr a t ed t h e i r h e a l t h a s p o o r e r b o t h b e f o r e a n d a f t e r t h e e p i s o d e .G i v e n t h e l a c k o f d if f e re n c e s b e t w e e n t h e n e w c a s e s a n d t h ec o n t r o l s o n m o r e o b j e c ti v e m e a s u r e s o f h e a l t h a n d s o c i a l s k il l,p o o r e r h e a l t h a n d s o c i a l in c o m p e t e n c e m o s t l i k el y a r e a t tr i b u t -a b l e t o a m o r e ne ga t i ve s e l f - a pp r a is a l . I n a dd i t i on , a s s ugge s t e dby o t he r s ( H i r s c h f e l d e t a l , 1983 ; I - I i r s c h f e l d , K l e r m a n , C l a y -t o n , K e l l e r , & A n d r e a s o n , 1 9 8 4 ; R e i c h , N o y e s , H i r s c h f e l d ,C o r y e l l , & O ' G o r m a n , 1 9 8 7 ), i n d i v id u a l s p r o n e t o d e p r e s s io nm a y h a v e a g r e a t er n e e d f o r c o n t a c t w i t h a n d e m o t i o n a l s u p p o r tf r o m o t h e r s , b o t h b e f o r e a n d a f t e r b e i n g d e p re s s e d . T h e p r e s e n ts t u d y i s th e o n l y o n e , t o o u r k n o w l e d g e , t h a t p r o v i d e s p r o s p e c -t i ve e v i de nc e t ha t e xc e s s i ve e m ot i on a l r e l i a nc e on o t he r s m a yb e a t r a it m a r k e r f o r d e p re s s i o n .

A n u m b e r o f d i re c t i o n s f o r f u t u r e r e s e a r ch a r e s u g g e s t e d . I t isp o s s ib l e t h a t r e s id u a l e f fe c ts o f h a v i n g b e e n d e p r e s s e d a r e m o r ee v i de n t i n i nd i v i dua l s w i t h a n e a r l i e r a ge o f f ir s t de p r e s s i ono n s e t o r a m o n g i n d i v i d u a l s w i t h m o r e n u m e r o u s d e p r e s s i v ee p i s o d e s i n t h e p a s t. F u t u r e s t u d i e s c o m p a r i n g p e r s o n s w i t h a ne a r l y o n s e t o r m u l t i p le e p i s o d e s w i t h r e le v a n t c o n t r o l g r o u p sa r e r e c om m e nde d . I t i s a l s o pos s i b l e t ha t d i f f e r e nc e s i n t hef o r m e r l y d e p r e s s e d a r e m o o d - s t a t e d e p e n d e n t ( M i r a n d a & P e r -s ons , 1988). T o t he e x t e n t t ha t d i f f e r e nc e s c a n be r e l i a b l y ide n t i -f ie d , s u c h k n o w l e d g e c a n a s s i s t i n t h e d e v e l o p m e n t o f p r e v e n t a -t ive i n t e rve n t i ons , w h i c h , by m od i f y i ng t he s e f a c t o rs , m a y r e -d u c e t h e p r o b a b i l i ty o f fu t u r e r e la p s e . I t m a y a l s o b e i m p o r t a n tt o i n c l u d e o t h e r v a r i ab l e s i n s t u d i e s o f t h i s n a t u r e , e s p e c i a ll y i nt h e a r e a s o f i n te r p e r s o n a l d e p e n d e n c e , i n tr o v e r si o n , m a r i t a ld i s t r e s s , a nd s oc i a l i n t e g r a t i on , a s s ugge s t e d by B a r ne t t a ndG o t l i b ( 19 88 ). W h i l e t h e p s y c h o s o c i a l s c a rs o f d e p r e s s io n a p -pe a r t o be r a t h e r e lu s ive , i nd i v i dua l s w h o ha ve be e n de p r e s s e di n t h e p a s t a n d t h o s e a t e l ev a t e d ri s k o f b e c o m i n g d e p r e s s e d

c o n s i s t e n t ly r e p o r t a n e l e v a te d n u m b e r o f d e p re s s iv e s y m p -t o m s , e v e n t h o u g h n o t i n a d i a g n o s a b l e e p i s o d e. P e r h a p s t h i sm o d e r a t e , c h r o n i c d e m o r a l i z a t i o n r e p r e s en t s t h e p r i n c i p a l r i skf a c t o r f o r f u t u r e de p r e s s i on . O n c e i t is s t a t i s ti c a l l y c on t r o l l e d ,a n y d i f f er e n c e s b e t w e e n f o r m e r l y a n d n e v e r - d e p re s s e d g r o u p sare negl ig ible .

ReferencesAltman , J. H , & Wittenborn, J. R. (1980). Depression-p rone p ersonal-i ty in wom en. Journal o f Abno rmal Psychology, 89 , 303-308.Amenson, C. S, & Lewinsohn, E M. (1981). An investigation into theobserved sex difference in prevalence of unipolar d epression. Jour-na l o f Abnormal Psycho logy , 90, 1-13,Andrews, E M , & W ithey, S. B. (1976). Social indicators of well-being:Americans 'percept ions of li fe qual i ty . New Y ork: Plenu m Press.Aneshensel , C. S. (1985). The natural history o f depressive symptoms:Implications for psychiatric epidemiology. In J. R. Greenley (Ed.),R e s e a r c h i n c o mmu n i t y a n d me n t a l h e a l t h (Vol. 5) (pp. 45-75).Greenw ich, CT." JAI P ress.Barnett, P. A . & Gotlib, I. H. (1988). Psycho social functioning an ddepression: D istinguishing am ong antecedents, concom itants, an dconsequences. Psychological Bulle t in , 1 04, 97-126.Billings, A. {3, & Mo os, R. H . (1985). Psycho social processes o f remis-sion in unipolar depression: Co mp aring depressed pat ients withmatched com mu nity controls. JournalofConsul t ingandClinicalPsy-chology, 53, 314-325.Blackburn, I . M , & Smyth, P. (1985). A test o f cognitive vulnerability inindividuals p rone t o depression. Brit ish Journal o f Clinical Psychol-ogy, 24, 61--62.Brow n, G., & Harris, 1". (1978 ). Social origins of depression: A s tudy ofpsychiatric disorder in wom en. New York: Free Press.Cam pbell, A., Converse, P. E., & R ogers, W. L. (1976). The qua l it y o f

American l i fe . New York: Russel l Sage.Cofer, D H., & Wittenborn, L R. (1980). Personality characteristics o fformerly depressed women. Journal of Abnormal Psychology, 89,3 0 9 - 3 1 4 .

C o h e n , J . I 6 0 ) . A c o ef f ic i en t f g r e e m e n t f o r o m i n a l s c a l e s. d u c a -t i o u a l n d P s y c h o l o g i c a l e a s u r e m e n t , 2 0 , 3 7 - - 4 6 .

C r o w n e , D . P ., M a r l o w e , D . ( 1 9 6 0) . n e w s ca l e f s o c i al e s ir a bi l it yi n d e p e n d e n t o f p s y c h o p a th o l o g y . J o u r n a l f o n s u l t i n g s y c h ol o g y ,2 4 , 3 4 9 - 3 5 4 .

D e p u e , R . A , & M o n r o e , S . M . ( I 8 6 ) . o n c e p t u a l i za t i o n a n d m e a s u r e -m e n t of hum an disorder and l i fe stress research: The problem o fchronic disturbance. Psychological Bulletin, 99, 36-51.Eaves, G, & Rush, A. J . (1984). Cognit ive pat terns in symptomatic andremittent unipolar ma jor depression. Journal of Abnormal Psychol-ogy, 93, 31-40.Endicott, J~ & Spitzer, R. L. (1978), A diagnostic interview: Th e sched-ule for affective disorders and schizophrenia. Arch ives o f G eneralPsychiatry, 35, 837-844.Folkman, S. & L azarus, R. S. (1980). An analysis o f coping in a middle-aged com mun i ty sample. Journal of Health and Social B ehavior, 21,219-239.Gonzales, L~ Lewinsohn, P. My & C larke, G. (1985). Longitudinalfol low-up of unipolar depressives: An investigation o f predictors o frelapse. Journal o f Consul ting an d C linical Psychology, 53, 461-469.Halstead, W. D, & Wepm an, J . M. (1949). Th e Halstead-Wepm an apha-sia screening test. Journal of Speech a nd H earing Disorders , 14, 9-15.Ham ilton, W. W~ & Abram son, L. Y. (1983). Cognitive patte rns a ndm ajor depressive disorder: A long itudinal study in a hospital setting.Journa l o f Abnorm al Psychology, 92 , 173-184.

Hirschfeld, R. M. A., Klerman, G. L, Chodoff , P, Korchin, S, &


8/8

S C A R S O F D E P R E S SI O N 271Barret, J . (1976). Dependency, self-esteem , and clinic al depression .Journal of he American A cade my of Psychoanalysis, 4, 373-388 .Hirschfe ld , R . M. A , K le rm an , G. L , Clay ton , P . J , & K el le r, M. B.(1983). Perso nality and dep ression: Em piric al findings. Archives ofGenera l Psychiatry, 40, 993-998 .Hirschfe ld , R . M , Kle rm an , G. L , Clay ton , P. J , Ke l le r, M. B , &An dreaso n, N. N. C. (1984). Perso nality and gende r-related differ-ences in depression. Journal o f Affective Disorders, 7, 211-22 1.Holmes , T . H, & Rahe , R . H . (1967) . The soc ia l read jus tment ra t ingscale. Psychosomatic M edicine, 11, 213-218.Jackson, D. N. (1974). Personality research form ma nua l (revised ed.).Por t Huron , M I: Research Psychologists .Kahn , R , & M il le r , N. (1978) . Assessment o f a l te red b ra in func t ion inthe aged. In M. S torand t, I. Siegler, & M. E. Elias (Eds.), The cl inicalpsychology o f aging (pp . 43-70) . New York : P lenum.Keller, M. B . Sha piro, R. W , Lavori, E W . & Wolfe, N. (1982). Recoveryin major depress ive d isorder. Archives ofGeneralPsychiat~ 39, 9 0 5 -910.Lewinsohn , P . M , Hantz inger , M, & Duncan , E . (1984). Is there an ageof elevated risk for unipolar depression?Unpubl ished manuscr ip t .

Lewinsohn , P . M. Hoberman , H. M, & Rosenbaum, M. (1988) . Aprospec t ive s tudy of r isk fac to rs fo r un ipo la r depress ion . Journal ofAbnormal Psychology, 97, 251-264 .Lew insohn, E M., Hops, H., Ro berts , R, & Seeley, J . R. (1988, No-vember). Adolescen t depression: Prevalencean d psychosocial aspects.P a p e r p re s e n te d a t t h e a n n u a l m e e t in g o f t h e A m e r ic a n P u b l i cHea l th A ssoc ia t ion , Bos ton , MA.Lewinsohn , P . M , M ermels te in , R . M , A lexander , C , & MacPhi l lamy,D. J . (1983). The unple asant events schedule: A scale for the m easure-me nt of aversive events. Journal o f Clinical Psychology, 41, 483--498.Lew insohn, P. M., Mischel, W, Chapl in, W, & Barton , R. (1980). Socialcompetence an d depress ion : The ro le o f i l lusory se l f -pe rcep t ion .Journal of Abnormal Psychology, 89, 203-212 .Lewinsohn , P . M , S te inmetz , J , I . a rson , D , & Frank l in , J. (1981). De-pression re lated cognitions: An teceden ts or consequences? Journalof Abnormal Psychology, 90, 213-219.Lewinsohn , P . M, & Ta lk ing ton , J . (1979). S tud ies on the measurem entof unp leasan t even ts and re la t ions with depress ion . Applied Psycho-logical Mea suremen t, 3, 83-101 .MacPhi l lamy, D. J , & Lew insohn , E M. (1974). Depress ion as a func-t ion o f levels o f des i red and ob ta ined p leasure. Journal of AbnormalPsychology, 83, 651-657 .MacPhi l lamy, D. J , & L ewinsohn , E M. (1982). The p leasan t even tsschedule: S tudies on reliability, validity, and scale intereor relation.Journal o f Consult ing an d Clinical Psychology, 50, 363-380.MeCroskey, J . D, & M eCain , T . A. (1974) . The measurem ent o f in te r-pe rsona l a t t rac t ion . Speech M onographs, 41, 261-266 .Meiehenbaum , D. (1977). Cognitive-behavior mod ification: A n integra-tive approach. New York: P lenum.M iran da, J~ & Persons, J . B. (1988). Dysfunction al attitud es are m ood -s ta te dependen t . Journal of Abn orma l Psychology, 90, 76-79 .

Parker, G , & Brown, L. 13. (1979). Repertoir es of respo nses to pot entialp rec ip i tan ts o f depress ion . Australian a nd New Zea land Journal o fPsychiatry, 13, 327-333.Paykel, E. S, & We issman, M. M . (1973). Social adjustm ent and depre s-sion: A longi tudin al s tudy. Archives of General Psychiatry, 28, 6 5 9 -663.Perr is , C~ Eisemann , M . yon Kn orr ing , L . & Perr is , H. (1984) . Pe rson-a l i ty ra i ts in fo rm er depressed pa t ien ts and in hea l thy sub jec ts wi th -ou t h is to ry o f depress ion . Psychopathology, 17, 178-186.Proe idano , M . E , & H elle r, K . (1983) . Measures o f pe rce ived soc ia ls u p p o r t f ro m f r i e n d s a n d f ro m fa m i ly : T h re e v a l id a t io n s tu d ies .American Journal of Comm unity Psychology, 11, 1-24.Radloff, L. S. (1977). The CE S-D scale: A se lf-report depression scalefor resea rch in the genera l popula t ion . Applied Psychological Mea-surement, 1, 358--401.Rask in , A . (1979) . S igns and symptom s of psychopa tho logy in the e l -derly. In A. Raskin & L. Jarvik (Eds.), Psychiatric symptoms andcognitive loss in th e elderly pp. 3-18). W ashington, DC : Hemisphere.Re ich , J , Noyes, R , Hirsehfe ld , R . Corye l l , W, & O'G orm an , T . (1987).S ta te and pe rso na l i ty in depressed and pan ic pa t ien ts . AmericanJournal o f Psychiatry, 144, 18 I - 187.Rippere , V. (1976). A nt idepress ive behav iour: A pre l imin ary report .Behaviour Research and Therapy, 14, 289-299 .Rippere, V. (1977). "What's the thing to do when you're feeling de-pressed?": A pilo t s tudy. Behaviour Research and Therapy, 15, 185-191.Rohde, P, Lew insohn, P. M , Tils on, M ., & Seeley, J . R. (1990). Dim en-s iona l i tyof cop ing and i ts re la tion to depress ion . JournalofPersonal-i ty an d Social Psychology, 58, 499-511 .Rosenb aum , M . (1980). A schedule for assessing self-controlbehaviors:Pre l im inary f ind ings. Behavior Therapy, 11, 109-121 .Shapiro , R , & K el le r, M. (1979). Long itudinalinterval follow-up evalua-tion (LIFE). Bos ton : Massachuse t ts Genera l H osp i ta l .Spitzer, R . S~ & End icott, J . (1977). The Schedule for af fect ivedisordersand sch izophrenic- -change (SADS -C) in terv iew. New York : New

York State Psychiatric Institute .Spitzer, R. S, Endicott, J . & Robins, E. (1978). Research diagnosticcriteria: Ra tionale and reliability. Archives o f General Psychiat~ 35,773-782 .Wilkinson, I. M, & Blackburn, I. M. (1981). Cognitive s tyle in de-pressed and recovered depressed pa t ien ts . Brit ish Journal o f ClinicalPsychology, 20, 283-292 .Youngren, M. A , & Lew insohn, P. M. (1980). The functiona l relation-sh ip be tween depress ion and prob lemat ic in te rpe rsona l behavior.Journal of Abnormal Psychology, 89, 334-341.Zeiss, A . M~ & Lewin sohn, E M. (1988). Endu ring deficits after rem is-s ion o f depress ion : A tes t o f the " sea r ~ hypothesis . Behavior Re-search and Therapy, 26, 151-158.R e c e i v e d M a r c h 1 5, 1 9 89

R e v i s i o n r e c e i v e d D e c e m b e r 2 8 , 1 9 8 9A c c e p t e d J a n u a r y 1 7, 19 9 0

5- are people changed by the experience of having an episode of depression a further test of the...

Documents